Heart Disease
What it is, what contributes to it, & how to reduce your risk.
February is National Heart Month, and with heart disease being the leading cause of death in the United States and globally, we’re going to spend the next few weeks covering what heart disease is, what contributes to it, and how you can reduce your risk of heart disease through diet and lifestyle.
Let’s start by breaking down what heart disease is.
What Is Heart Disease?
Heart disease, or cardiovascular disease, is an umbrella term for conditions that affect the heart and blood vessels. The most common forms of heart disease include the following:
Coronary artery disease (the most common type)
Heart attack
Heart failure
Stroke
Vascular disease, including peripheral artery disease (PAD)
Heart rhythm disorders (known as arrhythmia)
As a whole, heart disease is the top cause of death for both men and women worldwide. In the United States, 702,880 people died from heart disease in 2022, which is equivalent to 1 in every 5 deaths.
What Causes/Contributes To Heart Disease?
Coronary artery disease is the most common kind of heart disease, and it causes most heart attacks and chest pain (angina).
Coronary artery disease involves the progressive narrowing of the arteries that supply blood and oxygen to the heart. The narrowing is due to a buildup of fatty plaque (atherosclerosis) along the artery walls. These deposits are composed mostly of LDL-cholesterol and lipids.
In the beginning stages, there are no symptoms. However, as more plaque builds up and the arteries become more narrow, angina (chest pain) may develop due to the lack of oxygen to the heart. This “lack of blood to the heart” is referred to as myocardial ischemia.
People describe angina discomfort as a squeezing, suffocating, or burning feeling – usually in the center of the chest/behind the breastbone. It can also occur in the shoulders, arms, neck, or jaw.
Chest pain should not be ignored, as it’s a warning sign that your heart needs more oxygen.
Although the chest pain may only last a few minutes, it’s almost always a sign that you have blocked arteries and heart disease. If ignored and left untreated, it can result in heart attack or stroke.
A heart attack occurs when blood flow to an area of your heart muscle is completely blocked. This prevents oxygen-rich blood from reaching that area of heart muscle and causes it to die. Without quick treatment, a heart attack can lead to serious problems and even death.
Plaque can build up in any artery in the body, including arteries in the brain and neck. When plaque blocks the flow of blood to the brain, it can result in stroke.
Plaque in an artery can also break open. When this happens, blood platelets stick to the site of the plaque injury and clump together to form blood clots. These clots can partly or fully block an artery, also leading to heart attack or stroke.
Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias (irregular heart rate).
What Causes Plaque Formation?
Knowing that heart disease is primarily caused by a buildup of plaque in the arteries that supply blood and oxygen to the heart, it’s important to understand what causes plaque to build up in the arteries so you can prevent or reverse it.
The process of atherosclerosis or plaque buildup begins when there’s damage to the arterial wall. When arteries become damaged, they get tiny tears in them which allows for LDL-cholesterol and plaque to build up in those sites, and continue to accumulate over time, narrowing the arteries and blocking the flow of blood and oxygen to the heart.
To fix these damaged areas, the body sends special immune cells to promote “vascular remodeling,” which results in thicker, stiffer arteries, further reducing blood flow to the heart.
So in order to prevent or reverse this process of plaque buildup in the arteries, we need to reduce our exposure to the things that damage the arterial wall in the first place (since LDL is lodging into these tears/damaged areas of the arterial wall and promoting the process of plaque accumulation).
Here are the primary factors that damage the arteries, allowing for plaque to buildup, and increasing the risk of heart disease:
High Blood Pressure: When blood pressure is high for too long, it exerts additional strain on the walls of blood vessels. This damages the walls of blood vessels, causing them to develop tiny tears. As blood flows through, LDL-cholesterol and fats build up at these damaged spots, forming plaque. Check your blood pressure regularly and aim for a reading of 120/80.
High LDL-Cholesterol: Often referred to as the “bad” cholesterol, excess LDL-cholesterol contributes to plaque buildup in the arteries. In addition, free radicals oxidize excess LDL in your bloodstream, and it’s the oxidized LDL-cholesterol that’s sticking to the arterial walls, triggering an inflammatory response, and driving plaque buildup in the arteries. The best way to prevent LDL from oxidizing is to keep levels low, ideally <100 mg/dl.
Low HDL-Cholesterol: HDL cholesterol is considered the “good” cholesterol because it picks up excess cholesterol from the blood and arteries and delivers to the liver for elimination, ultimately helping to keep cholesterol levels healthy and balanced. This means that if your HDL levels are low, you’re at a greater risk for excess LDL-cholesterol accumulating in the blood and arteries. Aim for an HDL level of >50 mg/dl.
High Triglycerides: Excess triglycerides trigger inflammation of your arteries that leads to plaque buildup. Research shows that the more triglycerides you have in your blood, the more likely you are to develop atherosclerosis. Optimal levels for triglycerides are <150.
High Triglyceride-to-HDL Ratio: One of the best indicators of your risk of heart disease is your triglyceride-to-HDL ratio. According to The Great Cholesterol Myth, “people with a high triglyceride to HDL ratio have a 16x greater risk of heart disease.” To calculate this, divide your triglyceride level by your HDL level. For example, my most recent triglycerides were 39 mg/dl and my HDL was 109, giving me a ratio of 0.35 (39/109). You want this ratio to be 2.0 or less. A ratio of 5.0 increases your risk for cardiovascular events significantly.
Inflammation: Chronic inflammation can damage blood vessels and arteries, which promotes the buildup of plaque in the arteries (atherosclerosis).
Insulin Resistance & Diabetes: Raises heart disease risk significantly because insulin resistance promotes both plaque formation and advanced plaque progression. In addition, elevated blood sugars are a major source of inflammation, which damages blood vessels and arteries.
Poor Diet: High in processed foods, added sugars, and unhealthy fats lead to inflammation, elevated LDL-cholesterol, high triglycerides, and high blood pressure all of which damage the arteries and increase the risk of heart disease.
Sedentary Lifestyle: Physical activity improves the “good” HDL-cholesterol, keeps the arteries flexible, reduces blood pressure, and makes arteries less likely to collect plaque. Lack of physical activity has the opposite effect, increasing the risk of heart disease.
Chronic Stress: Contributes to inflammation and high blood pressure which damage the arteries and the risk of atherosclerosis.
Smoking: The chemicals you inhale when you smoke cause damage to your heart and blood vessels that contribute to plaque buildup in the arteries. In addition, smoking increases blood pressure which increases the risk of heart disease.
The good news is that these risk factors are modifiable, meaning that you have control over them!
Next week we’re going to look at the specific foods to limit that increase the risk of heart disease.
Talk to you then!
-xo Kate