Lionel H. Opie

What is good for the circulation also lessens cancer risk

Although there have been substantial advances in the prevention and management of cardiovascular disease (CVD) and its complications, a new player and concept has entered the scene, namely an association between CVD and cancer. There were two alerting signals to this remarkable coupling. On the one hand, disconcerting evidence has been provided that suggests that the use of angiotensin receptor blockers could be increasing the development of cancers.1–3 On the other hand, evidence has been provided that the preventative effects of aspirin both as an antithrombotic agent in CVD prevention and the subsequent discovery of its effects in lessening the development of cancer, especially but not only primary gastrointestinal and distant metastases.4 In addition, ideal cardiovascular health has been shown to be inversely associated with incident cancer in the Atherosclerosis Risk In Communities (ARIC) study.5 The American Heart Association (AHA) has now widened its health goals to adherence to seven ideal heart health metrics that are aimed at lessening the incidence of both CVD and cancer as part of its 2020 goals.6 To achieve this goal, the AHA is therefore pursuing partnerships with cancer advocacy groups to achieve reductions in chronic disease prevalence. The ideal health factors are four ideal self-help health metrics and three ideal measured health metrics (an untreated total cholesterol <200 mg/dL, untreated blood pressure <120 mmHg systolic and 80 mm Hg diastolic, and untreated fasting serum glucose <100 mg/dL) ( Tablexa01 ). Ambitious plans to reduce both CVD and cancer will be communicated to the American public through the ‘Lifes Simple Seven campaign’. Fundamental to the current ‘war on cancer’ is the role of lifestyle measures …

CHAPTER 32 – Myocardial Energy Metabolism

This chapter presents an overview of the process and regulation of myocardial energy metabolism. ATP provides the energy for contractile function, membrane homeostasis, and cellular functions, and interruption in the supply of substrate and/or oxygen results in significant changes in myocardial energy metabolism and contractile function. High rates of myocardial energy production are required to maintain the constant demand of the working heart for ATP. A constant supply of oxygen and at least one of the major exogenous substrates such as fatty acids, lactate, and glucose, are required for normal metabolic function and for ATP production to continue. Glucose has an inducible transporter, GLUT-4, which is regulated chiefly by insulin, and which responds well to the level of myocardial oxygenation and the workload of the myocardium. Glucose is activated to glucose 6-phosphate by hexokinase and can be diverted into either glycogen synthesis or glycolysis. Glycolysis transforms glucose into two three-carbon units (pyruvate), with the net production of ATP and the reducing equivalents (NADH 2 ) without any oxygen requirement. Pyruvate can be oxidized to lactate and released or activated to form acetyl-CoA, which then enters the citrate cycle. Fatty acids provide the major component of myocardial oxidative energy under both conditions of normal oxygen supply and moderate impairment of oxygenation (ischemia). The uptake and transport of fatty acids require fatty acid-binding proteins and intracellular fatty acid transport protein.

Lifestyle and diet : review article

Abstract Currently, there is widespread interest in many different diets. The best-known diets include the New Atkins diet in the USA, the Dukan diet in France, and in South Africa the Noakes diet. Two different approaches have emerged, one focusing on a life-long healthy lifestyle and the other emphasising weight loss. These are in fact complementary aims, as will be reviewed and reconciled. Furthermore, besides the dietary approach, there is a valid case for added drug therapy for selected lipid disorders with the use statins. In addition, new drugs are emerging that in the future might eventually considerably reduce the negative health impact of coronary artery disease.