Heart attacks are one of the leading causes of death in the UK. With as many as 30,000 out-of-hospital cardiac arrests occurring each year, survival rates can be as low as 1 in 10. It’s the severity of such medical events that means it’s important to not only recognise the symptoms of a heart attack but to understand how you can reduce your risk of falling victim.
Survival rates are significantly increased for those whose cardiac arrests occur in a hospital environment, and indeed, around 1.4 million of the UK’s current residents are heart attack survivors.
The simplest way to increase your likelihood of falling into this category is to educate yourself on what the symptoms of a heart attack look like, as immediate medical treatment is essential for those who are suffering or about to suffer a cardiac arrest.
According to the NHS, tell-tale signs include:
• Pain in your chest, which can feel like you’re being pressed down on by a heavy object, and which may radiate outwards to your jaw, neck, arms, and back
• Shortness of breath
• A feeling of weakness or lightheadedness
• An overwhelming sense of anxiety
In less common cases, this chest pain may not feel overly severe – closer to indigestion than a life-threatening condition – which is why it’s important to get yourself checked out if you experience any combination of these symptoms.
While it’s essential to recognise these signs, however, awareness is not the only way to increase your chances of survival – perhaps even more importantly, there are a number of preventative measures you can take which will reduce your risk of falling victim at all.
One of these is diet. An essential component in maintaining good cardiovascular health, this can significantly reduce your chances of suffering a heart attack, and one type of diet, in particular, has been shown to be beneficial: veganism.
The most important fact with regards to getting this right is ensuring that you’re eating a properly balanced menu – one that consists of at least five portions of fruit and veg; high-fibre, starchy foods like potatoes and rice; dairy or dairy alternatives; and proteins like beans, fish, and meat.
While this means that you don’t have to follow a vegan diet to improve your cardiovascular health, it is nonetheless recommended as the best option with regards to preventing heart problems, and there are numerous studies to support this claim.
Indeed, one particularly interesting piece of research indicated that following a vegan diet can impact gene patterns, turning on over 500 disease-preventing genes, while turning off those that are linked to breast cancer, heart disease, prostate cancer, and numerous other illnesses.
This science is supported by a slew of observational studies, which compared vegans and vegetarians to the general population. These similarly discovered that vegans are around 75 percent less likely to develop high blood pressure, and have a 42 percent lower risk of dying from heart disease.
Several randomised controlled studies have provided further evidence of this trend, by indicating that vegan diets are more effective in reducing LDL cholesterol, blood sugar, and total cholesterol levels, which all act as heart attack risk factors. In reducing these, the incidence of heart disease and cardiovascular issues is lessened by around 46 percent.
Interestingly, there is an additional factor that has been attributed to the cardiovascular benefits associated with veganism: that this type of diet is rich in whole grains and nuts – both of which support a healthier heart.
In fact, so beneficial are these for your body, that three one-ounce servings of whole grains daily can lower your risk of heart disease by an impressive 22 percent. Nuts, similarly, offer many benefits, including a reduction in cholesterol levels, which has the knock-on effect of lessening a person’s chances of suffering a cardiac arrest.
Consisting of plant-based products, a vegan diet has many surprising advantages, including much-improved health and longevity. A simple and effective way to reduce the dangers associated with cardiac arrests, it is well worth looking into for those who would prefer to stay happy, healthy, and free of heart problems as they age and move forward with their life.
If you are not yet ready to become a full-blown vegan, increasing your intake of plant-based foods, whole grains and good fats found in oily fish, nuts, seeds, avocados and olive oil and reducing your intake of meat and unhealthy fats (saturated and trans fats) is still likely to significantly reduce your risk of developing cardiovascular issues.
So, let's take a closer look at some of the key foods believed to be of benefit to cardiovascular health and what is thought to make them so: -
Leafy greens – Dark green leafy vegetables like spinach, kale, and cabbage are well purported for their numerous health benefits, cardiovascular health being one of them. Leafy green veg are rich in vitamin K, which helps to protect the arteries and encourage proper blood clotting, also preventing a build-up of calcium in the arteries. (Vermeer, 2012; Maresz, 2015). Leafy greens are also high in dietary nitrates which have been found to lower blood pressure, decrease arterial stiffness and improve the function of cells lining the blood vessels (Kapil et al, 2015). Studies have found a correlation between increased leafy green consumption and reduced incidence rates of heart disease. In one review of 8 studies, findings indicated reduced rates of heart disease amongst those increasing their consumption of leafy greens by up to 16% (Bendinelli et al. 2011).
Whole grains – whole grains like brown rice, quinoa, buckwheat, and oats are high in fibre, which may reduce LDL (bad cholesterol) and decrease the risk of heart disease. A review carried out by Aune et al (2016) of 45 studies, concluded that 3 servings of whole grains per day resulted in 22% lower risk of developing heart disease.
Good fats – Gone are the days when fat was seen as the bad guy. In fact, there is significant research to suggest that good fats or essential fatty acids are beneficial for cardiovascular health. Foods particularly rich in essential fatty acids include avocados, oily fish, walnuts, seeds, and olive oil. Increasing our intake of these ‘good fats’ has been found to reduce LDL cholesterol (bad cholesterol), reduce blood pressure and decrease oxidative stress and inflammation, which may also impact on cardiovascular health, overall lessening our chances of developing cardiovascular disease. In one particular study 324 people ate salmon three times per week for 8 weeks and at the end of the study were found to have significantly decreased diastolic blood pressure (Ramel, 2010).
Berries – Berries are rich in antioxidants like anthocyanins which help to protect the body and cardiovascular system from oxidative damage. Studies have shown that eating berries can reduce many risk factors associated with heart disease. In one review of 22 studies, eating berries was associated with a reduction in LDL cholesterol, systolic blood pressure, body mass index and inflammatory markers (Huang et al, 2016)
Beans – Beans contain resistant starch, which is resistant to digestion and is fermented by the good bacteria in the gut. Research has found consuming resistant starch to be effective in lowering LDL and triglycerides, also reducing blood pressure and inflammation, which are factors associated with the risk of developing heart disease. (Winham et al, 2007; Bouchenak & Lamri-Senhadji. 2013)
Dark chocolate – Chocolate with a high cocoa content is rich in antioxidants like flavonoids found to be beneficial to heart health. That’s right, you don’t have to give up your favourite treat. In fact, one large study found that those eating chocolate 5 times per week had a 57% reduced risk of coronary heart disease than non-chocolate eaters (Djousse et al, 2011). But make sure you choose good quality dark or raw chocolate with a high cocoa content, rather than the milky, sugary chocolate widely available.
Tomatoes – Tomatoes, particularly when cooked are rich in lycopene, the pigment that makes them red which also has powerful antioxidant properties. Low blood levels of lycopene have been linked to increased risk of heart attacks and strokes (Karppi, et al, 2012).
Garlic – Thanks to its allicin content, garlic has been found to reduce LDL cholesterol, reducing the risk of blood clots and stroke by improving blood flow and lower blood pressure. In fact, one study taking garlic extract in doses of 600–1,500 mg daily for 24 weeks was found to be as effective at lowering blood pressure as prescription medication. (Ashraf et al, 2013). When consuming garlic, it is best to either eat it raw or crush it and leave it to sit for a while before cooking to allow the allicin to be released, providing these health benefits. Although cooking reduces the therapeutic effects of garlic, crushing before cooking lessons the impact, therefore retaining a good proportion of the benefits. Also, the less time garlic is cooked for the better, so adding garlic towards the end of cooking is advisable to maintain its health benefits. (Cavagnaro et al, 2007; Olson, 2018)
Green tea – green tea is rich in polyphenols and catechins which act as antioxidants to prevent cell damage, reduce inflammation and protect heart health. Studies have demonstrated a link between green tea consumption and reduced blood pressure, LDL cholesterol, total cholesterol, and triglycerides. Matcha green tea, made with the whole tea leaf is thought to be of particular benefit (Bogdanski et al, 2012)
Limit salt intake – too much salt has been found to increase blood pressure and therefore have a detrimental impact on cardiovascular health. However, common table salt is made up of predominantly sodium chloride and anti-caking agents. There is a train of thought to suggest that consuming more pure forms of salt, such as pink Himalayan salt, which does not contain additives and has a balance of minerals in it more akin to a humans natural mineral composition has a less detrimental impact on health and the cardiovascular system and may, in fact, be positive, lowering blood pressure rather than raising it. More extensive research is needed to confirm or refute this claim, but it is an interesting concept that appears logical.
Blood sugar balance – A certain amount of glucose circulating in our bloodstream is perfectly normal and necessary. Insulin then allows sugar to enter our cells to provide energy. However, too much sugar in the bloodstream, or too little insulin can eventually cause damage to blood vessels and therefore increase a person’s risk of developing coronary heart disease. Thankfully, there are some simple dietary adjustments we can make to maintain blood sugar balance, such as eating protein with every meal, eating whole grains and avoiding refined carbohydrates or too much sugar. This slows down the release of glucose into the bloodstream, providing much healthier and more sustained energy supply and reducing the risk of damage to the blood vessels (BHF, 2019)
Avoid excessive alcohol consumption – studies show that regular light to moderate alcohol consumption (up to 1 drink per day for women and 1-2 drinks per day for men) decreases total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke occurrence. However, higher levels of alcohol intake are associated with an increased risk of cardiovascular disease. (O’Keefe, 2014). It is therefore important to consider alcohol intake and not exceed the recommended levels.
Lifestyle changes
Reduce stress levels
Our bodies are resilient and have the ability to cope with stress to a point, particularly short bursts of stress. However, in modern society, too many people are chronically stressed over prolonged periods and this can be hugely detrimental to our overall health and cardiovascular health. A review by Dimsdale (2008) confirmed the relationship between prolonged stress and adverse effects on the heart. Thankfully, there are many ways to help manage stress and the potential impact it can have on wellbeing. Eating the right nutrients, gentle exercise, yoga, mindfulness and Epsom salt baths may all be helpful in returning us to our relaxed state and therefore help to prolong our cardiovascular health.
Observational studies have linked ongoing low water intake with increased risk of adverse cardiovascular events. It is currently unclear exactly how lack of fluids increases the risk of cardiovascular events, but there is evidence that poor hydration may reduce endothelial function, increase sympathetic nervous system activity (our fight or flight stress response) and impact on blood pressure regulation (Watso & Farquhar, 2019). The stress on the body caused by poor dehydration further impacts on cardiovascular health (as above). This then creates a vicious circle because dehydration causes stress and stress causes further dehydration and impacts on electrolyte balance. Tea, coffee, and alcohol should be consumed in moderation due to their diuretic properties which may exacerbate dehydration[LS1]
Avoid smoking
The detrimental effects of smoking and passive smoking on human health is now something we are all familiar with. Studies show that those exposed to smoking have a higher risk of high blood pressure, strokes and heart attacks. This is because nicotine causes blood vessels to tighten, restricting blood flow. It also increases the risk of blood clots which may result in pulmonary embolism (Pietrangelo and Cherney, 2017)
Maintain a healthy weight
Maintaining a healthy weight is an important part of maintaining good cardiovascular health. “Excess weight and obesity are associated with an increased risk of cardiovascular diseases. This is a consequence on the one hand of obesity itself and on the other hand of associated medical conditions (hypertension, diabetes, insulin resistance, and sleep apnoea syndrome) “ (Csige et al, 2018)
Take regular exercise
Exercise and getting the heart pumping helps to maintain cardiovascular health by controlling blood pressure, increasing HDL (good) cholesterol levels and helping to manage weight. (Care of, 2019)
Recommended nutritional supplements
Omega-3 fatty acids have been found to support lower blood pressure, better lipid profiles, including lower triglycerides, and a reduced risk of death from heart disease (Mohebi-Nejad & Bikdeli, 2014). This is thought to be largely due to their anti-inflammatory properties. However, there is contradictory research with other studies refuting this claim. Hooper et al (2018) carried out an extensive systematic assessment of the effects of omega‐3 fats on cardiovascular health. Moderate‐ and high‐quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). They concluded that previous suggestions of benefits from EPA and DHA supplements appeared to have stemmed from trials with a higher risk of bias. Low‐quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality, and arrhythmia.
Peskin (2010) theorised the reason for these inconsistent results was because many of the studies are based on supplementation from Essential fatty acid derivatives, or oils that have been processed in such a way that they lose their therapeutic value. He argued that supplementation with, what he referred to as Parent Essential Oils, meaning the whole, unadulterated oil in its natural form. According to Peskin, the human body then creates its own derivatives of the oil as and when required but supplementing with derivative essential fatty acids may lead to overdosing in derivatives and be detrimental rather than beneficial to human health. This is an interesting concept that could potentially explain the inconsistent study results.
One study suggested Krill oil may be more effective in supporting cardiovascular health than fish oil. This is thought to be due to krill oil differing structurally and potentially being more bioavailable as a result. One study by Bunea et al (2004) compared the impact on cardiovascular health markers of krill oil, to fish oil and a placebo. The study concluded krill oil to be more effective for the management of hyperlipidemia by significantly reducing total cholesterol, LDL, and triglycerides, and increasing HDL levels. At lower and equal doses, krill oil was significantly more effective than fish oil for the reduction of glucose, triglycerides, and LDL levels.
From a Nutritionists perspective, it is important to consider the quality and purity of omega 3 supplementation. Some fish oils can be of poor quality, highly processed and a potential source of contaminates for example. Krill oil is also worth considering as an alternative supplement for cardiovascular health.
Sea buckthorn oil
Studies have found Sea Buckthorn oil may lower blood pressure, lower cholesterol and help to prevent blood clotting.
A recent study tested the impact of 0.75ml daily supplementation of Sea Buckthorn oil over a 30-day period on cardiovascular risk factors, hypertension, and systolic blood pressure.
Results of the study revealed normalisation of blood pressure in the hypertensive subjects, a significant reduction in cholesterol, oxy-LDL and triglycerides in hypercholesteraemic subjects and improved circulatory antioxidant status, demonstrating the efficacy of sea buckthorn oil on cardiovascular health. (Vashishtha et al, 2017)
Another small study looked at the impact of sea buckthorn oil supplementation on blood clotting. 12 men were given 5 grams of sea buckthorn oil or coconut oil per day. After 4 weeks, the men in the sea buckthorn group had significantly lower markers of blood clots (Johansson et al, 2000).
The cardiovascular health-enhancing properties of sea buckthorn oil are thought to be due to its combination of essential fatty acids and its phytosterol content, especially beta-sitosterol. More research is however needed to gain a more detailed understanding of the role sea buckthorn oil has on cardiovascular health. (Olas, 2018)
Green tea is rich in antioxidants called catechins which research has shown to be cardioprotective. In one study, significant cardiovascular benefits were observed when participants consumed 5-6 cups of green tea per day (Wolfrum, 2007). Green tea is also available in supplement form.
Pomegranate juice has been found to help reverse atherosclerosis and lower blood pressure (Stowe, 2011). However, more research is required on the impact of pomegranate on cardiovascular health in order to confirm these initial findings.
Magnesium
Research suggests supplementing with magnesium may reduce blood pressure and improve overall cardiovascular health. Oral magnesium acts as a natural calcium channel blocker, increases nitric oxide, improves endothelial dysfunction, and induces direct and indirect vasodilation (Houston, 2011). There are various forms of magnesium supplements available. Magnesium oxide, although relatively inexpensive is less bioavailable, meaning we are unable to utilise it very effectively. Then different forms of magnesium are recommended, depending on the purpose. For cardiovascular health, a magnesium glycinate supplement may be more appropriate. Glycinate is bioavailable, helps to reduce blood pressure and aid cardiovascular health and is less likely to impact on the digestive system than other forms, such as citrate. (Wu, 2019).
Potassium
Potassium may help to offset the rise in blood pressure resulting from a high salt diet, as well as improving overall heart function. Magnesium and potassium taken in combination has been shown to be more effective than when they are taken in isolation (Houston, 2011). Both magnesium and potassium displacement would be improved with a good night’s sleep as the sodium-potassium pump re-alkalises our cellular fluids.
CoenzymeQ10 (CoQ10, or ubiquinone) is a chemical that plays an important role in enabling our cells to extract energy from food. Because the heart is the hardest working muscle in your body, it’s essential that your heart has a constant supply of CoQ10 so it has energy to do its work. This chemical decreases with age and low cholesterol also depletes it.
Taking CoQ10 supplements has been found to reduce oxidative stress and increase antioxidant enzyme activity, relieving symptoms of cardiovascular disease. (Lee et al, 2012). However, CoQ10 is not very easy for the body to utilise. Ubiquinone is a more bioavailable form of CoQ10 which has been shown to be more effective.
Statins can deplete CoQ10, therefore anyone taking supplements may wish to consider supplementation.
Astaxanthin
Astaxanthin is an antioxidant that is known for giving many fish and shellfish their bright pink colour. Recent clinical studies suggest astaxanthin supports cardiovascular health and helps maintain cholesterol levels already within a normal range.
In a 2011 double-blind, placebo-controlled study on 27 overweight subjects, astaxanthin was shown to lower LDL cholesterol (Choi et al, 2011). In 2010, results from a randomized, double-blind study of 61 non-obese subjects showed reduced triglyceride levels for the astaxanthin group. Additionally, the study showed increased HDL (good) cholesterol (Yoshida et al, 2010)
Probiotics
Probiotics have been found to help lower blood pressure and circulating lipids known as triglycerides (Bronzato & Durante, 2018).
Low Vitamin D levels have been associated with the occurrence of coronary artery disease, heart failure, and atrial fibrillation. (Bronzato & Durante, 2018) In the UK vitamin D deficiency is common due to our need for sunlight on our skin to synthesis the nutrient. It is therefore advisable to get your vitamin D levels checked and supplement if necessary.
Disclaimer: Please note, none of this information is intended to diagnose or treat and it is important you seek guidance from a suitably qualified health practitioner should you have any concerns about existing health conditions and possible interactions with prescribed medication. (changed a little as you can buy a cod liver oil without medical advice).[LS2]
But how important really is cholesterol to cardiovascular health?
The common denominator in most research on cardiovascular health is that cholesterol is used as a marker to indicate cardiovascular disease risk and the efficacy of much of the above recommendations is measured on the impact these foods have on reducing cholesterol levels, amongst other markers. But is high cholesterol a reliable indicator of increased cardiovascular risk? A more recent comprehensive review controversially concluded either a lack of an association or an inverse association between LDL-C and both all-cause and CV mortality (Ravnskov, 2016). Although there have been questions about the methodology and reliability of this review, it certainly highlights the need for further research in this area to be clear on how much of impact cholesterol may have on cardiovascular health.
Another consideration regarding cholesterol is that sometimes only total cholesterol is measured, rather than individual readings of LDL, HDL, and triglycerides. If for instance total cholesterol is high, but mainly consisting of HDL (Good Cholesterol), research suggests that this could potentially be cardioprotective.
Research also suggests that dehydration can impact on lipid profiles, increasing both LDL and HDL. Dehydration does not appear to have much if any impact on triglyceride levels. (Campbell et al, 1994)
What other considerations may potentially impact on cardiovascular health?
Acidic Toxicity
Osteoporosis affects more women than men due to the rate of bone turnover increasing after menopause. This is largely due to the lower levels of oestrogen and its bone-protective effects, but also to the accumulation of toxins and subsequent tissue acidity that can occur once menstruation ends. Calcium is used to buffer this acidity and becomes misplaced, deposited in soft tissues and joints rather than utilised by bones. Calcification of joints and arteries (arteriosclerosis) occurs in both men and women in the same way
The common mainstream method for addressing this issue is to supplement with calcium at this stage, however, evidence suggests that this should be avoided to prevent speeding up hardening and furring of the arteries (Kruszka, B et al. 2016). .
A more beneficial approach could arguably be to address this acidity and calcium misplacement by using the right foods to alkalise the body and maintain the correct levels of nutrients requires for correct calcium utilisation.
Increasing alkalising foods in the diet, like certain fruit and vegetables and reducing more acidic foods, such as dairy, meat, caffeine, and alcohol is a great start. Juicing and smoothies are helpful in increasing the volume of these foods and nutrients in our diet. Wholefoods, particularly fruit and vegetables are low in sodium and high in potassium. This ratio (potassium being higher than sodium) is vital for the heart to properly pump blood through the body[AW3] . If sodium levels are too high, stiffening of the arteries results, leading to hypertension. Processed foods, on the other hand, tend to be low in potassium and high in sodium, therefore the increasing trend to consume more of these foods in the western world may be contributing to increased levels of cardiovascular disease.[LS4]
Vitamins and minerals key to effective calcium absorption, placement and bone health also need to be optimal, as discussed above. These include Vitamin D, Vitamin K, magnesium, boron, zinc, vitamin C and proline.
Interestingly, the average western diet includes more than the RDA of calcium but is deficient in magnesium. Magnesium is a relatively safe supplement and therefore arguably more beneficial in addressing the issue of calcium displacement and any resulting cardiovascular issues than calcium supplementation and the risks that come with it. It is thought that magnesium and potassium supplements taken in combination are more effective than when taken in isolation.
We have discussed at length the role and benefits of vitamin D and its potential link with mitochondrial function (the powerhouses of our cells) and ATP production in a previous blog. Optimal mitochondrial function is vital for our cardiovascular health too, so as well as playing a big part in proper calcium absorption, vitamin D influences cardiovascular health potentially by playing a huge part in mitochondrial health. However, a few words of caution, please get your vitamin D levels checked before embarking on a supplement regime. Too much vitamin D can also lead to calcium in the blood (hypercalcemia), potentially exacerbating cardiovascular issues. Optimal levels are what we should be aiming for. A qualified Nutritional Therapist will be able to provide you with guidance as to the appropriate supplementation levels for you. (are there any words of caution to suggest no more than 1000 – 2000iu daily or supportive research), I could always ask the HFMA why they don’t sign off more than 1000iu..[LS5]
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[LS1]I have added this in relation to dehydration but the research re caffeine consumption per se actually suggests it may reduce the risk of heart disease ….. We know it dehydrates though so fine in this context
[LS2]You can but I still wouldn’t recommend it if someone were on blood thinners for example…
[AW3]Strong statement, are you happy with this or would you like to be less certain?
[LS4]Changed slightly but pretty happy with the rest
[LS5]No, because I often prescribe up to 8,000 iu’s per day if client is deficient but only for a short time scale, then re-test and drop to maintenance level and everyone synthesises at different rates so impossible to guess someone’s need without testing. I can spend all my time indoors and still have pretty good levels for example, but another NT friend of mine who spends all her time outdoors is often deficient without supplementing with high levels….
