I plan to cover in great depth the prevention and management of cardiovascular disease over the next few Blogs.
This will be broken down onto “bite-sized” chunks as the data is extensive (to digest).
- Lifestyle choices with detail covering the process of physical conditioning (this Blog Matters of Health 4a)
- Lifestyle choices with nutrition
- Aggressive risk factor reduction with modern pharmacology
- Role of the Holy Spirit
The Compression of morbidity as we age:
The pandemic of overt clinical cardiovascular disease starts to manifest around mid-life but as you are now aware the pathology of the disease has started 2-3 decades earlier. As a major chronic disease the burden to society is high and the quality of life deteriorates progressively. Health care costs rise progressivley (yellow line below) until the end of life. The whole idea of primordial prevention of cardiovascular disease is to compress the chronic morbidity (blue line below) into the last few months of life, rather than struggling with chronic disease for the last few decades or life.
This “compression of morbidity paradigm” not only provides far better functional and productive quality of life in the latter decades but actually allows us to reach our “biological clocks” rather than dying prematurely. We don’t have clear data as to what the optimal biological clock is in us as genetics play are large component in our survival but according to Genesis:
Then the LORD said, “My Spirit will not contend with humans forever, for they are mortal; their days will be a hundred and twenty years.”
Prevention of Chronic Disease:
Published in Science (2002; 296: 695-698) from the Centre of Research for Disease Prevention it has been projected that with balanced lifestyle intervention and modern pharmacotherapy we can pretty much eradicate vascular disease; many cancers and the epidemic of overweight/ obesity related Type 2 Diabetes Mellitus.
Heart Rate and Survival:
In our lifetime we have approximately 8 000 000 000 heart beats per life. Remarkably (but not surprisingly with God as our Creator) this parameter is constant across all human and animal life (including reptiles, mammals and birds). There is a LINEAR inverse relationship to survival and resting heart rate (HR) per minute across ALL species. Man is also reflected on this curve for those with slow HR at rest have higher life expectancy as an independent parameter for survival.
Resting heart rate is thus a very important contributor to heathy ageing in both heathy individuals and with those who have established cardiovascular disease. In folk with heart failure or coronary disease the prognosis of patients with a resting HR > 80 bpm is considerably worse than those whose resting HR is < 70 bpm.
It has been calculated that by JUST reducing HR from 70 bpm to 60 bpm in heathy individuals you potentially ADD 13.3 years to life expectancy!
Relative risk of Death verses Objective Physical Performance:
This is a very important graph as it demonstrates that your OBJECTIVE performance base is the most important “benchmark” of SURVIVAL. Even if you think you are healthy if you can’t exercise to a workload of 5 METS then your prognosis is lousy. In fact you have the SAME prognosis as a heathy individual with poor performance base to a person with advanced cardiovascular disease who also can’t exercise through 5 METS.
The reverse is true in that if you have cardiovascular disease and CAN exercise to high workload > 10 METS (through stage 3 of Bruce protocol on formal exercise stress testing on a treadmill) your prognosis is as good as a corresponding “healthy” person who can achieve te same workload.
In other words your OBJECTIVE physical performance is the most important determinant of survival and life expectancy.
Cardiovascular Conditioning with Exercise:
The purpose of daily conditioning exercise is to change our intrinsic balance of our AUTONOMIC NERVOUS SYSTEM in favour of the parasympathetic nervous system. Individuals who are driven by and generally over express the SYMPATHETIC nervous system (the “fight-and flight” system) do not survive well and tend to “burn out’ with chronic disease. These individuals are “adrenaline” junkies and self destruct. By contrast the training up your parasympathetic nervous system with regular conditioning exercise slows the HR and lowers adrenaline (and other stress hormones) and lowers BP.
So What is Cardiovascular Conditioning (fitness)?
There are 4 components to fitness/ conditioning:
- Aerobic Fitness
- Muscular Fitness
- Flexibility and core strength
- Body Composition
A little more about visceral adiposity:
The adipose tissue (specifically visceral intra abdominal adipose tissue), once considered a simple energy warehouse, is now regarded as a complex organ not only contributing to the management of energy flux within the body but also interacting with the inflammatory system and the vascular wall. Recent studies have underlined that there is intricate interplay among adipocytes, the sympathetic nervous system, and the renin-angiotensin system which participate in the obesity-associated dysmetabolic state. Thus, the adipose tissue is believed to play an important role in the development of both hypertension and other complications related to insulin resistance. When adipocytes become enlarged, for unknown reasons, they secrete factors which attract inflammatory cells, called macrophages which in turn release toxic factors such as the interleukins responsible for damage to the liver and other organs including our arteries and promote the insulin resistance causing type 2 diabetes and accelerated atherosclerosis. Today we have tests to assess our inflammatory load, generally thought to arise from our arteries.
Aggressive reduction of obesity and in particular the visceral component, has major implication in reducing the associated chronic conditions of obesity.
To physically condition ourselves, requires a dedicated sophisticated daily training programme. Walking puppy round the block three times a week sadly does not suffice. It is important to objectively measure your conditioning response to assess the benefit of your exercise programme as I meet many people who consider themselves fit but are actually not optimally conditioned (poorly developed parasympathetic nervous system).
Physical conditioning is THE most important benchmark of healthy ageing and contributes to considerably improved quality and quantity of life.
Your need on average to dedicate 1-2 hours per day to perform the process to optimise the 4 components of physical conditioning, bearing in mind you would NEVER just study God’s inspired word for 15 minutes a day. Would you??
1 Corinthians 6:19
Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; 20 you were bought at a price. Therefore honour God with your bodies.
Yours in exercise