Top Seven Metrics to Reduce the Risk of Cardiovascular Disease.
In the last blog we discussed foods that can help fight off cancer, the second leading cause of death in the U.S. Today, let’s see how we can prevent the number one cause of death in the U.S. and the world, heart disease (1). Like cancer, most heart disease can be prevented with diet and lifestyle changes. But even more amazing, diet can reverse coronary artery disease! (2) This is another topic near and dear to my heart (pun intended) as my wife is a cardiologist, and her area of focus is on preventive cardiology, a specialty focusing on preventing heart disease. She would be very upset if I were trying to give nutrition advice and don’t bring up how nutrition can not only reduce the risk of cardiovascular disease, but prevent and reverse cardiovascular disease.
What Is Cardiovascular Disease?
What is cardiovascular disease? Cardiovascular disease is an umbrella term that describes problems with either the heart (cardio) and/or the blood vessels (vascular). These problems can manifest as hypertension, a heart attack (myocardial infarction), stroke, or arterial blood vessel blockages (coronary, peripheral or cerebral arterial disease). Blood vessels that transport nutrients to your body’s tissues are like pipes that transport water in a home. These pipes can get a buildup of gunk especially if you put things you shouldn’t put down the drain; this can slow the water flow and not drain anymore. Similarly, your blood vessels can build up gunk called plaques filled with inflamed cholesterol and platelets and clots if you put the wrong things in your body. Plaques can slow down blood flow which will slow down the delivery of nutrients and stress out the areas past the blockage. A heart attack occurs when arteries that feed the heart muscle suddenly become blocked so that area of the heart doesn’t get nutrients, and can die off. A stroke is when the same thing occurs in the brain. Coronary artery disease is when blood vessels in the heart are partially blocked and may cause symptoms such as shortness of breath or chest pain. This is why doctors give cholesterol lowering drugs and anti-platelet drugs (blood thinners) to try to help prevent these plaques from getting large and causing a heart attack or stroke. But what if there were just diet and lifestyle changes you could make that would work as well, or better than drugs to reduce the risk of cardiovascular disease?
Why Is Diet and Lifestyle Not Emphasized Enough to Treat Heart Disease?
Unfortunately, western medicine is mostly focused on drugs and treating problems once they occur. There is far less focus on non pharmaceutical remedies and prevention of diseases. According to the Center of Disease Control (CDC), 80% of cardiovascular disease is preventable. Yet it is the number one killer and most expensive disease Americans face (3).
You would think it would be a national priority to educate the public on good nutrition and lifestyle changes to reduce the risk of cardiovascular diesease and stop this killer, and reduce the health care costs associated with it. Millions should be spent on lifestyle intervention programs, research, improving good food options and availability. Instead, billions are spent on health care that focus on drugs, surgery, hospitalization, with billions lost in productivity just to barely slow down this killer.
Furthermore, nutrition is not even taught in medical school, nor in cardiology training. To become a cardiologist my wife had to do 4 years of medical school, 3 years of internal medicine residency, 1 year of cardiovascular research, then 3 years of cardiology fellowship. In all that training, there was no meaningful education on nutrition counselling or treatment of cardiovascular disease with nutrition. Not even when focusing on prevention! How can there be numerous studies and books written on how diet can prevent and treat cardiovascular disease, yet heart doctors don’t even learn about those treatments in training?
Doctors do not have time to counsel patients meaningfully in diet and if they did would they even be able to give good advice? Ninety nine percent of the nutrition information we learned was outside of formal training. I find this very concerning. Combine the lack of doctor training, the endless misinformation, and the big business of the food and pharmaceutical industries, and no wonder preventable diseases are still so prevalent and the solutions most advertised are drugs and surgery.
However, the medical community is slowly starting to come around. Several years ago, the American Heart Association (AHA) did put out recommendations on what they thought the top 7 factors to focus on, to optimize cardiovascular health, which is what we will highlight today.
Life’s Simple 7
According to the American Heart Association, there are 7 lifestyle metrics that can dramatically reduce the risks of cardiovascular disease:
- Controlling blood pressure
- Controlling cholesterol
- Reducing blood sugar
- Getting active
- Eating healthy
- Not being overweight
- Not smoking.
*5 components of healthy diet
1. Fruits and vegetables: ≥4.5 cups/day
2. 2.Fish: ≥two 3.5-oz servings/week (preferably oily fish)
3. 3.Fiber-rich whole grains (≥1.1gram of fiber per10 gram of carbohydrate): ≥three 1-oz-equivalent servings/day
4. Sodium: <1500 mg/day
5. Sugar-sweetened beverages: ≤450 kcal (36 oz)/week
There is a simple seven test above (4) you can take to score how you fare. Each component can be scored 2 points for ideal, 1 for intermediate, and 0 for poor. The composite Life’s Simple 7 score is rated optimal at 10-14 points, average at 5-9, and inadequate at 0-4. If you score in the optimal category, the risk of peripheral artery disease compared to those scored in the inadequate range was reduced by 86%. Just scoring in the average range reduced risk by 56% (5)! Improving 4 of the 7 (not smoking, being normal weight, meeting exercise and diet recommendations) can reduce the risk of chronic disease by 78% (6).
Drugs vs Lifestyle Change to Prevent Cardiovascular Disease
Let’s compare those numbers to a commonly used drug to prevent cardiovascular events, such as aspirin and statins. In a recent study, aspirin did not significantly reduce the rates of cardiovascular events compared to a placebo. Worse, there were higher risk of major bleeding episodes in the aspirin group compared to placebo (7). What about the number one selling drug class, statins? Statins is a class of medication that help lower cholesterol, reduce inflammation and oxidation. A study for a common statin, artorvastatin (LipitorⓇ) makes an argument for the drug by showing it reduced the risk of heart disease by 36% compared to placebo. However, in the study that meant for every 100 people taking a statin, only 1 heart attack was prevented compared to placebo (8). However, stains also can have negative effects including increasing the risk for diabetes, it may poison muscle fibers, they can damage stem cells, and may cause cognitive decline. For another comparison, A German study showed that eating 6 grams of chocolate can reduce the risk of heart disease by 39% (9)! Certainly, medications can have a role in high risk patients, in patients already with heart disease, and patients are unable to make or sustain the necessary diet and lifestyle changes but, in my opinion, too often utilized in early prevention. Yet, on the positive side, it is important to note the AHA and American College of Cardiology, European Society of Cardiology and The World Health Organization emphasize preventing and treating cardiovascular disease first with aggressive lifestyle changes (i.e. Life’s Simple Seven).
The Bottom Line
The lack of national education especially with medical providers on the role diet and lifestyle plays in preventing and treating cardiovascular disease, and all preventable diseases, is concerning to me. It’s even more concerning that we have so much research showing how a good diet can treat cardiovascular disease even compared to medications that are costly and have many adverse effects. The Simple 7 is a good start for setting attainable goals to strive to prevent, but also reduce, the risk of cardiovascular disease. It is certainly lacking a lot of specifics and details for the diet portion, however. This is why I wrote Nutrition 2.0 to help the average person learn more about how they can truly live and eat healthy. In the next blog I will give my top seven best and worse food choices, supplements to consider, and lifestyle changes.
2. A way to reverse CAD? Esselstyn CB Jr, Gendy G, Doyle J, Golubic M, Roizen MF. J Fam Pract. 2014 Jul;63(7):356-364b. PMID: 25198208
4. American Heart Association’s Life’s Simple 7: Avoiding Heart Failure and Preserving Cardiac Structure and Function. Folsom AR, Shah AM, Lutsey PL, Roetker NS, Alonso A, Avery CL, Miedema MD, Konety S, Chang PP, Solomon SD. Am J Med. 2015 Sep;128(9):970-6.e2. doi: 10.1016/j.amjmed.2015.03.027. Epub 2015 Apr 20. PMID: 25908393
6. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H. Arch Intern Med. 2009 Aug 10;169(15):1355-62. doi: 10.1001/archinternmed.2009.237. PMID: 19667296
7. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. John J. McNeil, M.B., B.S., Ph.D., et al for the ASPREE Investigator Group* October 18, 2018. N Engl J Med 2018; 379:1509-1518. DOI: 10.1056/NEJMoa1805819.