Category Archives: Heart Disease

Taking Care of Your Gums May Help Your Heart

Posted on November 3, 2013 | Comments Off on Taking Care of Your Gums May Help Your Heart

…according to an article at University Herald.

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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Heart Attacks: It All Boils Down to LDL-P

Posted on October 7, 2013 | 2 comments

…according to Drs. Thomas Dayspring and JamesUnderberg. By LDL-P, they mean LDL cholesterol particle number. I don’t know if these guys are right or not. I bet it’s more complicated than LDL particle number.

Most heart attacks (aka myocardial infarctions) 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.

***

 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.

Steve Parker, M.D.

h/t Dr. Axel Sigurdsson

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Posted in Coronary Heart Disease, Diet-Heart Hypothesis, Heart Disease

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Low-carb Diet Killing Swedes

Posted on June 29, 2013 | 2 comments

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 1,270 cardiovascular events: ischemic heart disease (heart attacks and blocked heart arteries), strokes, subarachnoid brain 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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Posted in Coronary Heart Disease, Heart Disease, Low-Carb Eating

Food Manufacturers Have Significantly Cut Trans Fats But Not Eliminated Them

Posted on May 24, 2013 | Comments Off on Food Manufacturers Have Significantly Cut Trans Fats But Not Eliminated Them

…according to an article at MedPageToday. Trans fats are thought to cause or aggravate heart and vascular disease.

As long as a food serving has under 0.5 g of trans fat per serving, the manufacturers in the U.S. can claim “zero” trans fat. If you see “partially hydrogenated vegetable oil” in the ingredients list, the product has trans fat. From the article:

To assess changes in levels of trans fats in food products, Mozaffarian and colleagues looked at 270 products from prominent brands — including General Mills, Kellogg Company, Heinz, ConAgra, Safeway, Giant, Campbell Soup, Sara Lee, and Walmart — that were selected from certain large supermarkets and sold between 2007 and 2011.

They found that by 2011, 66% of those products had reduced levels of trans fats, with a mean decline of 1.5 grams per serving and a mean 78% drop in trans fat content in that group.

Most of these reformulated products (82%) reduced trans fat content to less than 0.5 grams per serving, but half of them still contained partially hydrogenated vegetable oils in the ingredients list, the researchers found.

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Heart-Healthy Lifestyle Also Cuts Cancer Risk By Half

Posted on March 19, 2013 | 1 comment

…according to a report in MedPageToday.

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 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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Posted in Cancer, Coronary Heart Disease, Diet-Heart Hypothesis, Exercise, Heart Disease, High Blood Pressure

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Do Fruits and Vegetables Prevent Disease? Which Ones?

Posted on January 31, 2013 | Comments Off on Do Fruits and Vegetables Prevent Disease? Which Ones?

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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Posted in Coronary Heart Disease, Dementia, Diabetes, Heart Disease, Low-Carb Mediterranean Diet, Lungs, Osteoporosis, Stroke

Study Finds Low-Carb Diet Reduces Heart Disease Risk Factors

Posted on December 8, 2012 | Comments Off on Study Finds Low-Carb Diet Reduces Heart Disease Risk Factors

Obesity Reviews just published details of a recent meta-analyis of low-carbohydrate diet effects on cardiovascular risk factors.

A systematic review and meta-analysis were carried out to study the effects of low-carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria.

Over a thousand obese patients were involved.  By eating low-carb, blood pressure dropped by 3–4 mmHg, average body weight decreased by 7 kg (15 lb), body mass index dropped by 2, triglycerides decreased by 30 mg/dl, hemoglobin A1c dropped by 0.21% (absolute decrease), insulin levels fell by 2.23 micro IU/ml, while HDL cholesterol rose by 1.73 mg/dl.  LDL cholesterol didn’t change.

The authors conclusion:

Low-carboydrate diet was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown.

I haven’t see the full text of the article yet, so I don’t know the carbohydrate level under review.  I bet it’s under 50 g of digestible carb daily.  My Low-Carb Mediterranean Diet starts at 20-30 grams a day.

Steve Parker, M.D.

Reference:  Santos, F.L., et al. Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews. Article first published online: 20 AUG 2012. DOI: 10.1111/j.1467-789X.2012.01021.x

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Berry Science, or Berriology

Posted on September 18, 2012 | 2 comments

Mmm, mm, good! And they’re low carb

The Mediterranean diet was originally found to be a healthy diet by comparing populations who followed the diet with those who didn’t.  The result?  Mediterranean dieters enjoyed longer lifespans and less heart disease, cancer, strokes, diabetes, and dementia.

Over the last 15 years, researchers have been clarifying exactly how and why this might be the case.  A study from Finland is a typical example.

The traditional Mediterranean diet provides an abundance of fresh fruit, including berries.  Berries are a rich source of vitamin C and polyphenols, substances with the potential to affect metabolic and disease processes in our bodies.

The Finnish researchers studied 72 middle-aged subjects, having half of them consume moderate amounts of berries, and half consume a placebo product over 8 weeks.  Compared with the placebo group, the berry eaters showed inhibited platelet funtion, a 5% increase in HDL cholesterol (the “good” cholesterol), and a 7-point drop in systolic blood pressure.

What does platelet function have to do with anything?  Platelets are critical components of blood clots.  Blood clots can stop life-threatening bleeding, but also contribute to life-threatening strokes and heart attacks.  Inhibition of platelet function can decrease the occurence of blood clots that cause heart attacks and strokes.  That’s why millions of people take daily aspirin, the best known platelet inhibitor.

Cardiovascular disease is a group of conditions that include high blood pressure, heart attacks, poor circulation, and strokes.  Berry consumption in this small Finnish study resulted in favorable changes in blood pressure, HDL cholesterol, and platelet function.  These changes would tend to reduce the occurence and severity of cardiovascular disease.

So berries don’t just taste good, they’re good for us.  If price is a concern, focus on the berries that are in season or use frozen berries.

Steve Parker, M.D.

Reference: Erlund, I., et al, Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol.  American Journal of Clinical Nutrition, 87 (2007): 323-331.

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Salt Restriction May Do More Harm Than Good

Posted on September 10, 2012 | Comments Off on Salt Restriction May Do More Harm Than Good

Unfairly demonized?

I’ve been a salt-restriction skeptic for a couple decades.  The American Council on  Science and Health has a brief review of the latest research on salt restriction, and it’s not supportive of population-wide sodium restriction.

Remember, table salt molecules contain one sodium atom and one chloride atom.  Salt-restricted and low-sodium diets are usually designated by the amount of sodium, not salt.

That being said, I do believe some individuals have elevated blood pressure related to relatively high sodium intake.  This may apply to one of every five adults with high blood pressure.  To find out if you’re one of the five, you could go on a low-sodium diet—1.5 to 3 grams a day—for one or two months and see what it does to your blood pressure.  Get your personal physician’s blessing first.

Steve Parker, M.D.

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Huge U.S. Study Confirms Health and Longevity Benefits of the Mediterranean Diet

Posted on September 3, 2012 | Comments Off on Huge U.S. Study Confirms Health and Longevity Benefits of the Mediterranean Diet

This is a reprint of the very first blog post I ever did, from December 24, 2007, at my old Advanced Mediterranean Diet Blog.  

We now have results of the first U.S. study on mortality and the Mediterranean dietary pattern.  380,000 people, aged 50-71, were surveyed on their dietary habits and scored on their conformity to the Mediterranean diet.  They were visited again 10 years later.  As you would expect, some of them died.  12,105 to be exact: 5985 from cancer, 3451 from cardiovascular disease, 2669 from other causes.  However, the people with the highest adherence to the Mediterranean diet had better survival overall, and specifically better odds of avoiding death from cardiovascular disease and cancer.  Compared to the people with low conformity to the Mediterranean diet, the high conformers were 15-20% less likely to die over the 10 years of the study.  The study authors, funded by the National Institutes of Health, noted eight similar studies in Europe and one in Australia with similar results.

Nothing to do with this post…I just like this picture

Once again, my promotion of the Mediterranean diet is vindicated by the scientific literature.  I’m not aware of any other diet that can prove anywhere near this degree of health benefit.  If you are, please share. 

Steve Parker, M.D.

Reference: Mitrou, Panagiota N., et al.  Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population,  Archives of Internal Medicine, 167 (2007): 2461-2468.


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