Accumulation of fat in arteries due to hyperlipidaemia ( high fat levels in blood ) results not only in heart disease, but also stroke, and problems with circulation to legs and abdominal organs such as kidneys. Half the UK and Philippines adult population have hyperlipidaemia, one of several risk factors making these illnesses the commonest causes of death in both countries.
• Supplement smartly. Not top priority or most effective in lowering “ bad “ lipids ( LDL = low density lipoprotein cholesterol and total cholesterol ) to healthy levels. The three listed are not proven, and in any case unacceptable to the vast majority at risk.
• Eat heart –healthy. The diet should include less than 10% of calories from saturated fats, with increased fibre ( fresh fruit and vegetables ), and omega-3 fatty acids ( in fish ). “ Going meatless “ is unnecessary and unacceptable to many people.
• Raise a glass to red. Implying that taking up the habit of a daily glass of red wine might be beneficial is irresponsible. We have a major problem in the UK, and increasing problem in Philippines, of excessive alcohol consumption. Two glasses of wine daily increases the risk of mouth cancer and high blood pressure ( itself a risk factor for heart disease ), while even one glass increases the risk of breast cancer.
• Keep out cholesterol. Fruit and vegetables, margarine, and fruit juices should be sufficient for most people, with no need to spend on multivitamin tablets.
• Whittle your middle. Better to explain that your BMI ( Body Mass Index = weight in kilograms / height in metres squared ) should be 20-25. Excess waist circumference and BMI more than 25 puts you at risk - not only of heart disease, but also high blood pressure, diabetes, and some cancers.
• Get a move on. We don’t need a Californian study to confirm that regular exercise lowers blood pressure and the risk of heart disease.
• Stress less to lower cholesterol. Similarly, we already know stress is a risk factor, especially when associated with poor diet and poverty. Easy to say, not so easy to implement.
• What’s missing ?
1. Drug treatment. Top priority – treat those with known cardiovascular disease ; second – treat diabetics; third – treat others at high risk ( primary prevention if conditions present such as high blood pressure , raised lipids, family history, other illnesses, or smokers ). Lipid regulating drugs such as statins are expensive and have side effects. There’s not enough evidence to support giving them to men over 40 and women over 65. There are other drugs, but one of the statins is usually first choice.
2. Risk factors for heart and other vascular diseases like strokes are synergistic – they have an additive effect. Some – like hyperlipidaemia, smoking, high blood pressure, diabetes, poor diet, alcohol, lack of exercise and obesity, and stress – may be controllable by lifestyle change / drugs. Others – like increasing age and male sex – are not.
3. Cancer is likely to overtake cardiovascular disease as the top killer in the next few years. That’s because we’re living longer, and not only fewer people are getting heart attacks, but even if they do, improved treatment ensures more are surviving.
