February is typically the month we highlight heart disease, paying attention to all the issues involved with this killer of Canadians. And interestingly, we choose to devote the entire month, not just a day here and there, to focus on important messages, advocacy around care and education for the public.
While we may be afraid of breast cancer, passionate about brain health and motivated around osteoporosis, it is heart and stroke that will kill one out of three Canadians each year. That statistic demands our attention, our vigilance and our understanding in order to change that paradigm. We, as a population, are frightened of unknown viral diseases, and rightly so. But let’s not be complacent about our number one enemy, just because it is familiar. We must do better.
So what are the risks and how do we change them?
There are a number of risks we cannot alter. We cannot alter our family history, our genetic risk. We are born of one sex and risks are different for females and males. We cannot change aging as we all inevitably age.
But what can we change? The number one, most important, undeniable truth is that smoking kills. Even one to two cigarettes a day doubles your risk of a heart attack. There is no safe lower limit, no “small amount that won’t kill me,” no “just this once.” If you do nothing further, quitting smoking is the most important heart healthy behaviour I can recommend.
Let’s look at the other risk factors that are modifiable.
Hypertension or high blood pressure (BP) has been known as the silent killer as often patients have no symptoms, unless suddenly it’s very high or very low. Most doctors take blood pressure measurements on every visit for patients over 50. But don’t wait for your doctor. You can take your BP at most pharmacies or you can purchase a home cuff and an automated machine so that there are no surprises. While the number may vary, generally the goal is 140/90 or lower. It is different for different ages and situations but control of BP is essential. If you have high BP and are on medication, please follow instructions! The most perfect drug, well tested and well established will only work if you take it.
Hyperlipidemia or high cholesterol means too much fat in your blood. Partly that is from diet, eating foods that are fatty or from animal sources, about 30 per cent. There is also a genetic component where your liver produces too much cholesterol and even avoiding all animal fats will not have an impact. Yes, there are good components and bad components to cholesterol, the HDL, or high density lipoproteins and the LDL or low density lipoproteins. Bottom line, after much research, you need a low LDL to be healthy. Those with underlying risk, such as a previous heart attack or diabetes, need that LDL to be excessively low so there is less risk of another heart attack. So either through diet, exercise, weight loss or with the support of appropriate drugs, lowering cholesterol lowers risk.
Diet, weight and exercise are a trio of behaviours that seem to me to fit together. Those of us that are at an ideal weight, exercising regularly and eating a heart healthy diet in general are less likely to have a heart attack or stroke. And I absolutely believe that none of us are perfect! We all want to indulge occasionally and that is fine. What is not fine is when that indulgence becomes a regular habit.
We tend to have sedentary lifestyles in North America compared to other parts of the world. We drive rather than walk, we sit at a desk all day and then rush home, perhaps grabbing fast food on the way. Our overall life has become very hectic. But as I have said to patients and in my book, unfortunately, hectic does not equal aerobic. So let’s make some good choices, becoming more active on a daily basis, not just an occasional class at the gym. Let’s meet a friend for an exercise class or dance class or yoga or a hike, not for lunch, which typically starts with bread and butter!
February is heart month and we need to pay attention, as if our life depends on it. And it does.
For more information, this issue is discussed in my book A Woman’s Guide to Healthy Aging. There is also an excellent guide by Dr. Beth Abramson, a well-respected cardiologist at Toronto’s St Michael’s Hospital called Heart Health for Canadians. So no excuses, no accepting the phrase, “I just didn’t know.”