As the #1 killer in America, how can we increase our longevity and quality of life by preventing and delaying cardiovascular disease (ASCVD)?
In my previous posts, I touched on some of the factors which can increase our risk for ASCVD. Factors such as smoking, diet, activity habits can be modified, but the myth that disease states like diabetes, hypertension, and even our genetic predisposition to heart disease are inevitable is not true. These are not set in stone and can be mitigated through lifestyle choices. In the case of genetics, research has shown that our environment and lifestyle choices play a big role in which genetic traits may be "turned" on. This is called Epigentics, and an example of this can be seen with twins who have identical genetics. The manifestation of diseases such as cancer, heart disease, and diabetes can be drastically different between the two based on their lifestyle and environmental factors.
From a cardiovascular standpoint, diet plays a key role in preventing, delaying, and possibly reversing vascular damage. In general, diets consisting of limited quantities of lean meat, focusing more on oily fish rich in Omega-3 Fatty acids, more vegetables, raw nuts, fruits such as berries, and high in complex fibers and grains are heart protective. Unfortunately for some, the French paradox of wine in limited amounts being heart healthy is not true. Studies have shown that even low-moderate alcohol intake increase the risk of vascular disease and cancer. The diet which encompasses many of the key elements mentioned above is commonly called a Mediteranian diet. Evidence to support this diet can be seen in recent data from the United Kingdom Biobank project which studied almost 20,000 people and showed individuals with diets higher in red meat developed higher rates of heart disease, stroke, diabetes, and cancer. Studies have even shown less risk of Alzheimer's disease associated with the Mediterranean diet, probably in part due to less vascular and inflammatory damage to the brain. Dr. C.B Esselstyn, M.D. a physician at Cleveland Clinic has demonstrated over the past 20 years that regression of vascular disease can take place on a whole food, plant based diets with limited animal fats and protein.
Regular exercise, at least 3-4 times per week for 30-40 minutes at a time, such as brisk walking, weight training to maintain muscle mass, biking, swimming, and jogging improve blood flow, heart function, and decrease ASCVD. The goal with this type of exercise is to keep heart rate elevated in an aerobic or oxygen available environment. This is sometimes classified as zone 2 training and can be achieved by working to a heart rate of about 180-age. Complimenting this, studies looking at sauna use in the Netherlands have also shown lower cardiovascular events with regular hot sauna use, as it is believed that heat increases heart rate and stress on the body similar to exercise.
Finally, some nutritional supplements have shown positive vascular benefits. EPA (eicosapentaenoic acid), an Omega-3-Fatty Acid component of fish oil, has been shown, in a recent trial called REDUCE-IT, to lower cardiovascular events in high risk patients. Sulforaphane, a powerful antioxidant in broccoli and cruciferous vegetables, may lower vascular inflammation and be heart healthy. Finally, NAC (N-Acetyl-L-Cysteine) is the precursor to Glutathione which is a powerful anti-oxidant to help decrease inflammation and help with detoxification in our bodies. As always, diet and a healthy lifestyle take precedence. As with any new supplement or activity, always check with your personal physician about what type of activity is appropriate for you.
As a dcotor, my goal in Primary Care Prevention is to look at each person as a whole, taking into account their personal medical history, family history, lifestyle, medical disease states, and objective data from labs, etc. to formulate a personalized treatment plan to optimize health. At the center of this is always the patient who must be a willing participant. The outdated approach in medicine of waiting until a disease or condition takes place and then prescribing medication for it, without trying to determine the underlying causes for the disease state, is not serving our patients and does not provide the best care possible.