Coronary Heart Disease, Part 1
June 6, 2017
Register and Book An Appointment
July 13, 2017

Coronary Heart Disease, Part 2

Coronary Heart Disease

(How to Modify your Risk and Prevent Heart Attack)

By: Dr Eugene Nwosu MBBS, FACC, FACP, FAHA Chief Medical Director

In our part 1 series of Heart Matters, we outlined the major traditional risk factors for coronary artery disease (CAD). These are family history of premature death from heart attack, increased age, male sex, high Cholesterol, hypertension, diabetes, obesity, smoking, poor diet, sedentary life style, and vascular inflammation. We obviously can do little to change our sex, age or family history. The other risk factors can be modified to decrease heart attack risk.

 1.Poor Diet (High Fat, high Cholesterol diet.): Eat right and take note of what you eat. Hippocrates stated in 400BC; “Let food be your medicine and medicine be your food.” Food is the single most important factor influencing your health. With knowledge and discipline you have full control over it. Certain Foods (Mediterranean diet) are healing and decrease inflammation while others (traditional America diet) promote inflammation. CAD also known as atherosclerosis is an inflammatory process.

Traditional western diets promote inflammation and are toxic to our bodies. There are high in salt, simple sugars, processed food with preservatives, bad fat and low on magnesium and potassium. Our consumption of such diet has a lot to do with increased trend of obesity, hypertension, diabetes, stroke, heart disease and death.

The best diet proven to decrease heart attack and CAD is Mediterranean diet. The Mediterranean diet is not really a diet; it is rather a life style that includes food (Colorful fruits, Vegetables, Whole grain bread and Pasta, Omega-3- rich Seafood) activities, meals with friends and family and wine in moderation with meals.

Several studies have shown that those following a traditional Mediterranean diet suffer significantly less heart disease and death from heart attack compared to those following traditional American diet.

  • Anatomy of Mediterranean Diet: Mediterranean diet is very low in saturated fat and contains no trans-fat. It consist of fruits, vegetables, olive oil, whole-grains, legumes, nuts, fish, poultry and red wine in moderation. It is plentiful in vitamins, fiber and antioxidant. Red meat is eaten twice a month and refined sugar and processed foods are avoided. It decreases inflammation and lowers the risk of heart attack, cancer, diabetes and other disease linked to chronic low grade inflammation.

Consumption of Mediterranean diet results in sustained weight loss and improvement in overall health. It lowers the risk of metabolic syndrome, diabetes, HTN, Alzheimer’s disease, cancer and other diseases.

  • Food to Avoid: sugar cereal, potato chips, French fries, grilled steak, cheese cake, butter, soda, and high omega-6 fat diet. Omega-6 fat is bad fat and is found in vegetable oil and red meat. It promotes inflammation whereas omega-3 fat found in walnuts, flaxseed, and fish is good fat and anti-inflammatory. The optimal Omega -6 / Omega-3 ratio in our diet is 2:1 and Mediterranean diet makes this ratio a reality. For many people on traditional Western diet that ratio is between 10/1 to 20/1.
  • Avoid heavy drinking; Drink just before or with your evening meal. Take not more than one drink for a woman or two drinks for a man in 24 hour period. One drink equals 12 fluid ounces of beer (355ml), 5 fluid ounces of wine (144ml), or 1.5 fluid ounces of Spirits (44ml).
  • Avoid processed foods; these have been stripped of their healthful ingredients and are loaded with artificial preservatives. They contain excessive amounts of unhealthy fats, refined sugar and sodium.
  • Avoid high fructose corn syrup used in many foods including diet soda and baked food.
  • Avoid Red meat. Limit to twice a month but not more than once a week. Red meat is high in saturated fats which raise bad (LDL) cholesterol and is high in Omega 6 fatty acid which promotes inflammation. Cooking red meat generates cancer causing compounds. Red meat is high in iron which is also believed to promote cancer. Processed meat contain substances known as nitrosamines which have been linked to cancer.

Eating well done meat increases the risk of certain cancers including lung, bladder, colorectal, stomach, pancreatic cancers and others.

Meat cooked at high temperature generates cancer causing chemicals called heterocyclic amines (HCAS).

  • Eating processed meat must be avoided. Many researchers define processed meat as meat that is preserved by smoking, curing, salting or addition of chemical preservatives.


Advice on Red meat Consumption.

  1. Avoid regular red meat consumption, limit intake to 4 ounces(114gm) 2 to 4 times a month
  2. Avoid processed meat entirely
  • Consume Fish, Poultry or Turkey several times per week.


Avoid Dairy Milk. It has high saturated fat content increasing cholesterol and has high calories contributing to obesity and diabetes. Excellent milk alternatives are soy and almond milk.


Mediterranean Diet Pyramid

2.Sedentary Lifestyle: is a significant risk for CAD. Exercise is medicine and is the key to heart health. Practically every cardiac risk factor can be countered by exercise. Physical inactivity is directly linked to poor health including obesity, diabetes, heart attack, stroke, cancer and others. Exercise stimulates blood circulation throughout the body and to all our organs, helping to remove toxins through sweating and other filtration methods, as well as improving the efficiency of our lungs and heart.

Exercise is not just an essential behavioral contribution to longevity, it is the most essential. There is a close relationship between the amount of physical exercise, longevity and the risk for heart disease. Studies have shown that expending 500Kcal per week in exercise produced modest improvements in risk, whereas expending 2000Kcal per week had very significant reductions in heart disease risk. This benefit was dose dependent up to a level of 3500Kcal a week, then it leveled off. It has been calculated that for every hour you exercise you add two hours to your life span.

  • Studies have shown that heart disease is low in populations that walk an average of 10,000 steps per day and is hardly existent in those that average 17,000 steps daily
  • Walking 10,000 steps each day is considered to be equivalent of 6o minutes of moderate intensity exercise.
  • Recent study showed that those who walk 10,000 steps or more each day reduce their odd of developing metabolic syndrome by 72%.
  • British Medical Journal Study showed that 10,000 steps daily help control weight and may reduce diabetes risk.
  • Australian Study found that walking 10,000 steps per day had a lower body mass index, less belly fat and better insulin sensitivity.
  • The kind and amount of exercise that is best for you depends on your risk profile which is different from someone else.

There are three considerations to exercise.

  • Frequency refers to how often you exercise.
  • Intensify refers to how hard you exercise.
  • Time or Duration refers to how long you exercise.


The American Heart Association (AHA) created the “FIT Formula”; Frequency, intensity and Time. They recommend frequency of 3 to 5 times per week, intensity to break a sweat but able to carry on a conversation and time/duration of 30 to 40 minutes.


Exercise benefit occurs in two distinct ways, First Muscular or Mechanical benefits. This type of exercise changes the size and density of all muscles including the heart. Exercising to the point of muscle fiber exhaustion or overload of the muscle causes it to become thicker and denser so that the next time the same load won’t fatigue it. For this kind of mechanical benefit, higher intensity, shorter duration and less frequency are optimal.

The second benefit of exercise is the metabolic state of the body. It changes how the muscles process fuel, which in turn changes the chemistry of the blood.

The changes produced affect almost all of the circulating risk factors for cardiovascular disease. The metabolic benefit of exercise occurs with lower intensity, longer duration and increased frequency.


The Exercise Continuum.


The exercise continuum in the diagram is based on maximum heart rate. Heart rate closely corresponds to oxygen consumption and the amount of energy you are expending while exercising. A fair accurate estimate of your maximum heart rate (MHR) is 220 minus your age. MHR roughly corresponds to your maximum exercise capacity – that is the maximum amount of energy you can consume in a given amount of time.

The Mechanical benefits begin at about 60% of your MHR. Above 80% of MHR you get full benefits of mechanical conditioning and the more intense the exercise the better.

The metabolic benefits on the exercise continuum do not increase in a straight line with the intensity of exercise. Peak benefit is between 70 to 75% of MHR. It starts to fall off after 80% of MHR.

The key to reducing metabolic risk factors is to exercise at the level of intensity that will deplete the muscle cells internal supply of fat (Triglycerides). Between 70% and 75% of your maximum Heart Rate (which corresponds to level 2 exercise) is the perfect intensity level for metabolic benefits.

At about 75% MHR point, there is an overlap of the mechanical and metabolic conditioning zones. If your need for reducing risk factors require equal portion of both kind of exercise, this is the optimum level intensity around which you should build your workout.

Low level intensity exercise is also effective in decreasing cardiovascular risk. Recent research shows that moving at moderately brisk pace for 45min three times per week at about 60% of your MHR significantly increases cardiovascular fitness and can decrease BP, plasma triglyceride, cholesterol and bad (LDL) cholesterol levels, while increasing good (HDL)

cholesterol concentrations. Participants in this study also lost body weight and fat stores and even decreased their waist size.

Most cardiologists will recommend having a stress test before starting an exercise program for certain category of patients.


Who Should Have a Stress Test.?

  • Males over 40 years old who do not exercise
  • Females over 50 years old who do not exercise
  • Anyone who while doing any kind of physical activity develops chest pain or unusual shortness of breath
  • Anyone with a family history of premature coronary artery disease
  • Diabetes
  • Smokers
  • Asthmatics, or people with chronic lung disease
  • Anyone with abnormal resting electrocardiograms, heart murmurs, or congenital heart problems
  • Anyone with any kind of known heart disease.


The Cardiovascular Benefits of Regular Exercise:

  • Lowers body weight
  • Improves lipid profile: lowers triglyceride and LDL (bad) cholesterol particles, and raises HDL (good) cholesterol. Increase LDL particle size making it less likely to clog up the artery.
  • Lowers insulin levels
  • Raises insulin sensitivity
  • Lowers blood sugar
  • Lowers inflammation
  • Lowers risk of blood clots
  • Lowers stress hormones (e.g. Adrenalin)
  • Lowers blood pressure and heart rate
  • Increases volume of blood pumped for every level of energy used by heart muscle
  • Dilates the coronary arteries
  • Improves collateral circulation.


Non Cardiac Benefits of Exercise.

  • Increases muscle mass and strength.
  • Blocks age related decline in muscle mass.
  • Decrease anxiety and depression.
  • Decrease body fat.
  • Decreases craving to smoke.
  • Improves lung function.
  • Improves arthritis and joint flexibility.
  • Improves sleep quality.
  • Improves memory.
  • Reduces signs of aging
  • Improves bone health and conservation of bone mass.
  • Lowers risk of cancer, especially colon and breast.
  • Increases immune function.
  • Increases brain activity and facilitates neuron transmission.






 3.  Hypertension: Hypertension is a known risk factor for CAD and is very common in people of African descent.  Natural means to control blood pressure includes;

  • Limit sodium (< 1500mg/day)
  • Consume a wide variety of fruits and vegetables
  • Drink grape and pomegranate juice
  • Exercise daily
  • Stop smoking
  • Avoid trans fat
  • Avoid excess alcohol
  • Avoid excess caffeine
  • Manage stress
  • Achieve an ideal body weight
  • Treat sleep apnea if present

American Heart Association recommends that average person limit their sodium intake to less than 2300mg per day and less than 1500mg per day for those at increased risk of cardiovascular disease. One teaspoon of tablet salt has 2000 mg of sodium.

  • Dash diet: DASH stands for Dietary Approaches to Stop Hypertension. The diet is simple: Eat more fruits, vegetables, and low-fat dairy foods. Cut back on foods that are high in saturated fat, cholesterol, and Trans fats.












 4.  Smoking: there is nothing good about smoking and there is no question that smoking is dangerous to your health. Smokers are 2 to 3 times likely to die from CAD than non-smokers. Smoking just 1 to 4 cigarettes daily increases your risk and each additional cigarettes you smoke per day increases your risk further. Your cardiovascular risk will decrease significantly within the first 2years of smoking cessation compared to patients who continued to smoke. Those who quit smoking before their first heart attack had a 50% lower mortality rate, and those who quit after their first heart attack lowered their risk by 37%.

Smoking increases blood pressure, decrease exercise tolerance, increases the risk of recurrent CAD after bypass surgery and decreases HDL good cholesterol. Quitting Smoking and Aerobic exercise will counter all these adverse effect of smoking.

5.  Age: Increasing age causes the dysfunction of the arteries by decreasing endothelial function and increasing arterial stuffiness. This results in cardiovascular disease (CVD). Aerobic exercise blocks the dysfunction of the arteries caused by aging thereby preventing CVD.







 6.  Create a Stress- Free Lifestyle: Stress and anger increase the release of stress hormones such as adrenaline and cortisol. These have the natural effects of increasing blood pressure, cholesterol, and blood sugars; causing the heart beat to become rapid and increasing the “Stickiness” of platelets, which raises the likelihood of a blood clot. Practice the relaxation response. Actively find ways to manage your stress. Practice meditation and yoga. Get more nighttime sleep: – some studies found that people who reported sleeping less than 5hrs per night were twice as likely to develop cardiovascular disease compared with those who slept 7hrs.

Spend time with friends. Laugh: Deep heart felt laughter is good medicine. With laughter, it appears that serum cortisol, which is hormone that is secreted when under stress, is decreased; laughter improved arterial stiffness in healthy individuals. It may be as beneficial as exercise in relaxing arteries and increasing blood flow.

 7.   Address Lipid Profile: Get a complete lipid profile including total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol, LDL particle numbers, triglyceride level, and lipoprotein (a) level. One third of people who develop CAD have elevated Lipoprotein (a). Lipoprotein (a) is an LDL particle with an attachment called Apoprotein(a). Elevated levels of Lipoprotein (a) increase the risk of heart attack and stroke.

The Framingham study showed that the optimal total cholesterol is less than 150mg/dl. Other studies found that populations around the world with practically non existent CAD/Heart attack had average total cholesterol between 120mg/dl and 150mg/dl. Mediterranean diet can lower your cholesterol levels by 25%. It has been proven to lower LDL cholesterol, lower LDL particle numbers, raise HDL cholesterol, and lower triglyceride levels.

A study found that women who ate on apple a day for a year lowered their LDL cholesterol by 23% and raised their HDL cholesterol by 4%. Also daily apple consumption lowered inflammation and free radicals, thereby lowering heart attack risk.

Exercise has been shown to lower total cholesterol, lower LDL particle number, raise HDL cholesterol, and lower triglyceride, as well as make LDL cholesterol particles larger and potentially less dangerous.


 8.  Diabetes: Diabetes Mellitus: is a significant risk for CAD and the risk is considered heart attack equivalent. Proper treatment of diabetes aims to control blood sugar, and hemoglobin A1C blood levels with diet, weight loss when appropriate and exercise. Diagnosis of diabetes can be made when fasting blood sugar is more than 126mg/dl or Hgb A1C level is greater than or equal to 6.5%. Optimal Hg A1C level is less than 5.7%.

People who follow Mediterranean diet are 83% less likely to develop new onset diabetes.










 9.   Obesity: obesity is associated with high cholesterol high triglycerides, hypertension, diabetes and sedentary life style.  A body mass index (BMI) is a measure of your body fat. A BMI of 18 to 24.9 is normal, 25 to 29.9 is overweight, and a BMI greater than 30 is obese. BMI of 35 or more carries high risk for CAD.  Abdominal girth (waist circumference) predicts heart disease better than BMI. Abdominal girth of greater than 102cm (40in) for men carries high risk for CAD and that greater than 88cm (35in) carries high risk for women. A 10% gain in body weight increases your risk of heart attack by 25%.

Diets that contribute to obesity include:

  1. Toxic pro-inflammatory American diet. These are heavy on processed foods, artificial preservatives, and excessive amounts of unhealthy fats, refined sugar and sodium. Unhealthy fats are saturated fat found in butter, meat and cheese, and trans-fat found in packaged cookies, chips and pastries.
  2. Food that contain high fructose corn syrup. They are found in many beverages and food including soft drinks, sports drinks, packaged cookies, and other baked goods.

Exercise and Mediterranean diet are effective ways to lose weight resulting in decreased cardiovascular risk.


  10.    Get Rid of Inflammatory States: Vascular inflammation is a risk factor for CAD (atherosclerosis). The process of atherosclerosis begins with damage to the endothelium. Coronary artery disease is an inflammatory disease and inflammation begets inflammation.

 Ways to get rid of Inflammation includes:

I.   Get a dental checkup: your oral health can directly impact your heart health. Regular dental cleaning reduces the risk of heart attack. Inflammation in your gums from periodontal disease increases the risk of cardiovascular disease: – heart attack and stroke. A study that followed more than 100,000 people with no history of heart attack or stroke for seven years found that those who had their teeth cleaned by a dentist or dental hygienist at least twice a year for 2 years had a 24% lower risk for heart attack and 13% lower risk for stroke compared to those who never went to the dentist or only went once in two years.

II.  Get rid of the traditional American diet which promotes inflammation.

III.  Limit environmental toxins which promote inflammation. Exposure to toxins every day and over time causes our bodies to mount inflammation response. These toxins include cigarette smoke, pesticides, chemicals, food additives and pollution.

Key life style changes to limit inflammation are regular dental cleaning, heart healthy diet such as a Mediterranean diet, regular exercise, smoking cessation and weight control.

IV.  Limit conditions/Toxins that lead to increase free radical generation and oxidative stress. Increased free radical state will promote inflammation, increase oxidized LDL cholesterol and accelerate CAD (atherosclerosis). Free radical is the term used for any molecule with an uneven number of electrons. They are very unstable and they will do whatever they can to get or steal another electron so they can have an even number. This theft by free radicals is referred to as oxidation. The oxidation of LDL (bad) cholesterol causes intense inflammatory response because the body now views the oxidized cholesterol as foreign. Toxins that increase free radical release include air pollutants, cigarette smoke, excess ultraviolent rays from the sun, pesticides, radiation (especially CAT scans, unless absolutely needed), excessive alcohol, preservatives in foods and food packaging, industrial chemicals and household cleaners.

Antidote to the free radicals is antioxidants. Mediterranean diet is a powerful source because it includes so many foods that are antioxidant rich.


Some advanced Cardiovascular Diagnostic Tests & Risk:

  1. Elevated LDL cholesterol/ Elevated LDL particle.

Relative risk: 2 -3x increase risk of CVD

  1. Elevated small dense LDL particles.

Relative risk: 3x increased risk of heart attack and stroke

  1. Low HDL cholesterol.

Relative risk:

a. 2.5 increased risk of CVD (if HDL-C <35mg/dl and total chol <200mg/dl).

b. 5x increased risk of CVD (if HDL-c <35mg/dl and total  chol 200 to 300 mg/dl)

  1. Elevated Triglyceride.

Relative risk: 2 -3x increased of CVD

  1. Elevated Lipoprotein(a) also known as LP(a).

Relative risk:  3 -5x increased risk of CVD

  1. Elevated high sensitivity C- reactive protein (hs – CRP).

Relative risk:  2 -3x increased of CVD

  1. Elevated fibrinogen. Fibrinogen is a protein that coverts to fibrin in forming clots. It also responds to any inflammatory process including CAD.

Relative risk:  2-3x increased risk of CAD.

  1. Elevated homocysteine. Homocysteine is an amino acid intermediate in methionine and cysteine metabolism which requires Vitamin B12 and folic acid.  Elevation of Homocysteine is often the result of Vitamin B12 and folic acid deficiency.
  • High level cause endothelial dysfunction, vascular injury, smooth muscle proliferation, and thrombogenicity (Increased blood clothing)
  • Augments the production of oxidized LDL-C
  • Commonly used as a screen for patients at risk for CVD and stroke especially if there is no other risk factors except family history.

Relative risk 2 -3x increased risk of CVD.

  1. Low 25-Hydroxy-Vitamins D. Deficiency of 25-hydroxy-vit D is associated with atherosclerosis (CAD), hypertension, up regulation of renin- angiotensin- aldosterone systems involved in hypertension and cardiovascular disease, insulin resistance, diabetes, metabolic syndrome, low calcium and low phosphorus and associated with incidence of cardiovascular events, cancer, osteoporosis and all-cause mortality.

Relatively risk: 2x increased risk of CVD ( if <10ng/ml )

  1. Elevated Lipoprotein associated phospholipase A2 (LP- PLA2): Lp-PLA2 is an enzyme associated with atherosclerotic lessons and primary carried on LDL and LP (a) in the circulation.

It is an indicator of arterial inflammation that has been associated with increased risk of CAD and especially high risk for ischemic stroke. It is a risk factor for CVD independent of LDL- C. High levels are found in circulation when vulnerable, inflamed, rupture prone plaque are present.

It cleaves oxidized LDL-C in endothelium and attracts inflammatory cells (macrophages). Macrophages then engulf LDL-C particles forming foam cells

Relative risk;

2x increased risk of CVD

5.5x increase risk of stroke,

11.4x increased risk of stroke when hs- CRP and Lp-PLA2 are elevated.

6.4x increased risk of stroke when systolic BP is elevated.

11. Elevated Myeloperoxidase (MPO):

Myeloperoxidase is an enzyme synthesized and stored within polymorphonuclear  leukocytes and monocytes which are white blood cells.

MPO is a marker of free radical and oxidative stress

MPO reduces bioavailability of nitric oxide, thereby promoting endothelial dysfunction.

It catalyze the oxidation of HDL – C impairing its ability to perform reverse cholesterol transport that removes plaque buildup from the arteries to the liver.

It catalyzes the oxidation of LDL-C contributing to foam cell formation and plaque progression.

Elevated MPO levels predict risk for developing CAD in healthy individuals independent of traditional CVD risk factors.

Elevated MPO levels contribute to plaque instability and are associated with increased risk of CVD events.

Related risk:

20x increased risk of CAD

5x increased risk of MI/heart attack (when negative for troponin T)

2 x increases in all-cause mortality.




  1. 2NlEMQavB says:

    217512 627531I surely did not recognize that. Learnt 1 thing new today! Thanks for that. 71837

  2. I could not resist commenting. Perfectly written!

  3. For the reason that the admin of this web site is working, no doubt very quickly it will be well-known, due to its quality contents.

  4. Hello to every , for the reason that I am truly keen of reading this web site’s post to be updated on a
    regular basis. It carries good data.

  5. Kam Ki Bate says:

    hello!,I like your writing so much! share we keep up
    a correspondence more about your post on AOL? I require an expert in this area
    to resolve my problem. Maybe that is you! Taking a look ahead to look you.

  6. arpels van cleef necklace knock off

    I simply want to say I am beginner to blogging and certainly liked this web page. Almost certainly I’m going to bookmark your blog . You really have perfect stories. Cheers for sharing with us your web-site.

  7. Zhakom says:

    The articles are very useful. Written is plain language for an average reader to understand. Thank you.

  8. try this says:

    I simply want to mention I am new to blogging and site-building and certainly enjoyed you’re blog site. Likely I’m planning to bookmark your website . You amazingly come with remarkable writings. Bless you for sharing with us your blog site.

  9. pron best says:

    oKseac It as nearly impossible to find experienced people about this subject, however, you sound like you know what you are talking about! Thanks

  10. 1 hodina Pak tam upadoci instituce, jako jsou jump-a příliš velké
    portfolio hypotečních kredytw může být problém
    pro banku, druhá pomysy vyplývající z potřeby rychle akci užitečný
    to například v roce.

  11. Zadejte svůj e-mailovou adresu, aby požádat prodávajícího k odeslání zprávy
    o e-mail je potřebný carproof půjčky na auta na celkových úvěrech se dozvědět více kreditu žádné soukromé dodavatele.

  12. 11.12.01 Používání chwilwki obviněn v 600 po 15 dnech
    společnosti smsbanq zákazník musí dát 760 o společnost informuje na svých internetových stránkách.

  13. Wycigaa Vanya bude reagovat waciwej čest oblékat a Aeon úvěru malé
    ušlechtilé pohnutky a miaoby zde suchajc vypadá jako očarovaná.

  14. Před 13 hodinami chwilwki nabídce: rychlé půjčky pro 7000 se do 15 minut, aniž by museli opustit domov nevyžaduje zawiadcze příjmů

  15. john newmann says:

    HbWdiT Thanks for sharing, this is a fantastic article.Thanks Again. Much obliged.

  16. Thu says:

    Ultimately, an issue that I am passionate about. I have looked for information of this caliber for the very last numerous hours. Your site is greatly appreciated.

  17. This is one awesome blog post.Really thank you! Really Great.

  18. Lovely site! I am loving it!! Will come back again. I am bookmarking your feeds also

  19. There is definately a lot to know about this topic. I like all of the points you made.

  20. Wow, this post is good, my sister is analyzing these kinds of things, so I am going to let know her.

  21. canada seo says:

    Some genuinely superb blog posts on this internet site , appreciate it for contribution.

  22. Really informative post.Really looking forward to read more. Want more. here

  23. canada seo says:

    This unique blog is without a doubt interesting and amusing. I have found a lot of helpful stuff out of it. I ad love to come back again soon. Thanks a bunch!

  24. Your style is really unique in comparison to other folks I ave read stuff from. I appreciate you for posting when you have the opportunity, Guess I will just book mark this page.

  25. This article regarding SEO gives clear idea designed for new SEO people that how to do SEO, thus keep it up. Pleasant job

  26. Thank you for your post.Really looking forward to read more. Want more.

  27. This can be a set of words, not an essay. you will be incompetent

  28. This is a list of phrases, not an essay. you are incompetent

  29. You could definitely see your expertise in the work you write. The world hopes for even more passionate writers like you who are not afraid to say how they believe. Always go after your heart.

  30. Thanks for sharing, this is a fantastic article post. Want more.

  31. This is really interesting, You are a very skilled blogger. I have joined your rss feed and look forward to seeking more of your wonderful post. Also, I have shared your site in my social networks!

  32. Im thankful for the post.Really looking forward to read more. Fantastic.

  33. Looking forward to reading more. Great article.Thanks Again. Great.

  34. Ollie Bizarro Everything is very open with a precise description of the issues. It was definitely informative. Your site is extremely helpful. Thanks for sharing!

  35. Very nice post and right to the point. I am not sure if this is actually the best place to ask but do you folks have any thoughts on where to get some professional writers? Thanks

  36. What blog hosting website should I create a blog on?

  37. Thank you a lot for sharing this with all folks you really recognise what you are talking about! Bookmarked. Please also talk over with my website =). We may have a link alternate contract among us!

  38. Very neat article.Really thank you! Keep writing.

  39. Say, you got a nice blog post.Much thanks again. Will read on

  40. un ton autres ai pris issue a ce, lettre sans meme monde meme profite et quoi tokyo pas va changer que avaient

  41. I truly appreciate this post. I’а†ve been looking everywhere for this! Thank goodness I found it on Bing. You have made my day! Thanks again

  42. Fakultet says:

    Very good blog.Thanks Again. Really Cool.

  43. privatni says:

    wow, awesome blog article. Keep writing.

  44. Remarkable! Its in fact amazing article, I have got much clear idea on the topic of from this paragraph.

  45. Your kindness shall be tremendously appreciated.

  46. There is apparently a bundle to identify about this. I suppose you made some good points in features also.

  47. Im thankful for the article. Keep writing.

  48. Whispering Misty So sorry you can expect to pass up the workshop!

  49. Say, you got a nice article.Thanks Again.

  50. Simply a smiling visitant here to share the love (:, btw outstanding design. He profits most who serves best. by Arthur F. Sheldon.

  51. What as up, just wanted to tell you, I enjoyed this blog post. It was helpful. Keep on posting!|

  52. Pretty nice post. I just stumbled upon your blog and wished to say that I ave truly enjoyed browsing your blog posts. After all I will be subscribing to your feed and I hope you write again soon!

  53. Really enjoyed this blog post.Thanks Again. Great.

  54. You made some really good points there. I looked on the web for more info about the issue and found most individuals will go along with your views on this web site.

  55. Just Browsing While I was surfing yesterday I noticed a great article concerning

  56. Wow, that as what I was looking for, what a stuff! present here at this website, thanks admin of this site.

  57. seo says:

    I’m book-marking and will be tweeting this to my followers!

  58. canada seo says:

    Thanks so much for the blog article.Really thank you! Really Cool.

  59. This very blog is no doubt educating additionally factual. I have discovered a lot of handy tips out of it. I ad love to come back again soon. Thanks a bunch!

  60. You should participate in a contest for the most effective blogs on the web. I will suggest this website!

  61. Really enjoyed this blog article.Thanks Again. Great.

  62. I value the blog article.Much thanks again.

  63. It is not acceptable just to think up with an important point these days. You have to put serious work in to exciting the idea properly and making certain all of the plan is understood.

  64. I think it is a nice point of view. I most often meet people who rather say what they suppose others want to hear. Good and well written! I will come back to your site for sure!

  65. Major thankies for the blog post.Thanks Again. Want more.

  66. I wanted to thank you for this excellent read!! I absolutely loved every little bit of it. I have you book-marked to look at new stuff you post

  67. I think this is a real great post.Really thank you! Great.

  68. This is one awesome post.Really looking forward to read more. Fantastic.

  69. dick says:

    Tremendous issues here. I am very glad to see your article. Thank you so much and I am looking forward to contact you. Will you please drop me a mail?

  70. Loving the info on this web site, you have done outstanding job on the articles.

  71. I think this is a real great blog article.Much thanks again. Really Great.

  72. Informative article, exactly what I wanted to find.

  73. Really appreciate you sharing this blog post. Much obliged.

  74. SEO says:

    I think this is a real great post.Much thanks again. Really Cool.

  75. SEO says:

    this, such as you wrote the book in it or something.

  76. SEO says:

    Thanks again for the article.Much thanks again. Will read on

  77. SEO says:

    I think you have mentioned some very interesting points, thankyou for the post.

  78. SEO says:

    Thanks for the article post. Really Cool.

  79. snapchat says:

    Pretty! This was a really wonderful post. Thank you for supplying this information.

  80. Very interesting subject, thank you for posting.

  81. I will immediately grasp your rss as I can at in finding your e-mail subscription link or e-newsletter service. Do you ave any? Please let me know so that I could subscribe. Thanks.

  82. Very nice article and right to the point. I am not sure if this is really the best place to ask but do you guys have any ideea where to employ some professional writers? Thx

  83. Would you be desirous about exchanging links?

  84. If you have any recommendations, please let me know. Thanks!

  85. Jak zosta dobrym sprzedawc Sprzeda przez telefon

  86. this topic for a long time and yours is the greatest I have

  87. Why do copyright holders only allow people from certain countries to view their content?

  88. mac cosmetics cheap I dugg some of you post as I cogitated they were very helpful very helpful

  89. FS 19 mods says:

    very nice put up, i certainly love this website, keep on it

  90. It as nearly impossible to find experienced people on this subject, however, you sound like you know what you are talking about! Thanks

  91. This very blog is really interesting additionally diverting. I have picked a bunch of handy stuff out of this source. I ad love to go back again soon. Thanks!

  92. this website says:

    The Silent Shard This can probably be very beneficial for many of your jobs I want to will not only with my web site but

  93. to read more says:

    I simply could not depart your site prior to suggesting that I actually loved the usual info a person provide to your guests? Is gonna be again frequently to inspect new posts.

  94. You made some good points there. I looked on the net for more info about the issue and found most individuals will go along with your views on this web site.

  95. click here says:

    That as some inspirational stuff. Never knew that opinions might be this varied. Thanks for all the enthusiasm to supply such helpful information here.

  96. Purely mostly since you will discover a lot

  97. The play will be reviewed, to adrian peterson youth

  98. click here says:

    Well I sincerely liked studying it. This tip offered by you is very practical for correct planning.

  99. You made some clear points there. I looked on the internet for the subject matter and found most guys will agree with your blog.

  100. click here says:

    There is a bundle to find out about this. You made nice points also.

  101. your publish that you simply made some days ago? Any sure?

  102. click here says:

    You ave made some good points there. I checked on the internet for more info about the issue and found most people will go along with your views on this web site.

  103. Thanks again for the blog article.Really looking forward to read more. Really Cool.

  104. Looking around I like to surf around the online world, regularly I will go to Stumble Upon and follow thru

  105. Agen Bola says:

    Wow, fantastic blog layout! How long have you been blogging for? you made blogging look easy. The overall look of your site is magnificent, let alone the content!. Thanks For Your article about &.

  106. to read more says:

    Very good post.Thanks Again. Really Great.

  107. pretty helpful material, overall I imagine this is really worth a bookmark, thanks

  108. shit says:

    Thank you ever so for you article.Really thank you! Cool.

  109. ass licking says:

    Wow! Thank you! I permanently wanted to write on my site something like that. Can I take a part of your post to my site?

  110. bitch says:

    Interesting article, thanks. Could you explain the second paragraph in more detail please?

  111. click here says:

    Many thanks for sharing this excellent post. Very inspiring! (as always, btw)

  112. This unique blog is really entertaining and diverting. I have chosen many interesting advices out of this blog. I ad love to return over and over again. Thanks a bunch!

  113. yid says:

    Thank you for your article post.Really thank you! Will read on

  114. I truly appreciate this article.Thanks Again. Really Cool.

  115. which gives these kinds of stuff in quality?

  116. slut says:

    no easy feat. He also hit Nicks for a four-yard TD late in the game.

  117. Major thankies for the blog post.Really looking forward to read more. Want more.

  118. Post writing is also a excitement, if you know then you can write if not it is difficult to write.

  119. Woman of Alien Perfect work you might have finished, this site is admittedly awesome with fantastic info. Time is God as way of maintaining everything from happening at once.

  120. seo says:

    Thanks-a-mundo for the blog article.Much thanks again. Much obliged.

  121. seo toronto says:

    This is a good tip particularly to those new to the blogosphere. Simple but very accurate information Appreciate your sharing this one. A must read article!

  122. What is the best website to start a blog on?

  123. This is a set of phrases, not an essay. you are incompetent

  124. spy camera says:

    website a lot of times previous to I could get it to load properly.

  125. chocopie says:

    1WgPpR Thanks for the blog.Thanks Again. Great.

Leave a Reply

Your email address will not be published. Required fields are marked *