Understanding Integrative Cardiology

Welcome to Fullscript’s integrative medicine education series. Discover how integrative medicine improves patient outcomes and why it’s being adopted by forward-thinking practitioners across North America.  

While cardiovascular disease remains the number one disease cause of death worldwide, the Centers for Disease Control and Prevention (CDC) estimates that about 80% of all premature deaths due to heart attack and stroke can be prevented. (3) The American Heart Association agrees that heart disease is largely preventable. They point out that as the number one disease killer, it is also the most expensive disease costing nearly $1 billion a day! (1) What’s the answer to this expensive and dangerous dilemma? Many believe the answer is integrative cardiology, which combines conventional cardiology with evidence-proven integrative medicine.

Integrative cardiology

“Conventional cardiology is wonderful at treating acute cardiac problems such as myocardial infarctions, life-threatening arrhythmias, or acute heart failure, but it often falls short when it comes to preventing and healing heart disease,” explained Dr. Vivian A. Kominos, MD who has practiced cardiology for more than 30 years and has concentrated on integrative cardiology for the past 12. “Integrative cardiology employs conventional therapies with less conventional treatments such as mind-body medicine, acupuncture, nutrition, exercise, and spirituality.”

For Dr. Daniel Chong, ND, a naturopathic physician who specializes in heart attack, stroke, and dementia prevention, getting results for his patients was the reason he wanted to make heart health the focus of his clinical practice. “I have found that the cardiovascular system will respond in a very impressive way when things are done right using a thorough integrative approach,” he explained. “It’s very gratifying to see a patient’s efforts turn into truly life-changing positive results.”

According to the Scripps Center for Integrative Medicine, preventing and reversing heart problems requires more than the latest medications, surgeries, and interventional procedures. That’s why the Scripps cardiovascular disease fellowship focuses on all aspects of the patient’s health including:

• Complementing conventional medicine rather than replacing it
• Looking beyond the physical symptoms
• Making nutrition and exercise realistic and achievable
• Teaching effective ways to manage stress
• Using natural supplements wisely (4) 

The foundation of this focus also addresses key heart disease risk factors.

Addressing risk factors of heart disease 

With integrative cardiology, the old adage “an ounce of prevention is worth a pound of cure” is eagerly embraced.

“When a person comes to see me who has yet to have any evidence of disease, I get excited at the prospect of helping them discover any brewing tendencies or underlying factors they may have,” said Dr. Chong, who has a telehealth-based consultation practice in Portland, OR. “I feel that it’s my job to help the patient head things off at the pass well ahead of any serious cardiovascular issues. Unfortunately, much of the time, the typical cardiologist gets involved once an event has already occurred.”

When it comes to prevention, lifestyle is a key focus in integrative cardiology because a patient’s lifestyle can significantly influence their risk of developing heart disease. The CDC has identified these key heart disease risk factors:

• Consuming a poor diet that includes saturated fats, trans fats, and salt
• Drinking too much alcohol
• Not getting enough physical activity
• Using tobacco (3) 

Herein lies another disconnect with conventional cardiovascular medicine. While diet—and the corresponding obesity related to a poor diet—is a key risk factor, medical nutrition education is significantly lacking in conventional cardiovascular training. (2) “Surveys indicate that most cardiologists feel ill-equipped to provide adequate nutrition advice to their patients,” said Dr. Kominos, who is a Clinical Assistant Professor of Medicine at the Dr. Andrew Weil Center for Integrative Medicine. (5) 

A 2020 review identified nutrition as “one of the most crucial and modifiable risk factors” when it comes to the development of cardiovascular disease with an urgent call to increase medical nutrition education among cardiologists. (7) Of course, with any integrative approach, diet is a big focus—and that’s also true with integrative cardiology. 

Integrative testing

In addition to diet and other lifestyle factors, integrative cardiologists are well-versed in doing tests that identify early signs of a problem to help reduce the risk of heart disease.

Dr. Chong is a big proponent of the “test, don’t guess” philosophy. “Within the realm of integrative cardiology we have some incredibly helpful tools available that can help with very early identification of issues and thus allow us to avert a potential disaster,” he said. Some tests used in integrative cardiology include high sensitive C-reactive protein, homocysteine, omega 3:6 ratio, and oxidized LDL.

Better patient outcomes

Integrative cardiology also focuses a lot of attention on healing from heart disease. “Studies of heart disease prove that it is never too late to heal,” Dr. Kominos reminds us. “Integrative medicine understands the innate healing power of the human body and spirit.”

And research suggests it works. For example, a 2016 study featuring cardiovascular disease patients found that an integrative approach was associated with a decreased incidence of cardiac death, heart attack, and revascularization. (9) A 2014 study involving hospitalized cardiovascular patients found that an integrative approach led to statistically significant decreases in anxiety and pain compared to those who did not receive integrative medicine. (6) 

The bottom line

Integrative cardiology may be the wave of the future, but many experts agree that we aren’t there yet.

“I’d like to see a greater awareness of and respect for the healing power of the human body, especially the cardiovascular system, among cardiology and primary care communities,” said Dr. Chong. “This would then translate into a more widely accepted and well-rounded lifestyle-oriented, proactive approach to disease prevention versus disease management.”

Dr. Kominos, who has a private practice in Oceanport, NJ, agrees. “It is time for cardiology, and for all of medicine, to delve into the root causes of disease rather than treating the downstream effects of a sedentary lifestyle, high stress, poor nutrition, unsafe environments, and inadequate sleep,” concluded Dr. Kominos. “Cardiology, in particular, is ripe for integrative medicine.”