How to keep your heart healthy

Diagram courtesy of

Unfortunately, angioplasty or bypass grafts only treat the artery disease present at that time – they don’t stop the disease process of atherosclerosis (furring up of the arteries). Medications will help to slow down this process, but there are many other lifestyle factors that can lead to coronary artery disease – we call them “risk factors”.

Cardiac rehabilitation helps you make the lifestyle changes necessary to reduce these risk factors as much as possible.



Smokers are almost twice as likely to have a heart attack as people who have never smoked – read more.

  • Toxic chemicals in cigarettes cause inflammation in the artery walls which can lead to the build-up of atheroma and the stiffening of the artery walls
  • Smoking increases LDL cholesterol (bad cholesterol) blood levels and reduces HDL cholesterol (good cholesterol) blood levels
  • Smoking increases adrenaline levels, which raises the blood pressure and cardiac stress, causing constriction of blood vessels
  • Smoking significantly increases the risk of blood clots which can lead to heart attacks and strokes
  • Smoking increases levels of carbon monoxide in the blood, reducing the blood’s ability to deliver oxygen to the tissues
  • Smoking increases your blood pressure, putting extra workload on your heart.

Your smoking also affects the health of those around you – second-hand or passive smoking has shown to increase the risk of cardiovascular disease too.

Even if you’ve been smoking for years, quitting is beneficial to your health. If you stop smoking for one year, your risk of a heart attack halves. By 15 years, your risk is similar to that of a non-smoker.

Advice and support on stopping smoking is available from Smokefree Norfolk

Physical inactivity

Physical inactivity or sedentary lifestyle is one of the biggest risk factors for atherosclerosis – read more. 

The heart is a muscle and, like any other muscle, needs physical activity or exercise to help it work properly. When you’re active, your lungs do a better job of getting oxygen into your blood so it can be pumped to all the tissues and cells of your body.

Being active can reduce your risk of developing some heart and circulatory diseases by as much as 35%. Regular physical activity:

  • Helps control your blood pressure and keep it within healthy levels
  • Raises your levels of good cholesterol and reduces the bad cholesterol
  • Can help to control your blood glucose levels, reducing your risk of type 2 diabetes and controlling your diabetes if you already have it
  • Increases the number of calories you burn and helps you maintain a healthy weight.

Not only does regular activity protect your heart, it can also help your general wellbeing by boosting your mood, improving your concentration and memory, and helping you sleep better.

The World Health Organisation, based on all the evidence, recommends:

  • Adults aged 18–64 do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, or at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity
  • Aerobic activity should be performed in bouts of at least 10 minutes duration
  • For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week or engage in 150 minutes of vigorous-intensity aerobic physical activity per week or an equivalent combination of moderate and vigorous-intensity activity
  • Muscle-strengthening activities should be done involving major muscle groups on two or more days a week.

For patients who’ve had a heart attack, angioplasty or have other heart conditions, it’s important that returning to exercise is done safely. We’re here to help support your recovery, so please don’t start an exercise programme without guidance from one of our team.

You should be offered appointments to discuss returning to normal activity and increasing your exercise safely where appropriate.


Being overweight can increase your risks of heart attacks, strokes, vascular dementia and some cancers. The risk of developing type 2 diabetes is also increased, which can lead to further complications.

Carrying weight around your middle (apple shaped) is more of a health risk than carrying weight around your hips.

Using the Body Mass Index (BMI) along with your waist circumference is a guide to whether you’re the appropriate weight – see more information and how to calculate your BMI on the British Heart Foundation site.

The recommended waist measurements are:

  • Below 37 inches (94cm) for men
  • Below 31.5 inches (80cm) for women.

Adults of South Asian origin are at very high risk of health problems if their waist measurements are higher than the recommended measurements.

High Cholesterol

Cholesterol comprises bad or “non-HDL” cholesterol which contributes toward atherosclerosis (the furring up of your arteries) and good or “HDL” cholesterol which helps to get rid of the bad cholesterol.

Anyone can get high cholesterol and it can be caused by many different things. If you’re overweight or have diabetes, you are at greater risk of having high cholesterol.

Some factors you can control, like lifestyle habits, others you can’t. If you take care of the things you can control, you’ll help lower your risk.

Things you can control:

  • Eating too much saturated fat
  • Not being active enough
  • Having too much body fat, especially around your middle
  • Smoking can lead to high cholesterol levels and the build-up of tar it causes in your arteries makes it easier for cholesterol to stick to your artery walls.

Things you can’t control:

  • Getting older
  • Whether you’re male or female
  • Ethnic background
  • Familial Hypercholesterolaemia(FH), a form of high cholesterol you are born with
  • Kidney or liver disease
  • An underactive thyroid gland.

How can I lower my cholesterol levels?

  • Eat a healthy balanced diet, low in saturated fat
  • Get active
  • Quit smoking.

If your cholesterol is still high after making these modifications, or if we know you already have artery disease, you are likely to be recommended to take a statin. Other drugs can also be used if a statin is not enough or you’re unable to take a statin. Read more information on the British Heart Foundation and Heart UK sites.

High blood pressure

High blood pressure damages your artery walls, which can eventually lead to them becoming less stretchy. This means the cholesterol and other deposits that cause atherosclerosis are more likely to attach to the artery walls. Around half of heart attacks and strokes are associated with high blood pressure.

High blood pressure often has no symptoms, which is why getting it checked, especially as we get older, can be vital.

The guidelines suggest that you should keep your blood pressure under 140/80, except if you have diabetes or have had a previous stroke or heart attack in which case it should be under 130/80.

High blood pressure has many causes:

  • Age
  • Being of black African or black Caribbean descent
  • Being overweight
  • Smoking
  • Physical inactivity
  • Eating too much salt
  • Some medical conditions.

Even if you’ve a genetic tendency towards high blood pressure you can improve it with a healthy diet, exercise and by not smoking.


Diabetes causes high levels of glucose (sugar) in your blood which can cause inflammation in your arteries and make them more likely to develop atheroma (fatty deposits). This puts you at higher risk of heart attacks, strokes and other vascular diseases.

There are 2 types of diabetes:

Type 1: This is an autoimmune condition where your body damages the part of the pancreas producing the hormone insulin (which enables the body to use the sugar it takes in) so it can no longer do so. This means people with type 1 diabetes must inject themselves with replacement insulin. Ten per cent of people with diabetes have type 1, which is often diagnosed earlier in life.

Type 2: This is much more common than type 1 and tends to be diagnosed at an older age. It happens when the pancreas may not make enough insulin and/or the body cannot use the insulin it makes. Type 2 diabetes is closely linked with being overweight, especially carrying weight around your middle, being physically inactive and having a family history of type 2 diabetes. Some ethnic groups have a higher risk of developing type 2 diabetes. It can be treated by diet, tablets or injections of insulin or other drugs (or a combination of these).

Managing the risk factors for heart disease will also help you reduce your risk of developing type 2 diabetes or help you to manage your diabetes better.

Symptoms of diabetes include:

  • Thirst
  • Urinating more than usual
  • Tiredness
  • Unexpected loss of weight
  • Blurred vision
  • Genital itching or regular thrush
  • Wounds healing more slowly.

If you notice any of these symptoms it is important to see your GP. Read more on the British Heat Foundation site or the Diabetes site.


There’s a possibility that long-term stress causes high levels of hormones that can lead to developing atheroma in the arteries.

Stress alone is not usually the cause of heart disease but can lead to developing unhealthy habits like smoking, drinking alcohol, poor diet and lack of exercise which lead to artery disease. We all suffer stress from time to time, so it’s important to develop healthy coping habits. Find out more.

Air pollution

There are significant links between air pollution and artery disease. Eating a healthy, balanced diet and doing plenty of exercise can help to counteract this but try to exercise away from areas of high air pollution – for example, walk in parks or countryside rather than along busy city roads and avoid exercising at times of day when air pollution might be higher such as rush hour. Learn more about risk factors and more on the DRFRA site.

Gender, age and ethnicity

  • African, Afro-Caribbean and South Asian people are more likely to develop type 2 diabetes which increases the risk of developing artery disease
  • South Asian people are more likely to develop coronary artery disease then white Europeans
  • African or Afro-Caribbean people are more likely to have high blood pressure and strokes than other groups

It is not fully clear why this is, but is thought to be a combination of genetics and lifestyle factors. Read more.

Oestrogen tends to protect women from heart disease until the menopause, which is why men tend to develop it earlier. The risk of heart disease increases with age due to the cumulative effect of other risk factors over time.