What is CVD?Cardiovascular disease (CVD), is a group of conditions that includes stroke and heart disease. It kills one in three people in the UK.
CVD is caused by a build-up of fatty streaks and cholesterol in the blood vessels. While some contributing factors can't be altered, we can change our lifestyle.
Natural wear and tear to blood vessels makes it easier for fatty cholesterol to leak in and get stuck to the artery walls. This build-up causes the arteries to narrow, reducing the heart's ability to pump blood through them to the body. If they become completely blocked, it will cause a heart attack or a stroke if the blockage occurs in the brain's blood vessels. Importantly, not all cholesterol is bad. There are two types of cholesterol in the bloodstream: LDLs and HDLs. LDLs create the build-up in arteries, while high HDL levels are a good sign that you're not at risk of CVD.
Risk factors for CVDSome risk factors for CVD are potentially reversible or can be modified. These include:
Cigarette smoking
Increased levels of LDL cholesterol
High triglycerides (caused by the build up of fats derived from foods eaten or made in the body from other energy sources)
Low HDL cholesterol
Being overweight
Large waist circumference (being 'apple-shaped')
High blood pressure
Inactivity
Diabetes
Diet and CVD
Making small changes to your diet is one of the simplest and most effective ways to reduce your risk of CVD. You can do this by:
Reducing fat in your diet, especially saturated and trans-fats
Eating more fruit and vegetables, wholegrain food and soluble fibre
Drinking alcohol in moderation
Reducing salt to maintain a lower blood pressure
Cholesterol and CVDReducing the proportion of fat in your diet, especially saturated fat, can help to reduce blood cholesterol levels. There's a strong link between high blood cholesterol levels and the risk of heart disease. For those who don't have CVD or aren't considered to be at high-risk of CVD, normal blood cholesterol levels are below 5mmol/litre. This can be measured by your GP. People with average energy needs should aim to consume no more than 70g/day of fat and less than 20g/day of saturated fat.
Trans-fatty acids are a particular kind of fat that are naturally occurring in meat and dairy products but may also be produced when plant-based oils are hydrogenated to produce solid spreads, such as margarines. They're often found in confectionery and processed food like pastry, biscuits and cakes. They've been found to have the same effect on cholesterol levels as saturated fat and should be avoided as much as possible. Thankfully, many manufacturers have now modified processing techniques to keep these fats to a minimum. Check labels for hydrogenated fats.
When reducing total fat, it's important not to cut out the heart healthy fats from your diet including mono and poly-unsaturated fats and omega-3, mostly found in plant and fish oils.
How to modify your fat intake:
Use butter and other spreads sparingly
Choose lean cuts of meat or trim fat off
Grill, bake or steam food rather than frying
Swap saturated fats such as butter for unsaturated oils such as sunflower, rapeseed or olive oil
Limit your intake of trans-fats from processed food
Eat two to three portions of oily fish each week (e.g. sardines, mackerel, fresh tuna, salmon)
Essential fatty acidsEssential fatty acids such as omega-3s, which are found in oily fish, have been shown to reduce the risk of CVD by lowering blood triglycerides, reducing blood clotting and regulating heart rhythm. For general heart health, try to eat two portions of fish per week, one of which should be oily.
Stanols and sterols
Certain plant-derived compounds, called stanol or sterol esters have been shown to reduce cholesterol levels. Spreads, yoghurts, drinks and soya 'dairy alternatives' are now available containing these products. These sterol enriched foods may be particularly useful for those with raised blood cholesterol which has remained elevated even after making other dietary changes. Clinical trials show that when used regularly, they can reduce high cholesterol levels.
Fruit and vegetables
Fruit and vegetables are rich in many essential nutrients including vitamins C and E and carotenoids (which are all antioxidants). They may help to protect the heart by limiting the damaging effects of cholesterol on body tissues. Aim for at least five servings of fruit and vegetables a day. (See the Fruit and Vegetables article for more information on what a serving is.)
Wholegrains and fibre
Studies of large groups of people in the US have shown that diets rich in wholegrain food can reduce the risk of CVD by up to 30 per cent. You can include wholegrain food in every meal by choosing wholemeal bread and wholegrain varieties of pasta and rice.
Soluble dietary fibre, found in oats, beans and pulses, can help to lower LDL cholesterol. These foods should be included as part of an overall healthy balanced diet, at least two to three times each week.
Soya protein
A diet that includes at least 25g of soya per day has been associated with reductions in LDL cholesterol and CVD. Soya isoflavones in particular have been shown to reduce CVD risk as they inhibit the growth of cells that form artery-clogging plaque. Soya protein is also an excellent substitute for meat and is available in a convenient and tasty form in many ready-made meals. Another good source of soya protein is soya milk and yoghurt.
The British Heart Foundation has an excellent range of resources giving information about reducing your risk of cardiovascular disease.
Rest and relaxation
While exercise can help lower blood pressure and strengthen your heart, rest and relaxation can reduce your levels of anxiety and improve your reactions to stress - both of which can affect the blood vessels and heart. All of us have to contend with major life events from time to time such as a divorce, bereavement, job loss or financial problems. However, there's also a wide range of everyday events (being stuck in traffic, a row with your partner or a disagreement with someone at work) that can be stressful - and these everyday irritations may be even more stressful because they are constant.
Ways to manage stress
Keep a diary: make a note of stressful situations and how your react to them. This will help you identify what stresses you out, so you can begin to change your reactions.
Stay positive: your thoughts control your feelings. If you stop and listen to your emotions, you may be surprised to discover how negative they are. Replacing negative thoughts with positive ones will help you deal with stressful situations more calmly.
Learn to relax: pay attention to your posture and consciously relax physically. You may also want to try a technique such as yoga, massage, meditation or other complementary therapies.
Get as much sleep as you need: we all need different amounts of sleep and you will know how many you need to feel refreshed. Try to get this amount of sleep most nights.
Smoking and alcohol
Smoking and drinking are both linked with heart disease. But while there are no potential health benefits from smoking, moderate drinking can help to protect your heart.
Smoking
One of the most important things you can do to reduce your risk of heart disease is to stop smoking. Smokers younger than 50 are five times more likely than non-smokers to die of coronary heart disease. By stopping, you not only lower your risk of heart disease but also help reduce your risk of lung diseases such as cancer and chronic obstructive pulmonary disease (COPD). The key to successful quitting is to pick a method that's right for you. For example, if you're motivated by other people and enjoy their company, you may find encouragement and support by joining a group.
If you prefer to go it alone, you may find it helpful to buy a book or tape. Your GP can prescribe aids such as nicotine replacement therapy or, alternatively, you may benefit from a complementary therapy such as acupuncture.
Drinking alcohol
Consuming moderate amounts of alcohol - between one and two units a day - has been found to reduce the risk of CVD. Alcohol can increase HDL cholesterol and makes it less likely that clots will form. However, high intakes of alcohol are associated with increased risk. It's also worth noting that saving up your weekly units for a weekend binge doesn't offer the same benefits.
There's no need to give up alcohol altogether but it's important to drink sensibly.
Always eat when you drink: take a tip from the Mediterranean countries and always have a meal or snack when you drink alcohol. Know your limits: To reduce the risk of coronary heart disease, don't exceed 1-2 units of alcohol a day. A unit is equal to half a pint of regular strength beer or lager, one small glass of wine or a small (pub measure) of spirits. Watch your glass size: it's easy to exceed safe limits by using a bigger glass.
Mix and match: if you're at a party or drinking socially, try to have a non-alcoholic drink for every alcoholic drink you consume. Once you've consumed your daily units, drink only soft or non-alcoholic drinks.
Regular monitoring
People should also have regular blood pressure readings, height and weight monitoring, and tests for cholesterol levels. Those with high levels should be encouraged to improve their diet and can be treated for poor cholesterol levels with drugs - usually, statins or niacins.
The American Heart Association recommends that blood pressure should be no more than 140 over 90 Hg. The association recommends a series of diets, with no more than 30% of calories coming in the form of fats, and limiting calories in the form of saturated fats to between 7 and 10%.
