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» COMPLEMENTARY MEDICINES
Liza Oates, PhD, GradCert Evid-based CompMed,
BHSc (Nat), is a naturopathic practitioner and mentor
based in East Malvern, Victoria. She is the course co-
ordinator for ‘Food as Medicine’ and ‘Wellness Practices
& Perspectives’ in the online Postgraduate Wellness
program at RMIT University.
In 2012, cardiovascular disease (CVD) was the leading cause of mortality
among Australians, accounting for almost 30% of all deaths, and most
Australians have at least one risk factor.
Increasing age, gender, ethnicity
and genetics influence risk and are
considered non-modifiable risk factors.
Behavioural risk factors such as poor
diet, insufficient physical activity,
tobacco smoking and excessive alcohol
consumption can be improved; and
patients may benefit from interventions
that reduce excess weight, elevated
blood pressure (BP) and/ or blood lipids.
In recent years there has been a shift
away from assessing and managing
single risk factors to assessing multiple
risk factors to determine a person’s
‘absolute’ risk of experiencing a
cardiovascular event within a specified
time period.3 The Australian Absolute
CVD Risk Calculator (www.cvdcheck.org.
au) and the Reynolds Risk Score (www.
reynoldsriskscore.org) are popular tools
Nevertheless, health providers remain
alert to significant single risk factors
which may influence how aggressively
a patient needs to be treated.
a family history of CVD in an
immediate blood relative before the
age of 55 years
comorbid conditions such as type 2
diabetes or chronic kidney disease
obesity (BMI >30 kg/m2)
excessive visceral (abdominal) fat
(waist circumference >102 cm in men,
>88 cm in women)
very high blood pressure (SBP ≥180
and/or DBP ≥110)
total cholesterol >7.5 mmol/L.
While pharmaceutical interventions
have a place, for those at low risk
(<10% absolute five year CVD risk
and no significant single risk factors)
dietary and lifestyle modification is
often considered the frontline therapy.
For those at moderate to severe risk
(10–15% and >15% absolute five year
CVD risk respectively) dietary and
lifestyle modification should still form
part of the overall treatment strategy.
The addition of Complementary
and Alternative Medicines (CAMs) to
standard therapy is common among
Australians with cardiovascular
Even in patients successfully
managed with pharmaceutical
medicines, CAMs may provide
There is no clear consensus on the
benefits of CAM in the prevention of
CVD but then very little is clear in the
world of CVD prevention research.
Review efforts have been marred by
inconsistencies in dose, form and
outcome measures making it difficult
to establish clear clinical guidelines.
Nevertheless, several promising CAMs
emerge from the research literature
and these include fish oils, plant sterols,
fibre, and coenzyme Q10.
Higher levels of eicosapentaenoic acid
(EPA) and docosahexaenoic acid (DHA),
the omega-3 fatty acids found in fish
and fish oils, have been associated
with lower CVD risk, and studies report
that 1–4g/ day of fish oils significantly
decreases elevated triglyceride (TG)
The possible reasons behind
recent conflicting reviews have been
previously discussed7 and some authors
suggest that for best effects doses
should be individualised to achieve
an Omega-3 Index target range of
8–11% (high doses may be required to
Plant sterols and stanols, such as
those found in cholesterol-lowering
margarines, partially inhibit the
absorption of cholesterol in the gut
and may reduce elevated LDL and TG
As a result the Heart Foundation
(Australia)11 recommends the
consumption of 2–3 g of plant sterols
As reported in the January issue of
has been inversely associated with
all-cause mortality, especially CVD
mortality, and novel fibre supplements
have demonstrated benefits in
reducing several CVD risk factors. For
example, alpha-cyclodextrin (2g after
fat containing meals) binds to and
inhibits the absorption of dietary fat in
the gut resulting in potential benefits
for the management of blood lipids
Coenzyme Q10 (CoQ10) is an important
antioxidant synthesised via the
HMG-CoA reductase pathway.
often recommended to patients taking
statin drugs that inhibit this enzyme
as CoQ10 deficiency has been shown
Heart health –
what has the
BY DR LIZA OATES
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