Assembling The Bomb

”Few of us need to develop coronary artery disease and yet essentially all of us do,” says Dr. Jerel Zoltick, MD COL USA Cardiologist at the Walter Reed Army Medical Center and Pentagon. “It is a dynamic process that begins early in life, culturally manufactured by our sedentary lifestyle, smoking--including second hand smoke—fast food, processed food, high saturated fat, trans-fatty acids, lack of monounsaturated fats, lack of whole food, sugary carbohydrates, lack of fresh fruits and vegetables, and too much stress.”

All of these risk factors have one common denominator: they reduce the production of nitric oxide, altering the blood vessel lining (endothelium) from smooth to sticky. Like fly paper, the wall traps circulating cholesterol, where it oxidizes. The body sees the oxidized cholesterol as an invader and mobilizes white blood cells to attack. In the process of gobbling the cholesterol, the white blood cells ingest tissue, burrowing holes in the vessel wall and causing injury. Platelets mobilize to seal off the ragged edges. More distress signals are sent out, but the overwhelmed white blood cells can¹t keep up. In a last-ditch attempt to destroy the invader, they produce a deadly free radical called superoxide anion. This does not destroy the enemy, but causes more damage and the formation of a fatty streak. Unable to get a handle on the ulcerating mess, it¹s decided to seal it off. Growth factors summon fibroblasts and smooth muscle cells to form a cap, and this forms the plaque. The plaque may protrude into the vessel (lumen) or remain hidden in the wall, waiting to explode. 

Who develops more plaques and how unstable they are is multifactorial, and even then, there are individual differences. Dr. Zoltick asserts that, “I can take three people and all look alike and they have all of the same characteristics…and a lot of the same numbers, but they're developing arteriosclerosis at different rates.”

Diffusing the Bomb

A plaque is not an inert lump of lard but a living complex of cells and debris whose behavior can be changed. You can change the ulcerous, unstable plaque into more stable, fibrous plaque. Better yet, you can make it go away by soothing the inflamed inner lining of the arterial wall, which is called the endothelium.

First, stop what contributes to inflammation by limiting risk factors such as smoking, obesity, poor diet, uncontrolled diabetes, and lack of exercise. Of these, smoking is the greatest pro-inflammatory behavior. It has to go. 

What about the paradox of needing to exercise while exercise itself can trigger sudden death? Walk or choose another exercise that does not demand a great increase in blood flow suddenly. Dr. Zoltick advises men 50 or older to get a thorough workup, preferably by a cardiologist, before they engage in rigorous exercise. 

"I like to do two CRP tests, which helps to determine if it is reading inflamed arteries or a secondary infection," says Zoltick. "I would also do blood pressure, blood sugar, LDL/HDL [low density lipoprotein/high density lipoprotein], Lipo-A, cholesterol, triglycerides, a stress test, and homocysteine." (Homocysteine damages the endothelium of blood vessels, which greatly facilitates inflammation.)

Poor diet is where people become lost. Yet, it is key to preventing and reversing heart disease. 

"What you eat has a dramatic effect on the health of your endothelium," states Cooke.

You should eat seven to nine servings of fruits and vegetables per day. However, we know it is not so easy to change lifelong eating habits. A large change may be ideal, but some modifications can have large effects.

Decide never to eat another donut or at a fast food restaurant again. Replace simple carbohydrates, such as white rice, white bread, pasta, and potatoes, with complex carbohydrates, such as beans, legumes, and brown rice. Be generous with olive oil and garlic. When you get hungry for a snack, go for nuts, seeds, and fruit. 

You can eat a "typical" meal, but make some substitutions. Instead of bacon and eggs, have an omelet (the whole egg, not just the whites) with asparagus, mushrooms, and tomato. Forget the fried potatoes and instead have a glass of grapefruit juice with a teaspoon of Metamucil. For dinner, you can have a steak, but forget the baked potato with butter and sour cream. Instead, have coleslaw with carrots, raisins, peanuts, and some spicy black beans. Drink a glass of wine with dinner, and every afternoon, drink a cup of black tea.

An arsenal of supplements also can reduce inflammation and restore arterial health, including alpha lipoic acid; L-arginine; L-carnitine; coenzyme Q10; horse chestnut seed extract; grape seed extract; red grape juice; red wine; red rice yeast; black tea; soy, fish; fish oil supplements; olive oil; flaxseed; vitamins B6, B12, and B3 (niacin); folic acid; vitamin C ester; and psyllium such as Metamucil. 

Some people have a genetic predisposition to plaque formation and need pharmaceutical intervention. The statins, which often are given in combination with niacin, can have a dramatic effect on lowering "bad" LDL cholesterol and can help bring down inflammation. Having a family history of heart disease, however, doesn't necessarily mean you have bad genes. 

"Family is more than just genetics," says Zoltick. "We act like our parents, we eat like our parents." 

Many people still eat the same seven or eight unhealthy meals they're used to eating, adds Zoltick. You can break the cycle, however, by creating seven or eight new meals that contain foods that are healing to the heart.