What is coronary heart disease
Coronary heart disease (CHD) is caused by a narrowing of the coronary arteries that feed the heart. It’s the most common form of heart disease, affecting some 7 million Americans, and it’s also the number-one killer of both men and women. Each year, more than 500,000 Americans die of heart attacks caused by CHD.
Many of these deaths could be prevented because CHD is related to certain aspects of lifestyle. Some of the risk factors for CHD, or things that increase your risk of developing the disease, are high blood pressure, high blood cholesterol, smoking, obesity, physical inactivity, diabetes, and stress all of which can be controlled. On average, having high blood pressure, having high blood cholesterol, or being a smoker doubles your chance of developing heart disease. Therefore, a person who has all three of these risk factors is eight times more likely to develop heart disease than someone who has none. Also consider that being overweight increases the likelihood of developing high blood cholesterol and high blood pressure, and being physically inactive increases the risk of heart attack.
Other risk factors for CHD cannot be controlled, such as heredity, age, and sex. Heredity involves several issues, one of which is race/ethnicity. African Americans are more likely than European Americans to have severely high blood pressure and thus a higher risk of developing CHD. The risk for CHD is also higher among Mexican Americans, American Indians, native Hawaiians, and some Asian Americans. This elevated risk is partly due to higher rates of obesity and diabetes among these racial/ethnic groups. Other familial traits also put people at greater for CHD. For instance, most people with a strong family history of heart disease have one or more other risk factors, as well, such as high blood pressure or high cholesterol. For all these reasons, the children of parents with CHD are more likely to develop it themselves. This trend underscores the importance of addressing those risk factors for CHD that can be controlled, say, through lifestyle.
Age and sex are other risk factors that can’t be controlled. As will be discussed later, CHD develops over time, which means the risk increases as someone ages. Four out of five people who die of CHD are 65 or older. Older women, especially, are more likely than men to die within a few weeks after having a heart attack. Even so, men are at greater risk for having a heart attack than are women, and men typically have a heart attack earlier in life. Even later in life, when the death rate from CHD among women increases dramatically, it’s still lower than the death rate among men.
The relationship between sex and heart disease has been the focus of recent news stories, which have reported that women with CHD are often misdiagnosed. The reason behind this is that most of the models of heart disease have come from studying male anatomy and physiology and how males respond to diseases and to curative drugs. The problem is that men and women respond differently to diseases. Also, women are much more likely than men to get medical attention right away when they feel that something’s wrong. Of course, getting an early diagnosis won’t help if that diagnosis is wrong!
All of these factors increase your risk of developing CHD, but they do not describe all the causes of coronary heart disease. Even with none of these risk factors, you might still develop CHD. And while medical treatments for heart disease have come a long way, controlling the risk factors remains the most successful approach to preventing illness and death from CHD. In particular, getting regular exercise, eating a nutritious diet, and not smoking are the keys to controlling the risk factors for CHD.
What causes coronary heart disease
To understand what causes CHD, you need to understand how the heart works. Like any muscle, the heart needs a constant supply of oxygen and nutrients, and these elements are carried to the heart by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged, they cannot supply enough blood to the heart, which can have several effects.
If too little oxygen-carrying blood reaches the heart, it may respond with pain, which is called angina. This pain is usually felt in the chest or sometimes in the left arm and shoulder. However, the same inadequate blood supply may cause no symptoms, a condition called silent angina. When the blood supply is cut off completely, the result is a heart attack. When this occurs, the part of the heart that does not receive oxygen begins to die, and some of the heart muscle may be permanently damaged.
The thickening that occurs on the inside walls of the coronary arteries is called atherosclerosis, and it usually occurs when a person has high levels of cholesterol, a fat-like substance, in the blood. While circulating in the blood, cholesterol and fat build up on the walls of the arteries, making them more narrow and slowing or even blocking the flow of blood. When the level of cholesterol in the blood is high, there is a greater chance that it will be deposited onto the artery walls. This process begins in most people during their childhood and teenage years and gets worse as they get older.
What is cholesterol? Cholesterol, simply put, is nothing more than a molecule that the body uses as a building block to produce other types of compounds. Granted, this definition holds true for a lot of things, but it’s sufficient for our discussion here. In fact, picturing cholesterol as a child’s block or a Lego will be useful.
We hear a lot of talk about the different types of cholesterol, and a number of abbreviations are thrown around, such as HDL (high-density lipoprotein), LDL (low-density lipoprotein), and HDL/LDL (which is simply the ratio of the two). This is all a lot easier than it sounds. What’s important to remember is that the HDLs are the good cholesterol and the LDLs are the bad cholesterol. The bad ones are those that will clog up your arteries, making them hard and constricted.
That is really the crux of the problem. Once flexibility is lost in the arteries, the blood pressure goes up and the optimal levels of blood and other nutrients cannot reach the various parts of the body including the hardest working muscle of the body, the heart.
The earliest signs of CHD are often chest pain and shortness} of breath. A person may feel heaviness, tightness, pain, burning, pressure, or squeezing in the chest, usually behind the breastbone but sometimes also in the arms, neck, or jaw. These are the signs that typically bring a patient to the doctor for the first time. However, some people never have any of these symptoms and only discover that they have CHD after /they have had a heart attack. Women, especially, may be unfamiliar with the signs of CHD that are unique to women and may be unaware of their condition until they have had a heart attack.
It’s important to know that the symptoms of CHD cover a wide range of severity. Some people have no symptoms at all, some have mild and intermittent chest pain, and some have more pronounced and steady pain. Still others have such severe symptoms of CHD that doing normal, everyday activities becomes difficult.
How is coronary heart disease treated
CHD is treated in a number of ways, depending on the seriousness of the disease. For many people, CHD can be managed by making lifestyle changes and taking medications. People with severe CHD may need surgery. In any case, once CHD develops, it requires lifelong management.
Lifestyle Changes
As noted earlier, despite advances in treating CHD, making lifestyle changes remains the single most effective way to stop the disease from progressing. In particular, the person with CHD needs to eat a low-fat diet, get regular exercise, and not smoke.
Changing your diet to one that is low in fat, especially saturated fat, and low in cholesterol will help reduce your level of blood cholesterol, a primary cause of atherosclerosis. In fact, it’s even more important to keep blood cholesterol low after having a heart attack in order to help lower the risk of having another one. Eating less fat should also help you lose weight, and if you are overweight, losing weight can help lower your blood cholesterol. Losing weight is also the most effective lifestyle change you can make to reduce high blood pressure, another risk factor for atherosclerosis and heart disease.
People with CHD can also benefit from exercise. Recent research has shown that even moderate amounts of physical activity are associated with lower death rates from CHD. However, people with severe CHD may have to restrict their exercise somewhat. If you have CHD, check with your doctor to find out what kinds of exercise are best for you.
Smoking is one of the three major risk factors for CHD, so quitting smoking is a major lifestyle change in terms of preventing heart disease. Quitting smoking dramatically lowers the risk of having a heart attack and also reduces the risk of having a second heart attack in people who have already had one.
Medications
If making lifestyle changes was enough to prevent or control CHD, then medications would never be used. Diet changes, in particular, have been the traditional remedy for bad or high cholesterol, and while diet can make a difference, it doesn’t always take care of the situation. The body has the ability to produce its own cholesterol and to do that in rather high amounts when needed. This is a problem for someone who’s trying to control his or her cholesterol level by diet modification alone.
To help solve this problem, scientists have looked into ways to modify the body’s ability to produce cholesterol. The result has been a class of drugs known as statins, which generally address cholesterol synthesis by attacking the pathway at some point. Unfortunately, statins tend to be non-discriminant and knock out cholesterol production without regard for the type of cholesterol and the fact that the body does need some. Without some cholesterol, you would probably die. For instance, one type of statin, called Lovastatin, knocks out HMG-CoA reductase, an enzyme that is necessary for the production of cholesterol. Some of these pharmaceutical drugs also carry unwanted side-effects, such as muscle pain, tenderness, or weakness (especially associated with fever and a general feeling of discomfort); rash; yellow skin or eyes; unusual bleeding or bruising; swelling of the hands, face, lips, eyes, throat, or tongue; difficulty swallowing or breathing; and sore throat or hoarseness.
Some natural products are very similar to the pharmaceutical cholesterol-controlling drugs. These products are sold over the counter, mainly in health-food stores but sometimes in large discount retailers, as well. One such example is Red Rice Yeast (RRY), or as it’s also called, Red Yeast Rice. It naturally contains high levels of the same compound that is found in some of the pharmaceutical drugs to control cholesterol. RRY has been used for thousands of years in traditional Chinese medicine for this exact purpose, and Western science is now beginning to catch up.
Other medications are prescribed according to the nature of the patient’s CHD and other health issues. The symptoms of angina can generally be controlled by any of several types of drugs, such as beta-blockers, which decrease the workload on the heart, and nitroglycerine (along with other nitrates) and calcium-channel blockers, which relax the arteries. In addition, aspirin and other platelet-inhibitory and anticoagulant drugs can be used to thin the blood and prevent the tendency to form clots.
Beta-blockers are typically given to people who have had a heart attack in order to decrease the likelihood of their having another one. People with elevated blood cholesterol that is unresponsive to treatment through dietary and weight-loss measures may be prescribed cholesterollowering drugs, such as lovastatin, colestipol, cholestyramine, gemfibrozil, and niacin. Someone with impaired pumping of the heart may be treated with digitalis drugs or ACE (angiotension converting enzyme) inhibitors. And when high blood pressure or fluid retention is present, this condition is also treated.
If you have CHD, ask your doctor which medications you are taking, what they do, and what side-effects are common. Knowing more about these things will help you stick to the schedule that has been prescribed for you.
Surgery
Not all individuals can control CHD with lifestyle changes and medication. Surgery may be recommended for those who continue to have frequent or disabling angina despite the use of medications and for those who have severe blockage of one or more coronary arteries.
The first type of surgery, called coronary angioplasty or balloon angioplasty, involves inserting a catheter with a tiny balloon at its tip into a narrowed (clogged) coronary artery. The balloon is then inflated and deflated to stretch or break open the narrowed passage and improve the blood flow. The balloon-tipped catheter is then removed. Strictly speaking, angioplasty is not surgery. It’s done while the patient is awake and may last one to two hours.
If angioplasty doesn’t widen the artery or if complications occur, a coronary bypass operation may be needed. In this type of surgery, a blood vessel, usually taken from the leg or chest, is grafted onto the blocked coronary artery, bypassing the blocked area. If more than one artery is blocked, a bypass can be done on each. The blood can then go around the obstruction to supply the heart with enough blood to relieve the patient’s chest pain.
Having bypass surgery relieves the symptoms of heart disease but does not cure it. And in most cases, the patient still has to make a number of lifestyle changes after the operation. If his or her normal lifestyle includes smoking, eating a high-fat diet, or getting no exercise, changes will be definitely advised.
What is the probiotic solution
Taking probiotics has only recently been considered as a means of controlling cholesterol. Why only recently? There has been anecdotal evidence for many years of the correlation between taking probiotics and having low cholesterol. Consuming fermented foods, such as yogurt, and even plain probiotics was known to help lower cholesterol, so scientists set out to study that.
What they found in the probiotic studies on cholesterol was that when very high doses were used well over 100 billion live organisms per dose there was a reduction in blood cholesterol. Even more important, an increase in the ratio of HDL to LDL was observed. And the higher the HDL compared to the LDL, the higher the ratio.
Why is this important? If the LDLs are clogging things up, think of the HDLs as cleaning things out. As mentioned earlier, think of the LDLs as being like little Legos, with connectors that allow multiple cholesterol molecules to bind to each other. The LDLs collect in the arteries and build on one another, slowly clogging things up. The HDLs, on the other hand, are like Legos without connectors. Also, since the HDLs can’t bind to other things, they have a kind of “bowling ball” effect and knock out the LDLs from wherever they are grouping. So, if there are many more HDLs in comparison to LDLs, then fewer LDLs will be able to build up. Remember, the HDLs and the LDLs combine (numerically, not physically) to form the number that’s called total cholesterol. It’s all rather simple.
Given these benefits, probiotics have been looked at and used in high concentration. Strains such as Lactobacillus acidophilus (LA) have been used in 10s to 100s of billions per dose, and reductions in total blood cholesterol have been observed. More recently, some other specific strains have been looked at, such as Lactobacillus reuteri (LR), and the findings have been very important and interesting. In contrast to some of the other probiotics, LR can be used at very low levels to achieve very significant levels of cholesterol reduction. This is big news! Bear in mind, specific strains have been used for these studies, which will be discussed in more detail later in this section. But for now, remember that you want to find a strain that has scientific backing in terms of how it was chosen for production.
In order for the probiotics to function well in cholesterol reduction, it seems that they need to survive being ingested into the intestines. Now, why is that? When you eat probiotics, they enter your stomach and if they are not resistant to the acid, they will be destroyed by it. In fact, the vast majority will be killed. Then, when the survivors reach your intestines, they come in contact with another very harsh substance called bile, and they take another hit. Among its other functions, bile also serves as an antimicrobial substance. So, if the probiotics are not resistant to acid or bile, then they will not survive long enough to be of benefit.
How do those probiotics that survive help reduce cholesterol? As mentioned earlier, the body normally produces its own cholesterol; it doesn’t get it just from the diet. That’s why dietary modification is not always successful and when it is, the success is marginal at best. The body produces cholesterol and does a number of things with it. Again, think of cholesterol as a building block or Lego. One of the things the body builds with cholesterol is bile. Bile is produced in the liver, stored in the gall bladder, and secreted into the intestines to assist with digestion. The primary job of bile is to emulsify fat, which is a fancy way of saying it assists in the digestion of fat. After that, bile gets reabsorbed into the intestines and finds its way back to the gall bladder, where it’s stored until it’s needed again.
The body has evolved to be very efficient, and it doesn’t like to waste energy. Keep in mind, it takes energy to make compounds such as cholesterol and bile from scratch. It’s much easier just to reabsorb what has already been made. The body does this with enzymes, water, bile, and so on. The body likes to recycle as much as it can. It’s the ultimate conservationist!
Bile can suffer two fates when it reaches the intestines after being secreted from the gall bladder: It can either go on to do its job (that is, to assist in digesting fat), or it can be broken down by a process called de-conjugation. How this happens is not important. What is important is that the gastrointestinal micro flora can have an effect on the de-conjugation of bile. If the bile is de-conjugated, then there is a greater chance it will be flushed out of the body with other waste materials. There will still be some reabsorption, but it will be minimal.
If the bile gets excreted, it will obviously not be reabsorbed and recycled back to the gall bladder. The gall bladder needs to maintain a certain level of bile, and it will do whatever it has to do to maintain that level. As noted earlier, bile is produced in the liver from cholesterol. If the bile level drops because of lack of circulation back into the gall bladder which, in turn, is a result of probiotics acting on the bile in the intestines then the body will have to produce more. The liver will sense that the level of bile has dropped and respond automatically by making more.
The net result is that the body will start drawing on its cholesterol reserves in order to make more bile. The body will start feeding on itself, which is a good thing, at least in this case. Cholesterol will literally be pulled out of the blood and used by the liver to produce bile. This has a very pronounced and measurable effect.
We see a good result when high doses of probiotics are used. We also see a good result when low doses of some of the more acid- and bile resistant organisms are used. LR has been shown to be very acid and bile resistant. It can survive the journey into the intestines, where it can start pumping away on the bile and de-conjugating it, resulting in the excretion of the bile. LR has been observed to produce a 38 percent decrease in total cholesterol.
This is stunning, given the so-called one-to-two rule, which states that a 1 percent reduction of blood cholesterol causes a 2 percent lower risk of coronary heart disease. Remember, we’re talking about a 38 percent reduction in cholesterol here, so that means that taking LR probiotics can give you at least a 76 percent lower risk of CHD. That is major!
These beneficial effects can be achieved not only by taking high levels of probiotics but also by taking lower levels of some select strains. There are probably many different variants of each strain, each more or less acid and bile tolerant. What you should look for are products that use strains selected by the best technology available, such as DNA fingerprinting and cell-wall structure analysis.
Some companies have lines of products in which high-quality selection criteria are met. MAKTech is one such line, and I am sure there are others. I know the MAKTech line has actually taken this step further and isolated the components of probiotics that are beneficial. In the case of cholesterol reduction, there is an enzyme called a hydrolase that is responsible for the de-conjugation of bile. The MAKTech line offers this enzyme for people who don’t want to take probiotics, for whatever reason say, due to allergies. This sort of product offers these individuals all the advantages plus some extra choices.
Anyone who is concerned about getting CHD will want to take probiotics, even if he or she doesn’t care about all the other ailments discussed in this book. Taking probiotics as part of a healthy diet has been proven to have positive effects on CHD and other related conditions.
CHD is something we all need to be aware of. Women, in particular, should make sure they find a physician who understands women’s health issues, including their special risks for CHD.
