Ka Wai Ola - Office of Hawaiian Affairs, Volume 5, Number 7, 1 July 1988 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D.

Ka Ho'oke 'Ai: Mokuna 'Elua

Nīnau: E ke Kauka, is the Moloka'i Diet guaranteed to prevent heart attack? Pane: 'A'ole (no), ka Ho'okē 'Ai (Moloka'i Diet) is not guaranteed to prevent heart attack, but there is growing evidence that such a diet reduces the risk of coronary atherosclero-

sis (hardening of the heart arteries) and thus, its serious consequences, such as angina (heart chest pain), myocardial infarction (heart attack), heart failure, and fatal heart rhythm disorders. In other words, the probability or likelihood of heart attack and associated pilikia is emi 'ia (decreased), but complete protection cannot be assured in all cases because of the multiple interacting factors eoncerned. I 'Apelila (in April), the composition and main food items of ka Ho'oke 'Ai were recorded in this eolumn. I kēia mahina (this month), we will eonsider the experimental basis for this diet in countering the development of atherosclerosis and related conditions referred to in the foregoing paragraph. Figure 1 shows some of the relationships of the known risk factors involved in the occurrence of atherosclerosis, whieh is the central tissue abnormality of eoneem. Also shown are the major complications of coronary atherosclerosis, whieh account for symptoms, including death. Atherosclerosis refers to distinctive, irregular thickening of the inner wall of vessels, such as the coronary arteries of ka pu'uwai (the heart) (See Figure 2). Such a particular arterial wall thickening is cdso called an atherosclerotic plaque. A plaque is composed of a mixture of mushy dead tissue eontaining cholesterol, hardened koko (blood) from

bleeding, brittle ealeium, multiplying muscle cells and fibrous 'alina (scar). Experiments show that a plaque begins with injury to the inner surface of the wall in contact with the flowing koko (blood). Plaque-formation is hastened when the blood eholesterol is ho'onui 'ia (increased). Other studies show that an atherosclerotic plaque ean be prevented and even reversed when the blood cholesterol is ho'oemi 'ia (decreased), such as by restricting dietary saturated fat and cholesterol. The blood level of cholesterol is determined by 'elua (two) main factors: heredity and diet. In most instances, prudent diet wale no (alone) will lower the blood cholesterol to a "safe" range — less than about 200 mg/dl. In rare cases, ki'eki'e (high) blood cholesterol may be inherited and not significantly affected by limiting dietary fat and cholesterol. Koko cholesterol is of two main types. Low density lipoprotein (LDL) cholesterol from the ake (liver) is hapai 'ia (carried) in the koko and ho'okomo ia (deposited) in the walls of arteries and other tissues. High density lipoprotein (HDL) eholesterol is hapai 'ia from the vessel wall and other tissues to the ake (liver) for kiloi 'ana (excretion). Pēlā, the higher the LDL cholesterol and the lower the HDL cholesterol, the greater the risk of atherosclerosis and heart attack. Koko pi'i (high blood pressure), physical inactivity, puhi paka (cigarette-smoking), ko'iko'i (stress), family history of myocardial infarction and mimiko (diabetes) also increase the risk of heart attack. The precise mechanisms by whieh these other factors contribute to atherosclerosis and its eomplications are not as yet moakaaka (clear) and will be discussed in future columns. What is moakaaka is that as the atherosclerotic plaque in the arterial wall thickens, the opening in the vessel through whieh koko flows narrows, so

that less koko with oxygen and other nutrients reach the pu'uwai muscle fed by the particular artery (Fig. 2). The usual final critical event is honua (sudden) complete pani (closure) of the narrowed opening by ho'opili (attachment) of blood cells to the wall and blood clotting, a process called coronary thrombosis. The heart 'i'o (muscle) beyond the closed artery, deprived of blood, dies. This death of 'i'o pu'uwai from inadequate koko is called myocardial infarction by physicians, and "heart attack" by non-professionals. If the size of the dead heart muscle (infarct) is large enough, the patient will also make. Myocardial infarction is still the leading cause of death in the haole world, and we Native Hawaiians rank among those with the highest death rates from heart attack. No ke aha mai (why)? Ke kumu 'ano nui (the main reason) appears to be our adoption of a non-Hawaiian, indeed, antiHawaiian diet of nui loa saturated fat, cholesterol, total calories and salt. Our high rates of kokopi'i, mimikō, puhi paka, kukule (inactivity), pūhalalū (obesity), and ko'iko'i (stress) also contribute to the tragic outcome. To test the hypothesis of the relationship of ka mea 'ai Hawai'i kahiko loa (pre-haole Hawaiian diet) to ki'eki'e blood cholesterol as a cardiovascular risk factor in ka po'e Hawai'i, 10 Moloka'i homesteaders, who had been previously identified as having ki'eki'e blood cholesterol and triglyceride levels, participated in the seven-week Ho'okē'Ai in September-November 1987. I kēia mahina a'e (next month), we will review the details of the conduct and the hopena (results) of the study, and the implications for us kānaka maoli who are at ki'eki'e risk for heart attack and other /na'i related to ka mea 'ai.