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If you’re one of the 13 million Americans who have survived a heart attack or been diagnosed with heart disease, Dr. Janet Bond Brill offers a delicious and foolproof plan that can lower your risk of a second heart attack by up to 70 percent. Inspired by the heart-healthy Mediterranean diet, the Prevent a Second Heart Attack Plan is based on satisfaction, rather than deprivation.
Backed by cutting edge research, Dr. Brill explains:
• Why the Mediterranean diet is the gold standard of heart-healthy eating
• How “good carbs” such as oatmeal and popcorn lower bad cholesterol, prevent high blood pressure, and control your weight
• The science behind eating fish for heart health
• Why having a glass of red wine with dinner is great for your heart—and which wines are the best choices
• The easiest, most delicious daily habit that will cut your heart attack risk
Packed with every tool you need to eat your way to better heart health--including daily checklists, a complete two-week eating plan, and dozens of mouthwatering recipes to suit every meal, taste, and budget—Prevent a Second Heart Attack provides you with the knowledge, skills, and confidence to live long and enjoy the good life, the heart healthy way.
JANET BOND BRILL, Ph.D., R.D., LDN, is a diet, nutrition, and fitness expert who has appeared on national television. She is the author of Cholesterol Down: 10 Simple Steps to Lower Your Cholesterol In 4 Weeks Without Prescription Drugs, and specializes in cardiovascular disease prevention. Dr. Brill lives in Pennsylvania with her husband and three children.
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About the Author
Annabelle S. Volgman, MD, is a professor at Rush University Medical Center in Chicago, Illinois. Dr. Volgman’s primary specialty is cardiovascular disease. She studied at Columbia University College of Physicians and Surgeons, was a resident at the University of Chicago Medical Center, and was a fellow at Northwestern Memorial Hospital. She wrote the foreword to Prevent a Second Heart Attack: 8 Foods, 8 Weeks to Reverse Heart Disease.
Read an Excerpt
How You Got Heart Disease in the First Place
Making the Transition from Sickness to Health
The gods are just, and of our pleasant vices
Make instruments to plague us.
—King Lear, William Shakespeare (1564-1616)
Why are so many people having heart attacks in the United States? What triggers the formation of that first "fatty streak"-the earliest visible hint that something is awry in the arteries-and the eventual onset of advanced heart disease (a.k.a. atherosclerotic cardiovascular disease), our nation's leading killer?
We used to think that heart attacks were an inevitable consequence of aging. But in the last decades, research has revealed a surprising truth: Heart disease is a lifestyle-borne illness, and atherosclerosis (the leading cause of heart attacks and stroke, and the defining term for when fatty deposits build up inside the arterial walls) begins in childhood. A toxic mix of calorie overload, especially of processed foods high in damaging fats, sugars, and salt, coupled with inactivity instigates the long, slow process of arterial damage that results in a heart attack.
In this chapter, you will discover how, when, and why your own coronary arteries began to clog up, thereby setting the stage for atherosclerotic cardiovascular disease. You will learn about how you can take control of your heart health the Prevent a Second Heart Attack way-a doable strategy allowing you to take action to switch your disease course and ultimately remain a "survivor" for many decades to come.
YOU ARE WHAT YOU EAT
It is well known that what you eat and your level of physical activity have a major impact on your health. A poor diet greatly increases your risk of developing any number of chronic health conditions and diseases, including high blood pressure, obesity, diabetes, osteoporosis, several types of cancer, and heart disease.
Researchers at the University of North Carolina School of Medicine conducted a survey study examining the nutritional habits and chronic indicators of disease in 1,788 men and women whose average age was forty-eight.1 They found that people who ate a poor diet had significantly higher rates of disease (such as those with diagnosed high blood pressure and/or heart disease).
A poor diet was also strongly associated with individuals at high
risk of contracting a chronic disease precursor such as prediabetes. What type of diet did the high-risk people eat? One that was loaded with fast-food meals, sugary drinks, high-fat snacks, and lots of desserts/sweets; low in fruits and vegetables; and coupled with a sedentary lifestyle. The bottom line is, both the type and quantity of food consumed have a profound effect on your risk for heart disease, as diet plays a large role in your resistance or susceptibility to atherosclerosis.2
What would happen if we took an entire population that for centuries subsisted on a traditional, mostly vegetarian, whole-foods diet and a highly active lifestyle (in which the residents grew their own food) and switched them over to a highly processed, calorie-dense, Western diet and sedentary existence? Researchers in Mexico observed such a phenomenon.3
The Tepehuanos Indians living in the Sierra Madre Occidental Mountains of northwest Mexico subsisted on a plant-based diet, filled with green vegetables, beans, potatoes, breads, and tortillas made from root vegetables, eating meat and animal products very rarely. In 1995-1996 researchers also found that obesity was rare and diabetes was virtually nonexistent among the Tepehuanos.
In the year 2000, as part of a social assistance program, Western- style foods were made available to the Tepehuanos either for free or at a very low cost. The traditional Tepehuanos diet was thus substantially modified by the introduction of a Western-style diet filled with highly processed salty foods, meat, eggs, sugar, refined flour products, soft drinks, and other types of junk food. The effect of this drastic dietary change was documented at the ten-year follow- up assessment of the study. Total calorie intake rose 42 percent, accompanied by a doubling of protein and artery-clogging saturated fat intake. In addition, there was a notable decline in fiber and carbohydrate intake, as well as a dramatic reduction in the consumption of healthful polyunsaturated fat. The occurrence of heart disease risk factors escalated, mirroring the dietary changes. Obesity, diabetes, high blood pressure, a high blood level of triglycerides, and a low HDL cholesterol value all were now commonplace among the Tepehuanos Indians.
IT ALL BEGINS IN CHILDHOOD
For more than sixty years we have known that atherosclerosis starts in childhood and progresses to cause heart disease in middle age and beyond.4 Autopsy studies of the hearts of our nation's youth show that atherosclerosis, the underlying cause of CAD, manifests early in life. The 1953 results of an autopsy study of U.S. soldiers (average age twenty-two) killed in the Korean War surprised the nation when it was revealed that 77 percent of the hearts examined showed signs of atherosclerosis.5 A similar study of U.S. casualties of the Vietnam War showed that 45 percent of the hearts had atherosclerotic disease, with 5 percent exhibiting severe disease.6
In autopsies performed at the University of Louisville in Kentucky on young, mostly male victims of trauma (average age twenty-six), coronary atherosclerosis was observed in 78 percent of the study group-with 21 percent showing narrowing of the coronary arteries by more than 50 percent, and 9 percent showing blockage of more than 75 percent.7
At this point, you may be thinking, what do all these scientific findings have to do with reversing my disease? The takeaway message that you should extract from the autopsy research is that your disease did not surface last year or last week but has been brewing in your arteries since you were a child. And, as you shall see, it took a lifetime of additional lifestyle factors to hasten its progression to the advanced stage that bred your critical cardiac event.
Multiple risk factors accelerate plaque buildup
Risk factors are traits people exhibit that increase their likelihood for contracting disease. Major risk factors for heart disease, such as high LDL or "bad" cholesterol, diabetes, high blood pressure, smoking, and obesity, have a detrimental effect on the lining of the innermost layer of the coronary arteries, the endothelium.8
One of the most important studies that proved beyond a shadow of a doubt that these risk factors operate early in life in all Americans to propel atherosclerosis is the Bogalusa Heart Study. The longest and most detailed large-scale study of biracial children (black and white) in the world, the Bogalusa Heart Study began in 1972 in the town of Bogalusa, Louisiana, to determine the early course of heart disease and its association with established risk factors: lifestyle behaviors such as smoking, physical inactivity, and a high-fat, high- calorie diet. In an autopsy segment of the study, conducted at Tulane University Medical Center in New Orleans, researchers examined the coronary arteries of 204 young people between ages two and thirty- nine. (Most subjects had died from accidents.) The researchers found that 50 percent of the children age two to fifteen exhibited fatty streaks (the first visible sign of disease in the arteries), and 8 percent had full-blown plaque in their coronary arteries. The older group, age twenty-one to thirty-nine, had more advanced disease, with 85 percent having fatty streaks and 69 percent showing plaque in their coronary arteries.9 Hence, the Bogalusa Heart Study has changed the way we think about heart disease, which was formerly considered an adult problem. The study proved that heart disease can start the day you are born and that poor lifestyle choices made in childhood can have deadly effects later in life.
Young Americans living dangerously: More research proves the point
Findings from the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study provide even more support for the notion that multiple risk factors accelerate the atherosclerotic process in young people. Scientists autopsied 2,876 young accident victims (age fifteen to thirty-four) and examined their coronary arteries for evidence of heart disease. Confirmation
of atherosclerosis was found in an astounding 60 percent of subjects in the youngest group (age fifteen to nineteen), escalating to greater than 80 percent of men and 70 percent of women in the oldest group (age thirty to thirty-four).10
The PDAY study clarifies not only that atherosclerosis begins in youth but also that the risk factors for adult heart disease, if they appear at a young age, determine to a large degree the rate of progression of atherosclerotic plaque. Risk factors operating on young, vulnerable coronary arteries are the harbinger of future heart attacks, which will most likely appear at even younger ages in adulthood than currently observed.
CHILDHOOD OBESITY AND HEART DISEASE
The research is clear: Childhood obesity increases the risk of
atherosclerosis and premature death in adulthood,11 which is
why the explosion of childhood obesity should be of great concern to all Americans. A recent New York Times article reported on research conducted at the University of Missouri-Kansas
City School of Medicine.12 The scientists examined the thickness of neck arteries of obese children and adolescents between ages six and nineteen. The children also exhibited high levels of
LDL (or "plaque-building" cholesterol), triglycerides (another type of artery-clogging blood fat), high blood pressure, and low levels of HDL (or "good") cholesterol-all modifiable risk factors for CAD. Early warning signs of heart disease were clearly evident in the subjects. An ultrasound revealed that the subjects' arteries-and keep in mind that the subjects were all children and teenagers-resembled the "vascular age" of an average forty-five-year-old.
Further proof that the appearance of risk factors in children will increase the likelihood of a heart attack down the road comes from a Danish study that followed health statistics of more than 250,000 children into adulthood.13 The authors found that the higher the childhood body weight, the greater the risk of heart disease in adulthood. A thirteen-year-old boy weighing about twenty-five pounds more than average, for example, would increase his risk of having a heart attack before age sixty by 33 percent-a graphic illustration of the harmful effects of childhood risk factors on future adult health.
A STRATEGY FOR YOUR AND YOUR DESCENDANTS' SURVIVAL IS IN YOUR HANDS
You are now fully aware of the tremendous importance of aggressively controlling heart disease risk factors in your children, who by virtue of their genes are at high risk for developing your disease in adulthood. So now, let's shift the focus back to you and take a look at the best strategy for preventing and reversing your disease.
As a heart attack survivor, you should make prevention of a second attack your top priority. Why? Having survived a heart attack, you are categorized as "high risk" for having another. According to the American Heart Association (AHA), one out of three women and one out of four men will die within the year of having their first heart attack, from either another attack or sudden cardiac arrest. Obviously, changes must be made to prevent that second cardiac event.
Unfortunately, medications alone can't reverse the atherosclerotic disease process. You need to make lifestyle changes, too-all of which are outlined in this book. The foods and the exercise prescribed in Prevent a Second Heart Attack fight off heart disease by targeting what has been referred to as the trilogy of vulnerability,14 which are the three most vulnerable zones for high-risk cardiac patients: plaque, blood, and the heart muscle. As you will soon learn, when paired with the best modern medicine, a Mediterranean lifestyle plan can do three things:
1. Stabilize the high-risk, rupture-prone vulnerable plaque
(the type responsible for most heart attacks) and reduce the likelihood that the plaque will rupture, which could result in another and potentially fatal heart attack.
2. Stabilize vulnerable blood-the composition of which is prone to form blood clots easily.
3. Stabilize a vulnerable heart muscle-the type that is prone to having arrhythmia or electrical instability.
But What About Drugs?
Although Prevent a Second Heart Attack specifically describes how lifestyle changes can lead to heart disease prevention and reversal, lifestyle is only part of the equation. All individuals who have experienced a heart attack can boost their survival odds by taking their physician-prescribed medication. (Note: The general information presented in this section regarding medications should not be used as medical advice. Please talk to your personal physician regarding which medications are right for you.)
According to the AHA's most recent guidelines for treating individuals with established heart disease, most patients would derive benefits from taking four types, or classes, of medications:
• Cholesterol-lowering medications, such as a statin drug like Lipitor
• ACE (angiotensin-converting enzyme) inhibitors, a medication that blocks a blood vessel constriction enzyme, such as Lotensin
• Aspirin, an anti-inflammatory drug that also lessens the ability of blood platelets to stick together and form a clot in the coronary arteries
• Beta-blockers, drugs that lessen the workload of the heart, such as Toprol15
Cholesterol targets: Down with the "bad," up with the"good"
Much controversy exists regarding the optimal level of cholesterol- both "good" HDL cholesterol and "bad" LDL cholesterol-for the prevention of heart disease. One thing is clear, though: Because you have had a previous heart attack and are thus considered high risk, you should aim for getting your LDL down to the lowest goal recommended, less than 70 mg/dL. (In fact, other scientists have stated that in people with diagnosed heart disease, a blood LDL level of less than 40 mg/dL is the number to strive for to completely halt progression of plaque buildup.16) This goal (less than 70 mg/dL) can be achieved by combining lifestyle (diet and exercise) with a low- dose statin medication.17
I suggest you follow the ten steps outlined in my previous book, Cholesterol Down (Three Rivers Press), to help you achieve an LDL value of less than 70 mg/dL and boost the cholesterol-lowering power of your prescription medication. Here are my ten daily LDL- cholesterol lowering steps in a nutshell:
1. Eat 1 cup of oatmeal every day (most therapeutic dose: 3 grams of beta-glucan fiber per day).
2. Eat a handful of almonds every day (most therapeutic dose: 1.5 ounces or approximately 30 almonds per day).
3. Eat 2 tablespoons of ground flaxseeds every day (3 grams of alphalinolenic acid, or ALA).
4. Consume 3 grams (starting dose) to 10 grams (most therapeutic dose) of psyllium husk every day.
5. Eat cup of legumes (beans, peas, or lentils) every day.
6. Eat 1 apple every day.
7. Consume 2-3 grams of phytosterols per day, preferably taken at three separate meals.
8. Eat 20-25 grams of soy protein every day.
9. Eat a clove of fresh garlic and take one Kyolic One Per Day Cardiovascular aged garlic extract supplement every day.
10. Walk for 30 minutes every day.
You know you need to cut down your "bad" cholesterol, but what about the "good" cholesterol, HDL? It's not enough protection to just get your LDL under control. You also need to raise your HDL cholesterol, because low HDL (defined as less than 40 mg/dL) can greatly increase your risk for another heart attack. Individuals with really low HDL (<35 mg/dL) have eight times the risk of heart disease compared to those with a high HDL (>65 mg/dL).18 If all of these numbers seem confusing, I'll make it easy for you: To reach your "ideal" cholesterol levels, keep "good" HDL above 60 and "bad" LDL below 70.