Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Reverse Cardiovascular Disease

Tuesday, 18 October 2011 08:34 AM

Question: I had a stroke last month and was told I have hardened arteries. My total cholesterol is 120. My HDL is 34, my LDL is 69, and my triglycerides are at 87. My A1C was high at 7.6. How do I reverse this? I take Lipitor (20 mg) and diabetes drugs as well as omega-3 oils and B vitamins. And when I exercise, what heart rate should I aim for?
Dr. Hibberd's Answer:
These are excellent questions for anyone who has had an ischemic vascular event such as a stroke and wants to be more proactive. There are five modes of attack :

1. Control sugar levels. Tight glucose control with HBA1C values under 6.0. will help control blood glucose levels that, when elevated, can cause microangiopathy or small vessel disease that sets you up for inflammation of the arterial wall. The body then sets up a protective plaque to "cover " this inflammatory segment. When this plaque destabilizes, it may bleed into itself, blocking the artery and causing a stroke or heart attack.

2. Control blood pressure. Keep blood pressure as close to 120/80 as possible to reduce further damage to endothelium (the thin layer of cells that line the interior surface of blood vessels).

3. Manage weight. Weight management will help Type 2 diabetics control their condition with less medication. Fat cells become more responsive to insulin when they are not distended, and you will help avoid high insulin levels so commonly associated with diabetes and obesity.

4. Raise HDL levels. Even though your bad cholesterol (LDL) levels seem at target below 80, your low protective cholesterol (HDL) is an independent risk factor for premature vascular disease. Try to have this scavenger cholesterol, the HDL, as high as possible. The HDL removes harmful oxidized and microparticulate cholesterol from our vascular system, preventing plaque accumulation and allowing for plaque regression.

You can elevate your HDL by regular exercise, addition of prescription HDL-elevating medications from your doctor, and addition of pure cold water omega-3 fatty acid supplements (Lovaza may be a good option here). Niacin supplements may be useful for some under your doctor's supervision, but I am not a huge fan of niacin in diabetes since it can elevate blood glucose levels.

5. Exercise regularly. You already have vascular disease, and probably have some degree of coronary artery disease, so have a stress test under physician monitoring before you start an exercise program. A low-level stress test can evaluate what target heart rate you should set that won't cause heart strain. You must remember that diabetes affects the vascular system adversely, and it is not uncommon to see diabetics with heart attacks that had no warning chest pain.

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