Read an Excerpt
Chapter One
Way Beyond Cholesterol
For the past several decades, coronary heart disease (CHD) has been the number one killer of men and women in the United States and in most of the Western world. Doctors have long proclaimed it to be a polygenic disease, that is, a disease that has many causes involving both genetic traits and lifestyle choices. Today the list of contributing factors has grown longer than ever.
At first glance, this may appear to make the situation more complicated. But the good news is that as we identify those risks and learn how to eliminate them, we come to realize that heart disease is largely preventable.
Heart disease begins in childhood. The insidious process of clogging the arteries progresses quietly, and as early as the teenage years, tests can reveal significant blockage. Obviously, the time to begin preventive measures is as soon as possible.
That said, it's never too late to start prevention. By identifying your personal risk factors and dealing with them effectively, you can absolutely and unequivocally stop the progression of disease at any point in the cycle. Assuming that CHD hasn't already developed to the point of putting you at risk of a heart attack or making you a candidate for bypass surgery, you can halt the disease process and perhaps even reverse it before one of these cardiac events occurs. This is called primary prevention. And even if you have already had a heart attack, otherwise known as a myocardial infarction (MI), bypass surgery, or angioplasty, you can still take the measures needed to make sure you stop the progression of the disease. That is called secondaryprevention.
Sadly, most people lack either the knowledge or the incentive to take preventive measures to heart. This is true for both primary and secondary prevention. I understand that to some extent: Human nature makes us all feel that "It won't happen to me." But what about those who have already had a run-in with heart disease and continue to live their lives as they always have? To me that's like seeing a car or truck speeding down the street and stepping off the curb anyway.
A growing number of cardiologists and other physicians are becoming advocates of what is termed "aggressive secondary prevention"that is to say, taking all the steps necessary to not only modify but completely eliminate known risk factors such as elevated cholesterol levels or high blood pressure. My personal hero among those doctors is Sidney Smith, past president of the American Heart Association (AHA) and professor of medicine at the University of North Carolina at Chapel Hill. Dr. Smith, who used his AHA presidency as a pulpit to preach the gospel of aggressive secondary prevention to his peers in cardiology, has done much to change the way doctors treat their patients.
I go a step further. Certainly it's logical to do everything possible to avoid a second heart attack, but why not be Just as aggressive in avoiding the first one? That's what this book is all about: aggressive primary, as well as secondary, prevention. Heart disease is the enemy. A ruthless killer. Worse than anything dreamed up in Hollywood horror movies or ancient myths. Now is the time to pick up that sword of aggressive prevention and fight back.
Today we have gone way beyond cholesterol in identifying the many risk factors that contribute to heart disease. For now, we can't do much about changing the genes that make one particularly susceptible to CHD. Maybe someday soon. But by realizing that others in our families have fallen victim, we are forewarned and forearmed. Now let's turn to the risk factors.
Cholesterol: The Granddaddy of'em All
Way back in the 1950s, doctors in Framingham, Massachusetts, began a long-term study of that town's male citizens. They did blood tests, measured blood pressure, and watched and waited. Over a period of many years, certain correlations became clearer and clearer. Men who suffered heart attacks were most likely to be those who had elevated cholesterol levels in their blood. That began a controversy that raged for years.
Since the cholesterol measured in the blood, and later found in the blocked arteries of those who had died of heart attacks, was the same as the cholesterol found in animal foods, the logical conclusion was to limit the amount of cholesterol in the diet. But that didn't do much to lower blood cholesterol, and the connection to saturated fat was totally unknown in those days. I could write a whole book on the history of the debate around diet and heart disease, but the conclusion would be the simple fact that we now have proof positive that cholesterol levels in the blood do, in fact, play a major role in developing heart disease. And today we have the means at our disposal to lower cholesterol to harmless levels.
Just for the record, cholesterol is a chemical substance found in all animals, including humans. We all need it and we can't live without it. The body uses cholesterol to manufacture digestive enzymes, a variety of hormones, and the protective sheath around nerves. About 80 percent of the cholesterol found in our bloodstream is made by the body itself, mainly in the liver. Our diet contributes to only 20 percent or less.
That's why dietary measures alone often can't get cholesterol levels down sufficiently, particularly in those individuals with a genetic tendency to produce too much of the stuff. Diet alone typically lowers cholesterol levels by about 6 percent. Extreme dietary restrictions, which few people are willing to make, can lower levels further. But when one combines a reasonably heart-healthy diet with other measures, even the highest cholesterol numbers fall into the healthy zone. More about that as I "spin this yarn" throughout the book.
Why is cholesterol so important? Simply enough, it is an indispensable ingredient in making the gruel that forms blockages, known as plaque, in the arteries.
The New 8-Week Cholesterol Cure. Copyright © by Robert E. Kowalski. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
