The healthy heart guide

Heart attacks are our biggest killer – yet many are preventable. Julia Stuart on the simple changes that could save your life

Heart disease is the biggest killer of men and women in the West, accounting for more than 25 per cent of deaths. It remains the UK's single biggest killer, with someone in this country suffering a heart attack every two minutes. Too many of us don't know how to recognise the symptoms, according to a report published last week. And another showed that a significant proportion of people, including women, are more at risk of a heart attack than they believe. But there are plenty of things we can do to keep our hearts healthy.

Know the symptoms

A heart attack happens when a blood clot suddenly and completely blocks one of the arteries around the heart. As a result, part of the heart muscle does not get an adequate blood supply and is starved of oxygen, which can cause permanent damage. Most heart attacks occur as the result of coronary heart disease. The common or classic symptoms of a heart attack are a pain in the centre of the chest that can spread to the arms, neck or jaw. Some people can feel sick or sweaty, while others feel short of breath.

Women often experience less common heart attack symptoms, including a dull pain, ache, or "heavy" feeling in the chest; a mild discomfort and a general feeling of being unwell; a pain in the chest that can spread to the back or stomach; a chest pain that feels like a bad episode of indigestion; or a bout of dizziness. Women, whatever their age, are less likely to have heart attacks than men. But women are more likely than men to die from a heart attack, and those who live through one are more likely than men to have a second within four years. This might be because their heart disease is often more severe by the time they have their first heart attack.

"Far too many people delay calling an ambulance when they have a heart attack," warns Judy O'Sullivan, a cardiac nurse for the British Heart Foundation. "They either don't recognise the symptoms or think they should be much more severe than they are. The longer it takes you to call an ambulance, the greater your risk of dying. Three out of every 10 people who have a heart attack will be dead before they get to hospital. It is essential that you call an ambulance immediately. Paramedics say they would rather attend a false alarm than arrive and find it's too late to help someone. The life-saving treatment starts as soon as the paramedic arrives at your front door."

Diet

A healthy diet can significantly reducing the risk of developing heart disease. Plenty of fruit and vegetables are recommended, as evidence suggests they help to lower the risk of heart disease. Forget your Atkins diet, as starchy foods such as wholegrain bread, pasta and rice should also be included. Too much saturated fat from fatty meats, biscuits, cakes and full-fat dairy products can clog your arteries and put a strain on your heart. Eating oily fish regularly can help to reduce the risk of heart disease and improve the chances of survival after a heart attack. Omega-3 fatty acids found in oily fish help the heart to beat regularly, reduce triglyceride levels (fatty substances found in the blood) and prevent blood clots from forming in the coronary arteries. "Approximately three out of 10 cases of coronary heart disease in developed countries are due to low levels of fruit and vegetable consumption," says O'Sullivan.

Salt

Too much salt can cause high blood pressure, which increases the risk of developing coronary heart disease. Watch out for foods such as crisps, salted nuts, canned and packet soups and sauces, baked beans and canned vegetables, pork pies, pizzas and other ready meals. Three-quarters of a person's dietary salt intake comes from processed foods alone. "Salt is a hidden source of harm. Too many of us see it as a flavouring, rather than something that can potentially damage our health," says O'Sullivan.

Blood Pressure

The higher your blood pressure, the shorter your life expectancy. High blood pressure develops when the walls of the larger arteries lose their natural elasticity and become rigid, and the smaller blood vessels constrict. Problems with sight, breathlessness and nosebleeds can sometimes be a sign of high blood pressure. Not doing enough physical activity, being overweight, having too much salt in your diet, drinking too much alcohol, and not eating enough fruit and vegetables can play a part in high blood pressure, as well as genes.

People with high blood pressure run a higher risk of having a stroke (which damages the brain) or a heart attack. If left untreated for a long time, high blood pressure can lead to kidney failure and even damage your sight. Twenty-two per cent of heart attacks in Western Europe occur in people with a history of high blood pressure. Those over 40 should have a full risk assessment for heart disease done at their GP's surgery, which involves measuring blood pressure, blood cholesterol levels and blood glucose levels.

Cholesterol

Cholesterol is a waxy substance that is mainly made in the body. The liver makes it from the saturated fats in food. There is very little cholesterol found in foods, except for eggs, liver, kidneys and seafood such as prawns. Cholesterol plays an essential role in how every cell works. It is also used by the body to make other vital chemicals. Too much cholesterol in the blood can increase your risk of getting heart and circulatory disease. (Heart and circulatory disease includes coronary heart disease, stroke, and diseases that affect the circulation such as peripheral arterial disease.)

Doctors prescribe cholesterol-lowering medicines such as statins for people who are at greatest overall risk of suffering from coronary heart disease. You can also help lower your cholesterol level by eating a high-fibre diet which includes such foods as porridge, beans, pulses, lentils, nuts, fruits and vegetables. There is evidence that substances called "plant sterols" and "stanols" may reduce cholesterol levels. They are added to certain foods including margarines, some brands of spread, soft cheeses and yoghurts.

Exercise

Not being physically active is the most common cause of heart disease. Being physically active might involve going swimming, doing an exercise class or playing a sport, but it also includes everyday things such as walking, gardening and climbing stairs. The British Heart Foundation recommends aiming to build up to at least 30 minutes of moderately intense physical activity five or more days a week. During moderate exercise you should be breathing more heavily than normal and feel slightly warmer.

Risk factors

Factors likely to lead to coronary heart disease include family history, smoking, high blood pressure, high cholesterol, lack of physical activity, obesity and diabetes. Even if you have a family history of coronary heart disease, you can take measures to reduce your own risk – it may be that your relative's lifestyle led to their condition.

Stress

There is some evidence that stress, anxiety and depression can increase your risk of developing coronary heart disease. Also, psychological distress may increase the chances of smoking, becoming overweight or obese, drinking too much alcohol and having high blood pressur. Depression and anxiety can also cause physical symptoms which are sometimes very similar to the symptoms of heart disease – for example tiredness, chest pains, breathlessness and palpitations.

Coronary heart disease: the facts

How to help someone who's having a heart attack

* Someone suffers a heart attack every two minutes in the UK.

* Coronary heart disease remains the UK's single biggest killer.

* The longer heart-attack patients wait to call for medical assistance, the worse their chances of survival. Those who receive treatment four to six hours after the onset of symptoms are twice as likely to die as those who get treatment within one to two hours.

* Coronary heart disease is the leading cause of premature death in the UK.

* People experiencing heart-attack symptoms delay an average of 90 minutes before an ambulance is called. By the time treatment to restore blood flow to the heart is given, an average of two hours and 40 minutes have passed.

* Every year about 128,000 men and 103,000 women suffer heart attacks.

* While nearly half of all people who have a heart attack die from it, most people who don't live through a heart attack die before they reach a hospital. Nine out of 10 people who reach the hospital after a heart attack are still alive a year later. www.bhf.org.uk

* If a person seems to be unconscious, approach with care. To find out if the person is conscious, gently shake him or her, and shout loudly,'Are you all right?' If there is no response, shout for help.

* You will need to assess the casualty and take suitable action. Remember the mantra A, B, C – Airway, Breathing, Circulation. Open the person's airway by tilting the head back and lifting the chin. Listen and feel for signs of breathing for up to 10 seconds.

* If the person is unconscious and not breathing, phone 999 for an ambulance. Put the person face upwards on the floor. Open the airway again and give two of your own breaths to the person. This is called 'rescue breathing'. Close the person's nostrils with your fingers and thumb and blow into the mouth. Make sure that no air can leak out and that the chest rises and falls.

* Check for signs of circulation. This means checking for signs of normal breathing, coughing or movement.

* If there are no signs of circulation, or if you are at all unsure, start chest compressions immediately. Find the notch at the bottom of the breastbone. Measure two fingers' width above this. Place the heel of one hand there. Place your other hand on top. Press down firmly and smoothly 15 times. Do this at a rate of about 100 times a minute. Repeat two rescue breaths and then 15 chest compressions.

Keep doing the two rescue breaths followed by 15 chest compressions until the casualty shows signs of life, professional help arrives, or you become exhausted.