The next time you are in a room full of people, be it at work, in church, at a party or elsewhere, look around you. Half the people you see in that room will die of heart disease or stroke (collectively, cardiovascular disease. With a bit of good fortune, they will wait to die until they have reached a ripe old age, but many are not so fortunate. Yet as we understand more about the causes of cardiovascular disease, we are better able to keep many of those deaths from being “premature.”
When we speak of cardiovascular disease, we are speaking of an array of diseases that affect the heart and blood vessels. Those diseases include blockages of blood vessels which can lead to heart attack and stroke, abnormal heart rhythms, birth defects affecting the heart, thickening of the heart muscle (cardiomyopathy), heart infections and diseases that affect the valves of the heart. These conditions can separately or in combination lead to such complications as heart failure (commonly known as “congestive heart failure” or CHF), heart attack (myocardial infarct), stroke, aneurysm (in which the wall of an artery will bulge and weaken, potentially leading to a rupture in the wall), peripheral artery disease (in which blood flow is diminished usually first to the legs and feet) and sudden cardiac arrest (stoppage of the heart).
Although half of us will eventually succumb to cardiovascular disease, statistically that disease will not be a cardiomyopathy or a birth defect of the heart. Heart infections and diseases of the valves of the heart are also relatively rare when compared with blockages of blood vessels and abnormal heart rhythms. In the interest of simplicity, then, lets focus on blood vessel blockage and abnormal heart rhythms.
Blood vessel blockage occurs because we lay down plaque in the walls of our arteries. If that plaque forms in the carotid arteries, it puts us at increased risk for stroke. If that plaque forms in the aorta (the artery exiting the heart and carrying blood to such structures as intestines, kidneys and our legs) we are at risk for developing an aneurysm or developing peripheral artery disease. If that plaque forms in our coronary arteries (the arteries that supply the heart itself) we are at risk for heart attack. Studies have shown that the process of plaque formation begins as early as six months of age. Plaque forms when a transport protein called “low-density lipoprotein” (LDL) carries cholesterol to the walls of an artery and deposits the cholesterol there. Fortunately, we also have a transport protein called “high density lipoprotein” (HDL) which carries cholesterol away from the plaque formation to the liver where it is removed from the system.
Over the years much confusion has arisen about the importance of controlling cholesterol intake in our diet. That confusion stems in part from the fact that roughly 85% of the cholesterol we measure in our systems is cholesterol we manufacture, and we can control only about 15% of our total cholesterol through our diet and our activities. In other words, some of us are born to have higher cholesterol than others. However, controlling that 15% through diet and exercise may be critical. Diet must be focused on controlling weight, because obesity itself is a significant risk factor, and on limiting saturated fats (found in meat and full fat dairy products) and particularly transfats (found in some margarine, store bought cookies and cakes), while at the same time increasing your intake of food items that actually help lower cholesterol and LDL, such as oatmeal, oat bran and high fiber foods, fish and omega-3 fatty acids (the fish oil capsules have not been proven to work as well), walnuts, almonds and other nuts (in moderation because nuts do add calories), olive oil, and foods with added plant sterols or stanols such as some margarine, orange juice and yogurt drinks.
The role of exercise in keeping arteries open offers no confusion. One need go no farther than to take a look at the Tarahumara Indians who live in the Copper Canyon in Mexico. The traditional Tarahumara enjoyed a high percentage of red meat in their diet, much as many Americans do, but unlike most of us, the Tarahumara put that meat on the table by running it down, often running twenty miles or more a day to catch a bite to eat. But for the traditional Tarahumara, heart disease was virtually non-existent. Autopsy studies of Tarahumara who died from other causes (they do share the canyon with particularly unfriendly marijuana growers and drug smugglers), have revealed that their diet does produce cholesterol plaques in their coronary arteries, but with all that running, the diameter of their coronary arteries is about three times the diameter of the average American coronary artery. The other benefit of regular exercise is that exercise, like oatmeal and olive oil, improves the HDL/LDL ratio.
Do I hear you say, “That's all well and good, but there's something funny going on in my chest. What should I do now!” A fluttering in the chest or an irregular heart beat or pulse may be telling you that you have something wrong with the electrical conduction system of the heart, the pacemaker cells and fibers in the heart that control heart beat. The problem may be as innocent as a premature ventricular contraction which generally has no long term consequences or as dangerous as ventricular fibrillation, which is Mother Nature's way of telling you the game is up. As most of us do not keep an EKG machine at home, heart irregularities should be evaluated by your doctor. Once a diagnosis is made, treatment can be as simple as reassuring you that you have something quite innocent to more complex interventions.
If that “something funny” in your chest happens to be chest pain, then you must quickly decide if you are dealing with an emergency and how should you respond to that emergency. The typical picture of the chest pain of heart disease (angina) is a pain that comes on with exertion and is relieved by rest. The picture often painted is of a pain in the chest going down the left arm. Don't be fooled by the “typical” picture. Because the heart has no pain fibers of its own to let you know when it is hurting, it has to borrow pain fibers from elsewhere. So, commonly, it will use pain fibers involving the chest and the left arm. But the heart is not limited to using those fibers. Heart pain may manifest itself as a pain and tightening in the throat and jaw or in the back. Heart pain is not limited to the left arm and may borrow pain fibers from the right arm. It may mimic “gas,” though you won't get any relief by burping or belching. The nature of the pain is a tip-off as well. As I mentioned above, angina, which is a warning that you may be headed for a heart attack, usually comes on with some exertion and is relieved by rest. Once you are having a heart attack, the pain is not relieved by rest. On the other hand, if you find an area of tenderness to the touch along the sternum, or if you notice that taking a deep breath changes the nature or intensity of the pain, it is likely that you are not having a heart attack. When in doubt, call 911. Many experts also advise that you chew an aspirin as quickly as you can get to one. You certainly do not need to be macho at a time like this and drive yourself to the doctor's office or to the hospital. Your chance of survival goes up significantly in professional hands—in the back of an ambulance rather than the family car.