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A sudden, fatal heart attack in younger or middle-aged individuals can be incredibly distressing for both their families and the wider community. Years of extensive research have focused on understanding the causes of these tragic events, yielding notable progress. Nevertheless, heart disease still holds its position as the leading cause of death among humans, and the ongoing devastation caused by unexpected, fatal heart attacks remains a significant concern.
Media Hype and the Importance of Early Identification of Heart Attack Risk Factors
When a high-profile individual suffers an unexpected heart attack, the issue often gains significant media attention. After the tragic passing of Shane Warne in 2022, likely due to a heart attack, many people around his age sought cardiac check-ups. They were particularly after a specific test to ensure they weren’t at risk for a sudden heart attack. This rush was primarily driven by media headlines like “Best Test to Prevent Heart Attacks” and “A Test to Eliminate Surprise Heart Attack Risk,” accompanied by quotes from alleged experts.
A fatal heart attack represents the culmination of a process that has been developing for many years. Numerous risk factors, both environmental and hereditary, need to be present for years before a heart attack occurs. Early identification of certain genetic risk factors, such as Familial Hypercholesterolemia (FH) or elevated Lp(a) levels, can help modify them before they result in coronary disease. Thankfully, all environmental factors can be modified through education and lifestyle changes, including combating obesity, adopting a more active lifestyle, embracing a healthy diet, and avoiding tobacco use.
A wealth of research and actual patient experiences have demonstrated that adopting a “healthy lifestyle” can not only halt but even reverse the calcification of coronary arteries and the buildup of fatty deposits within arterial walls. This, in turn, lowers the risk of heart attacks and other vascular conditions, such as strokes.
The Fine Line Between Disease Prevention and Over-testing in Cardiology
In recent decades, the emergence of advanced imaging and lab technologies has led to a significant emphasis on “Disease Prevention” or “Preventive Medicine.” Cardiology is no exception, with prevention proving far more effective than treatment. However, it’s essential to understand that no single test can eliminate the risk of a heart attack or any other disease. There is a fine line between “disease prevention” and “over-testing.” Many cardiac tests, such as echocardiogram or stress echocardiogram, don’t require frequent repetition unless there’s a clear reason, like experiencing new symptoms or concerns. Concentrating on “tests” instead of promoting a healthy lifestyle can sometimes cause more harm and stress than benefits.
While tests like the coronary calcium score can be incredibly useful in determining an individual’s risk of a heart attack, they cannot be employed as “screening tools” for vast populations due to several limitations. If these caveats are disregarded, it can lead to negative consequences. Inappropriate ordering and misinterpretation of such tests can cause overdiagnosis, unwarranted invasive procedures, anxiety, and the unnecessary “medicalization” of patients.
A heart attack may still come as a surprise if someone continues to smoke and maintain an unhealthy lifestyle, irrespective of any “test” they undergo. Headlines such as “A test that can eliminate the risk of a surprise heart attack” promoted by some experts in the media can be both concerning and misleading. The sudden death of a public figure due to a “likely” preventable heart attack should not be used to endorse a single “test.” Rather, such unfortunate events should be leveraged as opportunities to advocate for healthy lifestyles and raise awareness about heart attack risk factors, which will ultimately prevent far more sudden heart attacks than any specific test.
What are the main risk factors for a heart attack?
Atherosclerosis is a progressive disease characterized by plaque build-up, a combination of fatty substances, cholesterol, calcium, and cellular waste, in the inner walls of arteries. This accumulation narrows and stiffens the arteries, restricting blood flow and reducing their flexibility. As a result, the supply of oxygen and nutrients to various organs and tissues can be compromised, potentially leading to severe health issues. Atherosclerosis is a primary cause of cardiovascular diseases, including heart attacks, strokes, and peripheral artery disease.
Studies have shown that various factors can speed up the development of “atherosclerosis,” resulting in early-onset cardiovascular diseases. These contributing elements are referred to as “risk factors,” which include:
|Major Risk factors for a Heart Attack|
|Hypertension (high blood pressure)|
|Strong family history of heart attack (in first degree relatives, men <55 and women <65 years of age)|
|Hyperlipidaemia (High cholesterol, High Lp(a) and very high Triglycerides)|
|History of inflammatory diseases like rheumatoid arthritis|
|Sedentary lifestyle and obesity|
Should you have any of these risk factors, it’s essential to undergo a few supplementary tests to assess your likelihood of developing early-onset coronary artery disease. The Coronary Artery Calcium Score (CAC score) and Lp(a) measurement are two widely recognized tests in this context. If either of these scores is significantly elevated, it indicates a substantially increased heart attack risk, independent of other risk factors.
What are the main components of a Healthy Lifestyle?
While modern medicine continues to make impressive strides, maintaining a healthy lifestyle remains the most effective method for preventing various illnesses and strengthening the immune system. The incidence of vascular diseases, such as heart attacks and strokes, is lower among individuals who engage in regular physical activity, consume a healthy diet, and abstain from smoking. To achieve a “healthy” lifestyle, there are a few critical factors to consider:
A quick online search yields countless pages on “the best diet.” The ideal diet is simple, enjoyable, and nutrient-rich.
The Seven Countries Study (SCS) was among the first to link diet and heart disease, examining populations with longer, happier lives. It showed that a healthy diet is pleasurable, diverse, and non-restrictive.
The SCS study’s lessons remain the foundation of a healthy diet, like the Mediterranean diet. Individuals who enjoy longer, more content lives consume more fruits and vegetables, use much olive oil, and avoid fast food. They eat small portions, savour drinks with meals, and don’t adhere to trendy diets. They eat when hungry, have early dinners, and fast until the next day. Simplicity is vital; the easier the plan, the more successful it will be.
Ultimately, the best diet for you is one that is sustainable, enjoyable, and meets your individual nutritional needs while promoting overall health and well-being.
|Crafting the "best diet"|
|Eat a variety of fruits and vegetables: Aim for at least five servings per day, opting for a range of colours and types to ensure a good mix of vitamins and minerals.|
|Choose whole grains: Replace refined grains with whole grains, such as whole-wheat bread, brown rice, and quinoa, which provide more fibre and nutrients.|
|Include lean protein sources: Opt for lean meats like poultry, fish, beans, lentils, tofu, and low-fat dairy products to meet your protein needs without excessive saturated fat.|
|Incorporate healthy fats: Favor unsaturated fats, found in foods like olive oil, avocados, nuts, and seeds, over saturated and trans fats.|
|Limit added sugars and processed foods: Minimize consumption of sugary snacks, beverages, and processed foods, which can be high in calories, unhealthy fats, and added sugars while lacking essential nutrients.|
|Elimination strategy: Implement this strategy by listing your food intake and removing unhealthy items. Often, this simple step is all that's needed. Refrain from purchasing unhealthy foods in the first place—make mindful choices when shopping.|
|Practice portion control: Be mindful of portion sizes to avoid overeating and maintain a healthy weight.|
|Cheat days: Designate a few days per week as "treat days" to enjoy indulgent foods like steak or fries. Reward yourself, but ensure you don't negate the progress made on healthier days.|
|Fasting: consider incorporating fasting, particularly overnight. Enjoy an early dinner and refrain from eating for 12 hours. Opt for a small snack like a biscuit or apple slice if hunger strikes.|
|Maintain consistency and positivity: Set achievable goals, such as losing 1 kg per month. You'll be amazed by the progress you can make in a year!|
Physical activity and exercise
Elevate your fitness routine with simplicity and consistency, as these elements are vital for success. Strive for at least 150 minutes of moderate-intensity exercise weekly to maintain a healthy lifestyle. Here are a few real-life examples of moderate-intensity exercises that you can easily incorporate into routines:
- Brisk walking: A 30-minute walk around your neighbourhood or local park at a pace that increases your heart rate and breathing.
- Cycling: A leisurely bike ride on flat terrain or cycling on a stationary bike at a moderate pace for 30 minutes.
- Swimming: Participating in a 30-minute low-impact water aerobics class or swimming laps at a moderate pace.
- Dancing: Attending a social dance class like Zumba, salsa, or line dancing for 30-45 minutes, maintaining a pace that elevates your heart rate.
- Gardening: Spending 30-60 minutes doing activities like raking leaves, weeding, or planting flowers, can increase your heart rate and help build strength.
- Hiking: Going on a nature hike on relatively flat terrain for 60 minutes or more, depending on your fitness level.
- Doubles tennis: Engaging in a friendly game of doubles tennis, which typically involves less running than singles and can be enjoyed for 60 minutes or more.
Remember that participating in any form of exercise is better than none, even if it’s just a short walk in the park. Walking is an easy, affordable, and effective way to stay active. To add more walking to your daily routine, consider parking your car farther from your workplace, enjoying a 15-minute walk to the office, or getting off the train or bus one stop earlier. These small, everyday activities accumulate, leading to substantial amounts of exercise over the week and enhancing your overall well-being.
“30 minutes of daily exercise” is the cheapest, safest and most effective “pill” you can take, with enormous physical and mental benefits.
A stressful lifestyle is often an underestimated risk factor for various diseases. Numerous young individuals in my practice have experienced heart attacks due to ongoing stress. The Seven Countries Study didn’t fully consider the fact that longer-living individuals, like those on the Greek island of Crete, were not only influenced by their diet but also by their contented way of life. They weren’t constantly striving for more, nor were they pressured by social media to alter their lifestyles. They were simply content, satisfied, and happy with their current situation.
Chronic stress can have a long-term impact on heart health. It’s essential to manage stress by incorporating relaxation techniques, engaging in regular physical activity, and consulting with a mental health professional. Taking these measures can lower the risk of heart attack and enhance overall health and well-being. Through my clinical experience, I’ve come to recognize that addressing daily stress in a timely and effective manner is crucial to avoid mental and physical exhaustion.
|Chronic daily stress can increase the risk of a heart attack in several ways:|
|Increased Blood Pressure: Stress increases adrenaline and cortisol, raising blood pressure.|
|Increased Heart Rate: In response to stress, heart rate can increase, increasing the heart's workload.|
|Inflammation: Chronic stress can cause inflammation throughout the body, including arteries. Inflammation is one of the main precursors of atherosclerosis.|
|Changes in Blood Sugar Levels: Stress can cause blood sugar levels to fluctuate, increasing the risk of diabetes.|
|Unhealthy Coping Mechanisms: Many people use unhealthy coping mechanisms to deal with stress, such as smoking, overeating, or drinking alcohol. These behaviours can increase the risk of heart disease.|
Smoking and the Importance of Smoking Cessation
Smoking is a major risk factor for heart disease, one of the leading causes of death worldwide. Numerous studies have demonstrated a strong connection between smoking and the development of cardiovascular diseases, including coronary artery disease, heart attacks, and strokes. In this section, we will explore the hazards of smoking, the benefits of smoking cessation, and its critical role in preventing heart disease.
Cigarette smoke contains over 7,000 chemicals, many of which are harmful and can damage the cardiovascular system. Some of the most harmful chemicals include nicotine, carbon monoxide, and tar. These chemicals adversely affect blood vessels, increase blood pressure, and accelerate the formation of atherosclerotic plaques, leading to a higher risk of heart disease and other cardiovascular events.
Nicotine, the addictive substance in tobacco, increases heart rate and constricts blood vessels, putting additional strain on the heart. Carbon monoxide reduces the oxygen-carrying capacity of the blood, forcing the heart to work harder to deliver adequate oxygen to the body’s tissues.
The Life-Saving Benefits of Quitting Smoking for Heart Health
Quitting smoking is one of the most effective ways to reduce the risk of heart disease. The benefits of smoking cessation are seen relatively quickly, and the risk of heart disease decreases significantly within just a few years of quitting. According to the American Heart Association, the risk of coronary heart disease is reduced by half just one year after quitting, and within 15 years, the risk approaches that of a lifelong non-smoker.
Smoking cessation not only lowers the risk of heart disease, but it also improves overall cardiovascular health and lung function and reduces the risk of other smoking-related diseases, such as lung cancer and chronic obstructive pulmonary disease (COPD). A comprehensive approach to quitting smoking may include behavioural counselling, nicotine replacement therapy, and/or medications to help manage withdrawal symptoms and cravings.
|How smoking increases the risk of a heart attack?|
|Damage to the lining of blood vessels (endothelium). This damage makes it easier for cholesterol and other substances to build up in the arteries, leading to atherosclerosis. Atherosclerosis can narrow and harden the arteries, reducing blood flow to the heart and increasing the risk of a heart attack.|
|Increased blood pressure: Smoking causes the blood vessels to narrow, which increases blood pressure. High blood pressure is a major risk factor for heart attack.|
|Increased heart rate: Smoking can also increase the heart rate, which can put additional stress on the heart.|
|Reduced oxygen supply: Smoking reduces the amount of oxygen that the blood can carry, which can put additional strain on the heart and increase the risk of a heart attack.|
|Increased risk of blood clots: Smoking can increase the risk of blood clots, which can block blood flow to the heart and cause a heart attack.|
Over the years, there has been an ongoing debate surrounding the cardiac benefits of Alcohol in the world of health and lifestyle. A topic that divides researchers, medical professionals, and the general public but has remained unresolved. But let’s explore when this debate began and the key points of contention.
The Controversy Surrounding Alcohol and Its Impact on Heart Health
The controversy started in the 1970s. At the time, a series of observational studies explored the relationship between alcohol consumption and heart health. One of the earliest, the famous “French Paradox,” revealed that the French population had a lower incidence of coronary heart disease despite consuming a diet rich in saturated fats. Many attributed this phenomenon to the moderate consumption of red wine in France.
Since then, numerous studies have investigated the potential health benefits of Alcohol, especially when it comes to cardiovascular health. While some research supports moderate alcohol consumption can lead to positive heart health outcomes, other studies have been more sceptical. This ambiguity is at the heart of the ongoing controversy.
Proponents of the cardiac benefits of Alcohol argue that moderate consumption (usually defined as one drink per day for women and up to two drinks per day for men) can provide some protection against coronary heart disease. For example, the antioxidants and polyphenols found in red wine have been linked to an increase in good cholesterol (HDL) and a decrease in inflammation, which can support overall cardiovascular health.
On the other hand, sceptics highlight the potential dangers of alcohol consumption, such as addiction, liver disease, and increased risk of cancer and cardiac arrhythmias. Some studies have even suggested that the relationship between alcohol and heart health may not be as straightforward, and any potential benefit may be due to the anxiolytic (anti-stress) effects of Alcohol, in general. Factors like genetics, lifestyle, and overall diet must be considered when evaluating the impact of Alcohol on heart health.
The Importance of Moderation
The debate over the cardiac benefits of Alcohol is far from being settled. As a result, many experts recommend that individuals who do not already consume Alcohol should not start for the sake of heart health alone. For those who do drink, moderation is key.
It’s important to note that, unlike moderate drinking, heavy drinking (more than three drinks per day or seven drinks per week for women and more than four drinks per day or 14 drinks per week for men) has been strongly linked to many cardiac and non-cardiac diseases. Examples of such diseases include:
|Heavy drinking can increase the risk of heart disease and a heart attack in several ways:|
|High Blood Pressure: Heavy drinking can raise blood pressure levels|
|Alcoholic Cardiomyopathy: Heavy drinking can cause alcoholic cardiomyopathy, a disease of the heart muscle that can weaken the heart and increase the risk of heart failure and heart attack.|
|Atrial Fibrillation: Alcohol consumption can also cause an irregular heartbeat (AF), which can increase the risk of blood clots and stroke.|
|Increased Triglycerides: Heavy drinking can increase the levels of triglycerides (a type of fat) in the blood, which can contribute to the development of atherosclerosis (a buildup of plaque in the arteries) and increase the risk of heart attack.|
|Weakened Immune System: Heavy drinking can weaken the immune system, making it harder for the body to fight off infections and inflammation that can contribute to heart disease.|
|Liver disease: Chronic heavy alcohol use can lead to liver cirrhosis, increasing the risk of heart failure and liver cancer.|
Do invasive cardiac procedures such as stenting or bypass surgery reduce the risk of a heart attack?
Invasive cardiac interventions like stenting or bypass surgery are often necessary for patients with significant coronary artery disease, but they are not a substitute for adopting and maintaining a healthy lifestyle. Comparing these procedures to a healthy lifestyle reveals different approaches to managing heart health and reducing the risk of a heart attack.
Invasive cardiac interventions:
- Stenting and bypass surgery are medical procedures aimed at improving blood flow to the heart muscle by opening or bypassing blocked or narrowed coronary arteries.
- These interventions are typically used for patients with stable angina, acute coronary syndrome, or significant blockages in multiple coronary arteries, where conservative treatment may not be sufficient.
- While these procedures can reduce the risk of a heart attack and improve symptoms, they do not address the root causes of coronary artery disease.
- A heart-healthy lifestyle focuses on preventing the development or progression of coronary artery disease by addressing modifiable risk factors.
- This approach includes regular physical activity, a balanced diet, maintaining a healthy weight, avoiding smoking, and managing stress.
- A healthy lifestyle can help reduce the risk of heart attack, stroke, and other cardiovascular diseases, as well as improve overall health and well-being.
While invasive cardiac interventions may be necessary in some cases, adopting and maintaining a healthy lifestyle remains essential for all individuals, regardless of whether they have undergone a cardiac procedure. A healthy lifestyle can not only help prevent the onset of coronary artery disease but also improve the long-term outcomes of patients who have already undergone stenting or bypass surgery.
It’s important to remember that each individual’s situation is unique, and the best approach to managing heart health depends on factors like the severity of coronary artery disease, overall health, and the presence of other medical conditions.
Ultimately, maintaining a healthy lifestyle with a balanced diet, regular exercise, stress management, avoiding tobacco use, and limited alcohol intake is the safest way to promote overall well-being and heart health. Moderation is key for those who choose to consume alcohol while understanding the numerous risks of heavy drinking.