Top tips for a healthier heart
Adapted from original post by Dr Stephens on Kinetik Well Being Feb 2022.
Do you know what the risk factors are for having heart trouble in the future? Can you name three daily lifestyle choices that keep your heart healthier? Read on to see how many tips you knew about already - hopefully you will also find a few helpful reminders and possibly even a couple of unexpected surprises.
Exercise
We all know that exercise is good for your heart. But do you know why? There are two main ways exercise benefits your heart:
1. It modifies other risk factors – it lowers bad cholesterol, increases calories used thereby potentially bringing any excess weight into a more optimal range, and can also reduce high blood pressure.
2. It has a direct effect on the heart through a mechanism known as ‘ischaemic preconditioning’ (ischaemia being the medical term for ‘lack of oxygen’). This is where having short periods where the heart is under stress from the increased demands of exercise seem to help it cope better in the future if ever it is starved of oxygen for longer periods, such as during a heart attack. For ischaemic preconditioning to be triggered, moderate to vigorous exercise is needed – ideally 30 minutes/day.
Smoking Cessation
Similarly, we all know that smoking is bad for our health and a major risk factor for developing heart disease. But did you know that it is never too late to reap the benefits of quitting? Journal articles have varying opinions on how long exactly it takes for the risk from smoking to totally disappear after someone quits (i.e. to drop to the level of someone who has never smoked) – there seems to be a range of opinions from between 2 years to potentially 15 years for former heavy smokers. But there are still significant benefits of quitting that come on much earlier, such as all of the carbon monoxide in your body going within 48 hours.
Alcohol
According to government advice, unless you are a woman over the age of 55y who drinks less than 5 units per week, chances are that unfortunately any alcohol that you drink is more likely to harm your overall health than benefit it (1). Of course, this is still somewhat controversial and you can easily find journal articles that suggest that consuming small amounts of alcohol may be beneficial to your heart in particular. It is fair to say also that the risk of overall harm from drinking in moderation is quite low, although just one drink a day can increase the risk of fractures in post-menopausal women.
Drinking excessively, however, can cause various problems with the heart, such as leading to a condition called ‘alcoholic cardiomyopathy’ which is where the muscular heart walls become larger and less efficient, meaning the heart isn’t able to pump as well, which can lead to blood pooling in different areas in the body amongst other dangerous consequences. Alcohol excess can also increase the risk of ‘ischaemic heart disease’ (i.e., angina, heart attacks).
Body Mass Index
Being overweight (BMI >25 kg/m2) can increase the risk of cardiovascular disease (eg heart attacks, strokes). But did you know that being underweight (BMI < 18.5 kg/m2) can also increase your risk? One study of almost half a million people showed that this was especially true for the younger population with the risk being more evident in underweight people under the age of 40 years old (2). Before you reach for the cookies though, it is worth being aware that there is a good chance that the link here is due to a reduction in muscle mass specifically, rather than due to a reduction in body fat.
Know your cholesterol
Yes, this one can get a bit tricky with good cholesterol (HDL), bad cholesterol (LDL), total cholesterol, ratios of one to another, and triglycerides (another type of fatty product in the blood). For the sake of simplicity, let’s just leave it at this: raised levels of bad cholesterol are known to be linked with heart disease.
Know your blood pressure
This is something that is extra important as raised blood pressure is probably the biggest risk when it comes to heart attacks. But most of the time, it doesn’t cause any symptoms. This, combined with many people not being able to afford to check in with their doctor regularly, is why America is behind Canada when it comes to diagnosing and managing high blood pressure.
If you don’t know your blood pressure, borrow (or buy) a machine and check it. You can plug your reading in here to understand more about what your numbers mean. If you don’t have access to a machine, and are a member of Cimarron Family Practice, please PLEASE book an appointment so I can check your blood pressure for you.
Know your average sugar levels
This one is fairly straightforward – raised sugar levels can increase the risk of heart disease. If you have diabetes, improving your blood sugar control (provided you don’t then go too far the other way and have lots of episodes of low blood sugar) will reduce your risk of this. Even for those who don’t have diabetes, having a raised sugar level may still increase your risk of heart disease (3).
A good way to check your sugar level is with an HbA1c (‘glycated haemoglobin’) blood test. Unlike a simple blood glucose level which only provides a snapshot glance into what your sugar reading is like in that one instant, the HbA1c gives an average reading over a 3-month period in just one test, meaning it is more reliable as an overall representation.
Know your other risk factors
It is helpful to know if you have any of the other risk factors that are sometimes less discussed than the usual ‘diet, exercise and smoking’. These include:
· Ethnicity: Increased risk for people of South Asian and Black origins.
· Medical Conditions: Increased risk for people who suffer from Migraines, Chronic Kidney Disease, Rheumatoid Arthritis, Lupus and of course Diabetes and Hypertension.
· Family history: Angina or a heart attack in a first degree relative under the age of 60y is significant.
· Medications: Increased risk with oral steroid tablets and atypical antipsychotic medications, amongst others.
Diet
Diet can affect the heart in a number of different ways: foods high in bad fats can lead to higher LDL cholesterol. Excess salt in the diet can leak into the blood vessels and raise blood pressure. Having too many calories can increase one’s BMI and have a knock-on effect on heart disease that way.
As well as avoiding these ‘harmful’ foods, consuming certain types of food such as whole grains, legumes, fish, chocolate (!), and drinking one cup of coffee per day might actually help keep our heart healthier4.
Connection
I’m suspecting that even if you were already familiar with most of the above tips, this one might come as a surprise. There are actually large amounts of data now that show how social connections and good quality relationships can be as protective for your heart as a healthy diet and exercise regime. A systematic review published by the British Cardiac Society showed a 29% increased risk of heart disease among people with poor social relationships (5). Another review phrased their findings in a more positive way, saying there was a 50% increased likelihood of survival from all causes of death in those with stronger social relationships (6).
References
2. Park D, Lee JH, Han S. Underweight: another risk factor for cardiovascular disease?: A cross-sectional 2013 Behavioral Risk Factor Surveillance System (BRFSS) study of 491,773 individuals in the USA. Medicine (Baltimore). 2017;96(48):e8769. doi:10.1097/MD.0000000000008769 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728753/
3. Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, et al Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysisBMJ Open 2017;7:e015949. doi: 10.1136/bmjopen-2017-015949 https://pubmed.ncbi.nlm.nih.gov/28760792/
4. Chareonrungrueangchai K, Wongkawinwoot K, Anothaisintawee T, Reutrakul S. Dietary Factors and Risks of Cardiovascular Diseases: An Umbrella Review. Nutrients. 2020;12(4):1088. Published 2020 Apr 15. doi:10.3390/nu12041088 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231110/
5. Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009-1016. doi:10.1136/heartjnl-2015-308790 https://pubmed.ncbi.nlm.nih.gov/27091846/
6. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010 Jul 27;7(7):e1000316. doi: 10.1371/journal.pmed.1000316. PMID: 20668659; PMCID: PMC2910600. https://pubmed.ncbi.nlm.nih.gov/20668659/