Basic Heart Health

Heart disease remains the leading cause of death in the industrialised world. It saturates the news and touches nearly every family — all from a single fist-sized organ. The encouraging part is that most heart disease comes down to a small number of processes, and most of those processes respond to things within your control.

How the heart feeds itself

The heart is supplied with oxygenated blood by the coronary arteries. If flow through these arteries is disturbed, heart cells cannot work efficiently and may become permanently damaged. Most commonly this happens through a process called atherosclerosis.

Atherosclerosis explained

Atherosclerosis begins when immune cells in the artery wall scavenge fat and cholesterol from the bloodstream. Initially this is normal metabolic housekeeping. Over years, however, these cells accumulate and form fatty plaques within the artery wall.

Two things can then go wrong. If a plaque grows large enough, it physically restricts blood flow — producing chest pain on exertion (angina). More dangerously, a plaque can rupture, exposing its contents to the bloodstream and triggering a clot that blocks the artery abruptly. That is the mechanism behind most heart attacks.

A degree of plaque builds up in almost everyone with age. Diet, smoking, blood pressure and blood sugar determine how fast.

Diet and your arteries

Saturated fat. Found mainly in butter, cheese, fatty and processed meats, and many baked goods, saturated fat raises LDL cholesterol. UK guidance suggests no more than about 30 g a day for men and 20 g for women. Replacing it with unsaturated fats — olive oil, rapeseed oil, nuts, seeds, avocado, oily fish — lowers cardiovascular risk more effectively than simply cutting fat.

Fibre. An indispensable and widely under-eaten part of the diet. Soluble fibre binds bile acids in the gut, prompting the liver to pull cholesterol from the blood to replace them. Aim for around 30 g a day from oats, beans, lentils, fruit, vegetables and wholegrains — most UK adults manage under 20 g.

Salt. Under 6 g a day. Most comes from bread, sauces and processed food rather than the salt cellar.

Oily fish. Two portions a week, one of them oily — salmon, mackerel, sardines, herring.

The Mediterranean pattern. Consistently associated with lower rates of heart disease: abundant vegetables, fruit, pulses, wholegrains, nuts and olive oil, moderate fish, and little processed meat or refined sugar. No single diet suits everyone, but this is the best-evidenced pattern available.

Beyond diet

• Stop smoking. Smoking damages the artery lining and dramatically accelerates plaque formation. It is the single most valuable change most people can make.
• Move regularly. 150 minutes of moderate activity a week, plus muscle-strengthening twice weekly.
• Watch alcohol. No more than 14 units a week, spread out.
• Sleep. Persistently short or poor-quality sleep is independently linked to raised blood pressure and cardiovascular risk.
• Know your numbers. Blood pressure, cholesterol and HbA1c are all silent until they aren't.

Warning signs

Call 999 for chest pain or pressure lasting more than 15 minutes, particularly with breathlessness, sweating, nausea or pain spreading to the arm, jaw or back. See your GP for chest discomfort that comes on reliably with exertion, new breathlessness on ordinary activity, or swollen ankles.

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Related reading: blood pressure and lifestyle.

This article is for general information and does not replace personalised medical advice.