Cardiovascular Disease

By Liz Pearson

THE CHALLENGE
Our current environment has been referred to as “obesogenic” – an environment where it’s extremely challenging to maintain a healthy body weight. Based on the Canadian Community Health Survey, rates of obesity for adults has doubled over the past two decades and tripled for adolescents. More than one out of every two adults in this country has an unhealthy body weight (36 per cent are overweight, 23 per cent are obese). One out of every four Canadian children needs to lose weight (18 per cent are overweight, 8 per cent are obese). And the numbers continue to climb.

Obesity is now recognized as a major risk factor for cardiovascular disease. It increases blood cholesterol, triglycerides and blood pressure and is linked to a significantly higher risk of diabetes. About three-quarters of people with diabetes die of some form of cardiovascular or blood vessel disease. Losing weight and keeping it off, although achievable, is a challenge for most people. The National Weight Control Registry consists of over 4,800 individuals who have been successful in long-term weight loss maintenance. Although the Registry has found very little similarity in how people lose weight, those that keep it off are more likely to do the following: eat a relatively low-fat diet, eat breakfast daily, weigh themselves regularly, and engage in high levels of physical activity (about one hour per day).

Heart Healthy Tip:
Abdominal fat is especially bad for the heart – it releases more inflammatory hormones and fatty acids than other body fat. That’s why measuring waist circumference may be a better indicator of cardiovascular disease risk than body mass index (BMI). A waist circumference of more than 35 inches/88 cm for women or 40 inches/102 cm for men means a higher risk of heart attack and stroke.

CARDIOVASCULAR DISEASE & PHYSICAL ACTIVITY
Physically inactive people have about double the risk of cardiovascular disease. Regular activity helps protect the heart by helping maintain a healthy body weight and reducing insulin resistance, high blood pressure, unhealthy blood fats, inflammation and the formation of blood clots. It also enhances insulin sensitivity, blood sugar control and blood vessel health. A minimum of 30 minutes a day of moderately intense physical activity on most days, and preferably all days, is recommended for those seeking a healthy heart. For weight loss and management getting closer to an hour of activity daily is preferable.

Heart Healthy Tip:
If you don’t already own one, consider a step counter. By keeping track of how many steps you take in a day, pedometers motivate people to add more activity to everyday living. Start by adding an extra 2,000 steps a day, which is equivalent to one mile. Remember, the best exercise is the one you enjoy and can do over and over again. Brisk walking is a great form of exercise. It can get your heart rate up and give you a solid workout. Plus it’s free and you can do it with friends for extra motivation!

PREVENTATIVE HEART HEALTHY NUTRITION TIPS
In the past, much of the nutrition advice for the prevention of cardiovascular disease focused on foods we should stay away from or avoid. Minimizing our intake of certain foods, such as those high in trans fats or saturated fats, is clearly essential. However, a tremendous amount of research now demonstrates that including certain foods in our diet, such as those rich in omega-3 polyunsaturated fats, as well as many plant-based foods, is critical for optimal heart health. Here’s my top 10 list for a diet based on the prevention of cardiovascular disease:

1. Your heart loves omega-3 polyunsaturated fats
Omega-3 polyunsaturated fats, found in higher fat fish like salmon, have been called as potentially potent as any high-tech drug and one of the most overlooked defenses against cardiovascular disease. Some researchers consider these fats the most important nutritional factor influencing cardiovascular disease risk. Omega-3 polyunsaturated fats help prevent irregular heart rhythms, reduce the risk of blood clots, inhibit plaque build-up, promote plaque stability, lower blood triglycerides, and relax blood vessel walls. Omega-3 fats come from plant sources, such as canola oil, walnuts and flaxseed, and marine sources, such as higher fat fish like salmon, mackerel, herring and sardines. Both plant and marine source omega-3 fats protect the heart, however, marine or fish source omega-3 polyunsaturated fats provide significantly greater protection as they are incorporated directly into cell membranes throughout the body, including the heart. Both types should be included in a heart healthy diet. Try eating higher fat fish like salmon, mackerel, herring, rainbow trout or sardines at least twice a week. Talk to your doctor about fish oil supplements. Make plant source omega-3 polyunsaturated fats (canola oil, walnuts, flaxseed) a regular part of your diet.

Heart Healthy Tip:
Butter or margarine? Choose a margarine that is non-hydrogenated, low in saturated fat and contains at least 0.4 grams of omega-3 polyunsaturated fats per serving. Choose heart-healthy oils like extra virgin olive oil and canola oil.

2. Trans fats and saturated fats: proceed with caution
We need to eliminate trans fats and minimize our intake of saturated fats. Both of these fats increase LDL cholesterol (the bad cholesterol that clogs arteries). Trans fats are especially nasty, as they also decrease HDL cholesterol (the good cholesterol that carries cholesterol out of the blood stream), make arteries stiff, and can prevent the conversion of plant source omega-3 polyunsaturated fats to the more beneficial marine source omega-3 polyunsaturated fats. According to the Heart and Stroke Foundation of Canada, trans fats are considered 4 to 10 times more harmful to heart health than saturated fats. They are found in some processed foods, such as cookies, crackers and snack foods, as well as deep-fried foods, like French fries and donuts. Avoid foods that contain hydrogenated vegetable, palm and coconut oils, as well as vegetable oil shortening. To minimize saturated fat intake:

  • Choose low fat milk products.
  • Choose lean meats, with an emphasis on “loin” and “round” cuts.
  • Take the skin off chicken or turkey
  • Pay attention to your intake of cheese, butter, ground beef and higher fat luncheon meats – all can significantly contribute to saturated fat intake. Cheese is the largest contributor of saturated fat in the North American diet.

While it’s important to limit or moderate overall cholesterol intake from food, for most people this doesn’t mean taking eggs off the grocery list. Limit consumption to no more than one egg daily and buy omega-3 eggs (they still contain cholesterol, but are higher in omega-3 polyunsaturated fats and vitamin E). This advice does not apply to people with diabetes, those at higher risk for cardiovascular disease or who already suffer from cardiovascular disease.

Heart Healthy Tip:
To avoid unhealthy fats, become an avid label reader. Look for products that are low in saturated fat (two grams or less per serving) and trans-fat free. Choose products that contain mostly polyunsaturated fats (including omega-3 polyunsaturated fats) and monounsaturated fats.

3. Load up on colourful fruits and veggies
The five-a-day fruit and vegetable message has long been linked to a lower risk of cancer. More recently, many health organizations are putting fruits and vegetables at the top of the list for a healthier heart. Fruits and vegetables contain an incredibly powerful mix of nutrients, fibre and plant compounds. Potassium is critical to a healthy blood pressure and reducing the risk of stroke. Folate helps reduce homocysteine in the blood, potentially decreasing damage to artery walls. Antioxidants – like vitamin C, vitamin E, beta-carotene and lycopene – reduce free radical damage or oxidation of LDL cholesterol (oxidized LDL is more likely to build-up inside artery walls). Fibre, especially viscous or soluble fibre, helps lower LDL cholesterol. The more fruits and vegetables we eat, the healthier our hearts will be, however, even just one extra serving daily is linked to a significantly lower risk of cardiovascular disease. Eating five, and ideally closer to 10 servings of colourful fruits and vegetables each day is what we should aim for. Include fruits and vegetables at every meal and snack, don’t leave home without them, and eliminate the competition (those less healthy foods that make you less likely to reach for the good stuff). One serving is a medium-size fruit or vegetable, 1 cup of salad or ½ cup of frozen vegetables or canned fruit.

Heart Healthy Tip:
Make colourful produce like broccoli, cantaloupe, carrots, mangos, oranges, tomatoes, red and green peppers, squash, sweet potatoes, kiwi, berries and dark leafy greens a regular part of your diet. They’re nutrient-rich and potent heart protectors.

4. Eat the whole grain, especially the bran
Whole grains – including whole grain wheat, corn, rice, oats, barley, quinoa, sorghum, spelt and rye – are made up of three parts: bran, endosperm and germ. When grains are refined to make white bread, white rice or refined breakfast cereals, the bran and germ are removed. The bran and germ, however, are loaded with heart healthy nutrients and plant compounds. The bran is rich in fibre, antioxidants, cholesterol-lowering plant compounds and minerals like magnesium – all important for heart health. The germ contains nutrients like vitamin E, copper and selenium, along with other plant compounds that fight disease. Based on a Cornell University study, about 80 per cent of plant compounds with potent antioxidant activity, such as the phenols and flavonoids, are found in the bran or germ fraction of the whole grain. Research from Harvard suggests the bran in particular, may be the most important player in heart health – so start each morning with a high-fibre, bran cereal. Viscous or soluble fibre found in whole grains like oats, barley are rye have been shown to lower blood sugar levels, reduce insulin requirements, and reduce blood cholesterol – all important factors in reducing the risk of cardiovascular disease. Researchers and health experts agree that every bit of whole grain you eat contributes to your health. Aim for at least three or more servings a day. One serving is a slice of bread, 30 g of cold cereal, ¾ cup of hot cereal, ½ a pita, or ½ cup of pasta.

Heart Healthy Tip:
The Whole Grain Council provides a list of generally accepted whole grain foods and flours. Visit www.wholegrainscouncil.org for more information.

5. Enjoy nuts every single day
It appears that eating nuts regularly may provide as much protection for the heart as taking a lipid-lowering medication. Many large scale studies support the strong link between nuts and heart health. Like fruits, vegetables and whole grains, nuts contain a complex mix of nutrients, fibre and beneficial plant compounds. In addition, nuts contain primarily good-for-your-heart mono and polyunsaturated fats. Adding more nuts to the diet is also one of the tastiest and easiest lifestyle changes most people can make. Is one type of nut better for your heart? Almonds are especially rich in vitamin E and magnesium. Peanuts are a great source of folate. Walnuts excel in omega-3 polyunsaturated fats. Eating a variety of nuts probably makes the most heart sense. Eat a small handful (about 1 oz/28g or ¼ cup) of unsalted, plain dry roasted nuts every day.

6. More beans please!
Beans or legumes have been called the best human plant food there is and potent tools in the treatment and prevention of chronic disease. A review of 11 studies highlights the benefits of beans for heart health. Eating beans lowers total cholesterol, LDL cholesterol and triglycerides, as well as increasing HDL cholesterol. Regular bean eaters are more likely to have a healthy body weight, healthy blood pressure and healthy blood sugar levels. They are at a lower risk of developing diabetes – a major risk factor for the development of cardiovascular disease. Beans are loaded with fibre, including viscous or soluble fibre (one half cup of most beans contains about seven grams of fibre). They’re rich in heart healthy nutrients like potassium, magnesium and B vitamins, including folate. Many beneficial plant compounds are found in beans, such as the isoflavones found in soy. In the Shanghai Women’s Health Study, involving 75,000 Chinese women, consuming one to two servings of soy daily was linked to a 75 per cent lower risk of cardiovascular disease. Making beans a regular part our diets should be a priority for everyone. Try to eat beans at least three times a week as a replacement to meat. Consider making soy, which is especially good for your heart, a regular part of your day.

Heart Healthy Tip:
Beans are antioxidant all-stars. Researchers tested the antioxidant activity in the skin of 12 common varieties of dry beans. Black beans demonstrated the greatest antioxidant activity followed by red, brown, yellow and white beans. Other types of beans include baked beans, peas and chickpeas.

7. Flavonoids: powerful plant compounds that protect your heart
Certain foods – like berries, pomegranate juice, cinnamon and dark chocolate – are rich in plant compounds called flavonoids. Emerging research suggests these compounds may be powerful protectors of the heart. As potent antioxidants, they help prevent plaque build-up by preventing oxidation of LDL cholesterol. They are important to the health of the endothelium – the cells that line blood vessel walls. By boosting nitric oxide production, for example, they help keep blood vessels dilated. Flavonoids also appear to have strong anti-inflammatory activity. Inflammation is now believed to be a key factor in the development and progression of cardiovascular disease. Eat flavonoid-rich foods daily for a healthy heart. Enjoy berries on your morning cereal or add frozen berries to low-fat milk shakes, yogurt or smoothies. An apple a day, with the peel on, is as good advice as ever. Enjoy a small glass of pomegranate or grape juice. Take time for green or black tea – three cups daily is good for your heart. Spice up your meals with plenty of herbs, spices, and onions. Leave room for high-quality chocolate (just a taste of dark chocolate will do)!

8. Slash the salt
High blood pressure is a major risk factor for cardiovascular disease and stroke. The science on salt and its link to high blood pressure is more solid than ever. In the DASH trial (Dietary Approach to Stop Hypertension) eating less sodium reduced blood pressure most in those eating a typical North American diet, however, even in those following a healthier diet plan (packed with fruit, vegetables and low fat dairy) lowering sodium dropped blood pressure significantly. The National Academy of Sciences recommends a sodium intake of 1,500 mg daily, with 2,300 mg (about a teaspoon of salt) being the maximum daily limit. Almost all Canadians exceed this limit and greater efforts are needed to slash sodium from the diet.

Heart Healthy Tip:
Easing off on the salt shaker is not enough. As much as 85 per cent of sodium comes from processed foods. Read labels and choose lower sodium products more often. Most fast foods are also salt landmines.

9. If you choose to drink alcohol, moderation is the key
More than sixty studies support a link between moderate alcohol consumption and a healthier heart. Alcohol protects the heart by increasing HDL or “good” cholesterol and decreasing the risk of blood clots. All types of alcohol protect the heart, however, red wine may provide further protection due to its flavonoid content. Excess alcohol consumption may increase blood pressure, triglycerides and the risk of stroke. If you do choose to drink alcohol, moderation is considered no more than two drinks daily for men and one drink daily for women. One drink is equal to 1.5 ounces of spirits, 5 ounces of wine or 12 ounces of beer. If you don’t drink, don’t start – simply focus on eating heart healthy foods like fruits, vegetables, nuts, beans and whole grains.

10. Don’t rely solely on supplements for the answer
At this time, the scientific data does not justify the use of high dose, antioxidant vitamin supplements – such as vitamin C, vitamin E or beta-carotene – for the prevention of cardiovascular disease. If you do take a supplement, a multivitamin is the best choice. A multi contains a balanced blend of all nutrients, including the B vitamins, such as folate, that may reduce cardiovascular disease risk by decreasing homocysteine in the blood. Eating whole foods is the best route to a healthy heart.

CONCLUSIONS
Based on a U.S. survey, two thirds of doctors provide nutrition counseling in no more than five minutes to 40 per cent of patients or less. Many doctors say they lack confidence in the ability to counsel patients about diets they feel patients don’t need or want. If we want to prevent cardiovascular disease, we need to devote far more time and energy to education. More dietitians need to be involved. People will make dietary changes – especially when they perceive them as important and achievable. Advice must be customized to fit personalities, lifestyles and ethnic background. Finally, more research is required to understand the barriers to healthy eating, including the impact of eating in social situations and dining out.

To improve the cardiovascular health of Canadians we should:

Never underestimate the impact of nutrition on heart health
Research supports emphasis on omega-3 polyunsaturated fats, fruits, vegetables, whole grains, beans, nuts and flavonoid-rich foods with restrictions on trans fats, saturated fats and sodium. Alcohol, if consumed, should be consumed in moderation.

Start early
Eating habits established in childhood can be entrenched by adulthood. Obese children as young as seven already have the beginnings of cardiovascular disease. Obese teenagers may be heading for heart attacks in their 40’s.

Dedicate resources to obesity education
The incidence of cardiovascular disease is highest among people who are obese. Research and education must be devoted to weight control, with much more emphasis on the prevention rather than the treatment of this problem.

Focus on keeping healthy people healthy
Researchers from the University of Liverpool estimate that by targeting people who are currently healthy we could prevent four times as many deaths as focusing on those who already suffer from cardiovascular disease. Prevention is the name of the game!

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