Heart disease - know your risk

Coronary heart disease, along with stroke and blood vessel disease, belongs to the group of conditions known as cardiovascular disease. Coronary heart disease is the leading cause of death in Australia. Over 16,000 people died from coronary heart disease in 2020.

Coronary heart disease can occur when arteries that supply blood and oxygen to your heart muscle become clogged with fatty material called plaque. This process is called atherosclerosis. It can start when you are young and can be well advanced by the time you reach middle age.

If your arteries become blocked or too narrow, blood and oxygen cannot easily reach your heart muscle and can cause symptoms like angina (chest pain). If a blood clot forms in the narrowed artery and blocks the blood supply to part of your heart, it can cause a heart attack. If this happens in the arteries supplying blood to the brain, this can cause a stroke.

Understanding your cardiovascular disease risk score

Your cardiovascular disease risk score estimates your risk of having a heart attack or stroke in the next five years. Your risk score is calculated by combining your risk factors. This is a bit like putting all the pieces of a puzzle together so you can see the whole picture. By looking at the whole picture, your doctor can discuss ways to reduce your risk of heart attack or stroke.

Your risk score is calculated as part of a Heart Health Check with your doctor (GP). Regular Heart Health Checks can help you better understand your risk of a heart attack or stroke in the next five years, and what you can do to manage your risk.

A Heart Health Check is a 20-minute check up with your GP which is subsidised by Medicare. As part of the Heart Health check, your GP will ask you about your medical and family history of heart disease as well as your lifestyle, including your diet, physical activity, and if you smoke or drink alcohol. Your GP will also check your blood pressure, cholesterol and blood sugar levels. Your GP will then take this information and use it to calculate your risk of a having a heart attack or stroke in the next five years and will support you to make positive changes to lower this risk.

People aged 45 years and over (or 30 years and over for Aboriginal and/or Torres Strait Islander Peoples) are eligible for a Heart Health Check.

If you identify as Aboriginal and/or Torres Strait Islander, it’s recommended you see your doctor or Aboriginal Health Practitioner from age 18 to identify any heart disease risk factors as early as possible.

Risk factors

A heart attack or stroke doesn’t happen because of a single risk factor. Usually, they happen due to a combination of risk factors.

There are modifiable risk factors (ones that you can change) and non-modifiable factors (ones that you can’t change).

Heart attack and stroke risk factors that you can change include:

• tobacco smoking
• poor diet
• physical inactivity
• overweight or obesity
• alcohol intake

There are also some health conditions that increase the risk of heart disease:

• high cholesterol
• high blood pressure (hypertension)
• type 2 diabetes
• depression, anxiety and social isolation.

Risk factors you can’t change include your age, sex, being post-menopausal and having a premature family history of heart disease.

Aboriginal and/or Torres Strait Islander Peoples and people from some ethnic backgrounds (South Asian, Middle Eastern, Māori or Pacific Islander) are also at increased risk.

The good news is that you can reduce your overall risk of having a heart attack or stroke by making heart-healthy changes and taking medicines, if your doctor has prescribed them.

Cholesterol and cardiovascular disease risk

Cholesterol is a waxy, fatty substance produced naturally by your body. The body needs cholesterol to make hormones, vitamin D and to build cells. Everyone has cholesterol, but too much means plaque can build up in the coronary arteries. This can make it harder for blood and oxygen to reach the heart and brain, which can increase the risk of a heart attack and stroke.

High cholesterol is mainly caused by eating foods high in saturated and trans fats.

Your total cholesterol includes two types of cholesterol:

• Low-density lipoprotein (LDL) – also known as ‘bad’ cholesterol because it can add to the build-up of plaque in your arteries and increase your risk of heart attack and stroke.
• High-density lipoprotein (HDL) – also known as ‘good’ cholesterol because it helps to protect you against heart attack and stroke.

Most of the total cholesterol in your blood is made up of ‘bad’ LDL cholesterol. Only a small part is made up of ‘good’ HDL cholesterol.

You should aim for low LDL cholesterol and higher HDL cholesterol. Your doctor will check your cholesterol levels as part of a Heart Health Check and will discuss what cholesterol levels you should aim for. They can also refer you to an Accredited Practising Dietitian for dietary advice.

Blood pressure and cardiovascular disease risk

Blood pressure is the pressure on the walls of your arteries as your heart pumps blood around your body. Blood pressure depends on two main things: the amount of blood pumped by your heart and how easily the blood can flow through your arteries.

Your blood pressure will go up and down throughout the day, depending on the time of day and what you are doing. However, high blood pressure is a condition where your blood pressure is consistently high.

Your family history, eating patterns, alcohol intake, weight and physical activity, have a strong influence on blood pressure. In some people, medicines, including the oral contraceptive pill, contraceptive ‘depot’ injections, steroids (cortisone-like medicines) and arthritis medicines can also raise blood pressure.

High blood pressure can overload your heart and arteries and can increase the risk of a heart attack or stroke.

High blood pressure can also affect arteries in other parts of your body, such as the eyes, kidneys and feet and legs.

Your doctor will measure your blood pressure as part of a Heart Health Check. Depending on your overall risk level, they may recommend you make changes to your diet and increase your physical activity. Some people may also need to take medicines to manage their blood pressure.

Diabetes and cardiovascular disease risk

People with diabetes are at greater risk of heart attack and stroke than people without diabetes.

The three main types of diabetes are:

• Type 1 diabetes – where the body doesn’t make insulin.
• Type 2 diabetes – where the body becomes resistant to insulin.
• Gestational diabetes, which women can develop during pregnancy.

Insulin is the hormone responsible for regulating blood sugar levels in the body.

Your doctor will check your blood sugar levels as part of a Heart Health Check. Depending on your overall risk of a heart attack or stroke, they may recommend you make changes to your diet and increase your physical activity. Some people with diabetes may also need to take medicines to manage their blood sugar levels.

Tobacco smoking and cardiovascular disease risk

As well as causing cancer, tobacco smoking affects the arteries that supply blood to your heart and other parts of your body. It reduces the amount of oxygen in your blood and damages your artery walls. Tobacco smoking also makes your blood ‘stickier’, causing blood cells to clump together. This slows blood flow through your arteries and makes blockages more common. Blockages may cause a heart attack or stroke.

Stopping smoking is one of the best things you can do for your health. Every cigarette that you don’t smoke is doing you good. The most effective way to stop smoking is with a combination of:

• support from Quitline (Tel. 13 78 48)
• stop-smoking medicines such as nicotine replacement therapy.

If you are ready to quit smoking or thinking about quitting smoking, talk to your doctor about ways to help you give up smoking. You can also call the Quitline on Tel. 13 78 48 or visit the Quit website.

E-cigarettes

Research shows that e-cigarettes can cause harm, including lung problems, poisoning and injuries, and seizures. There is also evidence that e-cigarettes can cause increases in heart rate and blood pressure, which may increase the risk of heart disease. It’s also not clear whether e-cigarettes are effective in helping people to stop smoking. For more information about e-cigarettes, speak to your doctor or visit the Quit website.

Healthy eating and cardiovascular disease risk

Eating a variety of foods is good for our health and can help reduce the risk of chronic diseases, including heart disease.

The Heart Foundation recommends people follow a heart-healthy eating pattern:

• Eat plenty of vegetables, fruit and wholegrains.
• Include a variety of healthy protein-rich foods, especially fish and seafood, legumes (such as beans and lentils), nuts and seeds. Eggs and poultry can also be enjoyed as part of a heart-healthy eating pattern. If you eat red meat, choose lean cuts and limit to one to three times per week.
• Choose unflavoured milk, yoghurt and cheese. If you have heart disease or high cholesterol, choose reduced fat varieties.
• Include healthy fats and oils. Choose nuts, seeds, avocados, olives and their oils for cooking.
• Add herbs and spices to flavour foods, instead of adding salt.

This way of eating is naturally low in unhealthy fats, salt and added sugar. It’s rich in wholegrains, fibre, antioxidants and healthy fats.

Check out the Heart Foundation website for a range of resources to help you follow a heart-healthy eating pattern.

For individualised nutrition advice, you can also speak to an Accredited Practising Dietitian.

Physical activity and cardiovascular disease risk

Physical activity is an important part of looking after your health and reducing your risk of a heart attack or stroke. Regular physical activity will:

• improve your long-term health
• reduce your risk of heart attack
• give you more energy
• help you to manage your weight
• help you to manage your cholesterol
• lower your blood pressure
• keep your bones and muscle strong
• make you feel more confident, happy and relaxed
• help you to sleep better.

If you have had a heart attack, regular physical activity will help you to recover more quickly. If you have diabetes, it will also help you to manage your blood sugar levels.

All types of physical activity count. Moderate-intensity physical activity, such as brisk walking, is great for your health. It is recommended that you:

• do 30 minutes or more of moderate-intensity physical activity five or more days per week. If you like, you can break this up into smaller bouts, such as three 10-minute walks
• are active on all or most days of the week, with some muscle-strengthening activities on at least two days each week.

Walking for heart health

Walking is a great activity for heart health. Getting involved with a Heart Foundation Walking group is a fun and social way to be active. You can also register for a free Personal Walking Plan. Visit Heart Foundation Walking for more information.

Walking for an average of 30 minutes or more a day can:

• lower the risk of heart disease, stroke, and diabetes
• help manage weight, blood pressure and cholesterol
• reduce the risk of some cancers
• maintain bone density – reducing the risk of osteoporosis and fractures
• improve balance and coordination, reducing the risk of falls and other injuries.

Alcohol and cardiovascular disease risk

Alcohol is not a necessary or recommended part of a heart-healthy eating pattern and drinking alcohol can increase the risk of a heart attack and stroke.

If you don’t drink alcohol, don’t start. If you do drink alcohol, the Heart Foundation recommends following the National Health and Medical Research Council’s (NHMRC) recommended levels of alcohol consumption:

• Healthy men and women should drink no more than 10 standard drinks per week and no more than four standard drinks on any one day.
• Children and young people under 18 years of age should not drink alcohol.
• To reduce the risk of harm to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby.
• For people with heart disease and related conditions or risk factors, the evidence is not strong enough to recommend a safe amount of alcohol consumption for heart health.
• For some people, the safest option is to not drink alcohol at all.

Speak to your doctor for advice and support to cut down on alcohol.

Overweight/obesity and cardiovascular disease risk

Being overweight or obese increases the risk of having a heart attack and stroke, along with other health problems including:

• type 2 diabetes
• high blood pressure (hypertension)
• high cholesterol
• gallbladder disease
• joint problems, such as gout, arthritis and joint pain
• sleep problems, such as sleep apnoea
• certain types of cancer.

Carrying extra weight around your tummy is also a risk factor for heart disease. Speak to your health professional for support to achieve and maintain a healthy weight.

Depression, anxiety, social isolation and cardiovascular disease risk

Studies have shown that having a mental health condition like depression or anxiety can increase the risk of developing heart disease. People who are socially isolated or do not have good social support are also at greater risk of developing heart disease.

Having social connections, healthy personal relationships and being part of a community are essential to maintain your mental health. Being physically active is one of the most effective ways to improve both your heart health and your mental health.

Depression and anxiety can be treated. If you’re feeling lonely, isolated, worried, or depressed, talk to you doctor and reach out to friends and family. You can also get more information and support from Beyond Blue.

Family history and cardiovascular disease risk

A person’s family history of disease (their genes) can increase their risk of having a heart attack or stroke.

If one or more of your immediate family members (such as a parent or sibling) has had a heart attack or stroke before the age of 65, it’s important to mention this to your doctor.

Even if you have a family history, this doesn’t mean you will go on to have a heart attack or stroke. One of the best things you can do is to book in for a Heart Health Check with your GP. Your GP will ask you about your family history as part of the check. If you have an immediate family member who had a heart attack or stroke at a young age, don’t wait until you become eligible for a Heart Health Check. It’s best to speak to your GP as soon as possible so you can start managing your risk today.

Sex, age and cardiovascular disease risk

Women and men are both at risk of having a heart attack or stroke. Men have a higher risk than women of developing heart disease in middle age. The risk rises as they get older.
For women, the risk increases sharply after menopause. It’s thought hormonal changes are likely to play role.

It’s important for both women and men to get a Heart Health Check when they become eligible. People aged 45 years and over, or 30 and over for Aboriginal and/or Torres Strait Islander Peoples can book in for an annual Heart Health Check with their GP.

Women can also have sex-specific risk factors for heart disease, including premature menopause, pre-eclampsia and gestational diabetes, and some cancer treatments. If you have any of these risk factors, speak to your GP as early as possible to reduce your risk.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Your GP (doctor) or other health professional.
• Heart Foundation Helpline Tel. 13 11 12
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice 24 hours a day, 7 days a week
• Community health centre.
• Diabetes Victoria Tel. 1300 437 386.
• Dietitians Australia Tel. 1800 812 942 or find a dietitian
• Heart Foundation Walking – find a walking group near you.
• Beyond Blue Tel. 1300 22 4636.
• Quitline Tel. 13 78 48
• Australian Centre for Heart Health Tel. (03) 9326 8544