HEART HEALTH

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Your heart does amazing things day in and day out. Its main function is to keep oxygenated blood circulating to every cell throughout your body, apart from your corneas. It does this by beating over 100 000 times every 24 hours. Women’s hearts beat around eight beats a minute faster than men’s.

Your heart may only be the size of a fist, but it’s the strongest muscle in your body. It’s a powerhouse that pumps over 5.7 liters of blood per minute. But it relies on a heart-healthy lifestyle to keep it working well.

Cardiovascular disease (CVD), often referred to as heart disease or stroke, are the number one cause of death around the world. 80% of heart diseases that happen before the age of 70 years can be prevented by eating well, keeping active, and not smoking.

CARDIOVASCULAR DISEASE (CVD) IN SOUTH AFRICA

In South Africa, non-communicable diseases (NCDs) are estimated to account for 43% of total adult deaths. CVDs account for almost a fifth (18%) of these deaths. Every day, 225 South Africans die from heart disease and stroke, more than all cancers combined.

Our high CVD-related death rate has been attributed to our unhealthy lifestyles:

18% of the population smoke tobacco

11 litres of pure alcohol is consumed per person per year

Nearly half of the population is unfit

Most of us eat too much salt and not enough fruit and vegetables

1 in 3 South African adults have hypertension which can increase risk of heart attack, heart failure, kidney disease or stroke

31.3% of adults in South Africa are obese. Almost 70% of women in South Africa are classified as overweight or obese, with the proportion of CVD deaths in South African women aged between 35–59 years one and a half times more likely than that of women in the United States.

CAUSES OF HEART DISEASE

CONTROLLABLE RISK FACTORS

Controllable risk factors are lifestyle related. You have the power to improve these risks; even a small improvement can make a big difference to your heart health:

Hypertension (high blood pressure)

High blood pressure, or hypertension, is the leading cause of death from heart diseases and strokes. In South Africa, it is responsible for 1 in every 2 strokes and 2 in every 5 heart attacks. High blood pressure causes damage to your blood vessels, including the blood vessels inside some of the organs such as the eyes, the kidneys and the brain. Uncontrolled high blood pressure can lead to a heart attack, stroke, kidney failure and blindness. The increased workload can also weaken the heart and lead to heart failure.
Tobacco use

Tobacco use is the single most preventable cause of death globally. Smoking is the second leading cause of cardiovascular disease and cerebrovascular disease, after high blood pressure. Smoking almost triples the risk of heart disease and more than doubles the risk of having a stroke by narrowing your blood vessels and reducing the flow of blood to your brain and heart.

Your risk of a non-fatal heart attack increases by 5.6% for every cigarette you smoke and persists even at only one to two cigarettes per day. The risk for heart disease is 25% higher in female smokers than in male smokers.
High cholesterol

High cholesterol is one of the most important risk factors for cardiovascular disease. A build-up of excess cholesterol in the inner walls of arteries can eventually cause them to narrow and become less flexible. This is called atherosclerosis. If a clot forms and blocks a narrowed artery that feeds the heart or brain, it can result in a heart attack or stroke.
Unhealthy diet
Unhealthy fats can raise your cholesterol levels. These are saturated and trans fats, which can be found in fatty and processed meats, chicken skin, butter, ghee, cream and hard cheeses, pies, pastries, biscuits, crackers, fast and deep-fried foods.

Added and refined sugars not only contribute to weight gain, but can also lead to increased blood sugar, inflammation, and insulin resistance. Sugary drinks are especially harmful: just one 340ml canned soft drink contains 9 – 12 teaspoons of sugar.

A high salt intake is linked to high blood pressure. Foods like packet soups, stock cubes, gravies, cheese, many breakfast cereals, breads, salty snacks, processed meats and fast foods are very high in salt.
Physical inactivity

Almost 40% of South Africans are physically inactive according to a recent WHO study. The heart is a muscle and needs exercise to stay fit and healthy. Inactive people double their risk of suffering a heart attack and have a higher risk of dying immediately after such an attack. Inactivity also increases your risk for high blood pressure, overweight and obesity, diabetes, cancers, osteoporosis and cardiovascular disease.
Diabetes

Most diabetics die from heart disease and strokes. Constant high blood sugar causes damage and narrowing of your blood vessels, raises blood pressure and increases your risk of a heart attack or stroke. People living with diabetes are also more prone to the development of atherosclerosis and blood clots. Diabetes can even affect the heart muscle itself, making it a less efficient pump.
Obesity

Being overweight or obese increases your risk for having a heart attack or stroke as well as numerous other health problems including high blood pressure, certain cancers, diabetes, gallstones, sleep apnoea and degenerative joint disease. Excess fat, especially around the waist, can also directly affect heart function and increase the risk of heart failure and abnormal heart rhythms.
Harmful alcohol use

Excessive alcohol consumption can significantly contribute to heart disease in several ways. It can lead to high blood pressure, heart muscle damage (alcoholic cardiomyopathy), and irregular heartbeats (arrhythmias), all of which are risk factors for heart disease. Alcohol also contributes to weight gain because it is often high in sugar and kilojoules.
Stress
Stress becomes unhealthy when there is too much for too long. Unhealthy stress is considered as much a risk factor for heart disease and stroke as cigarette smoking, diabetes, and hypertension. Not only does the physical impact of too much stress on your body increase your risk, it also often leads to other unhealthy behaviours which are often major risk factors for heart disease and stroke, such as:

skipping exercise

snacking on unhealthy foods

overeating

smoking or drinking alcohol excessively

UNCONTROLLABLE RISK FACTORS

These are risk factors that are out of your control but unfortunately predispose you to cardiovascular diseases. Being aware of your personal risk factors empowers you to monitor them and make decisions that can have a positive effect on them. Some of the most common include:

Age

Your risk for heart diseases increases with age, with the majority of CVD deaths in women occurring over the age of 55. However, the plaque buildup which contributes to CVD starts in childhood. The majority of CVD deaths may occur after 55, but your risk is set early in life through your lifestyle habits.
Sex

Women are slightly protected against heart attacks before menopause. After menopause, their risk increases. Women’s heart attack symptoms differ to those of men’s. This means they are more likely to be misdiagnosed, and less likely to receive the same level of treatment, as men. As a result, women are more than twice as likely to die after a heart attack compared to men, with significantly higher mortality rates at 30 days and 5 years post-heart attack.
Genetic
Family history
Poverty
Poverty can increase your risk of cardiovascular disease in several ways:

it increases your risk of stress, anxiety and depression

it can mean that healthy lifestyle choices are unaffordable or available

it can hinder access to good medical treatment

PROTECTING THE HEALTH OF YOUR HEART

Up to 80% of heart diseases and strokes that happen before the age of 70 can be prevented by making healthy lifestyle choices and managing chronic diseases. Living healthily can even help to treat existing heart conditions, like heart failure, atherosclerosis and coronary heart disease.

Manage chronic disease
Hypertension

Hypertension is diagnosed if your blood pressure is higher than 130/85. Levels of hypertension range from high normal to hypertensive emergencies (anything above 180/110) which require emergency medical treatment.

If your blood pressure is slightly higher than normal, you can prevent a further increase in blood pressure with healthy lifestyle behaviours. If your blood pressure is already high, it can be improved by making lifestyle changes and taking blood pressure medication.

The key to managing hypertension is knowing your blood pressure numbers. Have your blood pressure checked regularly.

Cholesterol

For most healthy people normal cholesterol levels are:

Total cholesterol LESS than 5 mmol/L

LDL cholesterol level LESS than 3 mmol/L

HDL cholesterol levels MORE than 1.2 mmol/L for women (it is 1.0 mmol/L for men)

The only way to find out if you have high cholesterol is to have a blood test. Managing high cholesterol involves a combination of lifestyle modifications and, in some cases, medication.

Diabetes

There are 3 main types of diabetes:

Type 1, which usually affects younger people

Type 2, which tends to develop gradually in adults and is the most common type

Gestational diabetes, which is high glucose levels only during pregnancy

Blood sugar levels are typically measured with a rapid test (finger prick blood test) or a fasting blood test (blood is drawn from a vein and sent to a laboratory).

Finger prick tests can be done at any time of day, and you get your results within seconds. A blood sugar level of 11.1 millimoles per litre (mmol/l) or higher suggests diabetes.

Fasting blood sugar tests are ideally done in the morning as they require you not to eat or drink anything for 12 hours prior to having blood drawn. Any reading below 5.6 mmol/l is considered normal and rules out diabetes.

Healthy lifestyle changes, and medication if necessary, is essential for control of blood sugar.
Stop smoking

There is no safe level of smoking, and there is no such thing as a safe cigarette, even those labeled mild and low nicotine. According to the American Heart Association, vaping is just dangerous.

Smoking increases blood pressure, increases blood clotting, increases carbon monoxide levels, and reduces oxygen levels. Passive smokers (non-smokers who breathe second-hand smoke) are also at risk.

Quitting smoking is the single best thing you can do for your heart health. It will improve your overall health and add years to your life. Your body will begin to heal itself almost immediately after your last cigarette. Within two to five years your risk of heart disease will have dropped significantly (and will continue to do so over time).
Eat a healthy diet
A healthy diet significantly impacts heart health by influencing blood pressure, cholesterol levels, and overall cardiovascular function. By focusing on nutrient-rich, whole foods and limiting unhealthy options, you can reduce your risk of heart disease and stroke as well as other noncommunicable diseases (NCDs), including diabetes and cancer.

Try to smaller, more regular meals. Enjoy your food, but avoid overeating. Eating too much – even if its healthy food – can lead to weight gain, increasing your risk for obesity, diabetes and heart disease.

For a heart healthy diet, you should:

Focus on a wide variety of whole foods.

Base your diet on fruits, vegetables, legumes (like lentils and beans), nuts and whole grains (like unprocessed maize, millet, oats, wheat and brown rice). These provide fibre, vitamins, and minerals, and are rich in potassium, which helps regulate blood pressure.

Aim for at least 400 g (i.e. five portions) of fruit and vegetables per day, excluding starchy root vegetables. One portion is roughly the equivalent of half a cup of cooked vegetables or one cup of salad. Half of every plate of food you eat should be made up of non-starchy, colourful vegetables.

Choose lean proteins over red meat and processed meats.

Lean protein includes fish (especially those high in omega-3s), poultry, beans, and lentils. Limit the intake of red meat to two to three times per week. Eat foods high in cholesterol like organ meats, calamari, shrimps and prawns sparingly.

One quarter of your plate should be lean protein.

Choose moderate amounts of high-quality carbohydrates.

One quarter of your plate should be carbohydrate. This equates to two slices of wholewheat bread OR half a cup of cooked brown or basmati rice OR one small potato OR one cup of cooked pasta OR one medium corn on the cob.

Limit saturated and trans fats.

These fats can raise cholesterol levels, increasing the risk of heart disease. Reduce your fat intake by:

steaming or boiling instead of frying when cooking

replacing butter, lard and ghee with oils rich in polyunsaturated fats, such as soybean, canola (rapeseed), corn, safflower and sunflower oils

eating reduced-fat dairy foods and lean meats, or trimming visible fat from meat

limiting your consumption of baked and fried foods, and pre-packaged snacks and foods (e.g. doughnuts, cakes, pies, cookies, biscuits and wafers) that contain industrially-produced trans-fats

Look out for the Heart Mark on foods to help you choose foods that are lower in salt, lower in sugar, lower in saturated and trans fats, and higher in fibre. All Heart Mark products comply with the latest South African legislation on trans fats and contain less than or equal to 0.2g of trans fats per 100g.

Include low-fat dairy products.

Dairy products (and dairy alternatives) are packed with calcium, protein, and other essential nutrients. Try to have at least two servings of low-fat or fat-free dairy products a day.

Reduce sodium intake.

Keeping your salt intake to less than 5g (one teaspoon) per day helps to prevent hypertension and reduces the risk of heart disease and stroke. You can reduce your salt intake by:

limiting the amount of salt and high-sodium condiments (e.g. soy sauce, fish sauce and bouillon) when cooking and preparing foods

not having salt or high-sodium sauces on the table

limiting the consumption of salty snacks

choosing products with lower sodium content

making use of fresh and dried herbs, spices, garlic or lemon juice to add flavour to your food, without adding extra salt or salty seasonings

Limit the amount of sugar consumed.

You eat more sugar than you realise, over and above the sugar you add to your tea and coffee. Sugars is added to processed foods and drinks by manufacturers. Sugar is also naturally present in honey, syrups, fruit juices and fruit juice concentrates. You can reduce your sugar intake by:

limiting the amount of foods and drinks you consume that contain high amounts of sugars, such as sugary snacks, candies and sugar-sweetened beverages (including sodas, fruit juices, flavoured water, energy drinks, ready‐to‐drink tea, ready‐to‐drink coffee and flavoured milk)

eating fresh fruit and raw vegetables as snacks instead of sugary snacks

drinking mostly clean water and unsweetened tea or coffee
Exercise regularly
Engaging in regular exercise reduces your risk of heart disease and stroke. Increasing your level of exercise helps to:

improve ‘good’ cholesterol levels

lower high blood pressure

reduce and control body weight

control blood sugar levels

reduce your risk of developing diabetes

help manage stress and release tension

delay / prevent chronic illnesses associated with aging

reduce your risk of bowel and breast cancer

reduce your risk of developing osteoporosis

smokers who exercise are twice as successful in their attempts to quit

The health benefits of exercise start with at least 150 minutes a week of moderate-intensity physical activity a week OR 75 minutes of vigorous activity per week – but additional benefits occur with more physical activity.

You don’t have to do all your exercise in one go. You can split your moderate exercise into 30-60 minutes a day for 5 days; and even split the 30 minutes into three 10-minute sessions if you prefer.

If you prefer more vigorous activity, you can split your 75 minutes into 25 minutes 3 days per week.

Start slowly and gradually increase the pace to a level that makes you sweat. An easy way of monitoring exercise intensity is to use the ‘talk test’ i.e. when exercising, you should be able to talk throughout the workout.

Aim to include muscle-strengthening activity at least 2 or more days per week for additional health benefits.

Remember, doing some physical activity is better than doing nothing at all! Ways to increase your activity levels include:

choose activities you find to be fun

try listening to music while you exercise

find a friend or family member to exercise with

get off the bus, taxi or train one stop earlier and walk the rest of the way

take the stairs instead of the lift

if you use a car, park further away from the entrance to the shop

try not to sit all day e.g. stand when speaking on the phone

go for a walk on your weekend – even better if you can do this along the beach, or in your local park for pleasure and relaxation

play with your children or grandchildren

go for a walk during your lunch break

put on some music and dance around your home!
Maintain a healthy weight
A healthy weight can be assessed most easily by measuring your waist circumference (the measurement around your body just above your belly button). A waist circumference of more than 80cm for women indicates an increased risk. Reducing your waist reduces your risk:

set a reasonable and realistic goal for weight loss. Slow and steady is the way to go.

eat slowly and enjoy your food, but eat less by reducing your portion sizes. Using a smaller pate can help.

avoid snacking when you’re not hungry and eating out of boredom or habit

stick to three balanced meals a day and have healthy snacks like fruit or veggie sticks in between if you’re really hungry

drink lots of water every day

make sure that your starchy foods are high fibre or wholegrain, as these will keep you feeling fuller for longer

choose lower fat foods

prepare food by baking, boiling or grilling to avoid adding unnecessary oils and fats to

increase your level of physical activity
Drink alcohol in moderation

The World Health Organisation (WHO) states that there’s no safe amount of alcohol to consume. Any level of alcohol consumption poses a risk to our health.

If you do consume alcohol, drink moderately. Women should limit their alcohol consumption to one drink a day. This is equal to 125ml wine OR 340ml beer OR 25ml of spirits or liqueur.
Manage stress levels
Stress is a part of everyday life, and some stress can be good for you. But too much for too long poses a serious risk to your health. Healthy methods to manage your stress is essential. Avoid common pitfalls like eating unhealthy foods and snacks, skipping exercise, drinking alcohol excessively and turning to smoking. These are all major risk factors for heart disease and stroke.

Better ways to cope with stress include:

sharing your troubles them with trusted friends or family

practising good time management by prioritising tasks and planning ahead of time. Focus on doing the important things and don’t stress about the things that don’t really matter

accepting that you can’t control everything, and relax about the things you can’t change

learning to say “no” if your to-do list is too long

giving up bad habits – too much alcohol, smoking or caffeine can actually increase your stress levels

exercising! Go for a walk or to the gym.

getting enough good quality sleep, which for most people is about seven to nine hours a night

taking the time to do things you enjoy. Be good to yourself and seek out things that make you laugh out loud. Laughing out loud enhances your intake of oxygen-rich air, stimulates your heart muscle, and reduces the production of stress hormones!

BE PROACTIVE

Complete the Bonitas Self Health Evaluation (SHE) to assess your health risks and what you can do to manage them. It should only take about 5-10 minutes for you to complete. You will find the SHE here.
Make use of the Bonitas Wellness Benefit, which offers members wellness screening to help detect serious chronic conditions like hypertension and heart disease. You can learn more about this benefit here.

HEART HEALTH

HEART HEALTH

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

CARDIOVASCULAR DISEASE (CVD) IN SOUTH AFRICA

CAUSES OF HEART DISEASE

CONTROLLABLE RISK FACTORS

UNCONTROLLABLE RISK FACTORS

PROTECTING THE HEALTH OF YOUR HEART

BE PROACTIVE

FURTHER READING