Cardiovascular disease risk is multifactorial with influences from your lifestyle, socioeconomics, and genetics. While you cannot affect your genetics there are a number of lifestyle factors that can have a profound effect on reducing your risk of cardiovascular disease and to many respects, attenuate genetic influences altogether. These factors include:
Maintain a healthy weight and waist circumference.
Stay regularly active.
Drink alcohol in moderation.
Quit tobacco/e-cigarette use.
Improve your stress resilience.
Maintain good sleep hygiene.
The above mentioned lifestyle factors all influence this process by either affecting the amount of damage caused to the arteries that allows for fats to enter the inner lining; causing changes to your weight; or by affecting the amount of “bad fats”, that are in your arteries and available to form the fatty plaques. The first step in the development of cardiovascular disease is a process called atherosclerosis, where fatty plaques start to form in the innermost part of your arteries, causing the space for the blood to flow through to become smaller. This smaller opening reduces blood flow and increases the likelihood of a blockage occurring en-route to the heart (causing a heart attack/angina) or to the brain (causing a stroke/TIA).
There are three main types of tested “cholesterol” are Low-Density Lipoproteins (LDL), High-Density Lipoproteins (HDL), and Triglycerides. LDL cholesterol is synthesized from mostly less healthy fat sources (e.g. foods high in saturated and trans-modified fats), the production of LDL cholesterol within your body is increased when carrying excess weight around your waist and when smoking cigarettes. LDL cholesterol is needed for healthy hormone production and in the transport of the other types of cholesterol. HDL cholesterol is synthesized from healthy fat sources (e.g. oily fish, nuts, seeds, avocados, etc.). This type of cholesterol is called cardio-protective cholesterol and helps to return excess cholesterol back to the liver for metabolism and excretion as bile salts, whilst also helping with tissue repair and reducing the risk of blood clots. HDL cholesterol production is increased when regularly exercising but is suppressed by smoking, elevated stress levels, and poor sleep quality. Finally, Triglycerides are energy molecules created from the breakdown of your food intake. This molecule is composed of 3 fatty acids combined with 1 sugar unit and contributes toward increased cardiovascular disease risk when excess concentrations are in the blood. Triglycerides are typically elevated when the body’s utilisation of dietary nutrients is out of balance (i.e. consuming excess food or alcohol). Triglyceride levels are often higher after meals but should remain low between meals if being properly utilised within the body.
Current standard lipid profiles assess cholesterol levels by measuring total cholesterol, triglycerides, and HDL cholesterol concentration in your blood. LDL cholesterol is not directly measured, instead it is calculated using the other results. Total cholesterol is how much of all the different types of cholesterol are in your blood and as a result tells us very little of any practical use. Elevated total cholesterol levels tell us nothing about cardiovascular disease risk on its own and can only point toward the need for further testing. As a result, this outdated measure should not be used for tracking or assessing cardiovascular disease risk. As LDL cholesterol is a calculation assuming that all remaining cholesterol that is not HDL or triglycerides is LDL, it too has little practical use as this number will include other known forms not covered here such as very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and apolipoproteins. The remaining results have some practical use but will hopefully be replaced by more accurate tests looking at cholesterol particle number and not concentration in the future. The key results to focus on are your HDL Cholesterol, triglycerides, and the ratio between these two (Note: HDL/Triglyceride ratio is rarely reported on your blood results but can be calculated yourself using the below link:
HDL/Triglyceride Ratio Calculator - www.thebloodcode.com/calculators/
Reference ranges for HDL Cholesterol, Triglycerides, and HDL/TG Ratio are as follows:
HDL Cholesterol: Ideal >1.03 mmol/l (Men), >1.27 mmol/L (Women)
Triglycerides: Ideal < 1.7 mmol/L
HDL/TG Ratio: Ideal 0.5 – 1.9
Your body composition (i.e. how much of you is made from fat or muscle), has a significant impact on your risk for developing cardiovascular disease. Excess body fat, specifically excess fat carried around the waist increases the production of bad forms of cholesterol, increases blood pressure, and increases your risk of developing diabetes, an independent risk factor for developing cardiovascular disease. Therefore, try to maintain a healthy BMI of between 18.5 and 24.9 kg/m2 for Non-South Asian populations and between 18.5 and 23.0 kg/m2 for South Asian populations and a healthy waist circumference of less than 94cm (Men) or 80cm (Women) for Non-South Asian populations or less than 90cm (Men) or 80cm (Women) for South Asian populations (Note: South Asian populations include those from the India, Pakistan, Bangladesh, South East Asia, Japan, and China). For additional help in how to lose excess body fat efficiently and keep it off forever, check out my Weight Loss for Everyone book (link below):
Weight Loss for Everyone - www.amazon.co.uk/dp/B07V8C97BM
There are a number of diets that are touted as providing benefits for reducing your risk of cardiovascular disease. However, the most scientifically validated diet out there for reducing your risk of cardiovascular disease is the Mediterranean diet. Like any healthy diet the main focus is to be more mindful of your food choices and reduce the amount of highly processed and low nutrient density foods you are eating. Below is an overview of how to follow a Mediterranean diet:
All meals should contain 3 basic elements: cereals (1-2 servings per meal from breads, pasta, rice, couscous etc. preferably wholegrain), vegetables (2+ servings per meal), and fruit (1-2 servings per meal and the default dessert of choice).
Drink 1.5 – 2 Litres of water/day.
Moderate amounts of dairy (2 servings per day) with a preference for low-fat dairy or traditional healthier forms such as Greek yoghurt or Skyr.
Extra virgin olive oil forms a large part of the Mediterranean diet and should be the primary source of fat and used for both cooking and dressing.
Olives, nuts, and seeds as healthy snack options and another source of good fats.
Spices, herbs, garlic, and onions are great sources of micronutrients and add flavour and palatability to your meals.
Alcohol can be consumed at no more than 1 small glass of wine/day for women and 2 glasses/day for men. Alcohol is not a vital part of the Mediterranean diet and can be completely omitted if desired.
Fish and shellfish (2+ servings/week), white meats (2 servings/week), and eggs (2-4 servings/week) are all great sources of protein. A variety of fatty fish is highly recommended including salmon, tuna, mackerel, etc.
Red meat (less than 2 servings/week) preferably from lean cuts of meat and minimally processed.
Legumes and pulses (2+ servings/week) are another great source of fibre and plant proteins.
Potatoes (3 or less servings/week).
Sweet/sugary foods, heavily processed/refined foods, and unhealthy fats should all be consumed as little as possible with a guide of no more than twice/week. These foods are very calorific and heavily contribute toward excess weight gain due to their easy over consumption.
In addition to food recommendations, the Mediterranean diet includes lifestyle recommendations that aid in maintaining a healthy balance in your life and encourage healthier eating behaviours and activity levels. These recommendations include: moderate portion sizes, eating with others, cooking, being physically active, and getting adequate rest.
Exercise affects your risk of developing cardiovascular disease by helping you to maintain a healthy weight, particularly carrying excess fat around your waistline, trains the muscles that line the arteries to contract and dilate better which improves your blood pressure levels, increases the production of so-called cardio-protective HDL cholesterol, aid in managing your stress level, improve sleep quality and more. To reduce your risk of cardiovascular disease it is recommended by the American College of Sports Medicine (ACSM), to adhere to a minimum of:
150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week
Include resistance training (i.e. lifting weights or bodyweight exercises) at least twice/weekfocusing on predominately compound exercises (i.e. exercise that use multiple joints at the same time such as squats, deadlifts, bench press, pull-ups etc).
Include basic mobility/flexibility exercises to maintain full range of motion.
While engaging in any amount of physical activity is better than none, to be most effective, these minimum amounts and the intensity are key. Your heart rate and/or breathing rate need to be notably increased during your exercise sessions for them to count as moderate-intensity exercise or harder. Activities such as yoga, Pilates, tai chi, Qi gong etc. while very good for other reasons such as improving mobility and building stress resilience, do not count as moderate-intensity exercise and cannot be counted toward your weekly targets.
SMOKING & ALCOHOL
Smoking is one of the leading causes of cardiovascular disease due the negative effects the chemicals within cigarettes have on your health. For example, smoking increases the production of LDL cholesterol and suppresses the production of HDL cholesterol and is a vasoconstrictor (i.e. it makes you blood vessels smaller and harder for the blood to flow through) to name just two. There are no safe amounts of cigarettes you can have and some health benefits from quitting can be seen in as little as 24 hours. In fact, if you only smoke while drinking you are at an even higher risk as alcohol enhances the cancer-causing effects of tobacco use.
There are lots of ways to quit smoking including Nicotine Replacement Therapy (i.e. patches, gum, lozenges etc.), medication from your GP (i.e. Champix), and/or counselling. One method that I would not recommend is e-cigarettes/vaping. E-cigarettes/vaping have already been shown to increase your risk of cancer from the trace metals found in the exhaled water vapour, and increase your risk of "popcorn lung" a condition caused by the flavouring that causes severe breathless symptoms similar to that of emphysema. It may also interest you to know that most “vaping” companies are owned by tobacco companies as many see this as the future of cigarette smoking, despite being very aware of the harmful effects that they can have.
While it can be challenging to give up smoking and you will need some willpower, you don’t have to do it alone. Talking with a Stop Smoking Practitioner at your local Pharmacy or GP clinic, can help you through your stop smoking attempt and help answer questions about replacing your negative habits with positive ones, for example when craving a cigarette, take a short walk to clear your head and increase your dopamine secretion (the happy hormone).
It is recommended by the UK Chief Medical Officers to consume less than 14 units of alcohol per week, and include 2-3 alcohol-free days per week. Regular excess alcohol consumption increases the risk of developing a number of diseases including cancers of the mouth and throat, strokes, heart, liver and brain disease, and nervous system damage. Binge drinking (i.e. drinking more than 6-8 units in one session), can also increase the risk of accidents and injuries as well as increasing the risk for developing heart disease. Regular alcohol consumption can also have a dramatic effect on your weight due to excess dietary calories. For example, a single pint of 5% beer contains on average 250 calories, therefore, drinking just 4 pints of beer in an evening equals almost 1,000 excess calories. To help keep a track on your alcohol intake I would recommend the drinkware app or website (link below), or a very basic rule of drinking less than 7 alcoholic drinks per week.
Unit & Calorie Calculator - www.drinkaware.co.uk/understand-your-drinking/unit-calculator
SLEEP & STRESS
Poor quality sleep can be associated with a wide variety of lifestyle choices including diet, exercise, sleep quantity/quality/consistency, stress, hydration, stimulant intake, and medications. Your resilience to daily stress can be analysed by measuring your heart rate variability (HRV), to assess the balance between the two opposing sides of your autonomic nervous system (ANS). The two sides of your ANS are the fight and flight side, which acts like the body’s accelerator, and the rest and digest side, which acts like the body’s brake. When these two opposing sides are working in an even balance, blood flow to the pre-frontal cortex is increased (this is the area of the brain associated with rational decision-making and is where your memories of how you have previously dealt with stressful events before is kept). Having access to this information allows you to think more calmly and rationally when dealing with stressful situations and you are more likely to have a less angry or emotional response to stressors. This underlying ability to react to stress in a positive way is dictated by our lifestyle choices, with caffeine, alcohol, smoking, poor sleep hygiene, and stress all reducing this ability. Staying physically active, reducing sedentary time, and practicing mindfulness meditation can all improve your ANS balance and your ability to react to stress positively.
Another useful technique to improve your stress resilience and also help you switch off more easily is mindfulness meditation which involves long deep breaths in and out to help stimulate the two sides of the autonomic nervous system to work in better balance. The easiest way to start mindfulness meditation is with guided breathing techniques found with a number of mindfulness apps. I have included a link to one of the best called Calm and recommend practicing these techniques for a minimum of 1-2 minutes/day or whenever you are feeling more stressed or are struggling to switch off.
Calm (mindfulness Meditation) app - www.calm.com
Your lifestyle can greatly affect the quality and quantity of our sleep, which can hinder the body’s ability to enter the two main phases of sleep needed for the body to repair itself both physically and psychologically. When deprived of sleep, the release of the hormones leptin decreases and ghrelin increases leading to increased fat storage and sugar cravings; the immune system is impaired due to a decrease in natural killer cells; blood pressure is elevated increasing cardiovascular disease risk, and memory, cognitive performance, and judgement becomes impaired. To help improve your sleep hygiene there are a number of tips that can also improve your ability to fall asleep and enhance the quality of your sleep:
Reducing the use of electrical devices (e.g. TVs, mobiles, computers etc.) within 1 hour of your bedtime as this can affect your melatonin levels, which increases your urge to sleep and decreases alertness.
Cut out stimulants such as caffeine, alcohol and cigarettes after 4pm.
Try eating/drinking food or drink rich in tryptophan(e.g. warm milk, turkey, baked potatoes), as this can help to release the happy hormone serotonin helping you to relax.
Take a warm shower/bath before bedtime to help lower the body’s surface temperature, a key step in falling asleep.
Build a regular night-time routine to create a natural circadian rhythm. You should try not to deviate more than 1-1.5 hours from your weekday bedtime and waking time, as this can cause a large disruption to your natural circadian rhythm leading to your feeling the need to “catch up” on sleep during the weekend.
So what’s your healthy heart age? Click on the link below to calculate your QRisk (i.e. your risk of developing a cardiovascular event in the next 10 years), then follow the above advice to lower your risk and become the best version of you.
QRisk3 Calculator - https://qrisk.org/three/index.php
I hope you found this information helpful. If you have any questions about how the team at Eat Move Perform can help you with your own health, fitness, or performance goals then please get in touch and we’ll be more than happy to give our support and advice.