PAMF Health Blog

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Inflammation: The Real Cause of Heart Attacks

Posted on Mar 11, 2013

A Sprained Artery

Let’s say you were playing tennis and were running to make a forehand return. Unfortunately, your foot slips and your ankle turns inward, causing you to fall to the ground. Your body instantly senses the injury and activates your immune system to initiate the process of inflammation. Blood vessels open up around the injured ligaments to allow an army of different cells, such as white blood cells, red blood cells and platelets, to flood the injured ankle and start making repairs. As a result of this response you notice the classic symptoms of inflammation, such as swelling, redness, heat and pain over the ankle. The swelling is actually like an internal ankle brace which prevents you from moving your ankle in a direction that would worsen the injury. For the most part, you can see that the inflammatory process is one that protects the ankle and helps with the repair process.

Now let’s replace the sprained ankle with a sprained or injured artery. Arteries are the blood vessels arising from the heart that feed and nourish every part of your body with oxygen and nutrients, from vital organs (heart, brain, kidneys, liver, intestines, etc.) to muscles, tendons, ligaments and joints. Arteries that leave the heart are large, but then as they travel further away from the heart, they grow incrementally smaller, until they become a mesh of tiny arteries called capillaries, which ultimately blanket their target destination which in this example was a sprained ankle. Now think of these capillaries that bathe your vital organs and body parts as being tiny straws. If you were to use a straw to sip on a glass of water, the inner surface of the straw that gets wet would be the blood vessel layer known as the ECL (endothelial cell layer). If you want to prevent a heart attack, you need to protect this vital layer and prevent it from being damaged.

The ECL is extremely sensitive and when it feels a threat coming on or when it’s damaged, it calls in the inflammation army. The threat may be tobacco smoke, high blood pressure, oxidative damage from a poor diet, increased stress, or a growing list of other factors. All those white blood cells and numerous inflammatory substances immediately arrive at the ECL to assess and repair any damage to the artery. Unfortunately, many of these cells do more harm than good. Macrophages, a type of immune cell, are like little mini “Pacman” that go after and penetrate the damaged ECL, gobble up any abnormal cholesterol under the surface, and transform into what are known as foam cells. Foam cells then recruit all types of inflammatory chemicals to be released that either form new plaque or cause an existing plaque to become unstable. The unstable plaque ruptures like an erupting volcano and then spews a giant blood clot into your artery, closing it off and causing a heart attack.

Inflammation is More Important Than High Cholesterol

Focus on the overall process of inflammation, rather than worrying about more specific factors like cholesterol. Abnormal cholesterol in the absence of inflammation rarely causes heart attacks. On the other hand, normal cholesterol levels in the face of rampant inflammation can cause heart attacks and a host of other chronic diseases. Keep in mind that over half of heart attacks are happening in individuals with normal cholesterol levels. Unfortunately many of these are people diligently taking their cholesterol medications, but still eating the wrong foods, overstressing, sitting too much, and accumulating larger amounts of inflammatory belly fat each year.

How You Can Prevent These Events From Happening

The first step is to pamper your ECL and prevent it from being damaged in the first place so it doesn’t call out for help by sounding the inflammation alarm. How do you do this?

1.Nutrition:  Oxidative damage to the ECL occurs due to dangerous substances called free radicals. Free radicals can result from a diet full of processed foods (especially high-fructose corn syrup and trans fats), chemicals, and a significant lack of natural anti-oxidants like vegetables, fruits, nuts, healthy fats like avocados, fish and olive oil, a glass of red wine, and yes even a couple of squares of dark chocolate (70% + is preferred). If this sounds like a Mediterranean style diet, you are right. The reason this type of eating plan cuts down heart disease, cancer and other chronic diseases is because it limits the oxidative damage to your ECL and dampens the inflammation that leads to plaque formation.  It’s tempting to want to pop some anti-oxidant vitamins to protect against this, but many of these are ineffective or even harmful, and don’t even come close to the benefits of getting your anti-oxidants through nutrition.

2. Exercise: Exercise, in particular, releases chemicals like nitric oxide which keep your arteries nice and relaxed, which also keeps your ECL happy and prevents it from sounding the inflammation alarm.  Don’t just focus on your gym workouts. Be sure you are getting 8,000-10,000 steps daily, keeping track with a pedometer or a device such as your I-phone which has one built in.

3. Excess Belly Fat: Excess belly fat is a major storehouse of inflammatory chemicals that contribute to heart disease. It also has chemicals that cause increased blood clotting. Virtually all the ingredients necessary for a heart attack can be found right inside those fat cells. Remember that increased insulin from a diet high in excess carbohydrates is a major cause of belly fat, so keep an eye on the sweets, sodas, breads, and all those so-called low-fat foods that may be making you fatter.

4. Inflammatory Emotions: Excessive and persistent stress, anger, depression, hostility and worry can cause low-grade inflammation which if combined with other factors such as increased belly fat, can set you up for a heart attack.

Leading an anti-inflammatory lifestyle not only reduces your risk of heart disease, but can also prevent a growing list of other conditions like cancer and Alzheimer’s disease.  Treating your mind and body well keeps your ECL happy, keeps inflammation restrained, and gives you the best chance for optimizing your health.

This blog post is contributed by Ronesh (Ron) Sinha, M.D., Palo Alto Medical Foundation Internal Medicine. Dr. Sinha works closely with the South Asian community to help reduce heart disease and diabetes risk, and provides corporate health lectures to promote wellness in the workplace. Dr. Sinha holds clinical faculty positions at UCLA; Stanford University School of Medicine; and the UCSF School of Medicine. He teaches Stanford and UCSF medical students.

Ronesh (Ron) Sinha, M.D.