Coronary heart disease (CHD) is the leading cause of death in the UK, looking after our hearts is very important! However, at recent conference(1) it was disclosed that almost half of us (48%) do not know what CHD is, recognise the symptoms or know what increases the risk. I hope to provide a little insight here.
CHD covers two main issues, heart attack and angina (severe chest pain). “Coronary heart disease occurs when the coronary arteries (the arteries that supply blood and oxygen to the heart muscle) become narrowed by a gradual build-up of fatty material within their walls. This condition is called atherosclerosis and the fatty material is called atheroma. In time, the artery may become so narrow that it cannot deliver enough oxygen containing blood to the heart muscle, particularly at times when there is more demand -such as when you are exerting yourself. The pain or discomfort that happens as a result is called angina. If the atheroma becomes unstable, a piece may break off and lead to a blood clot forming. If the blood clot blocks the coronary artery, the heart muscle is starved of blood and oxygen and may become permanently damaged. This is known as a heart attack.”(2)
The symptoms of CHD are varied and can include: shortness of breath, palpitations/irregular heartbeat, chest pain, jaw pain, arm pain, dizziness, fainting.
Risk factors are also varied and include: smoking, unhealthy/unbalanced diet, overweight, obesity, lack of exercise, excessive alcohol consumption, emotional/psychological stress, social isolation, diabetes and high blood pressure. The good news is that relatively simple dietary and lifestyle changes can protect the heart.
A fantastic resource that I highly recommend is The British Heart Foundation website. There you can read, in detail, about risk factors, dietary advice and you can also download factsheets and information booklets. There is a section dedicated to CHD prevention, which is key, it covers diet, weight, diabetes, cholesterol, smoking, diabetes, family history, stress and counselling.
Today I just wanted to cover a few points in relation to diet and heart health.
Fruit and Vegetables
The recommendation to consume vegetables and fruit for protection from heart disease is supported by an ever-growing body of evidence. Much evidence is drawn from studies linking higher consumption of vegetables and fruit to a lower risk of CHD (e.g. 3,4,5). I would like to highlight one of the most recent studies(6). The researchers found that that the benefit of fruit or vegetable consumption in reducing the risk of CHD increased proportionally by the number of servings consumed. Those consuming the most fruit (more than five portions per day) had a 60% lower risk for coronary heart disease when compared to those eating one or fewer portions per day. Consumption of vegetables more than three times daily was associated with a 70% lower risk of CHD compared to individuals who did not eat vegetables. Consumption of fruits and vegetables really does seem to provide significant protection against coronary heart disease! So Tuck in!
Vegetables and fruit are probably acting to protect against CHD through a variety of relevant substances including numerous vitamins and carotenoids, minerals, phytonutrients (bioactive plant chemicals) and fibre. Many plausible mechanisms can explain how these various nutrients or bioactive constituents in vegetables and fruit can prevent CHD. Try and include a variety of different vegetables and fruits in your daily diet. Each meal can contain a portion or two e.g. chop fresh fruit, or sprinkle a handful of unsweetened dried fruit into museli or yoghurt at breakfast time, include a side salad with lunch, snack on fruit or vegetable sticks rather than cereal bars, biscuits or other refined foods and aim to include at least two types of vegetable with your evening meal.
Supplemental vitamins and minerals
Taking vitamin and mineral supplements should not be seen as a substitute for a healthy diet. Supplements are void of many other substances found within fruit and vegetables which may be useful in CHD prevention such as phytochemicals (bioactive plant chemicals) and fibre. However, there is a lot of evidence that has looked at specific nutrients in the prevention of CHD (too much evidence to list), vitamins such as the B vitamins, vitamin E and D, antioxidant vitamins such as vitamin C and many carotenoids and minerals such as magnesium and selenium may be useful protective agents. If you feel that your diet is not rich in a variety of vegetables and fruits (at least 5 a day) you may wish to consider taking a broad-spectrum multivitamin and mineral supplement to ensure an adequate supply. There are so many available supplements, it can be a mind-boggling experience trying to choose a product! If you do decide to go down the supplement route I would recommend what are known as ‘food state’ multivitamin and mineral supplements. These are easily absorbed by the body and are produced from food sources, rather than the usual chemical-isolate form of product.
Incorporating wholegrain foods into the diet may help to reduce the risk of CHD. Whole grain foods (e.g. corn, barley, rye, oats & rice) in their most un-refined and natural form are rich sources of fibre, antioxidants, vitamins, minerals and phytonutrients, all of these probably act together to help protect the body against CHD. Many studies demonstrate that the consumption of whole grain foods may help to reduce the risk of CHD (e.g. 7,8,9). I would like to stress the importance of UN-REFINED foods. There are many products that now advertise the fact that they are wholegrain but they may also be loaded with added sugar and have a high GI, high glycaemic index (i.e. they release sugar quickly into the bloodstream) and I certainly wouldn’t recommend their inclusion into the daily diet. Be label savvy and look at the ingredients to see what you are buying.
Check back later this week for more heart healthy tips in Part II
(1)British Pharmaceutical Conference 2008 http://www.bpc2008.org/
(2)British Heart Foundation http://www.bhf.org.uk/
(3) Rissanen TH et al. 2003. Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. J Nutr. 133(1):199-204.
(4) Liu S et al. 2000. Fruit and vegetable intake and risk of cardiovascular disease: the Women’s Health Study. Am J Clin Nutr. 72(4):922-8
(5) Joshipura KJ et al. 2001. The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med. 134(12):1106-14
(6)Nikolic M et al. 2008. Fruit and vegetable intake and the risk for developing coronary heart disease. Cent Eur J Public Health. 16(1):17-20.
(7)Jacobs DR et al. 1999. Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women’s Health Study. Am J Public Health. 89:1-8
(8)Rimm EB et al. 1996. Vegetable, fruit and cereal fibre intake and risk of coronary heart disease among men. JAMA. 275:447-451
(9)Liu S et al. 1999. Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study. Am J Clin Nutr. 70:412-419
Written by Ani Kowal