Please note that this was previously published at http://www.wendykeslick.com and at elephantjournal. I am going to post some of my older posts as get this page set up and soon fresh thoughts and ideas will be forthcoming. Enjoy!
In striving for a high-quality life filled with vitality and the hope of longevity, we must always consider the heart and the entire cardiovascular system.
According to the World Health Organization (WHO), cardiovascular disease (CVD) is the leading cause of death around the world each year. WHO predicts that by the year 2030 more than 23 million people will die annually from CVD.
Considering that many forms of CVD are preventable, what can we do to reduce the number of deaths?
Before we get started, let’s take a moment to explore two common forms of CVD—atherosclerosis and coronary artery disease.
Atherosclerosis is a progressive dynamic disease characterized by the accumulation of lipids and fibrous elements in the large arteries—a dynamic and gradual process of endothelial dysfunction and chronic inflammation. Its major clinical diseases, including coronary heart disease (CAD) and cerebrovascular disease, account for around half of all deaths occurring annually.
Factors associated with atherosclerosis include
- Physiological factors—elevated level LDL/VLDL cholesterol, reduced HDL cholesterol, elevated blood pressure, diabetes mellitus (DM), obesity, metabolic syndrome, elevated levels of homocysteine, elevated levels of haemostatic factors, systemic inflammation
- Genetic factors—family history, gender (male)
- Lifestyle factors—depression, stress, high-fat diet, smoking, low antioxidant levels, infectious agent, harmful use of alcohol, physical inactivity
The process of atherosclerosis involves cells of the vascular wall, monocytes, T-lymphocytes, pro-inflammatory cytokines, chemokines and growth factors, which stimulate the acute phase protein production, causing damage and eventually plaque rupture. Their levels have been found as a way to predict cardiovascular risk in a variety of clinical settings. Both endothelial function impairment and vascular wall inflammation play a key role in the atherogenesis and in the stability of the established plaque, and this provides insight into novel therapeutic targets. Therefore, endothelial dysfunction and inflammation become promising targets for both primary and secondary prevention of coronary heart disease (CAD).
Coronary Artery Disease
Coronary artery disease (CAD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart. It’s the most common type of heart disease, is the main cause of mortality in developed countries and results from the development of atherosclerosis in one or more coronary arteries.
There are several types of CAD—one type is chronic ischemic heart disease (stable angina, variant angina, vasospastic angina and silent myocardial infarction ischemia). Stable angina (typical angina) is chest pain or discomfort that typically occurs with activity or stress.
Another type of CAD is acute coronary syndrome, which includes unstable angina and acute myocardial infarction. Unstable angina (atypical angina) is angina pectoris, which is caused by the disruption of an atherosclerotic plaque with partial thrombosis and possibly embolization or vasospasm.
Improving our cardiovascular health
The beneficial effects of regular exercise in the primary prevention of ischemic heart disease are clear. This is due to the effects of exercise on coronary risk factors. For example, significant reductions in LDL cholesterol and increases in HDL cholesterol with exercise have been confirmed in many clinical trials, and a dose response relationship exists with the increase in HDL being related to the amount of physical activity.
It has been shown that individuals who are physically more active appear to have lower rates of all-cause mortality, most likely due to a decrease in chronic diseases, including CAD. This low rate may result from an improvement in cardiovascular risk factors, enhanced fibrinolysis, improved endothelial function and decreased sympathetic tone.
Regular endurance and resistance exercise leads to alterations in the cardiovascular, musculoskeletal and neurohormonal systems, which result in a training effect that allows an individual to do increasing amounts of work at a lower heart rate (HR) and blood pressure (BP), and this effect is advantageous in patients with CAD, because it allows increased activity with less ischemia.
Other positive effects of exercise include weight loss, decreasing in blood pressure (BP) and lower insulin resistance. Regular exercise leads to increase in function capacity, a decrease in myocardial oxygen demand and increased ischemic threshold which lead to reduce mortality rates and fewer symptoms of CAD.
In addition, exercise training, as part of cardiac rehabilitation, is in routine clinical use for secondary prevention of coronary heart disease. Cardiac rehabilitation is safe and results in an important reduction in all-cause mortality. The specific mechanisms by which physical activity reduces CAD mortality are not known. However, modification of atherosclerotic risk factors does not fully explain the benefits that have been observed.
The Centers for Disease Control (CDC), the American College of Sport Medicine (ACSM) and the United States Surgeon General recommend that adults exercise for 30 minutes at moderate-intensity levels on most, if not all, days of the week to achieve a weekly energy expenditure of at least 1000 kcal. These statements stem from evidence stating that regular moderate physical activity provides many health benefits. In addition, these recommendations stress that physical activity can be accomplished in multiple short intervals—which may be more feasible for many individuals—rather than continuous 30-minute exercise sessions, however, low intensity exercise should be performed more frequently and for longer duration.
The bigger picture that includes nutrition, emotional well-being and the mind-body connection
An example of an effective lifestyle program that can help reduce the risk of heart disease and even reverse CAD, is the Ornish Program, developed by a team of researchers led by Dean Ornish, MD. Clearly ahead of his time, for the past 35 years, Ornish was able to show that beyond the mainstream accepted risk factors of heart disease that include high cholesterol, smoking, triglyceride levels, and oxidized LDLs, there are other factors that must be addressed including low-self esteem, hostility, emotional stress and isolation.
Instead of looking strictly at dietary changes as a means of prevention and treatment for CVD, he developed a program that incorporated a more synergistic model of wellness that takes a more holistic approach. This strategy seems to be the only lasting solution for patients with coronary heart disease, and it is supported by the contemporary holistic medical theory.
A study that was part of the Multicenter Lifestyle Demonstration Project examined both medical and psychosocial aspects of patients with coronary artery disease. The participants switched to a low fat, whole foods and plant based diet, exercised, learned stress management and received social support. In addition, their partners were also asked to participate in an effort to maximize the effect on the family unit. Patients showed significant improvements in their diet, exercise and stress management practices and these improvements were maintained over the 12-month period of this study. Both women and men also showed significant medical (e.g., plasma lipids, blood pressure, body weight, exercise capacity), psychosocial and quality of life improvements. This study showed that a multicomponent lifestyle change program can be implemented successfully and repeated at various sites.
Some specifics relative to diet
The lipid hypothesis (high cholesterol theory) comes up short in its effort to paint a complete picture of the connection between nutrition and cardiac health. For example, the Lyon Diet Heart Study compared the results of the American Heart Association endorsed diet to the Mediterranean Diet on a population of heart attack survivors. At the end of the study both groups had very similar cholesterol levels; however, second heart attacks, unstable angina and heart disease were experienced far less by he test subjects who were on the Mediterranean Diet.
Other research supports these results, as well. For example, a 10-year study found that adherence to a Mediterranean diet and healthful lifestyle was associated with more than a 50% lowering of early death rates. And a 5-year study of 7,447 people reported that the Mediterranean diet reduced the risk of heart disease in people at high risk by “about 30 percent” when compared with individuals on just a low fat diet.
This is possibly due to the correlation between a diet rich in fresh vegetables and fruit and the reduced inflammation that otherwise can lead to the development of heart disease. Inflammation is further reduced by the essential fatty acids that are found in nuts, seeds and fish. This could also explain why the French, with their elevated intake of rich, high-cholesterol foods, have one of the lowest rates of heart disease in the developed world.
The effects of nutrition on our health have become more known with the release of documentaries such as Forks Over Knives, Hungry for Change, Diet for a New America, Super Size Me, and more. Hopefully the popularity of such films will lead to a culture of better food choices for our health.
Another way to reduce inflammation in the arteries is by reducing insulin levels. This can be done by reducing sugar intake and high-glycemic carbohydrates such as pasta, short-grain rice, white bread and instant oatmeal.
Effects of mind-body techniques such as meditation, breathing exercises and yoga have been show to assist in reversing heart disease.
Studies at both Ohio State University and Georgia State University concluded that yoga is an effective way to reduce the levels of the cytokine interleukin-6 (IL-6), which is a marker for chronic inflammation. In addition, yoga has been shown to reduce blood pressure via the cortisol reduction and balancing of the central nervous system. Through various asanas (yoga postures), heart and lung function can be improved.
Also, research from the Ornish Program has shown that when patients with heart ischemic disease with severe atherosclerosis change their lifestyles and engage in meditation, the constricted and narrowed blood vessels can begin to expand again. In the controls, the blood vessels continued to constrict, and eventually these patients will need bypass surgery to graft new vessels in their hearts.
The effect of emotional healing on other tissues in the heart region
When a person heals emotionally and these emotions are connected to blockages in the heart region of the body, all tissues in this region might be affected. Since the coronary vessels are the weakest link, they break down first. When the person integrates the feelings giving informational disturbance to the tissues, the tissues will heal and so the coronary vessels can open again as the aging cells receive correct information on structure and functioning from the information system of the body.
By incorporating mind-body techniques into our daily life, we can reduce our stress levels and break free of the fight-or-flight syndrome. When we do this, we reduce the amount of cortisol and other stress-hormones being released by our adrenal glands. Conversely, if we were to remain in a state of stress, the adrenal glands would continue to pump out cortisol and other stress-hormones that negatively impact our health by increasing blood pressure and heart rate, causing arterial constriction and possibly even leading to the formation of blood clots.
As we read through the research related to CVD, we are continually reminded that as individuals we are empowered to make a commitment to a path that will lead us on our own personal journey to health. By adopting a lifestyle that combines exercise, stress-management, optimal nutrition and a dedication to embracing mind-body techniques, we become well-equipped to prevent or treat diseases many diseases including those of the heart.
Salaheddin Sharif, MD, MS, RCEP, is a sport medicine physician and registered clinical exercise physiologist at ACSM. He is a lecturer at Physiology Department, School of Medicine, Benghazi University in Libya, where he teaches theory and practical classes for medical, as well as dental, pharmacy and public health students within the university and various affiliated centers. He includes sports as essential part of his life and has earned a Black Belt of International Karate Organization Kyokushin Kaikan – I.K.O. Matsushima. He is determined to obtain his PhD in the United States. He also founded a nonprofit called Libyan American Friendship Association. Volunteering for this organization allows him to be an active participant in creating a democracy in Libya.