How to avoid a sudden heart attack when you get to your fifties

Many in my circle of friends are already in our mid-50s, and just in the last few months there have been three sudden heart attacks in otherwise healthy men, leading active lifestyles. This corridor roughly between the age of 40 and 60 is sometimes referred to as “Sniper’s Alley”, so what can you do? 

Two close friends had their first cardiac arrest and needed immediate heart surgery. Another very sadly had a fatal heart attack whilst dancing at a party in front of us. Men are generally more at risk than women, but after menopause, women’s risk can increase. So we all need to be alert to our risks and those of our loved ones.

Whilst lifestyle choices, like moderate exercise and not smoking, are crucial for cardiovascular health, they are certainly not the only things that affect heart health. Clearly genetics play a role too. If you do have any concerns about your heart health, it is important to see a cardiologist and have your heart and cardiovascular function checked as soon as possible.

It is equally important to proactively explore additional blood biomarkers and avenues for prevention, to protect your heart and overall wellbeing. This can be achieved through functional medicine testing, a set of blood tests that go beyond the standard tests usually done by a cardiologist and these can be arranged through the NatureDoc clinical team. These tests empower you to focus on adopting the right diet and food supplements for your specific needs and help to highlight metabolic and cardiac problems even before you start to get symptoms.

In this blog, I will provide you with advice on exactly what you can ask to get checked out when you are having blood tests. I also suggest simple diet and lifestyle steps you can take if you find your blood and gut markers are out of whack. 

The cholesterol story

Most people are aware that high total cholesterol poses a higher risk for heart attack and other cardiovascular complications. However total cholesterol is not the whole story. You want more high-density lipoprotein (HDL) cholesterol (the ‘good’ protective type) versus low density lipoprotein (LDL) cholesterol (which is the riskier type that can drive inflammation and oxidative stress). 

HDL cholesterol is a beneficial antioxidant that helps protect our arteries from inflammation and can remove fat deposits from the artery walls. It is also important for vitamin D synthesis as well as cognition and mood. The brain contains 23 per cent of all cholesterol within the body and it helps to build the myelin sheaths that protect us from neurological damage and cognitive decline. Therefore, we need enough HDL cholesterol as we age. 

However, there is even more to the cholesterol story than total HDL versus total LDL as there are three particle sizes of LDL cholesterol, the smallest one being the most problematic. A more in-depth cholesterol test can identify if a person has high levels of ‘small dense LDL’, a subtype of total LDL cholesterol, which is particularly worrying as it contributes to the formation of fatty deposits in the blood, increasing the risk of heart disease. Because these particles are so small, it is easier for them to invade the walls of the arteries and begin the process of arterial plaque formation. 

Small dense LDL can be raised even if the total LDL cholesterol is normal in your blood tests. It can also remain raised even if statin medications are keeping your LDL in check. 

Positive action: Raised small dense LDL can be addressed by lowering your carbohydrate intake, especially refined sugars, and keeping blood sugars better regulated. It is also important to eat a diet as close to a traditional Mediterranean diet as possible, with plenty of olive oil, fruits, vegetables, pulses, nuts, seeds, fish, egg, dairy and meats. Try and weave these into all three meals every day. Natural remedies that have been shown to reduce total cholesterol include turmeric, fenugreek, artichoke and the supplement guggul.

What does raised triglycerides mean?

The subject of blood lipid levels is way more than just cholesterol and a marker to tracking is that triglycerides, which can offer insights into both liver function and metabolic health. Elevated levels of triglyceride fats in the blood may indicate challenges in processing alcohol and glucose, highlighting that a lower carbohydrate diet and cutting back on alcohol is needed. Triglycerides are often raised before LDL cholesterol goes up, so it is an early indicator that the diet needs to be modulated. 

At the same time, when checking your triglycerides, you may also want to check your haemoglobin A1C (HbA1c) level. This measures your average blood sugars over two to three months and can be an early indicator of progression towards type 2 diabetes as well as cardiovascular disease. Another indicator of the start of blood sugar imbalance can be raised blood insulin levels. All three often come hand in hand when blood testing is carried out, and if any of these are raised then this is where more urgent dietary and lifestyle changes should be made. 

Positive action: Reducing triglycerides and related blood glucose markers can successfully be done over several months by cutting back your intake of refined sugar and carbohydrates and reducing alcohol intake. Give your liver a spring clean by eating plenty of apples, olive oil, lemon juice, ginger and turmeric, and drinking nettle or dandelion teas to help bring down those triglycerides. 

What is a high sensitivity C-reactive protein?

C-reactive protein is a measurement of inflammation and is commonly tested when you are very unwell. More recently, a better and more accurate test has been introduced called a high sensitivity C-reactive protein (known as hs-CRP).  

A high level of hs-CRP in the blood has been linked to an increased risk of heart attacks. Additionally, people who have had a heart attack already are more likely to have another heart attack if they continue to have a high hs-CRP level. 

As a rule of thumb hs-CRP levels below 1 mg/L are considered low risk, hs-CRP levels between 1 and 3 mg/L are considered moderate risk, and h-s CRP levels higher than 3 mg/L are considered high risk. But the good news is that their risk goes down when their hs-CRP level drops to a more normal range. This is easy to track via a simple blood test. 

Positive action: Ways to reduce hs-CRP are to take an anti-inflammatory approach to diet and weave in two or three portions of oily fish such as salmon, mackerel, sardines and anchovies to your diet and include plenty of turmeric and other anti-inflammatory spices. Ultra-processed convenience foods such as sweet cereals, margarines (even the ‘heart-friendly’ ones), snacks and highly processed ready meals are very pro-inflammatory so these need to be cut right back. 

What does it mean if homocysteine levels are high?

Homocysteine levels are a very valuable blood marker which can give you an understanding of both cardiovascular risk as well as risk of neurological disease. In addition to increased cardiovascular risk, a high homocysteine level poses a higher risk for Alzheimer’s, Parkinson’s, cancer, blood clots and stroke. Raised homocysteine, which is an amino acid in the body, is an indicator of B vitamin deficiencies and is easy to measure via a blood test. 

Early signs of raised homocysteine usually match that of low folate and vitamin B12 deficiency signs such as weakness, dizziness, sores on the mouth or tongue, tingling in the feet, legs, hands, or arms, tinnitus and hearing loss, fatigue, pale skin and muscle weakness.

Positive action: The beauty of this monitoring is that you can usually reduce homocysteine quite successfully within a few months by eating foods high in vitamin B12 and folate such as liver, red meat, eggs, fish, shellfish, pulses and leafy green salad leaves and green veggies. Whilst homocysteine is raised it is important to take specialist food supplements that contain folate, vitamin B12 as well as choline and/or trimethyl glycine (TMG).

What happens when oestrogen and testosterone deplete? 

We experience a drop in oestrogen and testosterone as we age, and this drop can pose a higher risk for cardiovascular disease. This is partly because our levels of inflammatory LDL cholesterol increase and then levels of protective HDL cholesterol decrease. Therefore, it is important for men to have their hormone levels monitored just as much as women and keep these at the optimal levels where possible. 

Even though men seem to be most at risk of heart disease compared with women, interestingly the risk to women post menopause increases rapidly because they are no longer making much oestrogen. This increased risk may be because oestrogen helps to lubricate all our organs and has an anti-inflammatory effect on the body. If you are a woman with other cardiovascular disease risk factors, then talking to a menopause doctor about using oestrogen-based HRT may be helpful. 

Positive action: Phyto oestrogens are abundant in plums, pears, apples, berries, onions, flax seeds, tofu, garlic and caraway seeds. There is evidence that testosterone levels can be supported by eating a higher protein diet and using weights whilst exercising. Both ashwagandha and fenugreek seed are therapeutic herbs with promising research that shows they can bring some  aid to flagging testosterone levels. 

The connection between microbiome and heart health

Most people have now heard of the importance of the gut microbiome and that a healthy gut can equal healthier physical and mental health. However, not many people are aware that the gut microbiome has a significant influence on cardiovascular health. It is now thought that the diversity of the gut microbiome and the balance of beneficial versus pathogenic bacteria can be an important part of the overall picture when it comes to maintaining a healthy heart. This is firstly because the beneficial flora in the gut helps to protect the rest of the body from chronic inflammatory activity and the main reason for arteries getting blocked is that they can become chronically inflamed. 

Lipopolysaccharide bacteria (known as LPS) or endotoxins, which are the outer layer of some intestinal bacteria that thrive in an unhealthy gut, can also seep from the gut into the blood stream. The key main inflammatory gram-negative bacteria in the gut that have been linked with poor cardiovascular health are e-coli, pseudomonas and klebsiella. These can be identified through a gut microbiome test. 

These unwanted bacterial strains do not just come from the gut. An unhealthy oral microbiome, with inflammatory bacteria lurking in the mouth, can also translocate to the cardiac region and affect cardiometabolic health. The baddies in the mouth have been identified as porphyromonas gingivalis, streptococcus mutans or streptococcus sanguinis which can be tested via an oral microbiome test. The bacteria that cause bleeding gums and gum disease can travel to the blood vessels elsewhere in the body, where they can cause blood vessel inflammation and damage which can lead to blood clots, strokes and even heart attacks. 

High levels of LPS in the blood can lead to metabolic syndrome and damage heart vessels, increasing the risk of conditions like type 2 diabetes, heart disease as well as liver problems. LPS can also influence how much LDL and HDL cholesterol you have in your blood. 

Positive action: If you are aware of LPS building up in the blood, then you can take action to reduce these by working on both your gut health and oral health. Building up the beneficial bacteria in the gut and mouth are thought to help protect the LPS from causing havoc in the bloodstream. Cultured foods such as live yoghurt, kefir, sauerkraut, kimchi, apple cider vinegar and miso can be helpful at restoring the equilibrium in the gut and the oral cavity. Bifidobacteria and lactobacilli live bacteria from probiotics can help to protect against LPS in the bloodstream. Some people need to take antimicrobial herbs to reduce the LPS bacteria such as garlic, oregano and thyme. Berberine is the most researched antimicrobial for reducing LPS and may also influence blood lipids and blood glucose balancing. So, the use of berberine may be acting positively on many aspects of cardiovascular health. 

Round up

Focusing on our heart health is paramount for us as we age and the low hanging fruit includes losing weight, increasing how much we exercise and stopping smoking. However, this is not always enough to prevent cardiovascular disease from progressing. 

So, this is where you might need to dig deeper and look at more specific dietary and lifestyle changes, with the benefit of some detailed biomarker testing. This information can help find out why your heart and arteries are struggling.  The positive changes you can make will ultimately help you feel healthier and more energised to enjoy the things you love doing, and to give you a better opportunity to enjoy a long and happy life with your family.

If you or a loved one have any worries about your metabolic health and feel that this is not being addressed in enough detail, then be in touch with our NatureDoc clinical team who can run blood, stool and hormone tests to get a better understanding of your biomarkers related to cardiovascular health. They can then guide you step by step on how to change your diet for the better, so you lower the risk of health problems going forward. 

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  1. It’s simply not true women don’t make oestrogen post menopause! We stop making E2 in the ovaries but we make estrone in the adrenals. This narrative of oestrogen deficiency has to stop