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Did you know?
One man dies approximately every 73 seconds in the United States (U.S.) from cardiovascular disease (1).

 

Cardiovascular disease (CVD) is an "umbrella term" that includes all diseases of the heart (cardio) and vessels (vascular), such as coronary heart disease (CHD), hypertension, myocardial infarctions (heart attack), and stroke. 

Heart disease is the leading cause of death for men in the U.S. resulting in deaths of 384,886 men in 2021—that's one in every four male deaths (1). The most common manifestation of this prevalent disease is a myocardial infarction (MI), which, on average, strikes men at age 65. Nearly 805,000 persons annually in the USA alone experience an MI (2).  

Approximately 10% of men have a diagnosis of CHD (commonly referred to as clogged arteries), causing angina, chest pressure, an MI, and/or the need for heart stents and bypass surgery. Tragically, half of the men who die suddenly of CHD have no previous warning symptoms and, therefore, a limited chance in the traditional medical model to be diagnosed before death (1). The critical message of research statistics is that even if a man has no symptoms, he may still be at risk for CHD and death due to heart failure. Further, cardiovascular disease is not just the number one cause of mortality in men and women 65 and older in the U.S. it is also a leading factor in deteriorating quality of life (3). 

Many factors contribute to CVD, such as smoking, poor diet, physical inactivity, excess weight/obesity, stress, and excessive alcohol consumption, all of which lead to a pro-inflammatory state (4–6). This inflammation can lead to endothelial dysfunction which is directly responsible for cardiovascular disease (6). Reduced nitric oxide production, increased oxidative stress, increased vascular permeability, and altered angiogenesis are a result of endothelial dysfunction (6).

Prevention is foremost

After World War II, the number of CHD cases began to rise. Until the early 1950s, CHD was primarily regarded as a feature of aging. Certain keen observers like Paul Dudley White, MD, of Harvard Medical School disagreed and felt a large proportion of MI and cases of CHD could be predicted by "risk factors" developed from research studies like the Framingham Heart Study initiated in the late 1950s(7). These studies identified that high blood pressure, high LDL cholesterol, and smoking were the key risk factors for CHD.  About half of Americans (47%) have at least one of these three risk factors (8). Several other medical conditions and lifestyle choices can also put a man at a higher risk for CVD, including diabetes, overweight and obesity, a diet high in processed foods, physical inactivity, and excessive alcohol use (1). This research led Dr. White to conclude in the 1950s that "Death from a heart attack before the age of 80 is not God's will, it is man's will." as stated in his obituary when he died at the age of 87, just one year after resigning from his medical practice (9).  

The matter of preventative care for cardiovascular health is pressing. The following suggestions can provide a comprehensive and effective strategy to identify CHD in men before a heart attack occurs.

# 1- Laboratory and screening tests

Abnormal lab results can include high total cholesterol, (oxidized) LDL cholesterol, triglycerides, glucose and/or insulin levels, and decreased HDL cholesterol, including HDL fractions. Lipoprotein(a) cholesterol levels may also increase, putting arteries at risk. For more details on laboratory testing, see the 4 Steps for Cardiovascular Health Prevention Using Laboratory Assessments blog, which details multiple tests that can be considered. 

#2-Clinical clues to silent CHD

CHD progresses silently for years before an MI or death occurs, but there are clinical signs or symptoms of impaired blood vessels in other parts of the body that can be an early warning system for CHD.  

Erectile dysfunction (ED). Some men have a built-in warning system for silent CHD. When achieving an erection is difficult or impossible, it can be a sign of clogged arteries in the pelvis that present before an MI occurs. There are, on average, three to five years between the onset of ED and the finding of CHD, which is plenty of time to detect and work on preventing cardiovascular issues (10). Unfortunately, the norm in clinical practice is a prescription for an erectile dysfunction drug without consideration of the risk of CHD. A complete evaluation for silent CHD has been recommended by expert panels (11).

Baldness. In a comprehensive study of almost 37,000 men, severe vertex baldness (balding at the crown of the head) strongly predicted the presence of silent CHD at any age, though frontal baldness did not (12). Another study explored the epidemiologic and genetic connection between male pattern baldness (MPB) and CHD. The researchers did not detect any genetic association; however, they reported that men with baldness had an increased risk for CHD, suggesting MPB could be a subclinical risk for atherosclerosis (13). As health professionals, assessing baldness can easily be incorporated into a full physical exam. Premature male pattern baldness has been associated with a 5.6 times greater risk for coronary artery disease (CAD) (14). 

Gray hair. A study published in 2018 found that a high amount of gray hair is a risk factor for silent heart atherosclerosis. A total of 545 adult men without known heart disease had a CT angiogram of their heart arteries, which can accurately identify silent problems. Having equal amounts of gray and dark hair, or mainly gray and white hair, correlated with finding silent heart blockages. The researchers hypothesized that atherosclerosis and hair graying occur through similar biological pathways, such as increased or impaired oxidative stress (15). Premature graying in young men has been associated with a 5.3 times greater risk for CAD (14). 

Diagonal ear lobe crease. One of the unique markers of silent CHD in the literature is a crease in the earlobe (specifically, an angled crease in the ear that runs diagonally from the canal to the lower edge of the earlobe). The ear lobe crease may result from poor circulation or a nutritional deficiency in collagen production but is often accompanied by vascular dysfunction (16). Although some medical professionals have argued that a crease is simply a general sign of aging, researchers used the most sophisticated CT scan method to measure silent CHD. They found that ear lobe crease predicted CHD even after accounting for other risk factors, such as age and smoking (17), while postmortem studies have found a 1.55-1.74 times greater risk of cardiovascular death than those who did not have the crease (16). This clinical clue can be easily assessed in clinical practice. Claudication: This term comes from Latin for "to limp" and is described as calf pain upon walking. Atherosclerosis can block leg arteries, particularly in smokers, before CHD is diagnosed. This symptom requires an evaluation without delay. Examining the pulses in the legs and simple measurements of leg blood pressure and blood flow can confirm a diagnosis of poor circulation and increased MI risk (18). Image 1: Diagonal ear lobe crease  Image credit: Kamal R, Kausar K, Qavi AH, et al. Diagonal Earlobe Crease as a Significant Marker for Coronary Artery Disease: A Case-control Study. Cureus. 2017;9(2): e1013. Published 2017 Feb 5. doi:10.7759/cureus.1013. CC-BY 4.0

#3- Hormones

Many aspects of cardiovascular health are affected by hormones, including some that may not be considered in men's health, such as estrogen and progesterone. Men produce both hormones, just in lesser amounts than their female counterparts. Testosterone, the principal male sex hormone, begins to decline in men around age 40, increasing the risk for CVD (19). 

Here are some of the reasons testosterone is essential for cardiovascular health:

• Testosterone alters myocardial and vascular behavior (19). 
• Higher testosterone levels are associated with reduced severity of CAD (19).
• Low levels of testosterone are associated with increased rates of heart failure and metabolic syndrome (20).
• Low testosterone contributes to increased fat mass/decreased muscle mass (19,20).
• Testosterone directly affects the vasodilatory effects on coronary arteries, doenregulating calcium channels and upregulating potassium channels (19,20).
• Testosterone shortens the heart-rate-corrected QT interval, which can be seen on an elctrocardiogram (20). Longer QT intervals can lead to life-threatneing arrythmia and can lead to sudden cardiac arrest. 
• Testosterone can assist in improving insulin sensitivity, hemoglobin A1C, and fasting glucose (20).

Other hormones, typically less thought about in men's health, and their impact on cardiovascular health:

• Estradiol helps to maintain the elasticity of arteries and blood vessels (21).
• Estradiol activates the gene responsible for the activity of high-density lipoproteins (HDL) (22) HDL helps transport cholesterol from the blood to the liver and other organs. 
• Estradiol aids in the reduction of LDL and may also act as an antioxidant (23,24). High levels of LDL, especially oxidized LDL-cholesterol, are considered a risk factor for CVD.
• Estradiol acts as an insulin sensitizer (25). As cells become resistant to insulin, blood glucose rises, increasing diabetes and heart disease risk. 
• Progesterone helps protect arteries from spasms (26). 
• The adrenal hormone cortisol affects sleep, energy, hair growth, muscle growth, and weight. Adrenal dysregulation and the biological effects of stress, mediated by hormones produced in the adrenal glands, play a major role in obesity and its consequences, including inflammation, insulin resistance, hypertension, atherosclerosis, and other conditions that together constitute metabolic syndrome (27,28).
• Thyroid hormones impact the metabolic rate (29).

Supporting hormone production naturally can be an easy clinical strategy. RevolutionPRO™ (Maca-OG™) is the proprietary combination of maca phenotypes specific for men's health. It provides support for hormone balance through the hypothalamic-pituitary-thyroid-adrenal-testicular (HPTAT) axis. 

I have been both taking and advising to patients to take RevolutionPRO™ for a decade. I have seen the difference in my follow-up lab panel and many of my male patients. They feel improved energy, vitality, libido, and successful sexual performance. Their lab values also show indicate improvements. It is always my number one "go-to" for men seeking a boost to their male health concerns.

Additionally, the Symphony Natural Health Medical Team created a comprehensive Heart Health Guide, which can be a resource for you and your patients. You will find this in the Clinical Toolkit.

Conclusion

"A heart attack after the age of 80 is an act of God
but a heart attached before age 80 is a failure of the medical system."

~ Dr. Paul Dudley-White

The statement by Dr. Dudley-White of Harvard Medical School was made in 1955 following this treatment for President Eisenhower following his massive heart attack. All these years later, there is a focus on learning CPR and having AEDs in gyms, airports, and other public places, but we are missing the main point: The key is early identification, prevention, education, and reversal of the silent disease. Once the disease is present, natural therapies can give hope to patients with even advanced disease; nutrition and nutraceutical therapies can improve their quality and quantity of life. 

There is no reason that Paul Dudley White, MD's vision cannot be achieved, making CHD an option and not an inevitable outcome for so many men.

References

1. Centers for Disease Control and Prevention [Internet]. 2023 [cited 2024 Jan 24]. Men and Heart Disease. Available from: https://www.cdc.gov/heartdisease/men.htm

2. Centers for Disease Control and Prevention [Internet]. 2023 [cited 2024 Jan 24]. Heart Disease Facts. Available from: https://www.cdc.gov/heartdisease/facts.htm

3. Centers for Disease Control and Prevention. Heart Disease Facts [Internet]. 2022 [cited 2023 Apr 20]. Available from: https://www.cdc.gov/heartdisease/facts.htm

4. Kamińska MS, Schneider-Matyka D, Rachubińska K, Panczyk M, Grochans E, Cybulska AM. Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. J Clin Med. 2023 Nov 13;12(22):7058. 

5. Malek AM, Vladutiu CJ, Meyer ML, Cushman M, Newman R, Lisabeth LD, et al. The association of age at menopause and all-cause and cause-specific mortality by race, postmenopausal hormone use, and smoking status. Prev Med Rep. 2019;15. 

6. Sun HJ, Wu ZY, Nie XW, Bian JS. Role of endothelial dysfunction in cardiovascular diseases: The link between inflammation and hydrogen sulfide. Vol. 10, Frontiers in Pharmacology. 2020. 

7. Tan SY, Kwock E. Paul Dudley White (1886–1973): Pioneer in modern cardiology. Singapore Med J. 2016;57(4). 

8. Centers for Disease Control and Prevention [Internet]. 2023 [cited 2024 Jan 24]. Know Your Risk for heart Disease. Available from: https://www.cdc.gov/heartdisease/risk_factors.htm

9. Dr. Paul Dudley White Is Dead at 87. The New York Times [Internet]. 1973 Nov 1 [cited 2024 Jan 24]; Available from: https://www.nytimes.com/1973/11/01/archives/dr-paul-dudley-white-is-dead-at-87-pioneer-in-care-of-heart-treated.html

10. Janjgava S, Doliashvili T. ERECTILE DYSFUNCTION AS A PREDICTOR OF CARDIOVASCULAR DISEASE. Georgian Med News. 2016 Dec;(261):36–41. 

11. Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87(8). 

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13. Pechlivanis S, Heilmann-Heimbach S, Erbel R, Mahabadi AA, Hochfeld LM, Jöckel KH, et al. Male-pattern baldness and incident coronary heart disease and risk factors in the Heinz Nixdorf Recall Study. PLoS One. 2019;14(11). 

14. European Society of Cardiology [Internet]. 2017 [cited 2024 Jan 24]. Male-pattern baldness and premature greying associated with risk of early heart disease. Available from: https://www.escardio.org/The-ESC/Press-Office/Press-releases/male-pattern-baldness-and-premature-greying-associated-with-risk-of-early-heart-disease

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17. Wang Y, Mao LH, Jia EZ, Li ZY, Ding XQ, Ge PC, et al. Relationship between diagonal earlobe creases and coronary artery disease as determined via angiography. BMJ Open. 2016;6(2). 

18. Mohler ER. Peripheral Arterial Disease: Identification and Implications. Arch Intern Med. 2003;163(19). 

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20. Kaur H, Werstuck GH. The Effect of Testosterone on Cardiovascular Disease and Cardiovascular Risk Factors in Men: A Review of Clinical and Preclinical Data. Vol. 3, CJC Open. 2021. 

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23. LaRosa JC. Metabolic effects of estrogens and progestins. Fertil Steril. 1994 Dec;62(6 Suppl 2):140S-146S. 

24. Sugioka K, Shimosegawa Y, Nakano M. Estrogens as natural antioxidants of membrane phospholipid peroxidation. FEBS Lett. 1987 Jan 1;210(1):37–9. 

25. Yan H, Yang W, Zhou F, Li X, Pan Q, Shen Z, et al. Estrogen improves insulin sensitivity and suppresses gluconeogenesis via the transcription factor Foxo1. Diabetes. 2019;68(2). 

26. Miyagawa K, Rösch J, Stanczyk F, Hermsmeyer K. Medroxyprogesterone interferes with ovarian steroid protection against coronary vasospasm. Nat Med. 1997 Mar;3(3):324–7. 

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