What can I do to keep my heart healthier?
The main treatment for coronary artery disease (CAD) is medication. But you can also do a number of other things to keep your heart as healthy as possible – for instance, try to stop smoking if you smoke, get enough exercise, and lose weight if you're overweight.
The main thing that people can do to prevent complications of CAD is lead a healthy lifestyle. There's a whole load of advice out there about how to do this. But lifestyle changes can often be difficult to make and stick to, particularly if there are no obvious immediate improvements. Support from other people can be helpful, for instance if your whole family changes their diet as well, or if you do sports together with friends.
Apart from age, smoking is the biggest risk factor for cardiovascular disease. It also increases the risk of many other diseases, particularly cancer and respiratory (airway) diseases. So quitting smoking can considerably increase your life expectancy. Although it isn't always easy to stop smoking straight away, many people succeed at some point. Various things can help you to stop smoking.
There is a huge amount of advice out there on healthy eating, diet tips and specific theories about nutrition. But most of this advice is not based on reliable scientific proof. A Mediterranean diet rich in fruits, vegetables, nuts and whole grain products is generally considered to be healthy. People who have CAD are also often advised to eat less salt and saturated fat in their diet. Salt can increase your blood pressure, and saturated fats can have a negative effect on your cholesterol levels.
Studies suggest that eating less saturated fats can lower your risk of complications such as heart attacks. But that doesn't mean people should avoid all kinds of fat. Instead, they can try to replace saturated fats with unsaturated fats. For instance, by eating more plant-based foods, and less meat and high-fat dairy products. Deep-fried foods also have a lot of saturated fats in them.
Most of the salt in our diets is found in processed foods. Some kinds of bread have a lot of salt in them too. So if you would like to cut down on salt, the easiest way to do that is by eating less of these foods.
Some people who have CAD avoid physical exercise because they are afraid of over-exerting their body. People with CAD might also be more aware of small changes in their body and become especially careful as a result. This could be particularly true for people who have angina (chest pain). Heart attacks are in fact more common following heavy physical exercise. But there is generally no reason for people who have CAD to be afraid of doing physical exercise. On the contrary: Staying physically active keeps people fitter and better able to cope with physical strain in everyday life. People who get regular exercise are less likely to have heart problems after more vigorous exertion. And exercise often has a positive effect on your mood too.
Most experts advise people with CAD to stay physically active and do low-intensity endurance exercise several times a week. One common recommendation, for example, is to walk briskly, jog, cycle or swim for 15 to 60 minutes on at least three days per week. People who aren't sure which type and intensity of exercise is suitable for them can consult their doctor. It's also a good idea to start slowly and then gradually increase the amount of exercise, to find the right balance.
Being overweight is often said to cause cardiovascular disease. People are considered to be overweight if they have a body mass index (BMI) of between 25 and 30. But studies have shown that being in this range doesn't increase, or hardly increases, your risk of cardiovascular disease.
If someone has a BMI of over 30 they are considered to be obese. Cardiovascular disease is indeed more common in obese people than it is in people who are a normal weight or only slightly overweight. But it isn't yet clear whether losing weight can reduce the risk of complications associated with CAD.
Limitations of a healthy lifestyle
Many recommendations related to diet or personal lifestyle aren't based on scientific proof. And people can still develop CAD despite being a normal weight, eating a healthy diet and not smoking. Lifestyle is only one of many factors that influence your health. Many other factors – such as age, sex and genes – can't be influenced.
Omega-3 fatty acids are mainly found in marine fish, but also in canola oil and linseed oil. They are sold as dietary supplements to be taken as capsules too. But the research findings on omega-3 fatty acids are disillusioning: An analysis of studies involving more than 35,000 people with coronary artery disease didn't find any evidence that they helped. Omega-3 fatty acids didn't influence the risk of heart attacks, strokes or other complications associated with CAD. Omega-6 fatty acids, which are mainly found in safflower oil, haven't been shown to have any benefits either.
Some people regularly take vitamin supplements to prevent cardiovascular disease. These products are believed to lower the production of “free radicals” in the body – substances that are said to have a harmful effect on the body’s cells. But long-term studies involving more than 300,000 people have shown that vitamin supplements have no health benefits. In fact, some of these products even seem to reduce life expectancy.
Like medication, vitamin supplements are not free of side effects. Vitamin E, beta-carotene and selenium may cause constipation, diarrhea and gas, for example. Very large amounts of vitamins A and C can lead to itching.
Balk EM, Adam GP, Langberg V, Halladay C, Chung M, Lin L et al. Omega-3 Fatty Acids and Cardiovascular Disease: An Updated Systematic Review. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Aug. (Evidence Reports/Technology Assessments, No. 223.)
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2012; (3): CD007176.
Bundesärztekammer (BÄK). Nationale Versorgungsleitlinie Chronische KHK. Langfassung. AWMF-Register-Nr.: nvl-004. February 19, 2016.
Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2015; 6: CD011737.
Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM et al. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. The BMJ 2013; 346: e8707.
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