When I gently scolded Kentucky cardiologist Dr. John Mandrola recently over his cheeky criticism of diet soda (he’s a bike racer, what can I say?), we began a subsequent exchange of emails that led me to his blog. There I found the simplest, clearest explanation of heart disease that I have yet discovered – particularly on the role that inflammation plays in causing our cardiac events. With the permission of this cardiac electrophysiologist (thanks, Dr. John), I’m reprinting his essay here, including his Primary Prevention Strategies, or “what regular people call healthy living”:
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“Heart disease is serious. It is the most common cause of death. Heart disease is also our most preventable disease.
“Heart disease is about inflammation. The same mechanisms that cause the throat to swell from an infection, the skin to redden after an insect bite, and a scar to form after a cut are what cause heart problems. Inflammation hurts the heart by reducing its supply of nutrients.
“The heart, like any organ, requires a steady flow of blood from blood vessels – in the heart they are called coronary arteries. When drawn on paper, coronary arteries look like inert pipes, but in reality the walls of these arteries, which are termed the endothelium, are teaming with activity. Endothelial cells grow, secrete chemical messengers, slough off and sometimes break. Meanwhile, platelets, ‘the sticky’ cells in blood interact physically and chemically with these same highly active cells in the arterial wall.
“In most forms of acquired heart disease, this interaction of blood and artery is where the rubber hits the road. More inflammation means the endothelium is more apt to swell (with fatty deposits), more apt to redden (with blood clots) and more apt to scar. This process is called atherosclerosis.
“Inflammation also activates platelets, making them stickier, and therefore more likely to clot and attach to the inflamed endothelium. A blood clot that attaches to an inflamed blood vessel wall is the mechanism of acute events like heart attack and sudden death, and in the brain, strokes.
“Heart health, therefore is about lowering inflammation. The things that lower inflammation are well known. Medical people call these Primary Prevention Strategies; regular people call it “healthy living”:
- Pick your parents well. Obviously, we have no choice here. but since genetics plays a large role in susceptibility to heart disease, knowing your family history is a powerful tool.
- Do not smoke. Smoking is highly inflammatory.
- Control blood pressure. Over time high blood pressure weakens the blood vessel wall.
- Control blood sugar – avoid diabetes altogether. Insulin is a growth factor which facilitates the deposition of fat and proliferation of scar tissue. These are bad for arteries.
- Control cholesterol levels. Maintain low levels of “bad” (LDL) cholesterol and high levels of “good” (HDL) cholesterol.
- Improve nutrition. Eat less. Eat better.
- Exercise smartly. Exercise is recommended every day that we eat.
- Sleep well.
- Be happy. Anger and negative-thinking are also inflammatory.
“At the core of preventing heart disease is ourselves. People can choose heart health.“
© 2011 Dr. John Mandrola
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Read the rest of Dr. John’s essay called Heart Disease: By Dr. John M (including his very icky photo of a clot sucked from a coronary artery during a heart attack). While you’re on his site, browse the many interesting articles you’ll find there. These include a very helpful overview of what the heck cardiac electrophysiology is all about (of special interest to those of you living with any heart arrhythmia) – all from the guy whose own high school guidance counsellor told him wasn’t smart enough to be a doctor. (SO THERE, stupid guidance counsellor!)