One of the best ways to live longer is to reduce your likelihood of dying from a heart attack since it continues to be the #1 killer in America. If we could prevent heart disease tomorrow, it is estimated that the average life expectancy of every American would increase by ten years.
We are led to believe by extensive drug marketing that elevated cholesterol is the cause of heart disease. Unfortunately, about 50 percent of the people who are hospitalized with heart attacks have normal cholesterol levels. What’s more, 25 percent of people who develop premature heart attacks have no traditional cardiovascular risk factors at all. So what if cholesterol was only a minor, secondary player in developing heart disease?
The Cholesterol Hype
Cholesterol does have a role in heart disease, but it is a secondary factor that plays a far lesser role in fatal heart attacks than the marketing of drug companies leads you to believe.
It has been known since 2001 that oxidized LDL is a far better predictor for the development of atherosclerotic lesions than the traditional measurement of LDL (1). But it was also at this time that the first statin studies began to appear. This gave the pharmaceutical industry a patented drug to “prevent” heart disease but unfortunately statins could not specifically lower oxidized LDL. Furthermore, the LDL story was such an easy story to tell because it could be summarized “if your cholesterol levels are high, you are going to die”. That marketing statement ignored the fact that the most common drug (i.e. aspirin) to prevent heart attacks had no effect on reducing cholesterol. Today lowering LDL cholesterol (but not necessarily lowering oxidized LDL) is the number-one priority of every cardiologist in America.
Various epidemiological studies have found that increased serum cholesterol levels occur more often in heart disease patients. But that increase is only 5 to 10 percent higher in those who develop heart disease than those who don’t. This doesn’t help explain why about half the people who die from heart disease don’t have elevated LDL cholesterol levels (less than 130 mg/dl). It also means that high LDL cholesterol is not a very good predictor of heart disease. On the other hand, a very different picture emerges if you look at the levels of oxidized LDL levels. You can see a very striking relationship in the prediction of heart disease with increasing levels of oxidized LDL levels (1). Even so the best way to lower oxidized LDL is not a statin, but high-dose polyphenol extracts (2), since they have anti-oxidant properties to help combat oxidation.
Unresolved Cellular Inflammation: The Reason Heart Disease Kills
A heart attack is simply the death of the muscle cells in the heart due to lack of oxygen caused by a constriction in blood flow. If this lack of oxygen is prolonged, and enough heart muscle cells die, your heart attack becomes a fatal one. What causes that constriction in blood flow is the rupture of soft vulnerable plaques that line the artery. Although you can’t see them, when they rupture they release a mass of cellular debris that accelerates the clotting process to stop blood flow and therefore stop oxygen from being delivered to the heart.
The reason heart disease remains the primary killer of Americans is not due to cholesterol, but unresolved chronic inflammation in the arteries that causes these soft vulnerable plaques to rupture. You may be asking yourself, “What on earth is unresolved cellular inflammation?” This is simply inflammation that falls below the threshold of perceived pain. That’s what makes it so dangerous. You have no indication it is present and therefore you make no effort to reduce it. This inflammation results from an increased production of inflammatory mediators such as eicosanoids. Statins have no effect on reducing eicosanoid levels in the body.
Eicosanoids, Resolvins, and Heart Disease
Eicosanoids are the hormones that intensify inflammation. You need some to activate the immune system, but in excess they promote cellular inflammation. These hormones are generated by the combination of high levels of insulin and omega-6 fatty acids in your blood. On the other hand, resolvins are the hormones that resolve inflammation. These hormones are generated by the levels of omega-3 fatty acids in your blood. You need to have both eicosanoids and resolvins in the proper balance in order to be in a state of wellness because you have to turn on inflammation as well as turn it off. Unfortunately, most of us produce too many eicosanoids, which leads to increasing levels of unresolved cellular inflammation and eventually to chronic diseases like heart disease.
Managing Unresolved Cellular Inflammation
The Zone Diet was developed primarily to reduce the overproduction of eicosanoids. Adequate levels of omega-3 fatty acids in the diet (usually requiring supplementation) will ensure adequate levels to promote the formation of resolvins.
A variety of factors forge the linkage between unresolved cellular inflammation and fatal heart attacks. First of all, eicosanoids make soft vulnerable plaque more likely to rupture. Eicosanoids act as powerful constrictors of your arteries and can lead to a vasospasm, a potentially fatal cramp or “charley horse” that prevents blood flow to the heart. Vasospasm is the second cause of fatal heart attacks. In addition, lack of sufficient levels of omega-3 fatty acids in the heart muscle can also lead to a fatal heart attack caused by chaotic electric rhythms in the heart. This condition, called sudden death, accounts for more than 50 percent of all fatal heart attacks.
How can you tell if you have the right balance of eicosanoids to resolvins for heart health? That knowledge comes from the AA/EPA ratio in the blood. Arachidonic acid (AA) is the building block of eicosanoids and eicosapentaenoic acid (EPA) is the building block of resolvins. You want to maintain that AA/EPA ratio close to 1.5, and ideally have about 4 percent of your total fatty acids in the blood consisting of EPA (3-5)
How The Zone Can Help Promote A Healthy Heart
For optimal heart health you need the appropriate balance of eicosanoids to resolvins. This is why I recommend a multi-factorial dietary approach. This entails the Zone Diet, omega-3 fatty acids, and polyphenol extracts. The Zone Diet can help reduce the overproduction of eicosanoids. Consuming adequate levels of omega-3 fatty acids can help increase the production of resolvins and the use of maqui polyphenol extracts can help minimize oxidized LDL (2). This three-part dietary system or what I call the Zone Pro-Resolution Nutrition system will all be described in greater detail in my upcoming book, The Resolution Zone.
- Holvoet P, Mertens A, Verhamme P, Bogaerts K, Beyens G, Verhaeghe R, Collen D, Muls E, and Van de Werf F. “Circulating oxidized LDL is a useful marker for identifying patients with coronary artery disease.” Arterioscler Thromb Vasc Biol 21:844-848 (2001)
- Davinelli S, Bertoglio JC, Zarrelli A, Pina R, and Scapagnini G. “A Randomized Clinical Trial Evaluating the Efficacy of an Anthocyanin-Maqui Berry Extract on Oxidative Stress Biomarkers.” J Am Coll Nutr 34 Suppl 1:28-33 (2015)
- Sears B. “Omega-3 fatty acids and cardiovascular disease: Do placebo doses give placebo results?” CellR4 5:e2302 (2017)
- Sears B. “Omega-3 fatty acids and cardiovascular disease: Dose and AA/EPA ratio determine the therapeutic outcome.” CellR4 6:e2531 (2018)
- Sears B. “Appropriate doses of omega-3 fatty acids for therapeutic results.” CellR4 6: e2578 (2018)