Heart Disease: Understanding the basics and how to avoid it!

Learn how heart disease develops, and how Modern Functional Medicine can help you prevent it.

Our heart is a non-stop, powerful muscle that pumps blood to every corner of our body, replenishing our cells with much needed oxygen for their normal function. However, an optimally functioning heart depends on multiple factors, extrinsic and intrinsic.

At the Australian Centre for Functional Medicine we understand that heart disease is influenced by multiple factors, from the food you eat to the daily routine you follow and the genes you inherited. All these factors and others influence the health of your hearth and the likelihood that you will develop heart disease.

In the past decades, heart disease has become a global problem, particularly in developed countries, where they represent the number one cause of death.

Find out how heart disease forms and what the Australian Centre for Functional Medicine can do to help keep your heart healthy.

How the heart works

Our heart is the organ in charge of pumping blood, non-stop, throughout the body. The heart is made up four chambers, which work together by contracting and relaxing, receiving oxygenated blood coming from the lungs and pumping it to the rest of the body.

A key feature of the heart, which allows it to contract and relax constantly, is the cardiac muscle tissue, which is made up specialised cells, called cardiac muscle cells and pacemaker cells. Cardiac muscle cells are responsible for the contraction and relaxation of the heart, while pacemaker cells produce electrical impulses that regulate the pace of the heart. These pacemaker cells are autonomous, and allow for the functioning of the heart independently from our central nervous system. There are between 2-3 billion of cardiac muscle cells in the heart, which allow for constant muscle movement and pumping of blood. The heart is also made up various other cell types, including smooth muscle and endothelial cells, fibroblasts and other connective tissue cells, mast cells and immune system-related cells. Together, all these cell types allow for the optimal and constant functioning of the heart¹.

When there is a heart attack, and the inflow of oxygenated blood is reduced, cells from the cardiac muscle tissue can die, and are replaced by scar tissue. Scar tissue does not have the same properties are cardiac cells, so your heart if left with a sub-optimal cellular makeup and function. After a heart attack, depending on how extensive id the cardiac ell damage, your heart may not be able to function properly again, potentially leading to an early death.

What is heart disease?

The term “heart disease” includes a wide range of different problems that affect the heart, including coronary artery disease (also known as coronary heart disease or ischemic heart disease), arrhythmias (abnormal rhythms of the heart) and genetic defects (mostly inherited genetic defects), among others.

Among all these conditions, the most common and the one that kills more people around the world is coronary heart disease, a condition that primary affects the blood vessels that connect with the heart.

Coronary heart disease is a condition where the arteries that supply oxygenated blood to the heart are blocked by plaque. Plaque is a substance made up of cholesterol, which can become attached to the inside of the arteries, making them narrower over time – a process known as atherosclerosis. As more and more of this plaque builds up inside the arteries, less blood can flow through the arteries to provide oxygen to the heart.

A heart attack occurs when the muscles of the heart stop working properly, due to a lack of sufficient oxygenated blood. Often, the main cause for the blockage of oxygenated blood comes from a fragment of plaque that has dislodged from the artery’s wall and is now blocking the way of oxygenated blood to the heart. If this condition is not treated quickly, the heart muscle cells start to die. Depending on how extensive the damage is, the heart function can be compromised, as death heart muscle cells are replaced by scar tissue, which does not function as muscle cells^2-5.

When you have a heart attack you may experience symptoms like:

• Chest pain or discomfort
  Most people experience pain, pressure, or discomfort in the centre or left side of the chest, which can last for a few minutes or can goes away and come back. It also can feel like heartburn, fullness or indigestion and the whole sensation can be mild or severe.

• Upper body discomfort
  Another typical symptom of an ongoing heart attack is pain or discomfort in one or both arms, or on the back, shoulders, neck, jaw, or the stomach area.

• Shortness of breath
  Sometimes, people who have a heart attack only experience this symptom. Other times shortness of breath may come along with chest pain or discomfort.

Development of coronary heart disease

Among all forms of heart disease, coronary heart disease is the most common, affecting more than half million Australians every year. See our article on this worrisome issue.

Coronary heart disease is, essentially, a disease of the arteries that supply oxygen to the heart. When the arteries get blocked by excessive plaque accumulated in the inner walls, a condition known as atherosclerosis, blood cannot go through and provide the oxygen heart cells need. Also, when significant amounts of plaque have accumulated in the walls of arteries, there is an increased chance that a fragment of plaque can dislodge and completely block an artery, causing total blockage and leading to cardiac cell damage, and heart disease.

At the Australian Centre for Functional Medicine we focus on two important factors influencing coronary heart disease: diet and lifestyle. These factors can lead to the slow accumulation of plaque in the arteries leading to the heart. A recent review,  which analysed the findings of 123 studies, showed that there is a positive association between the risk of coronary heart disease, stroke and heart failure with high consumption of foods like red meat, processed meat, and sugar-sweetened beverages and eggs⁵. In other words, the more you consume of these foods, the more likely you will develop a heart condition. The review study also found that foods like whole grains, vegetables, fruits, nuts, and fish has the opposite effect: high consumption of these foods was associated with lower risk of heart disease.

Heart Disease Focus on: Cholesterol

Atherosclerosis is caused by the accumulation of cholesterol in the inside of the arteries that connect with the heart. However, cholesterol is not a poison we need to avoid at all cost, but an essential component of our body.

Cholesterol function – cholesterol is a molecule used by our body to maintain the integrity and optimal function of cell membranes. It is also used as a building block for the formation of important biomolecules, such as steroid hormones, bile acids, and vitamin D.

However, excessive intake of cholesterol can be a problem, mostly because our body does not need any extra cholesterol. Here is an important fact: Our body can synthesize all the blood cholesterol it needs, hence why it is recommended to reduce the intake of cholesterol-rich foods. Foods rich in cholesterol include meat, seafood, poultry, eggs, and dairy products and consuming an excess of these foods will inevitably lead to an excess of cholesterol in our body.

In Australia, about half of all adults have more than the recommended levels of cholesterol in their blood. The main factor driving this worrisome trend is the unhealthy diet followed by a large proportion of Australians. Diets rich in animal-based fats, such as meats, processed meats (ham, salami), chips, deep-fried foods, cakes and pastries, as well as dairy products are all rich in cholesterol. At the Australian Centre for Functional Medicine we focus on helping our patients escape from their western diet and find a new and healthy way of eating.

Heart Disease: Beyond diet

Following an unhealthy diet is an important factor in plaque formation leading to atherosclerosis and, subsequently, heart diseases. However, at the Australian Centre for Functional Medicine we are mindful that there are other factors that influence the development ofheart disease. These include:

• Chronic inflammation
  In recent years, studies have identified low-grade chronic inflammation as an important factor influencing the development of atherosclerosis, from plaque initiation to acute plaque rupture, which precedes a heart attack⁶.

• Oxidative stress
  Polyunsaturated fatty acids (PUFA)-containing phospholipids and cholesterol esters found in the cellular membrane and in lipoproteins found in the blood can be readily oxidized through a free radical-induced lipid peroxidation (LPO), a process that results in a complex mixture of oxidation products⁷. Multiple studies have shown that these oxidized lipids take part of the inflammatory responses associated with atherosclerosis, through their interaction with immune and endothelial cells^8-10. See our article on this topic.

• Certain diseases
  People with certain autoimmune conditions, like Sjögren’s syndrome (pSS), a chronic systemic autoimmune disease, have been shown to have an increased risk of developing coronary heart disease¹¹. Also, some infections have been linked to an increased risk of heart disease¹². See our recent article on this topic.

• Metabolic syndrome
  The term metabolic syndrome includes various health problems, including high blood pressure, high blood sugar, thyroid malfunction (hypothyroidism) excess body fat around the waist and unhealthy cholesterol levels. All these conditions increase your risk of developing heart disease or stroke^13-15. Metabolic syndrome, for most cases, involves conditions that can be prevented or treated. See our article on metabolic syndrome.

• Genetic mutations
  Congenital heart disease is a genetic-based condition where the heart has structural abnormalities. This condition is the most common type of birth defect, affecting around 1% of all newborn infants. Studies have shown that people who develop congenital heart disease have mutations in a wide range of genes, with one study suggesting the involvement of early 400 genes¹⁶. Beyond congenital heart disease, studies have also identified genes that are associated with an increased risk of developing heart disease. Genetic testing, in some cases, can help clinicians identify people who are at a higher risk of developing heart problems^17-18.

• Stress and depression
  Studies have shown that chronic stress, such as that resulting from work stress, dementia caregiving, or social isolation, can cause an increased risk of developing coronary heart disease (CHD)^19-20. Other sources of stress have also been implicated with increased risk of heart disease. For example, one study found that people who have frequent outbursts of anger has a higher chance of developing an acute myocardial infarction or other heart problems²¹. Another study found that the incidence of myocardial infarction was 20 times higher in the 24 h after the death of a loved one²². See our article on stress and health.

• Smoking
  The overall health risks of smoking are well established, and among them is an increased risk of developing different forms of heart disease²³. Chemicals found in cigarettes can cause inflammation and other problems in the blood vessels leading to the heart. This can increase the chances of developing problems like atherosclerosis, coronary heart disease, stroke, peripheral arterial disease, and abdominal aortic aneurism^24-28.

• Lack of exercise
  Much like following a healthy diet, doing regular exercise is a good way to protect your heart. Leading a sedentary lifestyle has been shown to double your risk of developing coronary heart disease, compared to active people^29-30.

• Gut Microbiota
  Multiple studies have found associations between the composition of the gut microbiota and the risk of developing heart disease. Several potential mechanisms have been proposed to explain this link and involve factors like the presence of certain bacterial metabolites or how gut bacteria influence lipid metabolism, among other factors^31-36.Future studies will help us gain a better understanding of this link may one day help design tailored treatments that target gut microbiota. See our article on this topic.

Heart disease at the Australian Centre for Functional Medicine

For most people, coronary heart disease is a problem that takes decades in the making. The accumulation of cholesterol plaques within your arteries is a process that progresses over years of exposure of different risk factors, like following a poor diet, smoking, or leading a sedentary lifestyle.

The first line of defence against heart disease is to test and identify the underlying causes of heart dysfunction.  The Australian Centre for Functional Medicine investigates all possible drivers of heart disease and designs a personalised treatment plan.

For most of us, our life is filled with practices that are not heart friendly. Diet, for example, is one of the most important factors that determine the health of your heart. Finding an optimal diet that meets your body’s requirements is an important first step to protect your heart.

At the Australian Centre for Functional Medicine in Perth, we do not recommend the same diet for all our patients. Instead, we perform comprehensive testing, alongside advanced health questionnaires, which help us understand your health history and identify the drivers of your heart condition.  Based on this information, we can then create a personalised roadmap for treatment, which will include individualised nutritional plans.

The Australian Centre for Functional Medicine applies a modern approach to Functional Medicine, where heart disease is not considered an isolated event, but just the tip of the iceberg. Patients who have suffered a heart condition or are at risk of developing any form of heart disease are likely also experiencing many other problems, some of which might even be asymptomatic. At the Australian Centre for Functional Medicine we seek to uncover all your health problems affecting your body and design a comprehensive treatment plan to cure you. Become a patient today!

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