Mon 30 May_l 2016
Many patients who undergo coronary artery bypass surgery or stents often make the assumption that they are cured. This could not be further from the truth. Whilst stents or coronary bypass surgery can improve the symptoms of angina, and reduce the risk of heart attack in the short to medium term, the cause of furring up of the heart arteries continues to occur; this process is known as ATHEROSCLEROSIS.
Stents can be used to hold open blockages in the coronary arteries, but over time these stents can in themselves also become blocked. In addition, the furring can continue in other parts of the heart arteries leading to blockages in previously untreated areas. Surgery does offer better longer term results than stents, but even following bypass grafting, new disease can produce recurrence of symptoms and risk of heart attack.
There are many factors that work together to cause atherosclerosis. In order to slow down, or even halt the ongoing risk of atherosclerosis, these cardiac risk factors must be corrected to prevent further heart problems.
Smoking is a potent mediator of injury to the endothelium and there is no escaping the fact that both active and passive smoking (someone else’s exhaled smoke) promotes atherosclerosis. Smoking is also strongly linked to early ageing, lung disease, and many different cancers. There are many useful ways to help you stop smoking and we will dedicate a whole session on this topic in a subsequent newsletter.
There is not much we can do to change our genetic makeup, for now anyway. Having said this, family history can be very valuable in assessing patients at risk of heart disease where screening can then be used to avoid catastrophic consequences of significant silent heart disease. We will discuss more about cardiac screening in a subsequent newsletter.
We recommend that patients learn to measure their own blood pressure using devices which can be purchased online or on the high street. High blood pressure can be related to many lifestyle factors such as stress, obesity, lack of exercise and genetics. If modulating controllable factors does not reduce blood pressure effectively, then modern medication is very effective indeed.
Diabetes is a condition where the blood sugar is inappropriately high, either as a result of a lack of the hormone Insulin, or as a result of an altered response to Insulin. If you are a diabetic, then tight control of your blood sugar is vital. If you have developed diabetes in later life, the usual causes are again lifestyle factors, poor diet and obesity. Much can be done to correct this with dietary changes and weight loss. We strongly advise the assistance of a specialist dietitian in modifying diet related cardiac risk in diabetes.
High cholesterol in itself is not the complete story when it comes to heart disease risk. My mother was recently diagnosed with hypertension and her cholesterol was over 8mmol/L. As she was breathless, we performed CT Coronary Angiography (non-invasive scan of the heart arteries). Surprisingly, her heart arteries were completely normal. The reason for this is that cholesterol is carried in the blood stream as packages inside lipoproteins. A certain type of lipoprotein, called Low Density Lipoprotein (LDL) is the one involved in deposition of cholesterol into the arterial wall. My mother’s LDL levels were not high. So whilst we always aim for total cholesterol to be less than 4mmol/L, we are also interested in the levels of LDL in the body. Diet is really critical in assisting to lower cholesterol but we also prescribe lipid lowering agents called Statins to assist in this endeavour (more about these drugs in a later Newsletter).
Our bodies are remarkably good at tolerating dietary indiscretions from time to time. Relentless abuse on the other hand is not well tolerated. We should all be eating less sugar and salt in our diet, and good portions of vegetables and fruits are essential. Oily fish (such as salmon) seem to reduce cardiovascular risk as a result of high omega 3 content. We will be dedicating a whole newsletter to dietary advice in due course.
Exercise is an essential activity which promotes youthful appearance and vitality, and effective exercise regimes do not have to be very taxing. Twenty to thirty minutes of exercise each day, consisting of a brisk walk for example, is easily achievable. You must always discuss strenuous activity with your doctor before embarking on an exercise regime when you have been diagnosed with heart disease. Gradual and consistent progress is the key here.
Stress is very damaging to our bodies and can play a significant role in continued atherosclerotic risk. We still do not really understand how this occurs, but stress raises blood pressure, exposes our bodies to sustained release of damaging hormones like adrenaline and cortisol, and promotes adverse behavior which can be harmful to our health (alcohol and binge eating!). Relaxation with meditation, and exercise are very powerful antidotes for this often underestimated health risk.
If you really want to change your cardiovascular risk, you must reduce the risk of developing atherosclerosis by controlling exposure to these potent risk factors RIGHT NOW:
We will look at many of these action points in more detail individually in subsequent communications.
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