1. Introduction
Cardiovascular diseases (CVDs) involve multiple health conditions affecting the functioning of the heart and associated blood vessels. CVDs are one of the world’s most common diseases, causing a broad range of health problems and leading to nearly 18 million deaths each year, according to the World Health Organization. Heart attacks and strokes cause most deaths associated with CVDs, the two most common CVDs.
In Australia, about 1.3 million adults had heart, stroke and vascular disease in 2022, and about 600,00 were hospitalised with CVD as the primary diagnosis. CVD is also a significant cause of death, being responsible for about 25% of all deaths reported per year, according to the AIHW – this accounts for about 118 Australians dying from CVD every day.
CVDs affect both men and women, and there is a broad range of factors that influence a person’s risk. The causes of cardiovascular disease include lifestyle factors, genetics, gender and age. But, beyond the known causes of cardiovascular disease, the path that leads to the development of a CVD is complex, and both clinicians and patients need to work together to elucidate the best approach for treatment. For this reason, the integrative Functional Medicine approach used by AUSCFM is ideal for the optimal assessment of patients at risk of developing a CVD.
2. Cardiovascular Disease (CVDs): the basics
The cardiovascular system comprises the heart and the blood vessels that transport blood throughout our body. Diseases affecting the heart, or the blood vessels connected to the heart, are considered a form of cardiovascular disease or CVDs. The most common CVDs include:
- Coronary artery disease (Also known as coronary heart disease)
This condition occurs when atherosclerotic plaques (plaques) block blood flow in a coronary artery. Coronary arteries are vital as they transport oxygenated blood to the heart muscle. When someone suffers from coronary heart disease, the flow of oxygenated blood towards the heart is blocked or reduced by plaque. Atherosclerotic plaque is made up of fat, cholesterol, calcium, and inflammatory cells, and it builds up over relatively long periods due to factors like genetics and lifestyle factors, including diet and level of exercise.
- Cerebrovascular diseases
These conditions involve the blood vessels reaching the brain or its covering membranes. Among the different types of cerebrovascular diseases, the most common is stroke, which occurs when the flow of blood to the brain is blocked by plaque. Two common types of stroke include:
- Ischaemic stroke occurs when the involved blood vessel is an artery supplying blood to the brain.
- Haemorrhagic stroke – this occurs when the artery supplying blood to the brain is ruptured and begins to bleed.
- Peripheral artery disease (PAD); and
This condition occurs when plaque builds up in peripheral arteries, the blood vessels that transport blood from the heart to other body parts.
- Aortic atherosclerosis.
This condition occurs when plaque build-up affects the aorta, the body’s largest artery, which carries blood from the heart to the rest of the circulatory system.
People affected by CVD may experience one or more of a broad range of symptoms, depending on their specific condition (Table 1).
Table 1. Main symptoms associated with four types of CVDs.
| CVD | Symptoms |
| Coronary artery disease | Chest pain, Weakness, light-headedness, nausea, pain or discomfort in the arms or shoulder, shortness of breath (Source: CDC). |
| Cerebrovascular diseases | Brain damage, leading to sudden impairments, Dizziness, nausea, or vomiting, severe headache, confusion, disorientation or memory loss, numbness, Weakness in an arm, leg or face, especially on one side, abnormal or slurred speech, poor comprehension, total or partial loss of vision, loss of balance, coordination or the ability to walk. (Source: aans.org) |
| Peripheral artery disease | Pain, aching, heaviness, or cramping in the legs when walking or climbing stairs go away after rest. The foot or leg may become pale, discoloured, or blue. Leg weakness or numbness. Pain or a feeling of pins and needles in your leg or foot. (Source: NIH). |
| Aortic atherosclerosis | Chest pain, Dizziness or fainting, heart palpitations, nausea or vomiting, pain or discomfort in your shoulder, arm, neck or jaw, sweating, anxiety. (Source: Cleveland Clinic) |
Who is most at risk of CVDs?
There are several risk factors associated with the development of CVDs. People who smoke, follow an unhealthy diet, consume excess alcohol, and do not exercise regularly are generally at an increased risk of CVDs. For these people, these risk factors lead to elevated blood pressure, diabetes, raised blood glucose, raised blood lipids, and overweight or obesity – all conditions that have a solid link to an increased risk of heart attack, stroke, heart failure and other CVDs.
In addition to lifestyle factors (diet, exercise, smoking, etc), other factors are known to influence the risk of developing CVDs, including age, gender, infections and certain medications. For example, according to data from the ABS, CVDs are slightly more common in men compared to women. Also, age is an essential factor, with current data showing that the prevalence of CVD significantly increases with age. For example, about 0.6% of people who are 0-45 years old develop CVDs, compared with people who are 75 years or older, where the prevalence is nearly 28%.
Finally, genetics also play a role in the risk of developing CVD. Today, it is clear that the development of CVD results from the interaction of both genes and the environment. For example, if someone is tobacco smoking, is obese and doesn’t exercise has an increased risk of developing CVDs. Still, if, in addition, they have a family history of CVD, have congenital heart defects, or carry specific genetic variants, they may have an even higher risk of developing CVDs.
Understanding Cardiovascular Disease
Looking and feeling health is not enough to guarantee that you are risk-free of developing a CVD. Due to the complexity of factors associated with CVDs, a person may seem healthy, may be following a heart-healthy diet and exercise regularly, yet be at a high risk of developing CVD.
Plaque build-up in the blood vessels, the key underlying mechanism behind CVDs, occurs over the course of decades, and during this time a person may experience no symptoms. For this reason, it is important to take a proactive and comprehensive approach to assess a person’s risk of developing a CVD.
At AUSCFM, we recommend that our patients take a comprehensive set of tests to assess their real risk of developing a CVD. Under our Functional Medicine approach, we do not wait for patients to develop symptoms related to a Cardiovascular Dysfunction.
We aim to understand a patient’s risk of a CVD as early as possible and begin treatment immediately, following a holistic approach that seeks to address the root causes of Cardiovascular Dysfunction.
3. How is CVD Diagnosed?
Accurately diagnosing CVD requires a comprehensive assessment of all risk factors to understand a patient’s short and long-term CVD risk. At AUSCFM, we consider more than ten cardiovascular health markers, Australia’s most comprehensive approach. We aim to gain a complete picture of a patient’s cardiovascular health and accurately assess their risk of CVDs. In brief, our evaluation of CVD involves:
- Advanced Lipid Panels – this test measures various markers of lipid content in the blood, including LDL Size, HDL-P, LDL-P, Small LDL-P, Large VLDL-P, HDL Size, LP-IR Score, VLDL Size, and Large HDL-P.
- Inflammatory Markers—This test measures the levels of High-sensitivity C-reactive protein (hs-CRP), which indicates the levels of inflammation in the body.
- Markers of Oxidative Stress—This test focuses on levels of oxidised LDL, a marker that, when found at high levels, is associated with a wide range of health problems, including atherogenesis (plaque formation), Coronary artery disease (CAD), acute myocardial infarction, stable and unstable angina, metabolic syndrome, impaired glucose tolerance, insulin resistance, and untreated overt hypothyroidism.
- Lifestyle Panel: This test assesses multiple markers associated with heart health, including a basic lipid profile, C-reactive protein (hs-CRP), HDL Map, and Cholesterol Balance.
- Diabetes Panel—This test will help us assess whether a patient has diabetes and includes markers for evaluating glucose metabolism, such as fasting insulin, fasting glucose, and hemoglobin A1c.
- Omega Panel – This test measures the levels of omega-3 fatty acids. High levels of these fatty acids are associated with a lower risk of cardiovascular problems.
- TMAO – This test measures Trimethylamine N-oxide (TMAO) levels, a by-product of intestinal bacteria formed when we consume animal-based foods. High levels of TMAO are associated with a higher risk of developing atherosclerosis.
- Comprehensive Metabolic Panel (CMP) – This test measures levels of electrolytes such as sodium, potassium, and calcium and is particularly important for patients at risk of arrhythmia.
- Thyroid Panel – this test measures eight thyroid hormones and antibodies to assess thyroid function.
- MTHFR—This test assesses for clinically essential variations of the MTHFR gene, which codes for an enzyme responsible for folate metabolism. People with specific MTHFR variants have dysfunctional MTHFR enzymes that do not metabolise folate optimally, which can lead to an increased risk of certain CVDs.
- apoB particles—This test measures the levels of Apolipoprotein B-100. This protein is usually associated with lipids associated with increased risk of CVD, such as VLDL, IDL, LDL, and Lp(a) particles. High levels of an apoB test are strongly indicative of a higher risk of heart and blood vessel disease.
Finally, we recommend that most patients get tested for a coronary artery calcium score using a non-invasive computed tomography (CT) scan of the heart. This test measures calcium levels within the plaques in the coronary artery walls. The result of this test is a score that shows how much calcium is in the coronary arteries, which indicates coronary artery disease. A standard calcium test score is zero. The results of this test will help us assess a patient’s risk of coronary artery disease and recommend further tests or specialised treatments.
The National Heart Foundation of Australia recommends the use of a coronary artery calcium score for patients who are considered to have a moderate absolute cardiovascular disease risk or who have low absolute cardiovascular disease risk and additional “risk-enhancing” factors, such as a family history of CVD, high cholesterol, metabolic syndrome, and other conditions. Persons considered at high risk of CVDs are not generally required to take this test. Patients should consult with their AUSCFM practitioner to determine if a coronary artery calcium score test is recommended.
4. Cardiovascular Disease Treatment – How AUSCFM treats CVDs
Under the conventional medicine approach, Cardiovascular Disease Treatment involves medications and procedures to lower blood pressure and cholesterol. Procedures recommended may include angioplasty or bypass surgery to restore blood flow to the heart. A doctor may also recommend lifestyle changes, like quitting tobacco smoking and improving a patient’s diet and physical activity.
However, under conventional medicine, all treatments usually commence following the onset of symptoms.
At AUSCFM, we follow a functional medicine approach to Cardiovascular Dysfunction, which focuses on elucidating the root causes of CVD rather than just treating symptoms.
The Functional Medicine approach to Cardiovascular Dysfunction
Timing is another big difference between conventional and functional medicine approaches to treating CVDs. At AUSCFM, we rely on prevention and start treatments as early as possible before symptoms occur.
Some critical functional medicine approaches used by AUSCFM for Cardiovascular Disease Treatment include:
- Prevention includes getting patients to adopt a healthy lifestyle, including eating, exercising regularly, maintaining a healthy weight, not smoking, and managing any underlying health problems, such as high blood pressure or diabetes.
- Targeted nutrient therapy includes using a diet rich in specific vitamins, minerals, and other nutrients to support cardiovascular health.
- Supplements—For some patients, and following assessments, we recommend using certain supplements, such as omega-3 fatty acids, Coenzyme Q10, Magnesium, Vitamin D, garlic, hawthorn, and berberine. However, patients should consult with an ASCFM practitioner before taking any supplements.
- Complementary and Alternative Medicine – this approach includes various fundamental lifestyle changes that benefit cardiovascular health, including:
- Quitting smoking
- Improving levels of physical activity
- Acupuncture
- Herbal Medicine
- Mind-body therapies like meditation and yoga.
At AUSCFM, our ultimate goal is to resolve the underlying pathologies driving symptoms to restore patients to optimal health. Furthermore, our comprehensive CVD testing approach aims to assess Cardiovascular health before symptoms appear.
Patients will be treated by functional medicine doctors with ample experience using a holistic and multi-disciplinary approach to health care. Based on our comprehensive diagnostic approach, our functional medicine doctors will create a patient-centred treatment plan to tackle the source of Cardiovascular dysfunction from the inside out.
