Cardiovascular disease describes all the diseases of the heart and the circulatory system, so this includes coronary heart disease, heart failure and strokes. According to the World Health Organisation, sadly almost 18 million die each year from cardiovascular diseases, and this is set to rise to 26 million by the year 2030.

Also according to the WHO, 80% of premature heart attacks and strokes are actually PREVENTABLE!! This reminds us that we can take steps to take charge of our health.

There are risk factors for CVD that are not in our control, such as age, ethnicity, family history of the disease and genetics – such as certain genetic mutations (like MTHFR). 

Then there are the risk factors that we can control – and they are our diet, whether we smoke or not, alcohol consumption, and sedentary lifestyle/inactivity.

So although some aspects of heart disease may indeed be hereditary, there are preventable aspects of cardiovascular disease too – and this is what we will focus on here.

Preventable cardiovascular disease is associated with a buildup of fatty deposits in the artery walls of the circulatory system including the heart. This is known as Atherosclerosis and is the build up of plaque that narrows the walls of the arteries. This means that the pressure of the blood goes up in order to squeeze through the narrow walls. Not only does this increase stress on the heart to pump out the blood at higher pressure, it also means that the blood must be pumped at a higher speed too, and this increased velocity in blood flow can aggravate the plaques, leading to blood clots (a stroke if the brain is involved, or a heart attack if the heart is involved).

There are 4 mechanisms involved in the development of cardiovascular disease:

1. Lipids in the Blood

We have fats in our blood, and we need them to be the right type and in the right quantities. We have triglycerides – our basic fats from excess calories and foods, and we also have cholesterol – a fatty substance – produced by the liver in the majority (only around 20% of our cholesterol comes from our diet). 

Cholesterol is an essential substance which is why our body makes so much of it. It’s vital to produce hormones, to synthesise vitamin D, for nerve health as it coats all our nerves in a myelin sheath, and also for every single cell membrane throughout the body. So it is an essential liver protein, but we need cholesterol to be the right type, in the right levels and also undamaged, as this will then elevate our risk of cardiovascular disease.

In essence, we want good levels of HDL – the healthy cholesterol that we need for the above functions, and it also has the amazing adding bonus of sweeping up and getting rid of the LDL cholesterol (known as the bad cholesterol) that is associated with heart disease. (for more info on cholesterol – read blog here)

We can improve our blood lipid levels by 

• omega 3 essential fatty acids – oily fish, nuts, seeds, avocado
• garlic – in food or as a supplement – shown to increase HDL (good cholesterol)
• quit smoking – this inhibits the beneficial activity of HDL 
• increase fibre intake – this will help eliminate cholesterol from the body
• decrease sugar intake – it’s sugar that glycates cholesterol and causes damage

2. Inflammation

This is another driver of not only heart disease, but all major chronic health disease. In the short term, inflammation is absolutely necessary. When we have an injury, inflammation helps to heal a wound. The problem arises when this inflammation becomes chronic and ongoing. The body perceives the plaque buildup in its arteries as a wound. And so it produces inflammatory cytokines to go and heal this wound. However the plaques are not a wound and the inflammation doesn’t heal them, and so we are left with high levels of ongoing inflammation, and this then causes more injury and damage to the artery walls, irritates the blood vessels, and actually triggers more plaque to be formed.

So it’s clear that unresolved, chronic inflammation is a real determinant of health. This is a link to why overweight or obese people are more likely to suffer with heart disease. The extra layer of fat, especially around the middle, is not inert. It actually produces inflammatory compounds which directly contribute to inflammation in heart disease. 

We can measure the level of systemic inflammation in a blood test using the marker CRP (C reactive protein). It’s a reasonable indicator of inflammation and is used to look at heart health. Although it simply tells us there is inflammation but not where in the body that is, it remains a useful tool that indicates further investigation is required.

There are many factors that contribute to inflammation – and the first culprit would be diet. Highly processed food, junk food, refined carbs and sugar, are all inflammatory foods.

Our gut microbiome can also contribute to levels of inflammation, particularly when there is an imbalance of good to bad bacteria in our gut, or an element of leaky gut which can allow bacteria and toxins to get out the gut and into the bloodstream, and the immune system will then mount an inflammatory response to the foreign invader.

Insulin resistance, pre Diabetes, Diabetes and raised blood sugar are also inflammatory, so keeping our blood sugar balanced and reversing type 2 diabetes is so useful.

We can improves our levels of inflammation by 

• following an anti inflammatory diet as much as possible
• eating omega 3 fatty acids which are anti inflammatory
• consuming turmeric (curcumin) in food form or as a supplement
• increasing intake of antioxidants such as dark berries
• reducing stress (cortisol is inflammatory)
• cutting down on sugar as this is also inflammatory 

3. Endothelial Dysfunction

This is when the lining of the arteries stops functioning so well. This happens anyway as we age, and other conditions such as Diabetes will also contribute. When the endothelium (lining of the arteries) is working optimally, it will release nitric oxide that signals the blood vessels to relax and widen. This is what we want – nice wide and relaxed walls to allow blood flow. 

When the function is reduced, then the artery walls are more constricted. This restricts blood flow and increases blood pressure. This means the heart is pumping the blood at a higher speed too, which can cause injury to the vessels and the plaque.

Other than ageing, our endothelial function will be decreased by

• smoking
• Diabetes
• High blood pressure
• Inactivity
• Elevated LDL cholesterol and triglycerides
• Osteoporosis
• Hypothyroidism
• Genetic influences

Again, we can help restore some endothelial function by increasing our exercise, decreasing our sugar and processed foods, balancing blood sugar to help with diabetes, improving thyroid function (see previous blogs). 

One interesting supplement that has so far proven helpful in helping the endothelial cells release nitric oxide is pine bark extract – called Pycnogenol. It helps the blood vessels relax, and can also lowed LDL and increase HDL, lower blood pressure and decrease inflammation. There is currently much research around this supplement but it’s exciting news in the nutrition world at the moment!

4. Oxidative stress

This is the final major contributing factor to heart disease, and it describes the damage caused by free radicals to cells, increasing inflammation and overloading the immune system. Free radicals are the by product of many biochemical reactions in the body but can also be from external sources such as toxins, smoking, commercial oils heated at high temperatures such as rapeseed and sunflower oils. They all release free radicals when heated. 

Oxidative stress damages the endothelial wall and also increases and damages LDL cholesterol by oxidising them. This makes them more reactive cholesterol lipids that can cause the most damage and are what is found behind the plaque build up in the arterial walls. 

We can mitigate oxidative stress by

• increase antioxidants in our diet – blueberries, strawberries, kale, nuts,
• stop using highly processed oils – especially in cooking
• stop smoking 
• increase Selenium intake (fish, eggs, dairy, brazil nuts) – great antioxidant 
• consider a supplement such as CoQ10 – powerful antioxidant

Finally we need to address calcification as that is an issue associated with hardening of the arteries that can lead to heart disease. Calcification is the build up of free calcium circulating in the body. It harden the artery walls, increases plaque formation and clots, kidney stones, gall stones, and is associated with brain disease such as dementia too. 

We need to be mindful of taking excess vitamin D as this can lead to excess calcium – so it’s always wise to have a blood test to see your levels of active and storage vitamin D before supplementing (more info on previous blog). 

We also want to make sure we take vitamin D alongside vitamin K2 as this will help to direct the calcium to the bones, rather than in the blood. We can find K2 in most animal products like eggs, liver, beef, pork, chicken and also in hard cheeses and sauerkraut.

So it’s clear that there are many factors that contribute to heart disease that are actually within our control. We need to look at the nutrients we are eating, and supplement if necessary with those that are required for good heart health, such as CoQ10, selenium and omega fats. 

We need to look at our digestion and make sure it’s working optimally so that we can extract those nutrients and use them – from our foods and from our supplements!

We can address our lifestyle – reducing stress in general will always be helpful as cortisol (our stress hormone) is inflammatory, and also look the lose belly fat, be more active and less sedentary. Regarding Diabetes, which is a contributing factor to inflammation and heart disease, type 2 is lifestyle and diet related and so this is something that we can bring into remission. Even just losing some belly fat will go along way to reduce systemic inflammation and heart disease risk – so even small changes can have big impacts.

If this is a concern for you then small steps really do add up to make some big differences, – so changing one thing a week to upgrade our quality of food, or an extra walk, or swapping some white bread even for whole grain or sourdough, and bringing our blood sugar into balance, will all help to bring down triglycerides, improve our HDL/LDL ratio, make us more insulin sensitive, and even lose weight more effectively since insulin is our fa storage hormone!

As a nutritional therapist and health coach, this is something that I can help with in terms of diet, digestion, advice on good quality food based supplements, losing weight, addressing nutrition deficiencies, bringing Diabetes type 2 into remission,  and lifestyle advice. Please be in touch for more info