Love your heart

Your lifestyle could damage your heart

Be good to your heart
Heart healthy lifestyle

Most people take cholesterol lowering drugs to prevent heart disease (known as primary prevention). The rest take them to avoid another heart attack having already had one (secondary prevention).

There’s little doubt that it makes a difference when used to prevent a second heart attack. But there is strong disagreement over just how much they benefit people without heart disease.

Could simple lifestyle changes - such as eating an apple a day - be an effective alternative? 

The finding about apples came from scientists at Oxford University. They did a mathematical analysis of studies that showed how much fruit and vegetables in general helped cut heart disease.

They worked out that the benefits to everyone over 50 taking statins (cholesterol lowering drug) were about the same as if these people ate a portion of fruit or veg every day (it doesn’t have to be apples). There would be 8,500 fewer heart disease deaths with eating apples, and 9,400 fewer deaths if everyone took statins.

The researchers concluded it was an impressive demonstration of how effective a simple change in diet could be. But they also said it showed a massive increase in statin use could be worthwhile.


Should I only ever eat apples, then?

Everyone agrees that eating more fruit and vegetables is beneficial but experts strongly disagree about to whom it is worth giving statins. When it came to making their calculations about the benefits of statins, the Oxford researchers used a study published last year.

This found that even patients at low risk of heart disease benefited from statins, and the known side-effects, such as serious muscle problems and diabetes, happened to fewer than one in 1,000.

Independent studies suggest that you have to treat as many as 5,000 low-risk patients over 60 years of age to prevent just one death from heart disease.

‘If you massively expand statin use among people at low risk, all you are going to do is to drive a huge increase in the number of people suffering side-effects,’ said Dr Abramson.

I have high cholesterol, so do I need a statin?

Statins are certainly effective at lowering cholesterol, but questions are being asked about whether that actually affects heart disease risk.

Studies show that 75 percent of people admitted to hospital with their first heart attack have normal levels of cholesterol. Drugs that only lower cholesterol, unlike statins which have other effects such as reducing inflammation, have never been shown to cut heart disease.

Statins should be used to treat people at real risk. They now recommend paying special attention to diabetics (who are at higher risk of heart disease); they also lower the level of risk at which others should be treated.

Why not just switch to a healthy low-fat diet?

Following a low-fat diet and especially keeping saturated fats to a minimum has been a cornerstone of heart disease prevention for decades. But it, too, is being increasingly challenged.

‘This advice has, paradoxically, increased our cardiovascular risk,’ says Dr Malhotra. ‘In fact, saturated fat has been found to be protective. Vitamins A, D, E and K all need fat to carry them and to be effectively absorbed.’

Although he prescribes statins because the evidence shows they benefit heart attack patients, he also recommends a Mediterranean diet - rich in olive oil, nuts, oily fish, fruit and vegetables and a moderate intake of red wine.

Recently, a major clinical trial involving more than 7,000 people and lasting five years compared it to a low-fat diet and found it can prevent about 30 percent of heart attacks, strokes and deaths from heart disease, reported the researchers in the New England Journal of Medicine.

Other research has shown every additional portion of fruit and veg you have a day lowers your risk of heart disease by 4 percent, says Aidan Goggins, a pharmacologist specialising in nutritional medicine at the University of Surrey.

As well as eating apples, what else should I do?

Omega 3 fish oil could be the answer, as it helps with many of these active risk factors - which is why drug companies are looking at the oils with interest.

As well as fruit and veg, plenty of other foods come with calculated heart benefits. Every additional 10g of dietary fibre you have a day reduces the risk of cardiovascular problems by 17 percent. And each serving of nuts (up to four a week) reduces it by 8 percent. Two servings of wholegrains a day reduces the risk by a whopping 26 percent.


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