HEART DISEASE

AN EQUAL OPPORTUNITY KILLER
Most women are unaware that heart disease is likely to affect them, andwrongly assume that it is their menfolk who are statistically more likely to have a heartattack or a stroke. Women certainly can’t afford to be complacent
about heart health, and yet only around 15% of women aged over 50, which is when heart disease strikes) believe it to be a problem.  Coronary heart disease is easily the number one killer of women in the UK, with around 70,000 dying annually – around the same number as men.  The number of strokes (blood clots or haemorrhage to the brain) post-menopausally is actually worse, accounting for 13% of female deaths against 8% of male deaths.

Nationally, heart disease rates are finally beginning to fall slightly, but the decline for women is slower than for men.  This is likely to be because women are increasingly taking on traditional male habits and roles such as smoking, excess drinking and stressful jobs.

HORMONAL HELP

Women are protected to a degree against heart disease during their reproductive years by their hormones, but within 10 years of the menopause the rates are similar to that of men.  Bolstering oestrogen levels to reduce the risk of heart disease is one the main reasons why HRT is prescribed to post-menopausal women.

There are several criticisms regarding the idea of relying on HRT to solve the heart disease problem.  Firstly women who take HRT are likely to be more educated than women who do not, and their better diet probably has a protective effect.  This is likely to have skewed the results from studies and there has been criticism about how this has not fully been taken into account.   One of the arguments for using HRT is that it lowers cholesterol levels, and yet the question of whether cholesterol is a factor in heart disease is being hotly questioned.  And one of the possible side-effects of
hormone treatment is raised blood pressure – a risk factor for heart disease! The whole question of hormones and heart disease is obviously a complex one and when oestrogen is given to men in trials it seems to increase the incidence of heart attacks.

Whatever the protective effects of giving artificial oestrogen may or may not be, the most powerfully protective effects are likely to  come from diet and lifestyle changes.  At best oestrogens can only help to deflect the problem, but these other factors can actually prevent it.

GIVING BLOOD

Another anomaly between men and women relates to blood loss during menstruation leading to lower blood iron levels.   Of course men, and post-menopausal women,  do not lose iron in the same way as menstruating women and have higher blood iron levels on average.  Iron is strongly suspected of being a risk factor for heart disease as it is a pro-oxidant when it accumulates to excess in the blood.  Oxidation damage to arteries and cholesterol is a key player in the heart disease problem.  Interestingly men who give blood, and so mirror the iron-loss patterns of menstruating women, also have a lower incidence of heart disease.    This is likely to be a strong argument for post-menopausal women giving blood.

WOMEN AND ALCOHOL

Moderate doses of alcohol are generally thought to be protective against heart disease, and yet this is mostly  based on research which has been done on men.  Research on women is generally avoided in these circumstances precisely because their hormone fluctuations become confounding factors when interpreting results.   It is pretty much undisputed that alcohol raises oestrogen levels sufficiently to be a major player in the development of breast cancer.  This means that alcohol is only likely to be protective against heart disease, without this other major downside,  post-menopausally when oestrogen levels drop, and then not if HRT is being taken.  Because women have smaller livers than men, and because they have lower levels of an enzyme called alcohol-dehydrognase, the amount of alcohol needs to be considerably less than for men – one unit a day maximum against two units daily for men.  The most recent research shows that the protective effect of alcohol is likely to be at the level of only one or two units a week, and that more than this does not increase the benefit.

FACTORS IN CARDIO-VASCULAR DISEASE
(Heart Disease and Strokes)

RISK FACTORS
                    High blood pressure
                    High levels of LDL cholesterol
                    High homocystein levels

DIETARY FACTORS        
                    Low fruit and vegetable consumption
                    High salt intake
                    Low mineral intake (especially calcium,
                    magnesium, selenium and chromium)
                    Low fibre levels

LIFESTYLE FACTORS      
                    Smoking
                    Lack of exercise
                    Stress

HOW TO REDUCE HEART DISEASE RISK

There are many factors which are associated with lowering the risk of heart attacks and strokes.   The more of them that you can incorporate into your life, whether you are a man or a woman, the greater your chance of avoiding
the frightening possibility of paralysis from a stroke or a bypass operation if your arteries fur-up.   Below is a run-down of the most important eating and lifestyle factors to incorporate into your life.  If the list seems a little daunting, it is best to address one at a time.  Just concentrate, for example of eating more fruit, and then begin to add in oily fish and fresh nuts.  If you change habits slowly in this way, they are more likely to stick, than if you go on a health binge overnight.  And as heart disease takes many years to develop it is important to create lasting habits.

o  Smoking.  Give it up!

o  Fruit, vegetables, beans and salads. We eat an average of three portions daily, and the recommended amount is five.  A portion is an 80 gram serving (one apple, one orange, a dozen large grapes, a cup of cabbage or broccoli). However studies have shown that Mediterranean people who eat around eight portions daily have the lowest amount of heart disease in Europe.  This is even the case when they smoke (which is one of the most important risk factors for heart disease and strokes).

o  Fibre.   We eat only around 9 grams of fibre against the recommended 18 grams daily.   It has been established without question that fibre lowers cholesterol and stabilised blood sugar levels (which when they are rampant
are a source of oxidation damage to arteries).  The most valuable fibre to combat heart disease is soluble fibre found in oats, beans, and fruit.  Aim to eat fibre at each meal.  For breakfast you could eat porridge, oatcakes, fruit or baked beans.  For a main meal aim to include a portion of legumes  (beans, lentils, peas) and some fruit.  You can add beans readily to soups, salads, sandwiches, stews or eat them as a side vegetable.  For snacks include high fibre options such as oatcakes, rye crackers and nuts.

o  The most useful fats for thinning blood and building healthy blood vessels are those which are found in oily fish and in fresh nuts.  Eating two or three portions a week of oily fish, against the one portion we typically eat fortnightly, is highly protective.  In the walnut  growing districts of France people who eat more walnuts and use walnut oil have a 25% lowered risk.  Other nuts to eat (raw and unsalted) are Brazil nuts and almonds.  Hydrogenated fats, found in margarines and processed foods, are strongly suspected of being important contributors to the increase in heart disease we have seen since the war.

o  Excess salt is a killer.  You don’t even have to dramatically reduce the amount of table salt you use – 80% of the salt we consume comes from packaged foods, including breads and cereals.  Of course if you are unable to cut back on packaged foods as much as you would like, then you do need to get rid of the salt shaker and use delicious herbs instead.  We eat 9 grams daily and the amount to aim for is 6 grams daily.

o  Exercise is vital for reducing blood fats and exercising the most important muscle in the body – the heart.  If you are currently unfit it is wise to have a check up with your doctor before starting your regime.  Ultimately you will gain most cardiovascular benefit from a minimum of three sessions a week so that your heart pumps faster (but not so fast that you can’t hold a conversation).

o  Stress increases blood pressure by contracting the blood vessels and thickening blood.  Research has shown, for instance, that people who reported marriage problems were more likely to have elevated blood pressure than those
who said they were happy.  If you are under a lot of pressure it is really a good idea to work on how you deal with stress.

o  Cholesterol may be a bit of a red herring in the heart disease stakes. Unhealthy LDL cholesterol is often raised, but it is does not seem to be the most important factor.   In any event we make 80% of cholesterol in our bodies and going on a low-cholesterol diet has limited effect.  To balance cholesterol it is more important to support liver health by reducing alcohol and coffee to a minimum and eating healthy fats as described above.

o  The above are the real basics of heart health, but there are other important ways in which you can help yourself.  Homocysteine is a highly toxic compound made in the body from a protein building block called methionine.  Around 25% of people are genetically programmed to make too much, and this toxic compound seems to be closely linked to heart disease. The B-vitamins, folic acid, B6 and B12, have been shown to normalise homocyste in levels when taken as supplements (I would suggest at least 25mg of B6 and B12 and 400 mcg of folic acid daily, taken in a single bB-complex).  Vitamin E (between 400-800 ius daily) is a powerful  blood thinner and may well be a good alternative if the more commonly prescribed aspirin is not tolerated because of stomach disturbance (speak to your doctor before stopping aspirin and be cautious about using it at high doses if you are on Warfarin blood thinning medication).  The mineral magnesium is often needed when there are muscle cramps, and heart palpitations are frequently helped by supplementing 300-600 mg daily.  Many people report improved heart health after taking co-enzyme Q10, at doses of around 100 mg daily, and this may be because the heart is the largest store of CoQ10 in the body.  This is because CoQ10 is used for energy metabolism and the heart is always using energy.  Finally compounds in soya have been shown to be highly protective of the cardiovascular system.  It is not certain if supplements, which have isolated
these substances, are as beneficial as the food itself however and eating 2-4 oz of tofu daily is most likely to be beneficial.

The risks of heart disease can be greatly reduced by focussing on eating a healthy diet, reducing the effects of stress, and exercising.    For more information on how to improve your overall health read The Stress Protection Plan.   Click here for more information.