So far we have learned that CAD (coronary artery disease) is instigated and accelerated due to Lipoprotein contents invading the artery wall, and that the inner lining of the artery (a single layer of epithelial cells) is supposed to prevent this from occurring. We have also learned that the very small dense lipoproteins are closely associated with CAD development.
Coronary Vein Disease
So far we have discussed CAD. The reason we have not discussed Coronary Vein Disease is because it does not exist, but veins have exactly the same cellular inner lining as arteries. This begs the question, why are arteries affected and veins aren’t?
Well the blood in veins is different to the blood in arteries. This blood has less oxygen, and less nutrients. Could this be a problem? We know that the whole of our blood in circulation is turned over in less than a minute. We know that after we eat a meal nutrients like sugars and fats (lipoproteins) can be elevated for hours. Hence the difference in the level of nutrients is not likely to make veins exempt from atherosclerosis (CAD). What about the amount of oxygen, it is a volatile chemical. Oxygen is consumed by cellular metabolism and it is depleted in veins. While depleted in veins there is still plenty left. Hence if oxygen was a cause, the disease may be lesser in veins, but it should still exist and it doesn’t.
The biggest differences between arteries and veins is blood pressure. If we consider the issue of small particles invading artery walls by infiltrating between cells, or damaged surfaces of the artery, it makes sense that they would get a helping hand if being pushed harder against the protective lining of the artery. Lower blood pressure is the most likely reason veins are protected from CAD, and it is well known that high blood pressure is associated with CAD.
Hence monitoring and controlling blood pressure is important to prevent CAD, Heart Attack and Stroke.
What Can We Do to Lower Blood Pressure
Of the foods we eat lowering salt intake is the most significant dietary component we can alter to lower blood pressure. Salt’s chemical name is sodium chloride, and the sodium / potassium balance in our body controls the amount of water we retain. Blood is a water based system, more sodium equals, more water, which equals more blood. There is no extra space for the blood to go, so blood pressure rises. This being said lowering salt intake reduces blood pressure by about 4mmHg on average, this is not a huge amount, but can be significant if we already have high blood pressure.
As with everything else, it's about balance, too little sodium is not healthy, and too much is not healthy. We can’t spend our waking hours counting the grains of salt we eat, or buying scales that can measure down to milligrams.
Salt we sprinkle on our food or cook with is fine, it would be hard to find that ever causing over consumption. It’s the salt added to processed food that is the primary source of excess dietary salt, avoid processed foods and salt consumption should look after itself.
Damage Artery Inner Lining
The innermost layer of an artery is the protective layer made up of endothelial cells. This layer is only one cell thick. Any damage to the layer may enable greater transit of lipoprotein contents into the artery wall. Is there anything that could cause damage to this single cell layer that we can control or effect?
The answer is yes. Autopsies of young persons aged 25 to 35 have compared the degree CAD (remember it starts from childhood) with HbA1c tests of the deceased's blood and discovered that HbA1c was independently associated with with the level of CAD discovered. The higher the HbA1c results the greater the Level of CAD after accounting for other factors that are known to affect CAD. Sorry I’ve got technical.
HbA1c is the test performed to measure average blood sugar levels. The “H” represents hemoglobin which is the protein that carries the oxygen in our red blood cells.
Sugars damage proteins and in doing so produce even more damaging Advanced Glycation End (AGE) products this includes molecules like hydrogen peroxide, better known as bleach. We all know bleach can turn black hair blonde, well AGE’s damage protein and fats, including the proteins located on the cells lining the artery, and the apolipoproteins on the surface of lipoproteins. Table sugar and the sugar added to processed food is half fructose and half glucose. Fructose produces about 7 times more dangerous AGE molecules than glucose and the HbAc1 test does not measure blood “fructose” levels.
In essence sugar (and I suspect in conjunction with high blood pressure) can damage both the lipoproteins carrying the fats and cholesterol, as well as the epithelial cells protecting the lining of the artery, and this damage can aid the invasion of lipoprotein content into the artery wall accelerating the progress of CAD. (see sugar vs sweeteners in the general section)
Coronary Artery Disease is now stated as being an “inflammatory” disease with numerous reports stating that arterial inflammation is the cause of the disease. This is BS. Inflammation is the immune system's response to a problem, not the cause of the problem.
Taking a painkiller might eliminate the headache caused by a brain tumour; but that is curing the symptom and the cause, the tumour will still be there. The inflammatory aspect of CAD is the most dangerous end stage of the disease. It has been shown it can dissipate if the the underlying causes are rectified.
Take Home Points
Plaque build up is the result of lipoprotein particles and their remnants invading the artery wall. This can only occur if the inner protective single cell layer of the artery isn’t functioning properly or is damaged. High blood pressure (fluid dynamics) and “oxidation” damage resulting from excess blood sugars (excessive simple sugar and refined carbohydrate consumption) and the presence of small dense LDL particles cause Coronary Artery Disease and accelerate its progression to heart attack or stroke. Genetic luck and lifestyle (predominantly diet) are the cause of accelerated CAD and early death from heart attack or stroke. According to the science, for most of us lifestyle is responsible for about 75% of CAD and genetics the balance. Hence there is always room for lifestyle improvement, and the extension of vital health span.