February is American Heart Month. And if, like most people, you seldom give thought to your ticker – maybe it’s time to start. According to the Centers for Disease Control and Prevention, heart disease is the leading cause of death for both men and women in the United States, accounting for about 600,000 deaths – or one in every three deaths – in this country each year.

The term “heart disease” encompasses a variety of heart conditions, but the most common is coronary heart disease, also called coronary artery disease (CAD). CAD develops when a waxy cholesterol plaque builds up in your coronary arteries, the major blood vessels to your heart.

For many years, the theory of how plaques develop and cause problems within the arterial walls revolved around high blood cholesterol levels caused primarily by intake of saturated fats and high cholesterol foods, said Stephen Sinatra, MD, board certified cardiologist and co-author of The Great Cholesterol Myth. “This whole theory of how heart disease develops came out during the cold war when Eisenhower had a heart attack. Heart disease was on the rise then, and Eisenhower loved his bacon and eggs.”

At the time, according to Sinatra, a researcher named Ancel Keys presented a correlation between deaths from coronary heart disease and the consumption of fat among populations living in six countries. Only much later was it determined that Keys selected only those countries that fit his hypothesis, which was dietary fat consumption led to heart disease, and avoidance of dietary fat, especially saturated fats, was heart healthy.

This theory stuck – for many years, said Sinatra. “But we convicted the wrong man,” he insisted. “We need saturated fats for our lungs and our brains and for the transmission of impulses through the nervous system. And we need cholesterol in our skin to synthesize sunlight to vitamin D.”

Instead of vilifying saturated fats, said Sinatra, we should be focusing on the most important cause of heart disease – systemic inflammation. If you’ve ever had an athletic injury, you’re already familiar with painful inflammation with its redness, swelling and warmth that occurs as a result of immune system response to the injured area. But inflammation that occurs within the entire body, called “chronic systemic inflammation,” can wreak havoc in the body. It affects not just one area, but many internal organs and systems, including the blood vessels. And when the blood vessels are inflamed, they allow cholesterol to penetrate through the artery wall to form plaque deposits. Once there, the plaque oxidizes and becomes inflamed, causing a rupture in the artery wall, which leads to the formation of blood clots that may obstruct the flow of blood to the heart and cause a heart attack.

Diet definitely plays a factor in systemic inflammation, acknowledged Sinatra. Fats such as trans fats, for example, found in some margarines, snack foods like cookies or muffins, and fried foods like donuts or French fries – can increase inflammation. Omega 6 oils (found in safflower, sunflower, corn and sesame oils), while important in small amounts in the diet, can also promote inflammation. And sugary foods and drinks are huge players in the inflammatory process.

Certain health conditions are associated with systemic inflammation, too, said Amy L. Doneen, ARNP, medical director of the Heart Attack and Stroke Prevention Center in Spokane, Washington, and co-author of soon to be released book, Beat The Heart Attack Gene. “Numerous pathologies, including insulin resistance, periodontal disease, autoimmune inflammatory diseases such as rheumatoid arthritis and many others, increase inflammation,” she said.

But diet and inflammation are not the only culprits involved in the development of CAD, added Doneen, who explained that there’s a strong genetic component to heart disease, too. According to Doneen, genetic studies and numerous epidemiological studies have identified genetic markers for CAD, including a form of cholesterol that is a subtype of LDL (bad) cholesterol. This type of cholesterol, called Lipoprotein (a), or Lipo (a), is linked to genes on chromosome 6, and is a strong risk factor for CAD and stroke.

What to do to reduce your risk of CAD? Here are some important steps outlined in Doneen’s book:

Know your family history. Family history of cardiovascular disease is one of the most important risks to keep in mind, with studies finding as much as a threefold increase of CAD in those with a first-degree relative with the condition.

Get regular medical care, including blood pressure and cholesterol screening, weight checks and testing for insulin resistance. If you have high blood pressure, diabetes or prediabetes, follow the treatment plan your doctor has recommended to keep things under control. And dental care, including cleanings, should be done ideally every three months to prevent periodontal disease.

If you have chronic conditions that are linked with inflammation, such as hypertension, diabetes, rheumatoid arthritis or periodontal disease, if you have a first-degree relative with CAD – or if you are simply want to lower your risk for CAD – consider a consultation with a physician who specializes in advanced lipid testing, as well as testing for systemic inflammation, blood vessel plaque formation and genetic markers for CAD. Many of these tests are reasonably priced and can help you and your doctor to make a plan to reduce your cardiovascular risk before problems start.

Keep your weight down. Obesity is linked with insulin resistance and with inflammation. The best diet for most people is a Mediterranean-style diet that emphasizes plant-based foods, such as fresh fruits and veggies, nuts, whole grains, legumes and olive oil, along with moderate amounts of cheese, yogurt, fish and wine. Adding one or two squares of dark chocolate (at least 72 percent cocoa) daily can help to reduce cholesterol and blood pressure, and stave off insulin resistance.

Don’t smoke.

Exercise regularly. Workouts don’t have to be strenuous or long to benefit the heart. Even 15-20 minutes of daily walking can do wonders. Better yet, alternate bouts of higher intensity exercise (like jogging) with walking. Interval training helps to lower weight more effectively and improve cholesterol levels, as well as decreases your risk for insulin resistance.

Sleep 6-8 hours a night. Research links obesity, diabetes and heart attack risk with sleep deficit. MS&F


According to Janet Bond Brill, PhD, RD, LDN, a nutrition and fitness expert and author of Cholesterol Down, there are natural ways to lower your cholesterol. “Statins are a miracle drug, but they put a Band-Aid on the problem. You can get your cholesterol down with the most powerful medication there is – what you choose to put in your mouth, and exercise,” she said. Here are nine heart healthy things Dr. Brill suggests you put in your mouth each day:

Oatmeal – Preferably steel cut, is high in soluble fiber, which reduces the body’s absorption of cholesterol from the intestines, lowering your LDL (bad) cholesterol levels.

Unsalted raw almonds – Almonds are an amazing source of healthy fat and disease-busting antioxidants. And research shows that a daily handful of the tasty nuggets can lower your LDL numbers.

Ground flax seed – Flax seed’s health benefits come from high fiber and heart-healthy omega-3s, and may help reduce both total blood cholesterol and LDL.

Psyllium husk – Many studies suggest that diets high in water-soluble fiber such as psyllium husk can lower your triglyceride levels. And psyllium may also help to stabilize blood sugar levels, a definite plus for heart health.

Beans – Beans have cholesterol-lowering fiber, but they also contain phytonutrients that may play key roles in cholesterol reduction.

Apples – Polyphenols, antioxidant compounds found in apples, may help inhibit the oxidation of LDL cholesterol, which is the process that leads to plaque buildup in the arteries. Apples are also a good source of soluble fiber.

Plant sterols and stanols – Plant sterols and stanols are naturally occurring compounds found in plant cell membranes. They are structurally similar to the body’s cholesterol, so when you consume them, they compete with cholesterol for absorption in the digestive system, helping to block cholesterol. The National Cholesterol Education Program recommends that those with high cholesterol consume 2 grams of plant sterols and stanols daily, which can be found in fortified milk, yogurt or juices or in supplement form.

Soy protein – Numerous studies have demonstrated that including soy protein in the diet, especially in place of animal proteins, reduce both LDL and total cholesterol, especially in those with high cholesterol levels.

Garlic – Some studies have suggested that garlic can have a modest effect on lowering LDL levels.


The American Heart Association and the American College of Cardiology (AHA/ACC) recently released new cardiovascular prevention guidelines that have some medical professionals up in arms, particularly concerning the use of cholesterol-lowering statins. According to the authors, the guidelines are based upon the best available scientific data. In short, the new lipid lowering guidelines move away from statin treatment based solely upon targeted levels of LDL (bad cholesterol), HDL (good cholesterol) and triglycerides. Instead, the AHA/ACC recommend statin therapy for the following groups:
Those with confirmed heart disease
Those with LDL levels greater than 190
People ages 40-75 who have diabetes
People with a 10-year risk of heart disease greater than 7.5 percent, based upon a new risk assessment calculator that uses an equation to determine risk based upon race, gender, age, total cholesterol, HDL cholesterol, blood pressure, use of blood pressure medication, diabetes status and smoking status.

Although many who have confirmed heart disease, high LDL levels and diabetes are already using statins, adding the final group (those with a 10-year risk of heart disease greater than 7.5 percent), would amount to about 31 million people in all. That means a full one third of America’s population between the ages of 40-65 are being placed on statins, said John Higgins, MD, a sports cardiologist at the University of Texas Health Science Center at Houston. This is not entirely agreeable to him. “For people with confirmed atherosclerotic cardiovascular disease, statins appear to be very beneficial,” he said. “But for those who do not have diagnosed coronary disease, it is a little more difficult to put some of these on a medication for life that is expensive and that has significant side effects.”

Amy L. Doneen, ARNP, medical director of the Heart Attack and Stroke Prevention Center in Spokane, Washington, and co-author of soon to be released book, Beat The Heart Attack Gene, agrees that the guidelines may miss the mark, stating that there are many root causes of vascular disease that statin therapy won’t help. She said some people who have high cholesterol but not vascular disease or vascular inflammation may be treated needlessly. “We use statin therapy for individuals who have plaque in their arteries, not simply because someone has high LDL levels, because it is one of the best drug classes to treat vascular inflammation,” she said. “These guidelines have the potential to place many people on moderate to high dose statin therapy who don’t have arterial plaque and contrarily, miss many of the root causes of vascular disease that cannot be treated with isolated statin therapy.”

According to the AHA, the new cardiovascular prevention guidelines are simply a tool to encourage those who may be at high risk for heart disease to discuss the risks and benefits of statins with their physician. Which is a good plan, said Dr. Higgins, because statins, like any drugs, have side effects that may be uncomfortable. And for athletes, he added, “statins may impair the exercise training effect on maximal oxygen capacity and muscle adaptations.”

While you may ultimately need a statin, said Dr. Higgins, “exercise, diet and avoiding unhealthy habits are still my first line treatment for many. If we could do a better job with lifestyle changes, we could cut down on the use of statins.” MS&F

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