Author: Dr Nicci Drew
Heart of a lion. Those are the words we want to hear from our doctors.
After all it's our hearts that we need more than any other organ to live healthy, happy lives.
Your heart beats about 100 000 times in one day.
35 million times in a year.
And a remarkable 2.5 billion times during an average lifespan.
If you have had or witnessed an echocardiogram ( heart ultrasound) you will have felt a deep sense of awe at this tireless, loyal little muscular organ always working and always beating to keep us in the game of life. It is truly a miracle.
Unfortunately cardiovascular disease is the leading cause of death in Australia.
Cardiovascular disease includes coronary artery disease (angina, heart attacks), arrhythmia, stroke and peripheral vascular disease (poor arterial circulation to the limbs).
These are some of our alarming statistics:
Cardiovascular disease kills one Australian very 12 minutes
Affects one in six Australians - that's 3.72 million people
Claimed the lives of 43 946 Australians (30% of all deaths) in 2012
Is the main cause for all hospitalisations
Coronary artery disease kills 55 Australians a day, or one Australian every 26 minutes
Before we all become completely despondent, we need to look at what we can do to prevent cardiovascular disease, in order to have longer and healthier, happier lives.
As a GP I am often told by patients, "I don't care. When it's my time to go, then it's my time."
I appreciate that sentiment. However, there is a strong chance that a heart attack or stroke won't kill you but will leave you physically disabled for a decade or more. Quality of life is the goal. Living with a partial paralysis after a stroke or being constantly exhausted or short of breath after a heart attack is not only a big challenge for the patient but also for their families.
So let's see what we can do. What is in our control and what remains in the hands of fate ?
Risk factors can be divided into those that are modifiable (under our control) or non-modifiable (there is nothing we can do to change these).
Modifiable risk factors are:
High blood pressure
High blood lipids or cholesterol
Waist circumference and BMI (body mass index)
The non-modifiable risk factors are:
Age (increasing risk with age)
Gender (increased risk in men and relatively increased risk in post-menopausal women)
Family history - of premature cardiovascular disease
Social history - cultural, ethnic, socio-economic, mental health
Related and contributing factors are:
Chronic renal disease
In our February FAB (Fight against the bulge) campaign we are really focussing on achieving and maintaining a healthy weight, waist circumference, BMI and promoting an active lifestyle.
It's difficult to highlight one single risk factor as the most important.
However, as an indication of how vitally important exercise is to cardiovascular health, the following is true:
If you had to make the choice, after the age of 35, between being
(A) a non-smoker who does no exercise
(B) take up smoking and exercise regularly
Then (B) is the better of the two evils.
Exercise is the keystone to our health.
We are designed to move. Being sedentary tends to promote all the chronic illness.
Fortunately we have choice. The world offers us an abundance of options to move and keep our hearts healthy.
The most effective way to incorporate regular exercise into our lives is to change our mind-set completely. And to find something that we like doing.
Remember that our goal is to be healthy. It's not necessarily to look good, whether that be a muscle-bound gym junkie or a skinny bikini model. Health makes us happy.
Exercise should not be seen as another chore to add to our list of obligations. If this is the case then a healthy routine is not sustainable. We will soon succumb to boredom or stress.
I suggest the following:
Try to always "do something" - even 10 minutes of aerobic exercise lowers one's blood pressure
Fit short bouts of exercise into your day - park at the far end of the shopping parking lot; take a walk at lunch time; walk up the stairs and escalators, walk the last km to school with your child.
There are so many examples.
Standing instead of sitting is very beneficial. Sitting has been shown to promote central obesity or gaining fat around the waist. This type of fat is metabolically much more harmful than fat accumulated elsewhere (for example thighs and hips). I will elaborate more on the hip to waist ratio (HWR) and "Central obesity" later.
We are blessed with beautiful surroundings on the Gold Coast. It always perplexes me that people feel they must belong to a gym or have a personal trainer when the world around us is so full of opportunities to exercise.
I suggest that if you dread going to the gym or your gym routine has become stale that you try embracing what nature has to offer. Swim in the ocean, take a surfing class, grab a friend or family member and walk along one of our many beautiful wild hiking trails, hire a kayak, play a game of tennis, shoot basketball hoops with your kid, ride your bike, dance !!
It will not only be wonderful for your mental health but will become a way of life instead of a chore.
Of course sometimes personal trainers and gyms and structured exercise routines are the best way to start. But do keep an open mind and try something new every couple of weeks.
I also suggest not weighing yourself or counting calories. This leads to obsessions and too much stress on the outcome. Quite often exercise programs and diets fail because people are constantly counting calories. Throw your bathroom scales away. You will know how healthy you are by the way your clothes fit and by how much energy you have.
Life is far more interesting than a list of calories and a rigid exercise program.
Now looking at high blood pressure as a risk factor for cardiovascular disease:
Most people should aim for a BP under 140/90. If you have a chronic medical condition such as Diabetes then you should aim to have a blood pressure under 130/90.
An interesting observations from epidemiological studies is that regular daily exercise works just as well as a 1st line anti hypertensive medication to lower blood pressure. And without the medication side effects.
Exercise training reduces blood pressure in 75% of hypertensive patients. On average this equates to a reduction of 11mmHg systolic and 8mmHg diastolic.
The effect is more pronounced in the middle aged population and in women.
The reductions in blood pressure occur rapidly ie. from the first bout of exercise long-term reductions are evident.
There are greater reductions with more prolonged activity.
Low to moderate intensity training is as effective as high intensity training.
Sustained blood pressure reductions are present up to 24 hours after a single exercise bout.
Ten minutes is enough to produce some reduction in blood pressure.
Asian and Pacific Islanders reduce blood pressure more and also more consistently with exercise.
Numerous recognised studies show that continued modest weight loss may be sufficient for long-term blood pressure lowering.
Intentional weight loss (between 8-15kg) will result in a drop of approximately 9mmHg in systolic blood pressure.
This means anti hypertensive medication may not be necessary.
The most important point concerning weight is that it is not merely your BMI that is important.
Arguably of equal importance is waist circumference and waist to hip ratio (WHR).
Your waist measurement compares closely with your BMI, and is often seen as a better way of checking your risk of developing a chronic disease.
Regardless of your height or build, for most adults a waist measurement of greater than 94cm for men and 80cm for women is an indicator of the level of internal fat deposits which coat the heart, kidneys, liver and pancreas and increase the risk of chronic diseases such as diabetes.
94cm for men
80cm for women
A 1cm increase in WC is associated with a 2% increase in risk of cardiovascular event such as a heart attack.
A 0.01% increase in WHR is associated with a 5% increase in risk.
Hopefully we can all be inspired to follow our nutritionist's guidelines and to find our bliss in some form of exercise, so that we can all have the heart of a lion.
In future blogs I will discuss lipids, cholesterol, alcohol and nutritional factors.
In particular I will focus on the concept of the "metabolic syndrome" and the Banting dietary eating plan. Doctors and scientists are becoming more convinced that most chronic diseases are linked and stem from two main factors:
High carbohydrate diet
Lack of exercise
This will be discussed in detail in the next blog.