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Heart Health and Your Risk

February 17th, 2009

February is Heart Health month so what better time to assess your risk of a heart attack or stroke.

Major Risk Factors for Heart Attack and Stroke

Age (>45 for men, >55 for women)
Family history of early heat disease (before 55 in your brother or father, before 65 in your mother or sister)
Cigarette smoking
High blood pressure (>140/90, or if you take medications to lower your BP)
Diabetes
Low HDL (good) cholesterol (<1.0 mmol/L for men and <1.3 mmol/L for women)
High LDL (lousy) cholesterol (>3.4mmol/L)
High C-Reactive protein (a marker of inflammation)
The metabolic syndrome (a combination of the following):

-abdominal obesity –men >40 inch waist, women > 35 inch waist)

-Tryglycerides: > 1.7mmol/L

-Low HDL cholesterol

-High Blood Pressure

-High fasting Glucose (>6.1-6.9 mmol/L)

What can you do?

You can’t change your age or your genetic predisposition but you can quit smoking. You can also lower your blood pressure by eating less salt, eating more fruit and vegetables, and choosing low fat dairy. Drinking moderate amounts of alcohol (1 drink for women or 1-2 for men/night) may increase your HDL. Eating less saturated fats and trans fats can help reduce your LDL cholesterol. This means eating less red meat, eggs, high fat dairy foods, pastries, pie crust, donuts, butter, cream and hard margarine. To lower your C reactive protein you can lose weight and quit smoking. It may also help to eat fish, soy foods and eat less trans fat, French Fries and soft drinks which have a high glycemic index.
A common link for all is if you are overweight and you lose weight you will lower your risk factors and therefore your risk for heart disease.What can you add to your diet? This is the fun part. Rather than always thinking about cutting out and avoiding, consider what you need to add. You may find you cut out the bad stuff more easily if you are feeling full and satisfied. Taking a positive approach can help with long term success.Add Soluble Fibre: Soluble fibre can help lower cholesterol by forming a special gel that binds with fat and other cholesterol and carries it out of the body. Oatmeal, oatbran, psyllium (Metamucil, All Bran, Guardian cereal), barley, fruits (apples and citrus fruit), vegetables (eggplant, okra) and legumes (kidney beans), flax seeds (7-13 g/day)Increase total fibre to 25-38g/day or more)

Add Plant Sterols: 2-3g per day. Foods supplemented with plant sterols are not available in Canada yet. Supplements of phytosterols are available such as Moduchol by Vivitas.

Add Omega-3 fats: fatty fish, canola, soybean and flax oil. Aim for 1.5g/day of vegetable oils (flax and soy), eat 2-3 servings of fish per week (which provides 500mg EPA/DHA per serving), include 1g of EPA/DHA daily from fish or a supplement (discuss this with your MD)

Dietary Patterns:
The Portfolio Diet: This diet contains 75g of fibre from fruits, vegetables, whole grains and legumes, nuts and seeds and is rich in soluble fibre, plant sterols, soy and nuts (almonds). This diet, although difficult to follow due to the high fibre content has been shown to lower cholesterol as much as statin drugs.

The Dash Diet:
A plant based diet with low fat dairy and a sodium restriction. Nutrients such as potassium, omega 3 fats, Co-enzyme Q10 and arginine may help lower blood pressure in some cases as much as pharmacotherapy.

Micronutrients:
B Vitamins (B6, B12, folic acid (folate) can help reduce homocysteine (a risk factor for heart disease) but may not lower risk for cardiovascular events.

Vitamin E: Mixed results

Antioxidants (Vitamin C, A, E, Selenium): In general from fruits and vegetables may be helpful for reducing cardiac risk but in recent meta analysis did not prove to be effective

The Bottom Line: Achieve and maintain a healthy body weight, quit smoking, exercise regularly, and eat your whole grains, fruits and vegetables, nuts and seeds, fish and fish oils, soy and legumes and limit your sodium. Limit saturated fats and trans fats and toss in the odd glass of wine for good measure if you wish and consider adding phytosterols.