What really works for heart health?

More women die from heart attacks in Britain than any other condition, even cancer. So, what really works when it comes to preventing heart disease? Anna Magee reports

When you think about clogged coronary arteries and heart attacks, what comes to mind? Fat old guys? Think again. Heart disease is a real risk not only for men about also for Britain’s women.

In fact, according to the British Heart Foundation (BHF) heart disease kills more than twice as many women a year as breast cancer – a staggering 77 women a day will die from it and some 3.5 million British women live with heart disease – the same as men.

But a study by the University of Leeds has found that women with heart disease are 50 per cent more likely to be misdiagnosed than men.

‘We need to work harder to shift the perception that heart attacks only affect a certain type of person,’ said Dr Chris Gale, Associate Professor of Cardiovascular Health Sciences and Honorary Consultant Cardiologist at the University of Leeds who worked on the study.

‘Typically, when we think of a person with a heart attack, we envisage a middle aged man who is overweight, has diabetes and smokes. This is not always the case; heart attacks affect the wider spectrum of the population – including women.’

Moreover, new research released today from HeartFlow (a new technology the NHS is footing the bill for this year, that diagnoses patients with CHD by creating a personalised, 3D digital model of a heart) has found that a quarter of Brits can’t name a single symptom of heart disease. If you’re one of those, here’s a list:

Chest pain
Feeling sick
Stomach pain
Feeling sweat
Leg pain
Arm pain
Jaw or back pain
Choking sensation
Swollen ankles
Extreme fatigue
Irregular heartbeat

But there’s a caveat. Women’s heart attack symptoms are often more subtle than men’s and are often mistaken for panic attacks or indigestion, even by doctors and paramedics.

These don’t always include chest pain and may be as subtle as a feeling of general unwellness or lethargy that won’t go away however much sleep you get.

But there’s good news. According the Office of National Statistics, deaths from heart disease and stroke have halved since 2001, for both men and women.

Truth is, heart disease and heart attacks are largely preventable through the right diet and lifestyle changes.

‘We often associate heart disease with old age, taking multiple medications and risk of serious complications or even death,’ says clinical nutritionist Beth Morris.

‘But even before this stage, suboptimal functioning of the heart can affect our general wellbeing. Diet and lifestyle factors earlier in life can set the foundations for heart health later in life, such as high sugar and trans fats intake, prolonged stress and obesity.

‘If they get overlooked, more serious complications can develop so it is crucial to look after your heart with healthy lifestyle’.

Armed with a little knowledge and some commitment, you can lower your chances, while also gleaming the weight loss, mood-enhancing and general wellbeing boosting benefits that a heart-friendly lifestyle can bring.

So, what really works for heart health? Healthista spoke to the experts.

1. Do aerobic exercise at moderate intensity

Why exactly do experts go on about the importance of aerobic activity for the heart?

‘Aerobic exercise is ideal if you want to keep your heart healthy,’ says Ashleigh Doggett, senior cardiac nurse at the BHF.

‘When you do an aerobic activity, your body needs more oxygen therefore your heart and lungs have to work a lot harder.

‘This helps to make your heart and circulation become more efficient over time. It also helps develop your stamina, while burning calories too, helping to control your body weight and shape, which can increase your risks of a cardiac arrest.’

Doggett recommended building up to doing at least 150 minutes of moderate intensity aerobic exercise activity every week.

If you’re wondering if it’s okay to exercise ‘snack’, that is, split your 150 into tiny chunks done throughout the day, that’s fine. ‘Just make sure you put aside time to do moderate intensity aerobic activity in bursts of at least ten minutes at a time,’ Doggett advises.

But how can you figure out whether the intensity you’re doing is enough or too much?

Moderate intensity activities make you feel warmer, breathe harder and gets your heart beating faster than usual, but you should still be able to carry on a conversation.

‘If you are very unfit or overweight or if you have a health problem, you might only need to walk up a slope to get these responses.’ says Doggett. ‘However, if you are very fit, you could be running quite fast before you notice these physical reactions’.

To make sure you increase your fitness and strength safely to improve your heart health, it is important that you increase your heart rate to the right level while you are exercising, Doggett advises.

‘This means working out a safe range for your heart rate when you are taking exercise. To do this, you first need to work out your maximum heart rate (MHR).

‘Your maximum heart rate depends on your age. One way to work out your maximum heart rate is to take your age away from 220.

‘For example, the maximum heart rate for a 42 year old is: 220 – 42 = 178 bpm (beats per minute) and then exercise working up to your maximum heart rate (but not going beyond it)’.

And as if you don’t know – typical aerobic exercise includes jogging, fast walking, dancing, hiking, climbing, boxing, spin classes – anything that gets you out of breath and sweaty.

If you have already suffered a heart attack or had surgery, you may have gone to cardiac rehabilitation classes where they will advise you on what heart rate range is safe for you to exercise within, says Doggett.

‘For any other heart conditions, a cardiologist will be able to advise you on a suitable exercise intensity for you’.

2. Eat a Mediterranean Diet (especially healthy fats)

There are so many diets out there that claim heart benefits. But when Harvard School of Public Health looked at the considerable long-term human studies looking at the effectiveness of a Mediterranean diet for heart protection, it came out a winner.

‘Research supports the use of the Mediterranean diet as a healthy eating pattern for the prevention of cardiovascular diseases, increasing lifespan, and healthy aging,’ the researchers said, however they identified its key pitfalls, namely eating too many calories.

‘When used in conjunction with caloric restriction, the diet may also support healthy weight loss,’ they concluded.

Following a typical Mediterranean diet will give your heart health the best chances, says Victoria Taylor, senior dietitian at the BHF. Recent research also shows a diet high in vegetables, fruits, nuts and fish is also the best bet to help ward off depression too.

‘A typical Mediterranean diet includes lots of vegetables, fruits, beans, cereals and cereal products, for example, wholegrain bread, pasta and brown rice,’ says Taylor. ‘It also contains moderate amounts of fish, white meat and some dairy produce’.

It’s the combination of all these elements that seems to bring health benefits, but one of the key aspects is the inclusion of healthy fats.

‘Olive oil, which is monounsaturated fat, is most commonly associated with the Mediterranean diet but polyunsaturated fats are also present in nuts, seeds and oily fish and all help contribute to heart health.’

Just don’t over do it, so your calorie levels don’t go through the roof a tablespoon of oil per meal and a small handful of nuts are perfect.

3. If you’re over 40, get checked

Everyone over 40 is entitled to an NHS health check regularly. As heart disease symptoms are actually often silent, it’s essential to get on top of your blood pressure and cholesterol levels as these are the key indicators that you could be at risk.

‘NHS health checks start at age 40 when you can book in with your GP and they will check your height, weight, blood pressure, and take a blood test for cholesterol,’ says Doggett.

‘The health checks are designed to pick up signs of heart disease, diabetes, kidney disease and stroke’.

You can check your blood pressure at most pharmacies or search for your local pop-up blood pressure clinic if you don’t want to go to your GP surgery. You can also buy home testing cholesterol kits from a local pharmacy.

It’s also essential to know if you’re at an increased risk as the more risk factors you have, the more likely you are to develop heart disease, Doggett asserts.

‘Risk factors can include if you have been diagnosed with diabetes, having high blood pressure or high cholesterol and lack of physical activity, as well as family history, age and ethnicity.

‘It’s therefore important that we reduce our risks of developing heart disease by taking action on the ones that we can control – such as keeping at a healthy weight and doing 150 minutes off aerobic exercise a week as well as having a good knowledge and understanding of other factors we can’t control such as family history,’ explains Doggett.

If you are concerned about your risk of developing heart disease then speak to your GP. They will take all of these factors into account when recommending treatments or options for you.

4. Get your sterols

Are you thinking, what? Stay with us. Also known as phytosterols, these are naturally occurring substances found in plants that have been shown to lower LDL cholesterol, that’s the ‘bad’ cholesterol we need to keep at bay.

Research published in 2014 in the British Journal of Nutrition found that regular consumption of sterols could reduce LDL cholesterol by up to 12 per cent.

‘Sterols work to reduce the re-absorption of cholesterol in the gut, meaning that more is eliminated through the stools’, Beth Morris explains.

Plus, taking them with a particular strain of probiotic bacteria could be even more beneficial.

‘Research has found they may work synergistically with a strain of live bacteria called Lactobacillus plantarum, which can also support cholesterol elimination via the bowel and thereby help to lower total serum cholesterol levels.’

So where are these sterols found? ‘Plants!’ says Morris. ‘By increasing yo9ur intake of a wide variety of plants especially oats, pulses, nuts and flaxseeds, you will increase the amount of plant sterols you are consuming on a daily basis.’

There is a strong body of research showing phytosterols’ power to help control and lower cholesterol.

But what form is best? Many spreads and drinks are often marketed as cholesterol lowering because they contain plant sterols.

‘It is best to supplement with plant sterols themselves [along with a diet rich in vegetables, fruits, nuts and seeds] especially in the form of beta sitosterol, as the levels are more therapeutic.’ Try BioCare Bioplantarum Plus Sterols £24.95 which also contains Lactobacillus plantarum, the strain of gut bacteria shown to help lower cholesterol.

5. Consider co-enzyme Q10

If you’ve never heard of co-enzyme Q10, it’s time you knew about this nutritional powerhouse.

‘Coenzyme Q10 is present in almost every cell of our bodies, providing protection through its role in energy production and as an antioxidant,’ says Beth Morris.

In other words, co-enzyme Q10 is like the fuel that fires the mitochondria inside cells, where energy is produced.

‘CoQ10 is naturally concentrated in those tissues with the highest energy demands, notably the heart, and is consequently vital for heart function,’ says Morris.

There is strong research linking CoQ10 to heart health. For example, a 2015 review of the scientific literature published in BMJ Open Heart found that it was particularly helpful in protecting people who had had a heart attack from having another one in the future.

Indeed, studies have also shown that coQ10 levels are depleted by regular use of statins, common cholesterol-lowering medications, and this is where supplementing is often advisable, says Morris.

But CoQ10 is also great for energy and general health (editor Anna Magee swears by it).

‘CoQ10 is not considered a vitamin because our body can make it, however our levels tend to decline with age,’ says Morris.

‘It isn’t just supportive for heart health but for many other functions in the body too, especially energy production, therefore many of us can benefit from taking CoQ10, especially as we get older.’

You can also get CoQ10 from dietary sources such as beef, herring, chicken, nuts, broccoli and cauliflower, however the amounts are small. Try BioCare’s MicroCell 200 CoQ10 £38.95.

6. Drink green tea

At Healthista we are green tea fanatics. How many proven health credentials can one little cup of tea have on its CV?

When it comes to green tea – a lot, including anti-aging, metabolism-enhancing (consuming six cups a day can help you burn an extra 75-100 calories without doing anything else) and indeed, heart benefits.

The reason green tea is so important to heart health is because of its antioxidant levels. It contains antioxidant substances called catechins and flavonoids, in particular, one called EGCG (Epigallocatechin Gallate) that work to help prevent cell damage and provide other benefits.

These substances can reduce the formation of free radicals in the body, protecting cells and molecules from damage we acquire from our environments, thus helping reduce inflammation.

‘Antioxidants help to reduce inflammation and also protect LDL from getting damaged, which is when it is more dangerous and more likely to cause atherosclerosis, the build-up of plaque within the arteries,’ says Morris.

So how much green tea should you drink for heart benefits? An analysis of nine studies on green tea and heart health published in 2016 in the International Journal of Cardiology showed drinking 1-3 cups a day could help reduce risk with the least risk found in those who drank more than four cups.

But when it comes to antioxidants, don’t rely on green tea, says Beth Morris.

Make sure you get other important antioxidants into your diet, especially alpha lipoic acid (found in spinach, broccoli, yams and potatoes), glutathione (found in garlic and onions – see below), turmeric, vitamin C (found in kiwi and citrus foods), carotenoids (found in yellow and orange foods such as pumpkin, squash, yellow peppers and carrots) and berry extracts.

7. Eat more salmon

There’s a reason experts get themselves into a tizz by repeatedly advising us to eat fish, especially the fatty varieties such as salmon, herring and mackerel.

These contain omega 3 fatty acids which have been heavily researched to have protective properties for heart health, by reducing inflammation, supporting circulation and and managing blood lipid levels.

The reason getting your omega 3 fatty acids is so important is because your body doesn’t make them, hence why they’re termed ‘essential.’

Oily fish is an excellent source of omega 3 fatty acids as it contains the perfect balance of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which are fatty acids whose synergy is what is shown to provide heart health benefits.

But what if, like so many Brits, you don’t like fish and you really, really don’t care for the fatty variety?

‘Ideally, we want to take fish oils in their natural state and concentration of EPA and DHA,’ says Morris.

‘This is how your body recognises them and so oils that haven’t been altered through processing are much easier for your body to absorb and utilise.

‘When buying a fish oil product, make sure to avoid the ‘ethyl ester’ form of Omega-3 fats, which are poorly absorbed – this isn’t always labelled so make sure you check with the supplier.’

We like OmegaCare Liquid from BioCare £27.30, a high strength EPA and DHA omega 3 supplement flavoured with orange so it doesn’t repeat on you and doesn’t taste like fish.

8. Add soluble fibre to your diet

While the national recommendations for fibre in the diet are 30 grams a day, these include both insoluble fibre and soluble fibre.

‘For heart health, soluble fibre is particularly important,’ says Morris. ‘This comes from oat bran vegetables, flax seeds, chia seeds and grains such as quinoa or millet will help with healthy cholesterol excretion, blood glucose balance and blood pressure.

‘Insoluble fibre however, is also supportive for heart health. This particular type of fibre helps to stimulate the bowel, encouraging regular bowel movements which is essential for eliminating excess cholesterol’.

Good sources of insoluble fibre include beans, nuts and seeds and many fruit and vegetables (especially if you eat them with skins on.

9. Eat fresh crushed garlic three times a week

‘Garlic has been found to be especially helpful for heart health, in particular reducing blood pressure and cholesterol,’ says Morris.

Indeed, in 2016, researchers reviewed all the scientific literature on garlic and heart health – and there is a lot – and found that supplementing with garlic could help considerably to reduce high blood pressure and high cholesterol.

But according to Morris, eating it can be helpful for the heart too. Include garlic in your diet 2-3 times a week for general heart health support, or supplementing garlic extract can provide more of a therapeutic level.

And if you’re wondering what cooking method is best (and don’t care too much about odour…) think fresh, think crushed.

In 2009, a team of researchers from the Cardiovascular Research Center at the University of Connecticut School of Medicine learned how freshly crushed garlic – as opposed to dried or cooked garlic – protects the heart.

‘Freshly crushed garlic generates hydrogen sulfide, a gas that is also generated from rotten egg,’ said study co-author Dipak K. Das, a professor and director at the Cardiovascular Research Center. in the US where the research was done.

‘Although this gas in excess may become poisonous, in small quantities it functions as an intracellular signaling compound and can protect the heart.’

Because the hydrogen sulfide is a short-lived gas, it disappears when garlic is dried, processed, or cooked, he adds.

Dried or processed garlic does retain its antioxidant effects, however, and helps protect against free radical damage – just not to the extent that fresh garlic does.

Just keep the breath freshener close by.