The ten ways  cardiologists avoid heart disease

Times

19 hours ago

Coronary heart disease (CHD) remains one of the biggest killers in the UK, responsible for more than 66,000 deaths a year, with one person dying every eight minutes from the condition. It is the single biggest killer disease for men — one in eight dying from CHD — but the mistaken perception that heart attacks are not a big risk for women costs lives.
According to the British Heart Foundation (BHF), heart disease kills more women each year than breast cancer, with signs from studies that cases are rising among women under the age of 65. The BHF forecasts there could be one million more people living with heart disease in the UK by 2030.
We are all aware of basic matters of the heart, that its normal healthy functioning can be harmed by big risk factors such as smoking and drinking, being overweight and underactive, making poor dietary choices and having high blood pressure.
Over time, one or more of these can contribute to the narrowing of the arteries as fatty materials (called atheroma) such as cholesterol accumulate inside them. It is when arteries become narrowed by plaque to the extent that blood flow to the heart and brain is restricted that heart disease is diagnosed.
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Yet most cases — about 70 per cent according to the BHF — are preventable and cardiologists are convinced that if more of us were aware of the simple steps we can take to reduce our risk, the death toll would fall.
'By managing their lifestyle risk factors and keeping tabs on health, people can dramatically reduce their risk of heart disease,' says Oliver Guttman, consultant cardiologist at the HCA Wellington Hospital in London. 'This is true even for those who currently feel well, as early metabolic changes often occur silently.'
So, what are the rules for heart disease prevention? Here, Guttman and Hannah Douglas, consultant cardiologist at Guy's and St Thomas' NHS Foundation Trust, spell out their evidence-based recommendations for warding off CHD.
Blood pressure is one of the most important controllable risk factors for cardiovascular disease, yet hypertension is ignored or remains undiagnosed. A normal or ideal adult blood pressure is considered to be between 90/60mmHg and 120/80mmHg.
'Blood pressure is critically important and is truly a 'silent killer',' Douglas says. 'High blood pressure puts the entire vascular system under constant pressure and is a very significant risk factor for heart disease.'
Having your blood pressure checked by your local pharmacy free of charge is the first step to take. Also investing in a home DIY monitor is an option and the BHF has a list of approved devices bhf.org.uk. Blood pressure does ebb and flow, so a one-off high reading is usually nothing to worry about, but if it remains high for two or three weeks, see your doctor or nurse.
'Weight management and regular exercise are two of the easiest lifestyle methods that we know help to manage blood pressure,' Douglas says. 'But sustained high blood pressure should always be treated to reduce risk.'
Wearable devices such as smartwatches with ECG features, such as the Apple Watch and Fitbit, can be useful for detecting atrial fibrillation (AFib), an irregular heart rhythm that increases the risk of stroke and can contribute to heart failure.
'For people over 65 or those with symptoms such as palpitations or dizziness, these tools may help flag episodes of AFib early,' Guttman says. 'Do be aware that they can also give false positives, so any alerts should be followed up with proper clinical assessment.'
Routine monitoring for most under-65s is not necessary, he says, but if you are concerned about AFib speak to your GP. 'These trackers are best thought of as screening tools, not diagnostic devices, and their usefulness increases with age,' Guttman says.
Measuring cholesterol and blood triglycerides — or your lipid profile — should be done every 4 to 6 years and considered at low risk of CHD, Guttman says. 'You will need to have it checked more often if your lipid profile is abnormal, you are genetically at a high risk of raised cholesterol or if you are on medication,' he says.
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Finger-prick cholesterol checks can be carried out by your GP or your local pharmacy, or as part of the NHS health check in England. According to the BHF, below 4mmol/L (below 2.6mmol/L if you have had a heart attack) is a healthy level of non-HDL, bad cholesterol, the type that builds up in your arteries. Above 1mmol/L is a healthy level of good HDL cholesterol for men and above 1.2mmol/L is a healthy level for women. Healthy total cholesterol levels are below 5mmol/L, (4mmol/L if you've had a heart attack).
'Chronic inflammation is one of the key drivers of atherosclerosis, the plaque build-up in arteries,' Guttman says. 'A diet rich in anti-inflammatory, whole foods is ideal for helping to prevent this and is not only heart-protective but supports gut health, brain function, and long-term weight management.'
He recommends a Mediterranean-style diet with plenty of vegetables, fruits, whole grains, legumes, healthy fats, particularly extra virgin olive oil, and nuts, and a regular consumption of fish and seafood, which are high in heart-healthy omega-3 fats.
A review of clinical evidence in the journal Nutrients showed the approach is beneficial in reducing inflammation that is a risk factor for CHD. 'By also reducing or eliminating ultraprocessed, pre-packaged foods such as ready meals from the diet, we instead use more whole ingredients to cook at home, so it is an important step to take,' Douglas says. 'Whole food ingredients are going to be largely anti-inflammatory provided we balance the food groups and take care with not adding too much extra fat and salt.'
Given its benefits for muscles, bones and the waistline, there is a trend for favouring weight training over cardiovascular exercise among the over-50s. But Douglas stresses that one is not necessarily better than the other for the heart. 'I tend to advise a 50:50 mix of cardio and light weight training for optimum cardiovascular health,' Douglas says.
'Weight training has many benefits for blood pressure, general vascular health and bone density, but keeping active with cardiovascular, or aerobic, exercise is amazing for heart rate and blood pressure optimisation, weight management and has the secondary benefits of reducing the risk of other conditions such as type 2 diabetes which, in itself, is closely linked with poor heart health.'
Guttman says that, as a minimum, we should aim for the government targets of at least 150 minutes of moderate aerobic activity per week, and muscle-strengthening activities on two or more days per week. 'A mix of the two offers the best protection for cardiovascular and overall health,' he says.
Being overweight is a risk factor for CHD, but central adiposity — fat around the middle — is generally more telling than the scales. Getting a tape measure out every 4-6 weeks is the best approach. 'The body mass index [BMI] is still commonly used, but it doesn't reflect body composition or fat distribution,' Guttman says.
'For most people, keeping an eye on waist circumference is the easiest and most reliable way to monitor central fat, which is metabolically harmful and strongly linked to CHD risk.' High-risk waist measurements are over 102cm (40in) for men and over 88cm (35in) for women, although the numbers shouldn't be taken in isolation.
'We are all built so differently with different compositions of body fat and muscle,' Douglas says. 'We know that waist circumference has been linked with cardiovascular risk, so is definitely a useful gauge, but for those at higher risk of CHD an approach agreed between you and your clinician is best.'
Sleep is a key component in managing general health. 'There are very few conditions, medical, physical and psychological, that aren't worsened by poor sleep,' Douglas says. 'And this definitely includes heart disease.'
Poor or insufficient sleep is associated with high blood pressure, obesity, type 2 diabetes and irregular heart rhythm, all of which are risk factors for CHD.
'Sleep apnoea, which causes pauses in breathing during sleep, is another serious and underdiagnosed condition that significantly raises cardiovascular risk,' Guttman says. 'Most adults need 7 to 9 hours of good-quality sleep per night and prioritising a regular sleep schedule, reducing evening screen time, and managing stress can all help improve your sleep and consequently support heart health.'
Smoking remains one of the most powerful preventable risk factors for heart disease. 'It damages the arteries, increases blood pressure, promotes blood clotting, and accelerates plaque build-up,' Guttman says. 'Even light or occasional 'social' smoking and passive smoking increase CHD risk.'
There is no safe form of smoking. Research presented to the American Heart Association by cardiologists at the University of Wisconsin reported significant negative heart health impacts after vaping and smoking cigarettes.
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Immediately after vaping or smoking, increases in blood pressure, heart rate and blood vessel constriction were identified, and people who used e-cigarettes consistently performed worse than non-nicotine users on treadmill exercise tests used to predict CHD risk.
'I do worry about the long-term effects of vaping,' Douglas says. 'Although easier said than done, all smokers need to work their hardest to become ex-smokers, with any support available.' The heart benefits of quitting begin within days, and over time, the risk of CHD can fall to near that of a non-smoker.
Most CHD risk comes from a combination of genes and lifestyle. If you have a family history of heart disease, Guttman says you should always discuss with your GP or cardiologist whether additional testing is appropriate for you.
'Genetic testing can be helpful, especially in cases of strong family history of premature heart disease [heart attack or stroke before age 55 in men or 65 in women],' he says. 'Certain inherited conditions, such as familial hypercholesterolaemia, which is characterised by very high levels of non-HDL cholesterol in the blood, greatly increase heart disease risk and often go undiagnosed without testing.'
However, routine genetic screening is not recommended. 'In asymptomatic patients it often raises more questions than it answers unfortunately,' Douglas says. And even if you do have a genetic predisposition, there is no escaping the truth that healthy behaviours — not smoking, regular exercise, a balanced diet — will significantly reduce your CHD risk. 'Always discuss concerns with your GP or cardiologist, who will help to determine whether testing is appropriate for you,' Douglas says.
Women — be extra aware of symptoms around the menopause
Menopause is a key window for reassessing heart health and 'it's an ideal time for women to get their blood pressure, cholesterol, and glucose checked to ensure they're on track for the years ahead,' Guttman says. Some of the symptoms associated with the perimenopause and menopause, including sweating, palpitations, breathlessness, intolerance of exercise and panic attacks, are also symptoms of heart disease and, as such, can get overlooked.
'Understanding signs that can be associated with fluctuating hormone levels is key to recognising the difference between perimenopause and, for example, a cardiac arrhythmia,' Douglas says. 'Women should always seek medical help for worrying symptoms early. And if not satisfied with the outcome, seek a second opinion.'
HRT isn't prescribed to prevent CHD, but it may play a helpful role in managing menopausal symptoms in some women. For some of those under 60 or within 10 years of their menopause who are otherwise healthy, it might improve quality of life as well as improving some metabolic risk factors.
'I am a proponent of HRT for many peri and post-menopausal women for whom benefit outweighs risk,' Douglas says. However, HRT is not suitable for everyone, particularly women with a history of stroke, blood clots, or known CHD.
'Decisions about HRT should be personalised, weighing the risks and benefits with a healthcare professional,' Guttman says.