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Cause of heart attacks

What Causes Heart Attacks?

By Tom Cowan, MD

The kidneys nourish the heart.
-Traditional Chinese medical texts.

The story of how I came to understand the cause, and therefore the appropriate treatment, of acute coronary syndrome involves fascinating elements of surprise and serendipity. I thought it best, therefore, to describe how this tale unfolded for me.

Acute Coronary Syndrome (ACS) describes a constellation of illnesses that include angina (chest pain), unstable angina (basically bad chest pain) and myocardial infarction (otherwise known as heart attack or MI). These three illnesses form a continuum, with angina as the mildest symptom and heart attack—when there is actual death of the heart cells—as the most severe. The history of thought about this group of illnesses is both fascinating and controversial.

It seems that heart attacks were rare in this country until about the 1930s. The incidence of fatal MIs quickly increased from about 3,000 per year during that decade to almost half a million per year during the 1950s. In fact, mid century, this formerly rare disease had become the leading cause of death in the US. The incidence has risen continually since then until just recently, when it seems that the tide may be turning a bit and the incidence lessening, or at least leveling off. Nevertheless, after decades of reckless fiddling with the American diet as a way to prevent heart disease, almost a million Americans still die from heart disease each year.
The Conventional Theory

As you can imagine, when it became clear that we were suffering from an epidemic of this disease, physicians and cardiologists developed an intense interest in the cause and possible treatment of the disease. Around the late 1940s, the medical establishment proposed a simple and plausible explanation for MI, and this explanation soon became universally accepted.

The current thinking about heart attacks focuses on the blood supply to the myocardial (heart) cells from the network of coronary arteries, that is, the arteries that supply blood to the heart itself. There are four main arteries, each supplying blood to a different region of the heart. Medical experts believe that when one or more of these arteries gets blocked with plaque, a condition called atherosclerosis, then the inside of the artery becomes narrowed, the blood flow becomes compromised and, in times of myocardial stress (such as exercise or emotional trauma), the insufficient blood flow causes damage to the particular region of the heart fed by the blocked artery. This diminished blood flow first causes pain (angina) and then, if more severe, death to the heart tissue.

Here was an elegant and plausible theory. Voilà! Case closed. The only thing left to figure out was what was causing the arterial blockages. This answer was famously supplied by Dr. Ancel Keys in the 1950s. Keys fingered cholesterol as the culprit, claiming that excess cholesterol floating around in the blood built up as plaque in the arteries. For over fifty years the theory has survived without any significant changes. In fact, if someone has a heart attack today, we often call it a "coronary," referring to the presumed source of the problem, the coronary arteries.

This theory about the cause of heart attacks is so ingrained in our culture that until recently, even a medical skeptic like myself never really questioned it. My only issue with the theory centered on the material in the plaque, which research subsequently revealed to be mostly inflammatory debris, not cholesterol. But I never really gave any thought to the basic premise, namely, that blocked arteries cause heart attacks.

It should be mentioned that this theory about the cause of heart attacks has led to a massive industry devoted to its diagnosis and treatment. Angiograms (in which dye is injected into the vessels to see if they are blocked), bypasses, stents, angioplasties (like roto-rooters for blocked arteries), cholesterol- lowering drugs and lowfat, low-cholesterol diets are all based one hundred percent on the acceptance of blocked arteries as The Cause of acute coronary syndrome.

The whole debate in modern cardiology, both alternative and conventional, is how to stop the buildup of plaque or—more recently— how to prevent plaque in the arteries from breaking free and forming a clot, thereby completely blocking an artery already narrowed by the buildup.
The Digitalis Connection

Around two years ago I received an email from the son-in-law of a recently deceased and apparently well-known Brazilian cardiologist, Quintilaino H. de Mesquita. Before he died, Dr. Mesquita had published a summary of twentynine years of research carried out at his cardiology hospital, data on what he called the "true cause and effective treatment of MIs." His son-in-law and fellow researcher, Carlos Monteiro, emailed me a simple question, which was: "When you put your cancer patients on low-dose whole digitalis plant extract, does this lower their incidence of MIs?"

His question was actually a response to a series of articles describing the effectiveness of low-dose whole digitalis leaf extract in the treatment of a variety of cancers, which I had recently posted on my website, www.fourfoldhealing. com. I wrote back asking why he wanted to know this. He replied that in Dr. Mesquita's groundbreaking study on what he called the myogenic (that is, arising from the muscle) theory of heart disease, he had stumbled on an unexpected result: the digitalis they were using to treat MIs had also dramatically lowered the incidence of cancer in their heart patients, and mine was the only website they found that mentioned this association.

As I had never heard of either the myogenic theory or of the use of digitalis for heart attack, I asked what this was all about. His response was a box of articles and books all published over the last fifty years that seemed to refute the coronary blockage theory of MIs and support what he called the myogenic theory. I spent the next two months poring over these studies until I became convinced that this was perhaps the biggest medical news of the decade, maybe of the entire century.
The Myogenic Theory

Briefly, the myogenic theory of MIs states that:
The coronary obstruction theory does not adequately explain all the observed facts concerning MIs.
The major etiologic (cause and effect) factor in an MI is a destructive chemical process; specifically, in situations of stress on the myocardial (heart muscle) tissue, often as a result of small vessel disease, the myocardial tissue gets insufficient oxygen and nutrients. This leads to destructive lactic acidosis in the tissue which, if unchecked, leads to death of the myocardial cells. This process is largely unrelated to coronary artery disease.
The regular use of cardiotonics, primarily low-dose whole digitalis extracts or an extract of another herb called g-strophanthin, prevents this lethal acidosis and therefore prevents and corrects the true cause of this syndrome. The result is substantially lower morbidity and mortality from heart disease.

Let's look at some of the data supporting these three conclusions. First, does the coronary obstruction theory adequately explain the observed facts? Interestingly, in the 1940s and 1950s, when the coronary blockage theory was first proposed, the majority of cardiologists did not accept it. They pointed out that while coronary arteries are not the only arteries to have plaque, the only tissue to suffer from decreased blood flow during a heart attack is that of the heart. In other words, no one has a spleen attack or a kidney attack, yet the arteries feeding these organs also get plaque buildup.

Furthermore, the medical literature reveals some surprising findings. In a 1998 paper by Mirakami,1 the author found that of those with an acute MI, 49 percent had a blockage, 30 percent had no coronary blockage, 14 percent had insufficient blockage to impair blood flow, and 7 percent had "another condition." In a 1972 paper,2 a researcher named Roberts showed that in acute MIs, only 50-60 percent had evidence of sufficient blockage to impair blood flow. And a 25-year autopsy study of patients who died from an acute MI, carried out by Spain and Bradess, found that only 25 percent had sufficient blockage to account for their MI, while a total of 75 percent had only mild to moderate blockage.3 In a second paper,4 these same authors reported on a surprising discovery: when a heart attack is fatal, the longer the time elapsed between the MI and death (and then subsequent autopsy), the more likely they were to find significant blockages. If death occurred one hour after onset of an MI, only 16 percent had sufficient blockages to account for their MI; if death occurred 24 hours after the onset of an MI, the number with sufficient blockages to account for the heart attack increased to 53 percent. The authors concluded that the arterial blockages are a consequence, not a cause, of myocardial infarction.

As I looked into this subject further, I found that some of the most prominent cardiologists in our history were skeptical about the coronary artery theory of MI. For example, in 1972, Dr. George E. Burch stated, "The cardiac patient does not die from coronary disease, he dies from myocardial disease."5 A 1980 editorial in the prestigious journal Circulation states, "These data support the concept that an occlusive coronary thrombus (otherwise known as a blockage) has no primary role in the pathogenesis of a myocardial infarct."6 Finally, as recently as 1988, Dr. Epstein of the National Institutes of Health states: "They found that in an advanced state of narrowing of the coronary arteries, the supply of blood to the heart muscles is fully assured via collaterals that enlarge naturally in response to the blockage."7 In fact, researchers have found that the more the coronaries narrow, the less danger there is of a heart infarct.

These shocking studies dovetail perfectly with a different study, one that rocked the world of cardiology, published in 1988 titled "Twenty years of coronary bypass surgery."8 Referring to two major studies, the Veterans Administration (VA) study and the NIH Coronary Artery Surgery Study (CASS), the authors made the following statement: "Neither the VA nor the CASS has detected a significant difference in long-term survival between the medical and surgical treatment groups when all patients were included." In other words, surgery to bypass blocked arteries did not improve the chances of patient survival—not the result one would expect if blocked arteries were the cause of heart attacks. Thus, evidence for the coronary artery theory of MI is not strong; in fact, it is actually refuted in the relevant literature.
The Theory Fits The Facts

So, if heart attacks are not the result of coronary artery disease, then what does cause all these MIs? The myogenic theory of Dr. Mesquita, in fact, fits all the current observations about this condition. The myogenic theory postulates that as a result of disease in the small vessels—the capillaries and small arterioles—which is a consequence of such factors as stress, diabetes, smoking and nutritional deficiencies, heart cells, which are very active metabolically, suffer from inadequate oxygen and nutrient supply. This oxygen and nutrient deficiency increases under stressful conditions. When this happens, the heart cells revert to their backup system, which is anaerobic fermentation for energy generation— very similar to what happens in your leg muscles when you run too far or too hard. The anaerobic fermentation produces lactic acid which collects in the tissues. Because the heart, unlike your leg muscles, cannot rest, the acidosis progresses if untreated, leading to actual death of the myocardial cells.

As a result of this necrotic process, inflammatory debris collects in the tissues, and it is this debris that is the actual source of the coronary artery blockages seen in death from acute MI. As you would predict, the longer the time period between the MI and death, the greater the likelihood of blockage—exactly as observed in the studies. The only conclusion one can draw from this is that the heart cells die first and only then does the artery become blocked with debris liberated at myocardial cell death, which is precisely the kind of debris that is found in these blockages. The current practice of flushing out arterial blockages can help remove the debris and restore blood flow to the compromised arterial system, but this in no way suggests that blocked arteries represent the primary event in the sequence leading to an MI. However, the whole emphasis on the coronary artery blockage is fundamentally a dead end and doomed to failure, whether it is approached from a surgical (bypass, stents, etc.) or a medical (cholesterol-lowering drugs, restricted diets, etc.) point of view.
Myogenic Therapy

The myogenic theory points us to a very different kind of preventive treatment for heart disease, one that focuses on small vessel disease and the prevention of heart tissue acidosis. The theory also explains why stress, diabetes and smoking are such strong risk factors for MI, because these factors have all been shown to primarily affect small capillaries and small blood vessels, not the large coronary arteries. But the story gets even more interesting.

It turns out that there are simple, inexpensive and very effective compounds that effectively prevent lactic acidosis in the heart tissues. These medicines have been known for centuries as cardiotonics and have been used for treating heart disease in every traditional medical system in the world. The two best known are digitalis (the common foxglove) and strophanthus, an African vine. These plants are the source of so-called cardiac glycosides: digoxin and digitoxin from digitalis, and ouabain from strophanthus. The function of these compounds is to regulate the rhythm and power of the cardiac contraction and to prevent or reverse lactic acid buildup in the cardiac tissue. This is why these plants have been used for centuries to treat congestive heart failure, rhythm disturbances and other disorders of heart function.

The amazing thing is that these compounds are exact chemical copies of hormones made by our adrenal glands. And our adrenal glands produce these cardiotonics out of . . . cholesterol! Now we know why all the draconian dietary and pharmaceutical measures to lower cholesterol have not resulted in a decrease in the rates of MI, and why numerous studies have shown that as we age, those with the highest levels of cholesterol live the longest. When we lower cholesterol, we are depriving our bodies of the very substance they need to manufacture cardiotonics.

The myogenic theory also explains why stress can lead to heart attacks. In conditions of stress, our adrenal glands must work very hard to create numerous hormones that regulate the blood sugar and help the body heal. If the adrenal glands are weak or overloaded, production of cardiotonics goes on the back burner.

While there are few studies in the conventional literature that have considered the effectiveness of digitalis or strophanthus in the treatment of MI, Dr. Mesquita's clinical results over twenty-nine years show a dramatic lowering of the death rate, recurrent MI rate, angina rate and all symptoms in the spectrum of acute coronary syndrome with the use of oral low-dose digitalis glycosides. These results are published in Teoria Miogenica Do Enfarte Miocardico, available through the Infarct Combat project website, www.infarctcombat.org.

Also, a German cardiologist, Dr. Berthold Kern, used g-strophanthin in a study for the German government which showed a dramatic reduction in MIs in his practice, down from the expected 400 to 20, with the use of this medicine.9 Furthermore, many reports are coming in from Germany in which doctors have noted a decrease of up to 81 percent in angina attacks with the use of oral g-strophanthin.10

In my practice, I generally use oral strophanthin in the form of the preparation known as Strodival for all my angina and MI patients, and I have uniformly recorded a decrease in angina episodes, improved exercise tolerance and, thus far, no MIs. When combined with a nourishing traditional diet, cod liver oil, high vitamin butter oil, CoQ10 (which helps strengthen the heart muscle) and Standard Process heart nutrients (Cardioplus, two capsules three times per day, and Cataplex E2, two tablets three times per day), I have seen a huge improvement in the lives of patients with this otherwise devastating condition. (Note: Both digitialis leaf and Strodival are prescription-only items which need to be prescribed by a doctor who is well versed in their use.)

The final irony is that the traditional Chinese doctors were correct. The kidneys (their way of referring to the adrenal glands) help the body deal with stress as well as make hormones (digoxin and ouabain) that keep our marvelous hearts healthy, strong and open to enjoy the full richness of life

Why Plaque Is A Problem

While plaque in the arteries leading to blockage may not be the main cause of heart disease, there is no doubt that the phenomena of athersclerosis (plaque formation) is a real problem in people, especially as we age. Certain sections of our arteries are subject to thickening and the formation of what is called fatty streaks for reasons that have to do with flow dynamics, that is, the velocity of blood flow and turbulence in that particular artery. A certain amount of thickening in places where the blood creates a lot of pressure on the arteries is normal and protective, and it therefore occurs in everyone. But the build up of plaque is a different situation and can lead to many problems. For example, blocked arteries in the legs can cause calf cramps and pain, which we refer to as intermittent claudication (leg pain while walking). In the brain, plaque formation leads to ischemic (lack of blood flow) stroke. In the kidneys, diminished blood flow due to plaque formation is a possible contributing factor in some cases of hypertension (high blood pressure). Likewise, blocked arteries leading to the liver or spleen can result in reduced function of these organs. The reasons for this plaque formation are unclear. Although scientists have long blamed such build up on high cholesterol levels in the blood, informed medical researchers today often cite inflammation in the vessels as the cause. Of course, this inflammation is secondary to other factors, such as stress, consumption of processed vegetable oils and nutrient deficiencies (particularly of vitamins A and C and minerals like copper). But plaque formation is not a sufficient explanation for the whole phenomena of myocardial ischemia. The reason the heart but not the spleen or the liver has "attacks" is because the energy use of the heart is so much higher and also because the heart can never rest. Because scientists have overlooked these factors, treatment of heart disease today is far less effective than it otherwise could be. The only other organ that might be said to suffer from an "attack" is the brain when a stroke occurs. However, strokes usually happen when a clot forms in one of the arteries feeding the brain. The process is not the same as lactic acid build up in the heart.
How To Protect Your Capillaries
Avoid high blood sugar: diabetes is a serious risk factor for capillary damage. A high-fat, low-carbohydrate diet is your best defense against diabetes. If you have diabetes, follow the protocol posted at www.westonaprice.org/moderndiseases/ diabetes.html.
Don't smoke! Smoking is a risk factor for capillary damage.
Engage in moderate outdoor exercise.
Avoid commercial liquid vegetable oils, which are full of free radicals that can damage capillaries.
Follow a nutrient-dense traditional diet
Be Kind To Your Adrenal Glands

Since the adrenal glands, specifically the adrenal cortex (the outer portion of the adrenal gland), produce protective cardiotonics, an important strategy in protecting yourself against heart attack is to strengthen the ability of this important gland to work properly.
Avoid stimulants such as caffeine and related substances in coffee, tea and chocolate. Caffeine causes the adrenal medulla (the inner part of the adrenal gland) to produce adrenaline. In response, the adrenal cortex must produce a host of corticoid hormones that bring the body back into homeostasis. Repeated jolts of caffeine can lead to adrenal burnout, a situation in which the adrenal cortex is unable to produce the myriad of protective and healing substance for the body, including the cardiotonics.
Don't try to lower your cholesterol—the cardiotonics are made from cholesterol.
Take cod liver oil for vitamin A. The body needs vitamin A to make all the adrenal cortex hormones from cholesterol. Vitamin A intake should be balanced with vitamin D (from cod liver oil) and vitamin K2 (from the fats and organ meats of grass-fed animals).
Don't consume trans fats. Trans fats (from partially hydrogenated vegetable oils) interfere with the enzyme system needed for the production of adrenal cortex hormones.
Take care to avoid low blood sugar. When blood sugar drops too low, the adrenal glands go into overdrive to produce hormones that bring the blood sugar back up. This means avoiding sugar and not skipping meals. There is just no substitute for three good meals a day, at regular intervals, which contain adequate protein and plentiful amounts of good fat.

American Journal of Cardiology, 1998; 82:839-44.
Circulation, 1972; 49:1.
American Journal of Medical Science, 1960 240:701.
Circulation,1960, 22: 816.
American Heart Journal. 1972 Mar;83(3):340-50.
Circulation 1980 Jul;62(1):17-19.
Epstein SE. American Journal of Cardiology 1988 Apr 1;61(10):866-8.
Killip T. New England Journal of Medicine 1988 Aug 11;319(6):366-8.
Unpublished communication.
Unpublished communication.

About the Author

Thomas Cowan, MD, is a physician in private practice in San Francisco, California, a board member of the Weston A. Price Foundation, and a regular contributor to our "Ask the Doctor" column. His book The Fourfold Path to Healing is now available from NewTrends Publishing, http://www.newtrendspublishing.com/. Visit Dr. Cowan's website at http://www.fourfoldhealing.com.

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