Prevention Does Work: A Guide to a Healthy Heart

iUniverse, Inc.

Contents

Preface..............................................................viiIntroduction.........................................................ixDefinitions..........................................................2Concepts: Cholesterol Risks and Treatment............................8Concepts: Nutrition in Preventing Heart Disease......................10Diets for Heart Health...............................................12Diets for Losing Weight..............................................15Nutrition Issues Regarding Certain Foods.............................17Nutrition Issues Regarding Food Supplements..........................21Dietary Tips.........................................................25Other Prevention Issues..............................................27Special Patient Populations..........................................30Drug Therapy In Prevention: Focus On Cholesterol.....................35Introduction.........................................................44The Pantry...........................................................45Index................................................................93References...........................................................95

Chapter One

By Paul Goldfinger, MD, FACC. Cardiologist

Definitions

A cute myocardial infarction ("heart attack" or "M.I.") is a serious and sudden event that results in injury and possibly permanent damage to heart muscle. An "M.I." occurs when a fatty plaque within the inner lining of a coronary artery becomes acutely disrupted. This results in clotting and obstruction of blood flow. It may have taken many years for the plaque to develop, and the narrowing often isn't severe prior to the event, but the acute injury to the plaque is what sets off a cascade of events within the artery which results in total blockage. There are impressive therapies available now for the treatment of acute myocardial infarction

Arteries are blood vessels that carry oxygen rich blood from the heart to organs and tissues throughout the body.

Atherosclerosis is a condition in which fatty deposits (plaque) build up inside the lining of arteries. The plaque deposits are complex and consist not only of fat, but also of scar tissue, calcium, inflammatory cells, and muscle tissue. The risk of acute complications, such as heart attack, is particularly great if the plaque consists of soft mushy fat deposits. If the buildup is severe enough to cause obstruction to blood flow, then symptoms will often develop. Atherosclerosis can involve the coronary arteries (causing heart attack or angina), the carotid arteries in the neck (causing stroke), or the leg arteries (causing pain with walking, i.e. claudication). Atherosclerosis can occur in other areas as well, such as the arteries to the kidneys or the intestines, causing kidney failure or abdominal pains. It takes many years for plaque to develop, and the earliest sign (the fatty streak) can be found in children as young as 10 years old. Plaque usually develops slowly and silently (i.e. without any symptoms), but early detection is often possible.

ATPIII is the Adult Treatment Panel of the National Cholesterol Education Program which provides guidelines for cholesterol management.

BMI (body mass index) is a number that tells you if you are overweight, obese or normal. It is obtained from a chart that utilizes your height and weight. These charts can be found on the internet ( http://www. nhlbisupport.com/bmi/ ) Your doctor should have a copy of this chart. Twenty seven or less is a normal BMI. (NEJM 10/7/99). The lowest risk regarding weight is associated with a BMI of twenty five or less.

Cardiovascular refers to the entire system of heart and blood vessels (arteries and veins).

Cardiovascular disease (CVD) occurs when atherosclerosis compromises arterial blood flow and can involve the heart, brain, kidneys, legs and/or other vital areas of the body.

Cholesterol is a fatty substance found in all animal products, and the level in a person's blood relates to the amount of cholesterol ingested as well as to the body's ability to manufacture the substance in the liver. Genetic and dietary factors determine how much cholesterol is produced in the body. Vegetables do not contain cholesterol.

Coronary risk factors are the characteristics which make a person prone to develop coronary heart disease (CHD) and related cardiovascular disorders. They include high fat diets, high blood pressure, smoking, obesity, heredity, lack of exercise, diabetes, and abnormal blood cholesterol levels (especially high LDL and low HDL).

Coronary artery disease/coronary heart disease/atherosclerotic heart disease (CHD, CAD, or ASHD): This disease occurs when the coronary arteries (the arteries that supply the heart with oxygen) become partially or completely blocked by atherosclerotic plaque. A person with CHD may develop chest pains (angina), "heart attack" (myocardial infarction) or other complications, but it is also possible to feel fine and still have this condition (i.e. "silent" heart disease).

Complex carbohydrates are found in whole wheat flour, brown rice, potatoes, bran, legumes, soy, fruits and vegetables. These are "good carbs" because these foods contain substances that protect against cancer and heart disease.

CRP (C reactive protein). This blood protein is a "marker" for inflammation in the body. A blood test is available to measure CRP (high sensitivity CRP blood test), and a high reading has been correlated with risk for coronary disease. Increased risk is associated with levels above 2-3 mg/L. A level less than 1 mg/L is considered to be low risk.

HDL cholesterol (high density lipoprotein) is the "good cholesterol." This protein particle is responsible for "reverse transport" of cholesterol, which means that the cholesterol is carried away from the arteries and back to the liver for metabolism and removal from the body. This is the only lipid number that should be higher rather than lower. Levels that are low (i.e. under 40 mg/dl) are associated with increased heart attack risk, even if total cholesterol levels are normal.

Hyperlipidemia refers to elevations in blood lipids, such as hypercholesterolemia, which refers to high cholesterol levels, or hypertriglyceridema, which refers to high triglyceride levels.

Hypertension is a disease where the pressure in the arteries is too high (i.e. high blood pressure). The top number is the systolic, while the bottom is the diastolic.

Inflammation and/or infection in the body may be a risk factor, such as occurs with periodontal disease.

LDL cholesterol (low density lipoprotein) is the "bad cholesterol." LDL cholesterol becomes oxidized in the bloodstream, which means that it is chemically converted to a form that can stick to the interior lining of arteries and form plaque. It is the most important number in terms of risk, and that risk correlates with the degree of elevation. High levels relate mostly to dietary and genetic...