THE DOC AND CHEF SHOW EP. 13: THE HEART ATTACK EPISODE // SUPPORTING SCIENCE AND THE RECIPE
Coronary artery disease (CAD) is a common type of heart disease that occurs when the blood vessels supplying the heart muscle (coronary arteries) become narrowed or blocked and is the leading cause of death in the United States. About 695,000 people in the United States died from heart disease in 2021. That’s one person every 33 seconds and represents 1 in every 5 deaths.[1]
RISK FACTORS FOR HEART DISEASE
Several risk factors can increase the likelihood of developing coronary artery disease. These risk factors can be categorized into modifiable and non-modifiable factors:[2]
Non-Modifiable Risk Factors:
1. Age: The risk of CAD increases with age, particularly for men over 45 and women over 55.
2. Gender: Men are generally at a higher risk of CAD than premenopausal women. However, after menopause, women's risk catches up to that of men.
3. Family History: A family history of CAD can increase your risk, especially if a close relative (parent or sibling) had CAD at a young age (before 55 for men and before 65 for women).
Modifiable Risk Factors:
1. High Blood Pressure (Hypertension): Uncontrolled high blood pressure can damage the arteries and increase the risk of CAD.
2. Smoking: Tobacco smoke contains chemicals that can damage the blood vessels and decrease the oxygen supply to the heart.
3. Metabolic Syndrome: This cluster of conditions, including high blood pressure, high blood sugar, excess abdominal fat, and abnormal cholesterol levels, is caused by insulin resistance and increases the risk of CAD.
4. Diabetes: People with diabetes have a higher risk of CAD due to elevated blood sugar levels that can damage blood vessels.
5. Obesity: Excess body fat, especially abdominal obesity, can lead to conditions like insulin resistance and contribute to CAD risk.
6. Physical Inactivity: A sedentary lifestyle can lead to obesity and other risk factors for CAD. Regular physical activity helps maintain cardiovascular health.
7. Stress: Chronic stress and poor stress management can contribute to CAD risk, as stress may lead to unhealthy coping behaviors (such as overeating or smoking).
8. Sleep Apnea: This sleep disorder is associated with an increased risk of CAD due to interrupted breathing during sleep
9. Unhealthy Diet: A diet high in saturated and trans fats, cholesterol, salt, and added sugars can raise the risk of CAD. Conversely, a diet rich in fruits, vegetables, and whole grains can reduce the risk.
10. High Cholesterol Levels: High levels of LDL (low-density lipoprotein) cholesterol, often referred to as "bad" cholesterol, are one of the major contributors to plaque buildup in the arteries.
It's important to note that having one or more risk factors doesn't guarantee that you will develop CAD, but it does increase your risk. Reducing modifiable risk factors through lifestyle changes and, if necessary, medical treatment can significantly lower your risk of coronary artery disease. Regular check-ups and consultations with a healthcare provider are crucial for managing these risk factors and maintaining heart health.
CHOLESTEROL
Cholesterol is a waxy, fat-like substance made by your liver and is essential for good health. Cholesterol is a type of lipid (fat) that is found in your blood and is an essential component of cell membranes throughout your body. It plays several important roles in maintaining overall health. Cholesterol is produced by the liver, and it is also obtained through the foods you eat.[3]
Cholesterol is essential for the following functions in the body:[4]
1. Cell Membranes: Cholesterol is a structural component of cell membranes, helping to maintain their integrity and fluidity.
2. Hormone Production: Cholesterol is a precursor for the synthesis of several hormones, including sex hormones (estrogen, progesterone, testosterone) and hormones that regulate metabolism (cortisol).
3. Vitamin D Production: Cholesterol is converted into vitamin D when the skin is exposed to sunlight. Vitamin D is important for bone health, among other functions.
4. Bile Acid Production: Cholesterol is used to produce bile acids in the liver, which are essential for the digestion and absorption of dietary fats.
While cholesterol is essential for various bodily functions, it's important to maintain a balance of healthy cholesterol levels. Elevated LDL cholesterol levels can increase the risk of heart disease, while higher levels of HDL cholesterol are associated with a lower risk.
MEASURING CHOLESTEROL IN THE BLOOD
It's essential to monitor your cholesterol levels regularly, especially if you have risk factors for heart disease. Cholesterol levels are typically measured in milligrams per deciliter (mg/dL) of blood. Normal cholesterol levels can vary slightly depending on the guidelines used by different health organizations, but here are generally accepted reference ranges for adults in the United States:[5]
1. Total Cholesterol:
- Desirable: Less than 200 mg/dL
- Borderline High: 200-239 mg/dL
- High: 240 mg/dL and above
2. LDL Cholesterol (Low-Density Lipoprotein, often referred to as "bad" cholesterol):
- Optimal: Less than 100 mg/dL
- Near Optimal: 100-129 mg/dL
- Borderline High: 130-159 mg/dL
- High: 160-189 mg/dL
- Very High: 190 mg/dL and above
3. HDL Cholesterol (High-Density Lipoprotein, often referred to as "good" cholesterol):
- Higher levels are better.
- For men: Ideally, it should be 40 mg/dL or higher.
- For women: Ideally, it should be 50 mg/dL or higher.
4. Triglycerides:
- Desirable: Less than 150 mg/dL
- Borderline High: 150-199 mg/dL
- High: 200-499 mg/dL
- Very High: 500 mg/dL and above
It's important to note that these are general guidelines, and individual recommendations may vary based on a person's overall health, risk factors for heart disease, and other factors. Your healthcare provider will consider your specific situation when interpreting your cholesterol levels and determining the most appropriate treatment or lifestyle recommendations.
CAUSES OF HIGH CHOLESTEROL
Elevated LDL (low-density lipoprotein) cholesterol levels in the blood can be caused by a combination of genetic, lifestyle, and dietary factors. LDL cholesterol is often referred to as "bad" cholesterol because high levels of LDL can contribute to the buildup of plaque in the arteries, increasing the risk of coronary artery disease (CAD) and other cardiovascular problems. Here are some common causes of elevated LDL cholesterol:5
1. Diabetes: People with diabetes, especially type 2 diabetes, are at an increased risk of having elevated LDL cholesterol levels. High blood sugar levels can affect lipid metabolism.
2. Obesity: Being overweight or obese is often associated with elevated LDL cholesterol levels. Excess body fat, especially abdominal obesity, can lead to changes in lipid metabolism and higher LDL cholesterol.
3. Lack of Physical Activity: A sedentary lifestyle can contribute to higher LDL cholesterol levels. Regular physical activity can help lower LDL cholesterol and raise HDL (high-density lipoprotein) cholesterol, often referred to as "good" cholesterol.
4. Genetics: In some cases, elevated LDL cholesterol levels can be genetically determined. Familial hypercholesterolemia is a genetic condition that leads to very high LDL cholesterol levels from birth and significantly increases the risk of heart disease.
5. Liver Function: The liver plays a central role in the production and regulation of cholesterol in the body. Certain conditions that affect liver function can lead to elevated LDL cholesterol levels.
6. Dietary Choices: The foods you eat can have a significant impact on your LDL cholesterol levels. Consuming a diet high in saturated and trans fats (to learn more about trans fats, please see the blog post from our “Fat” episode), as well as dietary cholesterol, can lead to elevated LDL cholesterol. Foods such as meat, full-fat dairy products, fried foods, and commercially baked goods are examples of items that can increase LDL cholesterol.
WHAT ARE SATURATED FATS?
Saturated fats are a type of dietary fat that consists of saturated fatty acids. They are typically solid at room temperature and are often found in animal-based products and some tropical oils. Saturated fats have been associated with an increased risk of heart disease when consumed in excess, which is why dietary recommendations often advise limiting their intake. Here's more information about saturated fats:[6]
1. Chemical Structure: Saturated fats have no double bonds between the carbon atoms in their fatty acid chains. This means that each carbon atom in the chain is "saturated" with hydrogen atoms. This saturated structure gives these fats their solid form at room temperature.
2. Sources: Saturated fats are commonly found in the following foods:
- Animal Products: Fatty cuts of meat, poultry with skin, whole milk, butter, cheese, and other dairy products.
- Processed Foods: Many processed and fried foods, such as fast food items, baked goods, and certain snacks, contain saturated fats due to the use of oils and fats in food preparation.
- Tropical Oils: Coconut oil and palm oil are high in saturated fats. They are often used in cooking and in the food industry.
WHAT ABOUT DIETARY CHOLESTEROL
The relationship between dietary cholesterol and heart disease has been the subject of extensive research and debate over the years. Here's a summary of the current understanding:[7]
1. Dietary Cholesterol and Blood Cholesterol Levels: Dietary cholesterol, which is found in animal-based foods like eggs, meat, and dairy products, can modestly raise blood cholesterol levels, specifically LDL (low-density lipoprotein) cholesterol, often referred to as "bad" cholesterol, in some people. However, the increase in blood cholesterol levels due to dietary cholesterol is relatively small compared to the impact of saturated and trans fats in the diet.
2. Individual Variability: People vary in their response to dietary cholesterol. Some individuals are "hyper-responders," meaning that their blood cholesterol levels may increase more significantly when they consume dietary cholesterol, while others are "hypo-responders" and experience minimal changes. It has been estimated that 15–25% of the population are hyper-responders to dietary cholesterol, which does increase their risk fro heart disease.
3. Overall Dietary Pattern Matters More: Current dietary guidelines and research suggest that it's the overall dietary pattern and the types of fats consumed (particularly saturated and trans fats) that have a more significant impact on heart disease risk than dietary cholesterol alone. A diet high in saturated fats, rather than dietary cholesterol, is associated with higher LDL cholesterol levels and an increased risk of heart disease.
4. Updates in Guidelines: In recent years, guidelines from organizations like the American Heart Association and the Dietary Guidelines for Americans have shifted their focus away from specific cholesterol intake recommendations. Instead, they emphasize reducing saturated fat intake and adopting a heart-healthy diet pattern, such as the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets, which are rich in fruits, vegetables, whole grains, and healthy fats.
In summary, the relationship between dietary cholesterol and heart disease is complex. While dietary cholesterol can influence blood cholesterol levels, its impact varies among individuals. Current dietary guidelines emphasize the importance of overall dietary patterns and the reduction of saturated and trans fats as primary strategies for reducing the risk of heart disease. However, it is still a good idea to limit your intake of dietary cholesterol, especially if you are at increased risk for heart disease.
LOWERING HEART DISEASE RISK
Here are several strategies that can help lower LDL cholesterol:[8]
1. Dietary Changes:
- Reduce Saturated Fat Intake: Limit the consumption of foods high in saturated fats, such as fatty meats, full-fat dairy products, and fried foods.
- Choose Healthy Fats: Replace saturated fats with heart-healthy fats, such as monounsaturated fats (found in olive oil, avocados, and nuts) and polyunsaturated fats (found in fatty fish like salmon, walnuts, and flaxseeds).
- Increase Soluble Fiber: Foods rich in soluble fiber, like oats, beans, lentils, fruits, and vegetables, can help lower LDL cholesterol levels.
- Limit Dietary Cholesterol: While dietary cholesterol has less impact on blood cholesterol levels than saturated fat, it's still a good idea to limit high-cholesterol foods like organ meats and egg yolks.
2. Maintain a Healthy Weight: Losing excess weight, particularly abdominal fat, can lead to improvements in cholesterol levels.
3. Regular Physical Activity: Engaging in regular physical activity can raise HDL (high-density lipoprotein) cholesterol (the "good" cholesterol) and lower LDL cholesterol. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week.
4. Quit Smoking: Smoking damages blood vessels and lowers HDL cholesterol. Quitting smoking can lead to improvements in overall cardiovascular health.
5. Limit Alcohol Intake: If you drink alcohol, do so in moderation. Excessive alcohol consumption can raise triglycerides and lead to high blood pressure.
6. Medication: In some cases, healthcare providers may prescribe cholesterol-lowering medications, such as statins or other drugs, to help lower LDL cholesterol levels. These medications may be recommended if lifestyle changes alone are insufficient or if you have very high LDL cholesterol or other risk factors for heart disease.
7. Omega-3 Fatty Acids: Foods rich in omega-3 fatty acids, like flax seeds, chia seeds, hemp seeds, walnuts or taking an algae-based omega-3 supplement, may have a modest effect on lowering LDL cholesterol. However, it's essential to discuss supplementation with your healthcare provider.
SUMMARY
Lifestyle modifications, including dietary changes, increased physical activity, and weight management, can often help lower LDL cholesterol levels. In some cases, healthcare providers may recommend cholesterol-lowering medications to manage high LDL cholesterol levels, particularly when lifestyle changes alone are insufficient. But remember that managing cholesterol levels is just one aspect of heart health. Comprehensive cardiovascular risk reduction also includes controlling blood pressure, managing diabetes, and adopting a heart-healthy lifestyle. Always consult with a healthcare provider for personalized advice on managing your cholesterol and overall cardiovascular health.
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[-1] https://www.cdc.gov/heartdisease/facts.htm
[2] J Diabetes Res. 2018 Dec 11;2018:2341230.
[3] https://www.cdc.gov/cholesterol/about.htm
[4] Nutrients. 2019 Jul 18;11(7):1645.
[5] Circulation. 2019 Jun 18;139(25):e1082-e1143
[6] J Am Coll Cardiol. 2020 Aug 18;76(7):844-857.
[7] Circulation. 2020 Jan 21;141(3):e39-e53.
[8] J Am Coll Cardiol. 2017 Oct 3;70(14):1785-1822.
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