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The biggest risk factor for heart disease? Diabetes

A Q&A with the director of the OHSU Bob and Charlee Moore Institute for Nutrition & Wellness
Eating healthy
(Getty Images)

Kent Thornburg, Ph.D., has taken an unconventional approach to fighting chronic disease. On any given day, you can find him evangelizing this tenet: your risk for chronic diseases such as heart disease was determined before you were even born.

As part of American Diabetes Association Alert Day and National Nutrition Month, read what he has to say about the biggest threats to good nutrition and heart health.

What does the research show about the connection between nutrition and heart disease?

We have known for well over 50 years that there is a connection between diet and heart disease. What we have learned recently is that some people are more vulnerable than others because of experiences in early life. This new piece of research has taught us how most heart disease develops. 

What do you see as the biggest threat to heart health?

Everyone knows that smoking is a risk factor for heart disease but they forget that diabetes is an even more powerful culprit. Thus, the biggest threat comes in two forms. The first is the growing number of people who have type 2 diabetes or pre-diabetes (insulin resistance), which is close to 20 percent of the population. More than 65 percent of diabetics will develop heart disease. In Oregon, about 12 percent of the population has diabetes and another 5 to 6 percent of the population has diabetes that is developing or that has not yet been diagnosed. The rate of pre-diabetes is higher than it should be, and pre-diabetics may suffer cardiovascular damage before they are even diagnosed with diabetes. That’s why we call diabetes a vascular disease. 

The second threat is the poor diets of everyday people who are eating food with little nutritional value (a diet of highly processed foods). This, unfortunately, is a big part of the population. We are consuming high-fat, high-sugar and high-salt diets. This leads to high blood pressure and damage to blood vessels, which leads to heart disease and elevated risk for diabetes. 

In what scenario do you see the rate of heart disease declining, and conversely, increasing?

In December, The New York Times reported that life expectancy in the United States is declining for the first time since 1993, which coincides with the fact that death rates for heart disease have gone up for the first time since 1968. This reveals a large hole in our knowledge: medicine has become more effective at treating heart disease, yet the death rate is going up. Here in Oregon, it is estimated that about 225,000 people currently have heart disease and that the numbers will increase. The prevalence is expected to increase up to five times by 2030. Heart disease rates will decline when we as a society ensure that babies are well developed at birth and that children do not become overweight.

What trends in chronic disease give you hope, and what trends concern you?

There are two things that give me hope. One is that we have learned that with a diet of nutritious foods replacing overly processed foods, the health of the population will improve dramatically. Once we as a society understand and work to change the food culture to ensure that healthy whole foods are readily available to all, we have hope of reversing cardiovascular disease in this state. The other piece is that the CDC reported that the rates of diabetes among adults in the U.S. have gone down slightly. I hope that the statistic holds. In Oregon, we should also try to reverse the diabetes trend. 

The most frightening trend is the increase in diabetes in children and young adults in Oregon, especially among different ethnic groups.

What impact do social and environment factors have on cardiovascular health?

The socioeconomic factors are enormous. Toxic stress, or social stress, is just as detrimental to heart health as is poor diet. Many people who have one also have the other. For example, a person who has an abusive spouse or has lost a job or has been evicted may also have less access to healthy, nutritious foods. This is a double hit that elevates risk for heart disease.  

What is the difference between developmental origins of health and disease, or DOaHD, and epigenetics? 

Developmental origins of health and disease refers to the role of the prenatal and early postnatal nutritional and stress environments that cause vulnerability for disease.  These early factors change the way genes work by a process called epigenetics. These factors together are important because if babies are undernourished before birth, their organs are not as well developed and the wear and tear of life makes them more vulnerable to developing disease.

What do pregnant women need to know about nutrition and how it relates to heart health?

There are two sources of nutrients for the developing fetus: the food the mother eats, and nutrients from her body, protein and fat in particular -- babies need both. People talk about the importance of good nutrition during pregnancy because babies, boys in particular, use the nutrients the mother consumes as building blocks for their own body.

The one nutrient that women are most likely to leave out of their diet is omega-3 fatty acids. These fats build the brain and cardiovascular system in babies. Fish is a good source for omega-3 fatty acids as are certain plant derived foods like flax seed.  Mothers are warned not to eat too much fish because of mercury poisoning; however, pregnant women and children can safely eat low-mercury fish like salmon, trout or sardines two or three times a week without worry.

How do we need to change the way we think about health and nutrition to decrease heart disease?

Diet, nutrition, exercise and smoking avoidance are important for everyone at all ages, but if we want to improve the health of our population, we need to focus public health efforts on nutritious diets for men and women of reproductive age. Once we as a society have the courage to change our food culture, we can expect to be healthier ourselves and to have children who live healthy lives without suffering from debilitating disease and shortened lives.


Thornburg directs the OHSU Moore Institute for Nutrition and Wellness, and the OHSU Knight Cardiovascular Institute Center for Developmental Health; and is a professor of medicine (cardiovascular medicine) in the OHSU School of Medicine. Thornburg studies the roles of the placenta and the intrauterine environment as programming agents for adult-onset chronic disease, and leads studies on maternal diet and body in regulating fetal growth. He is principal investigator of several NIH-funded studies, including maternal-fetal signaling, training in translational cardiovascular research, thyroid hormone and heart development and placental function.  

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