Cardiovascular disease need-to-knows

Author: Jonine Moller

Cardiovascular disease prevention is a hotly debated topic, and rightly so, as it is one of the leading causes of death. As reported by the American Heart Association, 11.2% of people in the United States have a form of heart disease [1].

Worldwide, 17.9 million people die from CDV according to the World Health Organization

Due to the tremendous burden that cardiovascular disease places on healthcare systems worldwide, its prevention is crucial. To prevent developing cardiovascular disease, one must first establish the cause.

Everyone knows and agrees that a healthy diet is essential for overall health maintenance and promotion. Likewise, unhealthy diets are notorious for causing health problems. Unfortunately, though, not everyone agrees on what exactly a healthy or unhealthy diet is.

Intake of saturated fats was frowned upon for many years. It was thought that this is the dietary component mostly to blame for the high prevalence and incidence of metabolic and cardiovascular diseases worldwide. Many still believe it is a cause of heart disease, but the factual evidence is very lacking [2, 3, 4].

More recently, sugar and high intakes of highly refined and processed carbohydrates have been debated to be the actual guilty dietary parties [5]. High sugar intake is directly linked to rising levels of inflammation, oxidative stress, and visceral fat accumulation [6, 7, 8, 9]. Unhealthy cholesterol changes have also been attributed to diets high in sugar [5].

These are all very closely linked with the development of atherosclerosis and diabetes [6, 10]. Both atherosclerosis and diabetes form a part of or lead to adverse cardiovascular disease. In fact, atherosclerosis, which is the leading cause of cardiovascular disease, is well-established to be an inflammatory disease.

But what is cardiovascular disease? What is cardiometabolic disease? Is it different from metabolic syndrome? Are all these terms referring to the same thing? Cardiovascular disease and metabolic diseases are all chronic medical conditions that are closely related to each other. Their root physiological cause and risk factors are linked.

Cardiovascular disease is the umbrella term for conditions such as peripheral artery disease, strokes, coronary artery disease, and heart failure. Simply put, it relates to heart disease. Atherosclerosis (build-up of plaque within the walls of blood vessels) is the leading cause of cardiovascular disease.

Type 2 Diabetes Mellitus (T2DM) is the most prevalent metabolic disease and is a major risk factor for cardiovascular disease and death.

Signs and symptoms of poor metabolic health are:

• Obesity; a high waist circumference,
• Low HDL("good") cholesterol levels,
• High triglycerides (fat molecules in the blood) and LDL("bad") cholesterol levels
• Increased blood sugars.

These are also known risk factors for cardiometabolic as well as other chronic diseases.

All the risk factors are at least in part due to lifestyle. Most can be linked to chronic low-grade systemic inflammation and insulin resistance. Both of the latter are influenced and, at least in part, caused by an unhealthy and sedentary lifestyle. Certain individuals are, however, genetically more prone to declining metabolic and cardiovascular health.

If you experience any of the following medical signs, you should visit your doctor as soon as possible: (As set out by and modified from the American College of Sports Medicine [11])

• Discomfort, or ischemic or anginal pain in the chest, neck, jaw, arms, or surrounding areas. (Excluding pain characterized as a dull ache, sharp, stabbing, or pain that is provoked by a specific motion);
• Shortness of breath without justifying levels of physical activity, or abnormally uncomfortable breathing;
• Dizziness or fainting, especially during exercise;
• Shortness of breath or unusually uncomfortable breathing while sleeping lying down;
• Swollen ankles (bilateral)
• Unpleasant or forceful heartbeat or unusually rapid heart rate;
• Deep muscle aches that occur as a result of exercise, most frequently in the lower legs (intermittent claudication);
• Heart murmur;
• Feeling unusual fatigue or excessively out of breath with physical activity.

The presence of any of these signs or symptoms could indicate the presence of severe underlying disease. This disease may be either metabolic, pulmonary, or cardiovascular.

Several factors have been established to identify the risk of heart disease. The following are atherosclerotic cardiovascular disease risk factors as defined by the ACSM [11]:

• Age: being 45 years or older if you are a man and 55 years or older if you are a woman;
• Family history: have a first-degree relative that suffered from a heart attack, coronary artery surgery, or sudden death. This is applicable if it was before the age of 55 or 65 if male or female, respectively;
• Smoking: you are a smoker (primary or secondary) or have stopped smoking within the last 6 months;
• Sedentary: Not doing at least 30min of moderate-intensity exercise on at least 3 days of the week;
• Obesity: Have a body mass index of 30 kg/m2 or a waist circumference of more than 102 cm (male) or 88 cm (female);
• High blood pressure: blood pressure of ⪰ 140 mmHg systolic and/or ⪰ 90 mmHg diastolic;
• Dyslipidemia: LDL cholesterol ⪰ 3.37 mmol/L OR HDL ⪰ 1.04 mmol/L unless you are on medication to lower your cholesterol. If you have total high cholesterol, i.e., ⪰ 5.18 mmol/L, further investigation is warranted.
• Prediabetes: Fasting glucose of 5.55mmol/L or above or glucose of 7.77mmol/L 2 hours after a meal;

The presence of two or more of these risk factors for heart disease should encourage serious lifestyle interventions. Lifestyle changes should aim to prevent deterioration of health and risk for occult disease or cardiovascular events.

To minimize your risk for chronic disease and maximize your health, you should ensure the following:

• Do at least 150 minutes per week of physical activity (more about this in the article on exercising for health) [11];
• Follow a healthy diet (as far as possible, eat raw, whole natural foods. For specific guidelines, it is advised to consult with a dietitian or nutritionist);
• Do not smoke [12];
• Avoid excessive alcohol consumption [13];
• Get enough sleep (6 - 10 hours per evening) [14];

BioCertica offers a cardiovascular report that might help you understand how your genetic makeup might affect your heart health.

References:

[1] Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., Elkind, M. S. V., Evenson, K. R., Ferguson, J. F., Gupta, D. K., Khan, S. S., Kissela, B. M., Knutson, K. L., Lee, C. D., Lewis, T. T., … Tsao, C. W. (2021). Heart Disease and Stroke Statistics—2021 Update. Circulation, 143(8), E254–E743. https://doi.org/10.1161/CIR.0000000000000950

[2] Hoenselaar, R. (2012). Saturated fat and cardiovascular disease: The discrepancy between the scientific literature and dietary advice. Nutrition, 28(2), 118–123. https://doi.org/10.1016/j.nut.2011.08.017

[3] Malhotra, A. (2013). Saturated fat is not the major issue. BMJ, 347(oct22 1), f6340–f6340. https://doi.org/10.1136/bmj.f6340

[4] O’Keeffe, M., & St-Onge, M.-P. (2013). Saturated Fat and Cardiovascular Disease: A Review of Current Evidence. Current Cardiovascular Risk Reports, 7(2), 154–162. https://doi.org/10.1007/s12170-013-0295-z

[5] DiNicolantonio, J. J., Lucan, S. C., & O’Keefe, J. H. (2016). The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease. Progress in Cardiovascular Diseases, 58(5), 464–472. https://doi.org/10.1016/j.pcad.2015.11.006

[6] Ceriello, A., Esposito, K., Piconi, L., Ihnat, M. A., Thorpe, J. E., Testa, R., Boemi, M., & Giugliano, D. (2008). Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes, 57(5), 1349–1354. https://doi.org/10.2337/db08-0063

[7] Jamar, G., Ribeiro, D. A., & Pisani, L. P. (2021). High-fat or high-sugar diets as trigger inflammation in the microbiota-gut-brain axis. Critical Reviews in Food Science and Nutrition, 61(5), 836–854. https://doi.org/10.1080/10408398.2020.1747046

[8] Lin, W.-T., Kao, Y.-H., Sothern, M. S., Seal, D. W., Lee, C.-H., Lin, H.-Y., Chen, T., & Tseng, T.-S. (2020). The association between sugar-sweetened beverages intake, body mass index, and inflammation in US adults. International Journal of Public Health, 65(1), 45–53. https://doi.org/10.1007/s00038-020-01330-5

[9] Monnier, L., Colette, C., & Owens, D. (2008). Glycemic Variability: The Third Component of the Dysglycemia in Diabetes. Is It Important? How to Measure It? Journal of Diabetes Science and Technology, 2(6), 1094–1100.

[10] Ceriello, A., & Motz, E. (2004). Is Oxidative Stress the Pathogenic Mechanism Underlying Insulin Resistance, Diabetes, and Cardiovascular Disease? The Common Soil Hypothesis Revisited. Arteriosclerosis, Thrombosis, and Vascular Biology, 24(5), 816–823. https://doi.org/10.1161/01.ATV.0000122852.22604.78

[11] Riebe, D., Ehrman, J.K., Liguori, G. & Magal, M. Eds. 2016. ACSM’s Guidelines for Exercise Testing and Prescription. Tenth ed. Wolters Kluwer

[12] Duncan, M. S., Freiberg, M. S., Greevy, R. A., Kundu, S., Vasan, R. S., & Tindle, H. A. (2019). Association of Smoking Cessation with Subsequent Risk of Cardiovascular Disease. JAMA - Journal of the American Medical Association, 322(7), 642–650. https://doi.org/10.1001/jama.2019.10298

[13] Grigorakis, D., Bountziouka, V., & Kalogeropoulos, N. (2011). Alcohol Intake and Cardiovascular Disease Risk: Cheers, Tears, or Both? Food Reviews International, 27(3), 274–299. https://doi.org/10.1080/87559129.2011.563394

[14] Kim, C. E., Shin, S., Lee, H. W., Lim, J., Lee, J. K., Shin, A., & Kang, D. (2018). Association between sleep duration and metabolic syndrome: A cross-sectional study. BMC Public Health, 18(1), 1–8. https://doi.org/10.1186/s12889-018-5557-8