Written by Dr Katie Stephens, GP
Dr Katie graduated from the University of Manchester in 2007 (MBChB) and completed her GP training in the West Midlands in 2012 (MRCGP).
We all know that exercise is good for your heart. But do you know why? There are two main ways exercise benefits your heart:
- 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.
- 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.
2. 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.
According to UK 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 it1. 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.
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).
4. 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 old2. Before you reach for the biscuits 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.
5. 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 is known to be linked with heart disease.
- A measurement of how much fat is in your blood. The lipid profiles include: 1. Cholesterol 2. Triglycerides 3. High density lipoprotein cholesterol 4. Non-high density lipoprotein cholesterol.
6. Know your blood pressure
This is something that is extra important as raised blood pressure is a big risk when it comes to heart attacks. But most of the time, it doesn’t cause any symptoms. This, combined with the issue of NHS GP’s not being funded to do annual blood pressure checks, is probably why the UK is so far behind other similar countries when it comes to diagnosing hypertension (high blood pressure).
If you don’t know your blood pressure, borrow (or buy) a machine that is approved by the British and Irish Hypertension Society, like Kinetik’s are, and check it. You can enter your reading here to understand more about what your numbers mean.
7. 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 hypo’s) 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 disease3.
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. Kinetik now offers this test privately through an NHS lab, which you can access here.
- This test detects high or low blood sugar levels (HbA1c). Results will tell you if you have diabetes, if you're at risk of developing diabetes or if you have healthy blood sugar levels.
8. 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 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.
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 relationships5. 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 relationships6.
- 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/
- Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, et alGlycated 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
- 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/
- 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
- 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/