What puts me at risk for cardiovascular disease?

Do heart attacks and cardiovascular problems come out of the blue?

Two things happened while writing this article. First, I decided to drink some tea. It was Yogi brand ginger tea. The tea tag said, (brace yourself for the wisdom), “If you let yourself be successful you shall be successful.” Wouldn’t it be nice if we could just get out of our own way?

As I let that percolate, I was visiting one of those auto-citation cites. We all know how fun it is citing sources. I was alerted to the fact that ads keep them running. Well once I paused my ad-blocker to continue using the free service – an ad appeared for Jardiance touting its ability to lower blood sugar and A1C. Here I am writing an article on obesity, hypertension and diabetes and I can’t escape the ever-present direct to consumer pharmaceutical advertisement.

Back to the tea tag. Let’s repurpose that statement and say “if you let yourself be healthy you shall be healthy.” Being intentional about your health can empower you and encourage the perpetuation of healthy habits. If you make yourself take action, it will give rise to your volition.

This is essentially the power or faculty of choosing. We are at a time where Americans are choosing to be anything but healthy. The lifestyle-based diseases driving up healthcare costs were once non-existent, if not interspersed to a much lesser degree. It is our lifestyle choices that are fundamentally the key determinants of health, disease resistance, and longevity.

It takes some effort to shut off autopilot and build awareness around routine and choice. From my own personal experience, I’ve had to reevaluate choices only to find that a particular habit was a passive pattern, and not an intentional choice. When we can dissect our habits and detach from those that hold us back we regain control of things we want to change.

Let your intentional values and deeper principles guide you when you write that grocery list or you sit down to eat. Make food choices, sleep habits, activity expenditures, and practice stress reduction techniques by acknowledging outcomes and track if they meet expectations. Sometimes just the act of tracking increases our awareness, which helps us make better choices.

The broken heart

The U.S. death rate for coronary heart disease rose steadily during the first half of the 20th century, reaching a peak in 1968. At the time the effects of smoking, cholesterol, use of vegetable oils, high blood pressure, obesity and refined sugar intake were less recognized.

Had we stayed on that trajectory estimates put us at 1.7 millions deaths per year due to heart disease. Cardiovascular disease (CVD) is the leading cause of death in the United States and is one of the costliest chronic diseases.

Today there are around 425,000 lives lost to heart disease. By 2035, CVD prevalence is expected to increase to around 130 million Americans. The AHA predicts the costs related to the disease will double to over 1 trillion by 2035.

Heart disease is here to stay and spreading quickly. I think the message is falling on deaf ears. Heart disease is directly correlated with a handful of risk factors. All of which are trending upwards.

So why is the disease getting worse? It’s an epidemic with several factors that converge over time. The real underlying culprits, while preventable, continue to go unaddressed. What can individuals do to in terms of prevention?

The problematic trio of a heart attack: Obesity, High Blood Pressure, and Diabetes

Obesity gone viral

We’ve known for a long time that maintaining a healthy weight helps reduce the risks of developing cardiovascular disease. Excess bodyweight is a growing problem and also a major risk factor for cardiovascular disease. Obesity especially visceral obesity (fat stored within the abdominal cavity) can lead to changes in your metabolism and dyslipidemia. Think of dyslipidemia as an abnormal amount of fat in the blood. It’s why your doctors run blood tests on your cholesterol levels.

Even more there seems to be some confusion around the idea of a healthy weight. A study in Britain found that only 10% of people who were clinically obese put themselves into that category. Healthcare providers get to see first hand how individuals may be in denial about their state of health. There is also this idea of metabolic healthy obesity. This refers to people that are overweight but have no immediate indications of health issues, such as insulin resistance, high cholesterol, and elevated markers of inflammation.

In the USA, 69 % of adults are either overweight or obese and 35 % are obese. Obesity is among the leading causes of elevated CVD mortality and morbidity.

This is not a surprise when you understand that obesity has been shown to increase the risk of high blood pressure. Many Americans abide to an “obesogenic” diet, marked by increased portion sizes of calorie-laden foods. Carrying excess fat has been shown to produce metabolic stress.

Eating excess macronutrients (mostly refined carbohydrates and sugar) ramps up obesity-driven adipose tissue (aka fat cells) dysfunction and the associated inflammatory state. Adipose tissues secrete a number of biologically active molecules termed “adipokines”, and several of these are capable of promoting the pro-inflammatory state of diabetes. New studies show that these inflammation signals may be directly involved in joint pain and arthritis.

In many instances, obesity is the proximal trigger that culminates ultimately in diabetes and cardiovascular disease.

Diabetes mellitus affects more than 180 million people around the world, and the number of patients is anticipated to increase to 300 million by 2025.

It important to note that cardiovascular events vary based on the individual genomics, extent, distribution, and duration of obesity.

High blood pressure

High blood pressure (BP) is one of the most important risk factors for cardiovascular disease, which is the leading cause of mortality. Approximately 54% of strokes and 47% of coronary heart diseases, worldwide, are attributable to high BP.

Hypertension is the strongest or one of the strongest risk factors for almost all different cardiovascular diseases acquired during life, including coronary disease, left ventricular hypertrophy and valvular heart diseases, cardiac arrhythmias including atrial fibrillation, cerebral stroke and renal failure.

The large majority of people have what’s referred to as essential hypertension. Essential hypertension is high blood pressure that doesn’t have a known secondary cause.

There is still much uncertainty about the pathophysiology of hypertension. A small number of patients (between 2% and 5%) have an underlying renal or adrenal disease as the cause for their raised blood pressure. That said diet and lifestyle is inexorably linked.

Obesity is strongly associated with hypertension and cardiovascular disease. One of the effects of obesity is a change in arterial pressure. We see abnormal activation of the sympathetic nervous system and hormonal signaling pathways responsible for blood pressure regulation. Obesity is also associated with endothelial (cells that line the surface of your blood vessels) dysfunction and renal (kidney) functional abnormalities that may play a role in the development of hypertension.

In case you need a blood pressure refresher the top number is your systolic (maximum pressure that your heart exerts when beating) and the bottom number is your diastolic (amount of pressure on the arteries between beats)

One large study looking at over 70,000 people found these specific values when analyzing blood pressure and cardiovascular disease.

  • Systolic Blood Pressures of 120 to 129 mm Hg were associated with the lowest CVD and expanded-CVD mortality risks

  • Stage 2–3 hypertension, SBPs ≥160 mm Hg, or Diastolic Blood Pressures ≥90 mm Hg significantly increased the CVD and expanded-CVD mortality risk.

The prevention of hypertension and lowering one's blood pressure may help reduce the risk of developing heart disease.

Top Ten Tips for Lowering Your Blood Pressure Naturally

1. Reduce excessive refined carbohydrate and/or sugar intake

2. Increase your intake of minerals

3. Consume grass-fed dairy (if tolerated)

4. Eat one pound of fatty fish per week

5. Drink tea

6. Eat beets

7. Get some sunshine

8. Reduce stress

9. Focus on sleep

10. Exercise regularly

If you would like a more in depth patient handout send me an email at nick@spineandjointoc.com

Diabetes

Patient with diabetes (type 2) are often obese and hypertensive. Diabetes promotes disease in nearly all blood vessel types and sizes. This is especially important in the context of the heart. Constant and unremitting metabolic stress on the heart over time leads to progressive deterioration of myocardial structure and function, and heart failure is a typical end-result.

Diabetes and insulin resistance are powerful predictors of cardiovascular morbidity and mortality, and each is an independent risk factor for death in patients with heart failure. Other contributors to diabesity include limited access to healthy food choices, agricultural policies, physical activity, stress, and sleep patterns.

The “diabesity epidemic” in the United States over the past several decades is a major driver of costly expenditures socially and financially. Diabetes and obesity ramp up an individual’s probability that they may succumb to heart disease.

I hope this helps bring some awareness to what’s at play when someone is at risk for heart disease. All too often we wait until a particular disease has created irreversible damage. The best approach will always be to look at the underlying cause of a disease and make choices that eliminate the risk of disease onset.

Sources:

Akil L, Ahmad HA. Relationships between obesity and cardiovascular diseases in four southern states and Colorado. J Health Care Poor Underserved. 2011;22(4 Suppl):61-72.

Curr Atheroscler Rep. 2016 May;18(5):21. doi: 10.1007/s11883-016-0575-4.Obesity and Cardiovascular Disease: a Risk Factor or a Risk Marker?

Hypertension. 2005 Jan;45(1):9-14. Epub 2004 Dec 6. Obesity-associated hypertension: new insights into mechanisms. Rahmouni K1, Correia ML, Haynes WG, Mark AL.

Kjeldsen, S. E. (2018). Hypertension and cardiovascular risk: General aspects. Pharmacological Research,129, 95-99. doi:10.1016/j.phrs.2017.11.003

Overweight & Obesity Statistics. (2017, August 01). Retrieved from https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity

Scherer PE, Hill JA. Obesity, Diabetes, and Cardiovascular Diseases: A Compendium. Circ Res. 2016;118(11):1703-5.

Wu, C., Hu, H., Chou, Y., Huang, N., Chou, Y., & Li, C. (2015). High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults. Medicine,94(47). doi:10.1097/md.0000000000002160