31 May 2014

    Q Both my parents died of heart attacks when they were relatively young. I am worried that the same might happen to me. Is there any test that I can have to see how healthy my heart is?

    A My sympathies. This must be really quite concerning for you. It is certainly important for you to do the simple things like stopping smoking and ensuring that you have a sensible diet and plenty of exercise. In terms of testing, it would be important to know that your blood pressure is normal, that you are free from diabetes and that your cholesterol is low. It’s also important to look at how your weight is distributed. Your waist measurement — the circumference of your waist just above the navel — can determine fat distribution. The risk of cardiovascular disease is higher for women when it’s over 35 inches and for men at over 40 inches. In addition, it is important to be careful not to drink too much alcohol and, of course, to be aware of stress and to try to reduce it. There are also blood tests that can be performed that look at your cholesterol: Apo B and the PLAC test. These give additional information on risks that can be addressed with diet, lifestyle and medicines. And there is also a screen being launched by Storegene that looks at the genetically transferred risk of heart attack and stroke. It is early days for that test, but it would certainly be appropriate for you to discuss with your GP whether you should take it. It might even be worth asking whether a calcium score would be an appropriate test. This is a specialised CT scan (complex X-ray) that would give a guide as to whether you have laying down of calcium in and around your coronary arteries. Not all individuals in your situation need this test but it is worth discussing.

    Q My GP has found a ‘murmur’. It has never caused me any problems before. Is it dangerous? What should I do about it? I am 49 and otherwise in good health.

    A The vast majority of patients referred with a ‘murmur’ will be asked to undergo an echocardiogram, a completely painless procedure which uses sound waves to give us a picture of your heart. It uses technology rather like that which is used to look at a developing baby in the womb. Very few patients who are found to have a ‘murmur’ turn out to have anything that requires immediate treatment. Very occasionally the ‘murmur’, which is just a noise of blood passing through the heart, is found to be due to a valve that has a problem. This can be of significant concern. The echocardiogram will allow the doctor to either reassure you, or move on to further investigations if needed.

    Q I have recently been to my GP and she has said that my cholesterol is high. I’m keen to avoid taking medication, but is there a way I can reduce my cholesterol enough that I won’t have to take tablets?

    A The amount of cholesterol in your system is the sum of how much your body produces naturally, and how much you get from food, minus how much your body uses. There are things that you can do to control each factor. Smoking, high blood pressure and raised cholesterol are the big amendable causes of cardiovascular disease, so I would encourage you to stop smoking, to take care not to drink too much and make sure that you are eating healthily. It is important to reduce your intake of foods that contain saturated and trans fats, such as processed meats and processed meals generally, especially those high in sugar. Some foods contain unsaturated fats and these are actually very good for you. Furthermore, some foods, such as green leafy vegetables, can help to lower LDL cholesterol, and are therefore key in a cholesterol-lowering diet. It is also important to keep your salt intake to a minimum. Exercise plays its part by increasing the activity of certain enzymes in the body that help lower LDL cholesterol levels. I normally recommend that you try diet and lifestyle changes over a six-month period and then retest the cholesterol. This may alter things so that statins are not necessary. However, statins are being offered to many more people, and their effectiveness has been well proven, with the vast majority of patients being able to tolerate them well.