How not to have a heart attack

Dr Sonya Babu-Narayan understands the importance of the most vital organ in our body only too well. When she was in her 20s and embarking on her career in medicine, her mother died from a heart attack at only 42. It came out of nowhere, as she had no known history of heart disease. “I always knew I wanted to be a doctor,” she says, “but that day inspired me to specialise in the heart.”

Dr Babu-Narayan is now a consultant cardiologist at Royal Brompton Hospital, and associate medical director at the British Heart Foundation (BHF).

“Mum died with new symptoms and didn’t make it. But that was 30 years ago – and a lot has changed,” she says. “I like to think that she would have survived nowadays with the treatments we have.”

She is vocal in her belief that we can take steps to manage our heart health. “You cannot change your family history of coronary disease,” she says, “but we can use it as a motivation to make the changes that can save lives – to try to stop a heart attack from happening in the first place.”

More than half of us will have some kind of circulatory problem in our lifetime and now a new study from Our Future Health – which is set to be the UK’s biggest health study, by the BHF – has found that over 50 per cent of people have high cholesterol and one in four have high blood pressure, putting them at risk of future heart problems and other serious diseases including stroke, diabetes and dementia.

The results were collected from more than half a million people, who attended a clinic appointment where their blood pressure and cholesterol was tested. The researchers are now aiming to recruit a further five million volunteers across the UK to create a detailed picture of the nation’s health, with the aim of preventing and treating common diseases. Working in collaboration with the NHS, the programme is sending invitation letters to anyone over the age of 18 who lives near the new clinics that are being rolled out across the UK on a region-by-region basis. Anyone over the age of 18 can join by signing up online, completing an online health questionnaire and booking a clinic appointment.

Dr Raghib Ali OBE, the chief medical officer at Our Future Health, said: “High blood pressure and high cholesterol are key risk factors for two of the biggest causes of death and disability: heart attacks and stroke. But discovering who is at risk before it’s too late is crucial.”

But why is Britain’s heart health in such dire straits? It is certainly not helped by the fact that we are too partial to the biscuit tin and rather less keen on the cross-trainer, or that since the Covid pandemic 100,000 more deaths from heart conditions have been reported.

But it’s not all doom and gloom. In the 1960s, more than seven out of 10 heart attacks were fatal, according to the BHF. Today, more than seven out of 10 people survive. And there are measures everyone can take to lower their risks of serious heart disease.

What is the most common type of heart problem?

One in six people a day in the world die of coronary heart disease – the clogging up of the coronary arteries that limit the supply of blood to your heart. “It is the most common heart problem in the UK,” says Dr Babu-Narayan. “The coronary arteries are the blood vessels that carry nourishing blood to your living hard tissue, and if fatty material builds up inside those arteries, the arteries can’t carry as much blood to the heart.

“If that happens, you may develop angina or, worse, a heart attack. With angina there could be chest discomfort, pressure or pain when you’re doing something energetic, which gets better after you rest for a few minutes.” Either way, it’s important to see your GP as soon as possible.

Dr Babu-Narayan says that the build-up of fatty material (atherosclerosis) inside your arteries can start to happen decades earlier and silently progress before you ever have symptoms. If arteries that carry blood to the brain get similarly clogged up, it can lead to a stroke.

Atrial fibrillation (AF) is the most prevalent heart rhythm problem, causing an irregular or fast heartbeat. It is generally not life-threatening – many people live normal healthy lives with this condition – but it often needs treatment and can increase the risk of stroke five-fold, according to Heart Research UK. Cases have increased by up to 72 per cent over the last two decades.

What causes the biggest heart health problems?

“One of the leading causes of heart attack and stroke is undiagnosed and unmanaged high blood pressure,” says Dr Babu-Narayan. In England, if you are between 40-71, she urges everyone to attend a free NHS health check, where they can assess their cardiovascular risk factors. “If you have high blood pressure or cholesterol, it is important to bring it down with lifestyle changes (see below) or medication, if needed.”

A new anti-cholesterol drug, Inclisiran, has recently been discovered “which will save many more lives,” says Dr Babu-Narayan. “It lowers the so-called ‘bad LDL [low-density lipoprotein] cholesterol’ and adequately controls it to prevent future heart attacks or strokes.”

Adults with diabetes are also nearly twice as likely to have heart disease or stroke as adults without, according to the National Institutes of Health.

Something that all women should know, says Dr Babu-Narayan, is that having high blood pressure or diabetes during pregnancy is a long-term risk factor for future development of heart attack or stroke.

Carrying excess fat around the waist has also been linked to increased risk of Type 2 diabetes, high blood pressure and heart disease.

To check if you are in a healthy weight range, NICE (National Institute for Health and Care Excellence) now recommends that your waist measurement – its circumference in centimetres – be less than half your height. For waist to height calculators, visit omnicalculator.com/health/waist-height-ratio.

How can I improve my heart health?

“I think any type of exercise helps,” says Dr Babu-Narayan, “be it gardening, or trying to keep to a step count.” The NHS recommends 150 minutes of activity a week, which could be aerobic exercise – brisk walking, swimming, running or cycling. Anything that gets the heart pumping could improve your heart circulation and ultimately lower blood pressure.

“High impact training [short bursts of intensive exercise] is thought to directly target visceral fat, burning away those fatty deposits that can lead to insulin resistance or Type 2 diabetes,” says Dr Babu-Narayan. “But I say to my patients, do whatever you can, and enjoy, regularly. Even if you have heart disease, we still prescribe exercise where possible.

“It not only boosts your energy, but it also helps you sleep well, improves your mental health and lowers stress levels – all of which are important for long-term cardiovascular health.”

Strengthening the muscles will “take the demand off your heart” and allow you to do aerobic exercises and everyday tasks without getting breathless and tired, says Helen Alexander, a physiotherapist who specialises in cardiac rehabilitation at Nuffield Health at St Bartholomew’s Hospital. Lift weights, or use resistance bands, or even use your own body weight: start with moving from sitting to standing out of a chair, then progress to doing squats or press-ups against the wall.  

Lower impact exercise to improve flexibility and balance, recommended by the BHF, includes yoga, pilates and tai chi. Check with your heart specialist before starting any exercise regime.

What about sex? “Anything that makes you happy is good,” says Dr Babu-Narayan. “Certainly people with heart disease shouldn’t think they can’t have sex, They can – and they do,” she says.

“Stopping smoking is also one of the best things you can do to help your heart, because the chemicals in cigarettes cause the clogging up of your coronary arteries, which can lead to a heart attack one day.”

What are the signs of a serious heart condition?

“If you have ongoing pain for 10-15 minutes, at eight out of 10 severity, in the centre of your chest that goes to your arms, stomach or back, or makes you feel sick or sweaty, that could be the symptoms of a heart attack. Every minute matters, so call 999,” says Dr Babu-Nayaran.

Not all experience of breathlessness is to do with your lungs or lung disease, however.

“If you’re fighting for breath, and have fatigue and swelling of your ankles and lower legs, it could be a sign of heart failure [where your heart cannot pump blood around your body as well as it should]. And that’s something that needs to be seen by the GP,” she says.

More than a million people in the UK are living with heart failure. The main causes are a heart attack; cardiomyopathy, a disease of the heart muscle; or high blood pressure.

“There are four new drugs that are shown to make a big difference to the survival of people with heart failure, so early diagnosis is vital.”

Foods to make the heart healthier

It’s time, sadly, to step away from the cream cakes and bacon sandwiches. “As a nation we are definitely eating too much sugar, saturated fat and salt than is advised – all of which increase the risk of cardiovascular disease (CVD),” says Victoria Taylor, a senior dietician at the BHF.

“Too much saturated fat raises LDL cholesterol levels,” says Taylor, which collects in the walls of blood vessels and is linked with one in four heart and circulatory disease deaths in the UK. “Replacing it with unsaturated fat lowers cholesterol levels – and also leaves less room in the diet for unhealthy foods.”

Taylor recommends cutting out the saturated fat baddies of processed meats, butter, cream, biscuits and pastries. “Switch them for nuts, pumpkin and sesame seeds and avocados, which are good sources of unsaturated fat. Cook with olive oil, rapeseed oil or sunflower oil, instead of butter or lard.” The goose fat potatoes will have to be on hold for now.

Switch out salt and sugar

A whopping 85 per cent of the salt that we eat is already in the food that we’re buying and, surprisingly, bread and cereal can often be the worst offenders overall. Our consumption of salt is currently 40 per cent above the recommended 6g daily amount.

“We think of pizza or bacon being salty foods, but actually some of the biggest sources of salt in our diet are the things that we eat most frequently: bread and breakfast cereals,” says Taylor. “It’s really worth checking the food labels and colour codes (red for highest levels, green for lowest), and cooking from scratch to properly control salt levels.” Even snacks that seem healthy can be high in sugar or salt or unhealthy fats.

To keep your sugar fix: “Swap out fruit-flavoured yoghurt – one of the biggest sources of sugar in our diet – for plain natural yoghurt with seasonal fruit on top,” says Taylor. 

Also ditch the so-called healthy snacks: shop-bought smoothies, yoghurt-coated nuts (“which contain little yoghurt”); pressed dried fruit bars or honey-coated cashews high in sugar and salt. Taylor recommends a piece of fruit or veg with a hummus or tzatziki dip, wholegrain crackers or chopped up cherry tomatoes instead.

A heart-friendly menu

Have oats for breakfast – they are “high in soluble fibre, which help with lowering cholesterol levels,” says Taylor, “as it binds to the cholesterol in your body and helps it to pass through. Ideally top it with seasonal fruit or frozen fruit, which also counts at part of your five a day.”

For lunch or dinner, ramp up the fibre levels with wholegrains, pulses, fruit and vegetables, “which helps keep your digestive system healthy and keeps you fuller for longer.

“People who eat higher-fibre diets tend to have a lower risk of CVD,” says Taylor. Load up on broccoli, quinoa, beetroot, kale, sweet potatoes, spinach, and white beans – which are filled with heart-protective fibre, vitamins, and minerals potassium, magnesium and calcium.

“Bulking up your protein keeps you satisfied with your meal – helpful if trying to manage your weight,” says Taylor. “Great sources are beans and lentils, nuts and seeds, and chicken without the skin. Aim for two portions of fish a week, one of which is oily, as the oily fish contains Omega three oils, which are associated with lower risk of heart circulatory diseases” and help reduce triglycerides, a type of fat in your blood.

The magic Mediterranean factor

“The Mediterranean diet always comes out on top,” says Taylor, with its emphasis on plant-based sources of protein and unsaturated fat.

“It has the magic factor,” she says, “and encompasses all of these recommendations that we have for heart and circulatory health in one: it’s rich in fruit and vegetables, includes meat, fish, nuts and seeds, pulses, whole grains and olive oil.

“It’s also part of a traditional lifestyle, which includes taking time over your meals, enjoying food and being more active – all of which, ultimately, will benefit your heart.”