Despite all the attention it receives, cancer is not the leading cause of death in America. That dubious honor goes to cardiovascular disease (CVD). Heart disease remain the number one killer of men and women in the United States and throughout the developed world.
But what do we mean, exactly, by “heart disease”? There are various forms of heart disease, and some may be related to inborn defects, or even environmental factors such as chemotherapy for cancer. But for the vast majority of us, “heart disease” refers to heart attack and stroke.
The medical term for heart disease—cardiovascular disease—provides an important clue to the nature of this disease. This is a disease that’s not just about the heart itself. Rather, it begins in the blood vessels and only later progresses to the point where it may affect the heart muscle itself, or even cause damage to the brain. To understand how, and why, it’s helpful to understand a bit about the blood vessels.
It’s All About the Endothelium
Arteries carry oxygen-rich blood and nutrients to all the organs and tissues of the body, while wastes are removed through the veins. Of course, the heart serves as a pump that continuously beats, forcing blood through the body’s miles of vessels under pressure. The heart is a remarkable organ, capable of beating uninterrupted, day in and day out, for up to a century or more.
But to maintain the health of the heart and the blood vessels, it’s important to meet certain conditions. Blood vessels are lined with a specialized, delicate tissue called the endothelium. This tissue responds especially well to exercise and a healthful diet; especially one rich in dietary nitrates and natural antioxidants. Conversely, it begins to suffer dysfunction in the absence of these. In fact, many of the known primary risk factors for cardiovascular disease reflect these two imperatives.
Move It or Lose It
For example, sitting was recently identified as an independent risk factor for CVD. On the other hand, getting plenty of regular exercise—which can include any activity that gets you moving—is linked to a reduced incidence of CVD.
Certain foods, such as artificial trans fats, are essentially toxic to the endothelium. Fortunately, these dangerous synthetic “foods” have largely been phased out of the American food supply. But they have not been eliminated entirely, and may still be found in certain packaged, processed foods. This is yet another reason to pursue a whole foods diet and avoid highly processed foods.
Scientists have also identified processed deli meats as likely culprits that may be linked to increased risk of CVD. Diets high in added sugars are similarly suspect. In the past, experts believed that foods high in cholesterol, such as eggs, must contribute to the high blood cholesterol levels that have been implicated in greater CVD risk. But we now know that dietary cholesterol only accounts for a fraction of circulating cholesterol, so the emphasis on restricting cholesterol-rich foods has fallen by the wayside. It’s now considered safe to eat at least one egg per day, for example.
The Importance of Diet: Pro-inflammatory vs. Anti-Inflammatory
Scientists have learned that what’s truly important for heart health is the overall diet. It’s now crystal clear that a whole-foods, plant-centered diet is exceptionally healthy. Such a diet, typified by the Dietary Approaches to Stop Hypertension (DASH) diet, or the classic Mediterranean diet, features plenty of whole grains, vegetables, fruits, legumes, nuts, olive oil, and fish.
There is relatively little added sugar, and limited red meat. Fish, which often supplies the essential nutrients, omega-3 fatty acids, is an especially healthful source of lean protein. The omega-3s are essentially anti-inflammatory. Many of the antioxidants and other compounds in whole foods help contribute to an overall anti-inflammatory effect in the body.
Atherosclerosis—the Underlying Cause of Heart Disease
And that brings us back to the endothelium. It’s where most heart disease begins, often decades before any real symptoms arise. It begins with a condition called “endothelial dysfunction,” which eventually progresses to atherosclerosis. Sometimes called “hardening of the arteries,” atherosclerosis is the underlying cause of most CVD.
The process is complex, and unfolds gradually, but suffice to say that lack of exercise, smoking, poor diet, and sitting too much all take a toll on the health of one’s blood vessels. As atherosclerosis advances, blood vessels become stiffer, and less resilient. Blood pressure tends to rise, to compensate, which is why high blood pressure is a leading risk factor for—and indicator of—potential CVD. Accordingly, it’s crucial to keep one’s blood pressure within a healthy range.
In some instances of advanced atherosclerosis, a sort of complex sore forms within the blood vessels. This lesion may eventually attract white blood cells, calcium, and other cellular debris, which can aggregate to form a clot. When a clot breaks free, it may travel to smaller vessels supplying blood to the heart muscle itself.
A clot that lodges in one of these vessels may block blood flow altogether, causing the affected area of heart muscle to be starved of nutrients and oxygen. The resulting damage to the heart muscle triggers a heart attack. A similar process occurs in the brain when a clot travels there and lodges in one of the arteries supplying oxygen and energy to the brain. Deprived of oxygen and energy, muscle or brain tissue suffers near immediate damage, and may even die.
Incipient Atherosclerosis is Reversible—You Have the Power
The good news is that you can take control and reduce your risk of succumbing to the leading cause of death. You can take steps to improve or maintain the health of your blood vessels, by exercising regularly and embracing a healthful diet.
Among other nutrients, certain plant foods supply dietary nitrates, which have been implicated in better endothelial function and reduced blood pressure. Foods like beets and arugula are especially rich sources of nitrates. Fortunately, busy people who may not have time to munch on arugula every day, or juice fresh beets, can turn to our Berkeley Life Heart Health Supplements, or Berkeley Life Beetroot Powder for convenient ways to shore up your supply of blood pressure-supporting nitric oxide.