You can address 8 of the 12 causes of having a heart attack

– but you need to start NOW

 In my few years of medical practice in Africa, I retained one very unusual clinical memory – it concerned the death of an obese middle-aged gentleman on his way to hospital.

I had a long conversation with his family afterwards, trying to ascertain a cause of death in order to complete the death certificate.  The family said that the deceased was very well while going about his morning routine.  He had a shower, sat down to eat his breakfast and drink his morning coffee, and then suddenly he developed severe chest tightness, could not breathe and collapsed.

He had no symptoms of fever or chills to suggestive malaria or a serious infection.  He was transferred as an emergency but unfortunately could not make it to the nearest hospital.

A post-mortem examination was ordered and confirmed an acute coronary event (heart attack) as the cause of death.  That was my first heart disease case, a condition unheard of in Africa at that time.

Moving to the UK, I realised that heart disease was very common here, and it was in fact the number one killer in the western world.

#1 killer in UK, unknown in Africa – why?

I found myself making a comparison between the two populations.  While the African community kept a low profile, staying close to their ancestors’ lifestyle, the western practice was very different.

It seemed that our ancestors’ lifestyle protected Africans against heart disease, while a modern lifestyle not only put western people at risk of heart disease but put it top of the list as their number one killer.

In other words, this semi-global health tragedy occurred due to processed, refined food, sedentary life, sleep deprivation, inadequate sun exposure, disruption of family life and lack of social support.

In this article, I am going to empower you to lessen your cardiovascular risk in order to prevent heart disease.  I warn you: this may be hard to take on board – we have accepted so many biased views which have interfered with our understanding of the basic science of heart disease.  And there is your ounce of prevention at the end.

For example, you may have been led to believe that eating fat is going to makes you fat, and that you have to accept heart disease as an inevitable consequence.  On the other hand, our ‘hunter’ ancestors had a lower risk of heart disease despite being on a diet rich in animal fat, low in carbs, while our ‘gatherer’ ancestors, who lived on mainly plant-based food, also enjoyed a life free from heart disease.

This leads us to shift the focus from how much fat and how much carb you eat to the quality of the food.  It must be obvious that modern, processed, refined food is the culprit when it comes to heart disease.

We can extend the debate to include the far lower incidence of heart disease in the rest of the animal kingdom.  For example, atherosclerosis (deposition of fat into arterial walls) is unheard-of among lions, who consume huge amount of animal fat, rich in cholesterol.  This is because lions can produce phenomenal amount of vitamin C, which can repair arterial damage while human beings do not enjoy this luxury.

Feel the quality (of the food) not the type

We should not focus on cholesterol as responsible for heart disease.  Vitamin C is an antioxidant and having vitamin C on board is going to take care of any oxidants generated and stop the body from depositing cholesterol plaques under the artery lining.

So, knowing that oxidative stress plays a major role in the development of heart disease and acknowledging the protective effect of vitamin C is a great starting point.

This should set us free from the idea that eating red meat, eggs and bacon is the cause of heart disease and that statin is the treatment.

We know that 75% of the cholesterol in our bodies is made in the liver, and only 25% comes from our diet.  The body has effective systems to regulate this process.  Eating too much cholesterol slows down the liver, meaning it makes less cholesterol.

More interestingly, research has confirmed that a diet rich in saturated fat may normalise all cardiovascular disease risk factors, while a diet high in processed and refined carbohydrates will increase your risk of having a heart attack.

Lions have such a bad diet!

That’s what prevented the lion from having a heart attack while consuming a diet of saturated animal fats.  The lion calms oxidative stress by producing a huge amount of vitamin C.

This confirms that LDL cholesterol is not the problem.  It is the oxidised (damaged) LDL that puts people at risk of heart disease.  LDL is oxidised or damaged by free radicals generated by the consumption of a diet high in processed and refined carbohydrates.

Again, inflammation of the arteries makes them more vulnerable to the damaging effect of oxidised LDL.  Inflammation is also triggered by our modern diet of processed and refined carbs, toxic fat and commercial meat.

We know that sugar and refined carbohydrates cause insulin resistance, which usually progresses to metabolic syndrome.  This drives several heart disease risk factors, including obesity, belly fat, high blood pressure, high cholesterol and non-alcoholic fatty liver disease (NAFLD.)

Again, the blame should be put on the type, not the class, of carbohydrate.  By that I mean that you can eat as much real food as you like without sustaining heart disease.

 Africa and Europe

When I arrived in the UK, my professor made the comment that I was healthy, slim, full of beans and happy.  He attributed this to my high carb diet in Africa.  At the same time, he expressed a lot of concern about the high fat diet in the UK, causing an epidemic of heart disease.

I thought about this every time I saw a patient suffering from heart disease, until I learnt that the poison resides in the type not the class of the diet.

What is your risk of heart disease?

Framingham risk calculator has been available for so many years.

The NHS introduced a “heart age” tool, to encourage young adults to recognise their risk early and do something about it.  The tool also tells you the benefits you could gain by modifying one or more risk factors.

8 out of 12 cardiovascular risk factors are modifiable

Modifiable risk factors include high blood pressure, high cholesterol (high triglyceride, high LDL, low HDL), smoking, diabetes, being overweight or obese, lack of physical activity, having an unhealthy diet and suffering from stress.  Uncontrollable risk factors include age (over 45 in men, over 55 in women), gender (men have greater risk of coronary artery disease), family history, and race (Afro-Caribbean and Asian people have greater risk.)  It takes multiple risk factors to cause heart disease.

  • High blood pressure is dangerous, whether it is due to isolated systolic hypertension or diastolic. If your blood pressure increases with age, that should not be accepted as normal.
  • Smokers under the age of 50 are 10 time more likely to develop coronary artery disease than non-smokers.
  • 68% of diabetics, 65 or older, die from heart disease.
  • Increasing the protective HDL cholesterol (the good guy) by 1 mg reduces coronary risk by 2% in men, 3% in women.

He was sitting on a time bomb

I joined Professor Pringle of the University of Dundee at a campaign to reduce the risk of heart disease.  We met a chap in his mid 30s coming out of bingo.  He looked healthy but his blood pressure was dangerously high.  A further ECG also produced abnormal results.  We sent him for an urgent angiogram that confirmed his having three heart arteries critically blocked.  He was sitting on a time bomb, and his risk was only reduced after having a three-vessel bypass operation and complex drugs treatment.

Looking back, I think it would have been much easier and more effective if we had met this guy earlier, in order to reduce his risk factors without his having to undergo major heart surgery.

Who is the good guy and who is the bad guy?

Cholesterol is transported around the body in vehicles known as lipoproteins.  These are classified according to their density into HDL, LDL or VLDL.  High-density lipoprotein (HDL) represents the protective cholesterol (good guy), while low density lipoprotein (LDL) and very low-density lipoprotein (VLDL) represent the bad type of cholesterol.

You may have heard the popular analogy that represents lipoproteins as cars and cholesterol as passengers.

We routinely measure LDL-cholesterol (passengers) while ignoring LDL particles (cars). However, LDL-P (cars) is the driving force for plaque formation.  More cars on the road increase the likelihood of accidents, i.e. the increased risk of heart disease.

Therefore LDL-P can more accurately predict the risk of heart disease than LDL cholesterol (LDL-C.)

But what causes a high level of LDL-P?  LDL-P increases with the onset of metabolic syndrome (belly fat, obesity, high blood pressure, high triglyceride, low HDL.)  The level also goes up in poor thyroid function, with infection, a leaky bowel and in genetic disorders.

LDL particles are either large, fluffy, healthy beachballs or small, dense golf balls.  The latter are heavy and can stick together to initiate the formation of clots.  This could result in an acute vascular event.

Elevated levels of the protective HDL reduce cardiovascular risk more than having low LDL.  HDL are like trucks that pick up oxidised LDL and transport them to the liver to be processed.

Very high levels of HDL may not protect against heart disease due to accompanying abnormal lipids.  This could be the result of a genetic mutation, an overactive thyroid, primary biliary cirrhosis, chronic alcoholism or drugs such as corticosteroid, phenytoin, insulin or oestrogen.

An ounce of prevention

 You could a lot worse than start with a plant-based diet, with nutrient-dense vegetables, fruits, seeds and nuts.  Rainbow range of vegetables & fruits each colour covers a unique antioxidant activity.  Vitamin K2 prevents the deposition of calcium in the arteries, particularly in the elderly population.  The prevention dose is 180 µg daily, but the therapeutic dose is considerably above this level.  Vitamin K2 is very important for vegans as it is widely available in animal products, including cheese and pastured eggs, with very limited amounts in sauerkraut.  Sit less stand more, a standing desk will keep you active at work.

I would like to share with you this link on lifestyles interventions to modify cardiovascular disease risk.

And now, my friends, I would love to hear from you if you have any worries or experiences to share about heart disease.  Sharing your experience could just help someone else to change their lifestyle in order to mitigate their risk of coronary problems.  Such a simple thing can be life changing.  Thank you!