Manual Say No To Heart Disease: The drug-free guide to preventing and fighting heart disease

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Hypertension, myocardial infarction, atherosclerosis, arrhythmias and valvular heart disease, coagulopathies and stroke, collectively known as cardiovascular diseases CVDs , contribute greatly to the mortality, morbidity and economic burden of illness in Canada and in other countries.

It has been estimated that over four million Canadians have high blood pressure, a comorbid condition that doubles or triples the risk of CVD. The majority of Canadians exhibit at least one CVD-related risk factor, such as tobacco smoking, physical inactivity, diabetes, obesity, hypertension, a lack of daily fruit and vegetable consumption, and psychosocial factors, making these people more prone to developing a serious CVD-related illness in the future. It is therefore important that CVD-related causes and concerns be addressed.

The focus of the present review is to evaluate and compare the results of epidemiological, experimental and clinical studies, reporting on the influence of physical activity, dietary intervention, obesity and cigarette smoking on cardiovascular health and the prevention of CVDs. The preventive strategies against CVDs must be targeted at a primary health promotion level before some of the important underlying causes of CVD seriously afflict a person or a population at large.

Such preventive approaches would help in reducing not only employee absenteeism but also the hospital and drug costs burdening the health care systems of both developed and developing countries. At the advent of the 21st century, infectious diseases became relatively less of a concern, while chronic diseases continue to plague the global populace. Antibiotics and many other drugs help to treat acute diseases, whereas the biomedical model is limited when dealing with the health crisis resulting from chronic diseases, which develop over a prolonged period of time and persist for lengthy durations.

As opposed to their acute disease counterparts, most chronic diseases are largely related to lifestyle factors, and can be minimized or prevented, for the most part, by lifestyle changes. Chronic diseases have one or more of the following characteristics: they are persistent and leave residual disability; they are caused by nonreversible pathological conditions; and they require special training of the patient on rehabilitation, or may be expected to require prolonged medical supervision, observation or health care 1.

Among the most common chronic diseases that afflict humans worldwide are diabetes, cardiovascular diseases CVDs , osteoporosis, arthritis, obesity, chronic obstructive pulmonary disease, inflammatory bowel disease, central nervous system degenerative diseases and some cancers. CVDs and chronic obstructive pulmonary disease not only contribute largely to morbidity and mortality but also put a heavy economic burden on the health care system at both a global and a national scale. Therefore, it is important that CVD-related causes and concerns be addressed.

Leading causes of death in Canada in Percentages represent data combined from males and females of all ages. Data from reference 6. Given the scope and prevalence of CVDs, it is clear that a population health approach, using preventive measures, would be the most appropriate model to adopt to deal with this ubiquitous problem.

The focus of the present review is to evaluate the influence of physical activity exercise , dietary intervention, obesity and diabetes, and cigarette smoking on cardiovascular health and the prevention of CVDs. Prophylactic measures must be dealt with collectively because there is overwhelming evidence that the occurrence of CVDs can be reduced by making lifestyle changes. Thus, CVDs must be targeted at a primary health promotion level before some of the important underlying causes of CVD seriously afflict a person or a population at large.

Such preventative approaches would help in reducing not only employee absenteeism but also the hospital and drug costs burdening the health care systems of Canada and many other countries. With increasing longevity and growing elderly populations, patients with CVDs may require expensive treatment, such as cardiac bypass surgery, postoperative rehabilitation and lifelong medications. Health care professionals will continue to use their best judgement, knowledge of current scientific advances and the resources at hand to treat their patients who, when deemed neccessary, require medicines and surgeries.

Nevertheless, alternative interventions reported in the scientific literature for the prevention of CVDs should also be explored with the aim to minimize physician supervision and associated diagnostic and hospitalization costs. CVDs contribute greatly to the mortality, morbidity and economic burden of illness globally. More than four million Canadians have high blood pressure BP , a comorbid condition that doubles or triples the risk of CVD.

To date, CVD remains the leading cause of death. The economic burden of illness is measured by considering all direct and indirect costs related to this disease. Obviously, the costs of hospitalization and rehabilitation care for patients with CVD are very high in Canada, where universal health care is available to all Canadians. Because CVD often causes morbidity, persons affected by CVD are commonly forced to accept an inferior quality of life.

For instance, CVD-related potential years of life lost was , in Canada in Multiple risk factors are attributed to causing CVD. According to the Canadian Heart and Stroke Foundation, the following are some of the most significant risk factors: age, sex, family history, tobacco smoking, physical activity, being overweight, diet, BP and diabetes 3.

These risk factors fall into the categories of either nonmodifiable or modifiable risk factors. As described below, nonmodifiable risk factors consist of those conditions that a person cannot alter, whereas modifiable risk factors are conditions that can be altered by making certain lifestyle changes. Nonmodifiable risk factors include age, heredity or genetic makeup, and type 1 diabetes.

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Age is a predisposing factor for most chronic diseases because of the wear and tear the body undergoes over time ie, making it more vulnerable to chronic ailments. With advancing age, the body is exposed to various strains and stressors, as well as free radicals generated in the body, which hasten the breakdown of cell and organ functions. Epidemiological research has shown that people who have a family history of heart disease and coagulopathies are more prone to developing CVDs. Additionally, if a person is afflicted by type 1 juvenile diabetes, several aspects of his or her body functions are compromised, primarily fat metabolism and glucose tolerance.

Such metabolic disorders make the person more susceptible to developing CVDs. Diabetes is on the rise worldwide. Across Canada, diabetes prevalence peaks with age, and Childhood obesity is also on the upswing in Canada and the United States. Type 2 diabetes and obesity are conditions largely dependent on lifestyle factors; therefore, society needs to take responsibility for advocating a healthy lifestyle, so as to minimize the occurrence of lifestyle-related chronic diseases. The issue of potentially modifiable risk factors for CVD-related mortality and morbidity among different nationalities, their lifestyles and dietary habits has been the subject of innumerable epidemiological and clinical investigations.

In , the Canadian Heart and Stroke Foundation identified nine major modifiable risk factors for CVD, namely, tobacco smoking, alcohol abuse, physical inactivity, malnutrition, obesity, high BP, high concentrations of dietary fat and blood lipids, and high blood glucose concentrations 2. Sudden stress, frequent migraine and the use of oral contraceptives have also been identified as risk factors for the increased incidence of coronary disease and stroke 9 , A case-crossover study performed by Koton et al 9 showed that negative emotions, anger, sudden changes in body posture or startling events, all types of sudden stress, significantly increase the risk of the acute onset of ischemic stroke.

A systematic review and meta-analysis of 14 studies 11 case-control and three cohort studies showed that persons who regularly have migraines are at an increased risk of developing stroke, and a subgroup of women who have migraines and use oral contraceptives are at a greater risk of experiencing ischemic stroke In a landmark case-control study, Yusuf et al 11 determined the association between potential risk factors and acute myocardial infarction MI in 29, subjects 15, patients and 14, controls from 52 countries in Asia, Europe, the Middle East, Africa, Australia, North America and South America.

The additional seven risk factors for MI are diabetes, hypertension, abdominal obesity waist to hip ratio , psychosocial factors depression and stress , a lack of daily fruit and vegetable consumption, a lack of physical exercise and the amount of alcohol consumed. They emphasized that the vast majority of heart attacks may be predicted by the nine measurable factors regardless of the geographical region, ethnic group, sex and age. As a corollary to this conclusion, Yusuf et al 11 stated that similar health promotion strategies can be applied globally for the prevention of premature death and disability associated with MI.

Through regular physical activity, eating a healthier diet and by not smoking, it is possible to profoundly reduce the risk of MI in both sexes and all age groups. Contrary to what was previously believed, heredity or the genetic makeup of a person does not play a major role in causing CVD.

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In Canada and America, obesity, tobacco use and sedentary lifestyle are the leading preventable causes of morbidity and mortality. Other preventable causes of premature death and morbidity are type 2 diabetes and heart disease. Many of the modifiable risk factors are codependent, and altering one risk factor may change the degree of other risk factors.

Therefore, cooperative efforts from the health care authorities, medical associations and family physicians, as well as the school boards and dieticians, are needed to mobilize and promote prophylactic measures surrounding modifiable risk factors. Such health promotion policies regarding children and adults, including exercise, healthy eating habits and eduction on nutrition, and smoking cessation, would not only help in minimizing hypertension, obesity and type 2 diabetes in the general population, but would also help in reducing the tremendous health care costs associated with the treatment of CVDs in developed and developing countries.

However, it is the degree of physical exertion that differs among people. Several evidence-based studies have consistently indicated a positive correlation between physical activity and good health. Nevertheless, various aspects of physical activity must be considered when evaluating how well controlled studies have been conducted. Definitions of physical activity often vastly differ, rendering the results of different studies incomparable. Fortunately, there are three areas of interest that remain relatively consistent in defining physical activity, namely, intensity, duration and frequency.

Intensity refers to the degree or extent of exertion and is often presented as a percentage of target heart rate or lung volume ie, oxygen consumption [VO 2 ]. Duration refers to how long a particular activity is undertaken, and frequency refers to the number of times a given activity is performed. A multitude of studies 2 — 34 have been conducted showing a relationship between physical activity and overall well-being. It has been repeatedly shown that an inverse relationship exists between physical activity and the occurrence of CVDs ie, with increased physical activity, the relative risk of developing CVD is decreased.

With regard to specific surrogate markers and biological factors pertaining to CVD risk factors eg, high BP, and increased cholesterol and triglyceride concentrations , clinical and laboratory evaluations have been performed to show the benefits of physical activity. Such quantitative measurements were performed to determine the influence of exercise on blood coagulation and fibrinolysis, vascular remodelling, BP and blood lipid profiles.

Correspondingly, these studies have also shed light on the possible adverse consequences of exercise, especially when dealing with patients with chronic heart failure, and the precautions that should be taken to bypass these health risks 12 — Blood coagulation and fibrinolysis are two important physiological functions influencing the formation and breakdown of clots within blood vessels.

Fibrinolysis is an enzyme-activated phenomenon Moreover, these hematological functions are influenced by various blood factors, which either inhibit or promote clot formation or breakdown. To understand the effectiveness of the mechansims of coagulation and fibrinolysis, serum concentrations of biomarkers such as plasma fibrinogen, factor VIII, factor VII, tissue plasminogen activator t-PA , plasminogen activator inhibitor-1 PAI-1 and fibrin D-dimer are measured Blood platelet count and aggregation are also important aspects of optimal coagulation and fibrinolysis in the body Inhibition of platelet aggregation plays a very important role in the prevention of heart attacks and strokes.

On the other hand, increased serum concentrations of t-PA increase the probability of fibrinolysis; specifically, t-PA is responsible for promoting the activity of plasminogen, an enzyme that actively dissolves unwanted blood clots. PAI-1 inhibits the action of t-PA by binding to it and rendering it inactive. The remaining coagulation factors effectively act to build a clot by causing the aggregation of platelets and by forming the rigid network that is the basis of blood clot formation A balance in the serum concentrations of coagulation and fibrinolytic factors is important because they seem to be directly correlated to the risk of cardiovascular ischemic events such as stroke and MI.

Clotting and fibrinolytic factors play a pivotal role in the formation of thrombi and emboli Hence, in patients with CVD, it is essential to ensure that a proper balance of these blood constituents is maintained. Several studies have attempted to show the influence of exercise on blood coagulation and fibrinolysis and, overall, positive effects of physical activity have been reported 12 — El-Sayed et al 13 have studied the specific effects of exercise on plasma fibrinogen concentrations. They found a significant reduction in plasma fibrinogen concentration from These results show a positive effect of exercise on plasma fibrinogen concentrations.

The lower the concentration of fibrinogen content, the lesser the risk of thrombus formation, which consequently reduces the possible risk of ischemic cardiac events. Wang et al 15 attempted to show a relationship between platelet function and exercise training in 23 healthy men aged 21 to 23 years. Platelet adhesiveness and aggregability were the main determinants of the study. This study was further extended to examine the detraining of platelet function.

Detraining lasted for a period of 12 weeks, wherein the exercise regimen was stopped. It was found that detraining caused the platelet adhesiveness or aggregability to rebound back to normal levels after 12 weeks. These findings suggest that moderate physical activity can be beneficial in reducing risk factors associated with thromboembolic disorders. A review by Womack et al 12 examined multiple factors linked with coagulation and fibrinolysis. Overall, the review showed that, compared with sedentary people, those who took part in regular physical activity tended to exhibit more effective fibrinolytic profiles and a decreased potential for resting clot formation.

In sedentary people, the fibrinolytic capacity was reduced while the plasma concentrations of PAI-1 were increased, possibly leading to a larger coagulation potential. However, Wang et al 15 also found that exercise over short sudden bouts acute exercise was followed by increased coagulation potential. DeSouza et al 14 reported the influence of physical activity on coagulation and fibrinolytic factors in 51 healthy women aged 27 to 63 years. The authors also attempted to show age-related differences in physical activity.

Markedly different fibrinogen plasma concentrations were found between postmenopausal sedentary women and postmenopausal physically active women. Postmenopausal physically active women had significantly lower plasma fibrinogen concentrations than postmenopausal sedentary women 2. It therefore appears that postmenopausal sedentary women may be at a greater risk of developing thrombi. With regard to fibrinolytic systems, the postmenopausal sedentary women had markedly higher PAI-1 concentrations Each of these plasma factor profiles increased the potential coagulation risk and reduced the fibrinolytic capacity of the postmenopausal sedentary women.

When considered together, the findings of the above mentioned studies show that the probability of ischemic events or stroke is decreased with long-term regular exercise. The results of these studies also substantiate the need for regular physical activity and provide scientific evidence to support a possible reduction in thrombus formation with exercise. The reduction in thrombus formation is attributable to exercise-induced increases in t-PA and decreases in PAI-1, lower plasma fibrinogen concentrations, and decreases in the adhesion or aggregation properties of platelets.

Vascular remodelling is an old concept in the area of cardiovascular research. Components of vascular remodelling include angiogenesis, vasculogenesis and arteriogenesis. Angiogenesis pertains to the growth of new capillaries from pre-existing capillaries. Angiogenesis is considered an important aspect in the oncology discipline and is used as a therapeutic strategy to minimize the growth of new blood vessels around a neoplasm, thus causing shrinkage of the tumour due to curtailed blood supply. However, with regard to cardiovascular health, the aim of cardiovascular remodelling is to maximize angiogenesis to increase the level of perfusion in the cardiovascular tissues and cells, thereby reducing the detrimental effects of ischemia.

Vasculogenesis not only involves the formation of new blood vessels in their original position but also involves the growth of endothelial progenitor cells EPCs Arteriogenesis involves the modification of pre-existing arterioles, and this process affects the size, length and diameter of arterioles; however, the modified arterioles are invariably occluded before these adaptations Recently, several studies have been conducted to determine the effects of exercise on vascular remodelling. Although these studies were mainly performed in animals, evidence also points to parallel findings in humans.

It is now well recognized that cellular mediators control vascular remodelling, like many other physiological functions of the body.

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The most commonly known mediators for vascular remodelling are cytokines, vascular endothelial growth factor VEGF and fibroblast growth factor. VEGFs are a family of glycoproteins that activate EPCs, causing them to fuse to pre-existing capillaries and eventually generate new vascular cells and blood vessels. The fibroblast growth factors act as cell surface ligands that, like VEGFs, act on endothelial cells to stimulate the production of various enzymes essential for the digestive processes associated with angiogenesis Miyachi et al 18 showed that endurance training over time results in vascular remodelling in humans.

Specifically, arteriogenesis occurred causing the cross-sectional area CSA of various arteries to increase. The study was carried out in 12 healthy men aged 20 to 24 years.

The authors hypothesized that increases in blood velocity through the arteries may heighten the risk of CVD. Arterial dilation counteracted the potential increase in velocity, because resistance to the increased blood flow was reduced. Repeated measurements by using Doppler ultrasonograms were made to assess the velocity of the blood travelling through the ascending aorta.

The results of this investigation showed that by inducing arteriogenesis through exercise, it is possible to increase blood flow to those areas of the body that may previously have been experiencing ischemia. Additional studies in different age groups are needed to substantiate these findings on arteriogenesis.

Dinenno et al 20 conducted a study in men to assess the effect of exercise on vascular remodelling. The participants were divided into an endurance-trained or sedentary group. To determine whether physical activity had any influence on vascular remodelling, the investigators measured the diameter and intima-media thickness of the femoral artery from images generated from an ultrasound machine. Measurements showed that in the endurance-trained people, the lumen diameter of the femoral artery was 9. Furthermore, in the endurance-trained subjects, the femoral artery intima-media thickness was 4.

These end points are considered important for assessing the integrity of the cardiovascular system. The large diameter of the arterial lumen plays a significant role in minimizing resistance against blood flow and maximizing perfusion to organs, tissues and cells. In a study using rats, Kleim et al 17 found that exercise induces angiogenesis. Angiogenesis was evident by the increased blood vessel density in the area of muscle measured in the caudal forelimb area.

The results showed that angiogenesis in the exercised parts facilitated better oxygen transport, reduced diffusion time and improved glucose uptake by the tissues. Through prolonged exercise over a 30 day period, the rats ran an average of It was found that angiogenisis greatly benefited the musculoskeletal system and enhanced the functioning of the cardiovascular system in the rats. A study conducted by Laufs et al 21 examined a group of male mice that were randomly divided into either a physically active group or a sedentary group.

The exercise entailed voluntarily running a distance maintained on a running wheel a wheel was provided to each of the physically active mice. This study used the fact that vascular function not only depends on endothelial cells, but also is affected by circulating EPCs derived from the bone marrow.

The results revealed that physical activity elevates a particular subset of bone marrow-derived EPCs. These effects enhanced neoangiogenesis in the physically active group compared with the sedentary control group. Other advantageous effects of exercise were also noticed regarding neointima formation, lumen circumference and area of neoangiogenesis. These vascular angiogenic effects propagated by physical activity lend additional support to the hypothesis that exercise is tremendously beneficial for the cardiovascular system. In summary, the limited data obtained from both animal and human studies indicate that physical activity plays a positive role in manifesting useful changes linked to vascular remodelling.

Following exercise, the cardiovascular system benefits from increased angiogenesis, vasculogenesis and arteriogenesis. The theoretical foundation of vascular remodelling, accompanied by experimental evidence, shows a very promising approach for treating vascular ischemic diseases with exercise. Considering the positive influence of exercise on vascular remodelling, Lewis et al 22 have proposed gene therapy interventions that result in the upregulation of angiogenic factors.

From the findings of animal and human studies, it appears sensible to promote the use of daily physical activity in all age groups by implementing public health policies that advocate an active lifestyle. When considering the positive impact of exercise on the cardiovascular system, BP and heart rate measurements are part of the package.

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Vascular resistance is largely controlled by the neuroendocrine system, which produces various hormones that cause vasoconstriction or vasodilation of the blood vessels eg, catecholamines, cortisol, thyroid-stimulating hormone, angiotensin and endothelin. Some hormones eg, aldosterone, renin and adrenocorticotropic hormone influence BP by altering the blood volume or by modifying the glomerular filtration rate. Other hormones can influence BP by altering urinary flow rate and electrolyte disposal. The more constricted or narrow a blood vessel becomes, the greater the resistance produced on blood flow, consequently resulting in high BP.

Blood volume is an important factor affecting BP, ie, the larger the blood volume, the more blood the heart has to pump, and this action increases the workload on the heart. To understand the effects of physical activity on BP, it is important to measure both systolic and diastolic BP. Systolic BP is determined by the arterial pressure exerted when the heart is contracting or emptying, whereas diastolic BP is determined by the pressure exerted on the arterial walls when the heart is relaxing or filling.

Under stressful or vigorous exercise, the oxygen demand of the heart increases and, as a result, cardiac output and stroke volume increase, thus causing BP to increase as well. The results of four studies 27 — 30 that assessed the effects of exercise on BP are summarized in Table 1.

The data show that regular physical activity has a positive impact on lowering BP in hypertensive patients. All studies found consistent overall reductions in BP with the adoption of physical activity regimens. For instance, Rowland 28 found that in comparison with normotensive subjects, systolic BP was decreased by up to 8 mmHg and diastolic BP was decreased by up to 6 mmHg with the adoption of physical activity in hypertensive patients. Younger and older subjects who tended to have sedentary lifestyles risked an increase in BP over time, whereas those who were physically active seemed to evade this adverse effect.

These findings strongly advocate the need for moderate daily physical activity to prevent hypertension. Which component of BP diastolic or systolic is most affected by physical activity remains to be established. On the other hand, high BP is an important risk factor for inducing cardiovascular disorders, because hypertension increases the risk of cardiac ischemia and renal disease Blood electrolytes, lipoproteins, total lipids and cellular constituents play a pivotal role in maintaining cardiovascular health.

With regard to vascular plaque formation and BP, blood lipid profiles are of major interest. The lipids that are most easily and routinely measured are high density lipoprotein HDL , low density lipoprotein LDL and total cholesterol. LDL, also known as bad cholesterol, has a much higher triglyceride component than does HDL, also called good cholesterol.

On the other hand, HDL has a much higher protein content, lending to its higher density. LDL is the type of cholesterol that gets deposited in arterial blood vessels and, when floating freely in the vascular system, it tends to have its highest atherogenicity. The oxidation of LDL within blood vessels is considered to trigger the atherogenic process. Maintaining balanced blood lipid profiles is clinically important in minimizing the formation of arterial blood vessel plaques and thrombi.

Many studies have attempted to show the effects of exercise on blood lipid profiles, and the results of these studies are shown in Table 2 25 — 27 , Sudden death from cardiac exertion may occur during or immediately after vigorous physical activity. For the most part, spontaneous death may not be directly related to sudden bouts of exercise but may instead be due to some other underlying cardiovascular impediment. Maron 37 found that sudden cardiac arrest is even more baffling when it occurs in well-trained athletes. However, the majority of these athletes had a pre-existing electromechanical or structural heart disease, most commonly associated with atherosclerotic coronary artery disease CAD.

In view of these serious outcomes, it can be inferred that moderate exercise may be the most desirable activity, because it is not necessary that physical activity be of high intensity to elicit the same health benefits Generally, routine exercise of varying frequency and intensity is recommended in rehabilitation programs.

However, even low-intensity exercise may not be advisable for patients with chronic heart failure. This quote epitomizes the importance of consuming a balanced healthy diet to ensure overall well-being. Orally taken food undergoes various digestive and metabolic processes, and is either used as a source of immediate energy or stored in the body for later use.

In humans, the macronutrient foods that can be used for energy or storage in the body are carbohydrates, proteins and fats. Vitamins and trace elements, known as micronutrients, act as cofactors and play a pivotal role in intermediary metabolism and energy extraction processes.

The maintenance of nutrient balance is also required for protection against infectious diseases and the preservation of physiological homeostasis. Type 2 diabetes is a chronic disease that is consistently linked with the development of CVDs. To minimize diabetes-associated health risks, the diet can be altered to allow diabetic patients to more easily cope with their diminished metabolic capacities Davis et al 41 reported that a well-balanced diet with a reduced glycemic load may lower the risk of obesity and type 2 diabetes.

This inference was drawn from a two-year study performed in subjects 81 men and 98 women over 65 years of age. The participants were divided into two dietary groups with varying glycemic loads. The men and women in the lower glycemic load cluster consumed diets with a glycemic index of On the other hand, the men and women in the higher glycemic load cluster consumed diets with glycemic indices of The mean glycemic index for the entire sample was Participants with a lower glycemic load consumed more carbohydrates from cereal, fruits, vegetables and milk, whereas those with a higher glycemic load consumed more breads and desserts.

The results showed that, as opposed to the nutrient-dense carbohydrate foods, the lower glycemic load foods were highly useful in reducing the risks of diabetes mellitus, obesity and many chronic diseases in the elderly population. There is an abundant amount of evidence to suggest that diets rich in fruits, vegetables, whole grain breads, high fibre cereals, fish, low-fat dairy products and diets low in saturated fats and sodium, can markedly reduce the risk of developing obesity and CVDs. Research has also shown that, although people in the West do not generally follow these healthy eating habits, other nationalities eg, Mediterranean nations have been able to adopt heart healthy dietary standards Considering the potential benefits of the Mediterranean diet, it is suggested that North Americans and Europeans should also consider consuming such diets.

It has been almost 50 years since Ancel Keys 43 compared the rates of heart disease and the diets in seven countries ie, Greece, Italy, Yugoslavia, Finland, Japan, the Netherlands and the United States. His work was a scientific cornerstone that showed the health advantages of the Mediterranean diet, which consists of whole grains, fruits, vegetables, nuts and olive oil.

On the basis of his studies, Keys proposed that the plant-based diet of the people of the Mediterranean region offered protection against heart disease. Since that time, innumerable studies have been conducted to investigate the influence of dietary patterns and their ability to protect against a growing list of chronic diseases, including CAD and other CVDs, diabetes mellitus, and prostate and colon cancer, as well as some other cancers. Recently, two studies dealing with the Mediterranean diet and lifestyle factors were published by Knoops et al 44 and Esposito et al The first study 44 was performed with more than elderly men and women 70 to 90 years of age in 11 European countries.

This study assessed the effects of a Mediterranean-type diet and several lifestyle factors on the year mortality from all causes, including CVDs and cancer. Besides the diet, other lifestyle factors examined were physical activity approximately 30 min exercise per day , moderate alcohol use and whether the subjects smoked. While this study examined death rates, numerous other investigators have dealt with the reduction of chronic disease conditions and improvements in the quality of life with the Mediterranean-type diet and healthy lifestyles 46 — The second study 45 evaluated the effects of the Mediterranean-type diet on a cluster of risk factors for a condition known as metabolic syndrome.

Risk factors that contribute to metabolic syndrome include obesity or excess fat around the abdomen, high BP, abnormal blood cholesterol and glucose intolerance. Metabolic syndrome usually goes hand-in-hand with a host of risk factors for CVD and stroke, diabetes and some forms of cancer. The results of this study provided additional evidence on how to stay healthy and free of heart attack and stroke. Patients on the Mediterranean diet were also advised on how to increase their daily consumption of whole grains, vegetables, fruits, nuts and olive oil.

All patients were followed up for up to a two-year period. Compared with subjects on the lower-fat diet, those on the Mediterranean diet had improved endothelial function, which was indicative of decreased inflammation of the arteries and a potentially reduced risk of heart attack and stroke. By the end of the study, approximately one-half of the subjects on the Mediterranean diet no longer had the typical markers of metabolic syndrome, whereas subjects taking the lower-fat diet did not have any significant clinical improvements.

It is worth noting that the overall health benefits observed from the above mentioned studies occurred not due to the Mediterranean diet per se, but because of the combination of several other factors such as active lifestyle, nonsmoking and moderate use of alcohol. Numerous other dietary intervention studies 46 — 68 have shown relationships between cardiovascular health and a balanced diet. Collectively, the results of all these studies suggest that promotion of an active lifestyle and the choice of healthy food and dietary habits may provide a powerful weapon against the morbidity and mortality associated with CVDs and other chronic diseases worldwide.

For several decades, there has been controversy about the involvement of dietary fat and fatty acids in the occurrence of CVD. Most often, people were made to believe by dieticians that all fats were bad and their use should be kept at a minimum level. For example, monounsaturated fats, polyunsaturated fats, plant sterols and essential fatty acids are categorized as good fats.

On the other hand, saturated fats and trans fatty acids are categorized as bad fats. Physiologically, lipids play an important role in the proper functioning of the cardiovascular system 69 — Although the heart is fuelled in part by glucose and lactate, it predominantly and preferentially uses fatty acids to meet its energy needs.

Therefore, the idea of eliminating fats from a heart healthy diet is simply preposterous. Instead, the idea of maintaining a proper balance and appropriate ratios of fats in the diet must be stressed, thus allowing for the proper functioning of the cardiovascular system.

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  7. Some recently published findings regarding the role of fat and fatty acids in the cardiovascular system and overall health are discussed below. Due to the presence monounsaturated fat in olive oil, it has been suggested that consuming approximately two tablespoons approximately 23 g of olive oil daily may reduce the risk of CAD.

    On November 1, , the United States Food and Drug Administration allowed for a health claim on labels of olive oil and olive oil-containing foods that olive oil consumption decreases the risk of CAD in both men and women. According to the Food and Drug Administration, these labelling changes on olive oil products would help consumers to make more informed decisions about maintaining healthy dietary practices, while at the same time not increasing the total number of calories consumed daily Saturated, monounsaturated and polyunsaturated fats Figure 2 differ in their physicochemical properties and physiological function.

    Chemically, saturated fats contain no double bonds, whereas monounsaturated fats contain one double bond and polyunsaturated fats contain more than one double bond To date, the diet-heart hypothesis continues to gain support from experimental and clinical studies. Chemical structures of different fatty acids. Saturated fats contain no double bonds, monounsaturated fats contain one double bond and polyunsaturated fats contain two or more double bonds.

    Saturated fats tend to be solid at room temperature, whereas monounsaturated and polyunsaturated fats tend to be liquid at room temperature Recently, saturated fats and trans fatty acids have come under scrutiny as likely culprits in the manifestation of CVD. Trans fatty acids Figure 3 are those fatty acids that are made to undergo a chemical process known as hydrogenation, wherein hydrogen atoms are added to break double bonds in the fatty acid chain.

    This hydrogenation process saturates the fatty acids. Previously, hydrogenation was commonly used to harden soft margarine, until it was discovered that an isomeric trans configuration of the hydrogen atoms resulted from this process. Trans fats are found in highly processed foods such as doughnuts, cookies and crackers. The synthetically produced trans configurations of fatty acids are not naturally found in the body and may cause deleterious effects, especially in the cardiovascular system.

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    The body is unable to process trans fats and, as a result, they have been associated with increased risk of atherosclerosis and CVD The exact mechanism of action of saturated and trans fats in the development of heart disease is unclear, but various theories have been proposed. Physiologically, trans fats act more like saturated fats, which tend to block LDL receptors, thus preventing their uptake from the bloodstream. These circulating LDLs may then be oxidized and lay the foundation for atherosclerotic plaques.

    The unnatural configuration of trans fats makes them much less soluble and reduces their packing ability. As such, they tend to cause more damage within arterial blood vessels. In addition, high consumption of trans fats is said to increase blood concentrations of lipoprotein a Elevated plasma concentrations of lipoprotein a are considered to increase the risk of developing atherosclerosis, and the lipoprotein a complex mimics certain growth and clotting factors, thereby accelerating atherosclerosis.

    Once a correlation between trans fats and CVD was shown, a new process of using plant sterols in margarine was adopted, and this seems to play a positive role in maintaining cardiovascular health. As a result of the documented adverse effects, Denmark banned the use of trans fatty acids a few years ago. Canada has since followed suit, enacting legislation in the fall of that curtailed the consumption 8. Chemical structural differences between cis and trans fatty acids.

    Trans fatty acids rarely occur in nature, but are produced as a result of hydrogenation and fermentation, processes that saturate double bonds. The trans fats are hard for the body to metabolize and are responsible for causing atherosclerosis, heart disease, diabetes and obesity The relative ratio in which different dietary fats are consumed is closely linked to blood lipid concentrations.

    As stated earlier, high LDL and low HDL plasma concentrations are considered to cause deleterious effects on the cardiovascular system, whereas increased HDL and decreased LDL concentrations have cardioprotective effects In a systematic review of 27 studies 30, person-years of observation , Hooper et al 48 assessed the effects of dietary fat intake and prevention of CVD. Their meta-analysis included data from randomized placebo-controlled clinical trials of at least six month to two year duration.

    The dietary trials included any of the following interventions: reductions in the intake of total fat, saturated fat and dietary cholesterol, or a change from saturated to unsaturated fat. In comparison with the six-month trials, data from two-year follow-up trials provided stronger evidence of protection from cardiovascular mortality and morbidity after the modification or decreased intake of dietary fat or cholesterol. Based on the meta-analysis of well-designed clinical trials, it appears that significant reductions in CVDs can be achieved by continuous reduced intake of dietary fat and cholesterol, or by modifying the proportions of dietary fat and cholesterol intake.

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    You can form your own view. Subscribe now. New wearable device could transform treatment for stroke patients. Shape Created with Sketch. Health news in pictures Show all Junk food adverts on TV and online could be banned before 9pm as part of Government plans to fight the "epidemic" of childhood obesity.

    The Nutritional Reversal of Cardiovascular Disease: Fact or Fiction

    Plans for the new watershed have been put out for public consultation in a bid to combat the growing crisis, the Department of Health and Social Care DHSC said. On migrating from Africa around 70, years ago, humans bumped into the neanderthals of Eurasia. While humans were weak to the diseases of the new lands, breeding with the resident neanderthals made for a better equipped immune system. The breath biopsy device is designed to detect cancer hallmarks in molecules exhaled by patients.

    By their 10th birthdy, children have on average already eaten more sugar than the recommended amount for an 18 year old. The average 10 year old consumes the equivalent to 13 sugar cubes a day, 8 more than is recommended. While there is not enough evidence of harm to recommend UK-wide limits on screen use, the Royal College of Paediatrics and Child Health have advised that children should avoid screens for an hour before bed time to avoid disrupting their sleep.

    A study published in the New England Journal of Medicine has found that many elderly people are taking daily aspirin to little or no avail. A study by the University of Minnesota's Masonic Cancer Centre has found that the carcinogenic chemicals formaldehyde, acrolein, and methylglyoxal are present in the saliva of E-cigarette users.

    Obesity is a leading cause. The majority of antidepressants are ineffective and may be unsafe, for children and teenager with major depression, experts have warned. In what is the most comprehensive comparison of 14 commonly prescribed antidepressant drugs to date, researchers found that only one brand was more effective at relieving symptoms of depression than a placebo. Another popular drug, venlafaxine, was shown increase the risk users engaging in suicidal thoughts and attempts at suicide.

    Researchers at the Baptist Health South Florida Clinic in Miami focused on seven areas of controllable heart health and found these minority groups were particularly likely to be smokers and to have poorly controlled blood sugar. A major pressure group has issued a fresh warning about perilously high amounts of sugar in breakfast cereals, specifically those designed for children, and has said that levels have barely been cut at all in the last two and a half decades.

    New guidance by the National Institute for Health and Care Excellence NICE , the body which determines what treatment the NHS should fund, said lax road repairs and car-dominated streets were contributing to the obesity epidemic by preventing members of the public from keeping active. A new class of treatments for women going through the menopause is able to reduce numbers of debilitating hot flushes by as much as three quarters in a matter of days, a trial has found. Melissa Whiteley, an year-old engineering student from Hanford in Stoke-on-Trent, fell ill at Christmas and died in hospital a month later.

    The Government has pledged to review tens of thousands of cases where women have been given harmful vaginal mesh implants. Human trials have begun with a new cancer therapy that can prime the immune system to eradicate tumours. The treatment, that works similarly to a vaccine, is a combination of two existing drugs, of which tiny amounts are injected into the solid bulk of a tumour. Mothers living within a kilometre of a fracking site were 25 per cent more likely to have a child born at low birth weight, which increase their chances of asthma, ADHD and other issues.

    Thousands of cervical cancer screening results are under review after failings at a laboratory meant some women were incorrectly given the all-clear. Most breast cancer patients do not die from their initial tumour, but from secondary malignant growths metastases , where cancer cells are able to enter the blood and survive to invade new sites. Asparagine, a molecule named after asparagus where it was first identified in high quantities, has now been shown to be an essential ingredient for tumour cells to gain these migratory properties.

    A record number of nursing and midwifery positions are currently being advertised by the NHS, with more than 34, positions currently vacant, according to the latest data. Demand for nurses was 19 per cent higher between July and September than the same period two years ago. CBD has a broadly opposite effect to deltatetrahydrocannabinol THC , the main active component in cannabis and the substance that causes paranoia and anxiety.

    The numbers of people accepted to study nursing in England fell 3 per cent in , while the numbers accepted in Wales and Scotland, where the bursaries were kept, increased 8. The paper found that there were 45, more deaths in the first four years of Tory-led efficiencies than would have been expected if funding had stayed at pre-election levels. On this trajectory that could rise to nearly , excess deaths by the end of , even with the extra funding that has been earmarked for public sector services this year. Hours of commuting may be mind-numbingly dull, but new research shows that it might also be having an adverse effect on both your health and performance at work.

    Longer commutes also appear to have a significant impact on mental wellbeing, with those commuting longer 33 per cent more likely to suffer from depression. It is not possible to be overweight and healthy, a major new study has concluded. The study of 3. When you feel particularly exhausted, it can definitely feel like you are also lacking in brain capacity.

    Now, a new study has suggested this could be because chronic sleep deprivation can actually cause the brain to eat itself. David Lloyd Gyms have launched a new health and fitness class which is essentially a bunch of people taking a nap for 45 minutes. The class is therefore predominantly aimed at parents but you actually do not have to have children to take part.

    Tobacco and alcohol companies could win more easily in court cases such as the recent battle over plain cigarette packaging if the EU Charter of Fundamental Rights is abandoned, a barrister and public health professor have said. New research has found that babies born to fathers under the age of 25 or over 51 are at higher risk of developing autism and other social disorders. A study published today in the Medical Journal of Australia shows that we could be doing much more to prevent this from happening.

    Around 1. Given their high risk of another event, almost all such patients should be taking both a blood pressure- and a cholesterol-lowering drug a statin. Even if their blood pressure and cholesterol levels are normal, this has been shown to reduce their risk. Together, , people with known heart disease are estimated to not be taking both risk-lowering drugs. The reasons may lie at different steps along the treatment pathway: doctors in hospital not commencing treatments before discharge, general practitioners not following up after discharge, or patients ceasing their medications.

    For people who have not had a heart attack, preventive treatment is more controversial. However, there is widespread agreement among health professionals that people who are at sufficiently high risk of heart disease should take both drugs. It is calculated from combining risk factors: age and gender, whether they smoke, whether they have diabetes, their blood pressure, and cholesterol levels. The total number of people at high risk of heart attack or stroke not taking the recommended treatments was , This is surprising given everyone over the age of 45 or 35 if you are Aboriginal or Torres Strait Islander should have their blood pressure and cholesterol measured and a quantitative heart disease assessment recorded.

    But less than half have had this assessment completed. If you know your blood pressure and cholesterol readings, you can check your own cardiovascular risk score here , and look at the effects different treatments will have on your own risk here. When a risk calculator is not used, people who have a combination of risk factors that put them at high risk can easily be missed. Doctors and patients are more used to thinking about blood pressure or cholesterol levels individually.

    Doctors also find it difficult to explain the results from the risk calculator and the treatment options to patients.