Heart Health Month

Heart disease is the 2nd leading cause of death in North America, only behind cancer. 

When people talk about heart disease, there are terms that are used interchangeably, so let’s lay them out to be clear on the differences. 

Heart disease is often a catch-all phrase for a variety of conditions that affect the structure and function of the heart and is often used to refer to coronary heart disease.

Coronary heart disease (CHD) occurs when plaque builds up in the arteries and can lead to heart attacks, blood clots, and strokes. It is the most common type of heart disease. Atherosclerosis is the thickening and hardening of the arteries, however, when it occurs in the arteries to the heart, it is called coronary heart disease. 

Cardiovascular disease is the term for the different diseases that affect the heart or blood vessels, including coronary heart disease. 

Since coronary heart disease is the most common type of heart disease, that’s what I’ll focus on. 

Cholesterol is often said to be the cause of arterial plaque buildup that leads to CHD, and while it is a part of the plaque, it’s not just simply caused by the presence of cholesterol in the blood.  The more we learn, the more we understand that plaquing is actually an inflammatory response to arterial damage.

So what is Cholesterol?

Cholesterol is a fat-like, waxy substance that helps our body make cell membranes, many hormones, and vitamin D. It comes from the food we eat and from our liver. However, dietary cholesterol has been vilified for many years. But here’s the thing, the body tightly regulates the amount of cholesterol in the blood by controlling internal production; when our dietary intake is too low, our body makes more and when our dietary intake is too high, our body makes less. 

Now, let’s get a bit nerdy and talk about the science of atherosclerosis (the narrowing and plaquing of the arterial walls). When there is injury to an arterial wall, usually caused by high blood pressure, high blood sugars, nutritional deficiency, etc, an inflammatory response is launched.

This response sends a flood of specialized white blood cells (macrophages) and blood platelets to the site to help repair the damaged spot. Smooth muscle cells then head to the surface to produce collagen to help repair the site, but it’s patched roughly. Think of asphalt patch work on pot holes. Oxidized LDL (the “bad” cholesterol) then ‘sticks’ to the roughly patched areas along the arterial wall. Since it’s sticky, it catches other debris in the blood and becomes thicker.  Fibrous tissue caps made up of  this cell debris, smooth muscle cells, collagen, and calcium form on top creating the plaquing, which thickens and narrows the artery.

This plaquing can also break off which can cause a blood clot or stroke. Of course because we see cholesterol in the makeup of the plaquing, it makes sense that we’ve been told to watch our cholesterol intake – right? Well yes, and no.

Studies have shown that for 75% of the population, dietary cholesterol actually has very little impact on blood cholesterol levels and in the 25% that do show modest increases, it’s often in both LDL (“bad” cholesterol) and HDL (“good” cholesterol) and it does not affect the actual ratio of LDL to HDL or increase the risk of heart disease. 1 However, those with underlying health conditions like diabetes or have high stress levels or high blood pressure may be impacted more by higher cholesterol diets since there is a higher likelihood of arterial injury. 

Now that we know what coronary heart disease is, let’s talk about symptoms and how to reduce the risk. Studies which looked at the relationship between heart disease and lifestyle suggested that 90% of heart disease is caused by diet and lifestyle factors, which means that diet and lifestyle can play a role in reducing risk. 2 

There are however, differences in how clinical trials have been conducted. They have been predominantly male focused, leading women as well as their Doctors to dismiss or minimize their symptoms, resulting in delayed treatment.  While chest pain can be experienced by both males and females, females tend to experience more subtle symptoms that can be missed, especially in the absence of chest pain or discomfort. 

Common “subtle” warning signs of coronary heart disease:

Nausea
Vomiting
Unusual fatigue
Shortness of breath
Pain in the neck, jaw, or throat
Pain/discomfort in the upper abdomen or back
Pain or discomfort in the arms or shoulder
“Heavy” chest

Females also have a different set of risk factors than men. A big one being menopause, as estrogen levels (a protective factor) decrease, risk of chd can increase, as well as pregnancy with complications of high blood pressure. Females with a family history and diabetes are also at increased risk compared to males with the same. 3  

Risk factors that lead to arterial injury:

  • Diet:
    • A diet high in hydrogenated or rancid fats like those found in margarine, commercial baked goods, fast foods, and fried foods.
    • A diet high in refined sugars and highly processed foods. 
    • A diet lacking in fruits, vegetables, whole grains, and healthy fats.
  • Lifestyle:
    • Sedentary lifestyle
    • Smoking
    • Stress
    • Excessive alcohol use
  • Medical:
    • High blood pressure
    • Inflammatory diseases
    • Diabetes/insulin resistance
    • Oral contraceptives
    • Family history
  • Other:
    • Sex – female’s risks change as they age. Also for decades, almost all research was done on males, leaving a gap in understanding different presentation of symptoms and treatment. 
    • Access to health care, healthy food, and safe drinking water.
    • Ethnicity – Indigenous, South Asian, and Black African ethnicity are at higher risk for chd.4  But we would be remiss if we didn’t consider the impact of colonization and systemic racism in our healthcare system on risk factors, detection, and treatment. 5

Reduce your risk

  • Diet
    • Increase omega-3 fats like those found in cold water fatty fish as they have several cardiovascular benefits.
    • Increase monounsaturated fats like those found in olives, olive oil, macadamia nuts, and avocados as they have been shown to decrease LDL and raise HDL, as well as reduce inflammation and lower blood pressure.
    • Eat the rainbow. Antioxidant rich foods like dark leafy greens, berries, are full of heart healthy nutrients and anti-inflammatory properties.
    • Increase polyphenol rich foods like apples, green tea, blueberries, red wine, dark chocolate, extra virgin olive oil, and turmeric as they have been shown to improve the function of the inner lining of blood vessels and also promote anti-inflammatory actions. 
    • Increase vitamin C rich foods such as papaya, bell peppers, and broccoli, as this is needed for collagen production which helps with arterial strength. 
    • Increase fiber rich foods such as whole grains, beans, legumes, and vegetables. 
    • Drink water. Aim for half your body weight in ounces of water per day.
    • Reduce consumption of hydrogenated and rancid fats.
    • Reduce consumption of highly processed foods.
    • Reduce consumption of highly refined sugars.
  • Lifestyle
    • Move your body daily. Walking briskly for 30 minutes a day 5 days a week is a great start. 
    • Explore stress management techniques like exercise, journaling, meditation, find a hobby, deep breathing, talk to a professional if needed. 
    • Quit smoking.
  • Medical 
    • Reduce risk of high blood pressure
    • Reduce risk of diabetes/insulin resistance
    • Support gut health

By flooding your body with anti-inflammatory, nutrient dense foods that are rich in colour, healthful fats, and fiber, reducing and managing stress, and moving your body daily, you are reducing your risk for coronary heart disease. 

 
 
1. “Revisiting dietary cholesterol recommendations: does the evidence ….” https://pubmed.ncbi.nlm.nih.gov/20683785/. Accessed 8 Feb. 2021.
2.
“Effect of potentially modifiable risk factors associated with … – PubMed.” 11 Sep. 2004, https://pubmed.ncbi.nlm.nih.gov/15364185/. Accessed 9 Feb. 2021.
3.
“Gender differences in coronary heart disease – NCBI – NIH.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018605/. Accessed 11 Feb. 2021.
4.
“ETHNIC DIFFERENCES IN CARDIOVASCULAR DISEASE.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767706/. Accessed 8 Feb. 2021.
5. “First Peoples, Second Class Treatment – Wellesley Institute.” https://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Full-Report-FPSCT-Updated.pdf. Accessed 12 Feb. 2021.