We might worry about cancer and cognitive function, but as midlife women we often take our cardiovascular health for granted.
However, as Davina McCall demonstrated this week, we shouldn’t. The presenter, 59, recently revealed on her podcast she had been diagnosed with cardiovascular disease, which required an “important conversation”.
Cardiovascular disease is “the umbrella term to describe all heart disease and disease of the blood vessels”, says Dr Nabila Laskar, consultant cardiologist at Barts Health NHS Trust. It’s the leading cause of death among women globally. Yet, it’s still poorly understood.
According to the NHS there are four main types: coronary heart disease, where the arteries become blocked, making it hard for blood to flow to and from the heart; peripheral arterial disease, a build-up of fat in the arteries causing reduced blood flow to the legs and feet; aortic disease, a group of conditions that affect the aorta, the largest blood vessel in the body; and stroke, where blood stops flowing to a part of the brain.
While men are more likely to suffer from cardiovascular disease, the symptoms in women are often overlooked and strike those you wouldn’t expect. “Davina’s extremely fit. It shows it could happen to anyone,” says Laskar. Here’s what increases your risk – and how to lower it.
High cholesterol can be a cause
The only specific McCall gave about her diagnosis is that she’d had high cholesterol “for quite a long time”, although the “good” offset the “bad”. Cholesterol is a fatty substance in your blood, divided into the “bad” LDL (low-density lipoprotein) and “good” HDL (high-density lipoprotein).
LDL can build up on artery walls, forming plaques that narrow arteries, causing a condition called atherosclerosis and increasing the risk of heart attacks and strokes. HDL is beneficial because it absorbs the additional cholesterol in the body and sends it back to the liver to be broken down, says Laskar.
“With age, we all have an element of cholesterol build-up in our arteries,” she adds, stressing that while high cholesterol is a risk factor for CVD, high cholesterol doesn’t automatically mean you have CVD.
You won’t have symptoms of high cholesterol, so screening is essential
A blood test available on the NHS measures the millimoles per litre (mmol/L) of cholesterol. “The total should be under five,” says Dr Elise Dallas, a GP at The London General Practice specialising in midlife women’s health. “LDL levels should be under three and HDL levels above 1.2 and closer to two.” The NHS also tests for levels of triglycerides, a fat in the blood that can increase risk. “That should be under 1.7,” says Dallas. You can test your cholesterol with finger prick blood tests by post, but your GP obviously won’t have a record of your levels.
Another, ApoB (apolipoprotein B) test, measures how much of the protein ApoB, found on artery-clogging particles, is in your blood, and can be “a more accurate measure of the number of potentially harmful cholesterol particles circulating in the blood,” says Dallas.
If you have a family history of CVD, which can substantially increase your risk, the NHS may do an ApoB and “some choose to have it tested privately”, she says. Another, one-off, blood test called lipoprotein(a) can reveal if you have the genes that increase your risk. Again, this isn’t routinely offered on the NHS.
Check blood pressure regularly
High blood pressure increases the likelihood of fatty deposits rupturing from artery walls and contributing to a blood clot, causing a heart attack or stroke. “You can’t really feel high blood pressure, unless it gets extremely high, quickly,” says Dallas. “That’s why we screen for it.” The NHS will test your blood pressure, but you can also measure it at home – Boots sells a blood pressure monitor for £15. “Do it when you’re relaxed and seated, ideally avoiding caffeine, exercise or smoking for 30 minutes beforehand,” adds Dallas, who stresses the reading will go up and down and suggests taking it every six months. “A healthy blood pressure is around 135/85,” says Laskar.
Diabetes, belly fat and menopause also increase your risk while HRT can be protective
Adults with diabetes are around two to three times more likely to develop CVD, according to the British Heart Foundation. This is because elevated blood sugar levels cause “damage and inflammation to the lining of the arteries and if the arteries are weak, they’re more likely to build up plaque”, says Laskar. Postmenopausal women are at increased risk because of declining levels of oestrogen, which is “thought to be cardioprotective”, she says. “If they’re not taking HRT that protection disappears and cholesterol levels can change.” Higher levels of visceral fat stored around the middle, surrounding organs such as the liver, are another risk. “Visceral fat increases blood pressure and triglycerides and is associated with a higher LDL and risk of cardiovascular disease,” says Dallas.
The heart disease symptoms doctors mistake for menopause
Palpitations, sweats, nausea and aches can be mistaken for menopausal symptoms in midlife but may also “represent signs of cardiovascular disease”, says Laskar. One study in the journal Jama found that heart attacks without chest pain occurred in 42 per cent of women compared with 30 per cent of men. Women may have aches in their back or upper abdomen, says Laskar – a “red flag” discomfort that comes on with physical exertion. Sometimes people aren’t even aware they’ve had a heart attack, which increases the risk of later heart failure. Research on heart attack patients in England and Wales from the University of Leeds found women were 50 per cent more likely than men to receive an incorrect initial diagnosis than men. “It’s important to not ignore anything out of the ordinary,” she says.
Cutting out takeaways and sugary snacks can have a dramatic effect
Reducing your intake of saturated fat, which inhibits the liver’s ability to remove LDL from the blood, can lower cholesterol levels. A study in the Journal of Lipid Research found participants who reduced their saturated fat intake for eight weeks reduced their LDL levels by 11.8 per cent. NHS guidance is that men eat no more than 30g saturated fat a day and women 20g. “Fats available in whole foods are far healthier than fats you get from processed foods,” adds Laskar. “Avocado and nuts provide good (unsaturated) fats.” Because elevated blood sugar levels risk arterial damage, she suggests limiting “additional sugars we don’t need and foods we don’t expect there to be sugars in. Cereals have a lot of sugar we don’t appreciate. Natural sugars in fruits are fine.” Dallas adds: “Avoid cakes, biscuits and takeaways. Focus on a Mediterranean-style diet rich in vegetables, wholegrains, olive oil and oily fish.”
Even short 30-second workouts can help your heart
Exercise lowers risk by encouraging blood vessels to dilate, “and that allows the blood to flow more smoothly and reduces the tension on the walls, so blood pressure reduces”, says Laskar. Cardiovascular workouts – as the name suggests – are best for heart health. She recommends “150 minutes a week of moderate intensity exercise.” A systematic review in the Journal of the American Heart Association found moving from inactivity to the recommended 150 minutes of aerobic activity a week was associated with a 17 per cent lower incidence of CVD and a 23 per cent lower risk of dying from CVD. “Even short bursts of 30 seconds several times a day have been shown to help heart health,” adds Dallas.
Drink no more than 14 units a week
Laskar is reluctant to push lifestyle changes on patients. “But with smoking, I have no patience,” she says. “Smoking increases your risk (of CVD) by up to 30 per cent. The chemicals directly damage the lining of your arteries. It increases your heart rate and blood pressure. It increases your risk of blood clots.” She’s more relaxed about alcohol, provided we stick within the weekly 14-unit limit. “In excess it can increase your insulin resistance, so obesity and fat distribution across the abdomen increases. That contributes to fatty liver and can cause more problems with fat build-up in your arteries due to changes in LDL and HDL levels.”
Don’t be scared of statins
“Statins reduce the amount of cholesterol made by the liver,” says Dallas. “They are effective, especially if you have high cholesterol in your family.” A major review in the European Journal of Preventative Cardiology found statins – which block an enzyme in the liver which the body uses to make cholesterol – could lower LDL levels by over 50 per cent. “I don’t think you’ll find a cardiologist that doesn’t like statins in the correct group of people,” says Laskar. Side effects include muscle aches and pains, and, less often, abnormal liver function, so liver tests in the first year are required, she says. “But we have newer profile statins now that have a much better side effect profile.”