What really causes heart disease?

We’d like to think we’ve got a handle on preventing heart disease.  Despite the fact that the road to uncovering the heart healthy diet has traversed a few off ramps from avoiding saturated fat oozing from butter, meat and eggs, which garnered a few question marks from the paleo frenzied peloton to deleting bread, potatoes and pasta, vilified by hard-core dieticians, whose house is upheld by carbohydrates, to ultimately settling on vegetarian with mercury free fish three times a week, this meant or so we thought that finally we could put our feet up and light a celebratory cigarette rejoicing in the wisdom that at long last we’d fine-tuned the consummate cholesterol-neutralizing diet.  Cholesterol, our heart’s principal nemesis, had been defeated.

As it turns out this notion might be naïve.  Heart disease remains the number one cause of death both in Australia and globally which means that merely targeting cholesterol isn’t really getting to the heart of the problem.  Recent evidence suggests that lowering cholesterol and low-density lipoprotein or LDL, the so-called bad cholesterol, which can be achieved with diet and if that doesn’t work, aggressively with medications like the statin drugs, hasn’t been enough to prevent our arteries from becoming clogged with lethal heart-attack inducing fats.  Triglycerides, a cousin of cholesterol, which is also quantified when a routine cholesterol blood test is done, has emerged as the new villain in the piece with a likewise capacity to obstruct our blood vessels.  It goes up in those who are overweight and have high blood sugars often connected with a sedentary lifestyle and a high-carbohydrate diet, both increasing as a result of the coronavirus and a stay-at-home lifestyle.  Rather than just attending to cholesterol and LDL, focusing on ways to reduce triglycerides has now been prioritized as another primary objective for averting heart disease.   Aside from weight loss and reducing carbohydrates, regularly consuming fish as suggested above or taking prescription grade eicosapentaenoic acid, a derivative of fish oil, can help to lower triglycerides.

 Other factors that have come to the fore as causal agents include inflammation, which is the immune system in persistent overdrive, and lipoprotein(a), another distant cholesterol relative, primed mostly by bad genes rather than diet.   These can also be assessed with a blood test.  Air pollution, unremitting noise, disturbed sleep and ongoing stress have now been recognized as some of the drivers of inflammation that instigate heart disease. 

 Aside from a return to svelte, reducing our carbohydrates, optimizing our diet and upping our reliance on creatures of the ocean, probably less necessary if we decreased our girth, we need to care more about our environment, the noise we make and find a way to access more serenity and peaceful sleep.  Only then like Justin Timberlake might we have heart disease in our pockets.

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