h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

A fine article from a "text book" perspective. In the second paragraph I think the word should be "Atherosclerosis". However, let me describe my recent experiences. About 2-3 months ago, I started feeling pains in my chest when out walking - Angina. I had an exercise ECG - with the treadmill and wires taped to many parts of my body. It found nothing wrong! I was referred to a Cardiologist who performed an Angiogram (Angiography) on 25 May. I was awake during the process and the injection of a contrast agent (or dye) into my bloodstream allowed my arteries to show up on the monitor. I had a 90% blockage of my "LAD" coronary artery. I had to remain flat on my back for 6 hours whilst the hole in my femoral artery healed a bit. On 31 May, I was back in hospital for an Angioplasty - with the balloon on the end of the catheter to flatten out the plaque and the insertion of a Stent (a sort of wire mesh tube to hold open the artery). The whole process was amazing, considering the diameter of these coronary arteries is only 3-4mm. This time is was flat on my back for 20 hours while the "anti-freeze" and "rust inhibitor" medications wore off and allowed the hole in my artery to begin healing. For the Angiogram, I was in hospital for one day and for the Angioplasty, just under 48 hours. I can now walk briskly for 45 minutes with no chest pain. Next, I have to reduce my risk factors, such as Cholesterol and weight.

Hi TomGreyBeard!

The article is really just a presentation I had to do for a Biology class last semester. My dad has heart disease, and I knew a *lot* about it beforehand, so I knew I'd be able to answer any questions that anyone may have had.

My dad has his first angioplasty done about 15 years ago. He's going in for an angiogram on Monday, and it looks like he might need another one. Although after the first one he did a lot to get himself into shape, eating very well, exercising (to an obsessive degree!), he can't keep the cholesterol down. So the arteries keep clogging. Apparently his body produces cholesterol.

When I found out my cholesterol was high 11 years ago, I did all I could to reduce it with diet. And I've pretty much succeeded. It's been in the 170's since. I've got my fingers crossed for when I hit menopause ... that's when most women end up with their first heart attacks.

I wish you all the best TomGreyBeard! I hope your success continues! It's not easy changing your lifestyle! I know. If you'd like some low-fat recipes, let me know! I'll post the link for you!

Dear Shea,

What spread do you use? In Britain we have spreads rich in stanols, such as Benecol, which help to reduce LDL cholesterol. There is also increasing evidence that postprandial triglyceride levels play an important role in the development of atherosclerosis. A diet rich in monounsaturated fatty acids, such as those found in olive oil and peanut oil, and omega-3 polyunsaturated fatty acids, found in oily fish, like salmon, and walnuts is thought to be highly beneficial.These sort of fats are found in Mediterranian diets and statistically the Greeks, Italians, etc have lower rates of heart disease and strokes. It is thought that olive oil may be more beneficial that vegetable and sunflower oils due to the fatty acid composition of these oils. Also antioxidants found in fruit and veg may help to reduce the build up of plaques in atherosclerotic lesions. If it's useful I can probably find out more as this is the sort of thing my PhD is about.

There has been such debate over spreads ... the whole margarine vs. butter thing has been swinging back and forth for years. I personally use I Can't Believe It's Not Butter Light, and never in a bar form, always in a tub. It's half and half. I figure that whichever way they finally settle on, I'll be covered. That being said, I very rarely use a spread at all. It tends to go bad before I even finish the tub.

I've switched to safflower or canola oil for cooking, but if I'm "frying" something on top of the stove, or baking it in the oven, I only use canola spray oil in non-stick bakeware. Very little added fat that way.

My father eats very low fat, and uses Benecol spread (he uses it everyday), but his cholesterol won't come down. They said that his body produces its own cholesterol. He's just recently gone on cholesterol lowering medication (I can't remember which offhand). I'm afraid that's going to be my fate once menopause kicks in. I've been able to control my cholesterol through diet, for a total of 178, but the bad cholesterol is still high in comparison to the good cholesterol (can't remember if LDL is bad ... I think it is, but don't want to confuse the issue by writing the wrong thing).

Only a third of the body's cholesterol comes from the diet, the majority is made by the liver. You also only absorb about 40% of dietary cholesterol whereas you absorb more than 95% of triglycerides. The cholesterol drugs are probably some sort of statins which work by inhibiting the rate-determining step in cholesterol synthesis. A number of studies using statins - one of the most successful being in Glasgow, the heart disease capital of the world - significantly reduced the mortality due to atherosclerosis.

I personally dislike the terms good and bad cholesterol as they are physiolgically misleading. The liver produces a particle called very low density lipoprotein (VLDL) rich in triglycerides (TAG) compared to cholesterol which are supplied to the periferal tissues. As VLDL progresses around the body and more TAG is removed it forms LDL which are smaller denser particles which have a higher ratio of cholesterol to TAG. It's because LDL is smaller that it can penetrate lesions more easily thus sequestering cholesterol and leading to the formation of atherosclerotic plaques. But LDL is needed to supply cholesterol to the periferal tissues for various functions including cell membrane stability and hormone synthesis. It's just unfortunate that LDL has been given such a bad image. High density lipoprotein (HDL) on the other hand is seen as the good guy. It's function in a process known as the reverse cholesterol pathway is to remove cholesterol from the periferal tissues and return it to the liver for various reasons, helping to reduce cholesterol levels. HDL may also have problems but this is more theoretical and become overly complicated. It has a lot to do with the fatty acid composition of TAG.

Wow, DMS ... for someone wearing scarlet frilly knickers, you've really got it going!

Thanks for the information! I didn't know about TAG. It's amazing how once you get the cholesterol under control, the doctors stop talking to you about it! I personally see it as still being a problem for me, since if I stopped eating well, the cholesterol would zoom back up again, but after getting it tested, and having it fall in the normal range, it's no longer considered a problem!

Once you get your PhD, would you like to be my cardiologist?

Unfortunately I won't be qualified enough to be cardiologist though the thought of women stripping off for me to listen to their chests has a certain appeal. The problem is that I'm classed as a scientist as so can only fit in at an advisory role, usually to doctors who then ignore you. I also have a tendancy to use cell cultures rather than people though our research group does nutritional studies on volunteers and so I've been busy learning how to take blood or not as the case may be.

> the thought of women stripping off for me to listen to their chests has a certain appeal.

I must have missed that part of the Hippocratic Oath ...

It's funny, I was just talking to my mother this morning, and she said that my Dad had been to see the cardiologist yesterday. And the doctor said that triglycerides aren't that important, and it's the cholesterol you have to be concerned with. I suppose the great debate continues ...

There is increasing evidence that triglycerides are important. Part of the problem is that since the 70's cholesterol has had so much press. It is important, there's no doubt about that. But then so are triglycerides. Too many plasma triglycerides are also an indication of insulin resistance which can ultimately lead to non insulin dependent diabetes and from there the risk of coronary heart disease increases dramatically. It is thought that the type of fatty acids ingested can contribute to coronary heart disease. Saturated fatty are more of a problem that unsaturated fats. Though polyunsaturates have an increased chance of being oxydized which is also a risk factor. A lot of money is being spent on research into monounsaturates and omega-3 fatty acids which are what a traditional mediteranean (I never know how to spell that) diet is rich in and the meditteraneans have much lower rates of heart disease than the UK and other Northern European countries. After all the meditteraneans consume more fat on average than the British and have similar cholesterol levels. But then they also consume more fruit and veg and red wine. Studies have suggested that monounsaturates are more beneficial than polyunsaturates in the dietary control of noninsulin dependent diabetes. Given that it is now thought that 40% of the UK population is prone to developing this form of diabetes, and that diagnosis of this disease can take some time before it properly noticed, the diet as a whole should eb taken into consideration. Coronary heart disease is quite a complicated disease. It is assuming too much that cholesterol is the only thing to worry about. It's just that it'll take time before all the details are worked out and a clear message will get through to doctors. After all if triglycerides weren't such a problem why would companies hark on about the benefits of spreads and oils rich in polyunsaturates? Perhaps these claims are exaggerated but they still have to adhere to advertising standards. In the scientific community there isn't a debate as too whether triglycerides are risk factor or not. It's to what extent and how.

Hopefully this has made some sort of sense.

I might have to have a bit of a lie down as the thought of women stripping is getting to me. (I'm going to have to learn how to insert a winking eye smiley)

Sorry for the delay in replying ... I was in London for a week ... raising my cholesterol levels! <--- BTW, a wink smiley is made by typing ; - ) without the spaces, of course!

I really appreciate reading all the info that you have! Do you know what could cause high triglycerides?

As it happens I've just returned from a conference held by the Nutrition Society. I'm a bit tired and in the process of trying to make sense of what I've been learning. I'll have a bit of a think and see what I can find out. Though I warn you now that the answer will ptobably be very, very long winded and won't make a lot of sense. The references could take a while to gather as well. But I'll put a couple in one is by my supervisor the other is by the person how started a lot of this fuss in the first place. I'm not sure how easy they'll be to get though.

Williams,CM (1997)"Postprandial lipid metabolism: effects of dietary fatty acids" Proceedings of the Nutrition Sciety 56, 679-692

Patsch, JR et al (1992) "Relation of triglyceride metabolism and coronary heart disease" Arteriosclerosis and Thrombosis 12, 1336-1345