THE G.I. FACTOR: WHAT IS HEART DISEASE?

Most heart disease in the Western world, and increasingly elsewhere, is caused by atherosclerosis of the arteries, sometimes referred to as ‘hardening of the arteries’. Most people develop atherosclerosis gradually during their lifetime. If it develops sufficiently slowly it may not cause any problems, even into great old age, but if its development is accelerated by one or more of many processes the condition may cause trouble much earlier in life.

Atherosclerosis results in reduced blood flow through the affected arteries. In the heart this can mean that the heart muscle gets insufficient oxygen to provide the power for pumping blood, and it changes in such a way that pain is experienced (central chest pain or angina pectoris). Elsewhere in the body, atherosclerosis has a similar blood flow reducing effect: in the legs it can cause muscle pains on exercise (intermittent claudication); in the brain it can cause a variety of problems from ‘funny turns’ to strokes.

An even more serious consequence of atherosclerosis occurs when a blood clot forms over the surface of a patch of atherosclerosis on an artery. This process of thombosis can result in a complete blockage of the artery with consequences ranging from sudden death to a small heart attack from which the patient recovers quickly. The process of thrombosis can occur elsewhere in the arterial system with a range of consequences determined by the extent of the thrombosis. The probability of developing thrombosis is determined by the ‘tendency’ of the blood to dot versus the natural ability of the blood to break down clots (fibrinolysis). These two counteracting “tendencies’ are influenced by a number of factors, including some dietary factors (most notably the effect of fatty fish or fish oils in the diet).

People who have gradually developed atherosclerosis of the arteries to the heart (the coronary arteries) may gradually develop reduced heart function. For a while the heart may be able to compensate for the problem, so there may be no symptoms, but eventually it may begin to fail. Shortness of breath may begin to occur, initially on exercise, and there may sometimes be some swelling of the ankles. Modern medicine has many effective drug treatments for heart failure so this consequence of atherosclerosis does not have quite the same serious implications as it did in the past.

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