Like any muscle in the human body, the heart needs a constant supply of oxygen and nutrients delivered via blood in the coronary arteries. When the coronary arteries become narrowed or clogged and cannot supply enough blood to the heart, the result is coronary heart disease (CHD). If not enough oxygen-carrying blood reaches the heart, the heart may respond with pain called angina. The pain is usually felt in the chest or sometimes in the left arm and shoulder. (However, the same inadequate blood supply may cause no symptoms, a condition called silent angina.)

When the blood supply is cut off completely, the result is a heart attack. The part of the heart that does not receive oxygen begins to die, and some of the heart muscle may be permanently damaged. Congestive Heart Failure (CHF) is a condition in which the heart cannot pump enough blood to meet the needs of the body's other organs.

58,800,000 Americans have one or more types of cardiovascular disease (CVD) according to current estimates.^1 2 3

• High blood pressure⁴ — 50,000,000.¹
• Coronary heart disease — 12,000,000.²
  — Myocardial infarction — 7,000,000.²
  — Angina pectoris — 6,200,000.²
• Stroke — 4,400,000.²
• Rheumatic fever/rheumatic heart disease — 1,800,000.³
• Congenital cardiovascular defects — 1,000,000.³
• Congestive heart failure — 4,600,000.²
• 1 in 5 males and females have some form of CVD.^{2, 3}
• 1 in 3 men can expect to develop some major cardiovascular disease before age 60; the odds for women are 1 in 10.

Cardiovascular disease claimed 959,227 lives in the United States in 1996. This is 41.4 percent of all deaths or 1 of every 2.4 deaths. Cardiovascular disease was about 60 percent of total mention mortality, which means that of the more than 2,000,000 deaths from all causes, Cardiovascular disease was listed as a primary or contributing cause on about 1,400,000 death certificates.

Heart attacks and CAD coronary artery disease are significantly skewed toward the elderly population. According to the Framingham Heart Study, 95 percent of all heart attacks occur in people over the age of 40 and 55 percent occur within the 65+ population. Today, Congestive Heart Failure (CHF) is the most common diagnosis among hospital patients age 65 and older. Within this age group, one-fifth of all hospitalizations list CHF as either the primary or secondary diagnosis.

When you have too much cholesterol in your blood, the excess builds up on the walls of the arteries that carry blood to the heart. This buildup is called "atherosclerosis" or "hardening of the arteries." It narrows the arteries and can slow down or block blood flow to the heart. With less blood, the heart receives less oxygen. With not enough oxygen to the heart, there may be chest pain ("angina" or "angina pectoris"), heart attack ("myocardial infarction"), or even death. Cholesterol buildup is the most common cause of heart disease, and it happens so slowly that you are not even aware of it. The higher your blood cholesterol, the greater your chance of this buildup.

A high blood cholesterol level is not the only thing that increases your chance of getting heart disease. Here is a list of known risk factors:

Factors You Can Do Something About

• Cigarette smoking
• High blood cholesterol (high total and LDL-cholesterol)
• Low HDL-cholesterol
• High blood pressure
• Diabetes
• Obesity/overweight
• Physical inactivity

Factors You Cannot Control

Age:

• 45 years or older for men
• 55 years or older for women

Family history of early heart disease (heart attack or sudden death):

• father or brother stricken before the age of 55
• mother or sister stricken before the age of 65

The more risk factors you have, the greater your chance of heart disease. Fortunately, most of these risk factors are things you can do something about.

Cholesterol is needed by the body to perform several important functions. This fat-like substance is used to form cell membranes, contributes to the production of some hormones, and is transported in the bloodstream by carriers called lipoproteins.

These lipoproteins vary in size, weight, and composition and are classified as high-density lipoproteins (HDL — "good cholesterol") and low-density lipoproteins (LDL —"bad cholesterol).

Although cholesterol performs many essential functions in the body, excessive intake or synthesis of cholesterol can lead to disease. Elevated total and LDL cholesterol is associated with the risk of developing cardiovascular disease. On the other hand, HDL cholesterol shows a strong inverse association with the incidence of heart disease. So lowering "bad" cholesterol (LDL) and increasing "good" (HDL) cholesterol decreases your risk for heart disease. According to the American Heart Association, the total serum cholesterol level for adults should be less than 200 mg/dL, LDL cholesterol levels below 130 mg/dL (below 100 mg/dL with two or more other risk factors) and HDL cholesterol levels above 45 mg/dL are desirable.

Note: These categories apply to adults age 20 and above.

Symptoms:

• People with artery blockages may experience angina, a discomfort caused by inadequate blood flow. Individuals may experience pain in the chest, arms, neck or back -- generally lasting up to 20 minutes after exertion . These pains may occur on a consistent basis in the same area, such as the chest.
• If the heart disease leads to a heart attack, women are more likely than men to experience nausea or vomiting instead of the violent chest pain that characterizes a typical heart attack for men. In fact, it is possible for women to not experience any chest pain during a heart attack.
• You should call your doctor if you experience severe or prolonged angina that lasts longer than 10 to 15 minutes; pain that spreads to the neck, arms or shoulders; or pain along with shortness of breath, nausea, fainting or sweating. If you experience these symptoms, you may be having a heart attack.
• Chest pains unrelated to heart problems last less than five seconds in different parts of the chest, and are caused by deep breaths or movements, not exertion.
• Less common signs of a heart attack include unexplained fatigue, weakness or anxiety.
• Patients with coronary artery disease, a history of heart attacks, high blood pressure, heart valve diseases, cardiomyopathy (primary disease of the heart muscle), or congenital heart disease are prone to CHF.

Coronary heart disease CHD is treated in a number of ways, depending on the seriousness of the disease. For many people, CHD is managed with lifestyle changes and medications. Others with severe CHD may need surgery. In any case, once CHD develops, it requires lifelong management. A CHF treatment program usually includes a combination of rest, an appropriate diet, modified daily activities and medications.

Although great advances have been made in treating CHD, changing one's habits remains the single most effective way to stop the disease from progressing.

If you know that you have CHD, you should focus on

• Lowering cholesterol
• Reducing blood pressure
• Controlling blood sugar and
• Loosing excess body weight

People with CHD can also benefit from exercise. Recent research has shown that even moderate amounts of physical activity are associated with lower death rates from CHD. However, people with severe CHD may have to restrict their exercise somewhat. If you have CHD, check with your doctor to find out what kind of exercise is best for you.

Smoking is one of the three major risk factors for CHD. Quitting smoking dramatically lowers the risk of a heart attack and also reduces the risk of a second heart attack in people who have already had one.

If you know that you have CHD or have high cholesterol, changing your current diet to a low-fat diet will be beneficial. A low-fat diet emphasizes a reduction in saturated fat and cholesterol which will help reduce high blood cholesterol, a primary cause of atherosclerosis (plaque formation in arteries). In fact, it is even more important to keep your cholesterol low after a heart attack to help decrease your risk of having another one. LifeSpring emphasizes the control of saturated fatty acid intake because of its direct impact on plasma low-density lipoprotein or LDL cholesterol levels. By replacing saturated fat with predominantly unrefined complex carbohydrates and mono-unsaturated fat, like olive oil, which is not susceptible to oxidation, the risk of atherogenesis may be lowered. Dietary cholesterol can increase plasma and LDL cholesterol levels and should be limited to no more than 200 to 300 mg per day. Foods rich in soluble fiber have been shown to reduce total and LDL cholesterol in a fat-modified diet similar to the one recommended by LifeSource.

Persistently high blood pressure against the walls of the arteries is called hypertension. The escalation in pressure might originate from the heart’s pumping action or a narrowing of the artery or increases in the amount of blood being pumped through an artery. Untreated hypertension leads to many degenerative diseases, the most common being cardiovascular in origin. It accelerates plaque formation and encourages the formation of blood clots, which can close off an artery.

A systolic blood pressure (blood pressure during the contraction phase of the cardiac cycle) of 120 or less and a diastolic blood pressure (blood pressure during the relaxation phase of the cardiac cycle) of 80 or less is desirable.

Although there is general agreement in the scientific community that salt restriction can improve blood pressure in hypertensive individuals, there is currently no clear clinical evidence that exists which defines a desirable upper limit for sodium intake. LifeSpring recommends a daily sodium intake level of 2000 to 2400 mg.

Some of the latest research shows that the ratio of potassium to sodium levels in food may be even more important than the absolute level of sodium. A direct result of this research is the recommendation to select foods that have equal or higher levels of potassium compared to sodium.

High blood sugar levels may cause the walls of the arteries to become rough. This allows fatty substances to build up in the walls of an artery. More plaque may then form in these walls. By controlling your blood sugar, you can help lower your LDL cholesterol and other fatty substances. Also, plaque may be less likely to buildup in the walls of the arteries.

For more information on managing blood sugar, please refer to the "Diabetes" section.

Body weight is of considerable importance, since studies show a direct correlation between increases in body weight and elevation of blood pressure. Excess weight makes it harder for your body to use insulin, a hormone that controls blood sugar. It also makes your heart work harder. Losing even a few pounds may help you control your blood sugar. It can also reduce your risk for heart disease and heart attack.

Height and weight are useful in determining the nutritional status of adults. A measure called the body mass index (BMI) is a useful tool, which accounts for differences in body composition. BMI correlates the relationship of weight to height with body composition. It eliminates dependence on the frame size and gender. This index is calculated by multiplying your weight in pounds by 700, then dividing the result by your height in inches and dividing that result by your height in inches once more by dividing your weight with square of your height (kg/m²). A BMI index between 20 to 25 is considered ideal for good health. In general, a BMI of 27 or more indicates an increased risk of developing health problems.

The best way to achieve long-term maintenance of healthy weight is by regular physical activity and a balanced diet.

For reducing and managing a healthy body weight, please refer to the "Body Weight Management" section.

General recommendations are that patients should consume a healthy diet that is low in fat, especially saturated fat; low in cholesterol and high in whole grains, fruits and vegetables, ensuring an adequate fiber intake.

National Cholesterol Education Program (a part of the National Institute of Health) has developed a two-step guideline to help in lowering dietary fat, saturated fat intake and cholesterol intake. For those patients who have not reduced their fat and cholesterol intake prior to treatment, Step I is the initial therapy. For those already on the Step I diet, further reductions in saturated fat and cholesterol - the Step II diet - should achieve a lower cholesterol level. Also, those patients whose cholesterol level is in the high risk range (240 mg/dL and higher) or who have had a heart attack, should be encouraged to immediately adopt the Step II diet. These changes in diet should be carried out along with regular physical activity in all patients and weight reduction in the overweight. LifeSpring recommends a diet similar to the Step II diet but with additional emphasis on vitamins, minerals and phytonutrients. LifeSpring suggests 55 to 65% of calories from carbohydrates (predominantly complex and unrefined), 12 to 15% of calories from protein, and no more than 27% of calories from total fat.

The anti-oxidant vitamins A, C, & E and selenium are essential for a healthy human body as they protect against oxidative stress of the environment and aging. Research has also shown that vitamin E may help to reduce the risk of coronary heart disease.

B vitamins help convert fats and carbohydrates in food to the energy that the brain, muscles, and nervous system need.

Vitamin B6 and B12 work with folate to maintain a healthy level of blood homocysteine. Elevated homocysteine levels in plasma have demonstrated a strong epidemiological association with coronary heart disease, peripheral vascular, and cerebrovascular disease.

An emerging body of research points to the health-promoting benefits of a large group of water-soluble nutrients called flavonoids. Flavonoids function similar to antioxidants to protect against free radical damage. Scientific research has carefully documented that diets high in biologically active flavonoids appear to be beneficial to people suffering from many circulatory disorders including peripheral artery disease, heart disease, stroke, and various types of cancer. Influential scientific and medical studies have indicated that grape seed extract may inhibit LDL oxidation. Garlic is one of the most widely consumed and medicinally active herbs in the world. It has been shown to lower levels of cholesterol, low-density lipoprotein and triglycerides. A study among patients with high cholesterol concluded that, on average, a 9% reduction in cholesterol could be achieved with the consumption of the equivalent of one clove of garlic per day.

Medications are prescribed according to the nature of the patient's coronary heart disease CHD and other problems. The symptoms of angina can generally be controlled by "beta-blocker" drugs that decrease the workload on the heart (to decrease the recurrence of a heart attack), by nitroglycerine and other "nitrates", by "calcium-channel blockers" that relax the arteries, and by other classes of drugs. The tendency to form blood clots is reduced by aspirin or by other platelet inhibitory and anticoagulant drugs. For those with elevated blood cholesterol that is unresponsive to dietary and weight loss measures, cholesterol-lowering drugs may be prescribed, such as lovastatin, colestipol, cholestyramine, gemfibrozil, and niacin. An impaired pumping function of the heart may be treated with digitalis drugs or ACE inhibitors. If high blood pressure or fluid retention exist, these conditions are also treated accordingly.

It is important for you to ask your doctor which medication you are taking, what it does, and whether there are any side effects. Knowing more about this will help you stick to the schedule that has been prescribed for you.

Many patients can control CHD with lifestyle changes and medication. Surgery may be recommended for patients who continue to have frequent or disabling angina despite the use of medications, or people who are found to have severe blockages in their coronary arteries.

Strictly speaking, angioplasty is not surgery. It is done while the patient is awake and may last 1 to 2 hours. If angioplasty does not widen the artery or if complications occur, bypass surgery may be needed.

In a coronary artery bypass operation, a blood vessel, usually taken from the leg or chest, is grafted onto the blocked artery, bypassing the blocked area. If more than one artery is blocked, a bypass can be done on each. The blood can then go around the obstruction to supply the heart with enough blood to relieve chest pain.

Bypass surgery relieves the symptoms of heart disease but does not cure it. Usually you will need to make a number of changes in your lifestyle after the operation. If your normal lifestyle includes smoking, a high-fat diet, or no exercise, changes are advised.

1. Source: Phase I, National Health and Nutrition Examination Survey III (NHANES III), 1988–91, CDC/NCHS and the American Heart Association.   back to article
2. Source: National Health and Nutrition Examination Survey III (NHANES III), 1988–94, CDC/NCHS and the American Heart Association.   back to article
3. Source: National Health and Nutrition Examination Survey II (NHANES II), 1976–80, CDC/NCHS and the American Heart Association.   back to article
4. A person is considered to have high blood pressure when he or she has a systolic pressure of 140 mm Hg or greater and/or a diastolic pressure of 90 mm Hg or greater, or is taking antihypertensive medication.   back to article