Cardiovascular disease (CVD) kills one person every 37 seconds in the US alone. CVD-an umbrella term that includes coronary heart disease (CHD), heart attack, angina, heart failure and stroke-remains the West's biggest killer, and is responsible for nearly one-third of all deaths.
In addition, it's evident that medicine's response to its biggest challenge is woefully inadequate and, in the last month or so, it has been weakened even further. Aspirin-one of its most important 'just-in-case' therapies taken by millions of people every day-can no longer be considered a safe option for people who don't already have heart problems, a major new study has concluded (Lancet, 2009; 373: 1849-60). This will have major consequences, as around 37 billion aspirin tablets are taken every year around the world as a prophylactic, or 'just-in-case' remedy, for their 'blood-thinning' qualities.
The news has not been much better for medicine's other weapon against heart disease-the cholesterol-lowering statins. The worldwide market for these drugs reached 26 billion US dollars in 2008 (www.bharatbook. com/Market-Research-Reports/Statins-The-World-Market-2009-2024.html), even though one recent study into the leading product Lipitor (atorvastatin) discovered that the drug affects brain functioning and causes memory loss (Townsend Letter, 2009; 311: 64-70).
The cholesterol story
These phenomenal drug sales have been driven by medicine's continued belief that the two major causes of all heart disease are either raised or high blood pressure (hypertension), or high levels of LDL (low-density lipoprotein chol-esterol, better known as the 'bad' cholesterol), or hyperlipidaemia, caused by diabetes, smoking, poor diet, physical inactivity, obesity, drinking alcohol and genetic factors (Centers for Disease Control and Prevention. Heart Disease Risk Factors; online at www.cdc.gov/heartDisease/risk_ factors.htm).
Nevertheless, there's a very real possibility that medicine has got it completely wrong about choles-terol. Not only is it not necessarily the 'bad guy', it may actually play a vital role in repairing the damage caused by injury or after a heart attack. Furthermore, as we age, cholesterol becomes important for maintaining good mental health. As statins lower cholesterol levels, this supposed benefit may be causing the deterioration in brain functioning that researchers are now seeing with these drugs.
Medicine and the pharma-ceutical industry also choose to ignore the growing body of research that suggests that environmental factors are an unsuspected catalyst for many cases of CVD, that CVD may be an inflammatory disease and not one of accumulating fats, and that nutrition plays a key role both as a cause of heart disease and in its treatment.
Millions of healthy people who take aspirin to ward off heart disease now need to find a different therapy, a major new study has concluded (Lancet, 2009; 373: 1849-60). Aspirin can prevent plaque buildup, but its blood-thinning qualities can also cause a stroke as well as serious bleeding in the stomach. Overall, its risks outweigh any benefits when taken by a healthy person, according to the Anti-thrombotic Trialists' (ATT) collab-oration at Oxford University.
The ATT researchers reviewed six major studies that involved around 95,000 healthy participants who were taking aspirin as a 'just-in-case' remedy. Not only was the drug of only marginal benefit in prevent-ing a heart attack, but it also increased the risk of serious bleeding both in the stomach and in the brain by about one-third.
Despite the media furore over the ATT study, its findings were saying nothing new. In a study funded by the British Heart Foundation in 2001, researchers discovered that aspirin increased the risk of bleeding by 70 per cent. Lead researcher Professor Larry Ramsay also questioned the use of aspirin as a heart disease preven-tative in healthy individuals (Heart, 2001; 85: 265-71).
In its conclusion, the ATT team stated that healthy people who are at low risk of developing heart disease would do better to take a cholesterol-lowering statin instead, which can reduce the chances of "myocardial infarction [heart attack] and ischaemic stroke with little hazard".
Nevertheless, and contrary to the above recommendation, in February of this year, two separate studies arrived at the exact same conclusion: cholesterol-lowering statins-and, in particular, the leading product Lipitor (atorva-statin)-cause damage to the brain, and can cause memory loss and affect brain functioning. Although this had already been recorded as a possible side-effect-along with nausea, hostility, homicidal impulses, kidney failure, inability to walk, liver damage and impaired muscle formation-the extent of the problem may be far greater than the drugs regulators thought.
One of the studies, carried out by Duane Graveline and Jay S. Cohen, found that the problem was so extensive that they surmise it affects everyone who takes a statin, even though the cognitive damage may be 'subclinical'-not serious enough to be picked up by doctors (Townsend Letter, 2009; 311: 64-70).
As statins reduce cholesterol levels, this may not be so surprising. In the other study, Yeon-Kyun Shin, a professor of biophysics at Iowa State University, pointed out that high cholesterol, while supposedly bad for heart health, is vital for good brain functioning. A lack of cholesterol impairs the brain's thinking ability and memory.
"If you deprive the brain of cholesterol, then you directly affect the machinery that triggers the release of neurotransmitters. Neurotransmitters affect the data-processing and memory functions; in other words, how smart you are and how well you remember things," he said (Proc Natl Acad Sci U S A, 2009; 106: 5141-6).
The cholesterol conundrum
How could Nature have got it so wrong and created a lipid, or fat, that is both essential for good health and, at the same time, the West's biggest killer?
It hasn't; medicine has.
Our liver naturally produces around 1000 mg of cholesterol every day, a quarter of which is needed by the brain. This is sufficient for the body's needs, and the medical orthodoxy maintains that any excess as a result of a high-fat diet will end up causing arterial disease, even though critics have argued that there is no connection between fats in food and raised levels of cholesterol. Nevertheless, this second part of the cholesterol hypothesis has spawned the multibillion-dollar low-fat-food industry.
Your doctor would consider as dangerous a blood cholesterol level of 240 mg/dL and above, or 160 mg/dL for LDL cholesterol.
But this is an overly simplistic picture. Heart specialist Stephen Sinatra, assistant clinical professor of medicine at the University of Connecticut School of Medicine, began to doubt the cholesterol hypothesis when some of his patients with low cholesterol levels-some at just 130 mg/dL-still went on to develop heart problems. When he discussed this with other cardiologists, he discovered that they were noticing the very same phenomenon.
On researching the issue further, Sinatra discovered that:
- the body makes cholesterol as needed, so when you eat more, the body makes less;
- your cholesterol level rises and falls throughout the day;
- cholesterol levels also rise in winter and decrease in the summer;
- cholesterol rises following surgery, when you have an infection or when you're stressed; and
- cholesterol levels rise both dur-ing and after a heart attack.
"One reason for these variables is that cholesterol serves as a healing agent. The body produces chole-sterol when there is a healing job to do," he says (Townsend Letter, 2009; 311: 61). This would explain why cholesterol levels are high when people have heart problems, or after they've suffered a heart attack. Although cholesterol is often present at the scene, it has been wrongly identified as the perpetrator.
Cholesterol isn't only a healing agent. As we age, it appears to have an increasingly important role in keeping us mentally sharp, and also in helping us to live longer. One Dutch study found that individuals aged 85 and older who had high levels of cholesterol lived longer. They were also less likely to die from cancer or infection, the researchers found (Lancet, 1997; 350: 1119-23).
Sinatra believes that cholesterol becomes a potential danger to arterial and heart health only when it reaches levels as high as 320 mg/ dL, nearly a third higher than the current levels at which medicine will intervene. His approach is supported by the results of the Copenhagen City Heart Study, which looked at the health records of 19,698 people living in the city from 1976 through to 1988. Of these, 693 had suffered a heart attack within a five-year period.
But cholesterol was found to be directly linked to these heart attacks only when levels were so high that they were in the top 5 per cent recorded in all participants (BMJ, 1994; 309: 11-5).
So, while it plays a part in heart problems, cholesterol's role may not be anywhere near as significant as the current medical thinking believes.
Medicine concentrates on total cholesterol, LDL and HDL (high-density lipoprotein, the 'good' cholesterol) levels as the primary markers of heart disease. However, other markers may be just as important and suggest that CVD is an inflammatory process.
- C-reactive protein (CRP): If heart disease truly is a disease
of lipid accumulation, as the cholesterol hypothesis suggests, then CRP levels cannot predict future heart problems-yet it does. CRP is a marker of increased inflammation, and it's been proven to be a highly accurate predictor of stroke, diabetes, heart attack and cardiovascular death even years before the event (J Periodontol, 2008; 79: 1544-51). Statin drugs appear to have the unintended benefit of lowering CRP levels, and patients whose levels were lowered recovered better from heart disease-even when the drug failed to reduce LDL cholesterol levels (N Engl J Med, 2005; 352: 20-8).
- Fibrinogen: This is another protein that is a marker of increased inflammation. Fibrino-gen in the blood is an important indicator of heart disease, and those who have high levels are six times more likely to develop CVD. Conversely, individuals with low fibrinogen levels rarely go on to develop heart disease, even when their LDL levels are high (Arterioscler Thromb, 1994; 14: 54-9).
- Homocysteine: This amino acid is found as the byproduct of the normal breakdown of proteins in the body. It's a predictor of arterial disease and heart attack, and high levels will significantly increase the risk even when cholesterol is normal or even low (Eur J Cardiovasc Prev Rehabil, 2009; epub: March 16). Indeed, high levels of homocysteine can increase the risk of CVD fourfold (N Engl J Med, 1997; 337: 230-6). The biggest ever heart-health investigation, the US' Framingham Heart Study, revealed that the higher the level of blood homocysteine, the greater the extent of narrowing of the carotid arteries (N Engl J Med, 1995; 332: 286-91).
A growing body of evidence suggests that environmental fac-tors could be a major contributor to heart disease-and one that is ignored by medicine. Aside from the established risk factors of smoking, diabetes, stress and obesity, heart problems may also be caused by environmental pollutants and toxic substances, such as heavy metals, solvents and bisphenol A (BPA).
- Lead: Even at low levels of exposure, lead can bring about high blood pressure (J Toxicol Environ Health 1994; 43: 419-40). Most of us are exposed to lead when we drink water that has passed through old pipes, when we eat food that has been prepared in old ceramic dishes, when we breathe it into our lungs from the air, and from hair dyes and cosmetics.
- Mercury: The heart is one of the organs that is targeted by methylmercury. One of its most common sources is contamin-ated fish that swim in polluted waters. Indeed, one study has established the link between fish consumption and heart attack and cardiovascular disease (Nutr Rev, 2004; 62: 68-72).
- Arsenic: This chemical element is a cause of stroke, coronary artery disease and atherosclero-sis, or hardening of the arteries (Am J Epidemiol, 2005; 162: 1037-49). It's found in drinking water, food (especially chicken), pesticides, treated wood, medications and glass.
- Bisphenol A: High levels of BPA lead to angina, heart attack and coronary artery disease (JAMA, 2008; 300: 1303-10). This organic compound is used in plastic bottles, the lining of food cans and dental sealants.
- Solvents: These agents can cause heart arrhythmias, or irregular heart rhythms (Rom WN, ed. Environmental and Occupational Medicine, 2nd edn. Boston: Little, Brown & Co. 1992). They are used in hair dyes, paints, cosmetics, cleaning products, industrial chemicals, dry cleaning chemicals, petrol and paint.
Nutritional deficiencies may either be a direct cause of heart disease, or be the result of a process that can lead to it. In either case, correcting the deficiency may play a key role in reversing the disease risk-and even the disease itself.
- The B vitamins: Vitamins B6, B12 and folic acid are important nutrients for establishing heart health. In one study, the risk of heart disease was reduced by two-thirds in those who regularly supplemented with these vita-mins (Irish J Med Sci, 1995; 164 Suppl 15: 51A). Another study inadver-tently found that 3000 patients with carpal tunnel syndrome who were being treated with B6 also reduced their risk of acute heart attack and angina by 75 per cent after five years of treatment (Res Commun Mol Pathol Pharmacol, 1995; 89: 208-20).
- Chromium: This essential trace mineral is hard to come by in the standard diet as it's been refined and processed out of most of the foods we buy. Its importance to heart health is suggested by one study of patients with coronary artery disease, all of whom were low in chromium (Am Heart J, 1980; 99: 604-6). Supplementing with chromium also helps to control glucose levels in people with type 2 diabetes, which often leads to CVD (Diabetes, 1997; 46: 1786-91).
- Magnesium: This is another trace mineral that has been processed out of the standard Western diet, and individuals who are deficient in magnesium have an increased risk of devel-oping heart disease (Magnes Bull, 1981; 3: 165-77).
- Omega-3 fatty acids: While statins try to reduce levels of 'bad' LDL cholesterol, fish-oil supplements increase the body's 'good' HDL cholesterol instead. In one study, supplementing with omega-3 was better than the statin drug Crestor (rosuvastin) at preventing chronic heart disease (Time Magazine, August 31, 2008).
- Nattokinase: This is an enzyme that's derived from natto, a fermented soybean product that has been proven to support heart health. In one trial, nattokinase lowered both systolic and dia-stolic blood pressure in patients who had early-stage hypertension (Hypertens Res, 2008; 31: 1583-8). It was also tested in 204 travellers who had taken a longhaul flight (7-8 hours) and who were at particular risk of developing deep vein thrombosis (DVT). However, none of those given nattokinase suffered from a DVT compared with 5.4 per cent of those given a placebo (a sugar pill) (Angiology, 2003; 54: 531-9).
- Serrapeptase: If CVD is an inflammatory disease, this enzyme (produced by Serratia enterobacteria) could play an important role in countering it. Although there has been little research into its abilities as a heart-disease therapy, its anti-inflammatory qualities have been recorded in several studies. It was helpful in cases of post-operative swelling and pain (Int J Oral Maxillofac Surg, 2008; 37: 264-8), and for treating inflammatory conditions such as ear, nose and throat disorders (J Int Med Res, 1990; 18: 379-88), carpal tunnel syndrome (J Assoc Physicians India, 1999; 47: 1170-2) and musculo-skeletal injury (Fortschr Med, 1989; 107: 67-8).
- Bromelain: This is another enzyme (from pineapple) with anti-inflammatory properties, and for which there have been studies into its effectiveness in treating heart problems. It offers similar benefits as aspirin, but without the heightened risk of bleeding. It reduces blood platelet counts and platelet aggregation, the 'stickiness' and clumping together of platelets (Platelets, 2006; 17: 37-41; Experientia, 1972; 28: 844-5), and may also reduce angina (Acta Med Empirica, 1978; 5: 274-8). Bromelain may even have beneficial effects on hypertension-induced kidney damage-so far seen only in rats, so it may not apply to humans (Am J Nephrol, 1998; 18: 570-6).
Despite the billions of pounds and dollars being spent on statins, on low-fat foods and health education, heart disease remains the biggest killer in the West. Health officials console themselves with the fact that death rates from heart disease are falling, but it still represents 40 per cent of all deaths, so it hardly seems to be grounds for self-congratulation.
Medicine has become so obsessed with the theory that high cholesterol is the principal reason for heart disease-when, in fact, it is evidently doing more good than harm-that it has become blinded to other possible causes of CVD. There is, for instance, growing evidence to suggest that cardio-vascular disorders are the result
of an inflammatory process, and that cholesterol is a problem only at very high levels, far above today's trigger point for intervention.
What's more, medicine needs to consider environmental factors and to explore other ways of countering these challenges.
Indeed, heart disease is yet another example of medicine marching blindly to the beat of the pharmaceutical drum and of being in such a state of hypnosis that it barely knows to look anywhere else.
The Pressure's On
Along with cholesterol, high blood pressure (hypertension) is considered
to be one of the main risk factors for heart disease. And, as with cholesterol, it appears to be surrounded by myth, conjecture and half-truths.
Blood pressure is the force with which blood pushes against the walls
of the arteries, and 'healthy' levels vary according to our age. They are measured by the systolic pressure, when the heart is beating, and the diastolic pressure, when the heart is at rest between beats. On average, medicine considers a normal level to be 120/80 mmHg; the units 'mmHg' stand for 'millimetres of mercury'.
Anything above this level of pressure and you could be damaging your heart, blood vessels and kidneys-or so the theory goes.
The problem is that our blood pressure is not a constant. It's higher in the morning, and it jumps up when we're about to have our blood pressure measurements taken by a doctor, a phenomenon known as the 'white-coat syndrome'. It's also harder to read the older we get. One study of men aged 65 or over found that they had 'pseudohypertension', a false alarm from a faulty reading. The blood pressure cuff was reading a level of 180/100 mmHg, whereas their true level was only 165/85 mmHg, which is normal for their age (N Engl J Med, 1985; 312: 1548-51).
And, as we've been suggesting for heart disease (see the main text), high blood pressure may also be an inflammatory disorder. When researchers from Harvard Medical School analyzed blood samples from 20,525 participants in the Women's Health Study before and after hypertension was diagnosed, they found that a total of 5365 women had developed high blood pressure, and a very high percentage of these women had high levels of C-reactive protein in their blood, a well-known marker of inflammation (JAMA, 2003; 290: 2945-51).
Something in the Air
A new study has reinforced the suspicion that air pollution is another major cause of heart problems. Pollutants from cigarette smoke and cooking oils can change breathing patterns, raise blood pressure and alter the heart rate after even short exposures, researchers discovered when they exposed 40 healthy volunteers to polluted air. The effect was dramatic despite the fact that exposure levels were very low, reported the researchers from the University of Kentucky at the Annual Meeting of the American Physiological Society, held in New Orleans, in April 2009.
Cigarette smoke, in particular, contains low levels of cadmium, a highly toxic metal, and the inorganic-and more toxic-form of arsenic. Even second-hand smoke increases the risk of high blood pressure among non-smokers (Am J Epidemiol, 2005; 162: 1037-49).
The air itself also contains a mixture of chemicals, heavy metals, solvents, polycyclic hydrocarbons, pesticides and ozone. These come from car-exhaust fumes, jet fuel, pesticides, industrial waste and power plants. All forms of air pollution have been linked to raised blood pressure, stroke, heart attack, blood clots and hardening of the arteries (Rev Environ Health, 2007; 22: 115-37).
Finally, the air we breathe contains particulate matter (PM) that is a mixture of particles and liquid droplets. It is a mix of acids, such as nitrates and sulphates, organic chemicals, metals, and soil and dust particles. These particles can affect the heart and lungs, and cause serious health problems (see www.epa.gov/air/ particlepollution/ for more details). PM can also worsen the health status of those with existing heart problems and those who have increased markers of inflammation (Environ Health Perspect, 2006; 114: 992-8).