Maintaining good heart and blood vessel health is important for everyday life, as well as protecting against heart disease in the future. A healthy heart will mean that all activity – whether walking up the stairs, playing with your children or specific exercise – is easier and more fun.
Energy levels and wellbeing will also be better with a healthy heart and blood vessels, as low energy and mental fatigue could be a signal that too little oxygen is reaching the brain. All organs and muscles need oxygen in order to function properly and oxygen is carried around the body in the blood. Reduced blood volume, and correspondingly reduced oxygen, being transported around the body and delivered to the muscles and organs reduces their ability to work properly. This can occur as a result of reduced blood vessel capacity or width due to atherosclerosis or high blood pressure, increased blood thickness and poor heart muscle contraction due to partial damage to the heart muscle.
Cardiovascular or heart disease (CVD) is the leading cause of death worldwide and is in fact an umbrella term for all conditions affecting the heart muscle and blood vessels. Specific cardiovascular disease includes conditions such as:
Symptoms of cardiovascular disease include:
- Dizziness or light-headedness
- Increased heart rate (more than 100 beats per minute)
- Abnormal irregular heartbeat
- Chest pain or discomfort during activity that goes away with rest
- Difficulty in breathing
- A chest infection or cough that worsens
- Restlessness or confusion
- Disturbed sleep patterns
- Reduced appetite or nausea
You may be having a heart attack if you experience any of the following together and should seek immediate medical help:
- Pain or pressure in your chest that lasts more than a few minutes, or comes and goes
- Discomfort that spreads to your back, jaw, throat or arm
- Nausea, feeling light-headed or sweating
- Indigestion or heartburn
- Feeling weak, anxious or short of breath
- Fast or irregular heartbeats
Angina is usually experienced as central chest tightness/heaviness/pain which may be initiated or made worse by exercise or activity, cold weather or being under emotional stress. It may become better upon resting. There may be pain in one arm (usually the left) or both arms; there may also be pain in the neck, jaw or even the teeth. If these symptoms are new to you, seek urgent medical help.
Heart attacks involve a loss of blood flow to the heart muscle lasting for long enough that it can lead to the death of part of the muscle and a ‘heart attack’. Plaques, fatty deposits in the blood vessels, can gradually build up inside arteries and only need to block up to half the vessel diameter in order to rupture. This causes the blood to clot and cut off the blood supplied by that artery to the heart or other organs such as the brain.
Cardiovascular disease is now understood to be largely preventable and in most cases cardiovascular conditions can be completely prevented or significantly reduced with a healthy diet and active lifestyle. There are a number of factors that contribute to an increased risk of heart disease, including:
- Being physically inactive
- Being overweight or obese
- Family history of heart disease
- Ethnic background
- Gender – men are more likely to develop CVD at an earlier age than women
- Age – the older you are, the more likely you are to develop CVD
- High blood pressure
- High blood cholesterol
- Alcohol consumption
Although it is not possible to control some of these factors, most can be manipulated to significantly reduce the likelihood of developing CVD. For those with a family history of CVD or an inherited CVD condition, it is still possible to reduce the severity and mortality risk associated with your condition by following the same risk reduction advice as for people wishing to prevent CVD altogether. If you are unsure of what is best for you to do in order to reduce your risk of having a CVD event, seek help from your GP or healthcare practitioner.
In order to reduce your risk of CVD it is recommended that you:
- Exercise (increase your heart rate for 20 minute 5 times per week)
- Lose weight (BMI of below 24 or a body fat % of less than 24% for men and 30% for women)
- Reduce stress
- Stop smoking
- Eat a healthy and balanced diet
|Recommended cholesterol and triglyceride levels|
|Total cholesterol||4 mmol/L|
|HDL cholesterol||>1 mmol/L|
|LDL cholesterol||< 2 mmol/L|
Inflammation is a major factor contributing to the development of chronic disease and CVD is no exception. Atherosclerosis is essentially inflammation of the blood vessel wall and atherosclerotic plaques are filled with fatty molecules and inflammatory cells. High levels of inflammation throughout the body increase the risk of damage to the blood vessel walls and subsequent plaque formation, which can lead to blood clots.
Following on from the discovery that atherosclerotic plaques were filled with saturated fat and cholesterol in the 1970s, the medical profession began to recommend reducing intake of foods high in these to reduce heart disease risk. A considerable body of research, however, shows that this is both an ineffective and potentially harmful strategy to address heart conditions.
By removing all fat from the diet, we are also eliminating the building blocks of all cell membranes, particularly affecting the brain, as well as removing fat molecules needed for chemical messengers, protein function, normal growth, immune function, reproduction and metabolism. Fat is also a very efficient source of fuel that is much more filling when compared to carbohydrates – the food group most commonly increased to replace the calories lost by not eating fats.
In addition to removing the nutrient needed to support all of the above processes, choosing fat-free options will increase consumption of artificial ingredients that are added to make foods that are supposed to contain fat still palatable. Artificial flavourings, thickeners and sugar or sweeteners are added to these foods so that they taste more like their natural, full-fat forms. In doing this, the satisfaction associated with eating fatty foods is removed, often meaning that we consume more overall.
“By removing all fat from the diet, we are also eliminating the building blocks of all cell membranes, particularly affecting the brain, as well as removing fat molecules needed for chemical messengers, protein function, normal growth, immune function, reproduction and metabolism.”
Similarly to reducing fat intake, low cholesterol diets also result in an inadequate supply of the building blocks for essential body function and in this case affects hormones, bile acids (vital for digestion) and synthesis of vitamin D – low levels of which are linked to modern chronic illness including CVD!
It is now widely recognised that dietary intake of cholesterol has very little impact on the body’s cholesterol levels and so we strongly advise against cutting out cholesterol-containing foods such as eggs – eggs are actually tremendously nutritious!
On the whole, studies confirm that total fat consumption is not linked to CVD risk and that higher fat intakes may actually be protective against CVD and other diseases. Saturated fat is also not as bad as we have been led to believe and studies show that those eating ‘high’ amounts of saturated fat have a reduced risk of CVD and strokes compared with those eating the ‘ideal’ 2.5-11g of saturated fat daily. The amount of saturated fat consumed in comparison to the other fats found in foods is important, however, as too much of this type of fat compared to mono- and polyunsaturated fats can increase blood pressure and arterial stiffness (Yamagishi et al 2010).
“…studies confirm that total fat consumption is not linked to CVD risk and that higher fat intakes may actually be protective against CVD and other diseases.”
The most important factor to consider when thinking about the diet and CVD is the impact on cholesterol. There are two main types of cholesterol – high density lipoprotein (HDL) and low density lipoprotein (LDL) – and the amount of LDL compared to HDL and total cholesterol in the blood is a major predictor of CVD; reducing LDL relative to HDL is important for reducing CVD risk. Most people replace energy intake from fat with carbohydrate and today approximately 50% of our calories comes from carbohydrate. Whilst replacing 1% of energy from saturated fat with carbohydrate confers a small (0.03 mmol/L) reduction in LDL cholesterol, increasing carbohydrate consumption has been found to increase heart disease risk. Increasing carbohydrate intake relative to fat leads to increased triglycerides and reduced HDL. The primary reason for this is that carbohydrate directly alters the size of the cholesterol molecule, making it smaller, harder and denser. This is bad news for our blood vessels as small, hard cholesterol particles increase the likelihood of damage and penetration of the vessel walls. This, together with the inflammation that arises to repair the damage caused, is the major contributor to atherosclerosis. Small LDL particles are also not so easily recognised by receptors on cell membranes and so they stay in circulation for long periods of time, further increasing the damage potential. Fat, on the other hand, including saturated fat, increases cholesterol particle size and, as a result, reduces associated damage. Big, puffy soft cholesterol molecules are much less able to cause, and embed into, lesions in blood vessel walls, preventing plaque formation.
Not all carbohydrate has the same impact on CVD risk, however, and it is important to choose carbohydrates with low total carbohydrate content and those that are high in fibre. The carbohydrate content, combined with the amount of fibre, determines the glycaemic index (GI), which determines how quickly the energy (in the form of sugars) is released into the blood. The lower the total carbohydrate and the higher the fibre content of food, the lower the GI. A diet made up of high GI foods has been shown to increase heart attack risk, whereas low GI foods can help protect against CVD. Foods low on the GI scale include fruit, vegetables, legumes and unprocessed grains such as oats. These low GI foods are also high in vitamins, minerals and phytonutrients – important nutritional factors that also contribute to CVD protection.
The most effective way to reduce cardiovascular risk is to increase consumption of polyunsaturated fatty acids (PUFA). A 5% switch from saturated fat intake to PUFA can reduce heart disease risk by up to 10%. As with carbohydrate, however, it is important to choose the right type of polyunsaturated fat. Omega-6 PUFAs are abundant in plant oils, animal protein, nuts and grains, whereas omega-3s are found mainly in oily fish and some plant foods. The omega-3 family of fats are of particular importance for cardiovascular function, as excess omega-6 consumption increases CVD, whereas omega-3s offer significant CVD protection. The role of omega-3 fats in protecting against CVD is now well established and they directly help to:
- Lower inflammation
- Increase blood vessel relaxation
- Lower triglycerides
- Reduce platelet aggregation
- Stabilise plaques, preventing them from rupturing
- Protect against irregular heart rhythms
- Reduce blood pressure
Both the omega-3 index (the sum of the total omega-3 EPA and DHA levels in our blood cell membranes) and the AA to EPA ratio are highly accurate markers for CVD risk. These omega-3 specific measures are now considered to be a more potent risk factor for sudden cardiac death than high blood cholesterol levels or inflammatory markers (Dawczynski et al. 2010). Directly raising omega-3 and specifically EPA levels improves both the omega-3 index and AA to EPA ratio, significantly protecting against CVD.
The overwhelming evidence for the benefits of omega-3s means that supplementing with omega-3s is an important addition to a healthy diet for anyone wishing to reduce their risk of heart disease. Choosing the right omega-3 is important depending on the type of benefits you need most, as there are significant differences offered by the two key omega-3 fatty acids EPA and DHA.
The omega-3 index (EPA + DHA as a % of total fats) provides valuable information about the amount of long-chain omega-3 fatty acids within cells and tissue. It acts as a structural marker of omega-3 as well as for assessing CVD risk. Increasing the omega-3 EPA and DHA content of cell membranes to a minimum 8% is advisable for comprehensive cardiovascular support. It is possible to check your omega-3 index using our Opti-O-3 biomarker test.
It is now recognised that a number of cardioprotective benefits associated with fish oil relate specifically to EPA, as EPA is not only effective in reducing elevated triglyceride levels but may also have more favourable effects on total cholesterol than EPA- and DHA-containing supplements.
The benefits of EPA in cardiovascular health management also extend to the prevention of secondary cardiovascular events. Individuals who have had a previous heart attack can significantly reduce their chances of experiencing further ‘events’ by supplementing daily with 1-2g EPA. Based on evidence from the Japan EPA lipid intervention study (JELIS), the Japanese now hail EPA treatment as the ‘gold standard’ for lipid management. The importance of pure EPA is highlighted by the number of studies that have used (or currently use) EPA in isolation and include the MARINE study, the ANCHOR study and the REDUCE-it study.
In addition to EPA’s lipid-lowering benefits, supplementing with pure EPA, by reducing an unhealthy AA to EPA ratio, will modify the production of inflammatory and pro-thrombotic products known to increase the risk of developing CVD. Inflammation is also believed to play a fundamental role in the development of arterial fibrillation (irregular and often abnormally fast heart rate) and omega-3s are well documented for their benefits in normalising blood pressure and heart rate.
The physiological effects of EPA on the cardiovascular system, although well established, are different from those of DHA and it is clear that EPA is the primary fatty acid associated with reduced atherosclerosis risk. As such, interventions using pure/ high EPA that specifically target the AA to EPA ratio could be useful for the prevention of CVD. However, ensuring DHA levels are well maintained appears to be important for regulating blood pressure, reducing the risk of endothelial dysfunction and maintaining normal heart rate.
Elevated levels of circulating total homocysteine are a well-documented risk factor for the development of cardiovascular disease. Decreasing homocysteine levels in the blood directly reduces risk of both myocardial infarction and stroke. A rise in homocysteine levels of just 5 mmol/L increases the risk of coronary heart disease by approximately 20%. Levels of homocysteine in the blood are directly inﬂuenced by levels of the B-vitamins folate, vitamin B6 and vitamin B12 and low levels of these vitamins directly contribute to elevated homocysteine.
The role of homocysteine in the development of CVD is not fully understood, although it is well established that homocysteine plays a role in increasing damage and cell death of cells lining the blood vessels. Homocysteine also appears to contribute to the development of atherosclerosis via a number of mechanisms, including:
- Reduced vessel relaxation
- Increased vessel wall inflammation
- Increased oxidative stress-induced cell damage
- Increased expression of genes that switch on cell death
Homocysteine is also thought to contribute indirectly to cellular stress, which may worsen already altered cholesterol and triglyceride levels, further contributing to CVD risk. In addition, homocysteine appears to increase blood thickness and thus promote blood clot formation.
Supplementing with the B-vitamins needed to efficiently recycle homocysteine back into its health-promoting products has been shown to reduce homocysteine levels and can thereby help reduce associated health risks.
Coenzyme Q10 (CoQ10) is a natural antioxidant synthesised by the body from the same molecules used to make cholesterol. CoQ10 is also consumed in the diet by eating animal protein and some seed and nut oils, but dietary consumption contributes only a low amount to total CoQ10 unless organ meats are regularly consumed. CoQ10 is also available as a supplement, where it comes in two forms: ubiquinol, the active antioxidant form, and ubiquinone, the oxidised form, which the body converts to ubiquinol.
Coenzyme Q10 (CoQ10) is essential for energy production (in the form of ATP) and is heavily involved in heart function – in particular, heart muscle contraction and the movement of important molecules into the heart cells (through ATP dependent channels). The heart is particularly sensitive to low CoQ10 levels and the subsequent reduction in energy production capacity – a factor considered to contribute to heart disease. Consistently low levels of CoQ10 are observed in CVD patients and increasing intake of this nutrient may help protect against cardiovascular events.
CoQ10, in its ubiquinol form, is a powerful antioxidant that also plays an important role in regenerating other antioxidants, including vitamin E, vitamin C and lipoic acid. Its ability to quench free radicals helps to protect against cell damage and reduce oxygen damage to fat molecules such as cholesterol. LDL oxidation is an important contributor to the development of atherosclerosis.
CoQ10 may also help improve blood vessel relaxation and carbohydrate-induced vessel wall damage, further reducing atherosclerosis risk, particularly in patients with metabolic syndrome. CoQ10 helps to thin the blood and increase blood flow to the heart, as well as positively influencing the immune system by reducing stress and inflammation.
Statins are currently used as an effective method to prevent CVD by lowering cholesterol levels. Statins work through inhibiting the function of the enzyme that plays a critical role in the regulation of cholesterol synthesis. This enzyme (HMG-CoA reductase) is also involved in the production of CoQ10, so statin users may experience unpleasant muscle-wasting side effects arising from the subsequent block in CoQ10 production.
Supplementing with CoQ10 in the form of ubiquinol will help replenish any deficiencies in CoQ10 observed in CVD patients, statin users and older people and offers a number of potential protective effects to help support cardiovascular health.
Jacobson TA, Glickstein SB, Rowe JD, Soni PN: Effects of eicosapentaenoic acid and docosahexaenoic acid on low-density lipoprotein cholesterol and other lipids: a review. Journal of clinical lipidology 2012, 6:5-18.
Ballantyne CM, Braeckman RA, Soni PN: Icosapent ethyl for the treatment of hypertriglyceridemia. Expert opinion on pharmacotherapy 2013, 14:1409-1416.
Bays HE, Ballantyne CM, Braeckman RA, Stirtan WG, Soni PN: Icosapent ethyl, a pure ethyl ester of eicosapentaenoic acid: effects on circulating markers of inflammation from the MARINE and ANCHOR studies. American journal of cardiovascular drugs : drugs, devices, and other interventions 2013, 13:37-46.
Bays HE, Ballantyne CM, Kastelein JJ, Isaacsohn JL, Braeckman RA, Soni PN: Eicosapentaenoic acid ethyl ester (AMR101) therapy in patients with very high triglyceride levels (from the Multi-center, plAcebo-controlled, Randomized, double-blINd, 12-week study with an open-label Extension [MARINE] trial). The American journal of cardiology 2011, 108:682-690.
Yamanouchi D, Komori K: Eicosapentaenoic acid as the gold standard for patients with peripheral artery disease? – subanalysis of the JELIS trial. Circulation journal : official journal of the Japanese Circulation Society 2010, 74:1298-1299.
Rupp H, Wagner D, Rupp T, Schulte LM, Maisch B: Risk stratification by the “EPA+DHA level” and the “EPA/AA ratio” focus on anti-inflammatory and antiarrhythmogenic effects of long-chain omega-3 fatty acids. Herz 2004, 29:673-685.
Hayakawa S, Yoshikawa D, Ishii H, Tanaka M, Kumagai S, Matsumoto M, Hayashi M, Sugiura T, Hayashi K, Ando H, et al: Association of plasma omega-3 to omega-6 polyunsaturated fatty acid ratio with complexity of coronary artery lesion. Internal medicine 2012, 51:1009-1014.
Kashiyama T, Ueda Y, Nemoto T, Wada M, Masumura Y, Matsuo K, Nishio M, Hirata A, Asai M, Kashiwase K, Kodama K: Relationship between coronary plaque vulnerability and serum n-3/n-6 polyunsaturated fatty acid ratio. Circulation journal : official journal of the Japanese Circulation Society 2011, 75:2432-2438.
Refsum H, Smith AD, Ueland PM, Nexo E, Clarke R, McPartlin J, Johnston C, Engbaek F, Schneede J, McPartlin C, Scott JM: Facts and recommendations about total homocysteine determinations: an expert opinion. Clinical chemistry 2004, 50:3-32.
Fanapour PC, Yug B, Kochar MS: Hyperhomocysteinemia: an additional cardiovascular risk factor. WMJ : official publication of the State Medical Society of Wisconsin 1999, 98:51-54.
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For general heart health
Adults and children aged twelve years and over should take 2 capsules daily for a minimum of three months.
Adults and children aged twelve years and over should take 3 capsules daily for long-term management.
For cholesterol management
Adults should take 4 capsules daily for a minimum of six months.
Adults should take 3 capsules daily for long-term management.
For triglyceride management
Adults should take 8 capsules daily for a minimum of six months reducing to 4 capsules daily for a further six months.
Adults should take 3 capsules daily for long-term management.
Heart rate and blood pressure
Adults should take 4 capsules daily for a minimum of six months.
Adults should take 3 capsules daily for long-term management.
Pharmepa® RESTORE and MAINTAIN should be taken with food for optimum absorption and taken as a split dose where appropriate. It is not advisable to exceed the above dose unless advised by a healthcare practitioner.
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Echiomega Echium Seed Oil – for vegetarians & vegans
Adults and children aged twelve years and over should take 4 capsules of Echiomega twice daily to provide a sufficiently high dose of long-chain omega-3s. Take Echiomega with food for optimum absorption.
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Children aged 7-16 should take 1 tablet daily. Adults should take 1 tablet twice daily, at mealtimes.
It is not advisable to exceed the above dose unless advised by a healthcare practitioner.
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