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Cardiovascular

   Heart disease

Heart disease – and how to prevent and even reverse it – is a classic example of how the drug companies have oversimplified the problem and attacked the wrong targets with yet another set of ‘magic bullets’.

It’s also an example of how inexpensive and simple lifestyle changes can succeed where multi-billion-pound Big Pharma is failing.

Heart disease is usually the number one cause of death in the UK, although every now and then (as is the case today) cancer nudges ahead. In 1996 coronary artery disease was responsible for 24% of all male deaths in England in the over-65 age group, with strokes and other circulatory disease bringing the total death rate to 33%. Women are slightly less at risk but here too the figures are dispiriting, with heart disease causing 21% of all deaths.

The UK statistics, already the worst in the world, are due to get worse – in line with the increasing figures for obesity and diabetes. For example, Irish and Scots men are three times more likely to die of coronary artery disease than their French counterparts, and their wives are nine times more likely to die in this way than their French sisters. This is the well-known French Paradox.

It certainly does seem unfair that the French, with their full fat cheeses and their pestilential Gauloises and Gitanes, should enjoy such immunity. The reasons for this immunity are becoming progressively clearer, and are everything to do with the French lifestyle – and especially their diet. It’s not any one individual item on the menu but a heart-healthy combination of fresh fruits and vegetables, olive oil, red wine, dark chocolate and black coffee – and the nutrients in them.

Of course, there are always Big Pharma’s drugs – and plenty to choose from! In the pre-heart attack phase there are drugs to lower cholesterol, drugs to lower blood pressure and drugs to make blood platelets less sticky.

As the disease progresses and angina sets in there are drugs to slow the heart and reduce its workload, so that it requires less oxygen. And once the heart attack has occurred, there are drugs to alleviate the pain, drugs to dissolve blood clots and drugs to reduce the risk of a fatal arrhythmia. Sorted?

No. The drugs are expensive and cause many adverse effects. The ACE-inhibitors, for example, have one of the worst track records of any drug category for causing adverse effects. To make matters worse, the impressive array of drugs listed above is lamentably ineffective – they may treat some of the symptoms of heart disease, but they do little to prevent it from worsening, as our national statistics so clearly show.
 
Why are we getting it so wrong?

   MAGIC BULLETS, WRONG TARGET

For one thing, the drugs (which are, like all magic bullets, aimed at very specific targets) are fundamentally misguided. In the incipient heart attack victim many things are going wrong. So any strategy designed to knock out just one single element in the complex array of metabolic imbalances that drive the growth atheroma, is bound to be relatively ineffective.

Atheroma is the term that describes the fatty deposits on the lining of the arteries – ie furring of the arteries. Atheroma narrows the arteries, causing increased blood pressure and can result in angina, heart attacks and strokes.

In addition, the choice of targets involved in the design of most of the drugs in current use is poor, to put it mildly. None of them actually addresses the main problem which is a chronic inflammation of the arteries, known as Endothelial Dysfunction or ED.

When the lining of the arteries is inflamed, several potentially damaging mechanisms come into play. The degree to which arteries become narrowed, for example, is the end result of a balance of ‘dilator’and ‘constrictor’ influences. Dilators encourage the arteries to keep open, dilators encourage them to close.

When ED develops, the arteries become less sensitive to dilators and the constrictors dominate. The arteries narrow, and blood pressure goes up. At the same time, the sites of the inflammation attract immune cells that migrate into the inflamed tissue and break down, forming atheroma. (This is the main reason why high blood pressure is associated with an increased risk of heart attacks. Both have a common cause, namely the inflammation of ED.)

The vital significance of ED has not yet been recognised by the drugs industry. They are still selling products based on the now substantially discredited idea, dating back to the ’50s, that excess cholesterol in the arteries is due to excess cholesterol in the blood, which in turn is largely due to excess cholesterol in the diet.

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