Alternative names: Myocardial Infarction, MI, Acute Myocardial Infarction
Irreversible and unexpected, heart failure is the leading cause of death in Western countries. For 50% of men who die from heart attacks, the fatal attack is their first symptom.
Coronary artery disease (heart attack, or myocardial infarction) is the number one killer in the United States, yet it barely existed before 1900. A sampling of older cardiologists still working in the 1950s could not recall a case prior to 1910. Most people are unaware of this and do not readily believe it. It is not a highly publicized fact, possibly because it glaringly reminds us of the cause: the way we now live, principally the westernization of diet – the consumption of commercially processed foods. Some take a position that people were more active then, and we are more sedentary now. This is true, but should not be used as an excuse to continue eating what we prefer, instead of what we should.
There is a general misconception that cardiovascular disease affects only men, leading women to believe that they are not at risk. Although it is more prevalent in men, it is not a gender-specific health problem. Between 40 and 59 years of age, as many as 1 in 12 women display clinical evidence of heart disease. This prevalence rises to 1 in 3 among women older than 65.
The heart consists mainly of a special type of muscle known as myocardium. Just like every other muscle in the body, the heart requires its own steady supply of oxygen- and nutrient-rich blood. The heart is fed by its own circulation system, known as the main coronary arteries: the left anterior descending artery, the left circumflex artery, and the right coronary artery.
If one these three arteries becomes blocked, the part of the heart that it serves becomes starved of oxygen, leading to a condition called 'cardiac ischemia'. If this oxygen starvation continues for too long then the affected heart tissue begins to die, leading to a heart attack – also known as 'myocardial infarction', which literally means 'death of heart muscle'.
Most heart attacks are caused by coronary artery disease (atherosclerosis, or hardening of the arteries), in which the insides of the arteries become clogged with plaques consisting of cholesterol, calcium, and other substances. Each plaque has a soft inner fatty (lipid) core which contains a strong clotting agent, and a tough, fibrous outer shell that keeps the liquid core away from the blood. When one of these plaques ruptures and spills its contents into the bloodstream, a blood clot forms at the site of the rupture. If it grows large enough, it can block the flow of blood through a main coronary artery or a smaller branch artery and trigger a heart attack.
Chronic inflammation of the artery walls can lead to heart attacks by increasing the buildup of plaques.
Rarely, a heart attack can be triggered by a coronary artery spasm, in which an artery in the heart is temporarily constricted. Tobacco and drugs such as cocaine can cause these life-threatening spasms.
A tear in a heart artery (spontaneous coronary artery dissection or SCAD) can cause a sudden heart attack, and is often the cause in those who otherwise have low risk factors, especially women aged 30 to 50.
The risk of developing coronary disease is increased by many factors over which we have control, yet often are unwilling to eliminate:
Other risk factors include:
Exertion and excitement can trigger a heart attack in those at risk.
Many other risk factors can be reduced once they have been tested for. Laboratory testing is now going far beyond total cholesterol (HDL and LDL ratios) and triglycerides. Anyone with an elevated risk of heart disease should do specific testing to assess their risk and make the necessary changes. Such tests include hs-CRP, lipoprotein(a), homocysteine and fibrinogen among others.
Many who have experienced a heart attack describe the feeling as being "like an elephant was sitting on my chest", "a giant fist squeezing my heart", or "a squeezing sensation in my arms." The pain can be constant or intermittent, and usually lasts for 15 minutes up to several hours. It is not improved by rest or taking one's usual angina medication.
However, not everyone experiences these classic signs, or even any symptoms at all. For some, an 'uncomfortable' sensation, achiness, pain or pressure in their neck, jaw or shoulders is the only sign of heart problems or a heart attack. More symptoms are listed below.
Some heart attacks occur without any warning, but many people experience warning signs hours, days, weeks or even months in advance. One common sign to look for is episodes of chest pain caused by angina, which begins after exertion and is relieved by rest. Angina is similar to a heart attack in that blood flow to the heart is interrupted, but the difference is that blood flow is restored within minutes and heart tissue is not permanently damaged.
About 1-in-4 heart attacks occur without any warning: episodes of interrupted of blood flow to the heart are pain-free, even when they are damaging heart tissue. This is known as 'silent ischemia', and is common in those with diabetes.
Coronary artery bypass surgery, also known as heart bypass surgery, creates a new route ('bypass') for blood and oxygen to reach the heart. It is one of the most widely performed – and often unnecessary – surgeries in the United States.
While the surgery does increase long-term survival of those with the most severe forms (left main coronary artery occlusion and three-vessel disease) and relieves symptoms in 85% of patients, the long-term results actually indicate a reduced survival rate for those with mild to moderate coronary artery disease and a return of symptoms within five years. Complications arising from coronary bypass operations are common, as this surgery represents one of the most technically difficult procedures in modern medicine.
During coronary bypass surgery, the surgeon opens up the chest cavity by cutting the breastbone, then spreading the ribs to expose the heart. A healthy vein or artery from another part of the body (usually a leg) is connected (sutured) at one end to the blocked coronary artery and at the other end to the aorta or the internal mammary artery. In this way, the blocked portion of the coronary artery is bypassed, restoring full blood flow to the heart. One or more coronary arteries may be bypassed during a single operation.
About 1-in-4 heart attack patients die before reaching the hospital, and many suffer serious and potentially fatal complications while confined. Those who survive the initial heart attack and feel well a few hours later are more likely to have a full recovery. If part of the heart muscle has died, it is replaced by scar tissue over the next few weeks.
Every heart attack weakens the heart to some degree. Serious complications arising from a heart attack can include:
Most heart attacks occur over the course of several hours, so seek help immediately if you think a heart attack is starting.
Elevated levels of serum uric acid increase the risk of heart attack.
In evaluating 5,926 subjects who were between 25 and 74 years of age, after 16.4 years of follow-up, there were 1,593 deaths of which 45.9% were attributed to cardiovascular disease. It was found that increased serum uric acid levels were independently and significantly associated with the risk of cardiovascular mortality. [JAMA, May 10, 2000;283(18): pp.2404-2410]
Heart rate is a stronger predictor of cardiovascular death in the elderly, particularly in men, than traditional risk factors such as diabetes and hypertension. Elderly men with a resting pulse rate above 80 beats per minute have a significantly higher rate of cardiovascular mortality. A low heart rate, below 64 beats per minute, is protective against cardiovascular mortality.
Heart rate is a stronger predictor of cardiovascular death in the elderly, particularly in men, than traditional risk factors such as diabetes and hypertension. Elderly men with a resting pulse rate above 80 beats per minute have a significantly higher rate of cardiovascular mortality. A low heart rate, below 64 beats per minute, is protective against cardiovascular mortality.
Cardiac pain may occasionally present as upper abdominal pain. An acute myocardial infarction can cause upper-right or epigastric discomfort that may be similar to that of a gallbladder attack. Congestive heart failure may stretch the liver capsule.
The pain caused by a Myocardial Infarction may extend downward into the abdominal area.
In one study, subjects with heart disease had 10 times more fat in their stool than heart-healthy individuals. This means those with heart disease weren't absorbing their fats [Am J Cardiology 5: p.295, 1960].
In cases of heart disease, pain will usually be felt in the left or middle of the chest, but it can also be felt in the inner sides of the left arm, neck, jaw, or between the shoulder blades.
Hiccups can be one of the first signs of heart muscle damage or heart attack.
A Harvard study found that male-pattern baldness may be a marker for increased risk of coronary heart disease. Severe hair loss on the top of head resulted in a 36% increased risk. The risk became lower with less hair loss. [Archives of Internal Medicine, Jan. 24, 2001]
The presence of a diagonal earlobe crease has been recognized as a sign of cardiovascular disease since 1973. Over 30 subsequent studies have been reported in the medical literature, with the largest involving 1,000 unselected patients. The earlobe is richly supplied with blood, and a decrease in flow over an extended period of time is believed to result in collapse of the vascular bed, leading to a diagonal crease.
It appears that individuals with an earlobe crease have a 55% greater risk of dying from heart disease than those without the marking, with the risk becoming even more significant if diagonal creases appear on both earlobes. However, this predictive value does not apply to Orientals, Native Americans, or persons born with certain hereditary disorders.
Weight loss is a common finding among individuals with chronic heart failure. It is evident that malabsorption of fats is related to heart failure. In one study, subjects with heart disease had 10 times more fat in their stool than heart-healthy individuals. This means those with heart disease weren't absorbing their fats [Am J Cardiology 5: p.295, 1960]. Yet heart patients are typically placed on low-fat diets! These individuals were leaner, but not healthier.
People who are highly anger-prone are nearly three times more likely to have heart attacks according to a study in the May 2, 2000 issue of Circulation. The study adds to previous research showing a link to heart health and other emotions, such as depression and hostility.
Tired and heavy legs may indicate that the return blood flow from the legs to the heart is impaired. Gravity and impaired veins combined with possible heart problems result in oxygen-depletion in the legs, producing that heavy, tired feeling.
Arm pain, usually in the left arm, can signal a heart attack or impending heart attack.
In cases of heart disease, pain will usually be felt in the left or middle of the chest, but it can also be felt in the inner sides of the left arm, neck, jaw, or between the shoulder blades. This pain, also known as 'referred pain', should not be ignored. The pain that you experience is a manifestation of something going wrong in your body.
An episode of angina is not a heart attack. The pain of angina means that some of the heart muscle is temporarily not getting enough blood. Angina does, however, mean that there is underlying coronary heart disease. Although patients with angina are at increased risk of heart attack, an episode of angina is not a signal that a heart attack is about to happen. When the pattern of angina changes (more frequent or longer-lasting episodes, or occurring without exercise), the risk of heart attack in subsequent days or weeks is much higher.
Some studies show that people with gum disease are more likely have heart disease than those with healthy gums. In 2012, a scientific statement from the American Heart Association supported an association between heart disease and gum disease.
Periodontitis is a serious gum infection that damages the gums and can destroy the jawbone. It can also lead to an increase in inflammation across the body; overactivity of inflammatory pathways is a strong risk factor for the development of atherosclerotic heart disease and heart attack.
While systolic blood pressure is a better predictor of cardiovascular events than diastolic blood pressure or pulse pressure, all three measures are strongly and directly related to the risk of coronary and cerebrovascular events. [Archives of Internal Medicine, 2001; 161: pp.1183-92]
Excessive yawning can be caused by a vasovagal reaction and may indicate a heart problem.
April, 2017: A study involving 545 subjects and presented at the annual meeting of the European Association of Preventive Cardiology found that increased hair graying indicates a statistically significant increased risk of damaged arteries, arterial calcium deposits, and narrowing and hardening of the coronary arteries (coronary artery disease).
According to a report from the U.S. Surgeon General, "Cigarette smoking should be considered the most important risk factor for coronary heart disease." Statistical evidence reveals a three- to five-fold increase in the risk of coronary artery disease in smokers compared to nonsmokers. Risk of dying from a heart attack or stroke depends the number of cigarettes smoked, the number of years smoked, the age of smoking onset and depth of inhalation. However, when a woman stops smoking, no matter how long or how much she smoked, her risk of heart disease drops by 50% in the first year alone. Similar benefits would be expected for a man.
In 1999 the Journal of the American Medical Association reported that the risk of death from a heart attack rose 24-fold in the first hour after cocaine use.
Male carriers of the common hemochromatosis gene mutation are at 2-fold risk of a first heart attack compared with noncarriers. Some 10% to 20% of the population carry at least one gene for hemochromatosis. Full-blown hemochromatosis affects about 0.5% and gene carriers usually do not know that they are at increased risk. They have almost no increase in iron stores over those without the mutation [Circulation: Journal of the American Heart Association September 21, 1999;100].
Giving blood is the best way to lower iron stores, but a more recent study found no protective effect against heart attack among men who donated blood regularly. [Circulation January 2, 2001]
People who experience a jump in blood pressure when they consume salt are at increased risk of dying from heart disease. Even salt-sensitive individuals with normal blood pressure are at risk, as blood pressure eventually rises. [Hypertension (supp), Feb. 16, 2001] Hypertension and salt sensitivity are independent risk factors for cardiovascular disease.
Dehydration thickens the blood (which is about 50% water) and decreases its volume, thus lowering blood pressure. In an attempt to normalize (increase) blood pressure, the body constricts blood vessels. The heart is then forced to pump thicker blood through narrower vessels, putting it at increased risk of failure. A large study of 8,280 male and 12,017 female subjects found that staying sufficiently hydrated reduced the risk of coronary disease by 46% in men and 59% in women. [Am J Epidemiol. 2002 May 1;155(9): pp.827-33]
Women with the PCOS have a five to seven times higher risk of myocardial infarction and ischemic heart disease than other women. Surprisingly, the increased risk was found to be independent of obesity, supporting the argument that insulin resistance alone is important in determining cardiovascular risk. [Fertil Steril 2000;73(1): pp.150-6, J Clin Endocrinol Metab 1999;84(6): pp.1897-99]
Certain risks to cardiovascular health begin around the time of menopause, and rapidly increase after menopause. Examples include changes in blood pressure and cholesterol levels, and a more sedentary lifestyle.
The thyroid affects every organ in the body, including the heart. Almost any type of heart disease can be worsened by thyroid disorder, so thyroid function should always be checked if cardiac symptoms are worsening. Hypothyroidism weakens the heart muscle in both its contraction and relaxation phases, resulting in less blood being pumped. And, because the heart muscle does not relax normally in between beats, a potentially serious condition called diastolic dysfunction may result.
A review of research evidence by US physicians published in the medical journal Mayo Clinic Proceedings in June of 2012 suggests that excess exercise (for example intensive training schedules or extreme endurance competitions) can cause dangerous long-term damage to the heart. According to this review, the safe upper limit for heart health is a maximum of one hour of strenuous exercise a day, after which we reach a point of diminishing returns.
Since then, several studies have confirmed that the health benefits of exercise diminish for those who exercise excessively, for example among people who run more than 20 miles (32km) a week, more than six days a week, or faster than eight miles per hour (13kph).
During prolonged, intense exercise the body burns sugar and fat for fuel which creates free radicals as a byproduct. Free radicals bind with cholesterol to create plaque buildup in the arteries which increases risk of developing heart disease.
If you sleep less than six hours per night and have disturbed sleep you stand a 48% greater chance of developing or dying from heart disease.
Researchers at Columbia University Medical School studied 55 men undergoing X-ray exams of their arteries and found that those with a lower testosterone level had higher degrees of heart disease (blockage of the coronary arteries). This study also found that the protective HDL cholesterol levels were higher in men with higher testosterone levels.
Low testosterone is linked to hypertension, obesity, atherosclerosis and increased waist-to-hip ratio – all of these being heart attack risk factors. Administration of testosterone to men has been reported to decrease the risk factors for heart attack.
Elevated homocysteine levels are believed to exacerbate oxidative injury to blood vessels and increase pro-clotting mechanisms linked to stroke and heart attack.
Swedish researchers reported in 2011 that having tonsils (or the appendix) removed before age 20 increases one's risk of suffering a heart attack at a young age – 44% increased risk for tonsils, and 33% for the appendix.
Swedish researchers reported in 2011 that having the appendix (or tonsils) removed before age 20 increases one's risk of suffering a heart attack at a young age – 33% increased risk for the appendix, and 44% for tonsils.
While previous research has shown that depression in men and women is linked to heart disease, a recent study found that only men who are depressed face an increased risk of heart disease-related death. [Archives of Internal Medicine, May 8, 2000)]
Even if you never become diabetic, high levels of insulin contribute to cardiovascular risk by increasing the process of atherosclerosis. Insulin increases the rate at which cholesterol-laden plaque builds up on arterial walls. The abnormally high levels of insulin produced by all overweight individuals, diabetic or not, is an independent risk factor for early cardiac death.
Elevated uric acid levels, as seen in gout, may be associated with a higher incidence of coronary heart disease amongst alcohol abstainers, but has not been seen to occur in those who were light, moderate or heavy drinkers. [Journal of Clinical Epidemiology,1996;49(6) pp.673-678]
Cardiovascular disease is the leading cause of diabetes-related death. People with diabetes are two to four times more likely to develop cardiovascular disease. At least 65% of people with diabetes die from heart disease or stroke.
It is not clear yet if people with type 1.5 have the same high risk for cardiovascular problems as individuals with type 2.
Obstructive sleep apnea increases a person's risk of having a heart attack or dying by 30% over a period of four to five years, according to a Yale University study presented at the American Thoracic Society 2007 International Conference in May of 2007. Sleep apnea is associated with many physiological changes that increase the risk of both heart attack and stroke.
Statistics now show that the wide use of the Pill has given rise to health hazards such as breast cancer, high blood pressure and cardiovascular disease on a scale previously unknown in medicine.
May 23, 2012: A study of approximately 24,000 people between the ages of 35 and 64 and published in the journal Heart found that participants who took regular calcium supplements were 86% more likely to have a heart attack than those who didn't take supplements.
A November 2012 study published in the New England Journal of Medicine showed a 34% reduction in the risk of death associated with heart attack among patients who used aspirin daily.
The B vitamins help prevent cardiovascular disease by reducing levels of homocysteine, which damages the arteries and promotes the buildup of plaque in the arteries (atherosclerosis). Researchers at Harvard University found that a high level of homocysteine in the blood more than triples the risk of heart attack.
Extreme calorie restriction, which is common among yo-yo dieters, can increase levels of the stress hormone cortisol which, when present in the body over long periods of time, can increase one's risk of developing serious health problems such as heart disease, diabetes and even cancer. Risk increases each time the cycle of dieting and weight gain repeats.
Essentially every single study on low carbohydrate diets that measured uric acid levels has shown that uric acid levels rose. [Obesity Research 9 (2001):1S] Uric acid itself has been tied to cardiovascular disease risk in virtually every instance it's been studied over the last 50 years, and may be an independent risk factor by increasing free radical damage or making the blood more susceptible to clotting. [American Journal of Cardiology 85 (2000): p.1018]
In another clinical trial, despite statistically significant weight loss reported in the Atkins group, every single cardiac risk factor measured worsened after a year on the Atkins Diet (measures included LDL, triglycerides, total cholesterol, HDL, total-to-HDL cholesterol ratio, homocysteine, Lp(a), and fibrinogen). While the LDL in the Atkins group increased 6%, the LDL cholesterol levels in the whole-foods vegetarian group was cut in half, dropping 52%.
Based on an analysis of the Atkins Diet, long-term use of the Atkins Diet is expected to raise coronary heart disease risk by over 50%. [Journal of the American College of nutrition 19 (2000): p.578]
Men and women who ate legumes at least four times a week were found to have a 22% lower risk of coronary heart disease over 19 years than those who consumed legumes once weekly, researchers report in the November 26th issue of the Archives of Internal Medicine. The study was based on interviews and medical exams of more than 9,600 Americans who did not have heart disease when the study began. [Archives of Internal Medicine 2001;161: pp.2573-8].
Being overweight stresses our bodies and damages our health in many ways. Even those who are only slightly overweight have increased risk of heart disease and stroke.
An Australian study of 230,000 subjects reported in 2016 that prolonged sleep – especially when combined with a sedentary lifestyle – increases risk of premature death from diseases such as heart disease, diabetes and cancer by up to 300%. In addition, sleeping too much may be an indicator of illness such as cardiovascular disease.
An Australian study of 230,000 subjects reported in 2016 that prolonged sleep – especially when combined with a sedentary lifestyle – increases risk of premature death from diseases such as heart disease, diabetes and cancer by up to 300%.
In addition, sleeping too much may be an indicator of illness such as cardiovascular disease.
Linus Pauling discovered that supplemental L-lysine reduces the binding of lipoprotein-a, also known as Lp(a), in its binding to the walls of arteries. By preventing this action, plaque buildup is discouraged since plaque is made up primarily of Lp(a).
The naturally-occurring amino acids lysine and proline assist Lp(a) in its deposition and binding to stressed or injured vascular wall sites. However, when there is an extra quantity of lysine and proline in the blood stream, the Lp(a) attachment sites get blocked by these amino acids creating a "Teflon-like" layer around the lipoprotein particles. This prevents the Lp(a) from binding to artery walls, as well as helps detach Lp(a) plaque from preexisting sites in the vascular wall. This supplemental use of these amino acids can prevent plaque build-up and initiate the reversal of plaque deposits. The amount will vary between individuals. Seriously ill heart patients require 5-6 grams (5,000 to 6,000mg) of lysine daily. This strategy may be useful for treating type 2 plaque.
Where heart disease is concerned, animal fats are generally considered unhealthy due to their association with high cholesterol levels in the blood.
Research suggests that people who reduce salt in their diet by about 3gm per day can reduce their chances of developing cardiovascular disease by a quarter.
Coffee, including decaf, contains significant amounts of Vitamin K which is an important factor for blood coagulation. People at high risk for blood clots, strokes, and heart attacks should avoid coffee and decaf for this reason.
The use of monounsaturated oils such as olive oil may be more protective than a low fat diet. Use olive oil or coconut oil exclusively when frying. Avoid the use of hydrogenated fats (they contain trans-fatty acids) which may be worse than saturated fats in contributing to heart disease.
If you are at risk of having a heart attack, taking one aspirin daily can greatly reduce this risk. A quarter of heart attacks occur within three hours of waking up, when the blood is thickest and stickiest and the circulation is at its slowest, increasing the risk of clot formation. Therefore, the most effective time to take aspirin for the prevention of heart attack, stroke and deep vein thrombosis is before sleeping.
During a heart attack, it is important to get some aspirin into your bloodstream as quickly as possible by chewing 1 adult-strength or 2 to 4 low-dose aspirin. Most heart attacks occur when a cholesterol-laden plaque ruptures in a coronary artery, attracting platelets to its surface and causing a clot (thrombus) to build up. If the clot blocks the artery completely, it deprives part of the heart of oxygen and causes a heart attack. Aspirin helps by inhibiting platelets; only a tiny amount is needed to inhibit all the platelets in the bloodstream – in fact, small doses are better. This will slow clotting and decrease the size of the blood clot that is forming.
After a heart attack, aspirin can help prevent further attacks when taken daily. An appropriate preventative dose is around half a regular aspirin tablet (150-160mg), or two baby aspirin tablets (81mg each).
Research at the University of Oxford published in 2017 suggests that regular aspirin users without a history of heart attack or stroke should stop taking aspirin by their late 60s because after that age the risk of fatal bleeding probably outweighs the benefits.
A further study, published in the New England Journal of Medicine in September 2018, confirmed no detectable benefit from regular use of low-dose aspirin for those 70 and older who are at low-to-moderate risk of heart disease; instead it found an increase in the rate of death in that population.
A landmark study in 1986 of 242 men aged 50-79 and based on 12 years of research stated that a small supplementation of DHEA corresponded to a 48% reduction in death from heart disease and a 36% reduction in death from any cause, other than accidents. Indirect evidence does suggest that DHEA supplements might reduce the risk of heart disease, especially in men, but this is far from proven.
A Cardiovascular Disease Panel (Blood or Tissue Biopsy) can test for the presence of Chlamydia pneumoniae, Mycoplasma pneumoniae, Helicobacter pylori, Cytomegalovirus (CMV) and Human Herpes Virus 6 (HHV-6).
Selenium is considered to be from 200 to 500 times more potent an antioxidant than Vitamin E. Selenium and Vitamin E are synergistic as antioxidants and inhibit or prevent the damage to tissues by free radicals which have been cited as causal factors in heart disease.
If infection is present, selected antibiotic therapies such as UV blood irradiation or oxidative therapies (H2O2/ozone) can reduce the risk associated with certain infections.
Aside from CPR and dialing 911, there may be additional measures one can take when a heart attack occurs. Without help, a person whose heart stops beating properly and who begins to feel faint has only about 10 seconds left before losing consciousness.
These victims can help themselves by coughing repeatedly and vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds, non-stop until help arrives or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. Some claim that biting or stimulating the tips of the little fingers (heart meridian) can provide needed stimulation at this critical time, and improve the prospects of recovery.
People who live in a chronically stressed-out condition are more likely to take up smoking, frequently overeat, and be far less likely to exercise. All of these stress-related behaviors have a direct effect on the development of coronary artery disease.
It is also known that the surge in adrenaline caused by severe emotional stress causes the blood to clot more readily (a major factor in heart attacks) and that the stress of performing difficult arithmetic problems can constrict the coronary arteries in such a way that blood flow to the heart muscle is reduced. Stress increases homocysteine levels, a known risk factor for coronary artery disease.
Policosanol has other actions against heart disease in addition to lowering cholesterol. Like statin drugs, policosanol helps stop the formation of arterial lesions. One of policosanol's important actions is to inhibit the oxidation of LDL, which is the major contributor to arterial damage. Oxidized LDL promotes the destruction of blood vessels by creating a chronic inflammatory response.
Many studies have shown that higher omega-3 fatty acid intake, through fish consumption or through supplementation, can cut the rate of sudden cardiac death by nearly 50% in both apparently healthy patients and those who have suffered a previous heart attack.
To better understand this protective effect, Danish researchers examined the dietary patterns and individual fatty acid status of nearly 300 patients with ischemic heart disease, comparing them with specific parameters of cardiac function. They found that the patients who ate more fish had higher levels of omega-3 polyunsaturated fats in their blood cell membranes and in their fat cells. A higher level of two specific fatty acids, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) – especially within the cell membrane – was associated with higher heart rate variability in the patients. An increased heart rate variability indicates healthier pulse regulation, and appears to significantly reduce the risk of arrhythmia and cardiac death.
Supplemental vitamin C can help heal injured arteries when used with L-lysine and proline for plaque prevention and possibly removal. A typical prescription would be 3-6gm vitamin C, 3-6gm lysine and 0.5-2gm proline. Furthermore, vitamin C deficiency (as indicated by low plasma ascorbate concentration) is a known risk factor for coronary heart disease.
One year of supplementation with vitamin C (500mg bid) and vitamin E (400 IU bid) retarded the early progression of transplant-associated coronary arteriosclerosis in a study of 40 patients up to 2 years after cardiac transplantation. [Lancet 2002;359(9312): pp.1108-13]
Vitamin C treatment has a possible role in benefiting patients with coronary heart disease by countering the adverse effects of a high-fat meal. Researchers found that postprandial serum triglyceride concentration increased significantly at 2-5 hours after a high-fat meal in all groups. The postprandial flow-mediated dilatation was significantly aggravated in people not taking vitamin C (both with and without heart disease), but this parameter in patients and subjects taking vitamin C showed no significant change. [Clin Cardiol 2002;25: pp.219-224]
In a study published in Epidemiology in 2002, a substantial inverse association with myocardial infarctions (MI) was found for total dietary vitamin E (assessed by food-frequency questionnaire), in a case-control study of 475 survivors of a first MI and 479 controls in Costa Rica. Dietary gamma tocopherol intake was not associated with the risk of myocardial infarction. This study again indicates that alpha tocopherol may be the preferred form of vitamin E for protection from MI. [Epidemiology 2002; 13(2): pp.216-23]
See also: [Stephens NG, Parsons A, Schofield PM, et al. Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996; 347: pp.781-6]
105 male and female subjects with coronary artery disease who received folic acid (1mg/day), vitamin B12 (400mcg/day) and vitamin B6 (10mg/day) experienced a significant reduction in reblockage after angioplasty over those who did not take the vitamins. Homocysteine levels were reduced during the trial. [N Engl J Med November 29, 2001;345: pp.1593-1601]
The risk of a heart attack jumps nearly five-fold during the first hour after smoking marijuana, posing a particular threat to middle-aged users of the drug, according to a study in 2001. Starting in the third hour after smoking marijuana, no significant risk rise was documented.
Bulking up the diet with legumes such as beans and peas can lower the risk of heart disease, study findings suggest. Men and women who ate legumes at least four times a week were found to have a 22% lower risk of coronary heart disease over 19 years than those who consumed legumes once weekly, researchers reported. The study was based on interviews and medical exams of more than 9,600 Americans who did not have heart disease when the study began. [Archives of Internal Medicine 2001;161: pp.2573-8]
Legumes contain low levels of sodium and high levels of potassium, calcium and magnesium – a combination that is associated with a reduced risk of heart disease. Folate, a mineral also found in abundance in legumes, is thought to reduce blood levels of homocysteine, a compound that can boost heart disease risk.
Increased dietary copper through legume consumption may protect against heart disease. [Archives of Internal Medicine 162, 15: pp.1780-1, August 12, 2002]
A high-fiber diet, particularly one that is high in water-soluble fiber (such as fruit), is associated with decreased risk of both fatal and nonfatal heart attacks, probably because presence of such fiber is known to lower cholesterol. Numerous studies have linked diets rich in fiber with low levels of cholesterol. In particular, soluble fiber alters and lowers fat and cholesterol absorption in the large bowel, helping to reduce LDL, the 'bad' cholesterol.
Fiber-rich foods are also good sources of phytochemicals and anti-oxidants that help to lower the risk for heart disease. Blood pressure, a major heart disease risk factor, may also be reduced by eating diet rich in fiber, further helping to reduce the risk of heart disease.
Making positive dietary changes immediately following a heart attack is likely to decrease one's chance of having a second heart attack. In one study, individuals began eating more vegetables and fruits, and substituted fish, nuts, and legumes for meat and eggs 24 to 48 hours after a heart attack. Six weeks later, the diet group had significantly fewer fatal and nonfatal heart attacks than a similar group that did not make these dietary changes. This trend continued for an additional six weeks.
Fruits and vegetables contain antioxidant substances, such as vitamin C, vitamin E, and carotenoids, which protect cells against oxidative damage, which is related to cancer risk and other health problems. The multitude of phytochemicals found in various fruits, vegetables, grains, legumes, and nuts are thought to protect against heart disease and cancer.
A sedentary lifestyle of physical inactivity is almost as great a risk factor for heart disease as smoking because of diminished circulation and weight gain.
Research has shown that even moderate exercise can substantially reduce the incidence of coronary events. Aerobic exercise reduces cardiac risk by lowering LDL- and raising HDL-cholesterol levels, and by reducing blood pressure, body fat, blood sugar, mental stress, and blood clotting. Exercise also improves the heart's pumping ability, greatly enhancing the body's functional capacity and stamina.
It is never too late to start. Healthy people who begin exercising after age 45 can reduce their death rate by 23%, and even patients who have already had heart attacks can use medically-supervised aerobic exercise to reduce their risk of another heart attack by up to 25%.
Getting the right amount of chromium each day may help protect against heart attacks in people that are at high risk, such as those who have diabetes. Chromium seems to improve levels of blood fats such as cholesterol.
In Europe, researchers have found a statistically significant association between high dietary lycopene and a 48% lower risk of heart disease. [Am J Epidemiol 1997;146: pp.618-26]
Reduces homocysteine levels (major cause of heart disease), thereby decreasing risk of heart disease. A study found that people with a dietary intake of at least 300mcg per day of folic acid reduced their risk of stroke and heart disease by 20% and 13% respectively, compared with those who consumed less than 136mcg of folic acid per day. [Stroke 2002;33: pp.1183-9]
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