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Missing A Beat


Most of us know that pain or tightness in the chest may well signal the onset of a heart attack, writes Caryn Gootkin. But how many of us understand what we can do to avoid getting to that point?
Image: iStock© - Severe heartache, man suffering from chest pain. Image: iStock© - Severe heartache, man suffering from chest pain.

One of the Heart and Stroke Foundation South Africa’s (HSFSA) core messages is that at least 80% of early deaths caused by heart disease and stroke can be avoided by following a healthy diet, doing regular physical activity, and not smoking. With that in mind, let’s look at three causes of heart disease – cholesterol, hypertension and inflammation – and how to avoid them.

The lowdown on cholesterol

Cholesterol comes from the food we eat and is also produced by our body, which needs it to remain healthy. It builds cell membranes, fights off infections and helps with the proper functioning of hormones. But having too much cholesterol in your blood is one of the most important risk factors for cardiovascular disease.

Increased cholesterol levels can be caused by hereditary factors and poor lifestyle habits, such as alcohol abuse or diets high in saturated and trans fats. High blood cholesterol contributes to thick, hard deposits in the arteries, causing them to narrow and harden, a disease known as atherosclerosis. A clot that forms in and blocks a narrowed artery that feeds the heart or brain can result in a heart attack or stroke.

What makes getting to grips with cholesterol so complicated is that there are different types of cholesterol that make up the total cholesterol levels in our body. It’s not enough to know your total cholesterol number – ensure that your high-density lipoproteins (HDL) (“good” cholesterol) are high enough, and your low-density lipoproteins (LDL) (“bad” cholesterol) and triglycerides (total amount of fat in the blood) are low enough.

HDL is “good” because it acts as a scavenger, collecting excess LDL and transporting it back to the liver. If your HDL levels are too low, small LDL particles can enter and damage the arteries, triggering an inflammatory response that narrows the arteries and causes plaque formation.

Blood triglycerides are absorbed from food or manufactured in the liver to store unused calories as fat. Gabriel Eksteen, dietician and physiologist at HSFSA, explains that having abnormally high levels of fasting triglycerides in the bloodstream is an independent risk factor for heart disease, as they affect clot formation, thereby increasing atherosclerosis. “This is typically due to genetic causes, insulin resistance or high alcohol intake,” he says.

Know your numbers – cholesterol

The scary truth about cholesterol is that many people with high cholesterol feel perfectly healthy and don’t experience any symptoms, which is why it is often referred to as a “silent killer”. The good news is that if you have a family history of heart disease – or simply want to find out your cholesterol levels – a fasting blood test (called a fasting lipogram) will reveal your numbers.

Target values for cholesterol levels in individuals without other medical conditions: (If you are already at risk of heart disease or have diabetes, stricter limits may apply.)

How can I lower my bad cholesterol and triglycerides, and increase my good cholesterol?

Based on your lipogram, and if they think diet and lifestyle changes alone won’t be enough, your doctor may recommend that you take cholesterol-lowing medication, known as statins.

Statins – saint or sinner?

Statins work by blocking the enzyme the liver needs to make cholesterol, and are therefore highly effective at removing cholesterol from the bloodstream.

While many in the medical fraternity regard statins as among the safest drugs available, there is some controversy around the side-effects of these drugs, which include atorvastatin (Lipitor) and simvastatin (Zocor).

“In general, statins are safe and do lower the risk of atherosclerosis complications, especially heart attacks,” says Dr AD Marais, professor of chemical pathology and advisor to the HSFSA. “A few persons per 100 will report some muscle aches, and it is not always easy to know if this is due to the medication, but in some instances it definitely can be. When there is an extreme effect on the muscle, the kidney may be harmed as a consequence, but the condition usually recovers fully. Like with other medication, there can be a range of uncommon effects, including changes in bowel habits, liver injury, and many others.”

Practising the following diet, exercise pattern and lifestyle habits will also help you to achieve your cholesterol targets:

  • Choose healthier unsaturated fats (such as nuts, seeds, avocado, olive and canola oils), and limit saturated and trans fats. Eat fish rich in omega-3 fats at least twice a week.
  • Eat a diet high in both soluble and insoluble fibre, which means plenty of fruit, vegetables, legumes (beans, peas, lentils) and unrefined grains.
  • Avoid food and drink high in added sugars.
  • Exercise regularly (at least 30 minutes five times a week).
  • Quit smoking and avoid second-hand smoke.
  • Drink alcohol only in moderation.
  • Maintain a healthy weight.

Blood pressure – it’s all about the numbers

The term blood pressure refers to the pressure of your blood in your arteries – or how hard your heart has to work to pump blood through your blood vessels. When the walls of the arteries lose their natural elasticity, they become stiff and your blood vessels narrow, causing your heart to strain.

High blood pressure, also known as hypertension, is another silent killer; often there are no symptoms of this disease, the most common chronic disease of our time and the single biggest risk factor for heart disease and strokes, according to the HSFSA. (“In severe cases of extremely high blood pressure, sufferers may experience headaches, nosebleeds, tiredness, shortness of breath, flushing or dizziness,” says the HSFSA’s Eksteen.)

Doctors, nurses and pharmacists measure blood pressure by placing a blood pressure cuff on your arm and reading the results immediately. It’s that easy. Strange, then, that only half of hypertensives know that they suffer from high blood pressure. This is due to a combination of low levels of testing, the absence of warning symptoms and the belief that you only have to start worrying about your blood pressure when you hit middle age.

“We have to address blood pressure from the top down, starting with improved diagnosis in people unknowingly suffering from this silent disease,” said Dr Vash Mungal-Singh, haematologist and former CEO of the HSFSA, on World Hypertension Day earlier this year. The HSFSA recommends that all people over 21 have their blood pressure tested regularly.

Know your numbers – blood pressure

A blood pressure measurement is expressed as two numbers, one over the other. The top refers to systolic pressure (SBP), which occurs when the heart contracts; the bottom refers to diastolic pressure (DBP), or heart relaxation between beats. So a reading of, for example, 130/90mm Hg means that SBP is 130 and DBP is 90.

How can I maintain a healthy blood pressure?

  • Blood pressure can often be controlled by lifestyle modification, but medication is sometimes necessary and your doctor will discuss the various options with you.
  • Aim to lower your blood pressure by following these lifestyle and dietary guidelines:
  • Eat a healthy, balanced diet.
  • Reduce your salt intake to no more than 5g (1 teaspoon) a day. (“This includes what you add to food and what is already in foods that you buy,” says Eksteen.)
  • Eat at least five servings of a variety of fruits and vegetables each day.
  • Choose wholegrain and high-fibre foods instead of refined versions.
  • Limit saturated and trans fats, replacing them with healthier unsaturated fats (such as canola oil, olive oil, peanut butter, nuts and seeds, avocado or fish).
  • Try to include fatty fish (sardines, pilchards, salmon, mackerel) at least twice a week.
  • Drink no more than one (for women) or two (for men) units of alcohol per day.
  • Exercise regularly (at least 30 minutes five times a week).
  • Quit smoking and avoid second-hand smoke.
  • Maintain a healthy weight.

Reducing inflammation

Chronic inflammation is the body’s response to certain physiological triggers – excess weight, physical inactivity, high glucose and insulin – that cause plaque to form in the arterial walls, contributing to both atherosclerosis and peripheral artery disease.

“Atherosclerosis is primarily a chronic inflammatory disease, resulting from an immune response within the vascular walls,” says the HSFSA’s Eksteen. “This immune response is influenced by what we eat, toxins like tobacco smoke, stress and activity levels, to highlight the most important factors.”

The good news is that you can reduce current and prevent future inflammation by losing weight, exercising, and reducing your insulin and blood sugar levels.

Women and heart attacks

Most of us have seen movies where actors clutch their chest and fall to the ground. We may even believe that heart disease is the domain of men – but we’d be wrong. While women are just as prone to heart attacks, the scene in the movie may be less dramatic, as women’s symptoms are often far subtler. It is important to note the different ways women can experience heart attacks.

“Women can experience a heart attack without chest pressure,” says Dr Nieca Goldberg, medical director of the Joan H Tisch Center for Women’s Health at NYU’s Langone Medical Center. “Instead, they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper-back pressure or extreme fatigue.”

 

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