A build-up of fatty deposits (known as atherosclerotic plaques) causes narrowing of the arteries, restricting blood flow to the heart muscle. Heart attacks are usually caused by fatty plaques rupturing leading to a blood clot that blocks an artery.
Risk factors for developing heart disease include: high blood pressure; high cholesterol; obesity; a thick waist measurement; type 2 diabetes; smoking; a sedentary lifestyle; and some inherited conditions. Collectively some of these risk factors are known as metabolic syndrome.
This most common symptom of CVD is a type of chest pain called angina. It is generally triggered by physical exertion, when oxygen demand increases and is described as a dull, heavy or tight pain in the chest (some describe it as being like a severe form of indigestion) that can spread to the arm, neck, jaw or back. Typically, the pain lasts a few minutes. This is known as an angina attack and around two million people are affected.
Other symptoms of CVD can include heart palpitations and breathlessness. If the heart muscle is damaged your heart can start to beat abnormally, this is called an arrhythmia. However, often the first symptom of heart disease will be a heart attack or stroke.
A doctor will take a medical history and examine you. Standard tests for heart disease include checks on your blood pressure, cholesterol, weight, waist measurement and blood sugar, and questions about your activity levels and whether you smoke.
You might then be sent to a cardiologist (heart specialist) for more tests. These can include an electrocardiogram (ECG) to measure the activity of your heart and to check for any damage; an echocardiogram which uses ultrasound to check how the heart is functioning; a radionuclide test where you are injected with a harmless radioactive substance to see how the blood flows to your heart; a coronary angiogram where a dye is injected into your coronary arteries to highlight them on X-rays; a CT scan to show the amount of calcium in the arteries (an indicator of heart disease); or an MRI scan to produce clear images of the heart for signs of disease.
Who gets heart disease?
You are at increased risk if there is a history of CVD in your family, you are overweight or obese, particularly if you are ‘apple-shaped’( with fat stored around your middle), have high blood pressure or unhealthy cholesterol levels, you smoke, have type 2 diabetes, don’t exercise, have a diet high in saturated or trans fats and sugar. Stress, heavy drinking, and sleep apnoea (a disorder that disrupts normal breathing) are also implicated as putting you at increased risk.
Risks increase for men over 45 and women over 55. Heart attacks, however are three times more common in young men than women. After menopause, the risk becomes the same for men and women. Some ethnic groups appear more at risk, including British Asians.
Lifestyle changes are important. Keeping your weight down by eating a heart-healthy diet with omega 3 oils like oily fish and at least five (but ideally 10)portions of fruit and vegetables a day and taking regular exercise will help. Reducing your alcohol consumption and giving up smoking are also important.
Drugs called statins can be prescribed to lower cholesterol; anti-platelet medicines including aspirin or clopidogrel and anti-coagulants (blood thinners) to reduce the risk of blood clot. Blood pressure-lowering medication, including ACE-inhibitors to block hormones which raise blood pressure and calcium channel blockers to relax and widen your arteries, may also be prescribed, as well as nitrates to relax the coronary arteries, allowing more blood to reach the heart and prevent angina attacks.
If medication and lifestyle changes aren't enough you might need surgery. Options include the insertion of stents to widen narrowed arteries and coronary artery by-pass grafting where veins or arteries from other parts of the body are used to bypass narrowed arteries.
Taking omega 3 fish oils could potentially be helpful for heart function. Results from 11 clinical trials, involving over 15,000 people with a history of heart cardiovascular disease showed significant protective effects with a 25 per cent decreased risk of a heart attack, and a 32 per cent lower risk of a fatal cardiac event. Garlic supplements reduce cholesterol and dilate the arteries to reduce blood pressure in the arteries. Aged garlic extracts (e.g. black garlic), can reduce the level of soft plaque present in coronary arteries in people with metabolic syndrome who are at high risk of heart disease.
Other supplements that could help support heart health include the tomato seed extract Circulease®, magnesium, plant sterols, co-enzyme Q10, vitamin K2, and vitamin D3.