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.

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

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

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).

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.  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.

Todd Moody
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