Heart disease - know your risk

Coronary heart disease, along with stroke and blood vessel disease, belongs to the group of conditions known as cardiovascular disease. It is one of the leading causes of death worldwide.

Coronary heart disease can occur when the arteries that supply blood and oxygen to your heart muscle become clogged with fatty material called plaque.

This process is called atherosclerosis#

Atherosclerosis can start when you are young and may be well advanced by the time you reach middle age. If your arteries become blocked or too narrow, blood and oxygen cannot easily reach your heart muscle, which can cause symptoms such as chest pain (angina). If a blood clot forms in the narrowed artery and blocks the blood supply to part of your heart, it can cause a heart attack. If this happens in the arteries supplying blood to the brain, it can cause a stroke.

Understanding your cardiovascular disease risk score#

A cardiovascular disease risk score estimates your risk of having a heart attack or stroke over the coming years. It is calculated by combining your individual risk factors, a bit like putting the pieces of a puzzle together so you can see the whole picture. By looking at the whole picture, your doctor can discuss ways to reduce your risk.

Your risk score is worked out as part of a heart health check with your doctor. Regular checks can help you better understand your risk and what you can do to manage it. As part of the check, your doctor will:

• ask about your medical and family history of heart disease
• ask about your lifestyle, including your diet, physical activity, and whether you smoke or drink alcohol
• measure your blood pressure and check your cholesterol and blood sugar levels

Your doctor will then use this information to estimate your risk and support you to make positive changes to lower it.

Risk factors you can and cannot change#

A heart attack or stroke does not usually happen because of a single risk factor. They more often result from a combination of factors. Some are modifiable (ones you can change) and some are non-modifiable (ones you cannot change).

Risk factors you can change include:

• tobacco smoking
• poor diet
• physical inactivity
• being overweight or obese
• alcohol intake
• high cholesterol
• high blood pressure (hypertension)
• type 2 diabetes
• depression, anxiety and social isolation

Risk factors you cannot change include your age, your sex, being post-menopausal, and having a premature family history of heart disease. People from some ethnic backgrounds are also at increased risk.

The good news is that you can reduce your overall risk of a heart attack or stroke by making heart-healthy changes and, if your doctor has prescribed them, taking medicines.

Cholesterol and cardiovascular disease risk#

Cholesterol is a waxy, fatty substance produced naturally by your body. Your body needs it to make hormones and vitamin D and to build cells. Everyone has cholesterol, but too much means plaque can build up in the coronary arteries, making it harder for blood and oxygen to reach the heart and brain and increasing the risk of a heart attack and stroke.

Your total cholesterol includes two main types:

• Low-density lipoprotein (LDL) – also known as ‘bad’ cholesterol, because it adds to the build-up of plaque in your arteries and increases your risk of heart attack and stroke.
• High-density lipoprotein (HDL) – also known as ‘good’ cholesterol, because it helps protect you against heart attack and stroke.

Most of the cholesterol in your blood is ‘bad’ LDL cholesterol, and only a small part is ‘good’ HDL cholesterol. You should aim for low LDL and higher HDL. High cholesterol is mainly caused by eating foods high in saturated and trans fats. Your doctor will check your cholesterol levels and discuss the levels you should aim for, and can refer you to a dietitian for advice.

Blood pressure and cardiovascular disease risk#

Blood pressure is the pressure on the walls of your arteries as your heart pumps blood around your body. It depends mainly on the amount of blood your heart pumps and how easily that blood can flow through your arteries. Your blood pressure rises and falls throughout the day depending on the time and what you are doing.

High blood pressure (hypertension) is a condition where your blood pressure is consistently high. Family history, eating patterns, alcohol intake, weight and physical activity all have a strong influence on blood pressure. Some medicines can also raise it, including the oral contraceptive pill, contraceptive ‘depot’ injections, steroids (cortisone-like medicines) and some arthritis medicines.

High blood pressure can overload your heart and arteries and increase the risk of a heart attack or stroke. It can also affect arteries in other parts of your body, such as the eyes, kidneys, feet and legs. Your doctor will measure your blood pressure and, depending on your overall risk, may recommend changes to your diet and more physical activity. Some people may also need medicines to manage their blood pressure.

Diabetes and cardiovascular disease risk#

People with diabetes are at greater risk of heart attack and stroke than people without diabetes. The three main types of diabetes are type 1 diabetes, type 2 diabetes and gestational diabetes (which some women develop during pregnancy). Insulin is the hormone responsible for regulating blood sugar levels in the body.

Your doctor will check your blood sugar levels as part of a heart health check. Depending on your overall risk, they may recommend changes to your diet and more physical activity. Some people with diabetes may also need medicines to manage their blood sugar levels.

Tobacco smoking and cardiovascular disease risk#

As well as causing cancer, tobacco smoking affects the arteries that supply blood to your heart and other parts of your body. It reduces the amount of oxygen in your blood and damages your artery walls. Smoking also makes your blood ‘stickier’, causing blood cells to clump together. This slows blood flow and makes blockages more common, which may cause a heart attack or stroke.

Stopping smoking is one of the best things you can do for your health, and every cigarette you don’t smoke does you good. The most effective way to stop is usually a combination of support and stop-smoking medicines such as nicotine replacement therapy. If you are ready to quit, or thinking about it, talk to your doctor about ways to help you give up.

E-cigarettes#

Research shows that e-cigarettes can cause harm, including lung problems, poisoning, injuries and seizures. There is also evidence that they can increase heart rate and blood pressure, which may raise the risk of heart disease. It is also not clear whether e-cigarettes are effective in helping people stop smoking. For more information, speak to your doctor.

Healthy eating and cardiovascular disease risk#

Eating a variety of foods is good for your health and can help reduce the risk of chronic diseases, including heart disease. A heart-healthy eating pattern includes:

• plenty of vegetables, fruit and wholegrains
• a variety of healthy protein-rich foods, especially fish and seafood, legumes (such as beans and lentils), nuts and seeds
• unflavoured milk, yoghurt and cheese
• healthy fats and oils, such as nuts, seeds, avocados, olives and their oils for cooking
• herbs to add flavour

Eggs and poultry can also be enjoyed as part of a heart-healthy eating pattern. If you eat red meat, choose lean cuts and limit it to one to three times per week. If you have heart disease or high cholesterol, choose reduced-fat varieties. This way of eating is naturally low in unhealthy fats, salt and added sugar, and rich in wholegrains, fibre, antioxidants and healthy fats. For individualised nutrition advice, you can speak to a dietitian.

Physical activity and cardiovascular disease risk#

Regular physical activity is an important part of looking after your health and reducing your risk of a heart attack or stroke. It can:

• improve your long-term health
• reduce your risk of heart attack
• give you more energy
• help you manage your weight, cholesterol and blood pressure
• keep your bones and muscles strong
• help you sleep better
• make you feel more confident, happy and relaxed

If you have had a heart attack, regular physical activity will help you recover more quickly. If you have diabetes, it will also help you manage your blood sugar levels.

All types of physical activity count#

Moderate-intensity physical activity, such as brisk walking, is great for your health. A common recommendation is to do 30 minutes or more of moderate-intensity activity on five or more days per week. If you like, you can break this up into smaller bouts, such as three 10-minute walks. Aim to be active on all or most days of the week, with some muscle-strengthening activities on at least two days each week.

Walking is a great activity for heart health#

Walking for an average of 30 minutes or more a day can:

• lower the risk of heart disease, stroke and diabetes
• help manage weight, blood pressure and cholesterol
• reduce the risk of some cancers
• maintain bone density, reducing the risk of osteoporosis and fractures
• improve balance and coordination, reducing the risk of falls and other injuries

Joining a walking group can be a fun and social way to stay active.

Alcohol and cardiovascular disease risk#

Alcohol is not a necessary or recommended part of a heart-healthy lifestyle, and drinking alcohol can increase the risk of a heart attack and stroke. If you don’t drink alcohol, don’t start. If you do drink, less is better, and you can speak to your doctor for advice and support to cut down.

Children and young people under 18 years of age should not drink alcohol. To reduce the risk of harm to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol, and for women who are breastfeeding, not drinking alcohol is safest for their baby. For people with heart disease and related conditions or risk factors, the evidence is not strong enough to recommend a safe amount of alcohol for heart health, and for some people the safest option is not to drink at all.

Overweight, obesity and cardiovascular disease risk#

Being overweight or obese increases the risk of a heart attack and stroke, along with other health problems including:

• type 2 diabetes
• high blood pressure (hypertension)
• high cholesterol
• gallbladder disease
• joint problems, such as gout, arthritis and joint pain
• sleep problems, such as sleep apnoea
• certain types of cancer

Carrying extra weight around your middle is also a risk factor for heart disease. Speak to your health professional for support to achieve and maintain a healthy weight.

Depression, anxiety, social isolation and cardiovascular disease risk#

Studies have shown that having a mental health condition such as depression or anxiety can increase the risk of heart disease, as can being socially isolated or lacking good social support. Healthy personal relationships and being part of a community are essential for your mental health. Being physically active is one of the most effective ways to improve both your heart health and your mental health.

Depression and anxiety can be treated#

If you’re feeling lonely, isolated, worried or depressed, talk to your doctor and reach out to friends and family. Support is available, and getting help is an important step.

Family history and cardiovascular disease risk#

A person’s family history of disease (their genes) can increase their risk of a heart attack or stroke. If one or more of your immediate family members (such as a parent or sibling) has had a heart attack or stroke before the age of 65, it’s important to mention this to your doctor.

Even if you have a family history, this does not mean you will go on to have a heart attack or stroke. One of the best things you can do is to book a heart health check with your doctor, who will ask about your family history as part of the check. If you have an immediate family member who had a heart attack or stroke at a young age, don’t wait — speak to your doctor as soon as possible so you can start managing your risk today.

Sex, age and cardiovascular disease risk#

Women and men are both at risk of a heart attack or stroke. Men have a higher risk of developing heart disease in middle age, and the risk rises as people get older. For women, the risk increases sharply after menopause, and it’s thought that hormonal changes are likely to play a role.

It’s important for both women and men to have regular heart health checks. Women can also have sex-specific risk factors for heart disease, including premature menopause, pre-eclampsia, gestational diabetes and some cancer treatments. If you have any of these risk factors, speak to your doctor as early as possible to reduce your risk.

Key points#

• Coronary heart disease is one of the leading causes of death worldwide and is usually caused by a combination of risk factors.
• A cardiovascular disease risk score, calculated during a heart health check with your doctor, combines your risk factors to estimate your risk of heart attack or stroke.
• Some risk factors can be changed (such as smoking, diet, activity, weight, alcohol, cholesterol, blood pressure and type 2 diabetes), while others cannot (such as age, sex and family history).
• Heart-healthy changes — not smoking, eating well, staying active, limiting alcohol and maintaining a healthy weight — can substantially reduce your risk.
• See your doctor early if you have a strong family history or other risk factors, rather than waiting.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).