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 The Truth About
Heart Disease
How to Prevent Coronary Heart
Disease and Personalize Your
Treatment with Nutrition, Nutritional
Supplements, Exercise, and Lifestyle
Tailored to Your Genetics

Mark C Houston, MD
First edition published 2023
by CRC Press
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ISBN: 9781032230900 (hbk)

ISBN: 9781032230870 (pbk)
ISBN: 9781003275602 (ebk)

DOI: 10.1201/b22808

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Contents
About the Author....................................................................................................xvii
Introduction..............................................................................................................xix

Chapter 1 Overview of Coronary Heart Disease...................................................1

Some Informative Patient Cases with Coronary Heart Disease...........1
Patient Case 1........................................................................................1
Patient Case 2........................................................................................1
Patient Case 3........................................................................................2
Coronary Heart Disease in the United States.......................................2
Coronary Heart Disease Starts at an Early Age....................................3
Five Effective Ways to Prevent Coronary Heart Disease in 80%
of Patients..............................................................................................4
A Brief Summary of the Coronary Heart Disease Prevention
Program (CHDPP)................................................................................. 5
Summary and Key Take Away Points...................................................5
References............................................................................................. 6

Chapter 2 The Definitions and Real Reasons Behind CHD and MI.....................9
Summary and Key Take Away Points................................................. 13
References........................................................................................... 13

Chapter 3 What Are the Symptoms and Signs of Coronary

Heart Disease (CHD)?......................................................................... 15
Summary and Key Take Away Points................................................. 16
Bibliography........................................................................................ 17

Chapter 4 Actual Patient Cases of CHD and MI from My Practice: Do Not

Let This Happen to You...................................................................... 19
Patient Case 1...................................................................................... 19
Comment.............................................................................................20
Patient Case 2......................................................................................20
Comment............................................................................................. 21
Patient Case 3...................................................................................... 21
Comment............................................................................................. 21
Patient Case 4...................................................................................... 21
Comment............................................................................................. 22
Patient Case 5...................................................................................... 22
Comment............................................................................................. 23
Summary and Key Take Away Points................................................. 23

vii
viii Contents

Chapter 5 The Arteries, the Endothelium, Endothelial Dysfunction,

Glycocalyx, Glycocalyx Dysfunction, Nitric Oxide, and CHD..........25
Artery Structure and the Human Circulatory System........................26
The Lumen.....................................................................................26
The Glycocalyx.............................................................................. 30
The Endothelium............................................................................ 33
The Arterial Muscle (Media)......................................................... 35
The Artery Muscle or Media.......................................................... 35
The Adventitia................................................................................ 35
Summary and Key Take Away Points................................................. 35
References........................................................................................... 36

Chapter 6 What Do the Heart Arteries Do When They Are Damaged?

The Infinite Insults and Finite Responses in CHD............................. 37
Introduction......................................................................................... 37
Inflammation....................................................................................... 37
What is Inflammation?................................................................... 37
How Do We Recognize and Measure Inflammation?.................... 38
How to Treat Vascular Inflammation.............................................40
Supplements........................................................................................40
Oxidation and Oxidative Stress........................................................... 42
How Is Oxidative Stress Measured in the Body?........................... 43
Antioxidants Fight Oxidative Stress...............................................44
How is Antioxidant Defense Measured?........................................ 45
How to Treat Oxidative Stress........................................................46
Top Antioxidant Supplements........................................................ 48
Vascular Immune Dysfunction....................................................... 49
Final Conclusion.................................................................................. 51
Summary and Key Take Away Points................................................. 52
Bibliography........................................................................................ 53

Chapter 7 New Concepts in Coronary Heart Disease (CHD).............................. 55

Concept 1............................................................................................. 55
Concept 2............................................................................................. 55
Concept 3............................................................................................. 56
Concept 4............................................................................................. 56
Concept 5............................................................................................. 56
Concept 6............................................................................................. 57
Summary and Key Take Away Points................................................. 57
Bibliography........................................................................................ 57

Chapter 8 The Causes of Chest Pain: Is It a Heart Attack or Something Else?........ 59

Review of CHD Symptoms................................................................. 59
Contents ix

Causes of Chest Pain in Addition to CHD or MI................................ 59

Summary and Key Take Away Points.................................................60
Bibliography........................................................................................ 61

Chapter 9 CHD Genetics Part I: What Is in the Genes That Place

You at Risk.......................................................................................... 63
The Human Genome........................................................................... 63
Summary and Key Take Away Points................................................. 65
Bibliography........................................................................................ 65

Chapter 9 CHD Genetics Part II: What Is in the Genes That Place
You at Risk.......................................................................................... 67
Nutrients.............................................................................................. 68
Epigenetics.......................................................................................... 68
Nutrition.............................................................................................. 69
Mediterranean Diet......................................................................... 69
Pritikin and DASH Diets................................................................ 69
Specific Nutrients................................................................................ 69
Electrolytes..................................................................................... 69
Omega-3 Fatty Acids...................................................................... 70
Monounsaturated Fats.................................................................... 70
Genes Relevant to Cardiovascular Risk.............................................. 70
CHD and CHD Risk Factor Genes................................................. 70
Genes Relevant to Hypertension......................................................... 72
Genes Related to Cholesterol and Diabetes Mellitus That
Increase Risk for CHD and MI........................................................... 73
Summary and Key Take Away Points................................................. 74
Bibliography........................................................................................ 74

Chapter 10 What Are Your Genes Doing? Gene Expression in Coronary

Heart Disease (CHD) and How to Treat.............................................. 79
Treatment of Your Genes and Gene Expression................................. 79
Summary and Key Take Away Points................................................. 81
Bibliography........................................................................................ 82

Chapter 11 The Gut and Heart Connection: Gut Microbiome.............................. 87

Bad Food Choices Equal Bad Heart Arteries..................................... 89
Problems with Medications That Reduce Stomach Acid and
Cause Decreased Absorption of Vitamins and Minerals.................... 91
The Treatment for the Gut Microbiome.............................................. 91
Summary and Key Take Away Points................................................. 93
Bibliography........................................................................................94
x Contents

Chapter 12 Nutrition Part I: The Importance of Nutrition in Coronary

Heart Disease Prevention and Treatment............................................ 95
Introduction......................................................................................... 95
Nutrition and CHD.............................................................................. 95
Mediterranean Diet.........................................................................96
Dietary Approaches to Stop Hypertension: DASH
Diets 1 and 2................................................................................... 98
Dietary Fats.........................................................................................99
Omega-3 Fatty Acids......................................................................99
Monounsaturated Fats.................................................................. 100
Saturated Fatty Acids................................................................... 100
Conclusions and Summary on SFAs............................................ 101
Saturated Fatty Acid Key Take Away Points and Conclusions......... 102
Trans Fatty Acids.......................................................................... 102
Coconut Oil.................................................................................. 103
Milk, Milk Products, and Peptides............................................... 103
Whey Protein........................................................................... 104
Refined Carbohydrates, Sugars, and Sugar Substitutes.................... 105
Advanced Glycation End Products.................................................... 105
Protein............................................................................................... 106
Vegetarian Diets and Plant-Based Nutrition................................ 106
Animal Protein Diets.................................................................... 106
Soy Protein................................................................................... 107
Fish............................................................................................... 107
Dietary Acid Load and Protein......................................................... 107
Specific Dietary and Nutritional Components and Caloric
Restriction......................................................................................... 108
Caffeine........................................................................................ 108
Caloric Restriction........................................................................ 109
Alcohol......................................................................................... 109
Gluten........................................................................................... 110
Nuts............................................................................................... 110
Dietary Sodium, Potassium, and Magnesium.............................. 111
Summary and Key Take Away Points............................................... 112
References......................................................................................... 112

Chapter 13 Nutrition Part II: The Practice of Nutrition in Your Daily

Life to Prevent and Treat CHD......................................................... 125
Create Your Plate.............................................................................. 126
Non-Starchy Vegetables.................................................................... 126
Clean-Sourced Proteins..................................................................... 126
Health-Promoting Fats...................................................................... 127
Starchy and Root Vegetables to Consider......................................... 128
Contents xi

Something Sweet............................................................................... 128

Fruits................................................................................................. 128
Proteins and Foods to Say “Yes” To.................................................. 129
Pastured Poultry........................................................................... 129
Sweeteners.................................................................................... 129
Flours............................................................................................ 129
Herbs............................................................................................. 129
Starches........................................................................................ 130
Fermented Foods.......................................................................... 130
Nuts and Seeds............................................................................. 130
Foods to Avoid or Eat in Moderation................................................ 130
Sweeteners to Avoid..................................................................... 131
Legumes to Avoid......................................................................... 131
Oils to Avoid................................................................................. 131
Recipes.............................................................................................. 133
Breakfast Ideas.................................................................................. 142
Summary, Conclusions, and Take-Away Points................................ 147
Bibliography...................................................................................... 147

Chapter 14 The Blood Vessel, Brain, and Immune System Connections........... 149
The Autonomic Nervous System....................................................... 149
Treatment for an Overactive Sympathetic Nervous System.............. 152
Summary and Key Take Away Points............................................... 153
Bibliography...................................................................................... 153

Chapter 15 What Is Plugging Your Heart Arteries? Plaque Formation,

Types of Plaque, and Plaque Rupture................................................ 155
Why Do You Have a Myocardial Infarction?.................................... 155
Atherosclerosis.................................................................................. 155
Types of Plaques in the Coronary Arteries....................................... 159
What Does a Coronary Artery Plaque Look Like? The
Anatomy of a Plaque......................................................................... 160
Types of Plaques: Hard and Soft Plaque........................................... 161
What Makes a Plaque Prone to Rupture? These Characteristics
are Listed below (Figures 15.8, 15.9A, and 15.9B)............................ 162
Prevention and Treatment of Plaque................................................. 164
Summary and Key Take Away Points............................................... 164
Bibliography...................................................................................... 164

Chapter 16 Nonobstructive Coronary Heart Disease and Coronary

Artery Vasospasm............................................................................. 167
Introduction....................................................................................... 167
xii Contents

What Causes NO-CHD and CA-VS?................................................ 168

Diagnosis of Coronary Spasm........................................................... 168
Treatment........................................................................................... 169
Summary and Key Take Away Points............................................... 169
Bibliography...................................................................................... 169

Chapter 17 Women and Coronary Heart Disease (CHD).................................... 171

Introduction....................................................................................... 171
Presenting Symptoms of CHD in Women........................................ 171
CHD Risk Factors for CHD in Women............................................. 172
Menopause and CHD in Women....................................................... 172
Summary and Key Take Away Points............................................... 173
Bibliography...................................................................................... 173

Chapter 18 Coronary Heart Disease Risk Factors: The Traditional

Top Five Risk Factors and the Other 400.......................................... 175
Introduction....................................................................................... 175
Top Five CHD Risk Factors.............................................................. 175
Hypertension..................................................................................... 175
Dyslipidemia..................................................................................... 176
Dysglycemia, Hyperglycemia, Insulin Resistance, Metabolic
Syndrome, and Diabetes Mellitus..................................................... 177
Obesity and Body Fat........................................................................ 177
Smoking............................................................................................ 179
Top 25 Modifiable CHD Risk Factors.......................................... 179
Hyperuricemia.............................................................................. 180
The Other 400 CHD Risk Factors..................................................... 188
Summary and Key Take Away Points............................................... 193
Bibliography...................................................................................... 193

Chapter 19 Testing: Labs, Noninvasive, and Invasive Testing............................. 195

Clinical Signs, Blood Tests, and Noninvasive Vascular Testing
for Hypertension and Cardiovascular Disease.................................. 195
The Arteries.................................................................................. 195
Endothelial Function and Dysfunction.............................................. 196
Carotid Artery Ultrasound........................................................... 196
The Eye and the Retina..................................................................... 198
Coronary Artery Calcification.......................................................... 198
Echocardiography (Heart Ultrasound).............................................. 199
Aortic Ultrasound for Aneurysms and Kidney Size.........................200
Central Blood Pressure and Aortic Stiffness
(Augmentation Index)........................................................................ 201
Contents xiii

Electrocardiogram and Cardiopulmonary Exercise Testing............. 201

Complete and Advanced Cardiovascular Laboratory Testing.......... 201
Summary and Key Take Away Points............................................... 201
References.........................................................................................202

Chapter 20 How to Assess Your Risk Using CHD Scoring Tests.......................207

Framingham Risk Score....................................................................207
COSEHC Global Cardiovascular Risk Calculation..........................209
Rasmussen Center CHD Scoring...................................................... 210
CHAN2T 3 CHD Scoring System.................................................... 211
PULS Cardiac Test (CHL)................................................................ 211
Gene Expression Testing................................................................... 214
GES (Gene Expression Score) Corus CHD.................................. 214
Measurements.................................................................................... 214
Summary and Key Take Away Points............................................... 216
Bibliography...................................................................................... 218

Chapter 21 The Integrative Coronary Heart Disease (CHD)

Prevention Program........................................................................... 219
Nutrition............................................................................................ 219
Nutritional Supplements.................................................................... 219
NEO 40......................................................................................... 220
Arterosil........................................................................................ 220
D Ribose Powder.......................................................................... 221
Vitamin K2 MK 7........................................................................ 221
Aged Garlic: Kyolic Garlic Cardiovascular Formulation.............224
Omega-3 Fatty Acids.................................................................... 225
The Cardiovascular Benefits of Omega-3 Fatty Acids............ 226
Clinical Research Studies........................................................ 228
Safety of Omega-3 Fatty Acids................................................ 229
Dose, Ingredients, and Quality..................................................... 229
Curcumin...................................................................................... 229
Quercetin...................................................................................... 231
Coenzyme Q10............................................................................. 231
Absorption, Pharmacokinetics, and Drug Depletions............. 231
Clinical Physiology and Functions.......................................... 232
Cardiovascular Disease: CHF, CHD, Angina, and MI............ 232
Hypertension and Endothelial Function.................................. 236
Summary........................................................................................... 236
Mitoquinone: MITO Q................................................................. 237
Multi-Nutrient Cardiovascular Protection Supplement................ 237
Dosage..................................................................................... 237
Active Ingredients.................................................................... 237
xiv Contents

Exercise, Cardiovascular Disease, and CHD.................................... 237

The Aerobics, Build, Contour, and Tone Exercise Program........ 237
The ABCs of Exercise with a Twist............................................. 239
The Elements of ABCT................................................................240
The ABCT Elements in Detail..................................................... 242
Resistance Training................................................................. 242
What, How, and When to Lift...................................................... 243
Upping the Intensity with Supersets, Hybrids, and Rapid Sets........ 243
ABCT Resistance Training Hints................................................. 243
Aerobic Training in Intervals..................................................244
Maximum Heart Rate and Maximum Aerobic Capacity.............244
Always Combine Resistance and Aerobic Exercises................... 245
Core Exercises......................................................................... 245
Time-Intensive Exercise.......................................................... 245
Nutrition, Water, and ABCT Energy Drink............................246
Exercise on an Empty Stomach...............................................246
Nutrition Before, During, and After the Exercise Session........... 247
Getting Started with ABCT: Training Schedules and
Descriptions of the Lifts...............................................................248
The ABCT Training Schedules...............................................248
Chest Exercises........................................................................ 252
Back Exercises......................................................................... 253
Shoulder Exercises................................................................... 254
Arm Exercises......................................................................... 255
Leg Exercises........................................................................... 255
ABCT Summary............................................................................... 257
ABCT Conclusion............................................................................. 258
Weight Management, Body Fat, and Visceral Fat.............................260
Summary of the CHD Nutrition Program......................................... 262
Tobacco Products, E-Cigarettes, and Vaping.................................... 263
Control all Risk Factors for Coronary Heart Disease.......................264
Summary and Key Take Away Points............................................... 265
Bibliography...................................................................................... 265

Chapter 22 Medicines for CHD........................................................................... 277

Blood-Thinning Medicines............................................................... 277
Statins................................................................................................ 277
Beta Blockers..................................................................................... 278
Nitrates.............................................................................................. 278
Ranolazine......................................................................................... 278

Chapter 23 Future Perspectives........................................................................... 281

CHD Genetics and Informatics......................................................... 281
Contents xv

Stem Cells......................................................................................... 281

Nanotechnology................................................................................ 281
Inflammation Treatments and Immunotherapy................................. 281
Vaccines............................................................................................ 281
Bibliography...................................................................................... 282

Chapter 24 Grand Summary and Conclusions.................................................... 283

Eating a Healthy Heart Diet Is Easy, Tastes Good, and
Can Prevent CHD.............................................................................. 286

Sources................................................................................................................... 289
Index....................................................................................................................... 293
About the Author
Mark C. Houston, MD, MS, MSc, FACP, FAHA, FASH,
FACN, ABAARM, FAARM, DABC
Dr. Mark Houston graduated phi beta kappa and summa cum laude from Rhodes
College, with a BA in chemistry and math. He graduated with the highest honors
and the Alpha Omega Alpha honorary society distinction from Vanderbilt University
Medical School. He completed his medical training at the University of California
in San Francisco (UCSF) and then returned to serve as chief resident in medicine at
Vanderbilt Medical Center, where he received the Hillman award for best teacher.
Dr. Houston is the director of the Hypertension Institute and Vascular Biology, medi-
cal director of the Division of Human Nutrition and medical director of clinical
research at the Hypertension Institute in Nashville, TN. He is on the faculty and
director of the advanced cardiovascular medicine modules 16 A4M/MMI in the US
and director of the cardiovascular medicine module 2 for A4M/MMI. He is a clini-
cal instructor in the Department of Physical Therapy and Health Care Sciences at
George Washington University (GWU) School of Medicine and Health Science. He
served as an assistant professor of medicine and then as an associate professor of
medicine at Vanderbilt University School of Medicine and was an associate clinical
professor of medicine at Vanderbilt University School of Medicine (VUMS) from
1990 to 2012. He also served as an adjunct professor in metabolic medicine at the
University of South Florida, Tampa (USF) Medical School (2014–2018).
He has four board certifications from the American Board of Internal Medicine
(ABIM), the American Society of Hypertension (ASH) (FASH-Fellow), the
American Board of Anti-Aging and Regenerative Medicine (ABAARM, FAARM),
and the American Board of Cardiology (ABC) in hypertensive cardiovascular dis-
ease (DABC). He holds two master of science degrees in human nutrition from the
University of Bridgeport, CT (MS), and another in metabolic and nutritional medi-
cine (University of South Florida, School of Medicine-Tampa (MSc).
He was selected as one of the top physicians in the US in cardiovascular medicine
in 2018 by the US Consumer Research Council. Dr. Houston was also named as
one of the top physicians in hypertension in the US in 2008–2014 by the Consumer
Research Council. He was honored by USA Today as one of the most influential doc-
tors in the US in both hypertension and hyperlipidemia twice, in 2009 and 2010. He
was selected for the Patient’s Choice Award in 2010 and 2012 by Consumer Reports
USA. He was selected as one of the top 100 physicians in the US by the American
Health Council in 2017 and one of the top 50 functional and integrative medical doc-
tors in the US in August 2017. He was also named one of America’s best physicians
in cardiology in 2018 by the National Consumer Advisory Board. In 2019, he was
elected to the continental WHO’S WHO as a top doctor in the field of medicine as
the medical director and founder of the Hypertension Institute.

xvii