Heart disease is still a major cause of disability and death despite pharmaceutical advances in drugs to control blood pressure, thin the blood and lower cholesterol levels, plus medical advances in surgery to clear plaques and open up or replace diseased coronary arteries. Heart disease is a consequence of metabolic ill health, poor diet, and lifestyle choices that lead to stress, inactivity, and lack of sleep. However, there are many dietary and lifestyle changes you can make to reduce your risk of heart disease and improve your health…

What is heart disease?

Heart disease is caused by damage to the lining of the arteries (endothelium) that allows ‘waxy’ plaques to develop in the artery walls. These can grow over time, partially or sometimes fully occluding the artery. Unstable plaques can rupture, causing the body to react and develop a blood clot to contain the rupture. Clots can break off and cause a blockage further along the artery, which if it is in an artery supplying the heart muscle (coronary artery) will cause a heart attack, and if in the brain, a stroke.

What causes damage to the lining of an artery?

Little ‘rips and tears’ in the artery lining occur regularly through the day but are repaired rapidly. However, the repair mechanisms are complex and can be overwhelmed if damage is constant, opening the possibility of a plaque starting to form. Thus, preventing or minimising damage to the arterial lining will help prevent the development of plaque formation and heart disease.

So, what events damage the artery lining?

Many things can damage the artery lining but 3 of the most important ones (that you can do something about) are:

1. Smoking/wood smoke/air pollution/diesel particulates.

Inhaling tiny particles from smoke and pollution into the lungs, which can pass into the blood, causes direct damage to artery wall linings (1, 2, 3).

2. Eating too much sugar.

Sugar likes to stick to things! It sticks to protein molecules like haemoglobin (oxygen carrying molecules in red blood cells) and lipoproteins (cholesterol carrying molecules in the blood). It also sticks to and damages the walls of the arteries. This is why people with diabetes have double the risk of heart disease compared to non-diabetics (4).

3. High blood pressure (hypertension).

When blood pressure is consistently high it can damage the arterial lining through pressure induced oxidative stress and inflammation (5)

10 things you can do to limit damage to your artery linings and reduce your risk of heart disease.

1. Don’t smoke and limit your exposure to wood smoke and air pollution.

Wood smoke comes from a variety of sources: wood burning stoves, bonfires, barbecues and wildfires. Inhalation of the fine particulates (PM <2.5) from cigarettes, wood smoke and diesel particulates can cause heart disease by increasing blood pressure, increasing the tendency of blood to clot inside arteries, increasing insulin resistance, inducing damage to the artery wall lining and accelerating the formation of plaques (2).

2. Reduce sugar in your diet – eat a low-carb diet!

Excess sugar and refined carbs in the diet can wreak havoc on the lining of blood vessels, both directly and through increased oxidative stress and inflammation. Low-carb diets have consistently been shown to reduce the risk of heart disease through anti-inflammatory processes, and reduction of both oxidative stress and the aging processes that damage the lining of the arteries (6).

3. Avoid seed oils and trans fats.

Studies have shown that seed oils, such as sunflower oil, can increase the amount of oxidised LDL (oxLDL) in the blood of human subjects (7). OxLDL is implicated in the development of heart disease (8). In addition, trans fats produced from the hydrogenation of vegetable oils to turn them in solid fats for cooking and baking (margarine/shortening) are also associated with increased rates of heart disease (9).

4 Eat plenty of omega-3 fatty acids:

Omega-3 fatty acids from marine sources (fish and fish oils) have been well studied in relation to heart disease. A meta-analysis involving 127,477 people across 13 clinical trials concluded that marine omega‐3 supplementation lowers risk for heart attacks and cardiovascular diseases as well as death from heart disease and other cardiovascular diseases (10). Omega-3 reduces heart disease risk by reducing blood triglyceride levels, reducing inflammation and a tendency for blood clotting, slightly reducing blood pressure and slowing the progression of plaque formation (11). Omega-3 fats are found in fatty fish, flaxseed, chia seed, walnuts and grass fed meat.

5. Keep blood pressure under control:

Increase nitric oxide (NO) production in the body. Nitric oxide is produced in the lining of the arteries, and acts as a powerful vasodilator, relaxing the walls of the arteries to allow blood to flow through at a lower pressure. NO is also produced in skin cells and the lining of the nasal passages. Ways of increasing NO production include:

• Get exposure to daylight and sunshine. UVA radiation from sunlight increases NO production in skin cells which persists for up to 48 hours and can help to reduce blood pressure (12)

• Breath through your nose. As air passes through the nasal passages, it stimulates NO production in the nasal cavities and paranasal sinuses. NO production in the nose also protects against infections and has anti-inflammatory effects in asthma (13). Mouth breathing does not have this effect.

• Eat foods that increase NO production, such as garlic (14), meat, dark chocolate (15) and leafy greens (16). Meat provides the main source of CoQ10 in the diet and CoQ10 helps to preserve NO levels in the body (17).

6. Increase potassium in your diet.

Potassium can help to reduce high blood pressure and therefore has an important impact on reducing heart disease risk (18). Potassium reduces blood pressure by relaxing the walls of the arteries (vasodilation) and also increases the rate of sodium excretion by the kidney. Foods rich in potassium include apricots, spinach, broccoli, mushrooms, peas, cucumbers, aubergine, pumpkin and leafy greens.

7. Minimise stress.

Chronic stress is associated with heart disease, possibly through the negative effects of stress hormones on the cardiovascular system. These include increased inflammation, damage to the arterial lining, abnormal blood lipids and high blood pressure (19). Participating in stress reducing activities such as tai chi, meditation, breathing exercises, being outdoors, socialising and exercise can help to reduce blood pressure and heart disease risk (20).

8. Exercise regularly

Exercise has a positive impact on heart health by reducing blood pressure, decreasing the risk of diabetes, reducing inflammation in the body and reducing stress. Exercise also improves mitochondrial function and induces muscles to release myokines which preserve and improve cardiac function (21). A mixture of aerobic exercise (walking, running, swimming and cycling) and resistance training (weight training) bring the best benefits for heart health.

9. Consume plenty of vitamin C in your diet.

Dietary vitamin C may be better than supplementary Vitamin C at reducing cardiovascular disease risk (22). Vitamin C is crucial for helping repair the lining of arteries and may also have an impact on controlling blood pressure and increasing nitric oxide production (23). Foods high in vitamin C include peppers, tomatoes, strawberries, broccoli, Brussel sprouts, cauliflower and lemon.

10. Avoid non-steroidal anti-inflammatory drugs (NSAID) like ibuprofen, naproxen and diclofenac.

Long term use of NSAIDs is associated with increased risk of heart disease and stroke. This is because they can increase blood pressure and blood clotting which leads to plaque formation in the arteries (24).