- Cardiovascular Disease
1. Atherosclerosis
- Facts
- CVDs are the number 1 cause of death globally: more people die annually from CVDs than from any other cause.
- An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. Of these deaths, an estimated 7.4 million were due to coronary heart disease and 6.7 million were due to stroke .
- Over three quarters of CVD deaths take place in low- and middle-income countries.
- Out of the 17 million premature deaths (under the age of 70) due to noncommunicable diseases in 2015, 82% are in low- and middle-income countries, and 37% are caused by CVDs.
- Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity and harmful use of alcohol using population-wide strategies.
- People with cardiovascular disease or who are at high cardiovascular risk (due to the presence of one or more risk factors such as hypertension, diabetes, hyperlipidaemia or already established disease) need early detection and management using counselling and medicines, as appropriate.
If an airplane crashes hundreds of people die and the news
is filled with this top story for days.
Each day in the U.S. approximately 2400 deaths occur from cardiovascular
disease alone. This would be like 6
Boeing 747’s crashing per day! Yet these
deaths generally do not make the news broadcasts unless a famous person dies
from a heart attack. Much effort is put
forth to determine the cause of the airline crash—shouldn’t we be as concerned
with the cause of cardiovascular disease?
Heart disease usually develops silently—it is known as the
silent killer. Before any damage to the
heart occurs a process called atherosclerosis takes place over a period of many
years. This refers to a narrowing of the
arteries due to a buildup of fatty material inside the blood vessel walls. As fat and cholesterol accumulate on the
walls, the body reacts by covering the fatty deposits with a tough, fibrous cap
(mostly calcium) to prevent a blood clot from forming (if any fatty material is
allowed to come into contact with blood, it can stimulate the blood to clot. The fibrous cap protects against this
unwanted clotting. This capped fatty
deposit is known as plaque.
“Athero”
refers to the “mushy” or “gruel-like” fatty material and “sclerosis” describes the hard fibrous material of the cap.
This problem can begin as a “fatty streak” in the arteries
as early as the teenage years or even younger.
With each decade of life the plaque becomes more prominent. The changes
continue until eventually the arteries can become totally blocked.
Symptoms:
There may be no symptoms until the progression is very
severe and perhaps no symptoms will ever occur.
If symptoms do arise they may be vague (“atypical”) or they
may be classic “angina pectoris,” which is the first symptom in the progression
toward a heart attack. Angina pectoris
refers to chest pain on exertion or severe emotional stress that is usually
described as heaviness, pressure, or tightness centered in the middle or left
side of the chest. The pain can travel
up to the neck or jaw or down either arm.
Occasionally there is also back or stomach area pain. A large meal or cold weather may also
precipitate this pain.
These symptoms are caused by an insufficient blood supply to
the heart muscle, referred to as “coronary insufficiency.” Even under situations of significant exertion
a heart artery must have at least 50 to 60 percent of its diameter blocked
before the heart muscle suffers from lack of blood supply, which is the cause
of the pain. Many people with narrowing
even in the 70 percent range or greater have no recognizable symptoms.
Location of atherosclerosis: Common sites include the coronary arteries,
cerebral arteries, carotid arteries, aorta, renal arteries, and femoral
arteries.
Heart Attacks: Plaques may ulcerate, causing a break in the
protective cap. When this happens, a
combination of fibrous and fatty material is released into the blood
stream. Both the liberated fatty material
and the ulcerated plaque (sometimes called a lesion) can activate platelets,
the body’s clotting cells. A resulting
blood clot or the fatty material itself can lodge in an artery already narrowed
by plaque buildup. If this results in
complete obstruction of a coronary artery, the blood flow to the heart muscle
itself is stopped and heart muscle tissue will die. This is known as a myocardial infarction
(MI), or heart attack.
Congestive Heart
Failure: Many people die from their
first heart attack, but even if they survive, more than 2/3 do not make a
complete recovery. They are left with
some form of disability and a permanently decreased quality of life. Following a heart attack, the heart is weaker
because of lost muscle tissue. When the
heart is so damaged that it cannot sufficiently keep the body systems
functioning it is referred to as “congestive heart failure.” In this situation, an affected individual may
get short of breath easily, be generally fatigued, experience feet or ankle
swelling, or have fluid collect in their lungs.
Strokes: Strokes may also result from
atherosclerosis. They are caused by
rupture or obstruction (as by a clot) of a blood vessel of the brain Strokes may cause part of the body to be
paralyzed, blindness, loss of speech or hearing, and severe personality or
memory problems (depending on which part of the brain is damaged).
Aneurysms: The body’s largest artery, the aorta, is
commonly affected by atherosclerosis, resulting in aneurysms caused by a
weakened lining. If the aorta bursts
death is the almost sure result. Massive
internal bleeding occurs within a few seconds or minutes.
Kidney Damage: If the renal arteries become affected a
person can develop high blood pressure or lose the function of the kidney
entirely.
Leg Pain: Leg pain when walking (“intermittent
claudication”), limping, impotence and gangrene can result from atherosclerosis
in the femoral arteries in the thigh and posterior tibial arteries in the lower
leg and ankle.
Gangrene: If the peripheral arteries supplying the legs
and arms become narrowed, gangrene can result in blood poisoning and death if
amputation is not carried out promptly.
1. Diet
Keep cholesterol levels low.
The higher the cholesterol level
the higher the death rate. A man with a
serum cholesterol over 240 mg/dl has more than 3 times the risk of dying from a
heart attack than a man with less than 200 mg/dl. The increase in risk is most pronounced when
cholesterol levels climb over the 240 mg/dl mark.
Study: Finland—29,000 men and women over a 20-year
period (1972 to 1992). When these
individuals lowered the cholesterol in their diets, lowered their blood
pressure, and stopped their tobacco use, they reduced their heart attack risk
by more than half.
Statistics: Japan is at the bottom of the scale for heart
disease even though their smoking rate is much higher than the U.S. 59 percent of Japanese men and 14 percent of
Japanese women smoke while in the U.S. only 28 percent of men and 23 percent of
women smoke. Why is the Japanese rate of
heart disease lower than the U.S. rate?
It appears to be due to their significantly lower levels of cholesterol.
Atherosclerosis begins early in
life in Western nations. Even teenagers
have been found to have deposits of atherosclerotic fatty streaks on the inner
walls of their arteries. The higher the
blood cholesterol levels are the worse the problem is. Five percent of all heart attacks occur in
people under the age of 40, and 45 percent of all heart attacks occur in people
under the age of 65. The ideal goal for
total cholesterol is 100 plus your age.
Multiple Risk Factor Intervention
Trial (MRFIT): Among 300,000 men studied, the risk of death from heart disease
began to increase when total cholesterol exceeded 150 mg/dl.
Cholesterol’s Subtypes: HDL and LDL
Cholesterol always travels in
different carriers or vehicles in the arteries and veins. Each type of vehicle has a different weight
or density. The heaviest carriers of
cholesterol are called high density lipoprotein (HDL). Some lighter weight carriers are named low
density lipoprotein (LDL), while a still lighter vehicle is called very low
density lipoprotein (VLDL).
HDL actually protects us from heart
disease—it removes cholesterol from the arteries then carries that cholesterol
to the liver, where the body disposes of the fatty material through the
bile.
Study: In men with HDLs greater than 75 mg/dl there
was not a single heart attack, but when the HDL was less than 25 mg/dl, the
risk of heart attack was very high.
Women with an HDL cholesterol greater than 75 mg/dl also had low risk of
heart disease. Those with HDLs less than
35 mg/dl had a dramatic rise in their coronary heart disease risk.
LDL is the so-called “bad
cholesterol” that is linked to an increased risk of heart disease. It is probably oxidized cholesterol within
LDL that is the culprit. The level of
LDL in the blood is an important determinant of the rate at which cholesterol
is deposited in the artery walls.
Ratios of Total to HDL Cholesterol
are better indicator of heart disease risk than looking at either value
alone.
Vegetarians usually have an average
total cholesterol to HDL ratio that is low.
The following guidelines help
achieve this goal:
1. Avoid animal products.
Only animal products contain
cholesterol; plant foods do not. Animal
products also contain saturated fats; most plant foods do not. Both cholesterol and saturated fats
contribute to atherosclerosis, hypertension, and heart disease. Serum
cholesterol is extremely dependent on the type of protein consumed. Animal protein alone (even skim milk protein)
will increase blood cholesterol levels while plant proteins will decrease
cholesterol. Sometimes lowering
cholesterol is difficult or impossible until all animal protein is excluded
from the diet.
2. Avoid
hydrogenated oils like margarine (in subjects who replaced margarine on their
bread by canola or olive oil,
there was a distinct rise in HDL and slight
decrease in LDL).
3. Eat a
high fiber diet consisting of whole grains, fresh fruits and vegetables.
75% of the cholesterol made in the
liver is used to make bile acids. These
bile acids go to the small intestines to emulsify (break down) fats.
Low Fiber Diet: The bile acids are then reabsorbed into blood
stream and go back to the liver where they are reused. There is no need for the liver to use
cholesterol to make more bile acids.
Therefore, the cholesterol in our liver and bloodstream continues to
increase.
High Fiber Diet: Fiber from the food we eat then combines with
these bile acids and they are carried out of our bodies during with the
feces. More cholesterol is transformed
into bile acids to replace the bile acids that are excreted, therefore lowering
the total body pool of cholesterol.
Study: Found that adding 15 grams of fiber per day
to the diet lowered serum cholesterol by 15 percent. Those that consume a high fiber diet have a
65 percent less risk of heart disease.
Soluble fiber as found in oats is best for lowering cholesterol.
Regular use of
garlic helps lower LDL cholesterol and triglycerides.
4.
Add Omega-3 fats to your diet.
Omega-3’s help
to decrease stickiness of platelets, tend to decrease blood pressure, decrease
serum triglycerides, decrease damage from heart attacks, decrease likelihood of
blood vessels blocking up again after angioplasty or bypass surgery.
5. Avoid oxidized cholesterol. Stored foods that contain cholesterol can
combine with oxygen in the air and be “oxidized.” Oxidized cholesterol, even in small amounts,
has a lethal damaging effect on arterial walls. May be found in dried egg and
milk (found in packaged cake mixes, etc.), parmesan cheese, ice cream,
custards, and other products containing eggs, milk, and sugar especially.
6. Keep
triglycerides low.
High triglycerides (fat in the
bloodstream) are a risk factor for heart disease. The following guidelines help lower
triglycerides, boost HDL cholesterol and lower the risk of heart disease: lose weight (down to ideal weight), exercise,
eat less fat, decrease stress, stop smoking, abstain from alcohol, and avoid
sugar.
Tips to maintain a low fat diet:
Avoid fried foods; sauté in water
instead of oil. You may in moderation
safely use Extra Virgin Olive Oil. Olive
oil is monounsaturated and contains the beneficial Oleic Acid. It has the following properties:
►Does
not contribute to atherosclerosis
►Stabilizes blood sugar
curve—polyphenolics in olives can lower high blood sugar
►Increases production of
prostacyclin—protects against the formation of undesirable blood clots and helps
lower high blood pressure
►Does not contribute to tumor
growth
►High
in antioxidants—Vit E, tyrosol & 3-hydrox-tyrosol protects cell membranes
against damage
from free
radicals
►Blocks absorption of cholesterol
and promotes excretion of cholesterol through the bowels.
►Not associated with gallstones
►Protects the stomach and
intestinal lining
Avoid lots of refined sugar - it
increases insulin production which tends to increase fats and cholesterol in
the bloodstream, thereby thickening the blood.
This may contribute to diabetes as well as cardiovascular disease and
hypertension.
Higher amounts of iron stored in
the body increase the risk of heart disease.
Iron is a stimulant of oxidation and may increase the conversion of
normal cholesterol into oxidized cholesterol.
Iron also promotes higher hemoglobin levels which means more oxygen in
the blood. This may provide fuel for the
oxidation that iron stimulates. Higher
hemoglobin levels also make the blood thicker and more likely to clot and
initiate a heart attack. Too much meat
or iron supplements can contribute to this problem.
Antioxidants help prevent oxidation
of cholesterol. These include Vitamins
E, C, and beta-carotene as well as many phytochemicals. Vitamin E has been found to reduce one’s risk
of heart disease. 40,000 men were
categorized as to the amount of daily Vit. E intake. Those who consumed 60 IU per day decreased
their risk of heart disease by 34 to 50 percent. Good sources of Vitamin E are wheat germ,
vegetable oils, legumes, nuts (particularly almonds), whole grains, and green
leafy vegetables. A Harvard Univ. study
found that the consumption of beta-carotene foods reduced cardiac deaths. Over a period of nearly 5 years, some 1300
individuals were studied. Results showed
that an increased consumption of fruits and vegetables high in beta-carotene
decreased subsequent cardiovascular disease deaths. However, taking supplements of beta-carotene
did not lower the risk of heart disease.
7. Keep
homocysteine levels in the bloodstream low.
Homocysteine is one of the amino
acids that the body uses to construct proteins.
Researchers have now found that individuals with high levels of
homocysteine in their bloodstreams are twice as likely to have clogged
arteries. For every 10% rise in blood
homocysteine levels, heart disease risk goes up roughly 10% as well.
A healthy
lifestyle can beneficially decrease blood homocysteine levels.
·
Coffee drinkers and smokers have high blood
levels of homocysteine.
·
Folate and Vitamins B6 and B12 in the diet get
rid of homocysteine by converting it to methionine. Obtaining at least 400 mcg/day of folate in
fruits and vegetables may reduce the risk of heart attack and stroke by up to
40%. Good vegetarian sources of B6 are
bell peppers, sweet potatoes, English walnuts, Brussels sprouts, bananas,
garbanzo beans, sunflower seeds, sesame seeds, and rice bran. Sources of folate are parsnips, pineapple,
oranges, peanuts, green leafy vegetables, legumes, and okra.
·
Excessive amounts of methionine can be converted
by the body to homocysteine. Foods
containing high levels of methionine include eggs, cheese, beef, fowl, and
fish.
2. Exercise Regularly
Exercise has been shown to raise
HDL levels (HDL extracts the bad cholesterol from the arteries and helps
protect the arteries from damage). The
exercise should be active or aerobic to increase the heart rate and deep
breathing. The more aerobic exercise
obtained the greater the rise in HDL.
Exercise strengthens the heart muscle, helps control stress, clears fats
from the blood, and lowers blood pressure by increasing circulation.
3. Lower Stress
Levels
Stress is a
risk factor for heart attacks.
Study: 129 heart attack survivors were questioned
about everything that happened to them in the 26 hours before the attack. Serious stress was experienced by 51
percent. Individuals with pre-existing
heart disease more than double their risk of myocardial infarction when they
get angry. This increased risk continues
for two hours after the anger episode.
Stress can cause heart arteries to go into spasm. As a result, when the body’s clotting cells,
the platelets, try to pass through that artery they are restrained and clot
more easily.
4.
Do Not Smoke
Atherosclerosis is greatly
increased in smokers. Studies show that
those who are between the ages of 45 and 54 and smoke more than one pack per
day increase their risk of a heart attack by over 4 times. Older smokers increase their risk between 70
and 200 percent depending on their age.
Nicotine in cigarettes increases the risk of sudden death by
predisposing to fatal heart rhythm problems.
Smoking causes platelets to become stickier and clump together in an
unnatural way; in the coronary arteries or blood vessels going to the brain,
this could stop the flow of blood affecting control of limbs, speech, and even
resulting in sudden death. Smoking
greatly increases your risk of a stroke.
5. Avoid Alcohol
Alcohol is clearly linked
cardiovascular problems:
·
It may produce High blood pressure.
·
Alcohol increases the risk of both common types
of strokes: Hemorrhagic stroke caused by
bleeding in and around the brain, and the thrombotic stroke caused by blood
clots.
·
Cardiomyopathy (heart muscle disease): Heart muscles do not work as hard as they
should because of alcohol consumption.
As a result, fluid builds up in the lungs and then in other parts of the
body.
·
Cardiac arrhythmias may be minor (fluttering
sensations in the chest) or major (sudden death).
·
May cause significant triglyceride elevation.
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