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Causes of coronary heart disease Part II

Part I of this article on the causes of coronary heart disease ended off with a note that modern heart disease is a new form of heart disease that did not exist before 1900.

Most people who die from heart disease nowadays die from myocardial infraction, or heart attack. It happens when a massive blood clot causes obstruction of a coronary artery. Another common cause of death today is stroke.

In a stroke, the same thing happens – a massive blood clot blocks the flow of blood, except that it occurs in the brain!

This background about myocardial infraction is important for it tells us that two conditions can lead to a heart attack or a stroke:
  1. The build-up of abnormal plaque in the arteries. This abnormal plaque gradually hardens through calcification and it occurs most often in the large arteries feeding the heart or the brain.

  2. The blood clot – which doctors call thrombus – that blocks blood flow to the heart or brain.

I began my practice as a cardiologist in 1921 and I never saw a myocardial infraction patient until 1928.

- Dr. Paul Dudley White, who introduced the electrocardiograph (ECG) machine to America during the 1920s. Back then, heart disease was so rare that his medical colleagues advised him to find better ways to earn a living.

The build-up of ABNORMAL plaque is therefore just one of at least two possible causes of coronary heart disease. Yet the majority of doctors and scientist focus on this one factor, ignoring or paying scant attention to other causes.

The word ABNORMAL has to be emphasised. Earlier, we saw that people all over the world have plaque build-up in their arteries no matter whether they:

  • ate plenty of meat products high in saturated fats, of were largely vegetarian
  • lived in high-stress industrialized societies or slower paced traditional societies
  • had high rates of heart disease or little / no heart disease.

Thus, plaque build-up, on its own, is not one of the causes of coronary heart disease.

NATURAL plaque build-up is a protective factor. It occurs mostly in areas where the arteries might come under stress, such as places where they branch out or make a turn. Without this protective plaque build up, our arteries would weaken as we grow older. They might rupture.

With normal plaque build up, the blood vessels usually widen to accommodate the change. So blood continues to flow smoothly, unobstructed. The build-up is due to saturated fats and cholesterol but it is not a problem.

Heart disease starts to develop only when the plaque build-up is ABNORMAL; it is thicker and harder than normal and it deposits in areas where normal plaque do not usually occur.

There are many theories to explain this abnormal plaque build-up and they give us a better idea about the true causes of coronary heart disease. The predominant theory is that abnormal plaque build-up occurs due to damage or injury to the arteries. To repair the damage or injury, the body deposits saturated fat and cholesterol to patch up the area.

This suggests that saturated fats and cholesterol are not causes of coronary heart disease. Instead, they protect the body against the effects of artery damage. They are the "good guys" - not the "bad guys".

Blood clots

To discover the true causes of coronary heart disease, scientists must also understand what causes blood clots inside the arteries.

This aspect has not received adequate attention from researchers. But it is equally important. Because heart attack due to a blood clot can occur when the arteries are not blocked by abnormal plaque build-up. Here again, there are many possible explanations:

  • Inflammation is one of the possible causes of coronary heart disease. Normally, inflammation is a natural process that helps the body heal from injury. But with damage and injury occurs too often inside the arteries, inflammation might cause plaques to rupture and blood clots to form.

  • The integrity of artery walls is another factor. When the vessel walls are weak, they might break or tear. This will not only cause blood clots, but also rapid loss of blood.

So what causes damage or injury to the blood vessels – which lead to abnormal plaque build-up, inflammation, ruptures, blood clots... and finally to a heart attack? Here again, there are many different explanations. The many possible causes of coronary heart disease could include:

  • trans fats
  • free radicals
  • polyunsaturated oils that have turned rancid
  • sugar and other refined carbohydrates
  • excess omega-6 from refined vegetable oils
  • viral or bacteria infection
  • nutritional deficiency, including deficiencies of vitamins A, C and E, folic acid, vitamins B6 and B12, selenium, magnesium, etc
  • pasteurised and UHT treated milk
  • thyroid malfunction
  • coffee consumption
  • lack of exercise
  • exposure to carbon monoxide

Most of these theories provide better explanations – and have stronger supporting evidence – than the popular lipids theory that blames saturated fats and cholesterol as the causes of coronary heart disease.

What about smoking?

Smoking, too, is often cited as one of the major causes of coronary heart disease. But this idea, too, needs to be seriously examined.

Most signficant is the fact that smoking was widespread – just as saturated fats were widely consumed – at the turn of last century, when heart attacks were non-existent. There are several possible explanations for this:

  • Factors in traditional diets – including possibly saturated fats – could have protected against the negative effects of smoking.

  • Chemical additives in modern cigarettes – in the tobacco as well as in the paper – make them more harmful.

  • Both heart disease and the desire to smoke are caused by some other factors, such as stress, nutritional deficiency, etc.

In a long-term British study involving several thousand men, half of them were asked to reduce saturated fat and cholesterol, stop smoking and increase the amounts of unsaturated oils such as margarine and vegetable oils. The rest continued to eat their usual amounts of saturated fats and cholesterol, and also continued to smoke.

The study results, reported in The Lancet in 1968, were startling: After one year, those following the ‘healthy’ diet and lifetyle had 100 percent more deaths than those on the supposedly unhealthy diet and lifestyle.

A study of Indians from Bombay and Punjab found that those from Punjab had one-fifth the number of heart attacks even though they smoked eight times more cigarettes!

Lack of physical activity

This discussion can go on and on... But let's end off for now with one of the more straight forward causes of coronary heart disease – lack of exercise or physical activity.

When we exercise or perform physical activity, our heart beats more rapidly and the arteries widen to facilitate blood flow and provide more oxygen to the cells.

Lack of exercise may also point to other factors that may be the true causes of coronary heart disease. For example, people who are overweight tend to dislike exercise. Or, certain foods may make people feel lethargic and less inclined to exercise.

The causes of coronary heart disease are therefore not as straight forward as most doctors and health authorities make it out to be. But whatever the causes, saturated fats and cholesterol are not among them!

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