A systems engineering approach to coronary heart disease

Abstract

Coronary heart disease (CHD) is the largest cause of death globally. This is worrying considering the substantial investments made in the research and prevention of CHD. It may be possible that the current reductionistic research techniques used in CHD studies are not suitable due to the highly interconnected nature of human biology. It may thus be possible to gain a better understanding of CHD by using an integrative systems engineering approach. The objective of this study was to develop such a model and to use it to elucidate novel insights into the workings and phenomena of CHD. An extensive literature review was conducted to develop the integrated engineering model of CHD. The model contains information on the pathogenesis, biomarkers, pharmaceuticals and health factors of CHD. The health factors and pharmaceuticals were analysed using the integrated systems model. The interactions between them and biomarkers were further developed into novel “connection graphs'. The integrated systems engineering model of CHD and its simplification into “connection graphs” provided various new insights. These are not possible when using reductionistic approaches, i.e. when considering aspects in isolation. Examples include the possibility of existing CHD dietary guidelines actually increasing CHD risk. It also gives an explanation of the mechanisms by which moderate alcohol consumption could reduce risk. The integration of the risk effects of health factors and the appropriate treatment thereof further elucidated the possibility of large risk reductions which may be achievable through the treatment of stress and depression. The impact of such treatment has not been clear before. The potential of stress and depression treatment was further investigated in terms of the French paradox. The French have a much lower incidence of CHD mortality, up to 2.8 times less than neighbouring countries. A strong correlation between the increasing treatment of stress and depression and decreasing CHD mortality was found. Thus, this study may have elucidated that the answer to the decades old mystery of the French paradox. There may therefore be potential to reduce CHD mortality in some countries by 2.8 times by implementing the suggestions from this study The integrated model clearly indicates the importance of blood glucose and insulin on CHD. Thus, the blood glucose effects of various health factors were quantified and compared. In the analysis it was found that the CHD risk of most health factors was not confined to the blood glucose effect and was confounded by other aspects. Thus, the importance of an integrated model for CHD was again proved. This study developed a suitably integrated model of CHD. This model could be an appropriate basis for the development of a future simulation model of CHD as shown through the characterisation of the effects of a health factor and pharmaceutical control. Unfortunately substantial further work will be required to develop a full simulation model of CHD. However, the integrated model of CHD developed here could provide a basis for this daunting task.