Holistic Treatments for Coronary Artery Disorders - Heart Disorders

Holistic Treatments for Coronary Artery Disorders

Graboys asserts in the March 1994 Graboys Heart Letter that “everyone with a heart problem can benefit from an aggressive approach to the management of risk factors. Resetting life's priorities to include nutrition, exercise and stress management is necessary to continued heart health. I've worked with hundreds of patients who have recovered from a life-threatening heart problem using an ‘holistic’ approach to heart health.”

Nutritional Therapies.     Ornish claims that diet can almost immediately affect the heart. Even a single meal high in fat and cholesterol, he suggests, may cause the body to release a hormone, thromboxane, which causes the arteries to constrict and the blood to clot faster-one reason why heart patients often get chest pains after eating a fatty meal. According to Ornish, the diet he developed “allowed participants’ arteries to dilate and blood to flow more freely because the fat and cholesterol content was so low.”

Ornish's nutritional therapy focuses on lowering high blood cholesterol levels which form plaque and injure (tear) the linings of the coronary arteries. Ornish's vegetarian diet eliminates cholesterol, which is found in animal products (including meats), poultry, fish, and dairy products. Not only are vegetarian foods cholesterol-free but, with rare exception, they are low in saturated fat–a condition directly related to blood cholesterol levels. Ornish's diet excludes all oils and animal fats except nonfat milk and yogurt, as well as coffee, colas, MSG, tobacco, and other stimulants. All fried foods are strictly prohibited. Dairy foods high in vitamin D are also eliminated, including homogenized milk, because these products contain the enzyme xanthine oxidase which damages the arteries.

Ornish's diet allows only moderate use of salt and sugar. He also advises that eating increased amounts of dietary fiber, especially flax seed, oat bran and pectin, onions and garlic (both raw and cooked), vegetables, and fish can help reduce the consumption of saturated fats, cholesterol, sugar, and animal proteins. The diet is not restricted in calories because the type of food eaten is more important than the amounts consumed. An important adjunct is reducing fat consumption to 10% of total caloric intake. However, Ornish suggests that omega-3 fatty acids (eicosopentanoic acid-EPA) may be beneficial for some patients, and these are provided by the fish included in his diet.

In their book Prescription for Nutritional Healing, James Balch and Phyllis Balch recommend a well-balanced diet that contains adequate amount of fiber. They suggest raw foods, broiled fish, turkey, chicken, garlic, onions, lecithin, almonds and nuts (no peanuts), olive oil, pink salmon, trout, tuna, Atlantic herring, and mackerel. All of these foods contain essential fatty acids, are low in fat, and provide nutrients needed for normal heart functioning. Balch and Balch also counsel that no salt should be included in the diet.

American Heart Association (AHA) Diet.     The AHA's official diet for heart disease appears in The American Heart Association Low-Fat, Low-Cholesterol Cookbook, co-authored by Dr. Scott M. Grundy, one of the foremost lipid specialists in the U.S., and Mary Winston, senior science consultant for the AHA at its national headquarters in Dallas.

Grundy's book outlines the AHA's Step-One Diet and the Step-Two Diet, both of which are based on a nutritious eating plan calling for reductions in saturated fat and cholesterol. People concerned about preventing coronary artery disease by lowering their blood cholesterol levels are encouraged to first follow the Step-One Diet for three months. If they do not reach their target level by this point, they should adopt the Step-Two Diet.

Recommended Foods.     The AHA diet recommends the following foods to prevent heart disorders:

• Fish . Although fish is not entirely cholesterol-free, it generally contains less cholesterol than red meat. The AHA advises dieters to consume fish two to three times a week, especially fish high in omega-3 fatty acids (which may have cholesterol-lowering benefits), including: Atlantic and coho salmon, albacore tuna, club mackerel, carp, lake whitefish, sweet smelt, and lake and brook trout.
• Meat Products . Grundy's AHA diet permits a total of six ounces of poultry, fish, or lean meat per day (in one or two portions), provided that it is reasonably lean and contains between 500 and 600 calories. Red meat (including beef, lamb, pork, and veal) is permitted, so long as it contains a minimum of visible fat, and all outside fat is trimmed before cooking. Poultry is a good substitute for red meat only if it is a lean variety and if the skin is removed before cooking. Chicken and turkey are preferable to goose or duck.

• Fruits, Vegetables, Grains, and Legumes. These foods are low in cholesterol, tend to be low in fat, and, in many cases, are high in fiber and vitamins. A few exceptions include coconut meat (which is high in saturated fatty acids), olives, and avocados.
• Nuts and Seeds . Although both nuts and seeds tend to be high in fat and calories, Grundy states they do not contain cholesterol, and because most of their fat is unsaturated, they can replace high-protein, high-fat foods such as meat.
• Dairy Products . The AHA counsels dieters to virtually eliminate whole milk, and instead choose 1% or skim milk, both of which are rich in protein, calcium, and other nutrients without containing too much fat. Also recommended is consuming only low-fat or skim-milk cream, ice cream, and cheese, and substituting margarine for butter.

Restricted Foods.     The following foods are restricted or eliminated in the AHA diet to reverse heart disorders:

• Meat Products . Processed meats that are high in fat and calories-including sausage, bologna, salami, and hot dogs-should be used only sparingly. Organ meats-including liver, sweetbreads, kidney, brain, and heart-are extremely high in cholesterol and should be restricted or eliminated.
• Bakery Goods . Bakery goods such as pies, cakes, cookies, candy, and doughnuts should be restricted on the AHA diet because they are typically high in calories and contain few beneficial nutrients. Homebaked goods prepared with unsaturated oils and egg whites instead of whole eggs are preferable.
• Fats and Oils. All fats and oils that tend to harden at room temperature are eliminated from the AHA diet, including butter, lard, and tallow from animal sources and palm, palm kernel, and coconut oils from plants. Margarines can be used that have hydrogenated oil listed as a second ingredient.
• Beverages . The AHA suggests avoiding very high consumption-10 or more cups a day-of coffee and possibly tea because they are suspected of raising cholesterol levels. However, one to two cups a day does not appear to pose a risk. In addition, alcohol in moderation (one ounce daily) does not appear to be harmful, although the AHA does not believe it helps prevent heart disease.

Phytoestrogens.     As noted, Chinese and Japanese women who consume primarily vegetarian foods have lower heart disease rates than Western women. Adriane Fugh-Berman suggests that diets high in tofu, green soybeans, and other soy products that contain phytoestrogens (estrogen-like compounds found in plants) can decrease fat and calorie intake, and lower cholesterol levels. She cites a meta-analysis of 38 controlled trials that found that consumption of soy protein reduced total blood cholesterol levels by an average of 9%, LDL by 13%, and triglycerides by 10%.

Vitamin and Mineral Therapies.     Atherosclerosis and heart disease take many years to develop, and a daily regimen of vitamin and mineral supplements may be helpful in preventing or treating both. The best procedure is to consult a heart specialist who may recommend vitamin and mineral supplements depending on a person's diet, body weight, medical status, and absorption levels.

Plaque formation in arteries usually follows prior damage to the inner lining of the arteries. A sudden increase in blood pressure due to chronic emotional stress, for example, can cause small tears in the arterial linings, as blood vessels do not always dilate rapidly enough to accommodate sudden increases in pressure. As noted in Chapter 3, deficiencies of vitamins B, C, and E and magnesium can make this inner lining more susceptible to damage and subsequent plaque formation.

Vitamin B ₃ reduces cholesterol and try-glycerides in the blood and helps dilate the coronary arteries. Vitamin B ₆ (pyridoxine) and B ₁₂ (necessary for the conversion of homocysteine to cystathionine) also help reduce cholesterol levels, especially oxidized cholesterols known as oxysterols. Homocysteine is derived from methionine (an amino acid found in red meat, milk, and milk products) and converted with the help of pyridoxine to a non-toxic derivative. A deficiency of pyridoxine leads to the accumulation of homocysteine, which is damaging to endothelial cells (which line the heart) and can contribute to atherosclerosis.

Vitamins C and E help prevent and dissolve coronary blood clots, prevent excessive scarring of the heart after a heart attack, and facilitate circulation by dilating capillaries and developing collateral blood vessels.

As cited in the May 20, 1993 editions of The New York Times and The Wall Street Journal , researchers at the Harvard School of Public Health and Brigham and Women's Hospital in Boston reported that people who take daily megadoses of vitamin E have a significantly reduced risk of heart disease, although they cautioned that it is still too soon to recommend widespread use. Separate studies of more than 120,000 men and women who took daily vitamin E supplements of at least 100 International Units–more than three times the current U.S. RDA-showed that they had a 40% lower risk of heart disease than those who did not.

The researchers found that the reduction in risk appeared after two years of taking the supplements, and that people who simply consumed a diet rich in vitamin E did not derive the same health benefits as those who took the supplements. They also found that the benefit was not enhanced when people took more than 100 units. The researchers concluded that vitamin E, as an antioxidant, might reduce heart disease by having an effect on low-density lipoprotein (LDL) cholesterol, the so-called “bad” cholesterol.

Magnesium.     Ornish cites an impressive number of studies showing the benefits of taking magnesium for heart patients. Magnesium, according to Ornish, has been shown to reduce the risk of several different kinds of cardiac arrhythmias (abnormal heart rhythms). In two uncontrolled studies on a total of 18 patients suffering from a type of arrhythmia called torsades de pointes , magnesium reversed the arrhythmia in all cases. Another study of 18 patients with atrial fibrillation found that magnesium injections lowered their heart rates substantially. In 100 patients that had just received cardiac surgery, patients receiving intravenous magnesium suffered from only half the incidence of ventricle arrythmias that placebo subjects did. The hearts of the magnesium-treated subjects also pumped more blood after the surgery.

A meta-analysis of magnesium treating acute heart attacks found eight randomized controlled trials involving 930 patients. The magnesium-treated group showed 49% fewer serious arrhythmias, 58% fewer cardiac arrests, and 54% fewer deaths than the control group. As this study suggests, magnesium given after a heart attack helps people live longer. In a later, larger study of 2,316 subjects four weeks after they suffered suspected heart attacks, there were 24% fewer deaths among those given magnesium. A long-term, follow-up of the same study found that the mortality rate of magnesium-treated subjects was reduced by 16%, and the reduction for ischemic (oxygen-deprived) heart disease was 21%.

Selenium.     Selenium appears to have an effect on cardiovascular disease. One Danish study reviewed in Alternative Medicine: What Works found that men with the lowest selenium levels in their blood were 1.7 times as likely to suffer a cardiovascular event. Selenium is toxic in doses over 200 micrograms a day and an early sign of an overdose is a metallic taste in the mouth, dizziness, or nausea.

Pantethine.     According to the Encyclopedia of Natural Medicine , carnitine, pantethine, and co-enzyme Q-10 help prevent the accumulation of fatty acids within the heart muscle by improving the breakdown of fatty acids and other compounds. Pantethine has been shown to reduce serum tryglyceride and cholesterol levels significantly while increasing HDL-cholesterol levels in clinical trials. It appears to accelerate fatty acid breakdown as well.

Co-enzyme Q-10.     Co-enzyme Q-10, a vitamin that functions as a co-enzyme, protects against atherosclerosis by helping to prevent the formation of oxysterols. Co-enzyme Q-10 is an essential part of the mitochondria, the energy-producing part of a cell. Diseased hearts, according to studies reviewed by Fugh-Berman, tend to have less co-enzyme Q-10 in them, and supplementation with co-enzyme Q-10 appears to be treat various types of heart disease.

Karl Folders, a biomedical scientist at the University of Texas in Austin, suggests in the March/April 1994 issue of Natural Health that many heart patients suffer from a coenzyme Q-10 deficiency. One study found co-enzyme Q-10 deficiencies in 75% of 132 patients undergoing heart surgery. Dr. Peter Langsjoen, a cardiologist in Tyler, Texas, states in the same article: “In 80 percent of my (heart) patients, I see a clinical improvement within four weeks of administering coenzyme Q10.” According to Langsjoen, all forms of heart disease seem to respond to coenzyme Q-10.

In a randomized, double-blind, controlled trial of 641 patients with congestive heart failure, patients receiving co-enzyme Q-10 required fewer hospitalizations and had fewer serious complications. And a small controlled study showed that exercise tolerance increased in 12 angina patients treated with co-enzyme Q-10.

In coronary artery bypass patients, coenzyme Q-10 protected hearts from post-operative complications. In a controlled trial, 40 patients received co-enzyme Q-10 or a placebo for a week prior to their operation. The blood tests of treated subjects showed less evidence of heart injury than commonly occurs after this operation, and the treated group also had a lower incidence of arrhythmias during the recovery period.

Other minerals which have been linked with reducing cholesterol and platelet levels include calcium, chromium, and potassium. Dosages for these minerals should be prescribed by a heart specialist or physician.

Fish and Fish Oils.     The arteries of patients who've undergone coronary angioplasty often close up again. Fugh-Berman reviews a meta-analysis of seven trials on these patients which found that fish oil reduces the rate at which the treated arteries clogged up again. In four studies in which pictures of the arteries were taken, the difference between the placebo and fish oil groups was 14%. The more fish oil consumed, the greater the effect.

Eating fish appears to thin the blood, which may partially explain how fish oil helps arterial problems. A large, population-based study found that people who ate fish once or more a day had the fewest clotting factors in their blood. Fish in the diet is also associated with less risk of chronic obstructive pulmonary disease (emphysema or chronic bronchitis) in smokers.

In a meta-analysis of 31 trials on 1,356 patients, fish oil reduced blood pressure in hypertensive people, but not in those whose blood pressure was normal.

Botanical Therapies.     According to Alternative Medicine: The Definitive Guide , garlic, ginger, and hawthorn berry extract may be valuable in preventing and treating coronary heart disorders. Garlic contains sulfur compounds which work as antioxidants and help dissolve blood clots. Ginger has been shown to be effective in lowering cholesterol levels and making blood platelets less sticky.

A placebo-controlled, double-blind study reported by H. Kiesewetter in a 1993 issue of Clinical Investigations found that garlic-coated tablets reduced platelet aggregation. In this 12-week study, patients that took garlic significantly increased their walking distance by the fifth week of treatment. This increase was accompanied by a simultaneous decrease in platelet aggregation, blood pressure, plasma viscosity, and serum cholesterol levels.

Ginkgo biloba, according to nutritionist Donald J. Brown, writing in the May 1994 Townsend Letter for Doctors , is the premier botanical medicine used to treat intermittent claudication (clogging) caused by plaque or platelets. Brown suggests that using ginkgo biloba in conjunction with garlic should prove beneficial in treating coronary artery disease.

Michael Murray and Joseph Pizzorno report that hawthorn berry extracts are widely used in Europe to treat cardiovascular problems, and they cite nine studies demonstrating the effectiveness of the extracts in preventing angina attacks as well as lowering blood pressure and serum cholesterol levels.

Balch and Balch recommend barberry, black cohosh root, butcher's broom, cayenne pepper, dandelion, ginseng, hawthorn berries, red grape vine leaves, and valerian root. They suggest that some heart patients may benefit from suma herb tea, consumed three times a day with ginkgo biloba extract. These should all be prescribed by a physician, herbalist, or health practitioner.

Ayurvedic Medicine.     Several Ayurvedic botanical supplements may be beneficial in lowering blood cholesterol levels, and thus indirectly lower the risk of coronary artery disease. MAK-5, a food supplement prepared with sweetened ghee (clarified butter), according to Alternative Medicine: What Works prevented human platelet aggregation in vitro in one small study, and may also have antioxidant properties. In another uncontrolled study of 35 men, some with high and some with normal cholesterol levels, 50 grams of ray amla, the ayurvedic herb Emblica officinalis (also called Indian gooseberry) lowered total blood cholesterol levels. After a month, however, there was no significant reduction in either total or LDL blood cholesterol levels.

Chelation Therapy.     During chelation therapy a patient is given ehtylene-diaminertetraacetic acid (EDTA) to remove plaque and calcium deposits from the arterial walls. EDTA is usually administered intravenously several times a week over the course of two or three months in order to restore complete circulation. E. McDonagh reports in A Textbook on EDTA Chelation Therapy that 88% of patients receiving chelation therapy in one study exhibited improved blood flow to the brain. Dr. Charles Farr, co-founder of the American Board of Chelation Therapy, reports in Alternative Medicine: The Definitive Guide that he has given more than 500,000 chelation treatments to more than 20,000 patients in the last 20 years. Sixty to 70% of those with cardiovascular disease or circulatory problems improved. Many were originally scheduled to have bypass surgery or angioplasty. Farr claims that EDTA therapy is remarkably effective in removing arterial plaque, dissolving clots, dilating arterial blood vessels, and allowing essential nutrients to get to damaged tissues.

Homeopathic Medicine.     In the January 1994 issue of the Townsend Letter for Doctors , nutritonist Luc Chaltin argues that atherosclerosis causes most cases of coronary artery disease, and can be effectively treated with combined homeopathic remedies such as Digitalis, Glonoinum and Crataegus, Lachesis Muta, Bathrops, and Crotalus Horridus. Cactus Grandiflorus is very effective for long-term chronic afflication of the arteries, especially the capillaries. Chaltin cautions, however, that these remedies must be combined with a diet low in protein, especially animal protein, to reduce the uric acid content of the blood which inflames the inner walls of the arteries.

Estrogen Replacement Therapy.     Declining estrogen levels in women after menopause are believed to contribute to an increased risk of osteoporosis and heart attacks. Estrogen therapy, according to the May 1994 issue of the UC Berkeley Wellness Letter , raises HDL cholesterol. Hormone replacement therapy (HRT) usually includes progestin (a synthetic form of the hormone progesterone) along with estrogen. Recent studies cited by the UC Berkeley Wellness Letter suggest that the combined estrogen-progestin therapy also protects against heart disease. HRT is not appropriate for all women, however, and a physician should be consulted before starting treatment. The link between estrogen deficiency and an increased risk of heart disease varies with the age, health status, and nutritional and lifestyle habits of each individual.

There is preliminary evidence that low levels of sex hormones in men may play an indirect role in heart disease. A study reported in the June 1994 issue of the Harvard Heart Letter compared 49 heart attack victims, all of whom were under the age of 56, with an equal number of healthy volunteers. The two groups had similar levels of estrogen, the female hormone that is also present at low levels in normal men. Those suffering heart attacks, however, had levels approximately 20% lower of the male hormone dehydroepiandrosterone sulfate (DHEAS) than the healthy volunteers. How lower levels of male sex hormones might contribute to the development of heart disease is still not known.

Traditional Chinese Medicine.     Traditional Chinese Medicine (TCM) views heart disease as a problem stemming from poor digestion, which causes the build-up of plaque in the arteries. Chung San Yuan reports in a 1973 issue of the Chinese Medical Journal that the Chinese herb Mao-tung-chinghas been successfully used to treat coronary heart disease. Mao-tung-ching was administered daily (both orally and intravenously) to 103 patients. In 101 out of 103 cases, significant improvement resulted. The herb is believed to dilate the blood vessels, although its effectiveness in treating patients with coronary artery disease has not been confirmed in Western clinical trials. TCM practitioners often combine Chinese botanical therapies with acupuncture, believed to be an effective multiple treatment for chronic coronary heart disease cases. Further clinical trials are necessary, however, to evaluate the effectiveness of acupuncture in the treatment of cardiovascular disorders.

Exercise.     Among healthy people, Ornish claims that exercise causes the arteries to secrete a substance called endothelium-derived relaxation factor (EDRF) that opens (dilates) the coronary arteries and allows more blood to flow to the heart. In people with coronary artery blockages, however, the coronary arteries constrict during exercise because less EDRF is produced in coronary arteries that are partially blocked. Smoking also decreases the production of EDRF. Therefore, people with a heart condition should consult with a physician before starting an exercise program. People over age 35 that have not exercised regularly for several years should also be examined by their physician before beginning regular exercise.

Vigorous exercise may actually increase the risk of heart attacks in people with coronary artery blockages, who eat a high-fat diet, smoke, manage stress poorly, and use stimulants. Moderate exercise, however, as long as it is combined with lifestyle changes–for example, a low-fat diet, stress reduction, and the elimination of stimulants and smoking–is beneficial in the treatment of coronary disorders.

Graboys recommends for his heart patients any form of exercise that “breaks a sweat” for at least 20–30 minutes, three to four times a week, including brisk walking, jogging, rowing, swimming, non-impact aerobics, and outdoor (or stationary) bicycling. These aerobic exercises increase blood flow to the large muscle groups of the body, keeping the heart and circulatory system more healthy and functional. Regular exercise also contributes to weight loss or weight control, helps moderate the effects of stress, decreases the tendency of blood to form clots, helps the body use insulin, lowers blood pressure, and may boost HDL (“good”) cholesterol.

D. Nieman reports that the U.S. Centers for Disease Control reviewed 43 studies of North American and European working-age men. Controlling for age, sex, blood pressure, smoking status, and total serum cholesterol levels, 68% of the studies reported a statistically significant relationship between physical activity and the risk of coronary heart disease (CHD). The studies confirmed that both physical fitness and physical activity (whether on the job or during leisure times) are associated with reduced risk of CHD, and that regular physical activity should be promoted in CHD prevention programs as vigorously as blood pressure control, dietary modification to lower serum cholesterol, and smoking cessation. Next to high blood cholesterol levels, Nieman notes, lack of physical activity is the second most important risk factor for heart disease in the U.S.

Aerobic Exercise.     Any exercise program to reverse CAD must be moderate, progressive, and continuously monitored because overexercise can be dangerous. Regular aerobic exercise which is not extreme can be helpful because it helps dilate blood vessels, increase blood flow, and improve oxygenation of the blood.

Dr. Dean Ornish's Program for Reversing Heart Disease outlines a brief walking or jogging program three times a week for a minimum of 20 minutes, which, combined with a low-fat diet, reversed coronary artery disease in 41 patients. Ornish notes that the Cardiac Rehabilitation Program at Providence Hospital (Rhode Island) also found that regular brisk walking lowers heart rates and increases the heart's pumping ability.

Lowering Blood Pressure.     High blood pressure levels can permanently damage the heart, and many Americans take anti-hypertensive drugs to lower their blood pressure. However, Ornish states that these drugs often have severe side affects, including impotence, fatigue, depression, and blood cell disorders. Most of the patients following Dr. Ornish's program, for example, were able to decrease or discontinue their blood pressure medications. Ornish feels that the safest and most effective way to lower blood pressure is to use natural stress reduction therapies such as yoga, meditation, and visualization.

As discussed in Chapter 9, studies by Dr. Herbert Benson at the Harvard Medical School clearly show that yoga, biofeedback, visualization, massage, and progressive relaxation help lower high blood pressure which injures coronary artery linings and leads to the formation of coronary blockages. In Benson's studies, heart patients' blood pressure remained significantly reduced three to five years after making lifestyle changes that included meditation, group support, and exercise.

Ornish believes that deep breathing and imaging techniques aimed at reducing stress should be conducted frequently throughout the day to reduce the output of adrenal hormones and lower the level of platelet aggregation. He encourages patients to do these techniques before meals and at bedtime, as they not only reduce stress but also improve digestion. Ornish's program is supported by Dr. William Lee Cowden, a cardiologist in Dallas, Texas, who notes in Alternative Medicine: The Definitive Guide that some nutrients which may help reverse coronary blockages (including magnesium and vitamins B, C, and E) must be absorbed out of the gastrointestinal tract. If the tract is in a stressed state, it cannot absorb these nutrients nearly as well as when it is relaxed.

Yoga.     Both Ornish and Graboys recommend yoga as an adjunct to stress reduction therapies. The form of yoga used by Ornish's patients, hatha yoga, combines stretching and breathing techniques which produce a sense of equilibrium and rebalancing. It also includes visualization, progressive relaxation practices, self-analysis, and meditation.

Progressive Deep Relaxation and Alternate Nostril Breathing.     In Dr. Dean Ornish's Program for Reversing Heart Disease , Ornish describes several progressive deep relaxation exercises which his patients have used to induce the relaxation response. Besides connecting the mind and body, breathing also decreases heart rate, blood pressure, muscular tension, and sympathetic nervous system stimulation.

Visualization.     Visualization also directly produces the relaxation response, and lowers heart rate and blood pressure. According to Ornish, visualizing healing images can improve coronary blood flow by dilating the coronary arteries. Visualization also reduces the number and severity of irregular heartbeats. Ornish suggests that people with coronary blockages ask their cardiologist for a diagram showing the exact location of each blocked artery. Patients should choose a healing image that incorporates the following affirmations:

1. Your heart is beating regularly.
2. Your heart is pumping a healthy amount of blood with each beat.
3. The arteries in your heart are dilating and allowing more blood to flow.
4. New blood vessels are growing and supplying oxygen and other nutrients to your heart.
5. The blood is flowing smoothly and unobstructed.

Positive Thinking.     Positive thinking and a healthy outlook help the heart to heal. One study conducted by Dr. Daniel Mark, a heart specialist at Duke University, and reported in April 15, 1994 edition of The New York Times , concluded that optimism was a powerful predictor of who will live and who will die after being diagnosed with heart disease. Mark conducted a follow-up study of 1,719 men and women that had undergone heart catheterization, a common procedure used to check the arteries for clogging. The patients typically underwent the test because of chest pain, and all were diagnosed with heart disease. When interviewed initially, 14% said they doubted that they would recover enough to resume their daily routines. After one year, 12% of these pessimists had died, compared with 5% of those optimistic about recovering. Even when the severity of people's conditions was taken into account, outlook was a crucial factor in survival. In fact, optimism often seemed to have little bearing on how sick people were. Some of those with very mild heart disease had the grimmest views of their prospects. Dr. Mark concluded: “The mind is a tremendous tool or weapon, depending on your point of view.” In his study, pessimism appeared to be even more damaging to recovery than depression, which has also been shown to lower a person's chance of recovery from heart disease.

Hostility, anger, and anxiety may also play a key role in preventing heart disease. Psychologist Catherine Stoney of the American Psychosomatic suggests that hostile, anxious people metabolize fats more slowly than positive, relaxed persons, which may be a key reason hostility and heart attacks are linked. Those who seethe with anger–and usually try to suppress it–are slowest at ridding their bodies of dietary fat. Experts have known that hostile adults have higher cholesterol levels, and Stoney's finding–summarized in the April 15, 1994 edition of the Marin Independent Journal –may provide a partial answer.

Eliminating Smoking.     According to Ornish, smoking causes “many more deaths” from heart disease than from lung cancer, in both men and women. The nicotine and other toxic substances in tobacco are absorbed into the blood and injure the lining of the coronary arteries. Nicotine also causes the coronary arteries to constrict, and can lead to the formation of blood clots.

Ornish cites recent studies demonstrating that quitting smoking reduces the risk of heart disease by 64% within the first three years after stopping. When people stop smoking, nicotine is eliminated from the body quickly, and the risk of blood clots or coronary artery spasms decreases rapidly.

Although heart disease causes half of all deaths in the U.S., it is one of the most preventable chronic degenerative disorders. Eighty-five percent of all heart attacks are caused by atherosclerosis–hardening of the coronary arteries which block blood flow to the heart. Overwhelming evidence suggests that the risk of coronary artery disease, including angina and myocardial infarction, can be prevented through dietary changes, vitamin and mineral therapies, botanical therapies, exercise, and stress reduction, all of which help prevent excessive oxidation of cholesterol in the bloodstream.

In the past three decades, significant progress has been made in the war against heart disease. Although the U.S. population has increased in size and become more elderly, the total annual number of heart attacks has remained relatively constant. Thus, the rate of heart attacks per 100,000 people of any given age has declined by approximately 40% since the early 1960s. According the April 1994 issue of the Harvard Heart Letter , prevention has played a major role in reducing the heart attack rate, and at least half of the credit for this improvement belongs to patients, who have modified their diets to reduce cholesterol levels, avoided cigarettes, controlled their blood pressure, and undertaken regular physical activity.