All Things Cardiovascular Disease and The Link To Renal Function

 Did you know that people with kidney disease are more likely to die of cardiovascular disease than they are of kidney disease? Makes it pretty important to understand the causes of cardiovascular disease and how to prevent and treat it doesn’t it?

 Well that’s what I’m going to cover in today’s article.

Cardiovascular disease (CVD) is the number 1 cause of death globally with more people dying annually from CVD than from any other cause. It’s often referred to as ‘the silent killer’ because symptoms don’t typically arise until there is significant damage to the heart and arteries. 

Why is this topic so important for people with CKD? Well, CVD and CKD are inextricably linked. Having CKD greatly increases your risk of developing CVD and vice versa. 

Now, I know that’s obviously not good news but the fact that they are so tightly linked also means that anything you do to reduce your risk of developing CVD or to treat existing CVD is going to have the additional benefits of helping your kidneys and anything you do to heal your kidneys, is going to reduce your risk of CVD. 

To get started, first let’s get clear about what CVD is.

What is Cardiovascular disease?

CVD is the term used to describe many different conditions affecting the heart AND blood vessels.

Cardio = heart

Vascular = all the blood vessels in the body

https://pubmed.ncbi.nlm.nih.gov/31618136/

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or the brain.

Risk factors for CVD

There are lots of things that can increase your risk of developing CVD. Some of these risk factors are ‘modifiable’ which means they are things you can modify or change to reduce the risk, while some are unmodifiable which means they can’t be changed (like your age or genetics). Thankfully there are a lot more modifiable risk factors which means there is a lot you can do to reduce your risk of developing CVD.

Some of the risk factors for developing CVD include:

•     High blood pressure
•     Smoking 
•     High cholesterol
•     High blood pressure
•     Diabetes
•     Inactivity
•     Being overweight or obese
•     Family history of CVD
•     Increasing age
•     Diet
•     Alcohol consumption
•     Kidney disease

The link between CVD and CKD

https://www.researchgate.net/publication/259267327_Oxidative_Stress_and_Antioxidant_Therapy_in_Chronic_Kidney_and_Cardiovascular_Disease

If you know anything about the risk factors for CKD, you might notice that the risk factors above are all risk factors for CKD, this is part of the reason why CKD and CVD are so closely linked. They also both share two of the same main causes: diabetes and high blood pressure.

Atherosclerosis is another link in the chain between CVD and CKD. 

CKD is associated with an increase in atherosclerosis which begins in the early stages of kidney disease. On the flip side, atherosclerosis can slow the flow of blood to the kidneys which over time results in kidney damage and kidney disease. 

Atherosclerosis is the main underlying cause of CVD, so it warrants a bit more time and attention!

What is atherosclerosis?

Atherosclerosis is a disease in which plaques that are made up of fat, cholesterol, calcium and other substances build up in the walls of the arteries (the blood vessels that carry blood from the heart throughout the body).

Over time, the plaques harden and narrow the opening of the arteries and restrict the blood flow. When these fatty plaques break open, they form a thrombus (blood clot) that can further limit, or even block the flow of oxygen rich blood to organs and other parts of the body.

Atherosclerosis is a complex process, often starting in childhood and progressing with age. It usually does not cause symptoms until it’s in an advanced stage, where the narrowing of arteries becomes so severe that blood flow is interrupted, and CVD had developed.

Medical treatment of atherosclerosis

Medical treatment of atherosclerosis is primarily cholesterol lowering medications and high blood pressure medications. For the last 50 years, cardiovascular medicine has been based on low fat diets, cholesterol lowering drugs, an expanding list of blood pressure lowering drugs and various surgical techniques to widen and circumvent blocked arteries.

Despite these efforts, CVD is on the rise and remains the leading cause of death in the Western world. Is it just me that feels like something’s not quite right here?

One of the problems with drug treatment is that medications will always fail to address the cause. Sure, blood pressure medications might reduce the numbers you see on the monitor, but they do nothing to address the underlying cause, giving a false sense of security that all is well.

While blood pressure and cholesterol levels do contribute to cardiovascular risk, they are not, by far, the most important risk factors.

So what are? 

The answer is: inflammation, oxidative stress and insulin resistance.

By targeting these three risk factors, we are treating the three most important processes in the initiation and progression of CVD. And even better, these three risk factors are also closely tied to the development and progression of CKD, once again we can see another reason why CVD and CKD are so closely linked. 

The real problem: Inflammation

https://www.nature.com/articles/s41569-019-0169-2#citeas

I want to focus on inflammation because it’s important in all phases of CVD, including the early initiation of atherosclerotic plaques within the arteries, as well as the acute rupturing of these plaques that results in a heart attack, stroke and all too often, sudden death. 

Inflammation is also a primary driver of vascular oxidative stress and insulin resistance- both of which cause impaired function of blood vessels, causing them to constrict (narrow) instead of dilating (opening), driving up blood pressure and limiting the flow of oxygen around the body. 

Scientists now understand that atherosclerosis is in many ways an inflammatory disorder of the blood vessels, just as arthritis is an inflammatory disorder of the joints. 

Now, I’m going to tell you something that might be news to you, but scientists have known for decades. 

Inflammation has been shown to be a more important risk factor than cholesterol when it comes to atherosclerosis and CVD. 

You, like many others have probably been led to believe that high cholesterol is the problem, it’s not and I’m going to explain why.

Cholesterol itself is not dangerous. It becomes problematic, however, in the presence of inflammation. Inflammation creates free radicals, which damages cholesterol and other fats causing oxidised cholesterol.

Don’t believe me? Let’s take a look at the results of an 8-year study that showed that CRP (a blood marker of inflammation) is more predictive of cardiovascular events than LDL, the so-called ‘bad’ cholesterol.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC400721/

Those with high CRP and high LDL had the most cardiovascular events and the worst survival, those with low CRP and low LDL had the least cardiovascular events and best survival- no real surprise there. 

What was really interesting is that those with low CRP and high LDL had less cardiovascular events and better event free survival than those with low LDL and high CRP. 

What does this tell us? That inflammation is a more important risk factor that cholesterol levels when it comes to cardiovascular events and survival. 

Measuring CRP

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC400721/

CRP is easily measured on a blood test. When getting your CRP tested, make sure it is a high-sensitivity CRP test. This is because older tests for CRP, which are adequate for monitoring severe inflammatory conditions, do not have the ability to measure levels accurately within the range needed for cardiac risk detection.

But what about cholesterol?

It is important to remember that high levels of LDL cholesterol and triglycerides do remain a risk factor for CVD, but the only time cholesterol causes a problem on its own is when it oxidises.

Without getting too deep into the details, oxidised LDL cholesterol seems to be the ‘real’ bad guy- the type of cholesterol that actually causes heart disease (in contrast to the relatively innocent HDL and even non-oxidised LDL). So, if you’ve been paying attention to the science about cholesterol, you might know oxidised LDL cholesterol as ‘the one that actually gives you heart attacks.’

The oxidation of LDL is thought to occur when LDL cholesterol particles in your body react with free radicals; unstable molecules that are produced as a result of normal metabolism, a disease, or exposure to toxins. Oxidised LDL can also come from foods we eat. 

Oxidised LDL can actually be measured on a blood test, so next time you’re getting your cholesterol checked, ask your doctor to add oxidised LDL to the test.

Okay, now that you’ve got a better understanding of the real causes of CVD, let’s get into how to prevent and treat it naturally. I’ll give you a hint…… treating inflammation is key!

Natural prevention and treatment of CVD

The good news is, CVD is largely preventable and even reversible, through lifestyle and dietary changes and the use of herbal and nutritional supplements.

Dietary Changes

•     Follow an alkaline diet
•     Eliminate red meat and processed meat
•     Restrict salt in your diet
•     Eliminate trans fats
•     Increase fibre intake
•     Avoid refined carbohydrates
•     Predominantly vegetarian diet
•     Eliminate caffeine 
•     Beneficial foods: fermented soy foods, garlic, onions, ginger, turmeric, omega-3 fatty acids (fatty fish, flaxseeds (high in potassium), monounsaturated oils (olive oil), fresh fruit and vegetables, nuts and seeds (high potassium)

Lifestyle Changes

•     Lose weight if overweight
•     Exercise regularly
•     Avoid alcohol and tobacco
•     Manage blood sugar and treat insulin resistance
•     Get enough sleep
•     Manage stress levels
•     Address sleep apnoea if present

Herbal and Nutritional supplements

There are a number of different herbal and nutritional supplements that are beneficial in preventing and treating CVD so there’s no room to discuss them all, I’m only going to focus on some key supplements. 

Magnesium: plays an important role on cardiovascular risk reduction which isn’t surprising seeing as it hits some of the biggest targets when it comes to CVD initiation and progression. Has cholesterol lowering properties, reduces inflammation, blood pressure and improves insulin sensitivity.

Coenzyme Q10: a widely used antioxidant and mitochondrial stimulant and has also been studied for the reduction of high blood pressure. CoQ10 has been shown to protect blood vessels against oxidative damage, preserving their integrity and reduces oxidation of cholesterol. 

Omega-3 fatty acids (Fish oil): well known for its anti-inflammatory actions and also reduces oxidative stress, lowers blood pressure, lowers LDL and triglycerides and increases HDL (protective) cholesterol levels. Fish oil also reduces the ‘stickiness’ of blood so reduces the risk of blood clots. Fish oil has also been demonstrated to provide significant benefits to the heart muscle, improving heart rate and arrhythmias and improving insulin sensitivity. Another novel action of fish oil is to repair damaged blood vessels. 

Crataegus monogyna (Hawthorn): has a number of positive effects on coronary blood flow, blood pressure, heart contractility and generally improving heart function. 

Salvia miltiorrhiza (Dan Shen): has been traditionally used in the treatment of CVD including atherosclerosis, blood clots, ischaemic heart disease and high blood pressure. It is also anti-inflammatory and antioxidant, increases dilation of arteries to improve blood flow around the body and heals damage to the heart. 

Curcuma longa (Turmeric): because treating inflammation is such a key part of preventing and treating CVD it’s probably no surprise that turmeric deserves a mention. It is anti-inflammatory, an antioxidant, lowers cholesterol, prevents blood clots, can lower blood pressure and is known to decrease atherosclerosis. 

Don’t forget

Make sure you consult your healthcare practitioner before starting any new supplements to ensure they are appropriate for you.

Final words

There is one final point I want to make. Just because you have CKD does not mean developing CVD is inevitable. CVD is largely preventable by making some changes to your diet and lifestyle. Also, if you already have signs of CVD, I want to assure you that there is so much you can do to reverse it or prevent it from progressing. And don’t forget, anything you do to prevent or treat CVD is also going to have positive effects on your kidneys.

Hopefully I’ve given you a better understanding of the link between CVD and CKD and the ‘real’ culprits underpinning CVD. If you’ve found this information useful, please let me know by clicking the ‘SHARE’ button below or leaving a comment on our Facebook page.