What causes heart disease part 44

12th January 2018

I’m going to try and draw some of the strands together at this point, in an attempt to provide some advice as to how to reduce the risk of CVD. Of course, there is massive overlap with other health issues. Smoking, for example, does not just cause CVD; it also causes lung cancer, chronic obstructive pulmonary disease (COPD) and many other unpleasant things.

So, you could call this instalment of the blog: “How to remain healthier and live longer”. Here I am only going to focus on the big-ticket items, the things that have been shown to make a real difference to life expectancy. For example, even if you believe that statins are effective in reducing CVD risk, when you look at the clinical trial data – assuming you believe it, one hundred per-cent – the average increase in life expectancy is around four days, if you take a statin for five years¹.

Which means that, if you start taking a statin aged fifty, and keep taking it religiously for thirty years, you could expect to live for an extra: 6 x 4 days = 24 days. Or a bit less than a month. You may think this is worthwhile, you may not. This, by the way is the best-case scenario.

On the other hand, it has been estimated that if you take regular exercise, you could live for an extra four and a half years. Which makes exercise at least fifty-four times more effective than statins. Or, to put it another way 5,400% more effective.

As I hope that you can see, I am trying to give you a sense of the scale of benefits, or harms, that I am discussing here. Most of what is hyped by the pharmaceutical industry, and others, sits on the cusp of completely and utterly irrelevant. Is coffee good or bad for you? Who cares, the effect on life expectancy is in the order of a couple of days – either way.

Looking at preventative cardiovascular medications, the only ones that make a really major difference are anti-coagulants (blood thinners) such as warfarin, rivaroxaban, apixaban and suchlike. These are primarily used to prevent stroke in atrial fibrillation. Here, you can reduce the absolute risk of a stroke by around 50% over ten years. I am not sure how this can be re-calculated into increased life expectancy. I am sure it could be done, but it is complicated. However, this is still a massive benefit, and would mean years, not days, of extra life.

In short, if you have atrial fibrillation, you most definitely should take an anticoagulant. You might want to explore magnesium supplementation, particularly if you are taking an anti-acid PPI such as omeprazole, lansoprazole – or any of the other ’…prazoles.’ These lower magnesium levels. They also lower NO and, vitamin B12 levels and double the risk of CVD death. So, I would recommend never, ever, taking these long-term.

You might also want to try reducing weight, alcohol intake, stress/strain, and carbohydrate intake at the same time to see if you can flip out of atrial fibrillation naturally. It may work, it may not.

Moving away from that slight detour, what are the other real, big-ticket items? Perhaps the most obvious is smoking, or not-smoking. Smoking twenty cigarettes a day will reduce your life expectancy by around six years. Not only that, it will reduce ‘healthy life expectancy’ by far more. By which I mean you may well have ten or twenty years of such nasty things as: difficulty breathing, repeated chest infections, leg ulcers, angina, and suchlike, before you then die – early.

At this point you may be thinking, this is all incredibly conventional. Well, yes, it is. However, there is absolutely no doubt that exercise, and not smoking, have a massive and positive effect on health. Which means that they can hardly be ignored.

Of course, some people smoke and live to ninety, and some people take no exercise and live to ninety. So, what does that prove? Nothing at all. You can play Russian roulette for several rounds without blowing your brains out, but it is going to get you in the end.

My next big-ticket item, however, is not conventional at all. It is sunshine. If there is one piece of mainstream medical advice that I would vote as the single most damaging, it would be the current, ever more hysterical, advice to avoid the sun. If we dare expose ourselves to a stray photon, we are told, then we will vastly increase the risk of dying of skin cancer.

It is true that fair skinned people, living closer to the equator than their skin was designed for, can suffer superficial skin damage with excess solar exposure. There is also a significant increase in the risk of several types of skin cancer: basal cell carcinoma, squamous cell carcinoma and rodent ulcers (non-melanoma cancers). Whilst not pleasant, they can be easily spotted and fully removed. Which means that they are not a major health risk, and will have virtually no impact on life expectancy.

The type of skin cancer of greatest concern is malignant melanoma. Whilst melanomas can also be spotted early, and successfully removed, they can grow deeper into the skin. At which point cancerous cells will break off from the main melanoma ‘body’, and travel about in the blood stream, before getting stuck in various other places and growing (metastases). Five-year survival for metastatic melanoma is around 15 – 20%.

So, this truly is a cancer to be avoided, even if it is not common. But does sun exposure cause, or increase, the risk of, malignant melanoma? Here, from the Lancet:

‘Outdoor workers have a decreased risk of melanoma compared with indoor workers, suggesting that chronic sunlight exposure can have a protective effect. Further, some melanomas form on sun-exposed regions; others do not…

It has long been realised that indoor workers have an increased risk for melanoma compared with those who work outdoors, suggesting that ultraviolet radiation is in some way protective against this (melanoma) cancer. Further, melanoma develops most often on the back of men and on the legs of women, areas that are not chronically exposed to the sun.’³

Essentially states that the more sunlight areas of your skin are exposed to, the less likely you are to develop a malignant melanoma. How does this fit with the fact that there has been a steady rise in the incidence of malignant melanoma (incidence means number of newly diagnosed cases per year).

The first to question to ask is simple. Is this a real rise, or has it been driven by increased recognition and diagnosis? A study in the UK concluded that there has been no true increase in incidence. It is publicity, fear, and misdiagnosis that has created the apparent epidemic of melanoma. As noted in this article in the British Journal of Dermatology:

‘Melanoma epidemic: a midsummer night’s dream?’

‘We therefore conclude that the large increase in reported incidence is likely to be due to diagnostic drift which classifies benign lesions as stage one melanoma…The distribution of the lesions (melanomas) reported did not correspond to the sites of lesions caused by solar exposure. These findings should lead to a reconsideration of the treatment of ‘early’ lesions, a search for better diagnostic methods to distinguish them from truly malignant melanomas, re- evaluation of the role of ultraviolet radiation and recommendations for protection from it, as well as the need for a new direction in the search for the cause of melanoma.’⁴

In short, the rise in malignant melanoma is most likely an artefact, driven by diagnostic drift, and an increased recognition of early, benign lesions (‘lesion’ is just a word for an abnormal ‘thing’ found on the body). In fact, if you look at the evidence more closely, it seems that sunlight may, in fact, protect against melanoma. A study in the US looked at people who had already been treated for melanomas, to review recurrence and long-term survival:

‘Sunburn, high intermittent sun exposure, skin awareness histories, and solar elastosis were statistically significantly inversely associated with death from melanoma.’

The conclusion of the paper:

‘Sun exposure is associated with increased survival from melanoma.’’⁵

Maybe not quite what you expected. But then again, vitamin D is synthesized by the action on sunlight on the skin. It converts cholesterol to vitamin D, and vitamin D has potent anti-cancer actions. Remove this from the skin at your peril.

Enough of the fear of the sun and malignant melanoma. I don’t wish to get dragged any further onto the playing field of the anti-sun brigade. Instead, here is a list of benefits that have been found from increased sun exposure. I am giving you the most positive figures here (these are relative risk reductions).:

75% reduction in colorectal cancer
50% reduction in breast cancer
Non-Hodgkin’s lymphoma 20 – 40% reduction
Prostate cancer 50% reduction
Bladder cancer 30% reduction
Metabolic syndrome/type II diabetes 40% reduction
Alzheimer’s 50% reduction
Multiple sclerosis 50% reduction
Psoriasis 60% reduction
Macular degeneration 7-fold reduction in risk
Improvement in mood/well-being.^6,7

Well, what do you know. If you raise your gaze from malignant melanoma there is a world of benefits associated with greater exposure to the sun. With all these benefits, you would expect to see a real improvement in life expectancy. Does this happen?

Indeed, it does. There have been a series of studies in Denmark and Sweden looking at the benefit of sunshine. One of them, which looked at overall life expectancy, concluded that avoiding the sun was as bad for you as smoking.

‘Non-smokers who avoided sun exposure had a life expectancy similar to smokers in the highest sun exposure group, indicating that avoidance of sun exposure is a risk factor for death of a similar magnitude as smoking. Compared to the highest sun exposure group, life expectancy of avoiders of sun exposure was reduced by 0.6-2.1 years.’’⁸

This was a twenty-year study. If average life expectancy is around eighty years, we can safely multiply those figures by four, to work out that a decent amount of sun exposure can add somewhere between three, to eight years, to your life expectancy. Let’s call it five.

But it is not just cancer, diabetes and Alzheimer’s that are reduced by sunbathing. Sun exposure is also particularly good for the cardiovascular system, mainly because it increases nitric oxide levels. This, in turn, reduces blood pressure, and the risk of developing blood clots. It also protects the endothelium, and has significant benefits on lowering blood pressure and suchlike⁹.

Not only that, but lying in the sun is free and enjoyable. So, who could possibly ask for anything more?

At this point, you now know my first three big ticket items for living longer. More importantly, living longer with more ‘healthy’ and enjoyable years.