How to protect your heart: part 1

Written by: Dr Amanda Varnava
Published: | Updated: 02/05/2024
Edited by: Aoife Maguire

If you believe you're too young to worry about your heart's well-being, you may think again. In England, premature deaths from heart diseases are at a decade-high, warns the British Heart Foundation. Your heart, the size of a fist, pumps five litres of blood daily, delivering nutrients and removing waste. Exercise alone isn't enough to maintain heart health.


In the first article of a two-part series, leading consultant cardiologist  Dr Amanda Varnava suggests strategies to improve your heart health and provides guidance for different life stages, with attention to issues that may arise in your twenties.



How much exercise should I be doing?


Around five hours of aerobic exercise per week is beneficial for heart health, but beyond that, the advantages level off and there's a risk of musculoskeletal issues. A minimum of 90 minutes of moderately vigorous aerobic activity per week is recommended.


Regular exercise may lower the risk of heart disease, possibly due to decreased stress-related brain activity. Researchers from Massachusetts General Hospital found that physical activity was particularly effective in reducing cardiovascular disease risk in individuals with depression, based on data from over 50,000 adults around age 60.


Is there such a thing as exercising too much?


If you exceed five hours of exercise daily and regularly participate in Ironman-style marathons, this can impact the heart. However, the long-term effects are uncertain. After such intense events, there's a release of troponin, a heart muscle protein, suggesting possible inflammation. Microscopic scars in the heart muscle and increased calcium in coronary arteries may appear on scans, but this doesn't necessarily indicate a higher risk of heart attacks. It's crucial not to over-interpret scan results and assume that these changes indicate heart disease in super-endurance athletes.


Are there any dangers associated with frequent marathon running?


In veteran athletes and lifelong marathoners or who frequently take part in endurance sport, there's an eightfold higher likelihood of atrial fibrillation, a common heart rhythm disorder. Atrial fibrillation can cause irregular and fast heart rates, potentially leading to blood clots and increased stroke risk if untreated. Despite this, endurance athletes typically enjoy longer lifespans compared to sedentary individuals. The message isn't that exercise is harmful, but rather that there might be an optimal level for health benefits.


If I have a heart condition, do I need to limit or stop exercising?


In the past, individuals with heart conditions were often advised against exercise, but now, more patients are encouraged to engage in physical activity after a thorough risk assessment with a cardiologist. However, there are exceptions, such as aortopathy and arrhythmogenic right ventricular cardiomyopathy (ARVC), which may pose risks during exercise. ARVC, in particular, could progress during physical activity, and there's a risk of progression even for those without the condition but carry the gene.


Can non-cardio exercise be beneficial?


Wall sits and planks, static resistance exercises, contribute to better blood pressure and overall heart health. They release nitric oxide, a neurotransmitter involved in blood vessel dilation, into the body, which is good for the lining of the arteries.  

Incorporate a variety of activities into your routine, including aerobic exercises, resistance training, as well as meditative practices like yoga and breathwork.


What is the best diet for optimal heart health?


Maintaining low inflammation alongside a healthy weight is crucial. A diet low in sugar and processed foods but rich in anti-inflammatory foods like fruits and veggies is recommended. Experts suggest consuming 30 different plants weekly, advocating for turmeric and beetroot juice, both known for their anti-inflammatory properties and health benefits, including reducing heart disease risk.


Are there any supplements that are good for high cholesterol?


For those with high cholesterol, plant esters like Benecol or 1.5g of plant sterol supplements daily are recommended. These can complement statins in lowering cholesterol but shouldn't replace prescribed medication. Additionally, adding omega-3 fatty acids through fish or supplements reduces cardiovascular mortality, while flaxseeds suit vegetarians.


What foods would you recommend for those with raised blood pressure?


If you have high or borderline high blood pressure, the Dash (Dietary Approaches to Stop Hypertension) diet can be helpful. Dash foods are rich in the minerals potassium, calcium and magnesium and the diet focuses on vegetables, fruits and wholegrains. It includes fat-free or low-fat dairy products, fish, poultry, beans and nuts and limits foods that are high in salt, sugar and saturated fat.


What should I be aware of in my twenties and thirties to help my heart health?


It’s unlikely that you’re going to have high blood pressure, high cholesterol or diabetes at this stage of life. However, if you’ve got a strong family history of any of those conditions, you need to be checked. The first question to ask should be, do I have a family history of premature (before 50) heart disease? If your parents, grandparents, aunts or uncles have a heart condition or died suddenly under 50, talk to your GP about whether you need screening.


What can I do to manage blood pressure from a young age?


Managing stress is crucial. Recognising physical and psychological stressors early is vital, as they can contribute to conditions like high blood pressure. Symptoms like palpitations often indicate stress. A 2020 study in the American Journal of Cardiology revealed that meditation correlated with reduced risks of various health issues, including high cholesterol, high blood pressure, diabetes, stroke, and coronary artery disease, even after adjusting for various factors like age, sex, and depression. This underscores the importance of stress management through practices like yoga or meditation.


When do I need to start worrying about atrial fibrillation?


Risk of arrhythmias increases significantly after age 70. The most effective way to diagnose them is through an electrocardiogram (ECG). For those experiencing palpitations lasting several minutes, a cardiac rhythm monitor like Kardia or the ECG feature on the latest Apple Watch is recommended. You should regularly check your pulse, especially for those with risk factors like high blood pressure. A normal resting heart rate ranges from 60 to 100 beats per minute; however, in atrial fibrillation, it can exceed 140 beats per minute.


How can I safeguard my heart health in midlife?


Monitoring weight distribution is crucial, not just overall weight. Women with a waist measurement exceeding 35 inches (89cm) and men with over 40 inches (102cm) indicate unhealthy belly fat levels. High waist circumference is linked to diabetes risk and peri-organ fat accumulation, leading to artery inflammation and potentially triggering coronary heart disease, affecting 2.3 million people in the UK. This condition occurs due to fatty substance buildup in arteries, causing symptoms like chest pain. Regular monitoring and management of waist circumference are essential for heart health.




If you are concerned about your heart health and would like to book a consultation with Dr Varnana, do not hesitate to do so by visiting her Top Doctors profile today.

By Dr Amanda Varnava

Dr Amanda Varnava is a leading London-based consultant cardiologist and head of the Department of Cardiology at Imperial College Healthcare Trust. Her area of expertise is in inherited cardiac conditions, sudden death, collapse and sports cardiology. She established the Inherited Cardiac Conditions specialist clinic at Hammersmith Hospital, Imperial College Healthcare Trust and leads the Pregnancy and Heart Disease Service at Watford General Hospital. She is an expert in sports cardiology and one of the few national experts in this field. Dr Varnava sees many athletes (both professional and amateur) and is the cardiologist to a number of professional football teams including Arsenal, Watford, and Fulham FC.


Dr Varnava qualified from Oxford University and then St Bartholomew's Hospital with triple honours. She then undertook specialist cardiology training at some of the leading cardiac centres in the UK, including St George's Hospital, Royal Brompton Hospital, and The London Chest Hospital. Dr Varnava took up her consiltant post in 2005. She has a very active research programme and is an Honorary Senior Lecturer at Imperial College London. Dr Varnava's research into inherited cardiac conditions is published in leading cardiology journals, and she regularly speaks at national and international conferences.

Dr Varnava runs a paediatric screening service at St Mary's Hospital and sees patients from 12 years onwards in her private practice. 

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