How to improve heart health – and not 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. 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.”

Why is heart health important?

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 – 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.

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 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 heart disease?

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.

A heart attack – officially known as myocardial infarction or MI – is caused by a sudden loss of blood flow to part of the heart muscle. Without enough blood and oxygen, your heart can be seriously damaged, so you or whoever is with you needs to dial 999 fast if there are warning signs.

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.

Could I be at risk of heart disease?

“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.

What are the early symptoms of a serious heart condition?

“If your toes look discoloured, your feet are colder than normal or you have a cramping sensation in your calves when you walk, it may be worth seeing your doctor, as these can all be a sign of peripheral arterial disease (PAD),” explains Goss. Also known as peripheral vascular disease (PVD), the condition is caused by a build-up of fatty deposits in the arteries, restricting the blood supply to your leg muscles. About one in five people over 60 have some degree of PAD.

Watch out for swollen ankles too, says Goss, bearing in mind there are many different possible causes. “Hot weather can be to blame or it could even be a side effect of some blood pressure tablets – but swollen ankles can be a sign of a heart problem, so don’t just ignore them,” she says.

Feeling exhausted all the time? “Extreme tiredness can be another sign of a heart problem, so see your GP if there is no obvious cause and you’re getting enough sleep,” says Goss.

“If you’re having heart palpitations or it feels like you’re having extra beats, try not to worry as often it’s harmless, but it’s still a good idea to get it investigated,” explains Goss, bearing in mind anxiety can also speed up your heart rate. “However, if your heart feels like it’s beating extra fast and then you black out, you do need an ambulance.”

What are the symptoms of a heart attack?

“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 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.

“But 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.”

How to improve your heart health fast

Exercise

“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. 

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.

Sex

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.

Smoking

“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,” she adds.

Cut back on saturated fat 

“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.” And make sure you exercise portion control.

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.

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. 

Eat a high-fibre diet

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.

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 Mediterranean diet encompasses all the recommendations 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.

Avoid drugs and alcohol

Cutting down on booze is a vital move for protecting your heart. The British Heart Foundation (BHF) emphasises that, for your heart’s sake, it’s important not to drink more than 14 units of alcohol per week, spread across three days or more. 

“If your willpower is low, ask for small glasses, single shots, halves instead of pints or alternate one alcoholic drink with one soft drink,” says Ruth Goss, Senior Cardiac Nurse for the BHF.

It perhaps bears repeating that taking illegal drugs such as cocaine, amphetamines and cannabis is very bad news for your heart. “These and others such as LSD and ketamine can put a huge strain on your heart, increasing the risk of an irregular heartbeat, or even a heart attack or stroke,” warns Goss. 

Cannabis may be a Class B drug, but when mixed with tobacco and smoked, it can increase the risk of heart disease too. “Even so-called ‘legal highs’ can be very dangerous for your heart,” she adds. “If you’re on prescribed medication as well, bear in mind, you’re putting yourself at risk of even worse complications.”

Reduce stress in your life

This can lead to you making poor lifestyle choices, which can then increase your risk of developing heart and circulatory disease. “We may end up not exercising, not getting enough sleep or having an unhealthy diet,” says Goss. 

Develop some good stress management tools such as yoga, meditation, mindfulness, walking in the fresh air and talking to your friends and family to see how they can support you. Small shifts over time can improve your heart health.

Keep tabs on your blood pressure 

‘Normal’ blood pressure varies from person to person, so it’s vital to find out what your own blood pressure normally is, Goss advises. “If you’ve been monitoring it over time, you’ll then notice if it’s changing and getting higher, so you can get it checked out.” 

As well as via your GP, you can test your blood pressure at some pharmacies, gyms or via a blood pressure machine to use at home, she adds.

What heart tests are available?

If you’re worried, you can ask your GP to refer you for an electrocardiogram (ECG), a simple, non-invasive test that records the electrical activity of the heart. These are usually done within a hospital but can sometimes be done by your GP.

A hospital can also carry out specialist cardiac tests such as a heart CT scan (a type of X-ray) or an MRI scan. Depending on your circumstances, if you decide to pay to have these done privately, rather than wait for the NHS, you need to make sure you’re having exactly the right tests done – check with your GP which they would recommend as it depends on your symptoms. Often, many private clinics will require a GP referral letter too.

Additional reporting by Emma Elms