Prevent a Second Heart Attack

1

Making the Transition from Sickness to Health

The gods are just, and of our pleasant vices
Make instruments to plague us.

—King Lear, William Shakespeare (1564-1616)

Why are so many people having heart attacks in the United States? What triggers the formation of that first "fatty streak"-the earliest visible hint that something is awry in the arteries-and the eventual onset of advanced heart disease (a.k.a. atherosclerotic cardiovascular disease), our nation's leading killer?

We used to think that heart attacks were an inevitable consequence of aging. But in the last decades, research has revealed a surprising truth: Heart disease is a lifestyle-borne illness, and atherosclerosis (the leading cause of heart attacks and stroke, and the defining term for when fatty deposits build up inside the arterial walls) begins in childhood. A toxic mix of calorie overload, especially of processed foods high in damaging fats, sugars, and salt, coupled with inactivity instigates the long, slow process of arterial damage that results in a heart attack.

In this chapter, you will discover how, when, and why your own coronary arteries began to clog up, thereby setting the stage for atherosclerotic cardiovascular disease. You will learn about how you can take control of your heart health the Prevent a Second Heart Attack way-a doable strategy allowing you to take action to switch your disease course and ultimately remain a "survivor" for many decades to come.

YOU ARE WHAT YOU EAT

It is well known that what you eat and your level of physical activity have a major impact on your health. A poor diet greatly increases your risk of developing any number of chronic health conditions and diseases, including high blood pressure, obesity, diabetes, osteoporosis, several types of cancer, and heart disease.

Researchers at the University of North Carolina School of Medicine conducted a survey study examining the nutritional habits and chronic indicators of disease in 1,788 men and women whose average age was forty-eight. They found that people who ate a poor diet had significantly higher rates of disease (such as those with diagnosed high blood pressure and/or heart disease).

A poor diet was also strongly associated with individuals at high

risk of contracting a chronic disease precursor such as prediabetes. What type of diet did the high-risk people eat? One that was loaded with fast-food meals, sugary drinks, high-fat snacks, and lots of desserts/sweets; low in fruits and vegetables; and coupled with a sedentary lifestyle. The bottom line is, both the type and quantity of food consumed have a profound effect on your risk for heart disease, as diet plays a large role in your resistance or susceptibility to atherosclerosis.

What would happen if we took an entire population that for centuries subsisted on a traditional, mostly vegetarian, whole-foods diet and a highly active lifestyle (in which the residents grew their own food) and switched them over to a highly processed, calorie-dense, Western diet and sedentary existence? Researchers in Mexico observed such a phenomenon.

The Tepehuanos Indians living in the Sierra Madre Occidental Mountains of northwest Mexico subsisted on a plant-based diet, filled with green vegetables, beans, potatoes, breads, and tortillas made from root vegetables, eating meat and animal products very rarely. In 1995-1996 researchers also found that obesity was rare and diabetes was virtually nonexistent among the Tepehuanos.

In the year 2000, as part of a social assistance program, Western- style foods were made available to the Tepehuanos either for free or at a very low cost. The traditional Tepehuanos diet was thus substantially modified by the introduction of a Western-style diet filled with highly processed salty foods, meat, eggs, sugar, refined flour products, soft drinks, and other types of junk food. The effect of this drastic dietary change was documented at the ten-year follow- up assessment of the study. Total calorie intake rose 42 percent, accompanied by a doubling of protein and artery-clogging saturated fat intake. In addition, there was a notable decline in fiber and carbohydrate intake, as well as a dramatic reduction in the consumption of healthful polyunsaturated fat. The occurrence of heart disease risk factors escalated, mirroring the dietary changes. Obesity, diabetes, high blood pressure, a high blood level of triglycerides, and a low HDL cholesterol value all were now commonplace among the Tepehuanos Indians.

IT ALL BEGINS IN CHILDHOOD

For more than sixty years we have known that atherosclerosis starts in childhood and progresses to cause heart disease in middle age and beyond. Autopsy studies of the hearts of our nation's youth show that atherosclerosis, the underlying cause of CAD, manifests early in life. The 1953 results of an autopsy study of U.S. soldiers (average age twenty-two) killed in the Korean War surprised the nation when it was revealed that 77 percent of the hearts examined showed signs of atherosclerosis. A similar study of U.S. casualties of the Vietnam War showed that 45 percent of the hearts had atherosclerotic disease, with 5 percent exhibiting severe disease.

In autopsies performed at the University of Louisville in Kentucky on young, mostly male victims of trauma (average age twenty-six), coronary atherosclerosis was observed in 78 percent of the study group-with 21 percent showing narrowing of the coronary arteries by more than 50 percent, and 9 percent showing blockage of more than 75 percent.

At this point, you may be thinking, what do all these scientific findings have to do with reversing my disease? The takeaway message that you should extract from the autopsy research is that your disease did not surface last year or last week but has been brewing in your arteries since you were a child. And, as you shall see, it took a lifetime of additional lifestyle factors to hasten its progression to the advanced stage that bred your critical cardiac event.

Multiple risk factors accelerate plaque buildup

Risk factors are traits people exhibit that increase their likelihood for contracting disease. Major risk factors for heart disease, such as high LDL or "bad" cholesterol, diabetes, high blood pressure, smoking, and obesity, have a detrimental effect on the lining of the innermost layer of the coronary arteries, the endothelium.

One of the most important studies that proved beyond a shadow of a doubt that these risk factors operate early in life in all Americans to propel atherosclerosis is the Bogalusa Heart Study. The longest and most detailed large-scale study of biracial children (black and white) in the world, the Bogalusa Heart Study began in 1972 in the town of Bogalusa, Louisiana, to determine the early course of heart disease and its association with established risk factors: lifestyle behaviors such as smoking, physical inactivity, and a high-fat, high- calorie diet. In an autopsy segment of the study, conducted at Tulane University Medical Center in New Orleans, researchers examined the coronary arteries of 204 young people between ages two and thirty- nine. (Most subjects had died from accidents.) The researchers found that 50 percent of the children age two to fifteen exhibited fatty streaks (the first visible sign of disease in the arteries), and 8 percent had full-blown plaque in their coronary arteries. The older group, age twenty-one to thirty-nine, had more advanced disease, with 85 percent having fatty streaks and 69 percent showing plaque in their coronary arteries. Hence, the Bogalusa Heart Study has changed the way we think about heart disease, which was formerly considered an adult problem. The study proved that heart disease can start the day you are born and that poor lifestyle choices made in childhood can have deadly effects later in life.

Young Americans living dangerously: More research proves the point

Findings from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study provide even more support for the notion that multiple risk factors accelerate the atherosclerotic process in young people. Scientists autopsied 2,876 young accident victims (age fifteen to thirty-four) and examined their coronary arteries for evidence of heart disease. Confirmation

of atherosclerosis was found in an astounding 60 percent of subjects in the youngest group (age fifteen to nineteen), escalating to greater than 80 percent of men and 70 percent of women in the oldest group (age thirty to thirty-four).

The PDAY study clarifies not only that atherosclerosis begins in youth but also that the risk factors for adult heart disease, if they appear at a young age, determine to a large degree the rate of progression of atherosclerotic plaque. Risk factors operating on young, vulnerable coronary arteries are the harbinger of future heart attacks, which will most likely appear at even younger ages in adulthood than currently observed.