Lifestyle

Advice from your NHSHealth Check

Everyone is at risk ofdeveloping heart disease, stroke, diabetes and kidney disease.  Your health check is to look at your individualrisk and ways you can reduce it.

Calculating your cardiovascular health risk

Your Practice Nurse or Health Care Assistant willcalculate your health risk using your age, sex, smoking status, blood pressure,cholesterol level, etc. The score gives a fairly accurate indication of yourrisk of developing a cardiovascular disease over the next 10 years.

What does the risk assessment score mean?

You are given a score as a % chance. For example, if yourscore is 30% this means

that you have a 30% chance of developing a cardiovasculardisease within the next 10 years.  Inother words, 3 in 10 people with the same score that you have will develop acardiovascular disease within the next 10 years. Note: the score cannot say ifyou will be one of the three. Itcannot predict what will happen to each individual person. It just gives youthe odds.

You are said to have a high risk - if your score is 20% or more. That is, a 2in 10 chance or more of developing a cardiovascular disease within the next 10years.

Whattreatments are available to reduce the risk?

·                   If you areat high risk

If you are at high risk of developing a cardiovasculardisease then you will be given advice to tackle any lifestyle issues and drugtreatment is usually advised.

v  stop smoking if you smoke

v  eat a healthy diet

v  keep your weight and waist in check

v  take regular physical activity

v  cut back if you drink a lot of alcohol

v  Drug treatment, usually with a statin drug, to lower your risk.

v  Drug treatment to lower blood pressure if it is high. This is even if yourblood pressure is just mildly high.

·                   What if I amat moderate or low risk?

If you are not in the high risk category, it does notmean you have no risk - just a lesser risk. Drug treatment is not usuallyprescribed. However, you may be able to reduce whatever risk you do have evenfurther by any relevant changes in lifestyle (as described above).

Your risk factors can be split into two groups – thosewhich can be prevented or changed and those which are fixed and you cannotalter.

Fixed risk factors - ones that you cannot alter:

·                   A strong family history.This means a father or brother who developed heart disease or a stroke beforethey were 55, or in a mother or sister before they were 65.

·                   Being male.

·                   An early menopause inwomen.

·                   Age. The older youbecome, the more likely you are to develop these diseases.

·                   Ethnic group. People wholive in the UK with ancestry from India, Pakistan, Bangladesh, or Sri Lankahave an increased risk.

If you have a fixed risk factor, you may want to make extra effort totackle any lifestyle risk factors that can be changed. 

Lifestyle factors that can be prevented or changed:

·                   Smoking.

·                   Lack of physicalactivity (a sedentary lifestyle).

·                   Obesity.

·                   An unhealthy diet andeating too much salt.

·                   Excess alcohol.

·                   Hypertension (high bloodpressure)

·                   High cholesterol and/ortriglyceride (fats) in the blood

Note: some risk factors are more 'risky' than others. For example, smokingprobably causes a greater risk to health than obesity. Also, risk factorsinteract. So, if you have two or more risk factors, your health risk is muchmore increased than if you just have one. For example, a middle aged malesmoker who does little physical activity and has a strong family history ofheart disease has quite a high risk of developing one of the above conditionssuch as a heart attack or stroke before the age of 60.

Smoking

Lifetime smoking roughly doubles your risk of developingheart disease. The chemicals in tobacco get into the bloodstream from the lungsand damage the arteries and other parts of the body. Your risk of having astroke and developing other diseases such as lung cancer are also increased.Stopping smoking is often the single most effective thing that a person can doto reduce their health risk. The increased risk falls rapidly after stoppingsmoking (although it takes a few years before the excess risk reducescompletely). If you smoke and are having difficulty in stopping, then ask yourpractice nurse for help and advice.

Lack of physical activity - a sedentarylifestyle

People who are physically active have a lower risk ofdeveloping heart disease and diabetes compared to inactive people. To gainhealth benefits you should do at least 30 minutes of moderate physicalactivity, on most days (at least five days per week).

30 minutes in a day is probably the minimum to gain health benefits. However, you do not haveto do this all at once. For example, cycling to work and back 15 minutes eachway adds up to the total of 30 minutes.

Moderate physical activity means that you get warm, mildly out of breath, and mildly sweaty. Forexample: brisk walking, jogging, swimming, cycling, etc.

On most days. You cannot'store up' the benefits of physical activity. You need to do it regularly – atleast 5 days a week.

Obesity and overweight

If you are overweight or obese and lose weight it willreduce your risk of developing heart disease or diabetes. Even if you don’tlose all your excess weight, you will still get benefit from a small weightloss if you can keep it off.

Being overweight around your middle increases the riskeven more. As a rule, a waist measurement of 102 cm or above for men (92 cm forAsian men) and 88 cm or above for women (78 cm for Asian women) is asignificant health risk.

Diet

Eating healthily helps to control your weight, and loweryour cholesterol level. Both of these help to reduce your health risk. Briefly,a healthy diet means:

·                   AT LEAST five portionsof fruit and vegetables daily, ideally more, and have a variety of differenttypes. These contain antioxidants which may help to prevent cholesterolbuilding up in your blood vessels (see later).

·                   BASE YOUR MEALS ONSTARCHY FOODS such as cereals, wholegrain bread, potatoes, rice or pasta plusplenty of vegetables.

·                   CUT DOWN ON FAT by reducing fatty foods such as fattymeats, cheeses, full-cream milk, fried food, butter, etc. Use low fat, mono-,or poly-unsaturated spreads. If you eat meat it is best to eat lean meat, orpoultry such as chicken.  If you do fry,choose a vegetable or olive oil.

·                   INCLUDE 2-3 portions offish per week. At least one of which should be 'oily' (such as herring,mackerel, sardines, kippers, salmon, or fresh tuna).

·                   LIMIT SALT to no morethan 6 g a day (and less for children). See below for details. Tryflavouring foods with herbs and spices instead of salt.

Salt

Adults should eat no more than 6 g salt a day (about ateaspoon of salt) as salt increases blood pressure which can lead to strokesand heart disease.  The current averagedaily intake of salt in the UK is 9 g per day. About three quarters of the saltwe eat is already in the foods we buy. By simply checking food labels andchoosing foods with lower salt options, it can make a big difference.

Also, try not to add salt to food at the table.

Alcohol

The recommended upper limits for alcohol are men shoulddrink no more than 21 units per week (and no more than four units in any oneday) and women should drink no more than 14 units per week (and no more thanthree units in any one day). One unit is in about half a pint of normalstrength beer, or two thirds of a small glass of wine, or one small pub measureof spirits. Remember, alcohol contains empty calories so think about cuttingback further if you are trying to lose weight.

High blood pressure

You should have your blood pressure checked at leastevery 3-5 years. High blood pressure usually causes no symptoms, so you willnot know if it is high unless you have it checked. However, over the years,high blood pressure may do some damage to the arteries and put a strain on yourheart. In some cases, high blood pressure can be lowered by: losing some weightif you are overweight, regular physical activity, and eating healthily asdescribed above. Medication may be advised if your blood pressure remains high.

Cholesterol and other lipids

In general, the higher the blood cholesterol level, thegreater the risk of developing cardiovascular diseases (heart disease, strokeand diabetes). These are caused by a build-up of fat in the blood vesselscalled atheroma.  A patch of atheromamakes an artery narrower. This can reduce the blood flow through the artery. Intime, patches of atheroma can become larger and thicker. They may trigger ablood clot which blocks the artery and can cause a heart attack, angina, stokeor other problems.

As a rule, no matter what your cholesterol level is, thenlowering the level reduces your risk. This is why people at high risk ofdeveloping a cardiovascular disease are offered medication to lower their risk.A high blood level of triglyceride, another type of lipid (fat), also increasesthe health risk.

Further help and information

·         British Heart Foundation:Offer advice on all areas of heart disease

Tel (Heart Help Line): 08450 70 80 70     Web: www.bhf.org.uk

·                   NHS Choices: Offer adviceon healthy lifestyles, and health problems