Know the risks and be healthy

Heart disease doesn’t have to be a killer. Liz Bestic finds out what can be done to minimise the risks

For many people the first symptom of cardiovascular disease is a heart attack, but by then it can be too late – sadly, one in three heart attacks result in sudden death.

Cardiovascular disease (CVD) is normally caused by atherosclerosis, a furring or stiffening of the walls of arteries, which often has no visible symptoms. Yet if diagnosed early, it can be treated and managed.

Good news is that CVD can be prevented through better knowledge of the risk factors. These include raised cholesterol, diabetes, smoking, high blood pressure, physical inactivity, poor diet and being overweight.

“The single most important thing a smoker can do to prevent CVD is to give up,” says consultant cardiologist at Guy’s and St Thomas’ NHS Foundation Trust Professor Brian Clapp.

“Smoking is known to damage the lining of the arteries leading to a build-up of fatty material or atheroma, which can narrow the arteries, affecting the flow of blood to the heart muscle,” he explains.

The single most important thing a smoker can do to prevent cardiovascular disease is to give up

The carbon monoxide in tobacco smoke also reduces the amount of oxygen in the blood, making the heart pump harder to supply the oxygen it needs.

“Nicotine in cigarettes stimulates the body to produce adrenaline which makes the heart beat faster and raises blood pressure,” says Maureen Talbot, senior cardiac nurse at the British Heart Foundation (BHF). When you quit smoking the risks to heart health reduce almost immediately.

High blood pressure or hypertension is often called the “silent killer” because there may be no obvious symptoms. However, if left unchecked high blood pressure can be a major cause of CVD. It is important to get your blood pressure checked regularly.

According to Blood Pressure UK, ideally blood pressure should be below 120 over 80. The higher the blood pressure the higher the risk of heart disease. For instance, someone with a blood pressure level of 135 over 85 is twice as likely to have a heart attack or stroke as someone with a reading of 115 over 75.

Diabetes is also one of the top risk factors for heart disease. The most recent report of the NHS National Diabetes Audit shows that people with diabetes are 48 per cent more likely to suffer heart disease than those without the condition.

Diabetes UK says this is because diabetes makes it very difficult for the body to control blood sugar levels and high blood sugar damages blood vessels leading to a range of heart complications, including heart attack, heart failure and angina.

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The most recent Global Burden of Disease Study in 2010 shows that, while life expectancy in the UK has improved over the last 20 years, levels of ill health are now below average, compared with 18 other countries, on important indicators such as heart disease.

“There is a concern that, with an ageing population and the current levels of obesity and diabetes, past gains may not be sustained unless there are improvements in prevention,” says Ms Talbot.

The government’s policy on CVD has recently been set out in Cardiovascular Disease Outcome Strategy: Improving outcomes for people with or at risk of cardiovascular disease. The report says that more people could live longer and have a better quality of life if they were supported to adopt healthy lifestyles, such as quitting smoking, eating more healthily and being more physically active.

“It’s important that children are also encouraged to be heart healthy too,” Ms Talbot points out. A recent BHF report shows that 30 per cent of children are now obese and 40 per cent of 13 year olds consume a soft drink every day. It also warns that children are spending too much time in front of the TV, and are not eating the recommended five portions of fruit and vegetables a day.

BHF chief executive Simon Gillespie says: “These figures are a warning that many of our children are in grave danger of developing CVD in the future if they continue to live the same lifestyle. This is simply unacceptable.”

The NHS Health Check programme aims to encourage everyone between the ages of 40 and 74 to be assessed for their risk factors of heart disease. Those found to be at risk will be given support and advice to make positive lifestyle changes, such as giving up smoking and eating a healthier diet.

The programme covers around 15 million adults, all of whom should be offered blood pressure and cholesterol checks. However, coverage has been patchy and not everyone is being offered the check-up at age 40.

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Sixty-five-year-old Maureen Hennis was shocked to discover she had a problem. She is a fit, non-smoker, who had a heart attack out of the blue at work.

In hospital, she underwent angioplasty, whereby a blocked artery was widened and a short wire-mesh tube, called a stent, inserted to allow blood to flow more freely. This was followed by a cardio rehab course. However, symptoms returned and doctors found another blocked artery. She had two more stents fitted.

“I am living proof you don’t have to fit the ‘profile’ of a heart attack victim to be affected by heart disease. I was healthy, I didn’t smoke and I exercised regularly, but I still had heart problems,” she says.

Another major risk factor for CVD is raised cholesterol. This is a fatty substance carried around in the body by proteins. When these proteins combine they are known as lipoproteins.

There are two main types: low-density (LDL) and high-density (HDL). LDL is often referred to as “bad cholesterol” and too much in the blood can cause fatty deposits to form in the arteries, restricting blood flow.

Cholesterol is measured in units called millimols per litre of blood. Experts recommend aiming for a cholesterol reading of below four, particularly if you are already at risk of heart disease.

For most people, simple changes in their lifestyle, such as eating less saturated fat and a diet high in fibre and fresh fruit and vegetables, can be enough to bring their cholesterol levels down. For others it may be necessary to take statin tablets, which act to block production of cholesterol in the liver.

For some, however, high cholesterol is caused by an inherited condition known as familial hypercholesterolemia (FH). Currently, despite National Institute for Health and Clinical Excellence (NICE) guidelines, only 15 per cent of the estimated 100,000 cases of FH in England have been diagnosed, even though it is a treatable condition.

At Harefield Hospital, a specialised FH screening service has been set up where they use a system known as cascade screening, which involves progressive screening of family members, starting with those known to be most at risk.

Suzanne Sheppard, 41, from Cardiff, only discovered she had FH after her dad died of a heart attack at a young age. Her doctor recommended she and her family should have their blood cholesterol levels checked.

Her cholesterol levels were far too high and she was referred to a lipid clinic where a specialist offered advice on how to manage the condition. Now Suzanne keeps her heart healthy with regular physical exercise and a low-fat, high-fibre diet. She is also prescribed statins.

“Taking exercise, eating a healthy diet, encouraging your children to be healthy and being aware of dangers, such as smoking, drinking, high blood pressure and stress, are all important for long-term heart health, whether you currently have heart disease or not,” concludes the BHF’s Ms Talbot.