THE ROAD TO HEALTH: Heart Disease Prevention Through Lifestyle. J. Mauricz

In 1974, Marc Lalonde, Health Minister of Canada, published the report “A New Perspective on the Health of Canadians” in which he described the concept of “health fields”. This diagram is certainly known to graduates of faculties related to health promotion. Lalonde argued that health care, the physical environment, and even genetic factors  contribute even less than 50% to the possibility of maintaining health or developing a disease.

The contribution of factors that influence our health is as follows:

• health care – 10%
• genetic factors – 16% 
• physical environment – 21% 
• lifestyle – 53%

 

This means that our health is in our hands, and the choices we make every day constitute a 53% chance of maintaining it. 

 

So how do we make these daily choices? When we look at the statistics, our choices are really poor. Cardiovascular diseases are the leading cause of death worldwide. Nearly 40% of people die as a result of atherosclerosis which leads to a heart attack. Other equally important diseases include atrial fibrillation, hypertension, and  cardiovascular diseases that often reflect our overall health.

 

 

The results of the WOBASZ study show that our health outlook for keeping the heart in good shape is quite unfavorable:

• Overweight and obesity – 68% of men and 56% of women;
• Lack of physical activity – 57% of men and 55% of women;
• Dyslipidemia and hypercholesterolaemia – 70% of men and 64% of women;
• Hypertension – 46% of men and 40% of women;
• Smoking – 30% of men and 21% of women.

It is a disturbing fact that at least 1 risk factor is present in 90% of men and 89% of women. Other risk factors include, for example: insulin resistance, non-alcoholic fatty liver disease (NAFLD), menopause, metabolic syndrome, diabetes, hormone replacement therapy, and doping. When we consider just the disturbances in human carbohydrate metabolism, the future doesn’t look promising. Over 3.5 million Poles suffer from type 2 diabetes, and 5 million suffer from prediabetes. This is the moment when we do not have fasting glucose levels above 125 units or above 200 after a meal, but it is close. We can call it a semi-diabetic state. Pre-diabetes, however, does not come from nowhere. It preceded by insulin resistance. Here again we have a problem, because the statistics are unclear. It is not known how many people in Poland suffer from insulin resistance, because it is estimated that even every third patient has not yet been diagnosed and does not know about their disease. Meanwhile, early diagnosis and proper treatment – especially with the help of an appropriate diet and physical activity – make it possible to avoid complications that are dangerous to health, such as a heart attack. 

 

What if you are a prince or a fairy tale princess? You are not overweight, you don’t smoke, don’t have high blood pressure, but you’re crazy about training?

 

 

Over 42% of the so-called healthy population has hidden postprandial hypertriglyceridemia, posing a direct threat to health and life. These are the results of research conducted in the United States of America, but if translated into Polish reality, it would mean that about 8 million Poles are at risk of improper fat metabolism.

 

Diagnostics

So far, thinking about risk factors for the development of cardiovascular diseases has been limited to the use of statins and the implementation of a diet with a lower fat content, especially saturated fat. The need to limit salt and alcohol as well as smoking tobacco products are also mentioned. It must be admitted that these recommendations are not perfect. Firstly, the issues related to the harmfulness of saturated fatty acids to human health are most often not true. People with the Apo E polymorphism have problems with metabolizing them, but this is a fairly narrow group of people. Let’s think a bit. If meat or coconut oil were actually harmful, a large part of the inhabitants of Asia and Oceania would not live to be 40 years old… 

There are many indicators of atherogenicity. Total cholesterol, total cholesterol to LDL ratio, and more. The reference ranges that should be found in a healthy person with a minimal risk of developing cardiovascular disease are:

• Fasting glucose < 90
• HDL > 45 < 85
• TG > 45 < 85
• HDL = TG  
• HDL : LDL = 1 : 2-3
• LDL > 100 < 200
• ESR < 3 CRP < 1
• Homocysteine > 6 < 8
• Low AST and ALT
• ASO < 200

Is that all? Unfortunately no.

 

Postprandial lipemia is an independent risk factor for coronary heart disease. It is associated with increased blood levels of exogenous fatty acids and exogenous and intrinsic triglycerides, as well as increased inflammatory activity. Food-induced changes in lipid levels may persist for up to 12 hours after a meal, although after a standardized high-fat meal, changes in lipids peak after 3-4 hours. In people with metabolic syndrome, hyperlipaemia or type 2 diabetes, postprandial lipemia, measured as the absolute increase in triglycerides, reaches greater values than in healthy subjects. Increased postprandial lipemia may be a significant factor for residual risk, i.e. cardiovascular risk, in those who have atherogenic dyslipidemia (hypertriglyceridemia, HDL deficiency, and the presence of small, dense LDL).

 

Oral Fat Tolerance Test (can be compared to the oral glucose load test, but is used to assess lipid metabolism. The test provides information about abnormal postprandial fat metabolism.

Lipid Test Control is a standardized diagnostic meal used to diagnose abnormal postprandial triglyceridemia.

The relative indications for conducting an OFTT are: prophylactic examination of the lipid profile in all men over 35 years of age and women over 45 years of age, abnormal TG level in fasting and non-fasting tests, diagnosed atherosclerosis, type II 2 diabetes, insulin resistance, arterial hypertension, coronary artery disease, overweight (BMI over 27 kg / m2), lack of exercise, smoking, menopause, negative family history.

 

Nutrition rules

To sum up, our daily diet is mostly processed, rich in salt and sugar as flavorings and trans fatty acids to enhance taste sensation and prolong shelf life of food products. There is also a huge amount of wheat, which we eat in the form of buns and donuts, rolls, pizza, wafers, toast and all kinds of other food products such as pasta, noodles, dumplings,  and more. As a result of such a diet – rich in flour and often greasy, by adding cream, butter, lard, rapeseed oil and other fats, we supply the body with an excessive amount of calories, thus spoiling our shape, well-being and health. The consequences of overweight and obesity are the deterioration of the condition of the cardiovascular system, and hence the straight path to atherosclerosis and death. Remember also about triglycerides, it’s a silent killer.

 

 

Bibliography:

1. Drygas W i wsp. 2015, Waśkiewicz A i wsp. 2015, Kwaśniewska E i wsp. 2016, Pająk A i wsp. 2016, Stępaniak U i wsp. 2016. Wieloośrodkowe Ogólnopolskie Badanie Stanu Zdrowia Ludności – WOBASZ.
2. Skończyńska A i wsp. Lipemia poposiłkowa u mężczyzn z hiperlipemią i nadciśnieniem tętniczym. Arterial Hypertension 2010, vol. 14, no 1, pages 66–73.

Jakub Mauricz

Dietitian, expert in nutrition and supplementation, graduate of the Medical University of Gdańsk. He was responsible for the nutrition and supplementation care of professional athletes (including Joanna Jędrzejczyk, Mamed Khalidov, Michał Materla). Author of many recipes for food products and dietary supplements.