New Guidelines on Cardiovascular Disease Miss Mark

Well, they’re at it again. New guidelines on reducing cardiovascular disease risk have been released. They’ve called these “much anticipated,” however, I call them “inconsistent with research” and “likely to cause more harm than good.” The guidelines, appearing in Circulation, are likely to change clinical practice, unfortunately. They are the result of collaborations among the American Heart Association, the American College of Cardiology, and other organizations.

Essentially, it makes it far easier for physicians to prescribe statins (cholesterol lowering medication). It will likely result in tens of millions more Americans begin put on these medications.

Let’s start with the things that I do agree with in the new recommendations.

Obesity

There’s no single, ideal diet for weight loss. Intensive, supervised lifestyle changes for at least 6 months received strong endorsement. This is important. We offer professionally supervised weight loss programs at our office for the simple reason that it reduces the risk of many diseases and it can be very difficult to manage alone.

That’s it. That’s all I agree with. The rest of the recommendations fail to actually focus on the problem: INFLAMMATION! They focus far too much on treating cholesterol without any actual targets in mind to treat.

Inflammation

“The traditional view of atherosclerosis [hardening of the arteries] as a lipid storage disease [cholesterol accumulation] crumbles in the face of extensive and growing evidence that inflammation participates centrally in all stages of this disease, from the initial lesion to the end-stage thrombotic [clot forming] complications.” This quote is from a great study that reviews the mechanism behind cardiovascular disease. I added the information in the brackets to make it easier to understand.

The pharmaceutically-driven marketing and media would have you believe that high cholesterol alone will cause it simply to accumulate in your vessels eventually narrowing them so much they can no longer deliver enough blood to your brain or heart. Or alternatively, the narrowing causes a clot to form only to be dislodged and sent “downstream” where it gets caught in smaller arteries causing a heart attack or stroke.  This just isn’t true! Want to know what actually happens!!!?

How you actually get atherosclerosis:

Inflammation is central to this process. It begins with inflammatory changes in the cells that line your blood vessels. These cells are collectively called the endothelium. The cells begin to express adhesion molecules. These molecules do what they sound like – they make things stick! However, they don’t make cholesterol stick, they attract monocytes (a type of white cell), which then travel through the walls of our arteries (BAD) under the influence of various proinflammatory molecules designed to attract more white cells. Once within the arterial wall, the monocytes continue to undergo inflammatory changes, transform into another type of white cell called a macrophage, swallow up cholesterol, and they become what is called a foam cell. T lymphocytes (another type of white cell) also migrate into the arterial wall, where they release proinflammatory cytokines (messengers) that amplify the inflammatory activity. Through these inflammatory processes, the initial lesion of atherosclerosis, called the fatty streak, is formed. This continues to evolve to cause the dangerous atherosclerotic plaque, but every step along the way involves inflammation!

There you go – as you can see, it is not caused simply by the accumulation of “too much” cholesterol as it floats through your blood stream. It all starts because of inflammation. Without the inflammatory process the white cells of our body cannot penetrate the walls of our vessels. If they cannot get into the walls of our vessels, they cannot swallow up cholesterol and begin to build plaque. It really is that simple.

So what causes inflammation?

That’s a great question and very easy to answer. Poor diet and low levels of exercise cause inflammation to build leading to atherosclerosis. A diet that is high in refined sugar increases inflammation. A diet that is low in antioxidants (brightly colored fruits and vegetables) increases inflammation. And exercise is inherently anti-inflammatory; therefore, low levels of exercise drive up inflammation. Here are the basic diet and exercise recommendations everyone should follow:

Diet

Every time you eat, have a source of healthy protein (chicken, fish, grass-fed beef, bison, etc.) and a fruit or a vegetable. Make the emphasis on vegetables. Keep grain (yes, even whole grains) to a small portion of your diet (no more than once per day).

Exercise

Combine resistance training with cardiovascular training. Get at least 45 minutes of moderate activity 3 times per week. High intensity interval training is very beneficial.

If you incorporate these things into your life, you’ll avoid inflammation and you’ll live a long, healthy life without statins!!!