The 2014 Cardiovascular Disease Prevention SymposiumJuly 2014
By Ben Best
For years, Michael Ozner, MD, has been organizing the world’s largest cardiology conference devoted to the prevention of cardiovascular disease.
Dr. Ozner serves as medical director for the Cardiovascular Prevention Institute of South Florida and is a member of Life Extension’s Scientific Advisory Board.
On February 6, 2014, Dr. Ozner gave opening remarks at his 12th Annual Cardiovascular Disease Prevention International Symposium in Miami Beach, Florida. This article provides an overview of the various presentations made at this conference dedicated to preventing the most prevalent disease striking Americans.
South Beach Diet Gluten Solution
Arthur Agatston, MD, (Associate Professor of Medicine, University of Miami School of Medicine) is best known as the originator of the South Beach Diet for which he has written many best-selling books. The subject of his presentation (and the subject of his latest book) was gluten.
Gluten is a protein found in wheat and a few other grains. Gluten readily forms cross-links with itself and with other proteins. This crosslinking property makes bread chewy (viscous and elastic), but it also makes gluten difficult to digest. In people with celiac disease, gluten greatly damages intestinal villi, leading to diarrhea, abdominal pain, weight loss, fatigue, and anemia. Although up to 1% of the population has celiac disease, most of the victims are unaware they are afflicted.1-3
Much more common than celiac disease, according to Dr. Agatston, is gluten sensitivity, which can cause headaches, foggy mind, chronic fatigue, sinus problems, and constipation or diarrhea (among other problems).1 Although there is a definitive diagnostic test for celiac disease, gluten sensitivity can only be established by removing gluten from the diet and seeing if the symptoms go away. Celiac disease cannot be cured, symptoms can improve and intestinal healing can occur if celiac patients completely remove gluten from their diet.4 Removing gluten from one’s diet is not such an easy task, because gluten and wheat are added to so many products, particularly to achieve thickening. Dr. Agatston mentioned such unsuspected products as tomato sauce, yogurt, and toothpaste. Although wheat is not a GMO (Genetically Modified Organism), centuries of selective breeding and hybridization have increased the gluten content of wheat for the purpose of strengthening dough,2 which has led to an increase in celiac disease and gluten sensitivity.5
Dangers Of Fructose
Robert Lustig, MD, (Professor of Clinical Pediatrics, University of California, San Francisco) believes that sugar consumption, fructose consumption in particular, is more of a cause of type II diabetes than obesity. He said that sugar consumption in the US increased by a factor of 10 between 1820 and 1900, and doubled between 1900 and the year 2000.
Table sugar (sucrose) is composed of equal parts of the two simple sugars glucose and fructose.6 Fructose has often been recommended to diabetics because unlike glucose, fructose consumption does not stimulate insulin secretion as much as glucose (fructose has a lower glycemic index).7,8
But a study of overweight human subjects showed that a high-fructose diet promotes insulin resistance, visceral obesity, and elevated serum triglycerides (fats in the bloodstream), an effect not seen when glucose was substituted for fructose in the same diet.9
Insulin resistance is generally thought about as reduced ability of insulin to cause muscle to absorb glucose. But to Dr. Lustig, insulin resistance in the liver is more crucial. Unlike glucose, fructose is rapidly removed from the blood stream by the liver, which protects the rest of the body from the damaging effects of fructose. But the liver itself becomes damaged by fructose, and by the fats (triglycerides) that fructose causes the liver to manufacture.10,11 The resultant fatty liver is more causative of type II diabetes and insulin resistance than visceral fat,12,13 although the consequences are not so bad when fructose consumption is moderate.14
Fructose elevates uric acid production, which has damaging effects on the kidney and cardiovascular system.15,16 Most soda drinks are currently sweetened with high fructose corn syrup,17 partly because fructose is sweeter and more soluble than glucose.18 Increased consumption of those soda beverages has been linked to weight gain and might play a role in the growing incidence of obesity.19 Even fruit juice, which can be high in fructose, has been linked to type II diabetes.20 Dr. Lustig lamented the promotion of orange juice by pediatricians. Apple juice, which has more than twice the fructose as orange juice, is the juice most often given to children under age 5.21 Fruit juice is a poor substitute for fruit or milk, especially in light of the fact that half of children between the ages of 1 and 5 do not get enough calcium.21
Smoking And Psychological Factors In Cardiovascular Disease
Wayne Sotile, PhD, (Clinical Assistant Professor, Tulane University) discussed efforts to reduce or stop cigarette smoking. A long-term study of British doctors showed that smokers died about 10 years younger than non-smokers.22 A study of smokers who suffered a heart attack showed that 80% attempted to quit smoking after the heart attack, but after one year only about half were still not smoking.23
Dr. Sotile described tactics for reducing smoking, such as only smoking if a smoker rated the desire to smoke as being greater than 7 on a scale from 1 to 10. He said that simply encouraging smokers to keep a count of the cigarettes they smoked reduced cigarette consumption by half. But he also cited a study of heavy smokers which showed that a 50% reduction of cigarette consumption did not significantly reduce the risk of premature death.24 Complete cessation of smoking will provide definite health benefits—life and health are extended in proportion to how early in life a smoker completely stopped smoking.22 Dr. Sotile said that for those who are unable or unwilling to quit smoking, electronic cigarettes have considerably fewer toxicants and carcinogens than tobacco cigarettes.25
In a separate lecture, Dr. Sotile discussed psychological factors leading to cardiovascular disease. Studies of certain “type-A” behavior factors (competition and exaggerated commitment to work) have not shown convincing results that the personality type leads to increased risk of coronary artery disease, whereas hostility (a major attribute of the type A personality) has been associated with increased risk.26 Confounding this analysis, however, is the fact that hostile people more often have unhealthy lifestyles.26 Work stress is particularly toxic when there is high demand, but low decision latitude.26 Dr. Sotile thinks that the number of stresses is less important for cardiovascular risk than the number of uplifts (gratitude, interest, hope, pride, amusement, and love).
Women’s Issues In Cardiovascular Disease
Sharonne Hayes, MD, (Professor of Medicine and Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota) is concerned with both women’s issues and psychological issues associated with cardiovascular disease.
For example, certain metabolic changes during pregnancy can resemble diabetes, and may accelerate the development of diabetes after pregnancy.27 In a study involving subjects who lost their significant other, women were three times more likely to experience death of a spouse after age 65 than a man.28 The risk of a heart attack in the first 24 hours after the death of a spouse was increased more than 20 times, and it decreased subsequently.28 Women are more likely to die of stroke than coronary artery disease, whereas the opposite is the case for men.29 Women with a history of depression are two to three times more likely to have calcification of their coronary arteries than women without a history of depression.30 Patients with coronary heart disease are much more likely to have impaired endothelial function, and are much more likely to die if they are depressed.31 A study showed that anxiety is a stronger predictor of coronary artery disease than depression.32 Exercise reduces death rates in depressed heart patients.33,34 Another study cited showed that pet ownership is associated with lower blood pressure, reduced incidence of cardiovascular disease risk factors, and increased survival in individuals with existing cardiovascular disease.35
Dr. Hayes reported on a Mayo Clinic survey of the hierarchy of female concerns. What is most important to women is their children, followed by their home, their career, their pet, their spouse, and lastly, themselves. Dr. Hayes suggested that the low priority women give to their own needs can manifest in not taking time to look after their health, such as by exercising. As another example, she reported that 79% of women said they would call 911 if someone else was experiencing symptoms of a heart attack, but only 53% would call 911 if they were the one experiencing heart attack symptoms.29
Removing The Cause Of Atherosclerotic Inflammation
Ira Tabas, MD, PhD, (Professor of Medicine and Anatomy and Cell Biology, Columbia University, New York, New York) summarized his argument by saying that the first step in stopping inflammation caused by a splinter in the finger is to remove the splinter. Inflammation in atherosclerosis involves the inability to effectively clear dead immune cells with accumulated oxidized non-HDL cholesterol from blood vessel walls.36,37 Preventing the entry and retention of oxidized non-HDL cholesterol in blood vessel walls would help prevent atherosclerosis.38,39
Calcium In Coronary Arteries
Khurram Nasir, MD, (Research Director, Center for Prevention and Wellness, Miami, Florida) is concerned that half of the serious coronary artery disease incidents (including death) occur in individuals who displayed no previous symptoms.40 As a predictor of coronary artery disease, he has found imaging of calcium in the coronary artery to be superior to assessments of coronary artery wall thickness41 or blood levels of the inflammatory agent C-reactive Protein (CRP).42
In a study of about 44,000 patients, about half of the participants had coronary artery calcium detectable by electron beam tomography. The patients having the highest coronary artery calcium were about seven times more likely to die during a mean 5.6-year period.43 Dr. Nasir believes that because scanning for coronary artery calcium is easy and inexpensive, it should be as routine as mammograms. Some people avoid the coronary calcium score diagnostic test because of the radiation exposure.