Improving Heart Health

For those of you who may have concerns about heart health, and may consequently be on statins, blood-thinners or similar medications, here is some research on diet supplements that you may find interesting. Cardiovascular diseases are the result of generalized inflammation in the vascular system, the arteries and veins in our body: 

Plaque deposits line the walls of damaged arteries. A normal, healthy artery is too strong and the walls are too smooth for a deposit to form. Your body is remarkable and forms these deposits as a way to treat a broken or damaged wall in an artery. Unless the crack is fixed, or plugged with a plaque deposit, blood can break through the arterial wall completely and this would be total disaster. So, the body repairs the arterial walls with a sort of mortar, or plaque. 

A different article notes: 

Atherosclerosis affects only herbivores. Dogs, cats, tigers, and lions can be saturated with fat and cholesterol, and atherosclerotic plaques do not develop (1, 2). The only way to produce atherosclerosis in a carnivore is to take out the thyroid gland; then, for some reason, saturated fat and cholesterol have the same effect as in herbivores. 

Old world primates, such as men, are among the few animals on earth that do not produce vitamin C.  Linus Pauling, the only person to win two unshared Nobel prizes, proposed that heart disease was actually a reaction to insufficient amounts of vitamin C in the diet. That is, he believed vascular disease was a form of sub-clinical scurvy. Since these three elements were key to building strong arterial walls, his treatment regimen involved high doses of Vitamin C, lysine and proline. (Article 1, 2, 3).

So, why does heart disease happen? Pauling theorized that lipoprotein (a), which the human body does produce, is used by the body as a (poor) substitute for vitamin C. Lipoprotein (a) levels are genetically determined. Some people produce none, others produce high levels. Levels are only somewhat resistant to change by diet or physical activity (Article 1, 2, 3, 4, 5, 6). However, Lp(a) typically constitutes the majority, if not the entirety, of arterial plaque. Lp(a) appears primarily in primates who cannot synthesize Vitamin C ascorbate (Article 1, 2, 3, 4, 5, 6, 7, 8):

“LDL‐C” was associated with incident cardiovascular disease only when lipoprotein(a) cholesterol content was included in its measurement. Refinement in techniques to accurately measure LDL‐C, particularly in patients with elevated lipoprotein(a) levels, is warranted to assign risk to the responsible lipoproteins. (Article 1)

Apolipoprotein(a) carries 85% of all the oxidized phospholipids which can damage the coronary intima of all individuals and facilitate the development and eventual rupture of plaques. (Article 3)

The new PCSK9 inhibitors are one of the few things that seem to reduce Lp(a) levels. There are additional drugs in development which beneficially affect Lp(a) levels. Lp(a) levels are seen by some as much superior markers to coronary artery disease than simple HDL/LDL ratios.

TLDR:  Atherosclerosis has three main aspects: inflammation, arterial wall damage, and plaque build-up. The supplements below address each of those three aspects. The fibrinolytics break down existing plaque, the anti-inflammatories reduce the inflammation that attracted the plaque, and the anti-cholesterol supplements prevent new or additional plaque formation. Meanwhile the vitamin C, lysine and proline re-build the vessel walls to restore circulatory health.

Fibrinolytics (don't use before surgeries)

• Lumbrokinase reduces fibrin clots and may also reduce arterial plaque. It is used to treat stroke, atherosclerosis, coronary artery disease and deep vein thrombosis (Articles: 1, 2, 3).  Amazon has lumbrokinase as does Walmart.
• Nattokinase dissolves clots and arterial plaque, while lowering blood pressure. It operates via a different mode than lumbrokinase. (Articles:  1, 2, 3, 4, 5). Amazon has nattokinase supplements. (Article: 1)
• Natto (the fermented soybean food) has been shown to decrease both gut inflammation and arterial plaque formation.  In addition to taking nattokinase pill supplements, you may also consider eating natto (fermented soybeans). It is available in the frozen food section of Asian grocery stores like 99 Ranch. 
• Serrapeptase is sometimes recommended as well. Of the three, it is the weakest in fibrinolytic activity. 
• Indonesian tempe, a fermented soybean food, may also be a natural fibrinolytic agent. 

Anti-inflammatories

• Bromelain is an anti-inflammatory that treats angina pectoris, transient ischemic attack, thrombophlebitis and chronic rhinitis (Articles: 1, 2). Bromelain is also a fibrinolytic and may break down cholesterol plaques (Articles: 1, 2, 3). Don't use it before surgery (Article: 1, 2)  Amazon link.
• Taurine decreases blood pressure and inflammation. In a review published in Amino Acids, animal models suggest that a higher intake could help protect against heart disease and prevent fatty plaque build-up in the arteries. (Articles: 1, 2, 3). Amazon link. 
• Fisetin is an anti-oxidant and anti-inflammatory that reduces death of heart cells (ischemic damage) following a heart attack. It also appears to reduce plaque buildup. It may also regulate PCSK9 (Article 1, 2, 3, 4, 5, 6)
• Co-Q10. Statins are anti-inflammatories, but they often deplete the body of Co-Q10. Co-Q10 is an anti-inflammatory that improves mitochondrial function and may (or may not) reduce muscle pain common with statin use. Ubiquinol is the most active form of Co-Q10. This supplement also appears to reduce blood pressure. (Articles: 1, 2, 3, 4, 5)
• Luteolin is an anti-inflammatory that may help treat heart issues, covid and cancer (1, 2, 3, 4). Along with quercetin, it is a senolytic, clearing dead and dying cells from the body. Dosages are not clearly established. Care should be taken with flavonoids in general (1)
• Astaxanthine is an antioxidant that appears to slow atherosclerosis, reduce inflammation, reduce triglycerides, improve HDL, modestly lower blood pressure and improve exercise capacity in patients with heart failure. It may also serve to improve mitochondrial function. (Articles: 1, 2, 3, 4)

Cholesterol Reduction

• Quercetin is not only an anti-inflammatory, it lowers cholesterol by up to 12%. It is "is known for its anti-inflammatory, antihypertensive, vasodilator effects, anti-obesity, anti-hypercholesterolemic and anti-atherosclerotic activities." (Article 1, 2, 3). The lecithin-based form appears to be absorbed the best. (Article: 1)
• Berberine alone and in combination with other supplements provided an average LDL percent reduction of 20–30%. The good news: berberine appears to be a natural PCSK9 inhibitor. Oral dose from 150 mg to 1000 mg/day (Articles: 1, 2, 3, 4, 5). Amazon link
• Citrus Bergamot Extract studies showed a significant decrease in total cholesterol, triglycerides and LDLc. The decrease in total cholesterol varied from 12.3% to 31.3%, from 7.6% to 40.8% in LDLc and from 11.5% to 39.5% in triglycerides. (Articles 1, 2, 3) Amazon link.
• Pantethine (this is NOT B5, it is a derivative) lowers cholesterol effectively. (Articles: 1, 2, 3) Amazon link.
• PCSK9 inhibitors will also reduce cholesterol, but these drugs are very new and very expensive. Not only is the above-mentioned berberine a natural PCSK9 inhibitor, so is quercetin, curcumin, cashews, walnuts and peanuts. This may be why daily nut consumption has long been understood to be heart-healthy.
• Find fish oil with the highest concentration of EPA you can identify. Note: the effectiveness of fish oil and EPA for assisting with heart disease is controversial, but a lot of cardiologists still recommend it. EPA reduces blood-clotting and triglyceride levels. It also appears to reduce blood pressure. (Article: 1, 2, 3, 4).
• LDL Sweet Spot: "Our meta-analysis suggests that not only should LDL be reduced to a target level of < 80 mg/dL, but HDL should be increased to a target level of  >45 mg/dL to regress coronary plaques."

Re-building Arteries

• Lysine, according to Linus Pauling's research, provides essential cellular building blocks for repair of arteries. 2-3 grams daily for prevention, 3-6 grams for therapeutic benefit. "The use of vitamin C, lysine and proline is crucial for the body’s production of collagen and the protection of the endothelium of the artery walls" (Articles: 1, 2, 3) Amazon link.
• Proline, as articles referenced under "Lysine" show, can be even more effective than L-lysine. Both bind lipo-protein A, preventing plaque build-up. The reference interval for Lp(a) is 0-30 mg/dL. Take 250mg to 2000 mg proline daily. (Articles: 1, 2, 3, 4, 5, 6, 7, 8)

Vitamins (Arterial Rebuilding)

• Vitamin C and D are both good for general immune system support. Vitamin C is critically important for the creation of the cross-links in the collagen matrix that makes up strong arterial walls. It is possible high doses of Vitamin C may also reduce arterial plaque and slow down progression of atherosclerosis. High Vitamin C levels are also associated with low blood pressure. (1, 2) Because it is water-soluble, it is impossible to overdose on Vitamin C. Any excess is excreted through the kidneys with no damage to the body. 
• Low levels of Vitamin D are correlated to higher rates of congestive heart failure and higher rates of high blood pressure. As we age, vitamin D is harder to absorb, so higher doses are not unreasonable. Because it is fat-soluble, it is possible to overdose on Vitamin D, so regular blood tests should be used to monitor the levels. (1)
• Vitamin K2 is reported to prevent arterial calcification. It has different forms. The serum half-life of MK-4 variant of K2 is a few hours while the MK-7 variant can last up to 3+ days. (Articles: 1, 2, 3).  Amazon link.

Men's Heart Health: best cholesterol tests

Potassium is a good heart health supplement, that also has positive effects on reducing stroke and high blood pressure. There are no over-the-counter potassium supplements, but eating a couple of kiwis a day, or an avocado, will provide more potassium than a banana. 

Zinc also appears to be associated with heart health and reduced inflammation. However, too much zinc can interfere with copper absorption. Stay at or under 40 mg/day. Take it orally, don't use intranasal zinc, as it could destroy your sense of smell. (Article 1, 2, 3)

Green tea may be of benefit in lowering cholesterol and blood pressure (Article 1, 2)

Avoid red yeast rice (it is just an unregulated statin), L-Arginine and garlic supplements. (Article: 1). 

This 2019 article is a summary review of the effect various supplements have on heart health. This article reviews the effects of statins and Dr. Ornish's diet-based approach to reduce cholesterol.

       

High Blood Pressure

So, which of the above treat high blood pressure?

• Potassium - No supplements, just eat high-potassium foods like avocadoes and kiwis
• Magnesium - Supplements can cause overdose, keep it below 500 mg/day. One to two glasses of skim milk contain both potassium and magnesium, skim milk reduces blood pressure. (1)
• Vitamin D - Overdose is possible (it's fat-soluble), but kind of hard to do.
• Vitamin C - Impossible to overdose (it's water-soluble), but high doses will cause diarrhea until your body gets used to it.
• Nattokinase - Article 1, 2
• Taurine - Article 1, 2, 3
• Co-Q10 - Article 1
• Astaxanthin - if you have a seaweed allergy, avoid this. Article 1
• Green Tea - Article 1, 2

Fun Facts

We are told that physical activity and plant-based diets prevent hypertension and heart disease. Africa has by far the highest number of people eating plant-based diets in the world. Africans have among the lowest cholesterol levels in the world. Africa also has the highest rate of heart disease and hypertension.

"In Africa, where many developing countries in the world are located, plant protein is the most important protein source for the population."

https://www.zerohedge.com/medical/visualizing-daily-protein-sources-region

"Western European countries like Greenland, Iceland, Andorra, and Germany have the highest cholesterol levels in the world, with mean serum total cholesterols of around 5.5 mmol/L. African countries have the lowest cholesterol, some as low as 4 mmol/L."

"The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9686438/

"Racial differences affect the heritability of apo(a), with African-Americans having a lower heritability when compared to Caucasian populations 4. Despite lower heritability, absolute Lp(a) levels are highest in people of African ancestry"

Maybe it isn't just about eating plants. 

the Alaskan Inuit consumed around 3000 calories per day, with 50% of their calories coming from fat, 30%–35% from protein ....the traditional Alaskan Inuit diet was very low in refined carbohydrates and sugar....increase in the intake of carbohydrate appears to have contributed to dyslipidaemia in the Alaskan Inuit. Indeed, the average serum triglyceride level of the Point Hope Inuit was only 69 mg/dL. However, the triglyceride levels among boarding school Inuit were 124 mg/dL and 101 mg/dL, which represented increases of 80% and 46% in the men and women, respectively. Very low density lipoprotein (VLDL) levels of the Alaskan Inuit were also extremely low (<35 mg/dL) or about two to six times lower than levels found in US whites at the time (60–200 mg/dL)

... the Alaskan Inuit apparently had a fivefold lower cardiovascular mortality rate versus those in the USA at the time. Another autopsy study, this time spanning the subsequent decade (ie, 1959–1968), found a prevalence of cardiovascular disease of only 10.3% in Alaskan natives... the data suggest that the traditional Alaskan Inuit (based on autopsy studies from the 1950s and 1960s) had around 1/15th to 1/18th the rate of death from ischaemic heart disease compared with the USA at the time.

 In fact, a person's genome may be a bigger indicator of what diet they should follow:

the Inuit and their Siberian ancestors have special mutations in genes involved in fat metabolism. The mutations help them partly counteract the effects of a diet high in marine mammal fat, mostly from seals and whales that eat fish with high levels of omega-3 polyunsaturated fatty acids....Those genetic mutations, found in nearly 100 percent of the Inuit, are found in a mere 2 percent of Europeans and 15 percent of Han Chinese