Two Notes on Heart Disease

Simple one first: the British Medical Journal (vol 325, p 1202) reports “lowering homocystine concentrations by 3 micromoles per litre from current levels (achievable by increasing folic acid intake) could would reduce the risk ischaemic heart disease by 16 percent.” (Italics added.) Easy to do, and folic acid has recently been tagged as beneficial for all sorts of things.
The second is more profound, a rethinking of how heart disease works. Since the 80’s the dominant theory has been the “clogged pipes” (plumbing) theory. One’s arteries fill with plaque until they are so jammed that blood can no longer traverse – and you have heart pain (angina). Worse, a plaque breaks loose, causes a clot that blocks an artery completely, causing a heart attack. The implication – reduce cholesterol, which is the raw material of plaques. The problem with the theory is that about half the men who have heart attacks have normal levels of cholesterol. The emerging theory, bolstered by a recent large study, is that the core of heart disease is inflammation. In this model, atherosclerosis (plaque buildup) is really the result of runaway inflammation. There is a lot of detail to the theory – that statins, for example, prescribed to reduce heart disease risk, actually work by reducing inflammation; that estrogen may be a functional anti-inflammatory and this is why pre-menopausal women have far fewer heart attacks than men; that various bacteria and viruses really do increase the risk of heart attack, again by triggering inflammation – there’s more, but that’s enough for here. Bottom line, take your aspirin a day. (But – please note the FDA-recommended dosage is 50 – 350 milligrams/day, and the typical adult aspirin is 350, right at the top of the range. Many prefer one baby aspirin a day for a reduced dosage. Or just break it in half.) Reported in New Scientist 11 Jan 2003.) (1/31/2003)

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