Why does blockage occur?

Why does blockage occur?

This is the $64,000 question. Several theories are prevalent in the medical community and all of which carry weight scientifically.

High blood insulin levels

High blood insulin has the capability of scarring or acting almost as an acid on the inside of blood vessels. This damage to the intima, the inner layer on the inside of all blood vessels, stimulates a repair mechanism whereby circulating blood cholesterol is laid down almost like a bandage on the damaged areas in the blood vessels. Over a period of time this rough area in the affected blood vessels collect more cholesterol effectively narrowing the passage through which blood circulates with an end result of atherosclerosis.

Considering that type II diabetes or syndrome X is increasing in prevalence by double digits every year, this theory very well could be a major reason why heart disease is the number one killer in North America.  In syndrome X, insulin resistance is a normal side effect which in turn forces the body to increase the amount of insulin found in the blood, resulting in high levels of insulin in the blood which in turn can cause damage to the interior layer of the blood vessels. 

Elevated homocysteine levels

High homocysteine levels have been reported to be associated with heart disease but not necessarily to cause heart disease directly. Homocysteine is a normal constituent found in the blood stream; under normal circumstances it is changed into other amino acids for use elsewhere in the body. In order for this change to occur specific B vitamins, folic acid, B 6 and B 12 and enzymes need to be present. High homocysteine levels can cause LDL cholesterol to oxidize therefore forcing this form of cholesterol to fall out of solution, creating the potential for a blockage in the bloodstream, atherosclerosis. In addition it makes the blood stickier than it should be thereby reducing circulation and increasing the potential for stroke and heart attack. Lack of these vital B vitamins in the diet is one possible reason for creation of higher homocysteine levels, however a poorly functioning thyroid, kidney disease or psoriasis and some medicines can also contribute to this issue.

Oxidation of cholesterol

Just as high homocysteine increases the rate of oxidation of cholesterol, a lack of antioxidants in the blood can also create this same problem. Overall high blood cholesterol levels are also associated with heart disease however the ratio between LDL and HDL cholesterol is vital in determining whether you have an increased risk for developing heart disease. Low levels of HDL and high levels of LDL cholesterol are commonly found in patients with heart disease.

High triglyceride levels are also dangerous. 3

The liver creates cholesterol and is used for the formation of various hormones including sex hormones such as testosterone.

1. Cunnane SC, Hamadeh MJ, Liede AC, et al. Nutritional attributes of traditional flaxseed in healthy young adults. Am J Clin Nutr 1994;61:62–8.

Exercise and overall lifestyle

A sedentary lifestyle contributes dramatically to an increase in overall cholesterol levels. Regular exercise, at least two hours a week will reduce your chances of developing heart disease. Change in diet and stopping smoking are also vital. 2

Exercise and overall lifestyle

1. Sebregts EH, Falger PR, Bar FW. Risk factor modification through nonpharmacological interventions in patients with coronary heart disease. J Psychosom Res 2000;48:425–41 [review].

The Importance of Diet

You are what you eat. Being overweight especially if you have a beer belly rather than having fat accumulates on the hips increases the risk of heart disease.  Often the one common factor many patients with heart disease have is poor diet. By this I mean diets that are high in fats sugars and junk food and generally low in fresh fruits, vegetables and fiber including beans.

The average North American diet is excessively high in proteins and trans fatty acids including margarine, fried foods and some vegetable oils.  High trans fatty acid levels are now considered as being a substantial marker for future heart disease. 4

Eating a diet that is high in flaxseed and canola oils, which have higher levels of alpha-linolenic acid (ALA), increases blood levels of Omega 3 fatty acids which recent research has found to be a substantial protection against development of atherosclerosis.  A recent study reported that the so-called Mediterranean diet which is high in olive oil which contains substantial amounts of ALA had a 70% reduced risk of developing or dying from heart disease. 5

This diet contained high levels of beans, brightly colored fruit, vegetables, high fiber breads and cereals, fish and was low in meat, dairy fats and eggs.

Increased dietary fiber in the form of whole grain foods such as legumes, oats, psyllium, pectin found in fruit and beans which include guar gum can reduce the risk of heart disease by about 26%. 6

Insoluble fiber found in fruits and vegetables seem to have a better effect in reduction of arterial sclerosis. 7-9

It has finally been proved that a vegan diet (no poultry or meat, eggs, dairy of any kind) combined with exercise can reduce incidence of arterial sclerosis and atherosclerosis. 10

Drinking red wine at a moderate level, 2 glasses per day has been proven to reduce the incidence of heart disease. The active constituent appears to be resveratrol, the pigment that gives red wine its colour, although in its pure form it is colourless. 11-13  This is the basis for the French paradox, the fact the French have a low incidence of heart disease despite an average diet high in fats and rich foods normally associated with heart disease.

People that react badly to stress or who are aggressive or consistently angry along with type A personality have an increased chance of developing heart disease. 14-17

1. Ascherio A, Willett WC. Health effects of trans fatty acids. Am J Clin Nutr 1997;66(suppl):1006S–10S [review].
2. De Lorgeril M, Salen P, Martin J-L, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction. Final report of the Lyon Diet Heart Study. Circulation 1999;99:779–85.
3. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999;69:30–42.
4. Jenkins DJA, Kendall CWC, Ransom TPP. Dietary fiber, the evolution of the human diet and coronary heart disease. Nutr Res 1998;18:633–52 [review].
5. Wolk A, Manson JE, Stampfer MJ, et al. Long-term intake of dietary fiber and decreased risk of coronary hart disease among women. JAMA 1999;281:1998–2004.
6. Knopp RH, Superko HR, Davidson M, et al. Long-term blood cholesterol-lowering effects of a dietary fiber supplement. Am J Prev Med 1999;17:18–23.
7. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129–33.
8. Bertelli AA, Giovanninni L, Bernini W, et al. Antiplatelet activity of cis-resveratrol. Drugs Exp Clin Res 1996;22(2):61–3.
9. Chen CK, Pace-Asciak. CR. Vasorelaxing activity of resveratrol and quercetin in isolated rat aorta. Gen Pharm 1996;27(2):363–6.
10. Pace-Asciak CR, Rounova O, Hahn SE, et al. Wines and grape juices as modulators of platelet aggregation in healthy human subjects. Clin Chim Acta 1996;246(1–2):163–82.
11. Miller TQ, Smith TW, Turner CW, et al. A meta-analytic review of research on hostility and physical health. Psychol Bull 1996;119:322–48.
12. Kawachi I, Sparrow D, Spiro A 3rd, et al. A prospective study of anger and coronary heart disease. The Normative Aging Study. Circulation 1996;94:2090–5.
13. Thomas SA, Friedmann E, Wimbush F, Schron E. Psychological factors and survival in the cardiac arrhythmia suppression trial (CAST): a reexamination. Am J Crit Care 1997;6:116–26.
14. Angerer P, Siebert U, Kothny W, et al. Impact of social support, cynical hostility and anger expression on progression of coronary atherosclerosis. J Am Coll Cardiol 2000;36:1781–8.