It is funny, but nobody ever asks me that question. Doctors love to talk about cardiovascular risk (i.e. your risk of having a heart attack or a stroke). Patients often get very upset if their cholesterol is a little bit out of range, or their blood pressure is too high, but patients and doctors are often coming at cardiovascular risk from different angles.
High cholesterol and high blood pressure are not really diseases; only in really extreme cases do they cause any symptoms. They are risk factors. When we look at these measurements, we shouldn’t just be looking at the numbers themselves, we should be saying “what is the risk of this person having a stroke or a heart attack in the next 10 years”?
So for example, if I have a 30 year old whose cholesterol is a bit high and is slightly overweight, but has normal blood pressure, doesn’t smoke, and has no family history of heart disease or stroke, I would be encouraging him to eat healthily, lose a bit of weight and do some exercise. On the other hand, I could have a 60 year old patient with the same cholesterol measurement, who has smoked for 45 years, has a father who died at 62 of a heart attack, and who is borderline diabetic. And for him, I would be rapidly writing a prescription for a statin (a cholesterol lowering drug).
Most doctors use “risk calculators” these days, which can help to explain risk to patients. However, the numbers produced can often be quite hard to understand. Pictures and diagrams are really helpful; I often use a program called QRISK-2. Once you have put all the information into that system, it comes up with a little picture of 100 people, and a certain number of them will be coloured red. From this, it is easy to see that if there is only one red person, your cardiovascular risk is low, but if one out of every 5 people is coloured red, your risk of having a heart attack or a stroke is high and we need to be tackling your risk factors in a serious way.
So what are these risk factors and how can we address them if we want to live to a ripe old age?
Well, your family history is one of them, but sadly you cannot do much about that. If all your family members have strokes in their 60s, then your risk is higher. Likewise, your ethnicity contributes, for example if you are from a south Asian background, then your risk of heart disease is higher.
Most risk factors can be improved however, through your own actions. Smoking is the biggest risk factor and if you don’t smoke, you are already off to a good start.
For all your other risk factors, such as high blood pressure, high cholesterol, obesity and diabetes (which obviously is a disease in itself, but is also a major risk factor for cardiovascular disease), the actions you need to take are the same.
Firstly, exercise regularly. We should all be aiming for 30 minutes exercise five days a week. Does it sound a lot? The best way to exercise, and to sustain it, is to fit it into your normal schedule. Walk to work, walk to the shops, take the stairs instead of the lift, go out for a bike ride at the weekend, try out one of Luxembourg’s wonderful swimming pools, get a dog, put on a pedometer; the options are endless and exercise does not have to involve lycra and lots of sweat!
Secondly, eat healthily and watch your weight. Go for a Mediterranean style diet; loads of fresh fruit and vegetables, olive oil, fish, chicken, and pulses. Avoid too much red meat, high fat dairy, processed foods and sodas. Choose complex carbohydrates (i.e. the wholemeal, brown ones) rather than white bread, white rice and white pasta. Watch your portion sizes; most of us take in more calories than we burn off and we need to alter the equation from both sides. Yes, be more active, but reduce the amount on your plate as well and the weight will come off more easily.
Drinking too much alcohol can have a harmful effect on the heart. It also increases your blood pressure and contains loads of calories so will pile on the weight. Adding salt to your food also increases your blood pressure.
It may seem like a lot to think about, but if you can make small changes and stick with them, these changes will not only protect your heart, and reduce your risk of a stroke, but will keep you fitter and more active for longer, and also protect you from various different cancers.
Patients in Luxembourg love to come for their regular “check-ups” and blood tests. As I explain to my patients, there is not much point in having a check-up unless you are going to act on the results…
Go on, give it a try!
By Susie Tunstall-Pedoe, June 2014