Ask the doctor - heart health

I am a fit 34-year-old, but I have high blood pressure, which is a problem that runs in my family - my father died of a heart attack in his forties. What can I do to protect my health?

It's relatively unusual for someone of your age and fitness to have high blood pressure, so you should have a thorough check-up to establish the exact cause. It may be essential hypertension, which is hereditary, where a slight narrowing of the arteries is responsible for raising the blood pressure - but why this happens is unclear.

High blood pressure is a major risk factor for a number of health problems, including heart disease and stroke. Lifestyle changes can help: eat a balanced, low-fat diet, reduce your alcohol intake, don't smoke and exercise regularly. Otherwise, you may need medication. One of the commonly prescribed groups of drugs is ACE inhibitors. Your doctor may also discuss other options such as calcium channel blockers, diuretics and beta-blockers. As some people experience side-effects from their medication, it's worth discussing alternatives. But with proper management, you should be able to lead a full and healthy life.

Visit Blood Pressure Association (www.bpassoc.org.uk; 020 8772 4994)
Dr Louise Selby, SHE
 

 

Drinking coffee

I’ve been told that coffee can cause abnormal heart rhythms. I’m perfectly fit, but heart attacks run in my family and I drink about three cups of coffee a day. Do I need to stop?I’ve been told that coffee can cause abnormal heart rhythms. I’m perfectly fit, but heart attacks run in my family and I drink about three cups of coffee a day. Do I need to stop?

Most of the myths about coffee and your heart are just that - myths. ‘Moderate' caffeine intake is usually defined as about 400mg of caffeine a day, which is two to four 200ml (1/3 pint) mugs of brewed coffee, or four to 10 mugs of instant coffee. At this level, there's no evidence of any link with abnormal heart rhythms or palpitations. What's more, the stories about caffeine increasing your cholesterol levels only really apply to ‘boiled' coffee (coffee that is boiled in a pan and left to stand), which isn't commonly drunk in the UK.
Dr Sarah Jarvis, Good Housekeeping
 

Folic acid

I took folic acid supplements during my recent pregnancy, and now I’ve heard it can also help to prevent heart disease. How can I boost my intake?

Folic acid is one the B group family of vitamins. It's very important in early pregnancy and in preventing some kinds of anaemia, but it may also be an invaluable tool in the fight against heart disease. Green leafy vegetables, potatoes, pulses and lentils, liver, eggs and yeast extract are good sources. Many breakfast cereals are also fortified with folic acid - check the label and make sure it's low in sugar and salt, too.
Dr Sarah Jarvis, Good Housekeeping

 
Taking statins in the morning

There’s a history of heart disease in my family, so I have to take a daily tablet of cholesterol-lowering statin. The trouble is, I was told to take it at night, and I often forget if I’m tired. Could I take it first thing in the morning instead?

The group of drugs called statins has revolutionised the way doctors manage both cholesterol and heart disease, and the majority need to be taken at night to be most effective - it's all to do with how your body absorbs and uses them. Taking your statin in the morning, however, is almost certainly better than not taking it at all. If you have a real problem remembering, though, ask your GP about taking atorvastatin, which is the only statin that has been shown to be just as effective if taken in the morning.
Dr Sarah Jarvis, Good Housekeeping
 

Cholesterol readings

My total cholesterol reading is 6.0mmol/l and my doctor says this is fine, as I have high levels of ‘good’ cholesterol. But isn’t high cholesterol unhealthy even if it’s the ‘good’ kind?

By now most people are well aware that raised cholesterol is bad for your heart. But although your level is above the recommended reading of 5.0mmol/l, your doctor is quite right. If a lot of your total cholesterol comes from the ‘good' kind - called HDL cholesterol, which actually protects you against heart disease - your risks are much lower. The kind you need to worry about is LDL cholesterol. Your doctor or nurse can test for each kind and explain which reading is which.
Dr Sarah Jarvis, Good Housekeeping
 

Treatment of heart failure

I’ve been diagnosed with heart failure, which, my doctor tells me, means my heart doesn’t pump out as efficiently as it should. I’ve been started on three medications: a water tablet to relieve my symptoms, a beta blocker to keep my heart rate down and an ACE inhibitor, which works on my kidneys. I feel much better on these tablets, but I wonder if they’re all necessary?

The bad news is that heart failure is a serious condition that accounts for more hospital admissions in people over 70 than any other. It's extremely common in both women and men. There's good news, too, however, because the treatment of heart failure has been revolutionised in the past few years. You're already taking two of the new treatments - the beta blocker and the ACE inhibitor. Even if your symptoms are well controlled now, which I'm delighted to hear, these medicines are essential for improving your long-term outlook. In fact, I think there's another one you should talk to your doctor about. The results of a huge trial on a drug called candesartan have shown that regardless of any others you're currently taking for heart failure, adding candesartan can reduce your risk of death or admission to hospital significantly, as it helps your cardio-vascular system to work more efficiently.
Dr Sarah Jarvis, Good Housekeeping

 

Coffee and cholesterol levels

I try to follow a pretty healthy diet but I’m not sure about the effects of drinking coffee. Would cutting it out altogether help to reduce my cholesterol levels?

Generally, people who drink coffee regularly don't prove to have higher cholesterol levels than those who don't drink it. There may have been some confusion because it has been linked with raised cholesterol levels when it's made the Scandinavian way. There, coffee is often brewed by the boiling method, which means it's boiled in a saucepan and then left to simmer. Filtered and instant coffees don't carry the same risks, however.
Dr Sarah Jarvis, Good Housekeeping
 

Safety worries and statins

I’ve been told my cholesterol is high and that I need to take a medicine called a statin, which worries me because I’m sure I’ve read that statins can cause muscle breakdown. Is there a risk that taking it could do me more harm than good, and are some statins safer than others?

The condition you've heard about is almost certainly rhabdomyolysis, which has had a lot of publicity, but is actually extremely rare. In fact, if you took a statin for a year, your chances of dying from the condition are only about one in one million. And as statins can reduce your chance of dying of heart disease by about one in four, the benefits vastly outweigh any risks. A recent study showed that three of the most commonly prescribed statins - atorvastatin, simvastatin and pravastatin - are equally safe, and the newest one, rosuvastatin, has just been confirmed by the Food and Drug Administration in the USA as being safe, too.
Dr Sarah Jarvis, Good Housekeeping
 

Cause of heart attack

I’ve read recently that the most likely time to have a heart attack or stroke is first thing in the morning. Is there any truth in this? 

Heart disease and stroke kill almost one in five women in the UK - coronary heart disease (CHD) being the biggest killer in this country by far - and statistics do show that heart attacks seem to be more common in the morning. Studies suggest this may be related to raised blood pressure, which is the only major risk factor for both stroke and heart attack that varies significantly over the course of the day.

Raised blood pressure is incredibly common, but it can be very effectively controlled with medication. Unfortunately, it rarely causes symptoms until it brings on a heart attack or stroke. The best way to put your mind at rest and protect yourself is to have your blood pressure checked regularly by your GP. If you're taking once-daily tablets for raised blood pressure, it may also be worth checking how well your medication is working over the whole 24-hour period. Do this by having your blood pressure checked when you're due to take a tablet - in other words, 24 hours after taking your last one.
Dr Sarah Jarvis, Good Housekeeping

 

High blood pressure

My father has very high blood pressure and his brother died of a heart attack last year at the age of 58. My blood pressure has been normal until now, but has recently risen. I am 38 and although I don't exercise regularly, I'm not overweight. With my family history, should I be worried?

A one-off, above-normal blood pressure reading does not mean that you have 'high blood pressure'. Your reading will change throughout the day and can increase when you are more stressed or have just been exercising. However, it is important to monitor things to make sure that you don't have a medical problem.

In the UK, about half of people over 65 and one in four middle-aged adults have high blood pressure. It's not something you should ignore, as it can increase the chances of cardiovascular disease (such as heart disease or stroke).
Because you have a family history of high blood pressure, you may be more at risk. Ask your GP to arrange three further blood pressure tests, when you are relaxed. If it is consistently high then you should discuss treatment. This can include lifestyle changes and medication. There are several drugs available and the one chosen will depend upon any existing medical problems, age and ethnicity. In the meantime, you can help yourself by taking regular exercise, quitting smoking, eating a low-fat, low-salt diet and maintaining your current weight. If possible, reduce your stress levels by taking up yoga or some form of relaxation technique. Studies have also shown that garlic may have beneficial effects in managing hypertension. You can use it regularly to flavour your food or, if you don't like the pungent smell, buy odour-free garlic capsules. You could try Holland & Barrett, Odourless Garlic capsules, 100 capsules, £4.99.

Blood Pressure Association, www.bpassoc.org.uk. High Blood Pressure Foundation, www.hbpf.org.uk. British Heart Foundation, 0845 070 8070 (calls charged at local rate) or www.bhf.org.uk
Dr Louise Selby, SHE

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The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk