What can you do for your heart health?

Apart from age, smoking is the biggest risk factor for heart attacks and other cardiovascular (heart and blood vessel) diseases. It damages the blood vessels in a number of ways: Harmful substances in the smoke pass into the blood. That can increase the amount of harmful LDL cholesterol in the blood and cause small inflammations on the inner walls of the blood vessels. Deposits and blood clots can form more easily there. Smoking also causes the coronary arteries to become narrower, so less blood reaches the heart muscle.

Smoking increases the risk of many other diseases, too – particularly cancer and respiratory (airway) diseases. So people who quit smoking generally live longer. Although it's not 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 special theories about nutrition. Most of this advice is not based on reliable scientific proof. But research does suggest that you should limit the following in your diet:

• Foods with a high amount of saturated and trans-fatty acids (trans fats)
• Foods and drinks with a lot of sugar
• Highly processed foods
• Salt
• Alcohol

People with heart diseases are often advised to follow a "Mediterranean" diet. By this, experts mean foods containing lots of fruit and vegetables, nuts, wholegrain foods, fish, and poultry – in line with the recommendations listed above.

Studies suggest that this kind of diet can lower your risk of CAD leading to other health problems, such as heart attacks. A number of effects that diet can have on your health probably work together here: Saturated and trans fats lead to higher cholesterol levels than other fats do. Eating and drinking sugary things and highly industrially processed foods can increase the likelihood of obesity (being very overweight) in the long term. Salt can increase blood pressure. Alcohol increases the risk of many heart diseases, including heart failure and an irregular heartbeat, and is also high in calories.

Most people with CAD can lead an active life and do light endurance exercise. Physical exercise keeps you fit and helps you to cope with daily stresses. What's more, exercise often improves your mood and general wellbeing.

Before starting an exercise program, it can be a good idea to talk to your doctor about which types of sports are suitable and how strenuous they should be. Recommendations should take into account your personal fitness level, risk factors and any other medical conditions you may have. It is best not to do too little or too much: Taking it easy for too long can permanently weaken your heart, and training too intensively can increase the risk of heart attacks for a short while.

Medical experts recommend that people with CAD who don't have any special risk factors (such as severe heart failure) should do at least two hours of moderate endurance exercise each week. Examples include brisk walking, cycling, and swimming.

It doesn't matter how you spread the total exercise time out over the week. Each activity that lasts at least ten minutes counts. So, for instance, you could do 30 minutes of exercise 4 times a week – or 15 minutes 8 times a week.

Athletic sport is also not fundamentally impossible if you have CAD. But it's important to talk to your doctor about how much training is possible.

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 research has 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 have a normal weight or are slightly overweight. But there's currently a lack of reliable studies into whether losing weight can reduce the risk of complications in people with CAD.

Omega-3 fatty acids are mainly found in marine fish, as well as in rapeseed oils and linseed oil. They are sold as dietary supplements to be taken as capsules, too. These fatty acids are thought to have a good effect on things like fat metabolism and blood pressure. But the research findings on omega-3 fatty acids are not as expected: An analysis of research on dietary supplements involving more than 160,000 people didn't find any proof that they helped. The products didn't affect life expectancy or the risk of dying from cardiovascular diseases. Omega-6 fatty acids, which are mainly found in safflower oil, haven't been shown to have any benefits either.

What's more, an increasing number of large, reliable studies have suggested that fish oil capsules with omega-3 fatty acids could actually increase the risk of an irregular heartbeat ( atrial fibrillation).

Vitamin supplements have also been analyzed in many long-term studies involving over 300,000 participants. The vitamin products were not found to have any health benefits. In fact, some of these products even seem to reduce life expectancy.

Sometimes, people take vitamins that are believed to lower the production of “free radicals” in the body. These are substances that are said to have a harmful effect on the body’s cells. But long-term studies show that reducing free radicals doesn't improve health.

Very high doses of vitamin supplements can have side effects, too. For example, vitamin E, beta-carotene and selenium may cause constipation, diarrhea and gas. Large amounts of vitamins A and C can lead to itching.

In Germany, medical experts do not recommend using

• supplements with omega-3 fatty acids,
• vitamin supplements,
• herbal products or
• infusions that bind to metals in the body and are claimed to help against arteriosclerosis ("chelation therapy").