Session 2 - Heart Health Questions & Answers

This article was created in partnership with sanoLiving clinicians for trusted, accurate information.

During our Longevity Live Series session focused on Heart Health, participants shared thoughtful and important questions. Our sanoMidLife clinical team has provided evidence-informed answers to the questions that were submitted during the session.

How can I increase HDL?

If you're looking to raise your HDL (“good” cholesterol), lifestyle strategies can make a meaningful difference. Here are some examples: 

• Regular exercise (especially aerobic exercise) can help increase HDL levels
• Including good quality fats in your diet. Olive oil, fatty fish like salmon and sardines, or a quality fish oil supplement can be helpful
• Stopping smoking (if applicable) can improve HDL levels
• Avoiding trans fats, which can negatively impact your cholesterol profile

Type 2 diabetes and heart issues:

There is a strong connection between type 2 diabetes and cardiovascular disease. Diabetics are 5x more likely to develop heart disease.

Strategies include:

• Making sure your blood sugars stay under control
• Adopting a Mediterranean-style diet
• Ensuring you move your body regularly

Role of family history in predicting heart disease:

Genetics can certainly play a role, as can shared or similar lifestyle patterns within families. However, that doesn’t mean the things you can do to manage your risk don’t count. In fact, even with a family history, a healthy lifestyle can reduce risk by up to 50%.

How do I safely improve cardio capacity?

Improving cardiovascular fitness should be done gradually and safely.

• Start by maintaining a well-balanced diet to support your activity
• If you are new to exercise, begin small and manageable. Walking is an excellent starting point. Over time, increase your pace and duration. 
• Once that feels comfortable, you can add in other types of exercise such as biking or strength training. The key is to go slow and steady.
• If you are unsure where to begin, check in with your health care provider before starting.

Is heart disease hereditary?

Heart disease can be hereditary. There are genetic factors that may increase risk.

However, heart disease can also cluster in families due to shared lifestyle habits, such as food choices and sedentary behaviors, which can be contributing factors.

Advice for someone with high lp(a):

For individuals with high lipoprotein(a) levels, dietary modifications can be beneficial. A Mediterranean-style, low-glycemic-load diet has been shown to decrease atherogenic lipoproteins and reduce lipoprotein(a) levels. This approach emphasizes fruits, vegetables, whole grains, lean proteins, and healthy fats.

Sample dietary recommendations include:

• Replace refined grains with fibre-rich whole-grain cereals, bread, and brown rice
• Consume nuts and peanuts in moderation
• Choose liquid oils such as soybean, canola, corn, and olive oil instead of solid fats, butter, lard, and tropical oils
• Limit saturated fats and emphasize unsaturated fats
• Choose healthy protein foods and dairy products to naturally limit cholesterol intake
• Limit added sugars and desserts to occasional indulgences

Managing arteriosclerosis:

Managing arteriosclerosis from a lifestyle perspective involves several key strategies: 

• Dietary changes: Adopt a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins. Reduce intake of sodium, saturated fats, and processed foods. Include foods like low-mercury fish, chicken, turkey, tofu, legumes, and moderate amounts of red wine. Incorporate extra virgin olive oil, garlic, nuts (walnuts, hazelnuts, almonds), and dark chocolate in moderation.
• Physical activity: Aim for at least 150 minutes of moderate-intensity aerobic exercise per week. This can include activities like walking, swimming, or cycling. Even small amounts of physical activity can improve heart health.
• Stress management: Practice stress reduction techniques such as mindfulness meditation, yoga, or tai chi. Schedule regular downtime and self-care activities to manage stress levels effectively.
• Smoking cessation: If you smoke, quitting is crucial for reducing cardiovascular risk.
• Alcohol moderation: If you drink alcohol, limit consumption to moderate levels (less than 2 drinks per day).
• Regular health monitoring: Work closely with your healthcare provider to monitor blood pressure, cholesterol levels, and other heart-related risk factors. Annual check-ups are recommended to track your progress and adjust your management plan as needed.

Is high blood pressure stress or menopause?

Short answer – it can be both.

If you notice a consistent increase in blood pressure that coincides with the onset of menopausal symptoms (typically in your 40s or 50s), it may be related to menopause.

Stress-related increases in blood pressure are often more situational and may fluctuate depending on circumstances.

How does HRT work in terms of long-term prevention of cardiac pathologies?

Hormone Replacement Therapy (HRT) is not considered a first-line treatment for cardiac pathologies, but it may play a role in prevention.

Menopausal Hormone Therapy (MHT) may help prevent cardiovascular disease (CVD) in women who are less than 60 years old and within 10 years of menopause onset. In these women (who are recently menopausal and have no evidence of existing cardiovascular disease) MHT may reduce the risk of CVD and all-cause mortality and may slow the progression of atherosclerosis.

However, it is important to note that the benefits are not universal. For women over 60 years old or more than 10 years past menopause, initiating MHT may increase the risk of cardiovascular disease, venous thromboembolism (VTE), and stroke. It is therefore not recommended to start MHT beyond this window solely for primary prevention of coronary heart disease.

Measuring lipid particle sizes - is this important for CVD risk?

Measuring lipoprotein particle size and number can provide deeper insight into cardiovascular risk.

While traditional lipid panels measure the total cholesterol content in lipoproteins, they do not directly measure particle numbers or sizes. The number of atherogenic particles, rather than just their cholesterol content, is a crucial factor in determining cardiovascular risk.

Apolipoprotein B (ApoB) measurement is particularly valuable in this regard. Each atherogenic lipoprotein particle (such as LDL, VLDL, and remnant particles) contains exactly one ApoB molecule. Therefore, measuring ApoB provides a direct count of the total number of atherogenic particles in circulation, which is more informative for assessing cardiovascular risk than just measuring cholesterol content.

Are beets helpful for lowering blood pressure?

Beetroot has shown some potential for lowering blood pressure, although the evidence is mixed.

The 2020 International Society of Hypertension Global Hypertension Practice Guidelines recommend beetroot as part of a nitrate-rich diet for managing hypertension. Beetroot is considered a dietary intervention that may have beneficial effects on blood pressure, likely due to its high nitrate content

The recommended amount is 250 mg of beet juice per day, which can be consumed as whole food or in juice form. Beetroot is considered a very high source of dietary nitrates.

However, it’s important to note that nitrate content can vary depending on country of origin, growing season, and cooking method, which may affect potential benefits. Blood pressure should be monitored, and you should be under the care of a health care provider to discuss and determine whether this method is right for you.

Is there any possibility of getting off blood pressure meds? 

In some cases, yes.

With a healthy diet, consistent lifestyle changes, and careful monitoring from a health care provider, some individuals are able to reduce or come off blood pressure medications. This depends on the underlying reason for the prescription, but for some clients, reduction or discontinuation may be possible under medical supervision.

Chest pain and statins:

Statins typically do not directly cause chest pain or heart pain.

That being said, statins can cause muscle aches and pains. Because there are muscles in the chest (around the ribs and pectoral muscles), it is possible to experience muscle discomfort in and around the chest area.

Key Health Numbers:

Understanding your key health markers can help you monitor cardiovascular risk:

• Blood pressure: Ideal target 120/80
• HbA1c: <5.5%
• Fasting glucose: <6.0 mmol/L
• Triglycerides: <1.47 mmol/L
• Fasting insulin: Levels above 15.7 microU/mL (109 pmol/L) may suggest insulin resistance
• LDL ("Bad" cholesterol): <2.5
• HDL ("Good" cholesterol): >1.5
• Non-HDL (Total – HDL): <3.5 (or LDL number plus no more than 0.8 extra)

Are there cholesterol meds and bp meds that you shouldn't take together? 

Certain cholesterol medications (statins) and blood pressure medications can interact. These interactions may increase the risk of muscle damage (rhabdomyolysis) or alter medication levels.

For example, you cannot take a statin and a calcium channel blocker together. It is important to discuss and clarify all medication combinations with your health care provider to ensure safety.