Dare to Live

iUniverse, Inc.

Contents

Preface....................................................................................................................................................viiChapter 1 What is Arterial Plaque, How Does It Form, and Why?.............................................................................................1Chapter 2 Understanding Your Risk for Heart Attack (and the Concept of Risk Factors)......................................................................14Chapter 3 Exercise and Why It's Important.................................................................................................................51Chapter 4 Understanding Cholesterol, Lipoproteins, and the Role of Statins................................................................................65Chapter 5 Hormones........................................................................................................................................86Chapter 6 Endothelial Dysfunction: Where Cardiovascular Disease Starts....................................................................................103Chapter 7 High Blood Pressure (Hypertension) as a Risk Factor.............................................................................................112Chapter 8 The Role of Air Pollution in Heart Disease......................................................................................................118Chapter 9 Depression, Stress, and Anxiety.................................................................................................................120Chapter 10 Medical Conditions that Increase Cardiovascular Risk...........................................................................................126Chapter 11 Dietary Prevention of Heart Attack and Stroke..................................................................................................141Chapter 12 Heart Attack Prevention Diet...................................................................................................................152Chapter 13 Nutritional Supplements........................................................................................................................170Chapter 14 Alternative and/or Controversial Treatments for Atherosclerosis................................................................................204Appendix 1 Lists of Tests.................................................................................................................................215Appendix 2 Summary of Trials/Studies/Reviews Proving that Lowering LDL with Statins Prevents Cardiovascular Events or Reverses Plaque.....................218Appendix 3 Summary of Supplements.........................................................................................................................223Appendix 4 Risk Tables....................................................................................................................................225Appendix 5 Resources for Readers..........................................................................................................................229Index......................................................................................................................................................233

Chapter One

Atherosclerosis is a complex subject under continuous study by cardiology researchers. Why do humans get plaque? What is plaque? What is it made of? Why does plaque form in some areas and not others? The answers to these questions may surprise you. Our understanding of atherosclerosis is still evolving, and new risk factors continue to emerge. Atherosclerosis (arterial plaque) results from the process of atherogenesis, and unchecked atherogenesis often results in a heart attack. Arteriosclerosis is a similar-sounding term but refers to hardening (and loss of elasticity) of the arteries. It causes high blood pressure. In the most basic terms, plaque is the body's response to injury at the artery wall. We used to call the plaque in arteries a "callus" analogous to the thickening of the skin in response to mechanical friction and pressure.

Injury comes in two types: mechanical and chemical. Mechanical injury includes arterial stretching caused by the effects of blood pressure on the artery wall and shear stress caused by the frictional forces of passing blood cells over the inner lining of an artery over a lifetime, plus the stretching of the vessels with each pulse. Chemical injury includes factors such as oxidative stress (not enough antioxidants or too much oxidative stress), dietary deficiencies, hormone imbalances, smoking, pollution, too much (or the wrong kind of) cholesterol, immune system dysfunction, and lack of nitric oxide.

In CAD, coronary arteries (the arteries that supply the heart) can become narrow with plaque, or the plaque itself can rupture. If a clot forms in a coronary vessel, it could block blood flow and lead to a myocardial infarction, or heart attack. The most common cause of a clot in a coronary vessel is a plaque rupture. The rupture attracts platelets and other clotting factors and causes a clot to form. We call this a thrombus. When the heart muscle does not get enough blood, part of it can die. So, both heart attacks and strokes are mediated by blood clots.

Heart attacks are not always symptomatic, especially the small ones. Also some plaques may rupture but not cause an obstruction. But, if the blocked artery is not fixed, the part of the heart that it supplies can become permanently damaged. Damage to the heart muscle affects electrical patterns in the heart; these electrical abnormalities are what doctors pick up on an electrocardiogram.

Quantifying plaque is achieved through noninvasive coronary calcium scoring with electron beam tomography (EBT), carotid artery ultrasound, or 64-slice heart scanners. While an angiogram shows us if you have a blockage or narrowing of the artery, the heart scan allows us to identify plaque years before it will cause a heart attack. Plaque is the ultimate risk factor. If your calcium score or carotid artery plaque is growing, you have active disease; if it is regressing or remains the same each year, you have coronary plaque reversal or stable disease.

A stroke occurs when a blood clot forms and travels to the brain, where it lodges in an artery providing the blood supply to a particular region of the brain. The clot can occur from a ruptured plaque in the arteries that feed the brain, or it can happen spontaneously, usually because of untreated high blood pressure. The blockage causes damage to the brain because brain cells need oxygen and glucose to survive. Doctors call this an ischemic stroke. The severity and type of symptoms depend on where and how extensive the ischemia is. The more damage to the brain, the harder it is to recover. Some people do not recover; others have long-lasting speech or walking problems. Transient ischemic attacks, or TIAs, are a type of ministroke where the clot is so small that the body is able to break it up and heal the damage.

Some people experience cardiac chest pain without having a heart attack. This is called angina pectoris and indicates that there is compromised blood flow to the...