Causes of Heart Attack

Know the Hidden Causes
of Heart Attack

What are the causes of heart attack or stroke? And even though they are usually thought of separately, I’m really talking about both. It’s actually useful to use the same language for both, so we could talk about heart attack and brain attack (instead of stroke). Brain attack is a cutoff of blood supply to the brain, and heart attack is cutoff of blood supply to the heart. When it comes down to it, you can only prevent heart disease if you know its causes and take action. Here’s the really important news: it’s about more than cholesterol. I can give you guidelines on how to lower cholesterol, and that is very important. But with decades of good research behind us, we know so much more than we used to about the causes of heart attack that are separate from the cholesterol issue. Clearly, a holistic approach in medicine for heart attack prevention must look at the whole picture, from genetic and inflammatory markers that are often overlooked in screening tests, to lifestyle issues such as healthy diet and exercise.

First, cholesterol is only one single category of lipids that influence heart disease. Advanced testing is available which breaks down cholesterol into not only the good (HDL) and bad (LDL) but also gives details on the size of those particles, since particle size is another modifiable risk factor in addition to your total cholesterol numbers. And then it’s not only lipids that we need to be concerned about. Other advanced cardiovascular risk markers which are known causes of heart attack can be looked at and modified, often with natural medicines and diet . In addition to the basic cholesterol goals which I outlined when discussing how to lower cholesterol naturally, here’s a simplified list of my goals for your advanced cardiovascular risk markers:

• Lipoprotein(a), or Lp(a) less than 30

• LDL particle size distribution predominately “large and fluffy” or pattern A

• Homocysteine less than 10

• CRP (high sensitivity C-reactive protein) less than 3.0


What are some natural strategies for getting those numbers in line?

I address the strategies for lowering total and LDL cholesterol naturallyon another page.

Lipoprotein(a) is genetically predetermined and difficult (if not impossible) to adjust by lifestyle measures such as diet and exercise. This is one of the most important causes of heart attack which is most often overlooked in lipid testing. I generally recommend a prescription form of a high dose vitamin B3 (nicotinic acid, or Niacin), under doctor supervision.

LDL particle size can be improved especially by exercise, maintaining a healthy body weight, decreasing simple sugars in the diet, and taking a fish oil supplement.

Homocysteine is high when animal protein intake is relatively high and folate and B vitamin intake is relatively low. So I recommend lots of legumes and green leafy vegetables and limiting meat intake.

CRP marks inflammation in the body, and is often related specifically to the amount of belly-fat a person is carrying. If your waist size is greater than 35 inches for women or 40 inches for men, you are likely to have elevated CRP. Inflammation is what is so dangerous about plaques in the coronary (heart) arteries that can lead to heart attack, or stroke if the plaque is in the brain arteries. Lower CRP by decreasing belly fat (regular exercise and limit refined carbohydrate calories especially).

But in order to make these changes you need to know the numbers. If you are at high risk of heart disease, ask you doctor for advanced cardiovascular risk testing including the ones I have listed. These are available through large commercial laboratories, one of the best known being the Berkeley Heart Laboratories .

My bottom line recommendation: knowledge is power, so know all you can about your risk factors. You can drastically reduce your risk when you know the causes of heart attack, gather the data on advanced cardiovascular risk markers, and take action on that information. I hope that you will make a note in your calendar and begin these actions soon. Your heart is worth it!

To your health,


Robert Pendergrast, M.D.



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