Your heart is not only your most critical muscle but is also one of the hardest working as it never stops. Your adult heart beats about 100,000 times each day, though fitness level can affect your heart rate. The more fit you are the lower your heart rate. Also your heart rate drops while you sleep. This is because your metabolism slows and the parasympathetic nervous system which slows your heart and relaxes you is more active. Heart size depends on the size of the person as well as the condition of the heart. A healthy heart is generally about the size of the person’s fist. Your heart is one giant pump, every minute your heart pumps about five quarts of blood through a system of blood vessel that’s over 60,000 miles long. That translates to about 2000 gallons of blood every day.
Risk Factors for Heart Disease
- Family History – A strong family history for heart disease also increases a person’s risk. About 30% of disease risks is due to your genes and the rest your lifestyle. They say ‘genes load the gun and lifestyle pulls the trigger’. With the new era of DNA profiling we might be able to in the future predict your risks and then put the appropriate measures in place to reduce your risks of heart disease.
- Sex – Men have a slightly higher incidence of heart disease but after menopause the incidence increases in women.
- Age – The older you are the higher your risk of heart disease. However if you keep a healthy lifestyle from young and maintain it you still can prevent or delay heart disease.
Modifiable Risk Factors
- Smoking – If you are a smoker, quit. It is the single most important thing you can do for your heart. Smoking is one of the main causes of coronary heart disease. It causes free radical damage and increases inflammation which then starts the whole cascade of atherosclerosis. Many different chemicals found in tobacco smoke can damage your heart according to experts at Mayo Clinic. Smoking also decreases your body’s supply of oxygen and causes blood vessels to constrict.
- Diabetes Mellitus – Diabetes is part of the metabolic syndrome. In fact metabolic syndrome is now believed to have overtaken smoking as the number one cause of heart disease. You need to keep your diabetes well controlled as poorly controlled diabetes leads to macrovascular complications which leads to heart disease and strokes. Normal sugar level fasting should be below 5.6. A level of 5.6 to 6.4 is pre-diabetic and doctors now believe treatment should already start as this is already a risk factor.
- Hypertension – Blood pressure is not usually something you can feel and is sometimes called the silent killer. Normal blood pressure is 120/80. Up to 140/90 can usually be accepted in older individuals. You need to manage your blood pressure and it is good if you have home monitor set so that you can monitor it regularly.
- Cholesterol – Cholesterol is a fatty substance carried in the blood. Your body needs cholesterol to be healthy but an imbalance of cholesterol especially the bad cholesterol, LDL can deposit in inflamed arteries and lead to atherosclerosis and heart disease.
- Be physically active – Your activity level is one of the greatest potential risk factor for heart disease. People with low fitness levels have double the risk of heart disease as their more active counterparts. Also excessive amounts of sitting have been linked to increased risk of heart disease. You may have heard that sitting is the new smoking. Numerous studies have shown that sitting most of the day is linked to chronic health conditions. When we are more active, even with smaller movements like when we stand or shift from side to side, our muscles turn on genes that create chemicals and proteins that not only help us process blood sugar and cholesterol more efficiently but also create a healthier atmosphere in our blood vessels. That then leads to lower heart disease risk which is why you should stand up and move around at least every hour for a few minutes. The American Heart Association recommends at least 150 minutes of moderate intensity exercise or 75 minutes of vigorous activity or a combination of the two every week.
- Stay Slim – Achieve and maintain a healthy weight. Maintaining a healthy weight can reduce the risk of heart disease and other health problems. It can help to know your body mass index, waist measurements and body fat and what these mean.
- Manage Stress – The way you handle both personal and professional stress may affect your heart directly or it may affect other risk factors that lead to heart disease such as blood pressure, cholesterol levels, physical activity levels and eating, drinking and smoking habits. The stress hormones like adrenaline and cortisol can also cause increased free radicals and inflammation. Look after your mental health. We know that there can be a greater risk of heart disease for people who have depression, are socially isolated or do not have good social support. Having a good social life with family and friends can help.
- Homocysteine – This is also an independent risk factor not only for mental health but also heart disease. High levels can be reduced with folic acid and B12.
- Inflammation – This can be measured by testing your HsCRP (highly sensitive C reactive protein). Inflammation is now known to be the cause of many diseases including heart disease and cancer.
- Alcohol – Drink moderately. Although a glass of red wine contains antioxidants that may help reduce the risk of heart disease and alcohol can cause a slight rise in HDL cholesterol levels, drinking too much alcohol can increase your blood pressure, your triglycerides levels and your calorie count. Recommended drinking levels include one unit for women and two for men a day.
- Sleep – Lack of sleep is like a stress to the body and chronic sleep loss can be a risk factor for heart disease. The recommended sleep per night is about seven to eight hours.
- Nutrition – This is very important in preventing not only heart disease but also all chronic and lifestyle diseases. It was Hippocrates who said ‘thy food is thy medicine and thy medicine is thy food’. Although you might know that certain foods can increase your heart attack risk, it is often tough to change your eating habits. It is good to know which foods to eat more of and which foods to limit so that you can be on your way toward a heart healthy diet. The following is the heart healthy diet from Mayo clinic:
- Control your portion size – How much you eat is just as important as what you eat. Overloading your plate, taking seconds and eating until you feel stuffed can lead to eating more calories than you should. Use a small plate or bowl to help control your portions. Eat larger portions of low calorie, nutrient rich foods and smaller portions of high calorie, high sodium foods.
- Eat more vegetables and fruits – Vegetables and fruits are good sources of vitamins and minerals and are also low in calories and rich in fiber. The recommendation per day is four to five portions of fruits and vegetables of which at least three to four should be vegetables. One portion is the size of your open palm.
- Select whole grains – Whole grains are good sources of fiber and other nutrients that play a role in regulating blood pressure and heart health. Replace your refined grain products with whole grains.
- Limit unhealthy fats – Limiting how much saturated and Tran’s fat you eat is an important step to reduce your blood cholesterol and lower your risk of coronary artery disease. When you do use fat choose monounsaturated fats like olive oil or canola oils and polyunsaturated fats found in certain fish, avocados, nuts and seeds. But moderation is essential. All types of fat are high in calories.
- Choose low fat protein sources – Lean meat, poultry and fish, low fat dairy products and eggs are some of your best sources of protein. But be careful to choose lower fat options such as skim milk rather than whole milk and skinless chicken breasts rather than fried chicken patties. Legumes like beans, peas and lentils also are good sources of protein and contain less fat and no cholesterol making them good substitutes for meat.
- Reduce the sodium in your food – Eating a lot of sodium is a risk for factor hypertension and reducing sodium is an important part of a heart healthy diet. The recommended intake is no more than 2,300 mg a day (about a teaspoon of salt). Much of the salt you eat can come from canned and processed foods. It is better to eat more fresh and natural foods while avoiding manmade processed foods.
- Plan ahead: Create daily menus.
- Allow yourself an occasional treat.
Symptoms and Signs of Heart Disease
Also known as Coronary artery disease or Ischemic Heart Disease. The different types of heart disease include:
- Stable Angina – This is the typical chest pain that occurs on exertion and relieved with rest. The pain is usually explained as pressing in nature or like a heavy feeling over the chest. The pain can radiate to the jaw, left arm or back and might be associated with sweating or shortness of breath.
- Unstable Angina – Any new chest pain is considered as unstable angina. Also a previous stable angina that becomes more frequent or occurs even at rest is considered as unstable.
- Myocardial Infarction (Heart Attack) – Severe chest pain lasting more than half an hour and associated with sweating and shortness of breath. This is a medical emergency. They say time is heart muscle and the faster the patient is treated the better the prognosis.
- Coronary Artery Spasm – The symptoms are like a heart attack but is usually transient and usually no muscle damage occurs.
- Heart Failure – Sometimes especially elderly patients, might present with just heart failure without any history of chest pain.
Managing Heart disease
Depending on your symptoms doctors will do various tests to diagnose heart disease. This will include blood tests, electrocardiogram, stress test, echocardiogram and if necessary an angiogram. Treatment can be medication or if an angiogram shows blockage an angioplasty will be done where a stent is inserted to open up the block. If the blocks are very severe than a bypass surgery might be recommended.
Essential Nutrients for a Healthy Heart
Cardiovascular disease has long been and continues to be the number one killer in Malaysia. Various medications are routinely prescribed to reduce risk factors for heart disease like medications for high blood pressure, diabetes and cholesterol. Medications can be expensive and also have side effects. Dietary supplements are overlooked as alternatives to manage cardiovascular health and provide a powerful weapon in the fight against this devastating disease.
EPA and DHA (Omega 3)
EPA and DHA are Omega -3 fatty acids that have wide spread health promoting effects especially for heart disease. Several hundred studies have shown cardio-protective effects of fish oil. Fish oil works through several mechanisms to promote heart health such as improving heart rhythm and preventing clot formation and plaque build- up in arteries. Fish oil may also lower blood pressure and increase plasma levels of ‘good’ HDL cholesterol. Omega-3 fats potently reduce inflammation and these fats have also been shown to protect against muscle loss and even enhance fat breakdown.
Plant Sterols (Phytosterols)
In many studies, plant sterols have been shown to reduce cholesterol and prevent cardiovascular disease. They have a structure that is similar to cholesterol, causing it to decrease gut absorption and to enhance elimination of dietary cholesterol. A comprehensive review of 41 trials comparing plant sterols to placebo concluded that intake of 2 grams a day of sterols reduced “bad” LDL cholesterol by 10% with the effects independent of diet. The same study concluded that the cholesterol lowering properties are above and beyond that achieved with diet or medications that also lower cholesterol. Plant sterols have therefore been recommended by the American Heart Association for reducing cholesterol.
Coenzyme Q10 functions in the mitochondria as the “powerhouse” of the cell to assist in making energy (called adenosine triphosphate or ATP) from carbohydrates and fats. CoQ10 primarily acts as an antioxidant in the heart and is involved in the synthesis of energy, but it also has other important functions inside the mitochondria such as stabilizing membranes. CoQ10 protects the ‘bad’ cholesterol that is implicated in atherosclerosis from oxidizing. Because of CoQ10 role in oxidative stress, energy production and stabilization, it is useful in preventing damage to the heart during periods of stress. Research of CoQ19 spanning over 30 years shows potential for use in the prevention and treatment of cardiovascular diseases.
Polyphenols are micronutrients with antioxidant activity found mostly in whole foods such as dried spices, fruits, vegetables, red wine and cocoa. Polyphenols play an important role in preventing and reducing the progression of diabetes, neurodegenerative and cardiovascular diseases. The research supporting polyphenols in the prevention and treatment of cardiovascular disease is well documented. Flavonoid polyphenols help to reduce the clumping of platelets in your blood and improve the function of your cells that line your arteries and veins. Platelet clumping is one potential precursor in heart attacks and angina. Polyphenols are also important as antioxidants and reduce free radical damage and the inflammatory response in your body. Polyphenols also inhibit vascular endothelial growth factor which causes complications with atherosclerotic plaques in the arteries, a factor in cardiovascular disease.
Other supplements that have a role in heart health include Lecithin, Policosanol, Red Yeast Rice, Lycopene, L-Carnitine, Garlic, Niacin and Arginine.
Heart Disease is still a major cause of mortality in Malaysia and all over the world. Once you have heart disease not only is your quality of life affected but it can also be a chronic costly affair. The focus should be on prevention and looking at especially all the above factors that can be modified. The saying that Prevention is better than Cure really applies here.