Cholesterol, Stress, and Hypertension

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH


Let’s talk about stress and hypertension. Your Heart, Stress, and HypertensionStress and hypertension affecting many of us.  Stress and hypertension is a catalyst for many other ailments.  As many illnesses stress and hypertension can be difficult to control and treat.  But, it is possible to lead a healthier life and moderate your stress and hypertension.  Keep reading to learn more. 14 million Americans have heart disease and more than 2,600 die daily from heart attacks in the United States alone. According to the World Health Organization, 12 million people worldwide die every year from heart attacks, strokes, and other forms of cardiovascular diseases. 15% of adults in their late 30s to 40s are afflicted by this disease, about 50% of 55 to 64 year-olds, and 65% of those in the next decade are afflicted. It is obvious that most of the population slept through Heart Disease Prevention 101 in school.

To reduce the incidences of cardiovascular disease, researchers have been unearthing markers that have proven predictive values in this disease. Over 300 markers have been unearthed, including correlations between infection, age and height, and male pattern baldness to the increased incidence of cardiovascular disease. Keep reading to get a better idea of the impact of stress and hypertension on your health.

What are the latest alternative treatment options in normalizing three established risk factors – elevated cholesterol, hypertension and stress?

Elevated Cholesterol

Cholesterol, a lipid (fatty) component of all cellular membranes, is required to support cellular integrity and for the biosynthesis of vital hormones. 80% of our cholesterol is produced by the liver. The endogenous production of cholesterol is controlled by the rate limiting enzyme, HMG-CoA ( 3-hydroxy-3-methyglutaryl coenzyme A) reductase.

Cardiovascular disease caused by atherosclerosis begins in our teenage years. In response to the high cholesterol level, muscle cells underneath the endothelium, or inner lining, of blood vessels release a signal to attract monocytes. Monocytes are white blood cells that fight infection. When these cells migrate under the endothelium and amass cholesterol, calcium, and other substances, a plaque is formed. With time, the swollen endothelium loses its elasticity and may rupture. This injury to the lining draws clot-forming platelets, resulting in a clot or thrombus. The narrowed artery may cause chest pain (angina) or if completely obstructed, a heart attack.

Cholesterol, Stress, and HypertensionElevated serum cholesterol level is a recognized and well-established risk factor for developing coronary heart disease. For most people, lifestyle adjustments (including dietary changes and moderate exercise) are sufficient to normalize the cholesterol levels. For those who don’t respond to these methods, or for those with a genetic predisposition to hypercholesterolemia, standard medical therapy will employ drugs to bring cholesterol under control. These include bile acid sequestrants, cholestyramine, and colestipol.

A class of drugs used to aggressively treat elevated LDL levels is the synthetically derived HMG-CoA reductase inhibitors such as Iovastatin, pravastatin, and simvastatin. By inhibiting the production of HMG-CoA reductase, cholesterol production in the liver is reduced. Together, they belong to the “statin” group of drugs. These are among the most potent lipid-lowering agents available. To compensate for the resulting reduction of cholesterol production, the liver increases absorption of LDL cholesterol, further contributing to an overall reduction of LDL cholesterol levels.

While statin drugs are effective in lowering LDL cholesterol, they have serious side effects. Inhibition of HMG-CoA reductase also inhibits the intrinsic biosynthesis of Coenzyme Q10 (CoQ10), a central compound in the mitochondrial respiratory chain. CoQ10 is indispensable for optimum cardiac function, and reduction of CoQ10 constitutes a new risk of cardiac disease, especially for those whose cardiac function is compromised, such as those with congestive heart failure or cardiomyopathy. Statin drugs are also expensive to use with monthly costs around US $100-200.

To deal with the prohibitive cost of statins, researchers in China have examined the use of a natural food product called red yeast rice as a more affordable alternative to controlling cholesterol levels. Red yeast flour is used extensively in Chinese cooking as a flavoring agent and food coloring for dishes such as tofu, Peking duck, and Chinese spareribs. It is manufactured by fermenting rice with a specific strain of yeast called Monascus purpureus. It has been used as health-enhancing properties for over two thousand years.Only recently was it discovered that red yeast rice contains an abundance of lovastatin, the same cholesterol-lowering ingredient found in pharmaceutical statins, such as Mevacor, that acts as HMG-CoA reductase inhibitors.

Research for Hypertension and StressClinical research has been conducted in China and the United States. A single-blind trial with 502 patients diagnosed with hyperlipidemia was studied in China. Patients were randomized into one of four groups: three treatment groups and a control. These patients either had a serum total cholesterol of over 230 mg/dL, LDL of at least 130 mg/dL, or triglyceride of 200-400 mg/dL. All patients also had HDL levels lower than 44 mg/dL. Patients were given 600 mg red yeast rice twice a day (1,200 mg/day). After 4 weeks of therapy, the treatment group’s LDL level declined an average of 24.6% versus only 6.3% in the control group. Serum triglyceride levels declined an average of 19.8% in the treatment group versus 9.2% in controls. HDL levels increased by 12.8% in the treatment versus only 4.9% in the control group, and total cholesterol levels decreased significantly by 17.1% in the treatment group, compared to a drop in the control group of only 4.8%. Benefits continued to accrue over the course of the eight-week study, with patients in the treatment group achieving an average reduction in total cholesterol of 22.7% versus a 7% average reduction in the control group. LDL reduction was 30.9% in the treatment group, triglyceride levels were reduced by 34% in the treatment group versus 13% in the control group, and HDL increased by 20% versus only 8% in the control group.

A similar study over 12 weeks was carried out in America by Dr. David Herber of the University of California at Los Angeles. Dr. Herber’s study was a double-blind, placebo-controlled experiment involving 83 volunteers taking red yeast supplements. LDL levels dropped 15% among patients taking the red yeast supplement over an eight-week period. Most individuals following a very strict diet – without taking a cholesterol-lowering supplement – can only expect to have a 10% reduction in cholesterol level.

While generally well tolerated, minor side effects of red yeast rice include heartburn, flatulence and dizziness. These are usually resolved upon its discontinuation.

Nutritional Supplements Consideration:
– 600 mg Red Yeast Rice Powder twice a day for those with cholesterol levels greater than 200 mg/dl and triglyceride levels greater than 200 mg/dL

Elevated Blood Pressure

Blood Pressure, Stress and HypertensionHypertension and stress weakens the artery wall which are already stiffened and narrowed by plaques. As the heart is overloaded, blood pressure continues to rise. This increase forces the left ventricle of the heart to work even harder, causing left ventricular hypertrophy, resulting in chronic heart failure and electrical system dysfunctions, triggering arrhythmias.

Traditional treatment of hypertension varies from beta-blockers, vasodilators, diuretics, and calcium channel blockers. They are prescribed under the supervision of a physician and many have unpleasant side effects.

Alternative forms of treating hypertension through natural means have been under study in recent years, especially in relation to minerals. Epidemiological data suggest a relationship between blood pressure and calcium, potassium, and magnesium. Relatively high amounts of mineral intake can induce vascular smooth muscle relaxation and thus, peripheral resistance. These minerals are also critical in controlling conduction system and reduce the incidence of arrhythmias. Magnesium, in particular, plays a role in neuromuscular transmission activity and ion exchange. Studies have shown that patients with essential hypertension have significantly lowered blood pressure after 8 weeks on the mineral compared to the control group.

Other than minerals, essential fatty acids have anti-inflammation and platelet aggregation, thereby lowering blood pressure. A high intake of 5,000 mg to 10,000 mg of essential fatty acids is needed. This often causes a harmless but unpleasant fishy “burp” which is not well tolerated. Also, the herb Hawthorne has been known to cause vasodilatation, which reduces peripheral vascular resistance. It enhances cardiac ejection fraction and decreases blood pressure.

Nutritional Supplements Consideration:

  • Magnesium 400 – 700 mg
  • Calcium 800 – 1,000 mg
  • Potassium 400 – 600 mg (from food)
  • Hawthorne 160 – 250 mg (2% flavonoids and 18.75% procyanidins)

Elevated Stress

High Levels of Stress and HypertensionStress is a hallmark risk factor of cardiovascular disease, mainly due to its effect on arterial blood pressure, levels of atherosclerosis promoters, and neuroendocrine reactions. Studies of psychological stress in monkeys, for example, demonstrated an increased number of injured endothelial cells in the thoracic aorta. Acute psychological stress has also been shown to induce rapid and significant elevation in plasma homocysteine levels. The monkeys also suffered from exacerbated atherosclerosis via a heightened response of the sympathetic nervous system, which also exacerbates poor circulation. Studies have found that laboratory-induced stress, such as anger and irritability in heart disease patients, causes ischemia more than half the time.

Stress management can measurably improve performance on cardiac function tests. This is especially true of Type A personalities, whose chances of developing heart disease by the time they are 50 is four to five time greater than Type B personalities. The writing on the wall is clear – relax or else!

When focusing on stress and hypertension, it has been found that certain nutrients can reduce the effects of the stress response at the physiological level. Antioxidant nutrients, such as Coenzyme Q10 (CoQ1O), Vitamin E, Vitamin B complex, and Magnesium help counteract the increase in oxidative stress associated with psychological stress.

Nutritional Supplements Consideration:

  • Coenzyme Q10: 30 mg
  • Vitamin E: 400 IU
  • Vitamin B12: 500 – 1,000 mcg
  • Magnesium: 300 – 500 mg
  • Vitamin C: 500 – 2,000 mg
  • Beta Carotene: 15,000 – 25,000 IU

Discussion on Stress and Hypertension

Exercise, Stress and HypertensionIn addition to lifestyle modifications consisting of a healthy diet and moderate exercise, normalization of traditional established risk factors of cardiovascular disease may incorporate nutritional supplementation as part of the regimen. To normalize elevated cholesterol, red yeast rice powder may be considered. As mentioned prior reduecing stress and hypertension isn’t impossible.

  • To normalize high blood pressure, various minerals can be considered.
  • To normalize stress, various antioxidants can be considered.

© Copyright 2012 Michael Lam, M.D. All Rights Reserved.

High Levels of Stress and Hypertension
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Thank you very much for your response, Dr. Lam. It is an honor to hear from you, personally. I have browsed the articles you sent and will read them more thoroughly. I read your book last fall after a cardiologist recommended I get open heart surgery since I had MVP and was exercise intolerant in a stress test. I didn't have peace about that and started doing more searching and praying. I ran across your book, and I felt like it was written for me. I feel like I have become stronger over the past year, but I am still struggling, which led me to initiate here the other day. Thanks for all you do for the good of others.