Heart Month: Opportunity for a Return to Reason

It is February - Heart Month: the month of Valentine’s Day - a time to focus on the emotional as well as the health-related functions of the heart. At the Florida Heart Research Institute, we tend to view this time as an opportunity to refocus our efforts to stop heart disease through research, education and prevention—a busy time for increased cardiovascular risk screening and an auspicious time to intensify our educational efforts. The messages are remarkably simple and clear—1) cardiovascular disease, the leading killer of men and women in developed countries –and increasingly throughout the entire world is largely a preventable disease; 2) sudden cardiac arrest is a common phenomenon in which an educated public can save lives with simple measures which are within most everyone’s capabilities.

 

It would perhaps not be fair or even appropriate for a prestigious research institute such as FHRI to minimize the complexity of heart disease and the multitude of treatments, both established and emerging. In fact, a frequent visitor to the internet will be confused at best. For years physicians sung the anticipated benefits of hormonal replacement in post-menopausal women. Coronary heart disease is uncommon in women of childbearing age; incidence accelerates rapidly thereafter, surpassing that in men at around age 65. It therefore seemed obvious that hormonal replacement would lower the risk. In fact, laboratory studies documented the favorable effect of estrogen on platelet and other key functions. All was well until the matter was actually studied, and it was discovered that such therapy actually increased the risk of thrombotic events (stroke and deep venous thrombosis/pulmonary embolism) without lowering the incidence of coronary artery disease. Elevated homocysteine levels were clearly associated with increased risk of coronary disease. Folate successfully lowers homocysteine levels. Ergo, folate should lower the risk of coronary disease in people with elevated levels of homocysteine. Reasonable, but, once studied, wrong. Multiple studies demonstrated the success of folate in lowering homocysteine levels and doing absolutely nothing to lower the risk of coronary events. CRP is a serum marker of inflammation which is also associated with increased risk of coronary disease. Therefore, anti-inflammatory vitamins such as C and E should lower the incidence of coronary events. Reasonable again, and, once again, once studied, false. More recently, epidemiologic evidence suggests that those people who have high calcium in their diet may have a reduced risk of coronary disease. However, studies which supplement calcium found … found … (yes, by now you must have guessed it) an increased incidence of coronary events. Vitamin D is the “vitamin of the 21st century.” Once felt to be solely involved in calcium metabolism, this vitamin is found to have receptors throughout the body which may be involved in multiple critical cellular events. Multiple epidemiologic studies have found that low serum levels of Vitamin D seem to be associated with multiple disease processes, including cardiovascular disease. And the data on supplementation? - somewhat preliminary, but so far not so promising.

 

Obviously the situation in medicine is always somewhat more complex than logic would seem to dictate. A carbohydrate-based extreme low fat diet (such as the Ornish diet) and an intelligent fat and low carbohydrate diet (such as the South Beach diet) both seem to be protective against cardiac events. Caffeine as a stimulant would seem to be dangerous for the heart, yet coffee is, if anything more protective than harmful to the heart. Theoretically, if there were any form of alcohol that should be beneficial to the heart, it should be red wine; but no one has every convincingly demonstrated that red wine (or any wine) is more protective in moderate quantities than any other form of equivalent amounts of alcohol. It would seem that logic has no chance when it comes to medicine.

 

However, even though reason must always surrender to evidence, there are certain rational thoughts that it might be helpful for our hearts to consider this month. A body that ingests more calories than it consumes will necessarily store them as fat. A body that does not exercise is removing one of the major intrinsic homeostatic mechanisms for health. A body that ingests cigarette smoke, or any other toxin, on a regular basis is poisoning itself. A body that engages in excess is likely to lose its internal balance. A person that focuses on fear, anger and/or depression is unlikely to develop nurturing relationships. For all the rest, leave it to the researchers, and we’ll keep you posted as the stories unfold.