"Todd Moody [log in to unmask] " wrote:
>
> On Sat, 4 Aug 2001, Jim Walsh wrote:
>
> > "Todd Moody [log in to unmask] " wrote:
> > > Atherosclerosis, however, is not strongly correlated with heart
> > > disease, so perhaps the point is academic.
> >
> > I'm a little confused by that statement.
> >
> > Much (I would have thought *most*) heart disease *IS* atherosclerosis.
> >
> > (Unless you are defining heart disease slightly differently than what I think is the norm.)
>
> Heart disease is generally diagnosed by various symptoms, chronic
> and acute.  Angina is a symptom of heart disease; so is
> exertion-related extreme fatigue, sometimes called "cardiac
> insufficiency."  Heart attacks and other acute episodes are also
> obvious symptoms.  But plenty of people with atherosclerosis have
> none of these, and are not considered to have heart disease.

I think you will find that people with artherosclerosis in coronary arteries without symptoms are defined as having "asymptomatic CHD" (Coronary Heart Disease).

>
> One of the points that Ravnskov makes, which is often overlooked,
> is the fact that the Japanese, who have far fewer heart attacks,
> angina, etc., than Americans, are just as atherosclerotic.

Do you have any references to his material? I would be interested to read up on this.

> Furthermore, plenty of people have heart attacks, fatal and
> nonfatal, and angina -- who have little or no measureable
> atherosclerosis.

Again, I would be interested in references for this. Ischemic events are not unheard of without atherosclerosis, (prinzmetal's angina) but I from my understanding it is very rare. (Around 25%, meaning that 75% *do* have atherosclerosis.)


> We are indoctrinated to think of "blocked arteries" as the cause
> of heart attacks, but it is not so simple.  A heavily plaqued
> artery does have reduced blood flow, but in many cases this is
> not a problem because the heart develops collateral vascularity
> -- additional blood vessels to compensate for the reduced blood
> flow.  This is believed to be the reason why heart attacks in
> younger men are more likely to be fatal: There has not been time
> for much collateral vascularity to develop.

Collateral vessels are the bodies attempt to repair the problem (artherosclerosis). It is important to note that the bodies attempt rarely (probably never) manages to keep up with the process of artheroslerosis. (Resulting in a net deficiency of blood flow to the heart muscle.)


> The immediate cause of angina and heart attacks is not blockage
> of the arteries, but *constriction* of them.

In some cases yes, in *many* others, no.

Severely narrowed arteries can cause such a deficiency of blood flow to the heart that angina can and does result without vasoconstriction.

Likewise, a moderately narrowed artery, will become much more severely restricted during vasoconstriction than a completely patent vessel.

It is also known that an artery suffering from atherosclerosis, does not respond correctly to the chemical released by the body to dialate blood vessles. (They will constrict, even when the body is telling them to dialate!)


> And when they
> constrict, the most occluded places will be most vulnerable; but
> sustained constriction can damage the heart even when there is
> little occlusion.

In *some* individuals, yes. However, I have always understood that this is a rather rare situation. I would be interested in references to the contrary.

> It is very difficult -- almost impossible -- to cause heart
> attacks in animals by diet alone.  To do that, you must stress
> them.  Stress hormones cause vascular constriction.
> Prostaglandin imbalance causes vascular constriction.  Stimulants
> cause vascular constriction (probably by means of the other two).

I agree totally that stress is a major player in heart disease. (I believe that I am proof positive of that.) Medical science has great difficulty with "stress" because it is so difficult to objectively quantify.

I also believe that stress will accelerate the growth of artherosclerotic plaques.

> It is well known, but not much advertised, that the most
> significant risk factors for heart disease are not dietary.
> We've known about the hard-driven "type A personality" for years,
> for example.

Agreed.
That was me 12 years ago, when I had my first heart attack (at 30 yo).

> We know that job satisfaction is a major factor.
> We know that divorces, loss of loved ones, and the like are all
> risk factors for acute heart disease.  Atherosclerosis may make
> us more vulnerable, but it is apparently not a key player.

I can't go along with "not a key player".

Certainly artherosclerosis is not the "be all and end all" of heart disease, but (IMHO) it is certainly a "key player".

A prime example is myself. If I could snap my fingers right now and make the artherosclerosis disappear from my arteries, I would instantly gain about 80% functionality. I am disabled by the lack of blood supply to my heart, not the scars on my heart, nor vasoconstriction.


Jim.