We’re often told that regular exercise is great for our health – particularly preventing major diseases like cardiovascular disease. But does that mean if you’re fit and active, you don’t need to worry about ever getting heart disease?
Bottom line: while exercise is certainly helpful, nobody is off the hook completely says Dr Sundip Patel, a consultant cardiologist.
“The simple answer to the question is – and I’m afraid I’ve been seeing it more in recent years – heart disease is no longer a disease of the middle-aged, unfit and overweight, it is now a disease of the young, fit and healthy too so we must keep a very open mind,” says Patel.
There aren’t always obvious warning signs
Patel says it’s not all that uncommon to see patients in their 30s and 40s who, to all intents and purposes, are fit and active with healthy lifestyles – and “their only vice was family history”.
These healthy-seeming patients may present with “silent heart disease” (meaning there weren’t obvious symptoms, or symptoms were very minor and easily missed) or heart attacks that strike seemingly with little warning.
Plus, some people only find out they have high cholesterol or high blood pressure, for example, during a routine test – and these are major factors in developing future problems like stroke and heart attack.
Family history is key
Around 7.6 million people are living with a heart or circulatory disease in the UK, according to British Heart Foundation, and it remains a leading cause of deaths, averaging about one every three minutes. This includes things like heart attacks, heart failure and strokes.
There are lots of factors involved and genetics and lifestyle factors are both important – but Patel says being aware of your family history is vital. This means you can get things checked out as a matter of routine or ‘just in case’, rather than waiting for problems to present.
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“Obviously, if you have symptoms – classic symptoms being discomfort, tightness and heaviness of the chest, breathlessness, fluttering and palpitations, having a funny turn and feeling as if you’re faint and lightheaded – all that would trigger a cardiac review,” he says. “But otherwise, is there a family history? It’s the family history that can tell us a lot about whether there will be an adverse outcome.”
Spotting things like high blood pressure and cholesterol early means steps can be taken to treat and manage them. Problems within the heart and blood vessels may be picked up and treated early sometimes too, preventing things getting worse.
Is it still worth doing exercise then?
“Absolutely yes,” says Patel. This isn’t about saying there is no point bothering with being fit and keeping up a healthy lifestyle – there is very clear and strong evidence that it’s worthwhile. It’s just about remembering it’s only part of the picture.
Being fit doesn’t offset other major risk factors
Can getting plenty of exercise offset other environmental and lifestyle risk factors, like smoking, a poor diet and air pollution? “The brutal answer is no, you can’t offset one against the other,” says Patel. “Undoubtedly exercise does show benefits for heart health, but interestingly it does not have a major impact on cholesterol. But it will help your blood sugar and the risk of diabetes. Exercise will help your lung function and your heart rate.”
And no, regular workouts won’t undo the damage of smoking: “We know that smoking is one of the most potent contributors to heart disease,” notes Patel.
‘Looking’ fit and healthy doesn’t mean you are
Weight often crops up in discussions around disease risk and heart health. It can be a useful indicator and obesity is generally associated with increased disease risk. But Patel stresses that when it comes to cardiovascular disease, the outside doesn’t always match the inside: “A healthy diet is important, but not all overweight people have heart disease and high cholesterol and health problems, and not all of those who seem slim and fit on the surface have healthy hearts and circulation.”
