How to prevent heart disease...
Adam Murphy and Marika Ottman have more quick fire facts; this time on simple ways you can reduce your risk of having heart problems. Plus, Addenbrooke's cardiologists Sharon Wilson and Tian Zhao join Chris Smith and explain what drugs are available for treatment.
Marika - Heart attacks are very common: one person in three will be directly affected by heart disease during their lifetime.
Adam - There are lots of factors that increase the risk of developing heart disease.
Marika - Smoking is probably the most important one. Toxins in cigarette smoke damage the walls of arteries, increasing the chances that they will furr up and block. Nicotine, meanwhile, puts up blood pressure. So don’t smoke!
Adam - Family history is also a huge factor. If you have close relatives who developed heart disease or suffered heart attacks at a young age then there could be a genetic component, and that means you might have a higher risk too.
Marika - This includes being affected by a condition called “familial hypercholesterolaemia.” This is where the levels of cholesterol are too high in the blood, making it more likely that the cholesterol will build up in the walls of arteries, causing them to narrow.
Adam - You can have a test to monitor your cholesterol levels and tell whether you are at a higher risk.
Marika - ...and if your levels are high, fortunately there are drugs called “statins” that can reduce the production of cholesterol in the body, lowering the level and cutting your risk.
Adam - Statins are very safe and very effective: they can reduce your chances of having a heart attack by up to a third.
Marika - High blood pressure - or hypertension - is another major risk factor for heart disease.
Adam - Blood pressure that is regularly too high damages the linings of our arteries, increasing the chances that fatty deposits, called atheroma, will build up and narrow the artery.
Marika - You should ask your doctor to check your blood pressure next time you visit.
Adam - But don’t be alarmed if it’s apparently high the first time you take it: you might just be stressed, or one of a number of people with a condition called “white coat hypertension” which means their blood pressure goes shooting up whenever they go near a doctor!
Marika - If that turns out to be you, you can buy a home blood pressure monitoring machine and take your own blood pressure regularly when you’re relaxed at home.
Adam - If it’s still high under these conditions, you might need drugs called “antihypertensives” to bring your blood pressure back down to normal levels, which will dramatically cut your heart attack risk...
Marika - Another good way to reduce blood pressure and benefit your health overall is to take regular exercise.
Adam - This doesn’t mean that you need to go mad: park your car a bit further from work and walk the rest of the way; take the stairs rather than the lift when you can; cycle to the station; or get a dog and take it for a daily 20 minute walk. It all adds up.
Marika - And exercise is a great way to stay in shape, which is also important…
Adam - ...because being overweight is also a big heart attack risk factor: it increases cholesterol levels, puts up your blood pressure and you’re more likely to develop diabetes, which is a serious cardiovascular risk factor in its own right.
Marika - Diet is also very important: regularly eating fresh fruits and vegetables, reducing red meat consumption and avoiding fatty foods like chips, fried and fast food all helps, and alcohol in moderation of course!
Chris - Of course. Just the one bottle of shiraz then, rather than two!
With me are cardiologists Tian Zhao and Sharon Wilson. Now Sharon, we’ve heard people talking on the programme about high cholesterol and we heard Adam and Marika mention statins to control cholesterol. What are statins and how do they actually work?
Sharon - Statins basically interfere with a way that the body processes cholesterol to block it from being produced within the liver. So if you’ve got a reduced amount of cholesterol coming out of our liver, your blood levels naturally drops, but then you don’t go on to develop atheroma within the vessels of interest such as those within the heart.
Chris - What about how well tolerated they are?
Sharon - Statins are relatively well tolerated; the problem that we have is when people are on very large doses of statins. There’s a large range of the medication so that we can start at a fairly low dose up to a very very high dose. When people come into the hospital after having a heart attack we start them usually on a very high dose, and you need to go back to your local doctor or your local cardiologist to adjust your dose back to an appropriate number, depending on how your cholesterol responds.
Chris - Does everyone respond to a statin or are there some people that just can’t be dealing with them?
Sharon - The majority of people actually do respond quite well to statins but there is a subset of population that do have quite significant side effects. We’re talking about muscle pains with the top of your legs - you’re unable to get out a chair. And there are other alternatives of different medications that are available on the market that can help these people as well.
Chris - Now Tian, some people say that they regularly take aspirin - just a baby aspirin 75 milligrams a day. And they do that despite not having had a diagnosis of heart disease or heart attack, they do it because they believe it will reduce their risk in the long term. Is there merit in that argument?
Tian - That’s not the advice I would give to the public. I think if you’re worried about your risk of having heart disease, I think you should go to your primary care doctor - your GP - and have a discussion about it. And there are quite sophisticated ways we can try and calculate your risk, and depending on what that risk is there’s different advice we can offer. Aspirin is a very good drug but it’s not without side effects, and it is unfortunately an irritant of the stomach, for example, and can cause stomach ulcers. So it’s something, I think, that people should discuss with the doctor. Doing that consultation there are great alternatives to medication; for example lifestyle changes. Things like that to reduce your risk and not just taking tablets.
Chris - Many of the interviews that we’ve heard here have talked about inflammation in your arteries as a cause of arterial disease. Since aspirin is an anti-inflammatory, is there not one school of thought that could argue, "if I take an anti-inflammatory, I could slow down the progression of the inflammation and, therefore, the progression of arterial disease, particularly in people who might be at high risk of a heart attack". For example, they’ve got a very strong family history or very high cholesterol, high blood pressure, stressful job, etc?
Tian - That’s a great thought. We’ve looked at aspirin as an anti-inflammatory in heart disease. Unfortunately, most of the data which shows it acts as an anti-inflammatory is at much higher doses than prescribed clinically and, therefore, I think the majority of the effect is not there...