Vascular Disease Simplified: Causes, Types, and Prevention
Understanding the Different Types of Vascular Disease
During the Dark Ages of medicine, dying from heart disease meant the heart died. “He died from a broken heart” was a popular saying. Those days are gone, yet the mystery of heart disease has continued for many. Actually, most heart disease is vascular disease — also described as cardiovascular disease. Most problems attributed to a weak and/or diseased heart are caused by damaged blood vessels. Like any part of the body, when the heart is deprived of nutrition — and oxygen rich blood — it becomes weaker. Decreased blood flow to the heart over a period of time can thus weaken the heart. And shutting off blood flow to the heart due to an occlusion (clogging) results in ischemia — heart attack.
When narrowed arteries that feed the brain become clogged, this causes a stroke. The release of thrombin — blood vessel wall scar tissue — can clog one or more of the tiny vessels feeding brain tissues. The result is often brain damage. Damaged and narrowed arteries feeding the heart is coronary artery disease. Likewise, cor pulmonale heart disease is the obstruction of lung-heart blood vessels, often related to high blood pressure. Hypertension (high blood pressure) is caused by a lack of elasticity in the blood vessels — produced by the hardening (scarring) of damaged blood vessel walls. Varicose veins occur when the blood vessels that return blood to the heart become damaged. The lifter valves within the veins become weak, and don’t pump all the blood back to the heart. This accumulates blood in the veins and surrounding tissues — seriously engorging veins. Fibromuscular dysplasia, or FMD, is a swelling of the blood vessel walls. Recent research from the Mayo Clinic has found that at least 10 million Americans may unknowingly suffer from FMD. We can link most disorders related to heart disease or cardiovascular disease to one issue: damaged and weakened blood vessels: vascular disease, in other words.
So what is vascular disease?
Atherosclerosis is the typical scenario relating to blood vessel damage. Atherosclerosis occurs when the cells of blood vessel walls are injured by: 1: oxidized low density lipoproteins (LDL) 2: oxidized very low density lipoproteins (VLDL) 3: other oxidative radicals. The damage produces an immune response to heal the injury site. The immune system sends macrophages, Tcells, fibrin, plasmin, platelet-aggregating factor and other supporting players to the site to patch it up. The result is not unlike a scab, but it occurs inside the walls of blood vessels. This scabbing, or plaque, hardens the blood vessel walls and removes their elasticity and flexibility. It also results in a narrowing of the lumen — the opening through which blood flows. This loss of elasticity and narrowed lumen size results in high blood pressure and hardening of the arteries.
How do we know if we have vascular disease?
There are several tests that can reveal — by measuring inflammation markers — whether we have damaged, hardened and/or scarred blood vessels. These inflammation markers include homocysteine, fibrinogen and C-reactive protein. High levels of these indicate an increased immune response to blood vessel wall damage. As inflammation increases, the risk of thrombosis (and embolism) increases. Two test markers for this are betathromboglobulin and platelet factor 4. These indicate increased risk of heart attack, stroke and aneurysms. Physicians also measure cholesterol levels to gauge the oxidizing potential of LDL and VLDL. The ischemiamodified albumin marker measures a combination of abnormal cholesterol, vascular damage, inflammation, hypertension and hyperglycemia (high blood sugar — which can increase VLDL levels). The last National Heart Lung and Blood Institute’s (NHLBI) National Cholesterol Education Report detailed guidelines for serum cholesterol levels. The report showed that risk for vascular damage increases when total cholesterol is:
more than 200 mg/dL
triglycerides are more than 150 mg/dL
HDL-C is outside the 40 to 60 mg/dL range
LDL-C is above 100 mg/dL.
LDL levels above 130 mg/dL warrant therapeutic intervention, according to the report’s guidelines. Cardiovascular disease is still the number one killer in the U.S., and it is anticipated to remain number one through 2024. The American Heart Association has reported that one-third of Americans — about 80 million — have some form of cardiovascular disease, and almost half of Americans have cholesterol levels that increase their risk for heart disease.
The link between diet and vascular disease
Why is cholesterol so important? Remember that LDL cholesterol (and VLDL) easily oxidizes, and becomes a free radical that damages blood vessel walls. Foods that create high levels of LDL/VLDL in the body include fried foods, overly processed foods, sugary foods, saturated fats, hydrogenated oils — especially partially hydrogenated oils — and low fiber refined foods. Because the fatty acids in these foods have been degraded by high heat and other processing, they lend to higher levels of LDL/VLDL. A lack of fiber in the diet also lends to higher levels of LDL/VLDL. This is because fiber helps regulate and maintain healthy cholesterol levels by attaching to LDL/VLDL in the gut.
Green Tea: A Rich Source of Polyphenols with Heart-Healthy LDL-Lowering Benefits
Dietary strategies
A number of dietary strategies can significantly lower LDL/VLDL cholesterol, thereby reducing vascular damage. Even the conservative NHLBI has suggested “therapeutic lifestyle changes,” including reducing saturated fats to less than 7 percent of calories and increasing soluble fiber to 10-25 g/day. It also recommends plant sterols as “therapeutic options to enhance LDL lowering.” Let’s clarify these a bit further. Reducing saturated fat levels is an easy one. Most saturated fats are derived from animal products, so we can easily reduce saturated fat content in our diet by scaling these foods back. Increasing soluble fiber means eating more fresh fruits, vegetables and whole grains; and replacing processed foods with the real thing — whole foods. This means preparing whole yourself, a complete meal, rather than eating it in the form of a frozen dinner. Most nutritionists agree that 35-45 grams of fiber a day are important, with about three-quarters of that being insoluble. Yet, it is the soluble fiber that is most known for its cholesterol reducing abilities.
Sterols and polyphenols
Plant sterols make up the cell membranes of plant cells, and soluble plant fibers contain sterols. Research from the University of Toronto has established that plant sterols reduce LDL cholesterol levels. Plant derived phenols have also been shown to reduce lipoprotein oxidation and LDL/VLDL levels. Sterols and phenols do this by stabilizing the oxidized radicals that can damage blood vessels. They connect to and carry these “bad guys” that damage blood vessel walls out of the body. Some of the polyphenols showing significant LDL lowering benefits in the research include those from green tea, grapes and pomegranates. Most antioxidant fruits contain polyphenols and/or sterols.
Other heart healthy foods
Oats and barley contain significant portions of soluble fibers called beta-glucans. A 2007 analysis from the UK concluded that oats lowered total cholesterol and low density lipoproteins an average of 7 mg/dL among 10 different clinical studies. Despite its saturated fat content, healthy dairy reduces LDL. A study of 51 healthy adults in 2002 illustrated that CLA lowered VLDL-C and triglycerides. Probiotic dairy such as yogurt and kefir have shown additional benefit. These are rich in the blood-pressure lowering peptides valine-prolyl-proline (VPP) and tripeptide isoleucineproline- proline (IPP). USDA research has shown that polymethoxylated flavones (PMFs) can reduce cholesterol, high blood pressure and artery damage. PMFs are found in citrus fruits, especially in the peels. Apples have significant LDL lowering effects because of their high pectin levels. Pectin is rich in soluble fiber. Pectin has been shown to significantly absorb and remove LDL/VLDL in the gut. Avocado is good for vascular health. Avocados are rich in monounsaturated fats. They have been shown to reduce LDL cholesterol by as much as 18 percent. Another vascular friendly food is coconut and coconut oil. Coconut oil’s medium chain fatty acids have been shown to lower lipoprotein-A levels and reduce artery plaque. Garlic and onions have also been shown to reduce cholesterol levels and increase artery health. Many ascribe this benefit to their high levels of the antioxidant quercetin.
Vitamin D
Vitamin D has been shown to significantly reduce artery damage. A 15-year study that followed 559 adult women presented at an American Heart Association’s High Blood Pressure Research Conference found that vitamin D deficient women had triple the likelihood of developing hypertension. About 10-15 minutes a day of sun exposure produces the healthiest form of vitamin D, D3.
Staying Active: Monitoring Heart Health on the Go
Vascular disease and exercise
Exercise is also critical to preventing vascular disease. Why? Because exercise increases blood flow, increases the nutrient content of tissues, helps slow oxidation, and expands and contracts blood vessel walls. “Use it or lose it” is an apt statement when it comes to blood vessel health. When we exercise, our faster heart rate and blood flow increase the elasticity of blood vessels. The bottom line is that by eating a healthy diet and exercising regularly, we should be able to dodge much of the vascular diseases.
