Courtesy of The Times 27.9.2016 

You are only as old as your arteries. Much as we all like to look good on the outside, it’s the state of our circulation that will largely determine how long most of us live – and how enjoyable those extra years are.

Around 7 million people in the UK currently have some form of circulatory disease, with heart problems accounting for the majority. In a typical day around 200 people  across the UK die from heart attacks alone, and another 500 will end up being treated for one in hospital. And it is not just the stereotypical middle-aged man who is at risk – women get heart disease too, and are three times more likely to die from a heart attack than from breast cancer.

It’s a subject close to my heart thanks to the combination of a poor family history (at least one close relative under 60 affected), an unhealthy cholesterol profile and reaching an age (53) where I increasingly find myself treating patients younger than me. Nothing quite focuses the mind like performing CPR on a chap that is five years your junior.

Not all heart disease is preventable, but much is, so if you want to increase your odds of enjoying middle age and beyond, here are 5 tips I share with all my patients. And I take it as read that the dwindling minority of you who still smoke are aware that this is the single biggest risk factor you can change – what it does to your complexion and lungs, it also does to your arteries. So stop before it is too late.

Eat well and maintain a healthy weight

Diet can influence your heart and circulation in a number of ways.  If you are overweight – particularly if you carry the excess around your midriff – it induces metabolic changes that increase your risk of diabetes, high blood pressure, and an unhealthy cholesterol profile.  And the make up of your diet has an impact too.

Much has been made over the years of the importance of eschewing animal based saturated fats like cheese and butter, but the evidence that such a diet “furrs up your pipes” is not as convincing as many experts would have you believe.

I have tried a low-fat diet, as have many of my patients, and it had little impact on my waistline or my rather unhealthy blood fat profile (see below) so earlier this year decided to try the low-carb approach.  Suffice to say within six weeks I had lost several kilos and my cholesterol had fallen by nearly 20%.  I am now a convert.

One swallow does not make a summer, but I have seen similar results in many of my patients and this approach can be particularly beneficial for people with high blood sugars at risk of developing diabetes (high sugar is “corrosive” to the arterial lining).

I didn’t go mad.  I just cut out bread, sugary drinks, confectionery and biscuits, and limited my total carbohydrate intake to 150 grams per day.  In practice the changes meant lots of soup, Mediterranean type foods (excluding pasta) and plenty of meat and salad.  Google carbohydrate calculator to work out how to get your diet below 150 grams a day.

Finally, watch your salt intake if your blood pressure is raised (cutting back will help lower it). But if your BP is normal, I wouldn’t worry.

Check your pulse

We tend to take the beating of our hearts for granted but over a million people in the UK have an irregular pulse caused by atrial fibrillation – a condition that can cause everything from palpitations and breathlessness, to fatal strokes.

It’s thought that around half a million of those affected are blissfully unaware that the two upper chambers of their heart are not contracting in sync with the larger pair, compromising efficiency and increasing the risks of clots forming inside the heart.  Clots which can shoot off into the circulation and lodge in the brain.  Most people with AF are elderly (1 in 10 over-75 has the condition), but it can affect as many as 1 in 200 in their forties and fifties too.

You may notice a funny sensation in your chest, or get out of breath easily, but in many cases it only becomes apparent when checking the pulse and finding it is irregular (and often fast).  If you are not sure where to feel, or what to feel for, then visit www.knowyourpulse.org and all will be revealed.

If you are worried, see your GP or practice nurse who can organise an ECG to confirm what is going on, and take the appropriate steps to treat it / reduce the risk of dangerous clots.

Know your blood pressure and lipid profile

 The British Heart Foundation estimates that there are currently 5 million people with undiagnosed high blood pressure in the UK and if you are over-40 and haven’t had yours checked recently there is a fair chance you could be one of them.

Contrary to pub lore high blood pressure has few if any symptoms.  The only way to be sure is to measure it – something that you can very easily do at home.  Indeed I prefer my patients to check theirs away from the surgery so that we get a more realistic picture than a one-off reading in a busy clinic.

Your pharmacist will be able to supply an approved machine for less than £50, or many GP practices lend them out.  Take a series of readings at rest over a week. An average across the week of below 140/85 is generally regarded as healthy.  If you are consistently above this then talk to your GP.

Raised cholesterol levels are another silent risk factor that can prematurely age arteries, but it is not just about cholesterol itself.  A full blood fat profile needs careful interpretation and can often give a clue to the patient’s diet and lifestyle.  If you have lots of bad cholesterol (LDL), not much good cholesterol (HDL) and raised triglycerides then it is a fair bet that you have inherited a tendency towards an unhealthy metabolism (like me) and / or you have a poor diet, have a sweet tooth, perhaps drink more than you should, carry too much weight and take too little exercise.

But don’t get too bogged down in the numbers.  Most of us have higher than ideal cholesterol levels and on its own it is just one risk factor and often of little significance unless very high (such as 7.5 or above).

Work out your risk

 I spend much more time considering my patients’ overall risk of having an early stroke or heart attack than I do their blood test results.  Like most GPs I use www.qrisk.org to work out the likelihood of someone having a stroke or heart attack in the next decade.  It’s only a guesstimate based on things like family history, height ad weight, blood test results and the presence of other risk factors like diabetes, but it’s the best guide we have a the moment, and is constantly being tweaked to improve accuracy.

You can go online to calculate yours and see how changes like losing weight, stopping smoking and improving your cholesterol profile might influence your odds of running into trouble over the next ten years.  As a guide doctors consider 10% or more an indication to discuss statins to reduce risk (over 20% is deemed to be high risk).

But before your doctor reaches for the prescription pad, ask what you can do yourself to reduce your risk.  Most dietary and lifestyle interventions work better than statins and have myriad other benefits too.  Being told you are at moderate or high risk should be a wake-up call to think about self-help, not a reason, necessarily, to take a statin.  Treat cholesterol-lowering drugs as a supplement rather than a substitute to healthy living.

I was eligible for statins, and have tried them (with no obvious ill effect), but thanks to my recent diet and weight loss I am now off them and back below the 10% threshold.

Exercise

I first started getting serious about exercise on my 40^th birthday when I decided to run the London Marathon for charity and I have never looked back.  I do 3 – 4 hours of moderate intensity training at the gym, or out running, every week and have never felt better.  But don’t push too hard.

The very latest evidence suggests that there is a U-shaped relationship between exercise and the health of your heart.  The risk is high if you do too little, and then drops as you become more active before starting to rise again among marathon runners, triathletes and long distance cyclists.

Quite why taking a lot of exercise can sometimes damage the heart remains unclear but it is thought to result from shearing and stretching forces.  The higher your pulse rate and the longer you sustain the greater these forces are.

The risk needs to be put in context and balanced against the many other benefits of training, but for most people the sweet spot for heart health appears to be around two and a half hours of aerobic exercise every week at an intensity where you can just about hold a conversation.

High intensity exercise – short sharp bursts – is very much in vogue at the moment but I am concerned about advocating it to people over the age of 45.  For the same reason that I have advise my middle-aged patients not to take up squash to get fit – it is fine if you are already in shape, but not the best place to start if you want to avoid an early heart attack.

Does an aspirin a day keep the doctor away?

Millions of people have taken aspirin over the years to ward off an early heart attack or stroke – and latterly to reduce their chances of developing cancer – but its use has fallen out of favour recently thanks to growing evidence that it can do more harm than good. 

 The drug undoubtedly protects some people from an early demise from cardiovascular disease (and some cancers), but it kills and maims others – through bleeds in the gut or brain – who would have been fine had they never taken it.  The problem is neither doctor, nor patient, can be sure as to who is going to end up in which group.   How lucky do you feel?