Coronary heart disease prevention
Deaths from heart disease has reduced by over a quarter since 1975 (see graph) and has been put down to earlier diagnosis, treatment of cholesterol and high blood pressure, other drugs, improved lifestyle avoiding cigarette smoking.
However when you look at the graph, it's hard to see why it rose in the 1920s, and is gradually declining, almost suggesting an epidemic.
Nevertheless there are numerous things that we can do to reduce the risk of heart disease, especially for those at risk.
What doctors can do
- Statin drugs – these are probably the most profitable and prescribed drugs in the world, and have almost certainly been overused. They can reduce the risk of heart disease by approximately 20%, but they do have significant adverse and side-effects, and only for those at real risk of heart disease would we recommend that they be used . For a longer discussion on the statin drugs, see the page below on statins.
- Aspirin – for many years doctors have been recommending taking a low dose of aspirin, however the evidence for those without heart disease there is a slight reduction in heart attacks, but no difference in strokes and heart disease deaths, that a higher incidence of bleeding. Aspirin the should therefore only be used in people with definite heart disease.
- High blood pressure – there is no debate high blood pressure should be treated, and in doing so this does reduce the risk of heart disease.
- Diabetes – this is a real problem, it has a very high risk for heart disease, but unfortunately medical treatment makes little difference to heart disease. It does mean that optimal control of cholesterol and high blood pressure are crucial. Diet, weight loss and exercise are the best therapies for diabetes, and of course controlling the blood sugar.
- The poly pill – a single pill containing the combination of blood pressure lowering drugs (ACE inhibitors) and aspirin has been suggested for all middle-aged to older people, particularly those at risk. These do have significant side-effects, and as yet had not been shown to have any benefit at all.
What you can do
- Smoking cessation – this is the major avoidable cause of premature death, smoking not only causes heart attacks, but tends to make them more fatal. Much of the reduction in heart disease in the last quarter century is due to reduction in smoking, and it is never too late to stop. Benefits appear after only a few months, and after a few years the risk returns to that of a non-smoker, even in the elderly.
- Healthy diet – this is a very difficult topic, because for years we have been pushing the dangers of fats, replacing it with sugars which is led to the epidemic of type II diabetes. I don't think anybody can yet recommended diet that has been proven to be beneficial, other than vegetarian diets, or the Mediterranean diet which is the most palatable for Western people. It's important have lots of fresh fruit and vegetables, reduce the amount of sugar and also trans fats. Whether saturated fats are as bad as they have been painted we really do not know.
- Physical activity – many studies have shown that regular physical exercise not only maintains ideal weight and reduces the risk of diabetes, but also reduces heart disease. Rigorous exercise is probably unnecessary, just modest amounts of regular physical activities such as a brisk walk 20 minutes a day may be just as beneficial.
- Weight reduction – it is best to be near your optimal weight, particularly having a healthy waist circumference (less than 95 cm or 38 inches). This is because the fat in the abdomen is the most active and does the most damage. Having an idea waist circumference is the best way to treat diabetes, and even from non diabetics an enlarged waist probably has a similar effect on the arteries.
- Alcohol – while heavy alcohol drinking has major health problems, mild drinking (one per day for female and 2 per day for males) has actually been shown to reduce the risk of heart disease and death by almost a quarter. Whether this is enough to make a nondrinker start drinking I would be doubtful.
- Meditation and stress reduction – there seems little doubt that stress plays a big part in the immediate causes of heart attacks, and almost certainly in their development. Learning to relax, meditate and reduce stress in life must be beneficial.
- Nutritional supplements – there are a number of supplements that are beneficial with heart disease, and I would encourage you to take them:
- A good multivitamin and multi mineral – to make sure that the arteries have all the nutrients they require.
- Omega-3 fish oils – these reduce the risk of heart disease, and particularly sudden death, I would recommend 1 to 2 g of a high quality product per day.
- Vitamin D – this seems to be beneficial for most diseases including coronary artery disease, and 4 to 6000 international units daily seems optimal.
- Vitamin E – this should be in a good multivitamin, and I don't think there's any evidence suggesting that more vitamin E is beneficial.
- Antioxidants – grapeseed and similar products have a strong anti-inflammatory effect, and as inflammation is believed to be the underlying cause of coronary artery disease, taking these products seems a good idea.
- Vitamin C – there is conflicting evidence on vitamin C and heart disease, but I would recommend taking at least one to 2 g of vitamin C per day.
- Homocysteine reduction – this is a risk factor for heart disease, and can be reduced by combination of vitamins B6, B12 and folic acid. There is not much evidence that doing this is beneficial, and these products should be a good multi.
- Calcium and magnesium – calcium is beneficial for cardiac function, and there is no evidence that taking oral calcium effects the calcification in the coronary arteries. Magnesium helps relax the muscles, reduces the BP and has a beneficial effect on heart rhythm function as well. 800 mg of each per day.
- Vitamin K – there is some suggestion that vitamin K2 reduces calcium in the coronary arteries, which is an indication of coronary artery disease. Whether it actually reduces heart attacks or death are uncertain, but vitamin K 2 should be and a good multivitamin and multi mineral preparation.
The Nutritional supplements I use and recommend to my patients
For Heart prevention I recommend - USANA - Cellsentials *, Biomega, Active Calcium plus, vitamin D and Proflavanol C