10 Steps for Patients with Cholesterol-Induced Cardiomyopathy

Cardiomyopathy is characterized by a weakened, enlarged or inflamed cardiac muscle. The disease may be in primary stages (asymptomatic) or secondary stages (symptoms such as shortness of breath, fatigue, cough, orthopnea, nocturnal dyspnea or edema) with main types being dilates, hypertrophic, restrictive, or arrhythmogenic (1). Treatment may include drugs such as ACE inhibitors and beta blockers, implantable cardioverter-defibrillators, cardiac resynchronization therapy, or heart transplant (1). Factors leading to cardiomyopathy may include alcohol consumption, smoking, obesity, sedentary lifestyle, smoking and high-sodium diet (1).

Hypercholesterolemia can lead to fatty streaks in blood vessels that result in decreased flow of blood through arteries. The advent of hypercholesterolemia may be directly related to cardiomyopathy as it’s well established as a risk factor in inducing systolic and diastolic dysfunction (2). Statins such as Lovastatin are commonly prescribed because of efficacy for lowering cholesterol levels and they act by inhibiting HMG-CoA reductase to deplete mevalonate (3). Mevalonate, a precursor to cholesterol is also a precursor to coQ10 and squalene (4). Mevalonite, however, is also the precursor to coQ10 and squalene. Both of these are vital nutrients with profound effects on the body.

Patient Recommendations

I would advise a patient with cholesterol-induced cardiomyopathy to adhere to the following protocol:

1. Quit smoking – If the patient smokes, he is doing himself a grave disservice as smoking can increase oxidation of cholesterol leading to atherosclerosis. It may be an underlying factor in his cardiomyopathy.

2. Regular exercise – If the patient doesn’t exercise already, then he should begin an exercise program to strengthen his heart. I would advise only short periods of exercise combined with adequate rest as opposed to aerobic training because it would prevent exhaustion or excessive stress on the heart (9).

3. Get blood pressure checked regularly – Hypertension can be present without any symptoms and can be an etiological factor in cardiomyopathy. At ages past 60 there begins to be a higher risk of developing hypertension as well as declining muscle mass replaced by fat mass. A DASH eating plan (low-fat dairy products, lean meats, rich in fruits and vegetables) can assist in lowering or maintaining healthy blood pressure levels.

4. Lose weight if necessary – Overweight and obesity is an additional risk factor for hypertension (and hypercholesterolemia) because it increases volume of blood flowing through blood vessels. Along with exercise and a DASH eating plan, a weight-management program to lower calories steadily for 1-2 pounds per week can help a person lose weight effectively and safely.

5. Eat a diet high in soluble fiber – Diets high in soluble fiber are associated with lower levels of cholesterol. Soluble fiber such as from oats and psyllium hulls are shown to reduce blood cholesterol by inhibiting absorption of cholesterol from food as well as reabsorption of cholesterol through enterohepatic circulation.

6. Supplement with coQ10 (100 mg) – CoQ10 production peaks in the mid-20s and begins to decline with only around 50 percent production in patients past age 60. Additionally, statin therapy creates further decline in coQ10 synthesis for reasons discussed above. This patient could benefit from regular daily coQ10 supplementation in 100 mg doses. The CoQ10 will serve to support creation of energy and mitochondrial biogenesis in cardiac tissue to help maintain strong heart function.

7. Enjoy enough sunshine and take a vitamin D supplement – As people become older they are more susceptible to vitamin D insufficiency or deficiency, which as discussed earlier may lead to a weakened heart as suggested by emerging studies. Support for heart health can be achieved by keeping 25(OH)D to levels in the plasma to “sufficient” amounts (32 ng/mL) through sensible sun exposure (maybe along with exercise) and/or supplementation with vitamin D.

8. Supplement with D-ribose and l-carnitine – Both supplements can support elevated energy levels in cardiac tissue leading to improved heart function. In a randomized, double-blind crossover trial, D-ribose has been shown to improve diastolic function parameters and improve quality of life in patients with cardiomyopathy (10). L-carnitine combined with coQ10 and omega-3 fatty acids has been shown to improve cardiac function in dilated cardiomyopathy (11).

9. Eat leafy greens – Apart from the extra dietary fiber, the magnesium in leafy greens can be an additional support for heart health. Magnesium has a role in supporting healthy blood pressure levels and regulating heart function (12).

10. Eat fish regularly or take a quality fish oil supplement (4g daily) – Greater levels of EPA and DHA omega-3 fatty acids in the diet combined with coQ10 and l-carnitine has been shown in research to improve cardiac function in dilated cardiomyopathy (11).

Reference List

1. Wexler RK, Elton T, Pleister A, Feldman D. Cardiomyopathy: an overview. Am Fam Physician 2009;79:778-84.

2. Huang Y, Walker KE, Hanley F, Narula J, Houser SR, Tulenko TN. Cardiac systolic and diastolic dysfunction after a cholesterol-rich diet. Circulation 2004;109:97-102.

3. Littarru GP, Langsjoen P. Coenzyme Q10 and statins: biochemical and clinical implications. Mitochondrion 2007;7 Suppl:S168-S174.

4. Scharnagl H, Marz W. New lipid-lowering agents acting on LDL receptors. Curr Top Med Chem 2005;5:233-42.

5. Jeya M, Moon HJ, Lee JL, Kim IW, Lee JK. Current state of coenzyme Q(10) production and its applications. Appl Microbiol Biotechnol 2010;85:1653-63.

6. Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme q10 on myopathic symptoms in patients treated with statins. Am J Cardiol 2007;99:1409-12.

7. Visvanathan R, Chapman I. Preventing sarcopaenia in older people. Maturitas 2010.

8. Ahmed W, Khan N, Glueck CJ et al. Low serum 25 (OH) vitamin D levels (<32 ng/mL) are associated with reversible myositis-myalgia in statin-treated patients. Transl Res 2009;153:11-6.

9. Kohlstadt I. Food and Nutrients in Disease Management. Boca Raton, FL: CRC Press, 2009.

10. Omran H, Illien S, MacCarter D, St Cyr J, Luderitz B. D-Ribose improves diastolic function and quality of life in congestive heart failure patients: a prospective feasibility study. Eur J Heart Fail 2003;5:615-9.

11. Vargiu R, Littarru GP, Faa G, Mancinelli R. Positive inotropic effect of coenzyme Q10, omega-3 fatty acids and propionyl-L-carnitine on papillary muscle force-frequency responses of BIO TO-2 cardiomyopathic Syrian hamsters. Biofactors 2008;32:135-44.

12. Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism. Belmont, CA: Thomson Wadsworth, 2009.

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