Treatment of Cardiovascular Disease

A healthy lifestyle is the best option to reduce your risk

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The aims of treatments for cardiovascular disease are to relieve symptoms, reduce risk factors and the risk of blood clots, widen (or bypass) clogged arteries and prevent further complications. The most important option for anyone that has been diagnosed with a heart condition, or is at an increased risk, is to adopt a heart-healthy lifestyle. This significantly reduces the risk, but sometimes more drastic measures are required, including medications and surgery.

Heart-Healthy Lifestyle

Smoking is a known high-risk factor for cardiovascular disease, so becoming (or remaining) smoke-free is important. A healthy diet is essential to maintain a healthy heart. This diet should include a variety of fruits and vegetables, whole grains, lean proteins, and a reduced sugar and fat intake (especially saturated and trans fats). Alcohol consumption should also be limited. Regular physical activity helps to lower LDL-cholesterol levels and high blood pressure and helps to maintain a healthy weight. Physical activity also reduces the risk of diabetes (a complication of hyperlipoproteinemia type III) and increases the levels of “good” HDL-cholesterol, which removes the excess cholesterol from the arteries. Obesity is a well-known risk factor for both cardiovascular disease and diabetes, so it is important to reduce and maintain a healthy weight.

Stress and depression can increase blood pressure and the risk of heart problems. Learning how to relax and cope in stressful environments can reduce this risk. Useful and simple ways to reduce stress include physical activity, yoga, meditation and other relaxation therapy. Counseling or medications may be required to treat signs of depression. Even if a heart attack or stroke has already occurred, it is never too late to adopt a healthy lifestyle, as it will significantly decrease the risk of future cardiovascular problems.

Medications

For many people who are at risk of cardiovascular disease, maintaining a healthy lifestyle is all that is required to reduce and stabilize LDL-cholesterol and triglyceride levels. However, for those that are already suffering from serious symptoms (e.g. a recent heart attack), medications are started immediately to prevent further complications. Medications used to reduce LDL-cholesterol include statins, resins, fibrates, cholesterol absorption inhibitors, and niacin. These medications reduce the risk of any further clogging and plaque formation in the arteries by removing excess “bad” LDL-cholesterol or increasing the “good” HDL-cholesterol.

Procedures and Surgery

Medical procedures and surgery may be required to treat severe cases of cardiovascular disease and are more common in the elderly. Often this occurs in people that were not aware of their elevated cholesterol or triglyceride levels, until a serious complication (e.g. heart attack or stroke) occurred. Angioplasty is a procedure to open arteries that have become narrowed or blocked from plaque formation. This involved the insertion of a thin, flexible tube with an attached balloon into a blood vessel. The balloon is inflated in the narrow or blocked region of the artery to restore blood flow. A heart bypass may be required for severely blocked arteries. This involves the grafting of blood vessels so that blood flow can go around (bypass) the blocked coronary artery and therefore provide an adequate blood supply to the affected tissues. Cardiac rehabilitation is also recommended for anyone that has suffered a heart attack or undergone a medical procedure or surgery. This rehabilitation involves safe exercise training and education and counseling to reduce the risk of future heart problems.

Treating Hyperlipoproteinemia Type III

Hyperlipoproteinemia type III risk can be reduced by maintaining the heart-healthy lifestyle described above. In this situation, it is also very important to minimize carbohydrate and sugar intake. Medications, such as statins, are another effective treatment for this disorder. Surgery may be required to remove xanthomas. Hyperlipoproteinemia type III can increase the risk of diabetes, hence it is very important to monitor and maintain stable blood sugar levels to avoid further diabetic complications.

How Does APOE Genotype Influence the Response to Treatment?

Although a heart-healthy lifestyle is recommended for everyone, whether or not they are at risk of cardiovascular disease, this approach may not be effective for everyone. People with two APOE e2 alleles are less likely to have elevated LDL-cholesterol, but are at an increased risk of high blood sugar, elevated triglycerides and VLDL-cholesterol and hyperlipoproteinemia type III. These people do not respond well to a low-fat diet, but a lower carbohydrate and low-sugar diet is more beneficial to maintain healthy. Fortunately these individuals generally respond well to statins to reduce cholesterol levels if required. Individuals with one or two APOE e4 alleles are not able to metabolize fats very efficiently, so a low-fat diet is very important for people carrying this allele (whether or not they already have elevated LDL-cholesterol levels). These people tend to not respond as effectively to statin therapy, so maintaining a healthy-heart lifestyle is essential.

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Recommended Links: Ballantyne CM et al. (2000). Apolipoprotein E Genotypes and Response of Plasma Lipids and Progression–Regression of Coronary Atherosclerosis to Lipid-Lowering Drug Therapy. Journal of the American College of Cardiology. 36(5): 1572-1578.

Minihane1 AM, Jofre-Monseny L, Olano-Martin E, Rimbach G (2007). Symposium on ‘Molecular basis for diseases’ ApoE genotype, cardiovascular risk and responsiveness to dietary fat manipulation. Proceedings of the Nutrition Society, 66: 183–197.

Song Y, Stampfer MJ, Liu S (2004). Meta-Analysis: Apolipoprotein E Genotypes and Risk for Coronary Heart Disease. Ann Intern Med. 141(2): 137-147.

Thompson GR, O’Neill F, Seed M (2002). Why some patients respond poorly to statins and how this might be remedied. European Heart Journal. 23: 200–206.

What is Cardiovascular Disease? American Heart Association. (Reviewed 12/18/2014).

Heart Disease in Women. National Heart, Lung and Blood Institute (Updated 04/11/2014)

National Organization for Rare Disorders. Hyperlipoproteinemia Type III