Cardiovascular disease is the leading cause of death globally, attributed to nearly 18 million deaths annually. The cost of healthcare services, medicine, and lost productivity due to death contribute to an annual economic burden of $229 billion in the United States. Modifiable risk factors fuel most cardiovascular diseases and can be prevented by addressing and modifying lifestyle habits contributing to disease. This article will discuss a functional medicine approach to cardiovascular disease prevention and treatment through specialty lab testing and nutritional therapies.
What is Cardiovascular Disease?
Cardiovascular disease (CVD) is the umbrella term for diseases affecting the heart and blood vessels related to narrowing blood vessels, congenital heart and blood vessel abnormalities, dysfunctional heart valves, and irregular heart rhythms. Nearly 50% of American adults have some form of CVD. (1)
Coronary artery disease (CAD), or coronary heart disease, is the most common form of heart disease and the leading cause of death in the United States. It occurs when plaques form in the coronary arteries, impairing blood flow and oxygen delivery to the heart.
Heart failure, or congestive heart failure (CHF), affects six million American adults. It is a condition that develops when the heart is unable to pump enough blood to meet the body’s oxygen needs.
Peripheral arterial disease (PAD) is a condition in which narrowed peripheral arteries reduce blood flow to the extremities (arms and legs).
Arrhythmias are a collection of disorders affecting the rate and rhythm of the heartbeat. Many arrhythmias can cause the heart to beat too slowly (bradycardia), too quickly (tachycardia), or irregularly.
Deep vein thrombosis (DVT) occurs when a blood clot forms in one of the body's deep veins, usually within the legs. DVTs increase the risk of pulmonary embolism (PE) when they break loose, travel through circulation, get stuck, and block blood flow in the lungs’ smaller vessels.
Heart attacks and strokes are other examples of acute events caused by blockages in blood flow to the heart or brain, respectively.
Atherosclerosis, or atherosclerotic cardiovascular disease (ASCVD), is a hardening and narrowing of the arteries due to plaque buildup, a major contributing risk factor for PAD, heart attack, stroke, and aneurysm.
Symptoms of Cardiovascular Disease
CVD can present with many signs and symptoms, depending on the location of affected blood vessels. (1)
Symptoms of Heart Disease
- Chest pain (called angina)
- Chest pressure, heaviness, discomfort
- Shortness of breath (called dyspnea), especially with physical or emotional exertion
- Racing or irregular heartbeat (called heart palpitations)
- Dizziness and fainting
- Dry, persistent cough
Symptoms of Vascular Disease
- Intermittent claudication: pain and cramping in the legs with walking
- Poor wound healing
- Swelling and redness of the skin on the arms and legs
- Pain, weakness, numbness, and tingling in the extremities
- Changes in vision
- Difficulties with speech
What Causes Cardiovascular Disease?
The development and progression of CVD are complex and multifaceted and largely depend on the type of CVD present. Socio-economic, behavioral, and environmental factors can cause CVD. Genetics, aging, medications, and infections can cause arrhythmias or valvular heart diseases. Atherosclerosis is a major causative factor of CAD and PAD, increasing the risk for heart attack, stroke, and blood clots.
Cardiovascular Disease Risk Factors
Many chronic health conditions contribute to cardiovascular risk by increasing the burden on the heart to work harder, inflicting damage to the lining of arteries, increasing inflammation, and promoting plaque formation. Health conditions known to increase CVD risk include high blood pressure (hypertension), high cholesterol (hyperlipidemia), type 2 diabetes, obesity, preeclampsia, gestational diabetes, autoimmune disease, and chronic kidney disease (CKD). (1)
Lifestyle factors significantly impact blood pressure, cholesterol levels, body weight, and general cardiovascular health. Tobacco use, alcohol and drug use, lack of physical activity, and the Standard American Diet are known CVD risk factors.
A family history of CVD, especially in first-degree relatives (parents and siblings), is known to increase an individual’s risk through the influence of genetics.
Functional Medicine Labs to Test for Root Cause of Cardiovascular Disease
Detailed, comprehensive labwork plays an integral role in detecting and monitoring underlying risk factors for CVD, such as cholesterol and blood glucose levels, along with understanding the level of inflammation within the cardiovascular system.
Comprehensive Metabolic Panel (CMP)
A CMP is a panel of 14 biomarkers related to the body’s metabolic function, analyzing blood sugar, electrolyte and acid-base balances, and liver and kidney function. Elevated blood sugar, electrolyte imbalances, and kidney dysfunction can contribute to cardiovascular pathologies like arrhythmia, high blood pressure, and diabetes.
Thyroid hormone influences the heart’s function, blood pressure, and cholesterol levels. Thyroid dysfunction, and resulting thyroid hormone imbalances, can present as symptoms that masquerade as CVD, increase the risk for CVD, and worsen preexisting CVD (3). Conventionally, TSH is the only marker used to screen for thyroid pathology, which has been shown to miss up to 7% of overt thyroid dysfunction. A complete thyroid panel, measuring six hormones involved in the thyroid cascade and thyroid antibodies, offers the full picture of thyroid health and function for early detection of thyroid imbalance.
A comprehensive diabetes panel goes beyond the basic markers of blood glucose and hemoglobin A1c (HbA1c) to provide a better picture of glucose metabolism and insulin sensitivity. Similarly to thyroid function, early detection and treatment of insulin resistance can prevent the development of type 2 diabetes, reducing the risk of CVD.
Advanced Lipid Panel
Research has revealed that lipid markers beyond what is provided on a basic lipid panel better represent cardiovascular risk. Lipid particle fractionation, apolipoprotein B (ApoB), lipoprotein(a) (Lp(a)), and lipoprotein-associated phospholipase A2 (Lp-PLA2) are more sensitive in estimating cardiovascular risk than LDL cholesterol. (4, 5)
High-Sensitivity C-Reactive Protein (hs-CRP)
hs-CRP is a marker of systemic inflammation that, when elevated, is associated with CVD and the subsequent risk of adverse cardiovascular events and death (6).
The Multiple Autoimmune Reactivity Screen (Array 5) by Cyrex Labs measures many immune proteins (autoantibodies) against various body tissues that are predictive for certain autoimmune diseases. Early detection of autoimmunity is critical in preventing irreversible damage to targeted body tissues/organs and potentially reversing the disease progression to reduce CVD risk.
Functional Medicine Labs That Can Help Individualize Treatment for Cardiovascular Disease
Functional medicine labs help practitioners personalize treatment options for their patients. Below are some of the most common labs ordered for patients suffering from cardiovascular disease.
The Lifestyle Panel available through Boston Heart combines basic lipid markers with their HDL Map and Cholesterol Balance tests.
HDL is comprised of subpopulations of different sizes, compositions, and characteristics; these subpopulations are better predictors of CVD risk than HDL cholesterol values alone. The HDL Map measures the five most significant subpopulations to stratify CVD risk better, determine effective treatment strategies, and monitor patient response to therapy. (7)
The Cholesterol Balance test measures the major markers of cholesterol production and absorption. The results of this test provide insight into the physiologic driving mechanism behind an individual’s elevated cholesterol so that a targeted and effective intervention can be implemented. (8)
Fatty Acid Panel
The Fatty Acid Balance test from Boston Heart measures the body’s omega-3 and omega-6 fatty acids. The omega-3 to omega-6 fatty acid ratio influences systemic inflammation and CVD risk. Balancing fatty acids can improve lipid profiles, immune function, systemic inflammation, and cardiovascular outcomes.
Intestinal dysbiosis is associated with systemic inflammation, lipid and blood sugar dysregulation, atherosclerosis, high blood pressure, and increased CVD risk. A comprehensive stool analysis can diagnose dysbiotic patterns within the gut microbiome contributing to CVD. Dysbiosis can elevate serum trimethylamine N-oxide (TMAO), which is associated with a less favorable cholesterol profile, poor bile acid metabolism, and higher mortality. (9)
Organic Acids Test (OAT)
The OAT is a comprehensive metabolic snapshot of a patient’s overall health. Abnormal results can indicate nutrient deficiencies, intestinal dysbiosis, genetic variations, and lifestyle factors, providing a roadmap for treatment options and additional testing.
The Role of Nutrition and Dietary Supplements in Preventing and Managing Cardiovascular Disease
Research has shown that nutrients, including vitamins and minerals, are involved in pathways that modulate inflammation and oxidative damage within the cardiovascular system. Additionally, dietary habits influence and modulate metabolic pathways within multiple body systems, helping to reduce disease states and risk factors associated with cardiovascular disease. Therefore, nutrition and dietary supplements are instrumental in preventing and managing CVD.
Best Nutrition for Cardiovascular Disease
Because dietary patterns undoubtedly influence the development of CVD, nutritional interventions are part of the first-line treatment protocol in both conventional and functional medicine. There are many proven cardioprotective diets (discussed below). You should note that they all share the common principles of increasing dietary fiber, replacing saturated fatty acids with unsaturated fats, and emphasizing foods rich in antioxidants.
Nutrients & Foods to Emphasize for Cardiovascular Disease
Adequate intake of soluble and insoluble dietary fiber (27-40 grams daily) prevents hypertension, improves insulin sensitivity, stabilizes blood sugar, improves LDL cholesterol levels by aiding cholesterol elimination through the gut, and supports a healthy gut microbiome. Low fiber intake correlates with increased CVD risk and incidence of CAD and vascular diseases. (10)
Incorporating various colorful vegetables and fruits into the diet ensures an adequate intake of polyphenols, including anthocyanins, flavonols, and flavonoids. These antioxidant plant compounds protect the heart and blood vessels, reducing blood pressure and cardiovascular inflammation and improving lipid profiles. (10)
Fatty fish, sea algae, flaxseeds, and chia seeds are naturally rich in anti-inflammatory omega-3 fatty acids. Omega-3 fatty acids are associated with reduced inflammatory markers, triglycerides, blood pressure, and CVD. Omega-3s are anticoagulant, reducing the risk of platelet aggregation and blood clotting and supporting the healthy endothelial function of blood vessels. (10)
The Mediterranean diet is a dietary model emphasizing high-fiber foods, whole grains, vegetables, fruits, nuts, seeds, olive oil, and fatty fish. Dietary intake of saturated and trans-fats, refined sugars, and red meat is limited. A large body of evidence supports the beneficial effects of Mediterranean dietary principles on cardiovascular health. Studies have shown reductions in total CVD risk, risk of death from CVD, blood pressure, and inflammation. Lipid profiles also improve in patients following a Mediterranean diet. (10)
The Dietary Approaches to Stop Hypertension (DASH) diet was developed to manage hypertension. This diet emphasizes an increased intake of fruits, vegetables, nuts, low-fat dairy, and legumes and limits daily salt intake. Not only has the DASH diet been proven to reduce blood pressure, but reductions in LDL cholesterol, type 2 diabetes risk, and risk of death from CVD have also been observed in clinical trials. (10)
The Mediterranean-DASH Intervention for the Neurogenerative Delay (MIND) diet combines fundamental principles from the Mediterranean and DASH diets. This dietary model emphasizes green vegetables, nuts, healthy oils, fish, low-fat meat, and dairy intake. The foods are rich in cardioprotective and anti-inflammatory nutrients, reducing oxidative stress and improving metabolic function. (10)
The Nordic Diet, based on Scandinavian dietary habits, limits the consumption of red meat and increases the intake of vegetables, berries, canola oil, and fish. The Nordic Diet has been shown to improve LDL cholesterol, metabolic function, insulin sensitivity, CRP levels, and blood pressure. (10)
Supplements and Herbs for Cardiovascular Health
Dietary and herbal supplements can safely and effectively be added to a patient’s treatment protocol in combination with, or as a natural alternative to, pharmacotherapy. Below are commonly recommended supplemental options by functional medicine doctors for addressing CVD.
Hawthorne (Crataegus spp.) berry is rich in bioflavonoids with strong antioxidant activity. Hawthorne has been used traditionally as a cardiovascular tonic, and research supports its antioxidant, hypotensive, antiatherosclerotic, and antiarrhythmic effects. (11)
Magnesium is a mineral necessary for muscle function, blood vessel vasodilation, glucose and blood pressure regulation, and energy metabolism. Magnesium deficiency has been associated with hypertension and heart failure, and supplementation has been shown to improve heart function and reduce blood pressure up to 5.6/2.8 mmHg. (9, 12)
Coenzyme Q10 (CoQ10)
CoQ10 is an antioxidant involved in mitochondrial energy production and the reduction of oxidative stress. CoQ10 is especially important for the highly metabolic cells of the heart, where the demand for this nutrient is higher. Trials studying the effects of CoQ10 supplementation have concluded that it effectively increases cardiac ATP (energy) production, improves endothelial function and lipid profiles, and has potent antioxidant effects. (10)
Cardiovascular studies have observed clinically significant reductions in serum cholesterol and triglycerides, thereby decreasing atherosclerosis, with the administration of supplemental garlic. Additionally, aged garlic extract has antithrombotic and hypotensive actions. (13, 14)
Cardiovascular disease is prevalent worldwide and a significant contributor to chronic disease, decreased quality of life, and mortality. Identifying a person’s risk for cardiovascular disease and addressing risk factors is crucial for effectively preventing disease onset, progression, and secondary health complications. Specialty labs go beyond standard lab values to better predict and identify a person’s CVD risk and underlying contributing factors to disease so that effective and targeted interventions can be implemented. Nutrition is a mainstay therapy required for establishing solid cardiovascular foundations. While many evidence-based dietary protocols effectively optimize cardiovascular function and health outcomes, they all emphasize a whole-food approach that increases the dietary variety and cardioprotective nutrients.
Lab Tests in This Article
1. Cardiovascular Disease: Types, Causes & Symptoms. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21493-cardiovascular-disease
2. World Heart Federation. (2023, April 18). Cardiovascular Disease (CVD). https://world-heart-federation.org/what-is-cvd/
3. Harvard Health. (2022, March 15). Thyroid hormone: How it affects your heart. https://www.health.harvard.edu/heart-health/thyroid-hormone-how-it-affects-your-heart
4. Cromwell, W.C., Otvos, J.D., Keyes, M.J.. (2007). LDL particle number and risk of future cardiovascular disease in the Framingham Offspring Study—Implications for LDL management. Journal of Clinical Lipidology, 1(6), 583–592. https://doi.org/10.1016/j.jacl.2007.10.001
5. Di Angelantonio, E., Gao, P., Pennells, L. (2012). Lipid-Related Markers and Cardiovascular Disease Prediction. JAMA, 307(23). https://doi.org/10.1001/jama.2012.6571
6. Carrero, J.J., Franko, M.A., Obergfell, A. (2019). hsCRP Level and the Risk of Death or Recurrent Cardiovascular Events in Patients With Myocardial Infarction: a Healthcare‐Based Study. Journal of the American Heart Association, 8(11). https://doi.org/10.1161/jaha.119.012638
7. Boston Heart HDL Map ® Test – Boston Heart. https://bostonheartdiagnostics.com/test/boston-heart-hdl-map/
8. Boston Heart Cholesterol Balance ® Test – Boston Heart. https://bostonheartdiagnostics.com/test/boston-heart-cholesterol-balance-test/
9. Cloyd, J. (2023, April 10). A Functional Medicine Hypertension Protocol. Rupa Health. https://www.rupahealth.com/post/functional-medicine-hypertension-protocol
10. Szczepańska, E., Białek-Dratwa, A., Janota, B., et al. (2022). Dietary Therapy in Prevention of Cardiovascular Disease (CVD)—Tradition or Modernity? A Review of the Latest Approaches to Nutrition in CVD. Nutrients, 14(13), 2649. https://doi.org/10.3390/nu14132649
11. Tassell, M.C., Kingston, R., Gilroy, D., et al. (2010). Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease. Pharmacognosy Reviews, 4(7), 32. https://doi.org/10.4103/0973-7847.65324
12. Vazquez, K. (2022, September 9). This Is How Much Magnesium You Should Take Based On Your Age. Rupa Health. https://www.rupahealth.com/post/magnesium-101
13. Agarwal, K.C. (1996). Therapeutic actions of garlic constituents. Medicinal Research Reviews, 16(1), 111–124. https://doi.org/10.1002/(sici)1098-1128(199601)16:1
14. Ried, K., Frank, O., Stocks, N., et al. (2008). Effect of garlic on blood pressure: A systematic review and meta-analysis. BMC Cardiovascular Disorders, 8(1). https://doi.org/10.1186/1471-2261-8-13