By Melanie Sun, Mission San Jose High School, Fremont, California, USA
As the leading cause of death worldwide, it seems almost unavoidable that one day we or someone we know will be diagnosed with heart disease. It is estimated that a staggering 17.9 million adults die from cardiovascular diseases each year (WHO, 2019). The most common disease of this type, coronary artery disease, also known as atherosclerotic heart disease, often goes undetected until our later years when the first deadly warning signs arise. Previously, high rates of cardiovascular disease were seen as a concern only for affluent societies (Aje, 2009). However, between 1990 and 2020, the prevalence of just coronary heart disease was predicted to increase by 137% for men and 120% for women living in developing countries. Today, more than 75% of deaths associated with heart disease are in low and middle-income countries (Gaziano et al., 2010).
As its name suggests, atheroschelerotic heart disease is characterized by inhibited blood flow to the heart as a result of atherosclerosis, the accumulation of fat, cholesterol, and other components of plaque in the coronary arteries. Normally, the coronary arteries supply oxygen-rich blood to the heart to keep it beating. But over time, as plaque builds within the arterial walls, it hardens and causes the narrowing of these arteries (Atherosclerosis, 2020). This not only impedes the flow of oxygen-rich blood to the brain and throughout the body, but it can also rupture to create blood clots. As this process continues and crucial organs such as the brain and the heart are not supplied with oxygen, a stroke or a heart attack may occur (Hong, 2010).
But why should we wait until our hearts stop beating before we try to prevent these diseases? Research has shown that fatty deposits within the artery walls have been detected in children as young as ten years old. Then, in our twenties and thirties, the plaque within our arterial walls continues to build up until our early fifties when most begin to experience their first symptoms (Hong, 2010). Knowing this, it is in our best interest to do everything we can to reverse the progression of these silent killers.
According to the WHO, the major risk factors of cardiovascular diseases include a lack of exercise, smoking, excessive alcohol consumption, obesity, and an unhealthy diet. These factors also contribute to high blood sugar, high blood pressure, and high blood cholesterol, which can also increase the risk for other diseases (WHO, 2019). The increase in these risk factors in developing countries is a result of changes in the environment and society. Urbanization results in changes such as a more sedentary lifestyle and a shift to a western diet filled with artificial sweeteners, animal-based foods, and oils (Anand et al., 2015). Therefore, if one was to decrease these risk factors through lifestyle changes, then one would have a winning chance at combating heart disease.
In fact, it has been shown that lifestyle changes can reverse the onset of heart disease in affected individuals. In one study, researchers followed a group of patients with atherosclerosis who were either placed into an experimental group that altered certain lifestyle factors or a control group that maintained their current unideal lifestyle. After one year of following a low-fat vegetarian diet, managing their stress, stopping smoking, and exercising more frequently, 82% of the patients in the experimental group experienced the regression of their atherosclerosis, measured by the increase in the diameter of their arteries. In just one year and without the use of lipid-lowering medication, the majority of patients were not only able to stop the progression of their disease but also reverse the damage that the atherosclerosis had done (Ornish et al., 1990).
Despite these findings, current treatments for cardiovascular diseases continue to rely on methods that treat the symptoms rather than the underlying cause. The majority of countries rely on some form of medication to treat heart disease; for example, countries located in South Asia, the Middle East, Latin America rely on drugs such as aspirin and beta blockers (Gaziano et al., 2010). The use of these medications often includes side effects such as an increased risk of diabetes, chronic cough, and fatigue (Esselstyn, 2017). Surgical interventions are more expensive and are not much better either. Belgium, Germany, and the United States have the highest rates of patients undergoing angioplasty surgery, which involves the insertion of a stent into the clogged coronary artery (OECD, 2011). This procedure has a 1% mortality rate, while coronary bypass surgeries have a 3% mortality rate. With such a large number of individuals undergoing these surgical procedures, they account for approximately 27,000 deaths annually (Esselstyn, 2017).
Therefore, it is our duty to make choices that will give our bodies an opportunity to heal from within. It is common knowledge today that smoking, excessive alcohol usage, a lack of exercise, and obesity are severely detrimental to our health, but what exactly constitutes a healthy diet? A whole-food, plant-based diet low in animal products, processed foods, sugar, fat, and salt is an effective treatment for atherosclerosis (Esselstyn et al., 2014). Phytochemicals and fiber found in fruits and vegetables decrease the progression of atherosclerosis by decreasing inflammation and oxidative stress in the body, allowing for the repair of our endothelial cells and blood vessels (Tuso, 2015).
Luckily, many countries around the world have already begun to implement programs to lower the risk factors of cardiovascular disease associated with diet. For example, the Mexican government has placed a tax on sweetened beverages and junk foods, which has led other low- and middle-income countries to consider doing the same. Similarly, countries in Europe have begun taxing the same food groups that are associated with the increase in obesity rates (Anand et al., 2015). The Eastern Mediterranean Regional Office has developed programs that educate healthcare workers on cardiovascular diseases and advocate for healthy lifestyles as a cost-effective method of managing hypertension and other risk factors (“Regional activities,” 2016). Meanwhile, Chile has implemented a labeling system for packaged foods in which food manufacturers are required to place warning signs on products that exceed the healthy consumption level for fat, salt, sugar, and calories as mandated by the government (Anand et al., 2015). Through such administration, governments encourage food industries to produce products with healthier ratio of ingredients.
Although these efforts are moving societies worldwide towards a positive direction, few interventions encourage adequate fruit and vegetable consumption within their populations. Within 162 countries studied, 88% of them had a mean vegetable intake below the 400 grams per day recommended by the WHO (Kalmpourtzidou et al., 2020). Almost all countries encourage fruit and vegetable consumption, but about half of them fail to include the intake recommended by the WHO in their recommendations (Herforth et al., 2019). Furthermore, in low- and middle-income countries, fresh foods are not as accessible and affordable as processed foods introduced during urbanization (Kalmpourtzidou et al., 2020). Clearly, many would benefit from governments worldwide taking further action to ensure that all people are aware of the lack of fresh fruits and vegetables in their diet and that these foods are widely accessible regardless of economic status.
Every meal we consume becomes a chance for us to fight back against the wave of heart disease that is plaguing modern society. Although major lifestyle changes are difficult to adapt to, the collective efforts of government leaders and their citizens in encouraging more healthful habits are crucial for a fulfilling life free from the shackles of disease.
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