Category Archives: Heart Disease

March 14, 2014 · 6:34 AM

Your Oral Health May Help You Prevent Heart Disease

…according to an article at University Herald.

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The idea is that nasty bacteria around your gums somehow cause arterial inflammation in your heart arteries, which could lead to heart attacks. I’ve written about this before.

A quote from the article:

The researchers followed 420 adults as part of the Oral Infections and Vascular Disease Epidemiology Study (INVEST), a randomly sampled prospective cohort of Northern Manhattan residents. Participants were examined for periodontal infection. Overall, 5,008 plaque samples were taken from several teeth, beneath the gum, and analyzed for 11 bacterial strains linked to periodontal disease and seven control bacteria. Fluid around the gums was sampled to assess levels of Interleukin-1β, a marker of inflammation. Atherosclerosis in both carotid arteries was measured using high-resolution ultrasound.

Over a median follow-up period of three years, the researchers found that improvement in periodontal health-health of the gums-and a reduction in the proportion of specific bacteria linked to periodontal disease correlated to a slower intima-medial thickness (IMT) progression, and worsening periodontal infections paralleled the progression of IMT. Results were adjusted for potential confounders such as body mass index, cholesterol levels, diabetes, and smoking status.

Thickening of the arterial lining is linked to higher rates of heart attack and stroke.

It remains to be seen whether alteration of gum bacteria and periodontal disease via oral self-care and dental care will reduce cardiovascular risk going forward. Stay tuned.

Read more at http://www.universityherald.com/articles/5322/20131101/brushing-your-teeth-could-prevent-heart-disease.htm#rvx294vC7VKJ6Qu3.99

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February 11, 2014 · 4:55 AM

Do Nuts Help Or Hurt Cholesterol Levels?

Mixed Nuts Improve Diabetes, Too

Mixed Nuts Improve Diabetes

Most of the diets I recommend to my patients include nuts because they are so often linked to improved cardiovascular health in scientific studies. Walnuts are associated with reduced risk of type 2 diabetes in women, and established type 2 diabetics see improved blood sugar control and lower cholesterols when adding nuts to their diets.

Nut consumption lowers total and LDL cholesterol levels, and if triglycerides are elevated, nuts lower them, too. Those changes would tend to reduce heart disease.

Conner Middelmann-Whitney has a good nutty article at Psychology Today.

Steve Parker, M.D.

Reference: Joan Sabaté, MD, DrPH; Keiji Oda, MA, MPH; Emilio Ros, MD, PhD. Nut Consumption and Blood Lipid Levels: A Pooled Analysis of 25 Intervention Trials. Archives of Internal Medicine, 2010, Vol. 170 No. 9, pp 821-827. Abstract:

Background  Epidemiological studies have consistently associated nut consumption with reduced risk for coronary heart disease. Subsequently, many dietary intervention trials investigated the effects of nut consumption on blood lipid levels. The objectives of this study were to estimate the effects of nut consumption on blood lipid levels and to examine whether different factors modify the effects.

Methods:  We pooled individual primary data from 25 nut consumption trials conducted in 7 countries among 583 men and women with normolipidemia and hypercholesterolemia who were not taking lipid-lowering medications. In a pooled analysis, we used mixed linear models to assess the effects of nut consumption and the potential interactions.

Results:  With a mean daily consumption of 67 g of nuts [about 2 ounces or 2 palms-ful], the following estimated mean reductions were achieved: total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concentration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concentration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration to HDL-C (0.24 [5.6% change]) (P < .001 for all) (to convert all cholesterol concentrations to millimoles per liter, multiply by 0.0259). Triglyceride levels were reduced by 20.6 mg/dL (10.2%) in subjects with blood triglyceride levels of at least 150 mg/dL (P < .05) but not in those with lower levels (to convert triglyceride level to millimoles per liter, multiply by 0.0113). The effects of nut consumption were dose related, and different types of nuts had similar effects on blood lipid levels. The effects of nut consumption were significantly modified by LDL-C, body mass index, and diet type: the lipid-lowering effects of nut consumption were greatest among subjects with high baseline LDL-C and with low body mass index and among those consuming Western diets.

Conclusion:  Nut consumption improves blood lipid levels in a dose-related manner, particularly among subjects with higher LDL-C or with lower BMI.

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November 10, 2013 · 4:30 PM

Worried About Future Heart Attack? Check Your LDL Cholesterol Particle Number (LDL-P)

…according to Drs. Thomas Dayspring and James Underberg. I don’t know if these guys are right or not. I bet it’s more complicated than simple LDL particle number.

Even if you eat lots of eggs, most of your cholesterol is made by your liver. That's where statin drugs work.

Even if you eat lots of eggs, most of your cholesterol is made by your liver. That’s where statin drugs work.

Most heart attacks (aka myocardial infarctions) do indeed seem to be caused by acute rupture of an atherosclerotic plaque that’s been present for years. Two key questions are:

  1. What causes the plaque?
  2. Why causes them to rupture?

Underberg and Dayspring write:

The only absolute requirement for plaque development is the presence of cholesterol in the artery: although there are additional heart risk factors like smoking, hypertension, obesity, family history, diabetes, kidney disease, etc., none of those need to be present. Unfortunately, measuring cholesterol in the blood, where it cannot cause plaque, until recently has been the standard of risk-testing. That belief was erroneous and we now have much better biomarkers to use for CV risk-assessment. The graveyard and coronary care units are filled with individuals whose pre-death cholesterol levels were perfect. We now understand that the major way cholesterol gets into the arteries is as a passenger, in protein-enwrapped particles, called lipoproteins.

Particle entry into the artery wall is driven by the amount of particles (particle number) not by how much cholesterol they contain. Coronary heart disease is very often found in those with normal total or LDL-cholesterol (LDL-C) levels in the presence of a high LDL particle number (LDL-P). By far, the most common underlying condition that increases LDL particle concentration is insulin resistance, or prediabetes, a state where the body actually resists the action of the sugar controlling hormone insulin. This is the most common scenario where patients have significant heart attack risk with perfectly normal cholesterol levels. The good news is that we can easily fix this, sometimes without medication. The key to understanding how comes with the knowledge that the driving forces are dietary carbohydrates, especially fructose and high-fructose corn syrup. In the past, we’ve often been told that elimination of saturated fats from the diet would help solve the problem. That was bad advice. The fact is that until those predisposed to insulin resistance drastically reduce their carbohydrate intake, sudden deaths from coronary heart disease and the exploding diabetes epidemic will continue to prematurely kill those so afflicted.

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And for goodness’ sake, if you want to live longer, start reducing the amount of dietary carbohydrates, including bread, potatoes, rice, soda and sweetened beverages (including fruit juices), cereal, candy – the list is large).

Underberg and Dayspring don’t mention don’t mention LDL particle size, such as small/dense and large/fluffy; the former are thought by many to be much more highly atherogenic. Is that outdated?

Whoever figures out the immediate cause of plaque rupture and how to reliably prevent it will win a Nobel Prize in Medicine.

Read the whole enchilada.

Steve Parker, M.D.

About Dayspring and Underberg:

Thomas Dayspring MD, FACP, FNLA   Director of Cardiovascular Education, The Foundation for Health Improvement and Technology, Richmond, VA. Clinical Assistant Professor of Medicine, University of Medicine and Dentistry of New Jersey, New Jersey Medical School.

James Underberg MD, FACP, FNLA   Clinical Assistant Professor of Medicine in the Division of General Internal Medicine at NYU Medical School and the NYU Center for Cardiovascular Disease Prevention . Director of the Bellevue Hospital Primary Care Lipid Management Clinic.

h/t Dr. Axel Sigurdsson

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September 22, 2013 · 4:28 AM

Heart-Healthy Lifestyle Prevents Cancer, Too

…according to a report in MedPageToday. Type 2 diabetes is linked to higher incidence of several cancers: liver, pancreas, uterus, colo-rectal, breast, and bladder.  On a brighter note, diabetics have lower risk of prostate cancer. Diabetes is also associated with higher risk of heart disease.

I'm still not convinced that severe sodium restriction is necessary or even possible for most people

I’m still not convinced that severe sodium restriction is necessary or even possible for most people

The American Heart Association has published guidelines aiming to reduce premature death and illness caused by cardiovascular diseases such as heart attacks, high blood pressure, and strokes.

The guidelines focus on seven factors critical to cardiovascular health:

  • smoking
  • blood sugar
  • blood pressure
  • physical activity
  • total cholesterol
  • body mass index (BMI)
  • ideal diet

Using data from the Atherosclerosis Risk In Communities study (almost two decades’ follow-up), researchers found that those who maintained goals for six or seven of the American Heart Association critical factors had a 51% lower risk of cancer compared with those meeting no goals.

For detailed information about the specific goals, click here.

As you might expect, I was curious about what the American Heart Association considered a heart-healthy diet.  I quote the AHA summary:

The recommendation for the definition of the dietary goals and metric, therefore, is as follows: “In the context of a diet that is appropriate in energy balance, pursuing an overall dietary pattern that is consistent with a DASH [Dietary Approaches to Stop Hypertension]-type eating plan, including but not limited to:

  • Fruits and vegetables: ≥ 4.5 cups per day
  • Fish: ≥ two 3.5-oz servings per week (preferably oily fish)
  • Fiber-rich whole grains (≥ 1.1 g of fiber per 10 g of carbohydrate): ≥ three 1-oz-equivalent servings per day
  • Sodium: < 1500 mg per day
  • Sugar-sweetened beverages: ≤ 450 kcal (36 oz) per week

Intake goals are expressed for a 2000-kcal diet and should be scaled accordingly for other levels of caloric intake. For example, ≤ 450 calories per week represents only up to one quarter of discretionary calories (as recommended) coming from any types of sugar intake for a 2000-kcal diet.

Diet recommendations are more complicated than that; read the full report for details.  Only 5% of study participants ate the “ideal diet.”  The AHA-recommended diet may have too many carbohydrates for some diabetics. The Mediterranean diet easily meets four out of five of those diet goals; you’d have to be extremely careful to reach the sodium goal on most any diet.

Cardiovascular diseases and cancer are among the top causes of death in Western societies.  Adhering to the guidelines above may kill two birds with one stone.

Steve Parker, M.D.

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August 22, 2013 · 5:39 AM

You May Be Wasting Money On Worthless Heart Drugs

 

Open wide!

Open wide!

…according to an article at MedPageToday.  Specific brands of extended-release niacin and fibrates are mentioned, among others.  I particularly like this quote of Dr. James Stein:

“So at least $4.5 billion was spent on drugs with uncertain benefit and known risks,” Stein said. “I’d much rather these patients focus on exercising and eating a healthy, Mediterranean-based diet, which has been proved to reduce heart attacks and strokes, than spending money on these agents.”

It’s a good idea to talk to the prescribing physician before stopping any of your drugs.

Steve Parker, M.D.

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June 25, 2013 · 2:43 AM

Low Glycemic Index Diets Reduce LDL and Total Cholesterol

…according to a recent report in Nutrition, Metabolism & Cardiovascular Disease. LDL cholesterol is the type we think contributes to coronary artery disease and other forms of atherosclerosis.

Learn about glycemic index at NutritionData.

My Low-Carb Mediterranean and Ketogenic Mediterranean Diets are undoubtedly “low glycemic index.”  The Advanced Mediterranean Diet would also be significantly lower GI than the standard American diet.

Steve Parker, M.D.

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June 10, 2013 · 4:58 AM

Is Sugar the New Fat?

Lumps of Death

Lumps of Death

In the 1950s, John Yudkin wrote a book, Pure, White, and Deadly (amazingly still available at Amazon), blaming sugar as the primary cause of heart disease (coronary heart disease).  The idea didn’t gain sufficient traction and the dietary fat theory of heart disease became the reigning dogma.  Now that the latter theory has been discredited, researchers are looking at sugar again.

The British Medical Journal has a pertinent article you’ll undoubtedly enjoy, if you’re the sort of person who enjoys these things.  I quote:

“In recent years, and slowly, the sugar hypothesis has been making a comeback, driven in part by the emerging perception of heart disease as a consequence of what’s now described as the metabolic syndrome: obesity, dyslipidaemia, raised blood pressure, and insulin resistance. Although there is still no consensus about the causes of the syndrome, an excess of fat in the liver—a response to dietary sugar—is one of the acknowledged possibilities.  Fructose, found in large quantities in nearly all added sugars, is known to increase lipogenesis in the liver and the synthesis of hepatic triglyceride.”

Steve Parker, M.D.

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April 26, 2013 · 3:25 PM

Eggs Are Linked to Heart Attacks in Diabetics?

The general population doesn’t need to worry about eggs causing strokes or heart attacks according to a new meta-analysis reviewed at Forbes. We still have a question about high egg consumption and heart attacks in diabetics.

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April 6, 2013 · 2:00 AM

Which Diseases Do Vegetables and Fruits Prevent?

Potential answers are in the American Journal of Clinical Nutrition (2012).  I quote:

For hypertension, coronary heart disease, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For inflammatory bowel disease, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.

It bothers me that vegetables and fruits are lumped together: they’re not the same.

All of my diets—Advanced Mediterranean, Low-Carb Mediterranean, and Ketogenic Mediterranean—provide plenty of fruits and vegetables.

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January 14, 2013 · 5:48 AM

Is Low-Carb Killing Swedish Women?

MPj04384870000[1]A recent Swedish study suggests that low-carbohydrate/high protein diets increase the risk of cardiovascular disease in women.  I’m not convinced, but will keep an eye on future developments.  This is a critical issue since many women eat low-carb/high protein for weight loss and management.

Researchers followed 43,000 women, 30-49 years of age at enrollment, over the course of 16 years.  In that span, they had 1270 cardiovascular events: ischemic heart disease (heart attacks and blocked heart arteries), strokes, subarachnoid hemorrhages,  and peripheral arterial disease.  Food consumption was estimated from a questionnaire filled out by study participants at the time of enrollment (and never repeated).

In practical terms, … a 20 gram decrease in daily carbohydrate intake and a 5 gram increase in daily protein intake would correspond to a 5% increase in the overall risk of cardiovascular disease.

So What?

To their credit, the researchers note that a similar analysis of the Women’s Health Study in the U.S. found no such linkage between cardiovascular disease and low-carb/high protein eating.

The results are questionably reliable since diet was only assessed once during the entire 16-year span.

I’m certain the investigators had access to overall death rates.  Why didn’t they bother to report those?  Your guess is as good as mine.  Even if low-carb/high protein eating increases the rate of cardiovascular events, it’s entirely possible that overall deaths could be lower, the same, or higher than average.  That’s important information.

I don’t want to get too far into the weeds here, but must point out that the type of carbohydrate consumed is probably important.  For instance, easily digested carbs that raise blood sugar higher than other carbs are associated with increased heart disease in women.  “Bad carbs” in this respect would be simple sugars and refined grains.

In a 2004 study, higher carbohydrate consumption was linked to progression of blocked heart arteries in postmenopausal women.

It’s complicated.

Steve Parker, M.D.

PS: I figure Swedish diet doctor Andreas Eenfeldt would have some great comments on this study, but can’t find them at his blog.

Reference: Lagiou, Pagona, et al.  Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study.  British Medical Journal, June 26, 2012.  doi: 10.1136/bmj.e4026

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