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Arterial Disease

Some Topics

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Coronary Artery Disease

The coronary arteries supply blood to the heart itself. These are relatively small arteries that are easily obstructed by fatty plaques that grow in the walls of the arteries. The entrance to the left and right arteries are found in the aorta just above the aortic valve. Because the heart is pumping blood to itself, reduced cardiac output reduces heart blood flow, reduces pump strength, reduces heart blood flow until the heart fails. Aortic valve calcification becomes more prevalent with advancing age and tends to direct flow flow away form the coronary openings limiting pumping strength and cardiac output. This is first noticed as decreasing exertion tolerance.

During contraction of the ventricles, the coronary branches that penetrate the muscle are compressed. Flow through the surface vessels continues. Blood supply into the deeper layers of muscle occurs during diastole when the muscle is relaxed and the ventricles are filling with blood. The coronary arteries expand and contract. Sympathetic nervous system (norepinephrine) activity increases blood pressure by constricting systemic arterioles, but the coronary arteries dilate.

Heart attacks are the most obvious consequence of diseased coronary arteries and increased clotting of blood. The main event of a heart attack is the occlusion by a sudden blood clot of one or more blood vessels supplying the heart muscle. When blood flow is critically short, muscle cells die. This is called a myocardial infarct and the clotting event a thrombosis. Thrombosis occurs in arteries narrowed by fatty lesions in the arterial walls, a process known as atherosclerosis.

Well-known risk factors are family history, high blood pressure, smoking, diabetes, excess body fat, and physical inactivity. The risk of heart attacks positively correlates with higher blood levels of cholesterol; the risk of strokes does not. Smoking and diabetes are the greatest risk factors - a smoking, overweight diabetic over the age of 50is a walking time bomb.

Until recently studies of coronary artery disease focused on men and excluded women. The impression that heart attacks remain a men's problem is misleading. Women are protected against heart attacks by estrogen until the menopause and then rapidly catch up with men. The lifetime probability of a women in the US and Canada dying of a heart attack is 10 times greater than dying of breast cancer. When women do have heart attacks, their risk of dying is higher than men - 11.3% Vs 5.5%. Prevention in women is highly desirable and consists of of diet revision and exercise. 

AtherosclerosisAtherosclerosis is often referred to as "hardening of the arteries". This is actually a complex disease which involves tumor-like growths in the wall of arteries. These tumors accumulate high-cholesterol fat and grow to obstruct blood flow through the artery. If the tissue is vital, such as heart or brain, arterial obstruction may be lethal or, at best, disabling.Obstruction of a blood vessel is caused by a clot forming (thrombosis). The rupture of soft, fatty plaques can cause thrombosis even when the artery is not obstructed and looks normal on angiography.

Serum cholesterol is a predictor of coronary heart disease (but not strokes), and current recommendations set target goals of less than 200 mg % for blood levels. So called "normal levels" range from 180-300 mg%, depending on age and sex. Strict vegetarians may have serum cholesterol levels of less than 100 mg %, considerably less than their lactocarnivorous peer group. Half of the population with high cholesterol will have heart attacks, the other half will not. The finding of elevated cholesterol by itself is, therefore, ambiguous. Other risk factors must be considered.

The Alpha Nutrition Program achieves good nutrition with high fiber intake by increasing the intake of vegetables and fruit. We have no difficulty in recommending aggressive diet revision, sufficient to remedy an existing problem and vigorous enough to prevent vascular disasters. Imagine that you live in a little cottage by the sea, think quiet thoughts, walk everywhere, tend your organic vegetable garden, cultivate fruit trees (never sprayed), and go fishing once or twice per week. Now you have a perfect setting and a perfect diet for enduring good health.

Population studies in Europe have shown benefits of the "Mediterranean Diet" - most of the credit went to vegetable intake and olive oil. Several studies purport to show benefit from drinking modest amounts of red wine. The benefit is also available in purple grape juice. There is a general misconception that "moderate alcohol intake is cardioprotective" A French Study presented at the 1998 Congress of the European Society of Cardiology has shown that wine can be harmful to patients with established CAD. Alcohol intake increased blood pressure and blood fats; the negative effective was greater on a "Western" diet as opposed to a Mediterranean diet.


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