Redefining Cardiovascular Care: A Holistic Approach Beyond Traditional Risk Factors


To Mimi Guarneri, MD, FACC, ABOIM, the need for a new cardiology model is obvious. Research shows that 80 percent of premature deaths from cardiovascular disease could be prevented. Still, in our current health system, there are three deaths for every ten patients with cardiovascular disease.

“We know all this information, yet putting it into clinical practice to this day remains a challenge, and I eat the concept of universal health care,” said Guarneri, integrative cardiologist and President of the Academy of Integrative Health and Medicine. “And there's a reason we can't get where we need to go. It’s because we don't have universal health care.”

Speaking at the 2023 Academy of Integrative Health and Medicine Annual Conference in San Diego, Guarneri underscored the importance of a comprehensive approach to cardiovascular wellness, prioritizing prevention as much as treatment and considering genetics, lifestyle, environment, and mental health.

According to Guarneri, emerging research shows that risk factors for cardiovascular disease go far beyond genetics. New data from 2022 revealed emerging risk factors for cardiovascular disease like ambient air pollution, lead exposure, loneliness, social isolation, and non-alcoholic fatty liver disease, explained Guarneri. “These are things that honestly matter,” she asserted, highlighting the preventable surge in non-alcoholic fatty liver disease.

In addition, Guarneri said research indicates that sleep quality is associated with the risk of depression, which is linked to cardiovascular disease, heart attack, coronary artery disease, and stroke. We also know that heavy metals and toxins like cadmium, lead, and mercury are linked to kidney disease, diabetes, hypertension, and cardiovascular disease, she explained.

“So, when we keep saying we're going to cure vascular disease with statin therapy, I think we have to think twice,” Guarneri said. “It's like saying we have 30 holes in the roof. It's raining on us. We're going to fix one hole, and everything will be fixed.”

Guarneri also compared the health risks of social isolation and loneliness to that of smoking and obesity. "Not every issue can be remedied with medication,” she noted.

According to recent studies, Guarneri said that persistent organic pollutants and environmental toxins are linked to mitochondrial dysfunction and insulin resistance. “Again, this is just a connection between Mother Earth and illness. The sicker the planet, the sicker the humans. A healthier planet means healthier humans. It's not too complicated.”

Accessing cardiovascular disease risk usually involves testing for inflammation and HDL and LDL cholesterol, but Guarneri said those measurements give us nothing about how someone lives their life. However, additional testing can provide more insight into a patient's risk.

Guarneri said looking at a patient’s carotid artery plaque is an easy way to screen how aggressive you should be with treatment. Genetic risk scores can lead to earlier screenings, preventing disease progression. Guarneri also suggested testing a patient’s coronary calcification score, c-reactive protein levels, LDL and LDL particle number, and ApoB: ApoA ratio.

Aside from medical tests, observing a patient’s lifestyle is crucial, explained Guarneri. Studies show that even patients with a high genetic risk for heart disease can decrease their risk by 50 percent with a favorable lifestyle. Simple interventions like switching to a Mediterranean diet, aerobic exercise, stress management training, smoking cessation, limited alcohol consumption, and group psychosocial support can be highly effective at decreasing the risk of cardiovascular disease, Guarneri said.

In addition, chronic stress has tangible effects on our physical health, particularly on our telomeres, which affect cellular aging, said Guarneri. She explained that various studies have showcased the profound positive impact of meditation on health, including reducing anxiety and depression, which can benefit cardiovascular health significantly.

“Why Xanax? Why so many drugs when we have these tools in our toolbox?” Guarneri asked. “Research tells us that meditation leads to decreased anxiety, improvement in depression and pain, and quality of life. Why isn't it in every clinic? Why is it available for everyone?”

Medication cannot be the only solution to reduce cardiovascular disease risk factors. In fact, certain medications like proton-pump inhibitors (PPIs), used for acid-related disorders, may negatively impact heart health, Guarneri said.

Guarneri concluded her presentation by stressing that traditional risk factors and calculators are not 100 percent accurate as they fail to acknowledge many emerging risk factors. To achieve better cardiovascular health outcomes, she argued that physicians need to consider things like getting patients off PPIs, heavy metal and air pollution exposure, coronary calcium scores, and genetics.

“Right now, we’re not cleaning up the air; we’re not fixing that hole in the ceiling; stress, we’re not fixing that hole in the ceiling; loneliness, social isolation, all these holes need to be fixed.”

Editor's note: This article is part of our live coverage of the 2023 Academy of Integrative Health and Medicine Conference. Click here for a list of full coverage.