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An Introduction to Heart Disease

by Pierre S Aoukar, MD and Hratch L Karamanoukian, MD
Posted: February 16

One century ago, the diet we consume today in America would have been considered fit only for a king. With the evolution of science and agriculture, the rich foods traditionally afforded only to the affluent have become available for consumption by every person who so wishes to do so and at a reasonable monetary price, at that. We are, however, paying the price with our health. A non-traditional friend, who was very perceptive for a priest, we’ll call him, Father Pat, once ended his sermon with something to the order of this, “We spend our health garnering wealth and our wealth buying back our health.” This illusion paints an accurate picture of our approach to healthcare in this country. Of course, we can blame the government and there is some essence of truth in that argument. For instance, in the US we spend more per capita for healthcare than any other nation in the world, yet 55 million people or 20% of Americans have no healthcare of any kind. This is only a matter of fund reorganization and if people mattered more than politics, than certainly no American would go without health coverage. Even if every American were to have the best healthcare in the world, very little else would change. The leading causes of death would still be heart disease, lung cancer and stroke, in that order. The problem is not in the politics of healthcare, it is in our approach to health—our approach as doctors and your approach as patients.

Many physicians believe it is best to fix a problem once it’s been identified. In some cases, this is the only solution—brain tumors and broken bones, for example. Yet the majority of diseases that we deal with as medical doctors or surgeons are preventable—everything, including trauma, cancer (only 5% of cancers are thought to be inherited), heart disease, diabetes, stroke, homicide and the list goes on. The inevitable is that we will all die. What matters is how we live our lives or in simple medical jargon, quality of life. The idea of quality of life in medicine has not quite hit the mainstream. As doctors, we are still taught to learn everything and expected to know almost everything. Our job is to do whatever we can to save everyone’s life. But, if we are all going to die, then it would seem a paradox to try and save anyone’s life. Why even try? What many physicians do not realize is that our job is not mainly to make people live longer, but help them live better. Our responsibility is truly quality of life. We’ve already determined that medicine, in essence, can not save anyone’s life. The correct approach for medicine, therefore, is from a quality point of view. The amazing thing about quality is that it’s versatile and all-encompassing. Quality for one person may mean living a few extra years to see their grandchildren grow up. But for another, it may mean a life free of chest-discomfort and the burden of high-risk surgery. With a quality of life approach, medicine becomes personalized. After all, isn’t that the way it should be? Not everyone wants to live forever. If, however, your goal is the quest for the Holy Grail, forever has a lifetime of 120 years. That is, the human body is purportedly designed to survive for a lifespan of 120 years—a number based on the average lifespan of people from around the world who have lived the longest. Even if our job were to help you live forever, we’re not even close—we’re about 40 to 45 years off.

So, if nearly every cause of disease is preventable, then why are we still dying of heart disease, cancer and stroke? Why can’t everyone live to 120 years and just die of old age or natural causes? While growing up, whenever I was overburdened with the challenges of life, my father would always tells me, if life were simple and there were no challenges or problems to solve, life would be boring. Simply put, such a challenge gives us doctors something to do. The answers to these questions, however, are not simple. They involve genetics, lifestyle and limitations to medicine itself.

Genetics is undoubtedly the cutting edge and the last frontier of medicine, both at once. We have made great strides in mapping out the entire human genome, but we don’t yet have the knowledge to make use of it. In the future, we will be able to look at a single cell from the body, determine which DNA are damaged or imperfect and perhaps be able to fix the DNA itself. One step prior to that, we could look at your DNA, determine which diseases you are at risk to develop and attempt to prevent them with the tools of modern medicine. However, we are still far from even this stage in the genetics of disease. What we do know is that to a certain extent—and the magnitude is different for every person—your genes or DNA, predispose you to developing diseases. What we also know is that environmental factors—such as diet, exercise, smoking and stress—affect the expression of that DNA. In other words, the way you live your life helps determine which diseases you develop based on your DNA. Your DNA can make you more susceptible to lung cancer for example, if you smoke. Or your DNA can make your artery walls more likely to have plaques if you eat a high fat diet. This is the way—for which the majority of us—genetics affect disease. For an unfortunate few, genes are the direct cause of their disease and regardless of what environmental risk factors they control, the outcome will be the same. But, remember, this is the exception rather than the rule. Until we are able to manipulate genes, the best we can do is control our environmental risk factors—that means lifestyle.

Lifestyle—what you eat, how active you are, your level of stress, smoking, drinking, your contentness with life—constitutes the majority of your environment and the environmental risks to your body. So far, there is little we can do to control genes themselves, but our environment—now that’s a whole different ball game. Forget toxic waste, pesticides and radiation exposure. Those things play such a minor role in our disease processes that they are not worth worrying about. What you need to worry about are the things you do on a daily basis, the things from this world which have the most intimate contact with your body. Let’s take food as an example. Most of us eat between three and five times a day. Food comes in contact with about 27 feet of intestine and a surface area of 4000 square feet or two tennis courts. Throughout digestion there is a mere one layer of cells standing as a barrier between the inside of your body and the outside world—the food you’ve eaten. If this is beginning to worry you, it should. Diet is an incredible powerful environmental risk factor. Cigarette smoke, as another example is full of carcinogens and carbon monoxide, all in reality poisons; yet smokers (and non-smokers) repeatedly expose their lungs—with a surface area the size of one tennis court—to this vial plume. Again, only one cell layer stands to defend your lungs against the toxins contained in tobacco smoke. Smoking is the leading cause of lung cancer and the most preventable cause of death. According to the Harvard School of Public Health, by the year 2020, tobacco is expected to kill more people than any single disease, surpassing even the HIV epidemic. Though we know the harms of smoking and an unhealthy diet, we continue with these unacceptable practices. Furthermore, we are a sedentary nation. Does it take much to walk up one or two flights of stairs? Yet I continuously see people riding the elevator down one flight. Did you know that it takes twice as many muscles to frown than it does to smile? Do you remember the last time you were not stressed out about something? That’s probably enough. We don’t want to add to your stress, so, we’ll stop badgering. Hopefully you understand the point about environment. It’s not just the trees in your backyard and the sky above your head; you’re real environment is much more intimate than that.

You are reading this, obviously because you’re interested in the health of your heart or someone told you that you needed to read it. Whatever your reason, your heart is the issue at heart here. Heart doctors, whether cardiac surgeons or cardiologists have a special affinity for the heart. We focus so much on the heart that we tend to forget other organs exist or at least we’d like to. The truth is, all your organs work in synergy to keep your body functioning. The heart just happens to be situated centrally in the body. It’s the equivalent of a generator. When the generator runs out of fuel or the fuel line is clogged, it can’t provide energy to the rest of the building. This is exactly what happens with heart disease. The coronary arteries are the plumbing of the heart. They supply blood to the heart in that instant when it is not beating. With coronary artery disease, the plumbing becomes clogged with cholesterol deposits and blood clots. The heart cannot get enough blood to itself and the muscle starts to die—the result is a heart attack.

Heart disease does not happen overnight. It’s a slow, insidious creature that matures after years and years of growth. A famous study from Louisiana, the Bogalusa Heart Study, showed that plaques or fatty streaks in the coronary arteries start between 5 and 7 years of age and high cholesterol as early as 6 months. Autopsies performed on 18 to 21 year old American soldiers during the Korean and Vietnam Wars, showed early signs of heart disease, almost across the board, while Korean and Vietnamese soldiers had almost no signs of coronary disease at all. This difference has been attributed not to genetics, but to lifestyle, namely dissimilarity in diet. But humans have known about heart disease for a very, very long time.

Heart disease found its way into the process of human evolution at the beginning of the last Ice Age, about 12,000 years ago. At that point, humans switched from hunting-gathering to cultivating and herding, or domestication. Animal and plant species that would not have survived in the wild, thrived under human care. This process took 6000 years to maturation, at which time food was in abundance, rather than being scarce and scattered. High amounts of animal protein and fats became readily available, mostly still to the privileged in society. History tells us that heart disease was prevalent among Egyptian high society and Roman nobility. Hippocrates—the father of medicine from whom the Hippocratic Oath, “first do no harm,” is taken—described sudden death from heart attack. Hippocrates, as we shall see later, believed diet played the most incremental role in preventing human disease. Heart disease, however, started becoming prevalent only at the turn of twentieth century. There are two major reasons for this; both are the result of the Industrial Revolution. Industrialization made all foods readily available and affordable to everyone and allowed people to lead a more sedentary life. Prior to 1900, people rarely died of heart disease because activity was necessary. The majority of people walked to work, work was physically strenuous and when they returned home, the clothes needed to be washed by hand, the floors scrubbed, bread baked and supper prepared. This drastic change at the turn of the last century from a diet rich in fruits, vegetables and complex carbohydrates to one high in animal meats, fats and refined sugars, along with a sedentary life began to take its toll, not only on Americans, but industrialized countries world-wide. The greatest surge of heart disease took place between 1940 and 1967 and was described as a world epidemic. Since then the rates have been slightly declining, thanks largely to the advent of open heart bypass surgery, first pioneered by Dr. William Debakey in 1965. The prevalence of heart disease in the 20th century was augmented by the decline of infectious disease. With the use of antibiotics and immunizations, infectious diseases began to plummet. And a new form of indolent diseases were on the rise. The chronic degenerative diseases of the heart, cancer, stroke and diabetes slowly replaced microbes as the new plague of man. Today, heart disease continues to lead the death tolls in the US and in just a few years will become the leading cause of death on the planet.

The problem with chronic degenerative disease, is that, unlike infectious illness, there is no single known cause, but rather a host of etiologies or known causes. These diseases are so slow and chronic that it literally takes decades to research the effects of treatments, whether surgical or medicinal. If you are waiting for a magic pill or surgery, it will not come during your lifetime, so don’t sit on your haunches. We’ll all be dead by the time medical technology is anything like what you see on Star Trek. Right now, we have the knowledge—garnered from half a century of research—to prevent heart disease. In fact, the life adjustments that prevent heart disease are the same prescription for preventing cancer, stroke and diabetes. It’s a very simple recipe we’ve helped spell out for you in this book. But a recipe is meaningless without a cook. It’s your turn to cook. Living better should be your goal and living better now may mean a longer life down the line. Your quality of life begins with you. Doctors merely play a supportive role in your healthcare. In the end, you determine what happens to your body. We simply aid and advise you in carrying out those goals. We can not force you to exercise, to take your medications, to stop smoking or to eat the proper foods. The decision for a healthy, happy life is yours. You need to arm yourself with the tools to make those decisions. Here are the tools, the knowledge to change your life, to better your life.

Introduction to Heart Disease, Excerpt from the book: Everything Good For The Heart: The A to Z Guide, Aoukar PS and Karamanoukian HL. Magalhaes Scientific Press

Date of Article Publication:
In Press


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