The experts: Cardiologists on 20 simple, successful steps to a healthy heart
OOur hearts beat 100,000 times a day, but we usually don’t worry about maintaining them unless there is a problem. What do we need to know about how to get this vital organ pumping? Four cardiologists give their advice on how we can keep our hearts healthy.
Practice is key
“If you put exercise into a pill it would probably be better than anything a doctor could give you to improve heart health,” says Prof Dan Augustine, cardiologist at Royal United Hospitals Bath. The NHS advises 150 minutes per week of moderate-intensity activity, such as brisk walking “which leaves you a little out of breath,” says Augustinus, or 75 minutes of more intense exercise, such as running or cycling. “If you think back to ancient times,” says Graham Stuart, medical director of Sports cardiology Britain, “we had no cars, we walked everywhere and did manual labor. All body processes are designed to be active.”
Be aware of what your body can do
“If you haven’t done any exercise in the past, you need to build it up,” says Augustinus. “Older people have more heart problems when they exercise. If you are over 40, you need to be aware of your own risk factors, for example if you smoke or if you have a family history of coronary disease. Augustinus recommends regular health checks offered for free by the NHS every five years for people aged 40 to 74, and includes monitoring blood pressure, cholesterol levels and diabetes risk.
Exaggerating can also be bad
In general, you can’t exercise too much. “If you do really intense things like ultramarathons,” says Augustine, “there is some evidence that you can cause heart damage, but this probably returns after three or four days.” What’s more worrying, he says, is that people are overexerting themselves without being aware of underlying coronary diseases. This may be a reason why otherwise healthy people collapse during marathons, or middle-aged men cycling have heart attacks.
Avoid a sedentary lifestyle
“You’re not going from zero to 100% in terms of exercise, but think about how much you’re sitting,” says Augustine. “If you get your 10,000 steps every day, that’s pretty good,” says Stuart. Dr. Fizzah Choudry, a consultant cardiologist at St Bartholomew’s in London, says she walks around her house at night until she reaches this goal.
High cholesterol levels can be problematic
“Cholesterol is a type of fat in our bloodstream that is produced in the liver and also found in the food we eat,” says Choudry. “Drinking too much can lead to calcification of the arteries, especially the heart arteries and the blood vessels that supply blood to the brain. This can lead to problems such as heart disease and stroke. The cholesterol-laden plaque that builds up in the heart arteries can reduce blood flow to the heart, causing chest pain and angina, but it can also cause a sudden blockage of the arteries, which can trigger a heart attack.”
Hereditary risk must be assessed
If you have a family member under age 60 who has had a heart attack, you should see a doctor, Augustine says. Similarly, “If you have a parent, sibling or relative who has a heart problem that they are told is hereditary, then you should get yourself checked,” says Stuart. You can go to your GP or refer yourself. It’s important to access information about how to live safely with a hereditary condition, especially if you participate in exercise, Stuart adds.
Eating pattern plays an integral role
“I would recommend a Mediterranean diet,” says Stuart. “Fruit, vegetables, nuts and legumes are good for the blood vessels and good for the heart.” “Swap white bread, rice and pasta for whole-grain varieties, as they contain more fiber,” says Augustine. “They are more filling and digested more slowly. Proteins are very important and help the body grow and repair. Fatty fish is really good for reducing bad cholesterol, inflammation and lowering blood pressure.
Avoid unhealthy foods…
“I’m from Glasgow,” says Stuart, “and there’s a lot of evidence to suggest that deep-fried Mars bars aren’t great for the heart.” “What I tell patients,” says Choudry, who specializes in cardiovascular disease prevention, “is that you should try to reduce the amount of fats – especially saturated fat – and the amount of oils that you put in food. Also reduce carbohydrates. When people eat, they usually eat a whole plate of rice or pasta and then a little bit of meat and a little bit of vegetables. Cut the carbs in half and fill the rest of your plate with white meat, fish and vegetables, and you’ll start losing weight and reducing your cardiovascular risk.”
…and other no-brainers
“Quitting smoking can in itself significantly improve your life expectancy,” says Tharusha Gunawardena, a cardiologist who works in coronary interventions at the Royal Papworth Hospital in Cambridge, and describes herself as a “glorified plumber”. Choudry explains how his heart attack patients often “get a sudden wake-up call and say, ‘There’s no way I’m ever going to smoke again,’ which is great.” He also sees many younger patients who have used cocaine, which can cause a sudden heart attack immediately after taking it, or heart disease in the longer term. “From a heart point of view, alcohol is OK in moderation,” he says, as long as you stick to safe amounts, which according to British guidelines should be no more than 14 units for three days or more. “The most important thing is that you don’t eat too much,” says Augustinus.
Prioritize sleep
Gunawardena just got off the night shift. Night work has been shown to cause inflammation and worse cardiac outcomes, but he did a Brazilian jiu-jitsu session to feel “less awful.” “Many regeneration processes take place while we sleep and it is important to get eight hours of sleep a day,” he says. Better sleep can be achieved through positive sleep hygiene, he says, by avoiding screens and prioritizing rest before bed. “Your heart is a muscle, an engine,” says Augustinus. “It needs fuel and rest.”
Stress leads to unhealthy habits
‘Do I have evidence that says being emotionally stressed is bad for your heart? I can’t say,” says Augustinus, “but if you have a lot of stress and your biological clock is moving in all directions… you won’t be as physically active.” “We know that if you’re running on adrenaline you’re more likely to have abnormal heartbeats,” says Stuart. “If you’re constantly in a high-adrenaline environment, you’re more likely to have problems. How to deal with stress in the modern world is more difficult. I tell the teens I see to make sure they get time for rest, whether it’s meditation or a walk.”
Hearts can race sometimes
We become more aware of our heart rate when we are anxious or nervous, because the blood is pumped faster, for example when we exercise. Gunawardena explains: “We generally don’t notice our heartbeat, but sometimes people do. This could be because something strange is going on, such as their heart beating faster or irregularly. It can sometimes be a normal phenomenon; if you think about your heartbeat often you suddenly become aware of it, but palpitations as a symptom are an unusual awareness of it, which makes it feel strange. If someone is concerned about palpitations, especially if he or she is also breathless and experiencing chest pain, he/she should consult a doctor. “It’s hard to be too prescriptive,” says Gunawardena. “It can be a very individual experience. Some people may have an abnormal heart rhythm and experience very few symptoms, and there are others who find the more general, non-life-limiting symptoms much more dramatic.”
What is a heart attack?
“A heart attack is when you have a blocked artery,” says Choudry. “And because of the blocked artery, you don’t get blood flow to a certain part of the heart. That is the cause of the pain.” Choudry’s team deals with nearly 1,000 heart attacks a year and performs about 3,000 coronary interventions, which involve placing stents in people’s arteries when they become blocked to prevent heart attacks.
A heart attack can feel like a heavy feeling in the chest
Symptoms vary, Augustine says, but chest pain “that feels like a weight or heaviness” is common. Some patients describe it as “radiating down their throat or down their left arm.” This may be accompanied by a feeling of sweating or nausea. If you think you are having a heart attack, you should seek medical advice immediately.
A heart attack can lead to cardiac arrest
“When someone has a heart attack, the arteries are blocked and the muscles are deprived of oxygen,” says Gunawardena. “It causes an abnormal heart rhythm and that causes the heart to beat very fast and irregularly. Your heart should pump in a rhythmic, regular manner, but when it gets into one of these abnormal heart rhythms, it pumps in a very uncoordinated manner. And so people faint and then they go into what’s called cardiac arrest.”
We should all learn CPR…
“I can’t tell you how important it is for people to know how to perform CPR (cardiopulmonary resuscitation),” says Gunawardena. “If you don’t know how to perform CPR, then learn how to do it This way you are prepared if there is a serious complication of a heart attack.”
…and how to use an electrical defibrillator
“Ideally, they should be everywhere where sports are practiced,” says Augustinus. He recommends going to the Resuscitation Council website for information on where to find them and how to use them.
After a heart attack, driving and sex should be avoided for a month
Heart attacks “can really affect a person’s self-confidence,” says Gunawardena, because you can “suddenly become acutely aware of every feeling in the chest.” When it comes to sex, “most people tend to be nervous about it,” says Gunawardena, “and want to do all the cardiac rehabilitation and exercise first. As with everything, it’s a matter of starting slowly.” Sex, like any form of aerobics, is of course also very good for the heart.
That could be statins life savers
“Over the past two decades or more, lowering cholesterol with medications such as statins has led to a dramatic reduction in mortality from heart disease,” says Choudry. “Statins are commonly prescribed to all patients who have had heart disease and also to those who are at increased risk, whether due to elevated cholesterol levels or other factors.”
A pacemaker is not as life-changing as it sounds
Stuart gives the example of the Danish footballer Christian Eriksen, who had an implantable cardioverter-defibrillator, a type of pacemaker, installed after a heart attack. suffered cardiac arrest at the 2021 World Cup but continues to play professionally for Manchester United. There are minor inconveniences, such as having to call security at the airport, but “people can live a very normal life with it,” says Gunawardena.