Maintaining a Healthy Heart

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Although there are hereditary factors which may determine how healthy our heart will be, there are a number of well-recognized determinants for maintaining a healthy heart as we get older. Those who might already have inherited genetic factors that may pose some risks are the ones who should be paying extra special attention to certain factors known to increase the risk of developing arteriosclerotic coronary heart disease, myocardial infarct (heart attack), angina, congestive heart failure, hypertensive heart disease and other conditions, as well as the ways to lessen that risk.

Heart disease is variable, but common throughout the world; the latest Canadian statistics from 2012/13 show that about 2.4 million (8.5%) Canadian adults aged 20 years and older live with heart disease. It is the second-leading cause of death.

The American Heart Association has recently expanded its “Seven Steps to a Healthy Heart” to eight, following recent research reporting the beneficial effects of good sleeping patterns on heart health. Both that organization and the Canadian Heart and Stroke Foundation strongly promote adherence to these important recommendations for reducing the risk of heart disease or controlling established heart conditions.

Healthy eating: A heart-healthy diet is beneficial in reducing the risk of heart disease and stroke, as well as many other conditions. Recent research has shown a much lower incidence of dementia in those who follow a healthy diet. Your diet should emphasize fruits, vegetables, beans, whole grains and legumes. Dairy products should be limited and include low-fat or fat-free items. Poultry, fish, nuts and non-tropical vegetable oils are recommended. You should limit your intake of sugary beverages, added sugars, sodium, excessive carbohydrates, highly processed foods, fatty or processed meats and saturated fats.

A Mediterranean diet has long been recognized as one that supports good heart health and includes the above items, with olive oil as the primary source of fat. Wine with food in low or moderate amounts may be included and fruit is common as a dessert, instead of sugary items.

Fitness: Research has proven that exercise is one of the most important things which you can do to maintain good health not only for your heart, but also to help manage weight control and blood pressure, elevate mood and energy levels and improve sleep. For seniors, the need for daily exercise is especially important. As we get older, our muscle strength decreases, we are normally less active in our daily routine and many of us are far too sedentary. Exercise helps preserve our strength and balance. For many of us, especially snowbirds who can probably walk year-round, a brisk but comfortable walk for 30 minutes or longer, most days of the week, is the easiest and most available source of exercise. Yard work, gardening, playing with grandchildren, joining a fitness centre or gym, participating in certain hobbies and sports such as swimming, pickle ball and golf are all beneficial.

Losing weight: The best advice regarding weight control is to monitor your weight regularly and modify your diet and exercise when you are exceeding the normal values for your age, sex and build. Becoming overweight or obese can increase your risk for cardiovascular diseases, Type 2 diabetes, certain types of cancer, hypertension and osteoarthritis. Online calculators for your BMI (body mass index) reflect your weight-to-height ratio and can help guide you or your health advisor to your goal for optimal weight. Reducing your calories − as well as increasing your physical activity and exercise − can help you achieve healthier weight levels. Dieting in seniors is a complex issue and should be done with the guidance of a physician or dietician.

Nicotine: For many years, it has been proven that nicotine from cigarettes, pipes and cigars is associated with a significant risk for heart disease, as well as other illnesses. In June, the American Heart Association announced that recent laboratory research has shown that flavour additives in electronic cigarettes and related tobacco products could impair blood vessel function and may be an early indicator of heart damage. The association cautions against the use of all e-cigarettes which contain tobacco products and promotes further research into flavoured products. The widespread knowledge of tobacco being related to cardiovascular disease, lung cancer and other conditions, along with all of the public health laws restricting their use, has been a major factor in reducing the incidence of smoking and developing these conditions in Canada. Nevertheless, nearly five million Canadians still smoke and Health Canada reports that, in 2002, smoking was responsible for almost half of all deaths from coronary heart disease among Canadians under the age of 45 years. Smokers are up to four times more likely to have a sudden cardiac death than non-smokers.

Cholesterol: A high blood cholesterol level is one of the major risk factors for both coronary heart disease and stroke. Most of us have had our blood cholesterol levels taken from time to time − often from our 40s and even earlier, if other risk factors are present. There are two types of cholesterol, LDL (low density lipoprotein) which is the bad cholesterol and HDL (high density lipoprotein) which is the good cholesterol.

Another type of fat that’s measured is triglycerides. If LDL cholesterol and/or triglycerides are found to be above normal levels, there is an increased risk of developing atherosclerosis − the buildup of thick deposits on the inner walls of arteries restricting the normal flow of blood. The result can be a heart attack, a stroke or impaired circulation to the legs.

Changing your diet by reducing the intake of foods which come from animals − such as red meat, eggs and dairy products, including whole milk, cream and ice cream − may help, but medication is usually needed to lower the readings to a safe level. Many tropical oils, such as coconut and palm oils which contain saturated fat, can also contribute to elevation of LDL cholesterol. The common drugs prescribed to control elevated cholesterol are the statin drugs such as Lipitor, Crestor and Zocor.

Diabetes control: Type 1 diabetes usually starts in adolescents, is often hereditary and requires the lifelong use of insulin to control blood sugar levels. The more common Type 2 diabetes usually begins in adulthood and is most commonly controlled with oral medication such as Metformin. Type 2 diabetes more commonly develops in persons who have gained too much weight and are physically inactive. Weight reduction and improving lifestyle are important initiatives in not only controlling the disease, but also reducing the many risks of poorly controlled blood sugar levels including heart attack and stroke.

Blood pressure: A major risk factor for heart disease is high blood pressure and it’s the number-one risk factor for stroke. When blood pressure readings are higher than normal, the heart works harder to pump blood through the blood vessels and heart enlargement can occur. Maintaining a normal range for your blood pressure reduces the risk for both stroke and heart damage. Although dietary and lifestyle changes may improve your blood pressure, most persons so affected will require daily medication which most often will reduce the levels to normal. Most readings should be lower than 120/80; the risk from readings is considered medium at levels above that and is considered high at 135/85 and over. Diabetics especially should strive to maintain normal levels. Although a physician or nurse practitioner should be monitoring your levels, everyone who is being treated should be using a home blood pressure cuff to document regular readings.

Sleeping: Sleep duration has now been seen as a factor in cardiovascular health. For adults, the ideal level of sleep is 7-9 hours per night. Unfortunately, many seniors in particular don’t get that amount and others do not sleep soundly, often waking to void. All of the measures well known to possibly improve sleep should be adopted by such persons, including strict limits on daytime naps, increasing physical activity, possible dietary changes, keeping regular sleep hours and sleeping in totally quiet environments. If insomnia still persists, seek medical advice. Medication has only limited use in long-term insomnia because of its habit-forming risk and side-effects.

All of us should try and follow these recommendations in order to achieve the best cardiovascular health that we can. For those with one or more of the health conditions listed, it is even more important that you adhere to the recommendations to reduce the risk of developing or extending the degree of damage to your heart. With the national reduction in the use of tobacco, the improvement in pharmacotherapy and surgical procedures, as well as the preventive steps that can be taken, we should all be enjoying better cardiovascular health.

By Robert MacMillan MD