The chance of developing heart disease is increased if you smoke tobacco, have high blood pressure, have diabetes, have high blood cholesterol (which may be due to eating too much fat in your diet), are overweight or obese and/or do not take enough physical exercise.
• Smoking of tobacco is now clearly established as a cause of atherosclerosis. Few authorities now dispute the evidence. There are however some interesting dietary aspects: Did you know that smokers tend to eat less fruit and vegetables compared to non-smokers (and thus eat less of the protective anti-oxidant plant compounds)? Did you know that smokers tend to eat more fat and more salt than non-smokers? These characteristics of the smoker’s diet may be caused by a desire to seek stronger food flavours as a consequence of the taste-blunting effect of smoking. While these dietary differences may make the smoker at greater risk of heart disease there is only one piece of advice for anyone who smokes: please stop smoking!
• High blood pressure causes changes in the walls of arteries. The muscle layer (remember an artery is not a rigid pipe, it is a muscular tube, which when healthy can change its size to control the flow of blood) becomes thickened and atherosclerosis is more likely to develop. Treatments for blood pressure have become more effective over the last thirty years, but it is only now becoming clear which types of treatment for blood pressure are also effective at reducing heart disease risk.
• Diabetes is caused by a lack of insulin—either the body does not produce enough or the body ‘demands’ more than normal (because It has become insensitive to insulin). In diabetes some of the chemical (metabolic) processes which take place tend to accelerate atherosclerosis. Diabetes may also result in raised blood fats. The increased risk of heart disease is a major reason why so much effort is put into achieving normal control of blood sugar in diabetic patients, and also why all people with diabetes should be checked for the other risk factors of heart disease.
• High blood cholesterol increases the risk of heart disease. Your blood cholesterol is determined by genetic (inherited) factors— which you cannot change—and lifestyle factors—which you can change. There are some relatively rare conditions in which particularly high blood cholesterol levels occur. People who have inherited these conditions need a thorough ‘work-up’ by a specialist doctor followed by life-long drug treatment. In most people high blood cholesterol is partly determined by their genes, which have ‘set’ the cholesterol slightly high and lifestyle factors which push it up more. The most important dietary factor is fat. The Sets prescribed for blood cholesterol lowering are low fat (low saturated fat), high carbohydrate, high fibre diets. Body weight also affects blood cholesterol—in some people being overweight has a significant effect on the levels—attaining a reasonable weight can be helpful. The blood also contains triglycerides, another type of fat which is particularly high after meals. High triglycerides may be linked with increased risk of heart disease in some people.
• Overweight and obese people are more likely to have high blood pressure and to have diabetes. They are also at increased risk of getting heart disease. Some of that increased risk is due to the high blood pressure, and the tendency to diabetes, but there is a separate ‘independent’ effect of the obesity. When increased fatness develops it can be distributed evenly all over the body or it may occur centrally—in and around the abdomen (tummy). This central obesity is particularly strongly associated with the risk of heart disease.
Thus every effort should be made to get body weights nearer to normal – especially if the extra weight is ‘middle-age spread’.
• Exercise has several benefits for the heart. Cardiovascular fitness is improved by regular strenuous exercise and the blood supply to the heart may be ‘improved’. Exercise is also important in maintaining body weight and has effects on metabolism and some factors related to blood dotting. Getting regular exercise is clearly important.
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