How to protect your heart: part 2

Written by: Dr Amanda Varnava
Edited by: Aoife Maguire

In the second 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.



Should I be wary about drinking at any age?


Even if you adhere to the NHS guidelines (no more than 14 units per week), alcohol can directly harm the heart muscle. Abstinence is advisable for heart failure patients. Excessive alcohol intake increases atrial fibrillation and high blood pressure risks. A California study, which observed the drinking habits of 430,000 adults between 18 and 65, none of whom were teetotal showed a correlation between alcohol consumption and heart disease, particularly among women, due to raised blood pressure and inflammation.


How much coffee can I drink?


Drinking two to four cups of coffee daily is on balance, a positive thing, due to its antioxidant and anti-inflammatory properties, as shown in a 2022 study by the European Journal of Preventive Cardiology. Researchers discovered that individuals consuming this amount had a reduced risk of cardiovascular disease and premature death compared to non-coffee drinkers among 450,000 participants averaging 58 years old. However, caution is advised for those prone to vasovagal syncope, where excessive caffeine intake, especially without proper hydration, can lead to symptoms like dizziness, lightheadedness, and nausea, often seen in young individuals not balancing caffeine with sufficient water intake.


Should I be on a statin if I’m over 75?


By age 75, it's expected that your QRISK3 cardiovascular risk score surpasses 10%, warranting consideration for a statin. QRISK3 evaluates numerous risk factors including age, gender, ethnicity, blood pressure, cholesterol, BMI, smoking, migraines, mental illness, and various medical conditions. A score below 10% indicates low risk, translating to less than a 1 in 10 chance of a stroke or heart attack in the next decade. A score of 10% or higher suggests statin use, leading to a significant 25-35% reduction in stroke or heart attack risk.


At what age should I start taking my blood pressure?


It is recommended that you regularly monitor your blood pressure, especially if you have a family history of hypertension, even if you’re in your twenties. Around five million UK adults have undiagnosed high blood pressure, detectable only through testing. Testing can be done at a clinic, pharmacy, or home, with NHS suggesting checks at least every five years, increasing to annually by your forties. Invest in a quality upper arm monitor like Omron for £20-£30, ensuring accurate readings by uncrossing your legs. Aim for an average reading below 135/85mmHg in the UK or below 130/80mmHg in the US, particularly for those under 50.


Can long-haul flights negatively impact heart health?


You should consult a cardiologist before long flights if you have a heart condition or history of heart attack or stroke. Essential items for flights include flight socks and ample water. The UK Civil Aviation Authority advises waiting 7-10 days after an uncomplicated heart attack, 3 days after successful artery unblocking, and at least 2 weeks after a stroke to fly. Prolonged immobility during flights can increase blood clot risk; counteract by walking and stretching every few hours.


What should men in midlife be conscious of when it comes to their heart?


Erectile dysfunction (ED) warrants holistic consideration. When psychological causes are excluded, it may indicate underlying coronary artery disease risk, linked to atherosclerosis. Atherosclerosis restricts blood flow, affecting erections due to narrow penile arteries, often presenting as an early warning sign. Midlife onwards, ED may signal reduced penile blood flow, possibly due to cholesterol buildup. Manage blood pressure and cholesterol, and quit smoking to reduce ED risk. Certain medications like beta blockers or diuretics can cause ED, while PDE5 inhibitors can aid two-thirds of ED cases. Holistic assessment and lifestyle adjustments are key in managing ED and potential cardiovascular risks.


If a young person has high cholesterol, what should they do?


Distinguishing between high and very high cholesterol levels is crucial. Levels exceeding 7.5 with bad cholesterol (low-density lipoprotein LDL) at 4.5 may indicate familial hypercholesterolaemia, affecting 1 in 250 individuals, necessitating referral to a lipid clinic for genetic testing and tailored treatment. Moderately raised cholesterol requires consideration of age and risk factors for initiating lipid-lowering therapy, typically involving statins reducing cholesterol by 40%. Newer treatments like inclisiran can lower LDL levels by around 50%. Weight reduction can decrease cholesterol by 8-10%, but diet changes have a modest 2-4% impact. Genetic predisposition plays a significant role in cholesterol levels, outweighing dietary influences.


I’m a menopausal woman on HRT ― have I put my heart health at risk?


Earlier research hinted at potential harm to the heart from hormone replacement therapy (HRT), but Varnava contends this is outdated. She sees no grounds to discourage HRT use, anticipating forthcoming data to potentially demonstrate its heart benefits. While not typically prescribed for heart health, Varnava notes HRT's neutral stance for most individuals.


Do I need to limit my salt intake if I’m otherwise young and healthy?


For those under 30, excessive salt intake isn't a major concern, but generally, it's wise to limit it. Processed foods are the primary source of salt. The recommended daily limit for adults is less than 6g, approximately a teaspoon. However, if you have low blood pressure and experience fainting or lightheadedness, increasing salt intake may be advised.


Concerns about circulation, typically manifesting as cold extremities, are usually attributed to Raynaud's syndrome, distinct from heart issues and managed independently, posing no risk for heart disease.




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. 

View Profile

Overall assessment of their patients

  • Related procedures
  • Heart attack
    Hypertension (high blood pressure)
    Heart failure
    Injury valves
    Heart murmur
    Ambulatory electrocardiogram (Holter)
    This website uses our own and third-party Cookies to compile information with the aim of improving our services, to show you advertising related to your preferences as well analysing your browsing habits. You can change your settings HERE.