Being overweight – obesity
I don’t feel overweight but the doctor says I am. Have I got more chance of developing heart disease because of this?

Very overweight (obese) people do have more chance of developing heart disease and this has been mentioned earlier (see the section Risks of high blood pressure). Being fat increases the work the heart has to do, causes high blood pressure and leads to abnormal blood lipids (hypercholesterolaemia). It can also lead to you developing diabetes (see below). You should try to reduce your weight – see Chapter 9 for advice about healthy eating and losing weight. Big bellies are bad for your heart!

Stress
I have a very stressful job. Am I more likely to get heart problems?

There is no proof that stress actually causes heart disease but it can contribute to the symptoms. It is like a trigger, setting things off. Stress is a state of mind, not an illness, so it is difficult to obtain a precise measurement of it. We all feel stress but it affects us in different ways and we respond differently. Under stress people may smoke or drink more, overeat for comfort or have slightly higher blood pressures. Stress can be fun as well as unpleasant, for example watching a close team match or taking part yourself in team games. A sudden acute stressful incident is the most dangerous (such as a near-miss on the motorway) but usually cannot be avoided. Stress interacts with your chances of developing heart disease and can make them worse.

Will I be able to recognise the symptoms of dangerous levels of stress?
Symptoms will vary but, in general, when stress is detrimental, you will become tense, nervous and often afraid; you may sleep badly, wake early and have tension pains in the muscles of the neck or back.

Is there any way I can reduce my stress levels?
Yes, there are various ways you can help yourself.
•    Try to remove yourself from a stressful environment for some of the day. If work is stressful, go for a walk at lunch time. Keep physically active.
•    Don’t rely on caffeine or alcohol and don’t smoke.
•    Learn that you cannot solve all life’s problems alone and that they are not all caused by you.
•    Try relaxation tapes, yoga or deep breathing exercises. These work well for some people (see below).
•    Spend less time with people who irritate you.
•    Try to avoid rush-hour travel (leave for work earlier and walk the last mile or so).
•    Talk through any problems at work or with friends (don’t repress them and let them fester).
•    Avoid over-commitment – be positive but don’t be afraid to turn things down.
•    Don’t rush about;take your time, plan what you are going to do and follow it through – again be positive and don’t be deflected.
•    Most of all, keep life in perspective – yesterday is gone, tomorrow hasn’t happened, just get on with today and enjoy it.

The most important therapy is your own. Look at what you are doing and ask what your priorities are. If you had one day left in your life, would you shout and yell in traffic, or swear at the railway guard because the train is late (again!), or would you spend time with your loved ones, telling them how much they mean to you. Take deep breaths and keep the world in proportion. If you must do something, punch a pillow but laugh at yourself as you do it!
Really stressed people usually have other psychological problems which benefit from counselling or a support group. If you are unlucky enough to have a heart attack, a ‘cardiac rehabilitation programme’ is invariably helpful. It provides expert help and support as well as guidance on exercise and a healthy lifestyle. It is usually run by nurses who understand your fears and worries, and can help you regain your confidence.
Diffuse your feelings by using art, music, dance and exercise as a relief valve. There are many videos, tapes and books on stress man ¬agement which people have found useful. Any relaxation technique will help. Yoga is a very useful exercise and is an ideal way to wind down and relax. Take evening classes which will allow you to meet others and get awayfrom your normal daily routine.
Above all else, remember that by bringing stress under control you will not only benefit your heart but also improve your outlook on life, allowing better and more complete relationships with loved ones, friends and colleagues at work.

Why is so much emphasis placed on stress in the media?
There is a lot of money in stress management and it is an easy diagnostic dustbin. If you have a funny illness, it’s ‘a virus’; if you can’t explain something, it’s ‘stress’!

Diabetes

I have had diabetes for 30 years. What is the effect of diabetes on heart disease?
People with diabetes do have more heart disease than those without. Whilst very good and strict sugar control may reduce some of the risk, this is undone by an increased number of hypoglycaemic attacks. Although you can’t help having diabetes and, unfortunately, it cannot yet be cured, you can help the other factors that cause heart disease. Do not smoke, keep as fit as you can and avoid getting overweight; keep your cholesterol in check and aim for a normal blood pressure.
Many doctors routinely put people with diabetes on statins to reduce the risk no matter what their cholesterol level is.

I have diabetes and have now been told that I have insulin resistance and am at risk of heart disease – what is insulin resistance?

Normally, when you eat food, your blood sugar (glucose) levels go up; your body produces insulin as a response; insulin helps glucose to be taken up by the tissues, the glucose in your blood falls, and then your insulin level falls. It is called a negative feedback mechanism. If you are insulin-resistant the action of insulin in the tissues is less effective than it should be and glucose (sugar) is not used properly, so the sugar and insulin levels remain raised because the feedback is interrupted. Insulin in high levels can raise the blood pressure, cause salt and water retention and raise LDL (‘bad’) cholesterol and lower HDL (‘good’) cholesterol. Therefore, yes, insulin resistance can increase your risks of developing heart disease.
Being overweight, particularly abdominal obesity (a fat belly), is associated with or causes insulin resistance and Type 2 diabetes. By reducing weight, both diabetes and insulin resistance can be controlled or even overcome. It is more common among Indo-Asian people. Besides reducing your weight, you can also take medications to lower insulin resistance such as metformin or other anti-diabetic drugs.

Illegal drugs
I worry that my teenage daughter might have access to drugs. Do illegal drugs affect young people’s chances of heart problems?

Cannabis(or ‘pot’ or marijuana) increases the heart rate and blood pressure as well as body temperature. It also contains carbon monoxide in the smoke. Although it can help some medical problems, for example, the nausea of cancer therapy, severe pain and multiple sclerosis, heart problems is not one of them and it is therefore not recommended.
Cocaine(‘crack’) is a powerful addictive drug which can cause blood vessels to shut down (go into spasm; see Figure 2.7). It can raise blood pressure, cause strokes and lead to severe heart disease, provoking irregular heartbeats, inflaming heart muscle and causing heart attacks. Just one ‘fix’ can do it – my advice is don’t try it.
You may have heard that morphine helps the heart. It is not that simple. Children may begin with the idea of taking heroin (related to morphine) in small amounts and keeping it under control, but the addiction takes over, infection risks rise (from dirty needles or impure products), the heart valves can become severely damaged and the heart, overwhelmed by disease, gives up functioning properly. This leads to heart failure, resulting in a rapid and inevitable premature death.
If you think your child may be addicted, seek help. Help is available for recovery but an addict needs to admit to addiction, want to end it and accept help from professionals.
Ecstasyhas been very much in the news. Taking even one ecstasy tablet is akin to committing suicide. It may cause a very high fever, irreversible brain damage and heart failure.

Reference:
http://www.pubmed.com