Jillian L. Capodice, LAc discusses recent research and action steps that can be taken to prevent and control heart disease.

by  Jillian L. Capodice, LAc

Cardiovascular disease mortality still ranks number one according to the Centers for disease control with 652,091 deaths/year (about 27% of all deaths) (1). Cardiovascular or heart diseases (CVD) is a term that includes many heart conditions, the most common of which is coronary heart disease that can lead to heart attack.

There are many steps that can be taken to prevent and control heart disease and lower risk in both men and women.  From an integrative perspective the three most important are likely biologic therapies (diet/nutritional changes and dietary supplements), mind/body connection and related therapeutic strategies and exercise.  This article will briefly outline some of the most common diets, dietary supplements and mind-body research currently being done for heart health.


Recent diet/nutrition studies

1.  Women’s Health Initiative:  In women, coronary heart disesase is also the leading cause of death and until recently, estrogen was seen as protective against heart diesease.  However the findings from the large randomized Women’s Health Initiative (WHI) did not confirm this theory and instead demonstrated that there was variotion in the incidence of heart disease in women taking various hormone replacement therapies (HRT) and that these differences between HRT regimens and the timing of initiating HRT use may be crucial in HD prevelance (2).


2.  OmniHeart Trial:   This study compared 3 diets designed to reduce cardiovascular disease (CVD) risk:

  • one high in carbohydrate
  • one that replaced carbohydrate with unsaturated fat
  • one that replaced carbohydrate with protein

Methods:  The macronutrient contents of many seven-day menu plans from the OmniHeart Study, Dietary Approaches to Stop Hypertension (DASH) an many popular diets including the Zone, Atkins, Mediterranean, South Beach, and Ornish were evaluated for consistency with the US Food and Nutrition Board’s Acceptable Macronutrient Distribution Ranges.

Results: – The Ornish diet was highest in carbohydrate (75% of energy) and dietary fiber (67 g/2000 kcal) and lowest in fat (7%), saturated fat (1%), and cholesterol (6 mg/d)

– The Atkins diet was the lowest in carbohydrate (9%) and fiber (20 g/2000 kcal) and the highest in fat (62%), saturated fat (23%), and cholesterol (731 mg).

– The Zone diet had the highest protein content (35%) and meets the national guidelines for intakes of fat and protein, but not for carbohydrate.

–  The other diets analyzed (Atkins and South Beach) had moderate mixes of protein (16–26%), carbohydrate (33–54%), and fat (28–46%). 

Conclusions:  The OmniHeart diets fulfilled the major Institute of Medicine developed Acceptable Macronutrient Distribution Ranges but, of many of the popular diets, only the Zone diet did. The OmniHeart diets were generally consistent with national guidelines to prevent cancer, diabetes, and heart disease, whereas most popular diets had limitations for fulfilling one or more guidelines. The possible health effects of many of these diets especially for heart disease and related conditions should be analyzed (3)

Recent dietary supplement trials

1.  Red yeast rice:  Red yeast rice extracts have been used traditionally and in the creation of the pharmacological statin drugs including lovastatin (6).  This trial tested capsules of Xuezhikang (XZK), (Beijing WBL Peking University Biotech Co. Ltd (WPU) (Beijing, Peoples Republic of China), a partially purified extract of red yeast Chinese rice with multiple components (each containing the combination of lovastatin, also termed monoclonin K (2.5 to 3.2 mg/capsule); a small quantity of lovastatin hydroxyl acid; as well as ergosterol  and some other components).


Design: Randomized, placebo controlled trial of 5,000 patients with average low-density lipoprotein cholesterol levels at baseline for an average of 4.5 years

The primary end point was a major coronary event that included nonfatal myocardial infarction and death from coronary heart disease.

Results:  Frequencies of the primary end point were 10.4% in the placebo group and 5.7% in the XZK-treated group, with absolute and relative decreases of 4.7% and 45%, respectively. Treatment with XZK also significantly decreased CV and total mortality by 30% and 33%, the need for coronary revascularization by 1/3, and lowered total and low-density lipoprotein cholesterol and triglycerides, but raised high-density lipoprotein cholesterol levels

Table 2.  Events according to study group (intention-to-treat population)  (6)




Difference Placebo-XZK (%)

Risk Reduction With XZK (95% CI)

p Value


No. of Patients

Incidence (%)

No. of Patients

Incidence (%)




Nonfatal MI






0.38 (0.27−0.54)


Coronary disease mortality






0.69 (0.52−0.88)


Fatal MI






0.67 (0.38−1.20)


Fatal stroke






0.91 (0.42−1.99)


Coronary revascularization






0.64 (0.47−0.86)


CV mortality






0.70 (0.54−0.89)


Cancer mortality






0.44 (0.23−0.84)


Total mortality






0.67 (0.52−0.82)


CI = confidence interval.  Intention-to-treat population.
 Difference between the placebo and XZK groups.

Conclusions:  In conclusion, long-term therapy with XZK significantly decreased the recurrence of coronary events and the occurrence of new CV events and deaths, improved lipoprotein regulation, and was safe and well tolerated.

Other Major Factors Currently Under Study for potential effect on CVD/heart health (4)

  • Dietary Fat-Related Components that Modify LDL Cholesterol Levels: SFAs, Unsaturated Fatty Acids (UFAs), TFAs, and Dietary Cholesterol
  • Nuts and Lipid Lowering
  • Soy and LDL Cholesterol Level Lowering
  • Phytosterols and LDL Cholesterol Level Lowering
  • Total and Soluble Fiber: Effect on LDL Cholesterol Level Lowering and CVD Prevention
  • n-3 Fatty Acids and CVD Prevention
  • Hcy (homocysteine) and B Vitamins and CVD Prevention
  • Alcohol and CVD Prevention
  • Antioxidants and CVD Prevention
  • Vitamin C, Vitamin E, β-Carotene, CoEnzyme Q10
  • Obesity and CVD Risk
  • BMI, Abdominal Adiposity
  • Physical Activity and Effect on Lipid/Lipoprotein Levels and CVD Protection
  • Dietary Strategies to Prevent and Treat Metabolic Syndrome
  • Diet and Lifestyle Strategies to Lower Blood Pressure
  • Effectiveness of Medical Nutrition Therapy (MNT) for Hyperlipidemia

Mind/Body Research for CVD

According to NCCAM mind/body medicine focuses on the “interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health” (7).

1.  The SEARCH Study The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): a mindfulness-based psycho educational intervention improves depression and clinical symptoms in patients with chronic heart failure.  The SEARCH study was designed to assess the impact of a mindfulness-based intervention on outcomes including QOL and depression in patients w/chronic health failure (CHF).

Methods:  Prospective cohort study of 208 adults w/ L ventricular ejection fraction <40% and CHF assigned to treatment or control.  Treatment met weekly for 8 consecutive weeks of training in mindfulness meditation, coping skills, and support group discussion. With (3, 6, and 12 months of follow-up). 

Results:   Subjects had a mean age of 61 years, left ventricular ejection fraction 26%, and median New York Heart Association class II. The majority were treated with angiotensin-converting enzyme inhibitors (80%) and β-blockers (86%). When compared with controls, treatment resulted in lower anxiety (Profile of Mood States, P = .003), depression (Center of Epidemiology—Depression, P = .05), improved symptoms (Kansas City Cardiomyopathy Questionnaire symptom scale, P = .033) and clinical scores (Kansas City Cardiomyopathy Questionnaire clinical score, P = .024) over time. There were no treatment effects on death/rehospitalization at 1 year.



Figure 1. Center of Epidemiology—Depression change from baseline over time by treatment group (mean ± SE); P = .052 for overall effect from repeated-measures analysis. Wilcoxon rank sum P values for difference scores: P = .013 for change from baseline to 3 months, P = .007 from baseline to 6 months, P = .67 from baseline to 12 months. (8)



Figure 5. Unadjusted Kaplan-Meier event-free survival curve by treatment (P = .4739). (8)

Conclusions:  This study showed that an 8-week mindfulness-based psychoeducational intervention reduced anxiety and depression in subjects with CHF,  interventions of this type might have a role in optimal therapy for CHF and further study is warranted.   


1.  Centers for disease control.  Viewed at http://www.cdc.gov/nchs/fastats/heart.htm Monday January 16, 2009.

2.  Rossouw JE, Anderson GL, Prentice RL. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321–33

3.  de Souza RJ, Swain JF, Appel LJ, Sacks FM. Alternatives for macronutrient intake and chronic disease: comparison of the OmniHeart diets with popular diets and with dietary recommendations. Am J Clin Nutr. 2008 Jul;88(1):1-11.

4.  Van Horn L, McCoin M, Kris-Etherton PM, Burke F, Carson JA, Champagne CM, Karmally W, Sikand G.

The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc. 2008 Feb;108(2):287-331.

5.  Gadarla M, Kearns AK, Thompson PD. Efficacy of rosuvastatin (5 mg and 10 mg) twice a week in patients intolerant to daily statins. Am J Cardiol. 2008 Jun 15;101(12):1747-8.

6.  Zongliang Lu, Wenrong Kou, Baomin Du, Yangfeng Wu, Shuiping Zhao, Osvaldo A. Brusco, John M. Morgan, David M. Capuzzi and Chinese Coronary Secondary Prevention Study GroupEffect of Xuezhikang, an Extract From Red Yeast Chinese Rice, on Coronary Events in a Chinese Population With Previous Myocardial Infarction.  The American Journal of Cardiology, Volume 101, Issue 12, 15 June 2008, Pages 1689-1693

7.  http://nccam.nih.gov/health/whatiscam/mind-body/mindbody.htm.  Viewed February 17, 2009.

8. Sullivan MJ, Wood L, Terry J, Brantley J, Charles A, McGee V, Johnson D, Krucoff MW, Rosenberg B, Bosworth HB, Adams K, Cuffe MS. The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): a mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. Am Heart J. 2009 Jan;157(1):84-90.

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