Heart Disease

Heart disease is the leading cause of death worldwide and in the nation, and affects almost half of all Americans. A plant-based diet and lifestyle medicine address the root causes of heart disease and is the only dietary approach that has achieved clinical reversal of the disease. Discover the foods scientifically proven to prevent and reverse heart disease below.

Cases per year

About 697,000 people in the United States die from heart disease every year 1.

General frequency

In the US, 49.2% of the adult population, 126.9 million people, are living with heart disease in the form of coronary artery disease, heart failure, stroke, and hypertension 2

Risk

Coronary artery disease is the most common form of heart disease, around 20.1 million adults aged 20 and older have coronary artery disease 2.

Prevent, treat, and reverse heart disease with whole foods, plant-based lifestyle medicine

When I was working as a hospitalist, I will never forget the moment when a well respected cardiologist told me that she had never had to place a stent or send a patient to cardiac bypass surgery if they were following a whole food plant based diet.

Dr Yashoda Bhaskar, who has seen the power of lifestyle medicine treat heart disease first-hand.

Podcasts

Here are some top scientific studies that support the results our clinicians have seen first-hand:

Switching to a plant-based diet reduces the risk of heart disease by up to 61%

Plant‐Centered Diet and Risk of Incident Cardiovascular Disease During Young to Middle Adulthood

Scientists analyzed diet and cardiovascular disease occurrence in 4946 adults following a range of dietary patterns, over 32 years. When the study ended, scientists found that participants consuming a long-term plant-based diet and participants that had switched to a plant-based diet during the study had a significantly lower risk of cardiovascular disease, including coronary artery disease, hypertension, heart attack, stroke, heart failure and several other cardiovascular conditions. Following a plant-based diet reduced the risk of heart disease by 52%. The participants whose diets improved the most as they got older (became more plant-based) were 61% less likely to develop cardiovascular disease than those whose diets worsened the most 4

Lifestyle intervention reverses coronary heart disease

Can lifestyle changes reverse coronary heart disease? - The Lancet 

In this groundbreaking study, patients with coronary artery disease were randomized to a lifestyle intervention or to standard treatment alone. The lifestyle intervention consisted of a low fat, mostly plant-based diet, stress management activities and regular exercise. After one year 82% of patients in the intervention group showed regression of coronary artery disease with significant improvement in symptoms, weight, blood cholesterol levels similar to results seen with cholesterol-lowering medication. After a five year follow up patients had even further regression of atherosclerosis 5.

Whole-food plant-based diet reverses coronary artery disease and significantly reduces the risk of a future cardiac event 

A way to reverse CAD?

This program, run by Dr Esselstyn, was documented in two parts. The first was a group of 11 patients, of which 8 (73% of the participants) had documented regression of coronary artery disease 5 years after switching to a whole-food plant-based diet. Next, 198 participants with cardiovascular disease joined the program. 89% of this group adhered to the plant-based diet and saw extraordinary results: they had documented reversal of atherosclerosis and their cardiovascular event rate was just 0.6% compared to 62% in the non-adherent group 6

How to manage and even reverse heart disease with lifestyle medicine

What is heart disease? 

Every year we lose thousands of loved ones to a preventable threat: heart disease. 

Heart disease, which really means cardiovascular disease, is a group of several disorders affecting the heart and blood vessels. These include coronary artery disease, cerebrovascular disease, rheumatic heart disease, and other circulatory conditions, including heart failure, arrhythmias, and stroke. 

After high blood pressure, coronary artery disease is the most common type of heart disease in the US, where the coronary arteries get blocked by atherosclerotic plaques made up of fat, cholesterol, calcium, and other substances 7. This can lead to a heart attack, when a coronary artery gets completely blocked off by the atherosclerotic plaques. 

Strokes are responsible for 1 in 6 deaths from cardiovascular disease, and are caused by a blockage of the blood vessels supplying the brain 8

What causes heart disease?

Heart disease happens slowly overtime, and evidence suggests it may begin as early as childhood and worsens as we get older.

Healthy arteries are strong, elastic, and lined with smooth muscle. Diseased arteries, that lead to heart disease, are damaged and lined with atherosclerotic plaques that build up overtime; this is known as atherosclerosis.

Diet, high blood pressure, high cholesterol, smoking, diabetes, sedentary lifestyle, and psychological factors all contribute to the risk of heart disease. Poor diet is a huge risk factor for heart disease, and atherosclerosis is directly associated with the consumption of red meat, saturated fat, and refined carbohydrate. 90% of the risks attributed to developing cardiovascular disease are modifiable through lifestyle changes 9. With changes to unhealthy lifestyle behaviors using plant-based lifestyle medicine, many cases of heart disease can be prevented, treated, and reversed for good. 

Image shows a) the build up of an atherosclerotic plaque and b) the plaque in a blood vessel

Symptoms

Symptoms of heart disease vary greatly between individuals and different conditions. Some people experience chest pain (angina) and shortness of breath when living with heart disease 10. Others may have no symptoms of heart disease until they suffer a heart attack or heart failure 7

Symptoms of a heart attack include chest pain, shortness of breath, light-headedness, and pain in the arms, jaw, neck, and back . 

Diagnosis 

Various tests can be done by your doctor depending on what condition they think you may have.

Some common tests to assess cardiovascular disease include: 

  • Electrocardiogram (ECG) - a test to check your heart's rhythm and electrical activity and detect any issues with these. It can diagnose coronary artery disease, cardiomyopathies, and heart attacks.
  • Echocardiogram - a type of ultrasound that checks the structure of the heart and surrounding blood vessels. It can diagnose several heart conditions including heart failure, cardiomyopathies, and damage from a heart attack.
  • Stress test - a test that looks at how your heart responds to either exercise or medicine that raises your heart rate. 
  • Blood tests - to assess the levels of various risk factors for heart disease, such as your cholesterol levels, triglycerides, and lipoprotein (a). High cholesterol and apolipoprotein a / b levels are a major risk factor for developing heart disease. 
  • Blood pressure test 

Prevention and Treatment

Diet and lifestyle interventions should be the main treatment option for people with heart disease. Increasing physical activity and switching to a heart healthy plant-based diet tackles the root cause of heart disease with no unwanted side effects. 

The American Heart Association recommends eating a diet rich in whole plant foods to improve cardiovascular health and prevent heart disease. These include:

  • Fruits
  • Starchy vegetables
  • Non-starchy vegetables
  • Whole grains
  • Legumes
  • Nuts
  • Seeds

If you have heart disease, plant-based diet lifestyle medicine is a crucial tool to manage and potentially even reverse it, the science speaks for itself. There are many mechanisms by which a plant-based diet, combined with physical activity, restorative sleep, and stress reduction can prevent and treat heart disease without medications: 

  1. High blood pressure is a known risk factor for heart disease. Plant-based diets can reduce the risk of high blood pressure by up to 60% compared to an omnivorous diet 11. They are particularly effective when the diet is also low in salt. We have a page dedicated to treating hypertension with a plant-based diet. ‍
  2. High cholesterol is another significant risk factor for heart disease. In order to lower the ‘bad’ cholesterol in your blood, you need to reduce dietary saturated fat, trans fat, and to a lesser extent dietary cholesterol. Plant-based diets significantly lower blood total, LDL, HDL, and non-HDL cholesterol compared to omnivorous dietary patterns, and are naturally lower in saturated fat and cholesterol 12. Fiber, which is rich on a plant-based diet, also has cholesterol-lowering effects 13. Read more about plant-based diets and cholesterol here, ‍
  3. Saturated fat damages the lining of our gut, allowing bacteria to escape into our bloodstream and release harmful endotoxins. This causes inflammation and subsequent damage to our arteries, contributing to atherosclerosis and heart disease 14 15. Meat products, dairy, and processed foods are high in saturated fat. Saturated fat also raises LDL cholesterol, whereas unsaturated fats may be anti-inflammatory and lower CVD risk when replacing saturated fat in the diet 16. Plant-based diets are low in saturated fat, and higher in unsaturated fats. ‍
  4. Inflammation and oxidative stress, oxidative stress is a key part of atherosclerotic plaque formation. Plant foods are rich in polyphenols and other nutrients (vitamins C, E and beta-carotene) that are strong antioxidants and protect against oxidative stress. Antioxidants may also limit the oxidation of LDL-cholesterol which is also involved in atherosclerosis 17. Several components of animal foods, such as heme iron found in red meat and poultry, are pro-oxidative and contribute to increased risk of CVD 16. ‍
  5. TMAO, short for trimethylamine-N-oxide. Microbes in the gut can convert choline and L-carnitine, found in red meat, poultry, fish, eggs, and milk to a metabolite called TMAO, which promotes atherosclerosis and cardiovascular disease 18. This is not seen with the consumption of plant foods. 

Other benefits of plant foods for cardiovascular health include: 

  1. Bioactive polyphenols can increase nitric oxide production which helps to relax the blood vessels and improve blood flow 19
  2. Potassium, found in many plant foods, supports good endothelial function, lowering blood pressure and the risk of stroke 20
  3. Magnesium also helps to maintain cardiovascular health. It supports insulin sensitivity, is anti-inflammatory, and is a natural vasodilator which helps with blood flow 21

Useful links 

Books

Think you may be struggling with this and need to make a change? Get in touch with us today. 

References 

1. CDC. Heart Disease Facts | cdc.gov. Centers for Disease Control and Prevention https://www.cdc.gov/heartdisease/facts.htm (2022).

2. Virani, S. S. et al. Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association. Circulation 143, (2021).

3. Tsao, C. W. et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation 145, (2022).

4. Choi, Y. et al. Plant‐Centered Diet and Risk of Incident Cardiovascular Disease During Young to Middle Adulthood. J. Am. Heart Assoc. 10, e020718 (2021).

5. Ornish, D. et al. Can lifestyle changes reverse coronary heart disease? The Lancet 336, 129–133 (1990).

6. Esselstyn Jr, C. B., Gendy, G., Doyle, J., Golubic, M. & Roizen, M. F. A way to reverse CAD? J. Fam. Pract. 63, 356–364 (2014).

7. CDC. Coronary Artery Disease | cdc.gov. Centers for Disease Control and Prevention https://www.cdc.gov/heartdisease/coronary_ad.htm (2021).

8. CDC. Stroke Facts | cdc.gov. Centers for Disease Control and Prevention https://www.cdc.gov/stroke/facts.htm (2022).

9. Yusuf, S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet 364, 937–952 (2004).

10. Gaziano, T., Reddy, K. S., Paccaud, F., Horton, S. & Chaturvedi, V. Cardiovascular Disease. Disease Control Priorities in Developing Countries. 2nd edition (The International Bank for Reconstruction and Development / The World Bank, 2006).

11. Pettersen, B. J., Anousheh, R., Fan, J., Jaceldo-Siegl, K. & Fraser, G. E. Vegetarian diets and blood pressure among white subjects: results from the Adventist Health Study-2 (AHS-2). Public Health Nutr. 15, 1909–1916 (2012).

12. Wang, F. et al. Effects of Vegetarian Diets on Blood Lipids: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. J. Am. Heart Assoc. 4, e002408 (2015).

13. Brown, L., Rosner, B., Willett, W. W. & Sacks, F. M. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am. J. Clin. Nutr. 69, 30–42 (1999).

14. López-Moreno, J. et al. Effect of Dietary Lipids on Endotoxemia Influences Postprandial Inflammatory Response. J. Agric. Food Chem. 65, 7756–7763 (2017).

15. Bowman, J. D., Surani, S. & Horseman, M. A. Endotoxin, Toll-like Receptor-4, and Atherosclerotic Heart Disease. Curr. Cardiol. Rev. 13, (2017).

16. Satija, A. & Hu, F. B. Plant-based diets and cardiovascular health. Trends Cardiovasc. Med. 28, 437–441 (2018).

17. Tangney, C. C. & Rasmussen, H. E. Polyphenols, Inflammation, and Cardiovascular Disease. Curr. Atheroscler. Rep. 15, 324 (2013).

18. Koeth, R. A. et al. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat. Med. 19, 576–585 (2013).

19. Quiñones, M., Miguel, M. & Aleixandre, A. Beneficial effects of polyphenols on cardiovascular disease. Pharmacol. Res. 68, 125–131 (2013).

20. Aburto, N. J. et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 346, f1378–f1378 (2013).

21. Kolte, D., Vijayaraghavan, K., Khera, S., Sica, D. A. & Frishman, W. H. Role of magnesium in cardiovascular diseases. Cardiol. Rev. 22, 182–192 (2014).

 

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