What Your Doctor May Not Tell You about Heart Disease: The Revolutionary Book that Reveals the Truth Behind Coronary Illnesses-and How You Can Fight Them
By Mark C. Houston, MD, MS
Released in early February, this is an excerpt from the latest book by Mark Houston, MD, MS, SCH, ABAARM, FACP, FAHA. The associate clinical professor of clinical medicine at Vanderbilt University School of Medicine is also director of the Hypertension Institute in Nashville.
Chapter One – The Real Reason People Have Heart Attacks
This is a book about coronary heart disease, which comes about when the arteries that carry fresh blood to the heart are blocked and the flow of fresh blood to a portion of the heart drops dramatically or ceases entirely. Depending on the extent of the blockage, the result can be anything from the chest pain of angina to a sudden and fatal heart attack. Although a number of other problems can afflict the heart, including faulty valves, coronary heart disease is what most people think about when someone says “heart disease.”
Most doctors talk about coronary heart disease prevention as if it were a matter of dodging five “bullets,” namely:
- elevated cholesterol (specifically LDL “bad” cholesterol)
- high blood pressure
- diabetes mellitus
This focus on the “Big Five” risk factors is all pervasive; you’ve probably even seen those “How Long Will You Live?” equations that supposedly calculate the power these risk factors have to induce coronary heart disease. The equations contain instructions like “Subtract 6 points if your cholesterol is over 300” and “Add 2 points if you don’t smoke.” These may be fun to play with, but they are misleading because they don’t address the real causes of heart disease.
I prefer to think of the evolution of heart disease as a trip through a giant maze. When you first enter the Heart Disease Maze, you see hundreds of little pathways that wander all over the place, leading nowhere in particular. The walls lining these pathways are low, and there’s plenty of light, so you experience no feeling of urgency or danger; instead, you feel as if you can safely wander from path to path forever. These paths represent the hundreds of biochemical and other variations in your body that are often small and, by themselves, don’t matter. But if one variation is joined by others, you may find yourself on the fast track to heart disease. Examples of these variations include your blood levels of C-reactive protein, the size and number of your LDL cholesterol particles, the type and blood level of the fat known as triglyceride, your blood level of homocysteine, the type and size of HDL “good” cholesterol, your blood level of tumor necrosis factor (a marker of inflammation), and your blood level of interleukin-6 (a protein molecule that regulates the immune system). A few variations, such as uric acid levels, are routinely measured in standard blood tests; many others can be determined through specialized blood work or other tests. These variations also include certain diseases, such as chronic obstructive pulmonary disease, and infections, such as H. pylori, that by themselves don’t lead to heart disease.
But back to the maze: If you just strolled down a few of these paths for a while, then hopped over the short walls and walked out of the Heart Disease Maze, all would be well. However, if you kept walking and followed too many paths, or followed one or more for too long, you would suddenly realize that you were moving along a different kind of path-one with higher walls, less light, and a kind of spooky feeling. You would have moved from the innocuous “Variations Pathways” to one of the considerably more dangerous “Fast Track to Heart Disease Pathways.” You wouldn’t have noticed any signs indicating you were leaving the little Variations Pathways and entering the ominous Fast Track to Heart Disease Pathways, but there you’d be.
For many people, the Fast Track Pathways of greatest concern are the following seven:
- Inflammation Pathway
- Oxidative Stress Pathway
- Vascular Autoimmune Pathway
- Dyslipidemia Pathway
- Blood Pressure Pathway
- Blood Sugar Pathway
- Obesity and Increased Body Fat Pathway
Once you’re on a Fast Track to Heart Disease Pathway, you’ll find yourself moving faster and faster into darker, spookier territory. You’d like to stop but don’t know how, because there are no road signs or helpful people telling you how to get off. There are some doors in the very high walls that would let you out of the maze, but they’re difficult to spot unless you know what you’re looking for. Odds are you’ll keep moving ahead until you find yourself on the very dark and frightening “Faulty Arteries Pathway,” hurtling forward into the darkness. Even then there are a few ladders propped up against the very high walls that you could use to climb out of there, but they’re very hard to spot and grab hold of. That’s why there is a very good chance you’ll continue speeding forward in the darkness until you slam headlong into the brick wall called a heart attack.
This may be an oversimplified way of looking at the development of coronary heart disease and heart attacks, but it illustrates an important point: the disease process typically starts innocently with small problems having to do with inflammation, oxidative stress, or the way the immune system functions in the arteries (vascular autoimmunity)-a few minor variations in the levels of substances that most doctors don’t measure or even connect with heart disease. I call them variations because they’re often not out-and-out problems or diseases; they’re just a bit too much or too little of a measurable substance or the presence of a certain state. But when they’re combined with others, they can become troublesome. Even then they may not hurt you, thanks to your unique biochemistry and other factors. But if you have the wrong combination of genetics and other factors, you’ll need to slam on the brakes and get off that road as soon as possible, or your journey may come to an abrupt and unfortunate end, because now you have early-stage disease of the arteries, and they’re not working the way they should.
As a hypertension and vascular specialist practicing preventive cardiology, I’ve been frustrated by the fact that most people have no idea they’re in the Heart Disease Maze until they’re already on the Faulty Arteries Pathway or have splattered into the brick wall at the end of the journey. If only they knew how easy it is to step out of the maze at the beginning of the journey or how to get off the Fast Track to Heart Disease and Faulty Arteries Pathways or, better yet, how to avoid them altogether. But they don’t know because they’re not told these things by their physicians.
That’s going to change, starting now. In this book, I’ll introduce you to hundreds of biochemical and other changes (technically called risk mediators and risk factors) that make up the Variations Pathways, as well as several of the Fast Tracks to Heart Disease-inflammation, oxidative stress, vascular autoimmune dysfunction, dyslipidemia, disturbances to blood pressure and flow, and problems with blood sugar-that arise when variations interact with one’s unique body chemistry and lifestyle. But first, let’s take a look at the terrifying Faulty Arteries Pathway (technically called endothelial dysfunction) that inevitably results from these Fast Tracks-a pathway traveled by virtually everyone who has a heart attack.
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