Cardiovascular Disease, Atherosclerosis, Hyperlipidemia, and Chinese Herbal Medicine

by M.M. Van Benschoten, O.M.D., L.Ac.

Cardiovascular disease kills over 900,000 people each year in the United States, with approximately 540,000 deaths from coronary heart disease and myocardial infarction, and 157,000 deaths from stroke1 . The costs of cardiovascular disease in the United Kingdom including medical care and lost productivity totaled 29 billion pounds for 20042. Acute myocardial infarctions in diabetics doubled from 2,951 to 6,048 in New York City, with hospital days increased from 34,188 to 51,566 from 1990 to 20003. Diagnosed cases of diabetes in the U.S. in 2003 number 14 million, with 6 million undiagnosed cases, and a 61% increase in diagnoses has occurred since 1990. Heart disease death rates are 2 to 4 times higher in diabetics, and stroke risk is increased 1.8 to 6 folds.

Tobacco use increases the risk of coronary heart disease 2 to 4 times, doubles the risk of stroke, and increases the risk of peripheral vascular disease 10 times. There are 44 million current smokers in the U.S., and 1.4 million new smokers annually. High blood cholesterol and other lipids are the most prevalent risk factors, with10% of adolescents having cholesterol greater than 200 mg/dL, and 99 million persons with hypercholesterolemia greater than 200 mg/dL, 76 million with LDL greater than 130 mg/dL. Less than 50% of patients receive treatment, and less than 20% of patients with coronary heart disease reach LDL treatment goals with therapy4.

Physical inactivity increases risk of coronary heart disease by 1.5-2.4 folds, equal to the effects of cholesterol, high blood pressure, and tobacco use. The prevalence of obesity since 1993 increased 61%, incidence of obesity in children 6-11 increased 4.2% to 15%, with 9.2 million children age 6-19 overweight or obese. Abdominal obesity increases stroke risk 3 folds. Metabolic syndrome, defined as triglycerides and fasting blood sugar greater than 110 mg/dL, and blood pressure and waist circumference in the 90th percentile, has an incidence of 47 million people, representing 23% of adults. Daily caloric intake has increased 12% from 1985-2000, with 6% increase in total dietary fat; intake of meat has increased to 194 lbs total meat per person in 2001, 16 lbs more than in 1970. Only 17% of males and 27% females eat the recommended 5 servings of fruits and vegetables a day5.

Statin drugs are the treatment of choice for hyperlipidemia, lowering LDL-C which is formed from VLDL, and apolipoprotein B. Mevacor (lovastatin) has demonstrated a 37% reduction in risk of a first acute major coronary event, including myocardial infarction, unstable angina, and sudden cardiac death. Regression of atherosclerosis may be observed in 23% of patients6. Myopathy and rhabdomyolysis, muscle pain and atrophy may be caused by statins, as well as liver dysfunction, constipation, diarrhea, nausea, abdominal pain, and headache. Patients intolerant of statins who fail to improve their lipid profiles may then search out alternative means to reduce their cholesterol, triglycerides, and LDL.

Nutritional supplements are often used to assist in the management of hyperlipidemia; however, recent studies show the benefits to be of questionable value. A French study of nutrient supplementation demonstrated no major differences in ischemic cardiovascular disease incidence, total cancer incidence, or all cause mortality after a median follow-up time of 7.5 years7.