Diets and Chronic Diseases (Part 3: Heart Disease)

Many chronic diseases such as type 2 diabetes; hypertension (high blood pressure); heart disease; age-related cognitive decline including dementia and Alzheimer’s disease; and cancers may be thought of as inevitable part of aging.

Although statistically, the prevalence of these chronic diseases increases with age, especially after age 40, numerous clinical research and studies have shown the strong influence of diets and lifestyle in the prevention and management of these diseases.

Let’s not be part of the statistics!

In Part 3 of this article series, we present a summary of what the latest research have shown in terms of the appropriate diets for the prevention and management of heart disease.

The identified risk factors and contributors are also presented.

Prevalence

According to the CDC, heart disease is the leading cause of death in the United States for both men and women.¹

Atherosclerosis (narrowing of the arteries due to build-up of plaque) is considered the most prominent underlying process of heart disease. The narrowing of the arteries and blockage of blood flow can lead to heart attack, stroke and eventually congestive heart failure.

Risk Factors and Contributors to Heart Disease

Metabolic Syndrome

The prominent risk factors associated with heart disease are what is called the metabolic syndrome.² Metabolic syndrome is a cluster of metabolic disorders that jointly increase the risk of heart disease, comprising:

• Abdominal obesity: waist circumference of >40 inches in men, or >35 inches in women
• Elevated blood pressure: SBP of 130 mmHg or higher, or DBP of 85 or higher
• Elevated triglyceride level: 150 mg/dL or higher
• Depressed HDL (or good cholesterol) level: <40 mg/Dl in men, or <50 mg/dL in women
• Elevated fasting blood glucose level: 100 mg/DL or higher

Metabolic syndrome potentiates the initiation and progression of atherosclerotic plaque formation and rupture, where chronic inflammation and oxidative stress are key underlying processes.^3,4

Therefore, strategies to prevent obesity, elevated blood sugar levels (prediabetic or diabetic), and elevated blood pressure (prehypertension or hypertension), and to minimize chronic inflammation and oxidative stress are important.

LDL Cholesterol: Bad Cholesterol?

Cholesterol itself is not inherently bad. In fact, cholesterol is an important building block for cell membrane and steroid hormones including cortisol and sex hormones.

Recent studies have shown that oversimplification by forming a direct causal link between high LDL (or so-called bad cholesterol) level and the risk of heart disease does not seem to hold.⁶

On the other hand, chronic inflammation and oxidative stress that promote oxidation of cholesterol and LDL is thought to be the key underlying process that trigger the initiation and progression atherosclerosis and heart disease.⁵

In addition, recent studies have shown that a subfraction of LDL, called small dense LDL particles (sdLDL) may be a more reliable biomarker to predict the risk of atherosclerosis and  heart disease.⁷

Note that sdLDL may be elevated even in individuals with normal LDL level and vice versa, which may explain the reason behind conflicting results linking high LDL levels and the increased risk of heart disease.

sdLDL level was also shown to have strong association with other biomarkers of  metabolic syndrome and inflammation.⁷

Beneficial Diets and Nutrition for Heart Disease

Dietary approach that prevent and mitigate metabolic syndrome, as well as reduce chronic inflammation and oxidative stress are important strategies for the prevention and management of heart disease and associated complications.

Dietary patterns that have been shown to be beneficial for heart disease are similar to those for type 2 diabetes and hypertension. See details in:

• Diets and Chronic Diseases (Part 1: Type 2 Diabetes)
• Diets and Chronic Diseases (Part 2: High Blood Pressure)

In addition, there are some further notable dietary aspects to reduce chronic inflammation and oxidative stress associated with heart disease:^5,8

• Minimize or reduce consumption of fried foods.
• Avoid excess consumption of pro-inflammatory omega-6 polyunsaturated fatty acids (PUFAs) which are found in extracted vegetables oils including corn, soybean, sunflower and cottonseed oils. Instead, prioritize on obtaining healthy fats from whole foods including healthy monounsaturated fatty acids (MUFAs) (e.g. olive, avocado) and anti-inflammatory omega-3 PUFAs (e.g. cold water fish, flaxseed)
• Minimize or reduce consumption of red meats and processed meats.

One nutritional compound that was found in recent studies to have strong anti-inflammatory property and exerts cardioprotective effect is curcumin, the most bioactive compound found in turmeric spice. Curcumin was found to mitigate the risk factors associated with heart disease and may mitigate post heart attack and stroke complications.^4,9–12

 

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Related Articles

Diets and Chronic Disease (Part 1: Type 2 Diabetes)

Diets and Chronic Disease (Part 2: High Blood Pressure)

Diets and Chronic Disease (Part 4: Alzheimer’s Disease)

 

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References

1. Centers for Disease Control and Prevention. Heart Disease Facts & Statistics. Cdc.gov. https://www.cdc.gov/heartdisease/facts.htm. Published 2017.
2. American Heart Association. About Metabolic Syndrome. www.heart.org. https://www.heart.org/en/health-topics/metabolic-syndrome/about-metabolic-syndrome. Published 2016.
3. Golia E, Limongelli G, Natale F et al. Inflammation and Cardiovascular Disease: From Pathogenesis to Therapeutic Target. Curr Atheroscler Rep. 2014;16(9). doi:10.1007/s11883-014-0435-z
4. Kapakos G, Youreva V, Srivastava, A K. Cardiovascular protection by curcumin: molecular aspects. Indian J Biochem Biophys. 2012;49(5):306-315.
5. Kummerow F A. Interaction between sphingomyelin and oxysterols contributes to atherosclerosis and sudden death. American Journal of Cardiovascular Disease. 2013;3(1):17–26.
6. Ravnskov U, Diamond D, Hama R et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open. 2016;6(6):e010401. doi:10.1136/bmjopen-2015-010401
7. Hsu S, Jang M, Torng P, Su T. Positive Association Between Small Dense Low-Density Lipoprotein Cholesterol Concentration and Biomarkers of Inflammation, Thrombosis, and Prediabetes in Non-Diabetic Adults. J Atheroscler Thromb. 2018. doi:10.5551/jat.43968
8. Siri-Tarino P, Chiu S, Bergeron N, Krauss R. Saturated Fats Versus Polyunsaturated Fats Versus Carbohydrates for Cardiovascular Disease Prevention and Treatment. Annu Rev Nutr. 2015;35(1):517-543. doi:10.1146/annurev-nutr-071714-034449
9. Santos-Parker J, Strahler T, Bassett C, Bispham N, Chonchol M, Seals D. Curcumin supplementation improves vascular endothelial function in healthy middle-aged and older adults by increasing nitric oxide bioavailability and reducing oxidative stress. Aging (Albany NY). 2017;9(1):187-208. doi:10.18632/aging.101149
10. Ji X, Xiao J, Sheng X, Zhang X, Guo M. Curcumin protects against myocardial infarction-induced cardiac fibrosis via SIRT1 activation in vivo and in vitro. Drug Des Devel Ther. 2016:1267. doi:10.2147/dddt.s104925
11. Duan W, Yang Y, Yan J et al. The effects of curcumin post-treatment against myocardial ischemia and reperfusion by activation of the JAK2/STAT3 signaling pathway. Basic Res Cardiol. 2012;107(3). doi:10.1007/s00395-012-0263-7
12. Li W, Suwanwela N, Patumraj S. Curcumin by down-regulating NF-kB and elevating Nrf2, reduces brain edema and neurological dysfunction after cerebral I/R. Microvasc Res. 2016;106:117-127. doi:10.1016/j.mvr.2015.12.008