Coronary artery disease (CAD) is a prevalent condition caused by the accumulation of fatty substances, such as cholesterol, in the arteries. This buildup, known as plaque, narrows the arteries, restricting blood flow to the heart and brain. A heart-healthy diet plays a crucial role in managing CAD symptoms and slowing its progression. This article delves into dietary recommendations, lifestyle adjustments, and the significance of coronary artery calcium (CAC) scores in assessing and mitigating the risk of heart disease.
Understanding Coronary Artery Disease and Calcium Scores
CAD is a leading cause of death in the USA, with atherosclerosis being a primary contributor. Atherosclerosis is a chronic inflammatory disease affecting the inner lining of large and medium-sized arteries. Coronary artery calcification (CAC) is characterized by calcium deposits within the atherosclerotic plaque in the coronary artery wall, serving as a specific marker of coronary atherosclerosis.
A coronary artery calcium score is determined using a CT scan to measure the amount of hardened calcium, or plaque, inside the walls of your arteries. A score of 0 is considered optimal at any age, indicating no hardened plaque. Doctors may request this test after a Heart Health Check, which estimates your risk of heart attack or stroke in the next five years based on risk factors like high blood pressure or high LDL cholesterol. The ideal age for this preventative test is between 45 and 70 years, especially for those without symptoms like chest pain or shortness of breath.
The Link Between Diet, Calcium, and Arteries
It's natural to associate calcium-rich foods with calcium deposits in your body, but eating foods high in calcium does not directly affect what happens in your arteries. The exact cause of calcium crystal formation in certain body regions remains unknown. Damaged tissues can undergo changes that cause cells to adopt a bone-like structure, attracting calcium. When coronary arteries develop fatty deposits, the artery wall next to these deposits becomes inflamed and damaged, potentially leading to the formation of bone-like cells and calcium deposition.
Once calcium has been deposited in arteries, it cannot be reversed. However, the process can be slowed by aggressively addressing risk factors that contribute to fatty deposit formation. Doctors often recommend a high-dose statin to lower LDL cholesterol to less than 70 milligrams per deciliter (mg/dL), or even below 55 mg/dL, for individuals with a high coronary calcium score.
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Dietary Strategies for Managing CAD and High Calcium Scores
The cornerstone of managing CAD through diet is to lower LDL ("bad") cholesterol levels. Foods high in soluble fiber and low in saturated and trans fats are excellent choices.
Foods to Embrace
- Oats: Rich in beta-glucan, oats block cholesterol absorption from the digestive tract. Consuming 1.5 cups of oats daily can lower cholesterol levels by 5-8%. Enjoy it for breakfast, in yogurt parfaits, or blended into smoothies.
- Nuts: Almonds, pistachios, walnuts, and pecans contain arginine, an amino acid that promotes relaxed and supple blood vessels, improving blood flow. Nuts also contain magnesium and plant sterols that naturally help reduce plaque build-up in your arteries. The American Heart Association recommends three to five servings a week.
- Beans: Beans reduce cholesterol absorption and provide potent antioxidants for artery health. Aim for four to five half-cup servings weekly.
- Fatty Fish: Salmon, mackerel, and sardines are rich in omega-3 fatty acids, which lower triglycerides, reduce blood pressure, and slow plaque buildup. Eating at least two servings of fish a week could reduce your risk of heart disease.
- Olive and Canola Oils: These oils are low in saturated and trans fats and rich in heart-friendly unsaturated fats. Use them as your primary cooking oils. Monounsaturated oleic acid in olive oil can reduce the risks of strokes and cardiovascular disease.
- Avocados: Loaded with heart-healthy monounsaturated fats and potassium, avocados help regulate blood pressure and reduce vascular calcification. Use them as a replacement for condiments like mayonnaise.
- Whole Grains: Whole grains are full of fiber that helps improve blood cholesterol levels and protect against heart disease. Fiber fights the hardening of artery walls.
- Leafy Greens: Spinach, kale, and Swiss chard are packed with vitamin K, which helps prevent calcium from being deposited in your arteries. They’re also loaded with antioxidants that fight inflammation.
- Dark Chocolate: A small amount of dark chocolate (at least 70% cacao) contains flavonoids that improve circulation and reduce arterial stiffness.
Foods to Limit or Avoid
- Saturated Fats: Found in red meat, butter, cheese, coconut oil, and whole and 2 percent milk, saturated fats raise LDL cholesterol levels. Less than 6% of total daily calories should come from saturated fats.
- Trans Fats: Present in French fries, doughnuts, creamer, stick margarine, and shortening, trans fats also increase LDL cholesterol. Trans fats can no longer be added to foods in the United States, but they could be in products made in other countries.
- Excess Sugar and Salt: Sugar can increase your chances of having diabetes, while salt can raise your blood pressure. Both contribute to an increased chance of developing CAD. Limit added sugar to less than 10% of your daily calories and have no more than 2,300 milligrams (mg) of sodium a day.
The Impact of Macronutrients on Coronary Artery Calcification
Research suggests a complex relationship between macronutrient intake and CAC. A study involving asymptomatic men found that lower carbohydrate intake and higher lipid intake were associated with moderate/severe CAC. Specifically, a 1% increase in lipids and saturated fatty acids (SFA) intake was associated with a 4% and 8% increase, respectively, in the prevalence of moderate/severe CAC. Conversely, a 1% increase in carbohydrate intake led to a 2% decrease in the likelihood of moderate/severe CAC.
These findings highlight the importance of balancing macronutrient intake, emphasizing the reduction of saturated fats and incorporating complex carbohydrates.
Lifestyle Modifications for Heart Health
In addition to dietary changes, lifestyle modifications are crucial for managing CAD and maintaining heart health.
- Portion Control: How much you eat is just as important as what you eat. Avoid overloading your plate and continuing to eat after you feel full. Using a small bowl or plate can help you control your portion size.
- Regular Exercise: Physical activity helps maintain a healthy body weight, reduces blood pressure, and improves cholesterol levels. Aim for at least 30 minutes of moderate-intensity aerobic physical activity on 5 days a week or 20 minutes of high-intensity aerobic physical activity on 3 days a week.
- Maintain a Healthy Weight: Being overweight or obese increases the risk of heart disease.
- Stress Management: Make time to relax and manage stress through activities like meditation, yoga, or hobbies.
- Avoid Smoking: Smoking damages blood vessels and increases the risk of heart disease.
The Role of Calcium Supplements
There is some controversy regarding the link between calcium intake, particularly from supplements, and a higher coronary artery calcium score. While dietary sources of calcium (predominantly in the form of dairy products) seem to have a protective effect on the heart, caution must be exercised with regular high doses of calcium supplementation.
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Greater research is needed to determine the extent of plaque buildup and heart damage, particularly after taking calcium supplements which exceed 1400mg per day. A possible explanation is because not all of the calcium makes it to the skeleton or gets excreted in the urine, so it may build up in the soft tissues including the heart. Your body uses and responds to calcium differently when calcium is derived from supplements versus the diet. This may be because supplements contain calcium salts or it could be because a large dose of calcium is consumed all at once so the body is unable to process it as efficiently.
Practical Tips for Implementing a Heart-Healthy Diet
- Start with Small Changes: Gradually incorporate heart-healthy foods into your diet rather than making drastic changes all at once.
- Read Food Labels: Pay attention to serving sizes, saturated and trans fat content, sodium levels, and added sugars.
- Plan Your Meals: Create daily menus focusing on vegetables, fruits, whole grains, lean proteins, and healthy fats.
- Be Mindful of Portion Sizes: Use smaller plates and bowls to control portion sizes.
- Cook at Home: Preparing your own meals allows you to control the ingredients and portion sizes.
- Stay Hydrated: Drink plenty of water throughout the day.
- Don't Deprive Yourself: It's okay to treat yourself occasionally, but don't let treats derail your healthy-eating plan.
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