Heart and Arterial Disease
Diseases of blood vessels are a major cause of premature disability and death. Heart attacks and strokes are the most devastating consequences of damaged arteries and increased clotting of blood. The main event is the rupture of an atherosclerotic plaque and the subsequent occlusion of the artery by a blood clot. No group of diseases has received more attention than diet-related arterial disease. No other diseases have received more public promotion and educational effort both from government agencies and from private fund-raising organizations such as the American and Canadian Heart Associations.
Arterial disease is a whole body disease, but tends to be managed by physicians and surgeons as a localized disease. In other words, when the heart arteries are plugged you go to see a cardiologist and then a heart surgeon. When the vessels to the brain are involved, you go to a neurologist and then possibly a neurosurgeon. When the vessels to your leg are obstructed, you go to a peripheral vascular surgeon. When the vessels to your penis are plugged, you go to an urologist and a marital counselor.
Arterial disease is part of a package deal of disease manifestations that are caused any eating too much of the wrong foods, exercising too little and otherwise indulging in unhealthy habits such as smoking and overindulging in alcoholic beverages. Environmental factors such as air pollution with chemicals produced by the combustion of petroleum products and other fuels contributes to the body burden of disease. Each component in this package deal tends to have separate support and lobby groups that champion vested interests. Doctors tend to specialize in one component of the overall package. Thus diabetes is separated from obesity and obesity is separated from hypertension, often treated as a separate issue from coronary artery disease, which is separated from strokes. Getting all the specialized vested interests together has proved to be an impossible task.
You might have assumed that your family doctor is supposed to help you prevent all these disease, but his or her time is limited and preventive resources are meager at the doctor’s office. It turns you that the only person in the whole expensive medical/surgical network that can make sense of whole package deal - arterial disease and all its associated disorders - is the patient. It is up to you, dear reader to solve this collection of health problems by removing the causes! This book is dedicated to the effort of intelligent well-motivated people to become well-informed and to take charge of their own management. A non-smoking, fitness center that serves Alpha Nutrition Program meals can replace hospitals, clinics, MDs offices, rehab programs and nursing homes.
Thinking about common diseases is becoming more sophisticated. Life is a continuing series of interactions between a person and his or her environment. Some of the interactions are healthy and promote long lives. Other interactions are unhealthy and lead to disease. There is a continuum of events that progress from a young healthy body to one with vascular disease, organ dysfunction, organ injury, and finally, death.
Most of us would like to be health, productive and live a long life. Most of us have some control over interactions with our environment. We know that the critical dominants of disease are within the range of personal choices. When a person develops overt cardiovascular disease, we can usually conclude that they made poor choices consistently over many years. There are many reasons for wrong choices, beginning with ignorance. Some ignorance is a result of lack of understanding, but most ignorance is active ignoring and denying the harmful consequences of bad choices made. Obviously, the sooner that bad choices are corrected, the better the results in the long term.
Cardiologists realize that medical interventions tend to occur late in the disease continuum if at all. People in their 20s and 30s can have fatty plaque in their coronary arteries, but may not show up for medical care until they are older than 60 years. The evidence does suggest that some interventions are beneficial in terms of preventing heart attacks and strokes and that disease progression can be halted by important changes in diet and increased exercise. The occurrence of a heart attack or stroke conforms that atherosclerosis is advanced, damage has been done and that the rules of intervention have changed.
In a discussion of the progression of atherosclerosis, Weintraub suggested: “I think it is important that we recognize that this process is not something that we were supposed to have to endure. We eat things that are wrong and our lipid levels are far higher than they were ever designed to be, and as a consequence we are experiencing injuries that were never part of our biologic programming. Think of the renin-angiotensin-aldosterone (RAAS) system, which has direct pathobiologic effects on a variety of tissues. It was designed to be part of a repair or temporary compensation system. The problem is that we humans end up with the RAAS in the constant "on" position and we are constantly suffering oxidative injury from the oxidized lipids we graze on. We are not born with the ability to successfully handle the overload we place on our system, and this is why we develop heart failure after an MI -- because our normal, healthy, compensatory system is ill-suited for our bad behavior.”
There are many risk factor measurements in common use such as cholesterol, LDH and HDL. While risk factors are relevant, they do not reveal what everyone really wants to know – how much arterial damage already exists and how fast is it progressing. Weintraub suggested using two non-invasive tests: 1. measure microalbuminuria in the urine and 2. measure carotid artery intimal-medial thickening (IMT). Increasing carotid artery IMT and microalbuminuria show progression toward tissue damage. Stable or decreasing carotid IMT would be most reassuring.. He potions out that microalbuminuria is not an expensive test and carotid artery IMT is not less expensive than echocardiography. While an ECG is not expensive, it reveals only existing heart damage and is not predictive of progression of coronary artery disease.
From the Book of Heart and Arteries by Stephen Gislason MD