Heart disease and stroke account for almost 40% of deaths in Ireland, killing over 10,500 people here in 2004.* Lifestyle plays a major part in the development of heart disease and stroke. For example, an unhealthy diet can place you at risk as it can lead to obesity (being overweight) and can cause high cholesterol levels. Obesity currently accounts for at least 2,500 deaths in Ireland each year.**

Smoking is also a major cause of heart disease and smokers are twice as likely to have a heart attack as non-smokers. The risk of heart disease also increases for people who get little or no physical exercise.

However the good news is that the risk of developing heart disease and stroke can be significantly reduced or even prevented by taking various steps towards better heart health. Taking these steps should help you to feel better and to live a longer, healthier life.

* Central Statistics Office Ireland
** www.healthpromotion.ie
www.irishheart.ie

What are heart disease and stroke?

The heart is a muscular pump that constantly pumps blood around your body. Because it works very hard, the heart itself needs a good blood supply to its muscles. Small tubes called the coronary arteries carry blood containing oxygen and nutrients to the heart muscle. Narrowing of the coronary arteries makes it difficult for blood to reach the heart muscle and can lead to heart disease. A person with heart disease may experience chest pain called angina, especially after exercising.

If an artery leading to the heart muscle becomes completely blocked, it is called a heart attack. During a heart attack cells in the heart muscle may die because they are starved of vital oxygen and nutrients.

Like the heart, the brain is also supplied with arteries to feed it with oxygen and nutrients. If an artery leading to the brain is completely blocked, brain cells may die and brain damage may occur - this is known as a stroke.

What are the risk factors for heart disease?

A number of factors which cause heart disease and stroke have been identified. Some of these are factors you have no control over, eg. your age or gender. These are known as 'non-modifiable' risk factors.

However there are also many 'modifiable' risk factors which you do have control over, e.g. high cholesterol, high blood pressure and smoking. By controlling your modifiable risk factors you can reduce your overall risk of developing heart disease or stroke. You can find out more about your modifiable risk factors on the following pages.

Non-modifiable risk factors

• Family history. Has a close relative died of heart disease?
• Gender. Are you male?
• Age. If you are male, are you over 40?
• If you are female, are you over 50?

Modifiable risk factors

• High cholesterol
• Smoking
• High blood pressure
• Obesity (being overweight)
• Lack of exercise
• Diabetes. Do you have diabetes?

Source: European Society of Cardiology Guidelines.

Cholesterol

One of the best ways to prevent heart disease is to keep your cholesterol at a healthy level and prevent it from getting too high.

As having high cholesterol is not something you can just feel or see, many people don't realise that they have unhealthy cholesterol levels which are putting them at risk.

This is why it is so important for people who may be at risk of developing heart disease or stroke to have their cholesterol levels checked regularly. This can be done easily by a GP or hospital clinic.

What is cholesterol?

Cholesterol is a soft, fatty, waxy substance which is found in the blood and plays many important roles in the human body. We need a certain amount of cholesterol to produce the cells in our bodies e.g. cells in our brain, nerves and skin.

We get cholesterol from two sources:

• it is produced inside the body by the liver
• it also found in some foods we eat including meat, poultry, fish, seafood, eggs, and dairy products.

While some cholesterol is essential to our well-being, high levels have been strongly linked with an increased risk of developing heart disease and stroke.

Are there different types of cholesterol?

The word 'cholesterol' is often seen as being negative but there are 'bad' and 'good' forms of cholesterol.

Guidelines for healthy levels of cholesterol have been developed by the European Society of Cardiology and can be found on the following pages.

LDL ('bad') cholesterol

LDL (low-density lipoprotein) cholesterol is known as the 'bad' form of cholesterol. Too much LDL cholesterol in the blood tends to stick to the walls of arteries. This can build up over time causing a 'plaque' to form. The plaque hardens the walls of the arteries and makes it more difficult for blood to get through.

If an artery leading to the heart muscle becomes completely blocked, it is called a heart attack.

If an artery leading to the brain is completely blocked, brain cells may die and brain damage may occur - this is known as a stroke.

» LDL cholesterol should be 3 mmol/l or lower

HDL ('good') cholesterol

HDL (high-density lipoprotein) cholesterol is known as healthy or 'good' cholesterol because it removes LDL cholesterol from the walls of the arteries. This helps to prevent heart disease.

» HDL cholesterol should be 1 mmol/l or higher

Total cholesterol

This is the sum of all the cholesterol in your blood, including LDL and HDL cholesterol. The higher a person's total cholesterol, the greater their risk for heart disease.

» Total cholesterol should be 5mmol/l or lower

Triglycerides

Triglycerides are another type of fat which is found in the blood and used by the body to provide energy.

» Triglycerides should be 2 mmol/l or lower

How can I get my cholesterol tested?

A simple blood test can provide the information that you and your doctor need to know about your cholesterol levels.

Your GP or a hospital clinic will take a blood sample. You may need to fast for 12 hours beforehand to get an accurate result.

The results will provide information about your levels of LDL, HDL, total cholesterol and triglycerides. Your doctor will discuss the results with you.

Smoking

Smoking is a major cause of heart disease and 7,000 people die from the effects of tobacco each year in Ireland.* Cigarette smoke contains carbon monoxide, a poisonous gas which reduces the amount of oxygen in the blood and forces the heart to work harder. Smoking increases LDL cholesterol and causes narrowing of the arteries. It also causes many cancers and breathing conditions.

* www.ash.ie
www.irishheart.ie

High blood pressure (hypertension)

Blood pressure is a measure of the force of the blood pushing against the walls of the arteries. If a person's blood pressure is too high this is known as hypertension.

Hypertension can cause silent damage to the blood vessels and the heart. If untreated, this damage progresses over time and may lead to a heart attack or stroke.

Hypertension usually has no symptoms so some people may have it for years without even knowing it. The only way you can find out if you have hypertension is by having your blood pressure checked. If your blood pressure is too high your doctor will suggest a treatment plan for you which may include medication to help lower the pressure.

» Blood pressure should be lower than 140/90 mmHg

Diabetes

Diabetes is a condition which occurs when the sugar (glucose) level in the blood is too high. Having diabetes places you at a higher risk of a heart attack or other heart disease. Heart disease and stroke are the main causes of death in people with diabetes worldwide, with an estimated two out of three people with diabetes dying from these conditions.

Relatively small improvements in blood glucose, blood pressure and cholesterol can greatly reduce the risk for people with diabetes. What this means is that as well as taking care of your diabetes, you must also pay close attention to the health of your heart.

www.diabetes.org

The latest European guidelines recommend that for people with diabetes:

» Total cholesterol should be less than 4.5mmol/l
» LDL cholesterol should be less than 2.5mmol/l
» HDL cholesterol should be more than 1mmol/l
» Trigylcerides should be less than 1.7mmol/l
» Blood pressure should be less than 130/80 mmHg

Obesity

Obesity is the medical term used to describe the state of being overweight to the point where it is harmful to your health. Obesity causes heart disease, hypertension, non-insulin dependent diabetes and high levels of cholesterol. Your Body Mass Index (BMI) is a number which is based on your height-weight ratio and gives an indication of whether you are overweight or not.

» BMI should be less than 25

Lack of exercise

Lack of exercise has been clearly proven as a risk factor for heart disease but today's sedentary lifestyles mean that many people get little or no physical activity.

» Get 30-45 mins of physical activity 4 to 5 times weekly

How can I reduce my risk?

A healthier lifestyle is your best defence against developing heart disease and stroke. There are many things you can do to protect yourself.

Eat a healthier diet

A balanced diet which is low in fat can help you to protect your heart by lowering the amount of LDL cholesterol in your bloodstream. Try to eat less saturated fats like butter, margarine, chocolate and cream. Instead, swing the balance in favour of more fresh foods, fruits and vegetables, wholegrain and oat-based cereals, low-fat dairy products, nuts and seeds, oily fish and lean meat. Eating less salt (sodium) will also benefit your blood pressure levels.

» Eat 5 portions of fruit and veg a day

Get active

A reasonable level of regular exercise is not only good for your heart but also helps you to look and feel better. When combined with a balanced diet it helps to keep your weight at a healthy level. Taking the first steps to being more active can be as simple as taking the stairs rather than the lift, doing some gardening or walking to your local shop instead of driving there. Before undertaking any exercise plan, please discuss it with your doctor first.

» Get 30-45 mins of physical activity 4 to 5 times weekly

Maintain a healthy weight

If you're overweight, a sensible diet coupled with regular exercise will help get your BMI to a healthier level. If you're already at a healthy weight, you can help maintain it by taking exercise and eating well. See the accompanying information sheet for more details on BMI.

» Keep an eye on your BMI!

Give up smoking

If you're a smoker, giving up will reduce your risk of heart disease and stroke and improve all aspects of your general health. The good news is that within five years of quitting, the risk of a heart attack falls to about half that of a smoker. Within 10 years, you will have about the same risk of heart disease as someone who has never smoked.*

» Quit smoking!

*www.irishheart.ie

Getting your cholesterol and blood pressure to target

If lifestyle changes do not bring your cholesterol or blood pressure to healthier levels then your doctor may decide that you need to take medication.

There are medications available which lower your cholesterol and blood pressure. You will need to take your medication every day for long-term benefits.

For further information on all aspects of heart disease and stroke, log onto www.heart.ie

Associations and Support Groups

Irish Heart Foundation Tel: 01 668 5001, www.irishheart.ie

Cro West of Ireland Cardiology Foundation Tel: 091 54 4310, www.croi.ie

ASH Ireland (Action on Smoking and Health)Tel: 01 231 0521, www.ash.ie

Diabetes Federation of Ireland Helpline: 1850 909 909, www.diabetes.ie

Volunteer Stroke Scheme Tel: 01 455 9036, www.strokescheme.ie

Useful websites

www.healthpromotion.ie Health Promotion Unit

www.irishhealth.com Independent health website

www.safefoodonline.com Food Safety Promotion Board

www.bordbia.ie Bord Bia

www.bim.ie Bord Iascaigh Mhara

This information has been reproduced with kind permission of Pfizer Healthcare Ireland

This information should not be taken to constitute medical advice. For detailed advice and before beginning any major lifestyle changes you should consult your G.P.