Integrating Pharmacology and A Root Cause Medicine Approach to Cardiovascular Care

Cardiovascular disease (CVD) is the leading cause of death among American adults, with a person dying every 33 seconds. For the over 127 million adults living in the US with CVD, despite advancements in prescription medications, CVD management remains an ongoing challenge.

Root Cause medicine can provide a more patient-centric approach to enhance care by addressing the underlying causes of CVD. This article explores the concept of integrating pharmacological treatments with root-cause medicine principles to manage CVD.

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What is Cardiovascular Diseases (CVD)?

Cardiovascular disease (CVD) is a category of conditions that affect the heart and blood vessels. Common types of CVD include coronary artery disease, hypertension, and heart failure. These conditions are often multifactorial, with a number of risk factors such as a person's genetics, lifestyle, and environmental factors playing significant roles in their development.

Coronary Artery Disease 

Coronary artery disease (CAD) occurs when the blood vessels that supply blood to the heart become narrowed or blocked. The most common causes are due to the buildup of cholesterol plaques (atherosclerosis) in the arteries and excess inflammation. This can lead to chest pain (angina), heart attacks, and other long-term issues.

Hypertension

Hypertension, or high blood pressure, is a risk factor for CVD. Defined as 130/80 mm Hg, hypertension occurs when the force of blood against the arterial walls of the arteries is consistently higher than it should be. Over time, called resistant hypertension, this condition can damage the arteries and lead to heart disease, stroke, and other health problems.

Heart Failure

Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It can result from conditions such as CAD, hypertension, and diabetes, and can lead to persistent symptoms such as fatigue, shortness of breath, and swelling in the legs.

The Role of Pharmacology in Cardiovascular Care 

Pharmacology, also referred to by pharmacists as pharmacotherapy, is the cornerstone of traditional CVD management, providing symptomatic relief and reducing the risk of serious complications. Common pharmacological agents used in CVD management include a number of prescription drug classes including statins, beta-blockers, ACE inhibitors, ARBs, and anticoagulants.

Statins 

As the drug class with one of the highest total annual prescriptions in the US in 2021, statins are administered to lower cholesterol levels–like low-density lipoprotein (LDL) cholesterol–which plays an instrumental role in the development of atherosclerosis. By inhibiting the enzyme HMG-CoA reductase, statins reduce the production of cholesterol, leading to a lower LDL. This process can help prevent the formation of atherosclerotic plaques and reduce the risk of cardiovascular events.

Beta-blockers 

Commonly used to manage hypertension and other heart-related conditions, beta blockers work by blocking the effects of adrenaline on the beta-adrenergic receptors in the heart, which can reduce the heart rate and blood pressure. Beta-blockers also help improve heart function and can be beneficial for patients with heart failure or a history of heart attacks.

Angiotensin-converting enzyme (ACE) inhibitors 

ACE inhibitors are a class of medications used to manage hypertension and heart failure. They work by inhibiting the conversion of angiotensin I to angiotensin II, a powerful vasoconstrictor. This leads to vasodilation, which helps lower blood pressure, reduce the workload on the heart, and improve cardiac outcomes.

Angiotensin II receptor blockers (ARBs)

ARBs are an often forgotten but important drug class used in cardiovascular care due to their ability to block the effects of angiotensin II, a hormone that causes blood vessels to constrict. By dilating blood vessels and reducing blood pressure, ARBs can help manage conditions in a treatment protocol for hypertension, heart failure, and post-heart attack care.

Anticoagulants

Anticoagulants, such as warfarin and direct oral anticoagulants (DOACs), are used to prevent blood clots in patients with certain types of CVD, such as atrial fibrillation or venous thromboembolism. These medications inhibit the clotting process, reducing the risk of stroke or other thrombotic events.

Traditional pharmacology in the treatment of CVD focuses on symptom management and risk factor reduction but may overlook underlying causes. Medications such as those described in this section are prescribed to control cholesterol levels, blood pressure, and heart function. While these medications can be effective in controlling symptoms and reducing the chance of adverse events, they often do not address the causes of CVD. Functional medicine practitioners use a whole-person approach to cardiovascular care beyond symptom management, combining pharmacology with root cause medicine principles to optimize patient outcomes.

Principles of Root Cause Medicine in Cardiovascular Care

Functional medicine practitioners recognize the importance of addressing the root causes for more comprehensive care. Root cause medicine, within the context of cardiovascular care, is an approach that identifies the contributors to the development, progression, and complications of CVD. Rather than only focusing on symptoms, this type of precision medicine views the presenting condition as a result of a combination of factors rather than a single cause. 

Functional medicine prioritizes the value of personalized care, as the etiology of CVD can vary greatly from person to person. These factors can include genetic predispositions, such as a family history, as well as lifestyle modifications, such as diet, supplements, movement, sleep quality, and stress management. Treatment plans are tailored to each person, taking into account their health goals.

Integrating Pharmacology with Root Cause Approaches

Integrating pharmacological treatments with functional medicine is fundamental for enhancing CVD management. This integrative approach addresses lifestyle modifications, dietary changes, and physical activity to combat both the symptoms and the underlying causes of CVD, leading to improved patient outcomes. 

Physical Activity

Encouraging patients to engage in regular movement can improve cardiovascular health and reduce the risk of CVD. Exercise programs tailored to individual needs and abilities can complement pharmacological treatments by improving heart function, normalizing blood pressure, and reducing cholesterol levels.

Sleep

At night, the body repairs and restores itself, including the heart and blood vessels. Adequate sleep helps regulate blood pressure, reduce inflammation, and maintain healthy blood sugar levels–all of which are important for cardiovascular health. Insufficient sleep has been linked to an increased risk of developing hypertension, coronary artery disease, and stroke. Ongoing research demonstrating an adequate amount of sleep each night in combination with pharmacotherapy may be key for maintaining a healthy heart.

Nutrition 

Dietary interventions, such as the Mediterranean diet or the Dietary Approaches to Stop Hypertension or DASH diet, can help reduce the risk of CVD and improve outcomes in patients with existing CVD. These diets emphasize whole grains, fruits, vegetables, lean proteins, and healthy fats while limiting processed foods and refined sugar.

Patients who followed a Mediterranean diet have shown a lower risk of developing CVD compared to those who did not. One clinical trial showed that when losartan (ARB) was taken in combination with the DASH diet, there was a greater blood pressure-lowering effect than on its own.

Personalized medicine plays a crucial role in tailoring treatment plans for patients diagnosed with CVD. By taking into account individual differences, personalized medicine allows functional medicine practitioners to prescribe drugs in tandem with complementary lifestyle modifications that are most likely to be effective for each patient.

Challenges and Considerations 

When integrating traditional pharmacotherapy with root cause approaches in CVD management, there are many moving parts to consider. Patient compliance with lifestyle modifications can be a significant barrier, as patients may find it challenging to maintain new healthy habits. There may also be cost implications associated with implementing lifestyle interventions, such as nutrient-dense fruits and vegetables, and group exercise programs.

Supportive interdisciplinary teams, inclusive of functional medicine practitioners, will play a vital role in the shift to a comprehensive patient-centered treatment paradigm. Through a collaborative approach, healthcare teams can work together with the patient to educate them on their multifaceted treatment plan. Monitoring patient progress and adjusting regimens as needed will be essential to effectively manage CVD using an integrative approach.

The Future of Cardiovascular Care 

The future of cardiovascular care is poised to undergo a transformation, driven by the growing need for precision medicine. This shift represents a departure from the one-size-fits-all approach to cardiovascular care, towards a more patient-centered model that considers risk factors differences and treatment goals. Innovations in technology and research are in part driving this integration, with personalized medicine playing a role in tailoring treatment plans to individual patients.

New technologies, such as diagnostic imaging tools, wearable devices, health-focused apps, telemedicine, and specialized biomarker tests, are also enabling patients to take a more empowered role in preventing and managing their health outcomes. The integration of root cause medicine, traditional pharmacotherapy, and technology is poised to advance integrated cardiovascular care. 

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Key Takeaways

Integrating pharmacology with a root cause medicine approach offers a more patient-centered strategy for improving cardiovascular outcomes.

By optimizing diet, exercise, sleep, and stress management for CVD patients, functional medicine practitioners can amplify the effectiveness of prescription medications, to enhance quality of life.

Further research and cross-functional collaboration across healthcare providers are needed to explore new pharmacological treatments, lifestyle interventions, and technologies to improve cardiovascular care for future generations.