Cardiovascular disease, sodium vs. saturated fat/cholesterol

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Cardiovascular disease, sodium vs. saturated fat/cholesterol

Postby Aaron52101 » Fri Apr 03, 2015 1:25 pm

Hi Jeff,

I was rereading James Kenney's article on salt that you often recommend, and I was wondering if I could get your thoughts on the role of salt in the diet and the progression of cardiovascular disease vs the role of saturated fat and cholesterol. Kenney at times seemed very suggestive that salt's role in raising blood pressure and causing hypertension is a better indicator of CVD risk then other factors and that in some populations that consume diets higher in animal products they are protected because they don't add salt to their diets, and have low rates of CVD (I may be extrapolating on this as he doesn't go deep into detail on the role of saturated fat and cholesterol in the article). Yet, I would say generally in the US lipid markers are considered to be more valuable as an indication of CVD risk than blood pressure, though of course both are important biomarkers. So my question is, hypothetically, if we had four groups, one that ate a whole food plant based diet and had low sodium levels, one that ate a plant based diet but added lots of salt, one that ate a standard American diet but with low sodium levels, and one that ate a standard American diet with salt, what type of difference in CVD outcomes would we expect to see? Obviously we can do both, that is not consume large amounts of saturated fat and add high amounts of salt to our diet, which I do and don't intend to change, and both of them play roles in other conditions not just CVD so they should be avoided for that reason as well, but would one be more important than the other in your opinion for CVD prevention?

Thanks
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Re: Cardiovascular disease, sodium vs. saturated fat/cholest

Postby JeffN » Sat Apr 04, 2015 6:50 am

Thanks.

My response is simple, both are very harmful, both are major contributors of leading causes of death & disease, so avoid them both. Trying to weigh which one is more important in our sick population that is living in such a toxic food environment seems pointless to me.

My answer is limit both.

However, Dr Kenney likes to wax philosophical at times so I asked if he would respond to you. Here is his response...

" Clearly if the goal is to prevent CVD events it is important to limit both SFA & cholesterol to lower nonHDL-C and to limit salt to lower BP. The ASCVD** calculator is calculating the risk of atherosclerotic CVD events. Clearly most Americans eat so much SFA and cholesterol that is the most common CVD event in the USA, which is CAD. But ASCVD or atherosclerotic CVD is not the same as risk for CVD events and in populations that eat a lot of salt but not much SFA and cholesterol most CVD events are not atherosclerotic. For example, in Japan in the 1970s ASCVD was very low and yet deaths from hemorrhagic stroke and heart failure were very high. Stroke was the #1 killer of Japanese back then and may still be today although stroke deaths are way down and SFA and cholesterol intakes are now much higher.

If dietary saturated fat and cholesterol intake are very low and serum nonHDL-C is very low then there will likely be little atherosclerotic plaque even in the presence of HTN. As we have seen in children with no LDL-receptors and very high nonHDL-C levels you can get plenty of atherosclerosis even with very healthy BPs of 100/60. Since the accumulation of cholesterol in the artery wall is the primary pathological event leading to coronary artery disease and atherosclerotic CVD events (mostly CAD) elevated BP with very low nonHDL-C levels prevents atherosclerosis. Oddly enough it appears to me that atherosclerotic plaques in the carotid arteries may actually be somewhat protective against hemorrhagic stroke in people with very high BP, perhaps because the narrowing of carotid arteries lowers BP in the brain - at least that is my speculation. The lower BP in the brain may then reduce the risk of hemorrhagic stroke - as these strokes are largely related to BP rather than atherosclerosis.

If you want to reduce atherosclerosis lower serum nonHDL-C by eating less SFA and cholesterol. If you want to reduce hemorrhagic stroke risk lower BP by eating a lot less salt. If hemorrhagic stroke, heart attacks, and heart failure are not something you want in your future I'd say limit salt, SFA, and cholesterol.

BTW - veins have the same cholesterol as do arteries but they almost never develop atherosclerosis do they? Want to see veins develop atherosclerosis? Have a bypass procedure that removes a healthy plaque-free vein from your leg and use it to bypass and atherosclerotic coronary artery. Not long before that vein develops a lot of cholesterol filled atherosclerotic lesion. What changed the BP or the serum cholesterol level in that vein? What does that tell you? Clearly a diet high in SFA and cholesterol and low in salt results in atherosclerosis. Add salt and increase the BP and yet more of those elevated apoB-containing lipoproteins will get forced into the artery wall and the plaques will grow even more quickly.

If someone has both a nonHDL-C level and a SBP of 100 each their risk of any CVD event will be extremely low. Now ask yourself if you had to have one or the other of these CVD risk factors doubled to 200 which one would you pick? Food For Thought"


It seems prudent for those whole follow a healthy low fat vegan diet to also make sure they...

1) keep their sodium intake low,
2) keep their blood pressure low,
3) avoid blood thinners including medications and supplements/herbs that are blood thinners,
4) insure adequate B12 levels to help keep their homocysteine levels low

In Health
Jeff

**ACSVD = atherosclerotic cardiovascular disease

The comments in regard to the ACSVD were because another colleague who is a WFPB MD and was in on the discussion, ran the numbers in the ACSVD calculator trying to adjust for BP vs Lipids and said,

"If you look at the ASCVD risk calculator and adjust for cholesterol and hypertension with all other things being equal, you can see you have to have a pretty high blood pressure, uncontrolled on medication for the risk calculator to give the same cardiovascular risk as total cholesterol 240 with HDL 50 in excellent blood pressure on no medications (i.e. the ASCVD calculator biases towards cholesterol being a bigger issue than blood pressure."
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Re: Cardiovascular disease, sodium vs. saturated fat/cholest

Postby Aaron52101 » Sat Apr 04, 2015 8:33 am

Thanks Jeff for your insight and getting in touch with Dr. Kenney to allow him to elaborate on his position as that was very informative and really put things in perspective and I believe my question was fully answered and more so :D
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Re: Cardiovascular disease, sodium vs. saturated fat/cholest

Postby JeffN » Wed Nov 13, 2019 8:40 am

Here is an editorial on the issue that appeared this week in Circulation.

Achievement of Very Low Low-Density Lipoprotein Cholesterol Levels: Is It Time to Unlearn Concern for Hemorrhagic Stroke?
Circulation. 2019;140:00–00. DOI: 10.1161/CIRCULATIONAHA.119.044275

https://www.ahajournals.org/doi/10.1161 ... 119.044275

It reinforces my comments above...

It seems prudent for those whole follow a healthy low fat vegan diet to also make sure they...

1) keep their sodium intake low,
2) keep their blood pressure low,
3) avoid blood thinners including medications and supplements/herbs that are blood thinners,
4) insure adequate B12 levels to help keep their homocysteine levels low


In Health
Jeff
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Joined: Tue Jan 08, 2008 5:56 am


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