The Australian Federal Government has recently announced that there will be about $73 rebate per patient given to Doctors so that Doctors can spend more time and offer a longer consultation with patients advising them of heart health – a heart health check. On the surface, this looks like a good initiative as the major cause of deaths in Australia is Cardiovascular disease. Something like one person dies per 30 minutes from CVD -mainly heart attack .. Doctors are expected in the visit to arrange cholesterol blood tests, test for high blood pressure and discuss lifestyle changes such as diets, and exercise. With patients who are deemed to be overweight discuss weight loss programs. This may be a big ask of Doctors for various reasons . Many Doctors work in bulk bill clinics and see one patient every 12 minutes so in reality to get them to fit in a 20-minute heart health consultation to discuss the above may be a stretch. By comparison, Naturopaths or Nutritionists, by comparison, a take up to an hour to go through the lifestyle and nutritional factors that can contribute to CVD. Heart Health is dependent on a range of lifestyle factors such as stress load, emotional happiness, diet and nutrition, exercise and heredity factors. Although Doctors are well placed to perform Medical tests there are questions on whether they are the right placement for lifestyle counseling. To add to the complexity many Doctors are overweight, suffer a high rate of CVD and also suffer a high rate of depression and suicide. Many are drug therapy orientated and reluctant to discuss diet and exercise to which many have not been trained. ( as compared with Nutritionists and Exercise physiologists) So an issue of credibility factor t comes into play here. Would you listen to someone about weight loss who themselves are overweight ??
Statins have become the drug of choice for assisting with the prevention of CVD and there has been considerable peer pressure for Doctors to prescribe these medications as a quick fix or to be seen as doing something for the patient whose cholesterol levels go above what the Drug companies recommend. The concept here is -” Well your cholesterol is up so to prevent a heart attack you will need to go on a statin ” This scenario is the commonplace most clinics throughout Australia and it is interesting to observe that the blood test prescribing level has come down over the years thus increasing the Statin scripts.
Interesting to note that in the USA approximately 25% of the population take statin medications yet more die of Heart disease than ever before.
Recent research, however, has shown the genesis of heart disease takes place in the blood vessels, mainly the small blood vessels feeding the heart muscle. These vessels can be prone to inflammation which can be caused by high blood sugar levels ( glucose), lack of nutritional factors that keep blood vessels soft and pliable and less likely to inflame for example Vit K, polyphenols and flavonoids. Flavonoids and polyphenols are phytochemicals found in plants that help keep blood vessel walls pliable and less prone to damage through oxidation. Cholesterol is a factor but cholesterol is there only to help heal inflamed tissues. The role of cholesterol is to repair damaged cells and tissues. If inflammation was not there then cholesterol would not be needed by the damaged blood vessels and not caught up in the inflammation process. If there is a lot of oxidation or damage to blood vessel walls then cholesterol is attracted to the area affected and can be caught up in the oxidative process and thus contribute to plaque build up. Once plaque has built up then calcification of the plaque may take place as the bodies method of sealing off the damaged tissue. Unfortunately, plaque and calcified plaque can be unstable and if it breaks loose it can lodge in a small blood vessel causing either stroke or Myocardial infarction – Heart Attack. This process is called Atherosclerosis.
Although being obese or overweight is a risk factor for CVD, Heart attacks do occur in slim people due to the oxidative damage in the blood vessels. This oxidative damage does not develop overnight but occurs over years of wear and tear on the blood vessels due to the factors that have been mentioned. It is not unusual to have persons in younger age brackets to have heart attacks.
Interestingly although exercise is good for the heart and blood vessels, too much exercise can promote oxidation of tissues due to the high velocity of the blood on blood vessel walls ( and the action of glucose as well ) Oxidative stress can lead to inflammation of the blood vessel walls as they release inflammatory chemicals as a response . These chemicals then promote a cascade of chemical reactions that can lead to the thickening and damage of blood vessel walls causing them to stiffen. This process is called Arteriosclerosis.
In part 2 we will discuss how to prevent CVD and what questions that may be useful to ask your Doctor before taking Statins.