The incidence of coronary heart disease statistics. Coronary artery disease
Health ecology: If this epidemic is so widespread yet preventable, why aren't we doing something?..
A chapter from Michael Greger's book How Not to Die. Food that can prevent and cure diseases"
Imagine if terrorists created a biological weapon that would spread without barriers and mercilessly kill an estimated 400,000 Americans every year. This is equivalent to one person every 83 seconds - every hour, around the clock, year after year.
This pandemic would not leave the front pages of the news. The best military and medical minds would be busy finding a cure for this plague. And the work would not stop until the terrorist attack was stopped.
Fortunately, we don't lose hundreds of thousands of people every year to a preventable threat... or are we losing?
In fact, we are losing.This biological weapon is not a lethal germ, but it kills as many Americans every year as have died in all previous wars. It can be stopped - but not in the laboratory, but right in our grocery store, in the kitchen and at the dinner table.It does not require vaccines or antibiotics. A simple fork is enough.
So what's going on? If this epidemic has spread so widely and is still preventable, why are we not doing anything?
The killer in question is coronary artery disease, and it hits just about everyone who eats standard American food.
Our main killer
The #1 killer in the US is fatty deposits on the walls of arteries, called atherosclerotic plaques.
Most Americans who eat regular food have plaque buildup inside coronary arteries- blood vessels that surround the heart like a crown and supply it with oxygen-rich blood.
Plaque formation is called atherosclerosis - from the Greek words athere (slurry) and sklerosis (hardening), this is the hardening of the arteries with pockets of cholesterol gruel that accumulate under the inner lining of the vessels.
This process takes decades, plaques gradually narrow the space for blood flow.
Restricted blood supply to the heart muscle can lead to chest pain and tightness that occurs with exertion and is known as angina pectoris. If the plaque ruptures, it can form inside the artery blood clot (thrombus). This sudden disruption of blood flow can cause heart attack (heart attack) damaging or even killing part of the heart.
When it comes to heart disease, you may think of friends or loved ones who suffered from chest pain and shortness of breath for many years before their death. However, for most Americans who die suddenly from coronary heart disease, the first symptom of the disease may be the last. It is called "sudden coronary death" . Death occurs within an hour of the onset of symptoms.
In other words, you may not even realize you're taking a risk until it's too late. You can feel great, and an hour later you can die. That is why it is so important to prevent coronary heart disease until you get to know it better.
Patients often ask the question, "Isn't heart disease a consequence of aging?" I understand very well where this common misconception comes from. The heart beats billions of times in a lifetime. Isn't the motor supposed to stall sometime? No.
There is a wealth of evidence to show that coronary heart disease was previously unheard of in many parts of the world. For example, in the famous China Study (China-Cornell-Oxford project), scientists looked at eating habits and frequency chronic diseases hundreds of thousands of Chinese people living in rural areas.
For example, in the province of Guizhou, with a population of 500,000, no death from coronary heart disease in men under the age of 65 was recorded for 3 years.
In the 1930s and 40s, Western-educated doctors established a large network of missionary hospitals in sub-Saharan Africa. They noticed that many of the chronic diseases ravaging the countries of the so-called developed world were absent in much of the African continent. In Uganda, an East African country of many millions, coronary heart disease was "nearly absent."
Maybe the inhabitants of these countries simply died too early, not living up to heart disease? No. Doctors compared autopsy data from Uganda and the US in people who died at the same age. Scientists found that out of 632 autopsies in St. Louis, Missouri, 136 had heart attacks. What about 632 people of the same age in Uganda? Just one heart attack. Ugandans were 100 times less likely to have heart attacks than Americans. The doctors were so amazed that they looked at 800 more deaths in Uganda. Of more than 1,400 autopsies, only 1 case revealed one small healed scar in the heart, that is, the heart attack was not fatal. Throughout industrialized countries, coronary heart disease is the leading cause of death. In central Africa, CHD was so rare that it killed less than 1 in a thousand.
Immigrant studies show that resistance to heart disease has nothing to do with African genes. When people move from low-risk areas to high-risk areas, incidence increases dramatically as diet and lifestyle are adopted in the new place of residence. The exceptionally low incidence of CAD in rural areas of China and Africa is associated with exceptionally low cholesterol levels in these populations.
Although the diet in China and the diet in Africa are different, they have something in common: both diets are based on plant foods such as grains and vegetables. Eating a lot of dietary fiber and very little animal fat, people have an average cholesterol level below 150 mg/dL (6, 7), the same as people on a plant-based diet.
What does all of this mean? This means that ischemic heart disease isit is the result of a choice.
If you look at the teeth of people who lived 10,000 years before the invention of the toothbrush, you will see that they have almost no cavities. They never used dental floss - and yet they did not have cavities. This is because at that time there were no candies yet.The reason people get cavities is because the enjoyment of sweets outweighs the expense and discomfort of dental treatment.And if we are talking about atherosclerotic plaques in the arteries? This is not plaque removal. This is a matter of life and death.
Heart disease - main reason from which we die. It is up to each of us what to eat and how to live, but isn't it better to make a conscious choice, having studied the predictable consequences of our actions?Just as we can avoid sugary foods to keep our teeth healthy, we can avoid trans fats, saturated fats, and other artery-clogging foods.
Let's take a look at how coronary heart disease develops over the course of a lifetime and learn how simple dietary choices can prevent, stop, and even cure the disease.
Is fish oil a myth?
According to the American Heart Association guidelines, people at high risk for coronary heart disease should consult their doctor about taking omega-3 fish oil supplements. Thanks to them, fish oil capsules have created a multi-billion dollar business. Americans consume over 100,000 tons of fish oil every year.
What does science say? Can fish oil supplements prevent and treat coronary artery disease, or is it a fairy tale? A systematic review and meta-analysis of the best randomized clinical trials on the effects of omega-3 fats on life expectancy, heart disease mortality, sudden death rates, heart attacks, and strokes has been published in the Journal of the American Medical Association. The review included not only work on fish oil supplements, but also the impact of advice to eat more oily fish.
What turned out? Generally scientists have not found a positive effect of fish oil on overall mortality, mortality from heart disease, the frequency of sudden death, heart attacks or strokes.
Or maybe it helps prevent a second heart attack? Alas, no such effect was found.
Where did this idea come from that omega-3 fats found in fish and fish oil supplements are beneficial? It was once noted that supposedly the Eskimos are less likely to have heart disease, but this turned out to be a myth. Some of the early research looked encouraging. For example, the 1980s DART study of 2,000 men found that the group who were advised to eat oily fish had a 29% lower mortality rate. That's impressive, and it's no wonder the study has attracted so much attention. But people forgot about the second study, DART-2, which gave the opposite results. The second study was conducted by the same group of scientists and involved 3,000 men. But this time, participants who were advised to eat oily fish, and especially those who were given fish oil capsules, had an increased risk of dying from heart disease.
After comparing all the studies, the scientists concluded: the use of omega-3 fats in daily clinical practice is not justified.
What should doctors do when patients follow the American Heart Association guidelines and require fish oil supplements? Here's what the Director of Lipids and Metabolism at the Mount Sinai Cardiovascular Institute had to say about it:
"Taking into account negative results of this and other meta-analyses, it is our job as physicians to stop the active sale of fish oil supplements to all our patients…”
Ischemic heart disease begins in childhood
A study published in 1953 in the Journal of the American Medical Association radically changed our understanding of how coronary heart disease develops. Scientists conducted a series of 300 autopsies on Americans who died in the Korean War, with an average age of 22. Amazingly, 77% of the soldiers already had visible signs of atherosclerosis of the coronary vessels. Some arteries were narrowed by 90% or more. This study "strongly demonstrated that atherosclerotic changes appear in the coronary arteries many years and decades before coronary artery disease (CHD) becomes a clinically apparent problem."
More recent studies of accidental death victims between the ages of 3 and 26 found that fatty streaks, the first stage of atherosclerosis, are present in almost all American children by the age of 10. After reaching the age of 20 and 30, these fatty streaks can turn into full-fledged plaques - such as those found in American soldiers during the Korean War. And by the age of 50-60 they start to kill us.
If the reader of these lines is over 10 years old, the question for you is not whether you want to prevent heart disease with healthy food, but whether you want to be cured of the heart disease that you already have.
How early do these fat streaks start to appear? Atherosclerosis can begin even before birth. Italian scientists looked inside the arteries of newborns who died shortly after birth. It turned out that if a mother has a high level of cholesterol from LDL (low density lipoprotein), then the arteries of their children will be more likely to be damaged. These findings indicate that atherosclerosis may begin as a disease proper nutrition not in childhood, but already in utero.
It has become a common habit for pregnant women to stop smoking and drinking alcohol. But in order to take care of the future generation, it is necessary to switch to a healthy diet.
According to the editor-in-chief of the American Journal of Cardiology, Dr. Roberts, the only critical risk factor for the formation of atherosclerotic plaques is cholesterol, namely elevated level in the blood of LDL (low density lipoprotein).
LDL is also called "bad" cholesterol, because. with the help of it, cholesterol is deposited in the walls of the arteries.
Autopsies of thousands of young accident victims have shown that blood cholesterol levels are closely related to the severity of atherosclerosis in their arteries.
To drastically lower your LDL levels, you need to drastically reduce your intake of three substances:
1) trans fats, which come from processed foods and are found in meat and dairy products;
2) saturated fats, present mainly in products of animal origin and artificial food (fast food, etc.);
3) to a lesser extent - dietary cholesterol, contained exclusively in animal products, especially eggs.
Do you notice a pattern? All three sources of bad cholesterol– #1 risk factor for heart attack – found in animal products and processed artificial foods. This well explains why populations with traditional plant-based diets have generally been protected from the coronary heart disease epidemic.
It's cholesterol, you idiot!
Dr. Roberts was not only the editor-in-chief of the American Journal of Cardiology for over 30 years; he is the Executive Director of the Baylor Heart and Vascular Institute and the author of over 1,000 scientific publications and over a dozen books on cardiology. He's on topic.
In his editorial, "It's Cholesterol, You Fool!" Dr. Roberts proves that there is only one true risk factor for coronary heart disease: cholesterol.
You can be a couch potato smoker with obesity and diabetes and still not get atherosclerosis as long as your blood cholesterol levels are low enough.
The optimal LDL level is 50-70 mg/dl, and obviously the lower the better. A newborn has this level, people in populations where there is practically no coronary artery disease have this level, and the progression of atherosclerosis in cholesterol-lowering trials stops at this level.
An LDL level of about 70 mg/dl corresponds to a total cholesterol level of about 150, a level below which there were no deaths from coronary heart disease in the famous Framingham Heart Study, a decades-long project to identify risk factors for heart disease.
Dr. Roberts writes: "If such a goal were to be set, it would put an end to the great calamity of the Western world."
The average cholesterol level in the United States is much higher than 150 mg/dl - it is about 200 mg/dl. If you have a total cholesterol level of 200 mg/dl in your tests, your doctor may rate it as normal. However, in a society where it is normal to die of a heart attack, having "normal" cholesterol is not so good.
To completely protect yourself from a heart attack, you need to lower your LDL levels to at least 70 mg/dl. As Dr. Roberts noted, to achieve this goal for our entire population, there are two ways: put more than a hundred million Americans on medication for life, or recommend that they all switch to a diet based on whole plant foods.
So the choice is simple: medication or diet . All health insurance covers cholesterol-lowering statins, so why change your diet when you can just take pills for the rest of your life? Unfortunately, these drugs don't work as well as you think they do, and they can also cause unwanted side effects. side effects.
Would you like fried potatoes with that Lipitor over there?
Lipitor, a cholesterol-lowering statin, has become the best-selling drug of all time, with worldwide sales of over $140 billion. This class of drugs has generated so much enthusiasm in the medical community that some medical officials have suggested adding it to drinking water in the same way that fluoride is added. One cardiology journal even suggested selling McStatin as a fast food supplement along with ketchup to help counteract the effects of junk food.
For people at high risk for coronary heart disease who are unwilling or unable to lower their cholesterol naturally through food, the benefits of statins generally outweigh their risks.
but these drugs have side effects, such as damage to the liver or muscles. Some doctors order regular blood tests for patients taking these drugs to monitor for liver toxicity. You can also check the blood for the presence of muscle breakdown products; however, biopsy data show that people taking statins may experience muscle breakdown even without laboratory signs or symptoms such as muscle weakness or pain.
decline muscle strength and performance, sometimes associated with statins, may not be as important for younger people; however, for the elderly, they increase the risk of falls and injury.
Recently, new concerns have arisen. In 2012, a new mandatory requirement was issued to warn physicians and patients that these drugs may cause brain side effects such as memory loss and confusion.
Statins have also been found to increase the risk of developing diabetes.
A 2013 study of several thousand breast cancer patients found that long-term statin use could double the risk invasive cancer mammary gland in women. The leading cause of death in women is coronary heart disease, not cancer, so the benefits of statins still outweigh the possible risks, but Why take the risk when you can lower your cholesterol levels naturally?
Proved that a plant-based diet lowers cholesterol as effectively as the best statins, but without any risk. In fact, the "side effects" of a healthy diet are always desirable: less risk of cancer and diabetes, liver and brain protection - these are discussed a lot in this book.
Ischemic heart disease can be cured
It's never too early to switch to a healthy diet, but when is it too late? The founders of healthy lifestyle medicine, Nathan Pritikin, Dean Ornish, and Caldwell Esselstyn Jr., recruited patients with advanced heart disease and offered them a plant-based diet very similar to that used by those populations in Asia and Africa that do not suffer from coronary heart disease. They hoped that a healthy diet would halt the development of the disease and prevent progression.
But something amazing happened.
The pain started to go away. The patients got better. Once they got off the artery-clogging diet, their bodies began to dissolve some of the plaque that had already formed. The lumen of the arteries expanded without medication or surgery, even in some cases of severe damage to the three coronary arteries. This indicates that the body itself sought to heal, but it was never given a chance to do so.
You can go to the doctor and complain about shin pain. “Not a problem” - you will hear in response; you will be prescribed painkillers. You will return home and continue to beat your shin on the table three times a day, but the painkillers will make you feel better. Thanks modern medicine! This is exactly what happens when people take nitroglycerin for chest pain. Medicine can give great relief, but it does nothing about the cause of the disease.
Your body wants to regain its health if you allow it to do so. But if you keep hurting yourself three times a day, you will disrupt the healing process.
Take smoking and the risk of lung cancer. One of the most startling things I learned in medical school is that 15 years after you quit smoking, your risk of getting lung cancer is comparable to that of a person who has never smoked. Your lungs can be completely cleared of all tar, as if you had never smoked.
Your body wants to be healthy. And every night of your life as a smoker, when you fall asleep, the healing process begins bye - bam! You won't light a cigarette the next morning. Just as you hurt your lungs with every puff, you hurt your arteries with every bite. When you practice moderation, you're just hitting yourself with a smaller hammer, so why hit yourself at all? You can stop hurting yourself, get off the knurled track and allow the body to carry out the healing process.
Endotoxins cripple your arteries
Harmful foods disrupt not only the structure of your arteries, but also their work. Arteries are not just tubes through which blood flows. These are dynamic living organs.
About 20 years ago, it became known that one intake of fast food - sausages and McMuffin eggs - for several hours reduces the elasticity of the arteries, halving their ability to relax normally.
And as soon as this inflammatory condition begins to pass after 5-6 hours - it's time to have lunch!
And you hit the arteries again with a new portion of junk food, which is why many Americans are constantly in the danger zone of chronic low-level inflammation.
Unhealthy food doesn't just cause internal damage sometime 10 years from now, it does it right here and now, hours after it enters the mouth.
Initially, scientists placed all the blame on animal fat or protein, but recently attention has shifted to bacterial toxins known as "endotoxins" .
Some foods, such as meat, contain bacteria that trigger inflammation whether they are alive or dead, even after being fully cooked.
Endotoxins are not destroyed either by heat treatment, or by acid in the stomach, or by digestive enzymes; therefore, after eating animal products, these endotoxins end up in the intestines. They are then carried by saturated fats through the intestinal wall into the bloodstream, where they can trigger an inflammatory response in the arteries.
This phenomenon may explain why heart disease patients so quickly benefit from switching to a plant-based diet that includes fruits, vegetables, whole grains, and beans.
According to Dr. Ornish, within a few weeks of switching to a plant-based diet, both exercise, and without them, patients experience a 10-fold reduction in the frequency of angina attacks. This rapid disappearance of chest pain occurs much faster than the body is able to clear the arteries of plaque.
I.e, A plant-based diet not only helps cleanse the arteries, but also improves their daily functioning..
On the contrary, in the control group, where patients followed the usual recommendations of doctors, there was an increase in the frequency of angina attacks by 186%. Not surprisingly, their condition worsened: they continued to eat the same food that had left their arteries in a deplorable state.
The powerful effects of changing diets have been well known for decades. For example, an article titled "Angina and the Vegan Diet" was published in the American Heart Journal back in 1977.
The vegan diet contains only plant foods, excludes meat, dairy products and eggs. Doctors described cases like the following: a 65-year-old man with severe angina pectoris, when walking, he has to stop every 9-10 steps. Can't even get to the mailbox. Switched to a vegan diet and the pain subsided in a few days. A few months later he could walk in the mountains, pain was completely absent.
You are not yet ready for healthy eating? There's a new class of anti-anginal drugs for you, like ranolazine (sold as Ranexa). The director of the pharmaceutical company suggested that his product would be used by people "unable to maintain significant dietary changes associated with a vegan diet."
The drug costs over $2,000 a year, has relatively few side effects, and does work… technically speaking. At the highest dose, Ranexa prolongs exercise tolerance by 33.5 seconds.
More than half a minute!
It doesn't look like those who choose medicine over diet will be able to walk mountains in the foreseeable future.
Brazil nuts for cholesterol control?
Can one serving of brazil nuts lower cholesterol faster than statins and keep it low for a month - just one serving?
This is one of the craziest studies I have ever seen. Scientists - where else? – From Brazil, 10 men and women were given one serving, ranging in size from 1 to 8 Brazil nuts. Amazingly, compared to a control group with no nuts at all, one serving of 4 Brazil nuts almost instantly lowered cholesterol levels. LDL levels - "bad" cholesterol - decreased by as much as 20 points in just 9 hours after eating Brazil nuts. Even drugs don't work that fast.
Here's the really crazy part of the results: The scientists re-measured the participants' cholesterol levels 30 days later. Even a month after eating one serving of Brazil nuts, cholesterol levels remained low.
Usually, after the publication in the medical literature of a work like the one described above, showing too good results to be true, doctors wait for the results of repeated studies, and then change their mind. clinical practice and begin to recommend the novelty to their patients - especially if the work is done on 10 patients and incredible results are obtained.
But when the impact is cheap, simple, safe, and beneficial—we're talking about 4 brazil nuts a month—there's no need to work hard at gathering evidence, in my opinion. I think, by default, it is reasonable to follow the proposed method until its inefficiency is proven.
However, more does not mean better. Brazil nuts contain so much of the mineral selenium that if you eat four of them every day, you can exceed the recommended daily intake of selenium. However, this is not something to worry about if you only eat 4 Brazil nuts per month.
Follow the money
Studies showing that coronary heart disease can be cured by a plant-based diet - alone or in combination with other healthy lifestyle factors - have been published for decades in the world's most prestigious medical journals. Why didn't they lead to a new public health policy?
In 1977, the US Senate Committee on Nutrition and Human Needs tried this. This committee, known as the McGovern Committee, released the US Nutrition Goals, a report recommending that Americans reduce their consumption of animal products and increase their consumption of plant foods. As the founder of the Department of Nutrition at Harvard University recalls, “the producers of meat, milk and eggs were very upset.” And this is an understatement.
Under pressure from business representatives, not only was the goal “reduce meat consumption” removed from the report, but the entire Senate Committee on Nutrition was disbanded. Because of the support for this report, several prominent senators subsequently lost their seats in the Senate.
More recently, it was revealed that many of the members of the U.S. Diet Guidelines Advisory Board had financial connections in the business, from candy bars to the McDonald Healthy Living Council and the Coca-Cola Institute for Health and Wellness. One committee member served as brand ambassador for a cake mix maker and then for Crisco before writing the official Diet Guidelines for US residents.
One commentator noted in the Food and Drug Law Journal that the reports of the Nutrition Guidelines Advisory Committee:
“did not contain discussions of all scientific research on the health effects of eating meat. Had the Committee discussed these studies, it could not have substantiated its recommendation to eat meat, as studies have shown that meat increases the risk of chronic disease - which is contrary to the aims of the Directives. Thus, by simply ignoring the studies mentioned, the Committee reached conclusions that would otherwise have seemed incorrect.
But what about the doctors? Why didn't my colleagues embrace the mentioned studies demonstrating the power of proper nutrition? Sadly, the history of medicine is replete with instances in which medical circles have rejected compelling scientific evidence if it conflicted with the prevailing view.
There is even a name for this phenomenon called the Tomato Effect. The term was coined by the Journal of the American Medical Association as a reflection of the fact that tomatoes were once classified as a poisonous food, which is why they were avoided in North America for several centuries, despite numerous evidence of their benefits.
It is very unfortunate that most medical schools do not require a course in nutrition. But even worse, official medical organizations are actively lobbying to limit nutrition education for doctors.
At the same time, the American Academy of Family Physicians (AAFP) was known for its cooperation with PepsiCo and McDonald's. And before that, she had financial ties with the cigarette manufacturer Philip Morris.
Here is the official position of the American Dietetic Association: "There are no good or bad foods, there are good or bad diets".
No bad products? Really? The tobacco industry used to say something similar: "It's not smoking itself that's bad, it's "excessive" smoking". It looks like it, doesn't it? It's all about moderation.
The American Dietetic Association (ADA), which produces food information leaflets and healthy diet recommendations, has its own corporate connections. Who writes these information leaflets? The food industry pays the ADA $20,000 per sheet to participate in this process. Therefore, we can get information about eggs from the American Egg Council and about the health benefits of chewing gum from the Wrigley Institute of Science.
In 2012, the American Dietetic Association changed its name to the Academy of Nutrition and Dietetics, but did not change its policy. It continues to accept millions of dollars annually from manufacturers of artificial junk food, meat, dairy, soda and candy.
In exchange, the academy allows them to hold formal educational workshops where nutritionists are taught what to say to their clients. When you see the title "registered dietitian" - it means that he took such courses.
Fortunately, there is a movement within the dietitian community to overcome these trends, such as Dietitians for Professional Integrity.
What about individual doctors?
Why don't all my colleagues urge their patients to give up chicken breasts?
The most common excuse is lack of time during the appointment; however, the main reason why physicians do not give healthy dietary advice to patients with high cholesterol is that they think that patients may "fear the deprivation of dietary advice."
In other words, doctors think that patients will feel unreasonably deprived of all the junk they eat.
Can you imagine a doctor saying, “I would like to advise my patients to stop smoking, but I don’t know how much they will like it”?
Dr. Neal Barnard, President of the Physicians Committee for Responsible Medicine, recently wrote an interesting editorial in the Journal of Ethics of the American Medical Association describing how doctors have gone from spectators or even smoking accomplices to tobacco fighters.
Doctors have realized that it is more effective to advise patients to stop smoking. Today Dr. Bernard says this: “Switching to a plant-based diet is like quitting smoking in terms of nutrition” .
Translator's resume
Ischemic heart disease (CHD) is the leading cause of death. At the heart of coronary artery disease is atherosclerosis of the coronary vessels (supplying blood to the heart muscle) - the formation of a cholesterol plaque under the inner shell of the vessel. This process flows for a long time without symptoms, and then manifests itself with bouts of chest pain during physical exertion. Often, the disease first manifests itself in the form of a sudden cardiac arrest.
IHD is not a mandatory attribute of aging: in some countries, its frequency has traditionally been very low (100 times lower than in the US), especially before the widespread use of the "Western" diet in the world. In central Africa, CHD was so rare that it killed less than 1 in a thousand.
When people from these countries switch to a “Western” diet, the frequency of coronary artery disease rises sharply. A diet based on whole plant foods has a protective effect. It provides low cholesterol levels in the blood. CHD is the result of diet choices.
Atherosclerosis of the coronary vessels in people adhering to the "Western" diet begins in childhood(at the age of 10 years), and by the age of 20 it is already clearly expressed, although until the age of 40-50 it most often does not cause any symptoms.
The main risk factor for the development of atherosclerosis is an increase in the level of "bad" cholesterol in the blood. The severity of atherosclerotic vascular lesions correlates with the level of cholesterol (Cholesterol) in the blood.
The source of increased cholesterol in the blood are 3 groups of substances: trans fats; saturated fats; cholesterol (all found predominantly in animal products and processed artificial foods).
A diet based on whole plant foods protects against high blood cholesterol levels and, accordingly, against atherosclerosis.
The target level of total cholesterol for the population should be 150 mg/dL and below. This is possible only if you switch to a plant-based diet (rejection of animal products).
Statins are cholesterol-lowering drugs that are toxic to the liver and muscles.(in older people, it increases the risk of falls and injury), side effects in the form of memory loss and confusion, and increase the risk of developing diabetes, doubling the risk of aggressive breast cancer.
A plant-based diet lowers cholesterol as effectively as the best statins, but without any of the risks.
Fish oil and oily fish do not reduce CHD mortality(according to some reports - increase). Widespread recommendations in this regard should be reconsidered.
plant based diet not only prevents the progression of atherosclerosis, but also leads to a cure for coronary artery disease due to the resorption of atherosclerotic plaques in the arteries.
The negative effect of animal products on the arteries is due not only to an increase in cholesterol levels, but also to a rapid (within a few hours) decrease in vascular elasticity due to an inflammatory reaction in the vessel wall. This effect may be due to bacterial toxins (endotoxins) found in animal products that are not destroyed in the stomach and intestines.
Elimination of animal products leads to a rapid decrease in the level of endotoxins in the blood. which can explain the rapid (within a few weeks) recovery of vascular function in patients with coronary artery disease when switching to a plant-based diet.
This healing effect of switching to a plant-based diet has been known since 1977. A plant-based diet is incomparably more effective in restoring exercise tolerance than the latest drugs for the treatment of IBS.
Brazil nuts are a promising way to lower blood cholesterol levels: a serving of 4 nuts quickly (after a few hours) and for a long time (up to 30 days) reduces the level of "bad" cholesterol.
Widespread adoption of a plant-based diet is hampered by conflicts of interest among regulators who influence the preparation of official nutritional guidelines.
An example is the United States: in 1977, a Senate report was prepared recommending a reduction in the consumption of animal products and an increase in vegetable products. Under pressure from business representatives, the report was severely edited, and the relevant Senate committee was dissolved.
The medical community is poorly aware of the real possibilities of preventing coronary artery disease through dietary modification - due to insufficient education in this area and due to the conflict of interests of professional medical organizations cooperating with manufacturers harmful products nutrition. published . If you have any questions on this topic, ask them to specialists and readers of our project .
According to statistics heart diseases leading among all other diseases as a cause deaths. That is why heart diseases are in the zone of special attention, and it is important that not only physicians and scientists, but also the population itself treat this problem with special attention. Out of 100,000 people, only 330 men and 154 women die from myocardial infarction every year, and 204 men and 151 women die from strokes. Among the total mortality in Russia, cardiovascular diseases account for 57%. Every year, 1 million 300 thousand people die from cardiovascular diseases in Russia - the population of a large regional center. The lion's share here belongs to coronary heart disease and arterial hypertension with its complications - myocardial infarction and stroke.
Coronary artery disease- one of the most dangerous diseases, which accounts for one of the highest percentages of deaths from diseases of the circulatory system. Factors that contribute to the development of coronary heart disease include smoking, hypertension (high blood pressure), high blood cholesterol, hereditary predisposition, and a sedentary lifestyle.
The narrowing of the lumen of the coronary arteries leads to the formation of blood clots in them. Coronary thrombosis usually leads to myocardial infarction(necrosis and subsequent scarring of a section of the heart tissue), accompanied by a violation of the rhythm of heart contractions (arrhythmia).
Arterial hypertension (hypertension) in the form of chronically elevated blood pressure It is common worldwide and accounts for almost 25% of all cases of cardiovascular disease. Initially, the heart adapts to high blood pressure, increasing the mass and strength of the heart muscle (cardiac hypertrophy). However, with very high and prolonged arterial hypertension, it gradually weakens, hypertrophy is replaced by a simple expansion of the cavities of the heart, and heart failure occurs. Hypertension is often the cause of coronary heart disease. Other common causes of death in long-term hypertension include strokes and kidney damage.
Causes of heart disease
A certain significance as a root cause lies in the modern way of life. The desire for comfort creates conditions for the weakening of the body. Despite the fact that in the age of current speeds a person is forced to move a lot, he actually moves very little; too much is in a state of physical rest. Muscles that do not receive a constant moderate load lose their efficiency and functionality - they weaken. This applies equally to the circulatory system. Without proper support for performance, not only the heart weakens, but also the blood vessels. Sedentary lifestyle leads to metabolic disorders, and hence to the failure of entire organ systems. Overweight often appears, which, in turn, becomes an enemy for the activity of the heart - atherosclerosis develops, since weakened vessels simply cannot withstand the emerging load.
The work of the cardiovascular system is closely related to breathing. One of the most important functions of the blood is to provide organs with oxygen, and disturbances in the work of the respiratory organs inevitably affect blood circulation. It is worth mentioning here the extremely common bad habit – smoking. In addition to the fact that inhaled smoke causes great harm to the lungs, nicotine, when it enters the bloodstream, leads to constriction or spasm of peripheral vessels, which makes it difficult for the blood circulation of the extremities.
If above we were talking about an abnormally long state of physical rest modern man, then with regard to psychological rest, the situation seems to be exactly the opposite. The city dweller is in circumstances almost chronic stress, but nervous system has no less close relationship than breathing with the cardiovascular system. It is difficult, and even impossible, to completely avoid stressful situations, but it is quite possible to maintain a healthy state of the body, which would make it much easier to endure nervous tension. However, quite often a person, finding himself in a psychologically difficult situation, resorts to medicines or alcohol, which, of course, gives some calming effect, but in fact only complicates the work of the heart.
A very important risk factor for the development of diseases of the heart and blood vessels is the overall level cholesterol. If the content is too high, cholesterol begins to be deposited on the walls of blood vessels, which reduces the lumen of the vessel and leads to further complications.
It can be argued that the tendency to develop diseases of the circulatory system can be inherited. If one or both parents suffered from heart disease, the risk of such a pathology in the child increases. However, one cannot take heredity as a decisive factor.
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- Heart disease - statistics, causes
In connection with the acceleration of the pace of life, more and more people suffer from heart ailments. Ischemic heart disease is the most common cardiovascular disease. It is IHD that is common among the population of developed countries of the world. Different kinds coronary heart disease, according to statistics, are one of the main causes of disability and mortality.
In order to actively and successfully fight this disease, you need to know its nature, causes, methods of treatment and prevention rules.
What is ischemic heart disease?
According to the definition given by the World Health Organization, ischemic disease is a violation of the normal functioning (dysfunction) of the heart, which can be expressed in acute or chronic form.
It occurs as a result of a decrease in the supply to the heart muscle of such an amount arterial blood, which is necessary for healthy contraction of the myocardium.
In the vast majority of cases, the normal supply of vital oxygen to the myocardium, which comes with the blood, is hindered by morphological changes in the coronary arteries. The most common manifestation of such changes is the narrowing of the artery, which reduces the volume of blood sold and creates an imbalance between the possibilities of blood flow and the needs of the heart for oxygen and nutrients.
The main factors in the occurrence and development of coronary artery disease
Atherosclerosis of the vessels can lead to narrowing of the vessels of the heart and deterioration of blood flow, after which ischemia begins to develop. In this case, a fatty layer is gradually deposited on the walls of the vessels, which then becomes thick and hardens.
Thus, the free lumen in the vessels, allowing blood to flow into the heart muscle, decreases. Accordingly, the myocardium is supplied with less blood, which causes heart failure.
Arterial hypertension - persistently high arterial pressure- represents another obstacle to the normal blood supply to the heart. At first, a person feels pain only after increasing physical activity. But if treatment is not taken, then pain in the region of the heart begins even at rest.
The development of coronary disease is also possible with such phenomena as spasms that occur in the coronary vessels, problems with the diastolic-systolic functioning of the heart muscle, and the appearance of blood clots inside the blood vessels.
Classical epidemiology suggests some other risk factors for CHD, including elderly age, obesity, diabetes, insufficient amount of physical activity, smoking, alcohol abuse and others.
The main symptoms accompanying coronary heart disease
Blood circulation in the vessels can deteriorate sharply due to partial or complete closure of the vessel by fragments of an atherosclerotic plaque that has come off the walls, or by a thrombus.
This leads either to angina pectoris - a chronic lack of oxygen for the myocardium (with incomplete closure), or to an acute phase - myocardial infarction (with complete closure of the vessel lumen).
Chronic ischemic heart disease is accompanied by pain in the chest. The same syndrome is typical for manifestations of acute coronary heart disease.
Angina pectoris has its characteristics: chest pains as a result of physical activity or significant emotional and mental experiences. The pain impulse (no more than 2-3 times) in this case usually does not last long - up to 10 minutes in total. If the patient maximally reduces physical activity the pain disappears. Angina pectoris can develop and worsen, leading to more frequent and increased pain, worsening of the patient's breathing.
With a heart attack, pain appears unexpectedly, at first they are in the nature of rather short attacks. But their intensity increases greatly, and after half an hour or an hour the pain becomes very strong, unbearable. This can go on for up to several hours. Diagnosis of this form of coronary artery disease usually entails the patient's disability.
Often, attacks of coronary artery disease are accompanied by pain radiating to the arm, left shoulder, neck, even in the teeth. Sometimes, in addition to the classic symptoms, there are shortness of breath of varying severity, heartburn, suffocation.
Complications possible with ischemia
Myocardial infarction is actually a complication of the chronic course of coronary artery disease. In more than half of the cases, it becomes the result of a rather prolonged attack of angina pectoris.
Another form of complication is heart failure. When blood is supplied to the organs at a rate and in volumes insufficient for normal tissue metabolism, swelling of the extremities, shortness of breath, palpitations, and fatigue appear.
The most dangerous complication that directly threatens human life is acute heart failure. Its sudden attack can lead to rapid coronary death.
In this case, a fatal outcome can occur either 5-6 hours after the onset of heart palpitations and acute pain, or instantly. According to statistics, acute insufficiency is the cause of death of patients in almost three-quarters of the recorded cases of this complication. Often died as a result acute insufficiency were poorly examined or received insufficient treatment.
Diagnosis of coronary heart disease: some features
A correct and timely diagnosis of heart disease is the key to successful treatment of the patient. Diagnosis of coronary artery disease consists of several stages and involves fixing the nature pain syndrome, determining the place of its manifestation and the conditions against which pain and discomfort appear, establishing the effectiveness of taking nitroglycerin.
To complete the picture of the disease, a cardiologist usually conducts electrocardiographic monitoring (ECG), ultrasound echocardiography, a study of the behavior of the heart muscle during exercise on a bicycle ergometer and other exercise devices. It is mandatory to conduct pharmacological tests, determine the level of cholesterol in the blood and blood serum. Can also be performed CT scan(for suspected heart defects and vascular aneurysms) and myocardial scintigraphy.
One of the ways to diagnose coronary heart disease is the method of coronary angiography. It consists in determining the state of the coronary arteries. The task of coronary angiography (or coronary angiography) is, in particular, to establish the degree of narrowing of the lumen of the affected blood vessel.
How is coronary disease usually treated?
To date, two main methods are known and used: conservative and operative (surgical).
A conservative (non-invasive) method of treating coronary heart disease is mainly reduced to a drug effect on the affected organ. In the case of IHD, various variants of beta-blockers, long-acting nitrates, and calcium channel blockers are most often used. To eliminate acute pain attacks, traditional nitroglycerin is used.
If the non-invasive method does not give a significant positive result, one has to resort to surgical intervention. In some cases, according to the indications, a stent is inserted through the skin into the cavity of the vessel, which retains the lumen necessary for normal blood flow (this method is called intraluminal angioplasty).
A traditional coronary artery bypass grafting operation is also performed, during which special shunts are applied to normalize blood circulation - additional blood flow pathways that bypass the blockade. Bypass surgery is performed by attaching a healthy artery to a coronary vessel. The "material" for shunts is the patient's own intrathoracic artery or saphenous vein, which is located on the patient's thigh.
What should be the prevention of coronary disease?
The measures proposed as prevention of ischemia are aimed at eliminating the insufficient supply of blood to the myocardium caused by vascular atherosclerosis as the main prerequisite for the onset and development of this disease.
The right diet plays an important role here. It should exclude foods high in fat and cholesterol, such as fatty meat and organ meats, high-fat dairy products, rich broths. Some animal fats must be replaced with vegetable fats.
No prevention of coronary disease can be complete and effective if the patient does not give up smoking. Tobacco provokes coronary death in almost 30% of cases.
In order to prevent heart failure, a healthy person must lead an active lifestyle, in which there should be a place for special cardio workouts in the fresh air.
Only in this case, you can keep your heart in good physical condition and significantly extend your life.
The survival of patients with angina pectoris depends on many factors: the severity of coronary atherosclerosis, left ventricular hypertrophy, arterial hypertension, heart failure, severity and duration of ST segment shift, arrhythmias, exercise tolerance. Thus, the survival rate of patients for 10 years with FC I was 54.6%, FC II - 46.2%, FC III - 35.7% and with FC IV - 20.6%. Patients who have been ill for a long time tend to have a greater number of coronary arteries affected, and the prognosis is worse than in patients with a short (less than a year) duration of the disease. With a single-vessel lesion, mortality within 5 years is 10.2%, with a two-vessel lesion - 11.8%, and with a three-vessel lesion - 20%.
ECG changes are an important aspect in determining the prognosis in chronic coronary heart disease: 10-year survival in people with normal ECG is 68.8%, with changes in the ST segment and T wave - 42.7%, with large-focal changes after transmural myocardial infarction - 36, 1%, with doubtful signs of myocardial infarction - 34.8%, with violations of intraventricular conduction - 13.3% and with signs of left ventricular hypertrophy - 4.6%. The most unfavorable prognostic factors are a history of myocardial infarction, arterial hypertension associated with ST segment depression. An independent prognostic sign reflecting the state of the coronary circulation and myocardial function are the results of a bicycle ergometric test. The lower the exercise tolerance, the greater the severity and duration of the ischemic shift of the ST segment on the ECG, the worse the prognosis.
The prognosis for IHD with cardiac arrhythmias is determined by the type of arrhythmia. Sinus tachycardia, bradycardia, in the absence of clinical manifestations does not have a significant effect on the course of IHD.
With sinus bradycardia, hemodynamic disturbances may occur and in such cases it is necessary to carry out treatment. Ventricular extrasystole (including, possibly, single) paroxysmal tachycardia, especially ventricular, increases the risk of sudden death, require treatment. Flickering, atrial flutter also have an adverse effect, and in the absence of contraindications, it is necessary to restore the heart rhythm.
Implantable defibrillators significantly reduce mortality in life-threatening ventricular arrhythmias and are indicated in patients who have had a cardiac arrest, patients with sustained paroxysms ventricular tachycardia not associated with acute myocardial infarction and refractory to drug therapy.
In the treatment of AV block II and III degree, which manifests itself clinically, distal AV block, bifascicular block, which progresses to complete AV block in the acute period of myocardial infarction, sinus bradycardia, manifested clinically, the installation of a permanently implanted pacemaker improves the quality of life. At the same time, one should be aware of the possibility of complications: depletion of the power source, violation of the integrity of the electrode, infection of the electrode bed, myocardial perforation, pacemaker syndrome (dizziness, fainting, decreased blood pressure and congestion in the lungs).
In spontaneous angina pectoris (Prinzmetal's angina), spasm of the coronary arteries, as a rule, occurs in stenotic segments. If signs of spontaneous angina pectoris appear in patients with exertional angina, then the prognosis worsens and approaches the prognosis for unstable angina.
The risk of myocardial infarction is highest in patients with unstable angina and is 10-20%. Most often, myocardial infarction develops in patients with recent angina pectoris and in patients with a sudden change in the nature of attacks, which are accompanied by characteristic ECG changes. In 75-85% of patients drug therapy allows for stabilization. If it is ineffective, planned coronary angiography is indicated, followed by angioplasty or coronary bypass grafting.
After surgery, in 70-80% of patients, angina attacks decrease or completely stop, however, occlusion in the first year occurs in 15-20% of operated patients.
From acute infarction myocardium, up to 35% of patients die, with a little more than half of them at the hospital stage. Prognosis for myocardial infarction depends on many factors. So, great importance has the age of the patients. For example, in persons over 60 years of age, mortality reaches 39% and above, and in those under 40 years of age it is 4%. The prognosis is influenced by such factors as myocardial infarction, widespread atherosclerosis, lung diseases, venous pathology, obesity, diabetes mellitus, hypertonic disease suffered a stroke. The prognosis worsens with the severity and duration of ST segment elevation, cardiogenic shock, stage III heart failure, recurrent coronary pain, mental disorders, in the presence of coarse systolic murmur, dysfunction mitral valve, rhythm and conduction disorders, etc.
V.N. Lazarev, candidate of medical sciences
"Prognosis for coronary artery disease, mortality from angina pectoris, myocardial infarction"– section