DH heading for heart disease - advice please.

[aNewOne]

DH (41) saw practice nurse yesterday for some blood results and a bit of a check up:
bp 145/95
cholesterol 6.8
blood sugars 6.9
His father had a quadruple bypass at 50.
Where on earth do we start on improving his health? Which is the most important area to focus on?
He is not overweight (well, maybe half a stone, tops). He goes to gym and plays football. He feels fit and healthy. His diet isn't terrible - if anything it's boring, but he does like and eat plenty of fruit and salad. He doesn't - and wont - eat fish, nuts, seeds or most 'good-fat' foods.
Worryingly, he left gp surgery with no follow up appointment. He has not been put on statins or any other medication.
He did used to take plant sterols and is going to start again.

Anyone got any experience of dealing with such a predisposition or advice on how he can lower his risks of heart disease.

Thanks.

Look up the British Heart Foundation - I think they have a helpline too. I'm afraid he really is going to eat the stuff he 'won't' eat, and I suspect winching his weight down too would be a good idea as well. BHF is really good, though.

Thank you motherinferior that's really helpful - their website looks excellent.

Reducing salt in his diet might help a bit (it's in an awful lot of stuff that most people don't realise) and after a while your taste buds get used to it and don't notice it's missing.
Stress is also something that is advised to reduce but that's often easier said than done.
My DH's mantra (cardiologist) is eat less, move more & don't smoke. (drs are rubbish at following this advice)
I would get your DH to make another appointment and discuss it with his GP as they are best placed to advise.

Sorry to hear this - it sounds like it's in the genetics. My DH is in a similar situation. His father died in his early fifties after years of CV problems, his uncle has a pacemaker etc etc. DH had a stroke when he was 54.

GP put him on statins, which didn't agree with him at all so I've now got him on 100mcg per day CoQ10 and his cholesterol is OK. Also his BP is fine as long as it's not being taken by anyone in a white coat. Might be worth looking at CoQ10 and also Niacin.

Any road up, sounds like it's time for a stocktake.

D

I'd make an appt with the Doctor, does the practice know about his family history? it sounds obvious but quite often they dont know due to a) not asking and b) patient not thinking that its relevant.

He could try more porridge for the cholestoral (sp?)
Low salt for bp (sains do a very good one, my dh bp dropped by about 20 points when we changed)
Following a low gi diet for the blood sugar (dont forget some fruits break down to sugar faster than others eg apples and pears dont break down as quickly as soft "exotic fruits") so eating more vegetables would help to.

Quite honestly I think the gp would be delighted if a patient went to them wanting to prevent something rather than having to treat a preventable occurrance.

I would go with the salt reduction and see if you can get his BP down a bit. Why weren't statins suggested?

Definitely GP appointment; but also do make it clear it is his health and he needs to be the one in charge of it, because that is the best way for him to look after himself. You can't be responsible for him!

Thanks for responses.
Nurse did ask about family history.
Statins were mentioned but when DH said he had used natural sterol supplements in past with good effect (chol dropped from 7.9 to 6.5 when he was using them) she suggested he restart them. He would be happy to try statins and he says he will see gp about them.
Nurse suggested he come back in 6 months.
I borrowed a BM monitor from work and last night after tea his blood sugars were 7.6.
He says he'd like to give it 3 months of taking sterols and making lifestyle changes before going to gp.
I'll tell him about the advice re salt reduction and diet.
RockinD we'll look into supplements esp CoQ10 and niacin, thank you.
He doesn't smoke.

High blood pressure is a concern but high cholesterol isn't. Google Cholesterol Myth and read some of the articles from good sources.

Reducing salt intake can help reduce blood pressure. Watch for hidden salt in all sorts of foods.

I would also say: there's a limit to how much advice you can get, usefully, from people on the internet (I am a health journalist, but not a heart specialist, for instance). GP, BHF: they're the ones with the expertise.

Have a look here:

www.nhlbi.nih.gov/health/public/heart/hbp/hbp_low/hbp_low.pdf

How much exercise does he do?
Exercise is a fundamentally important part in reducing heart disease, but it needs to start off moderately if he is not a big exerciser already. Aerobic-style exercise will help him.

Cholesterol is produced in the body from saturated fats in the diet; reducing dietary cholesterol intake doesn't make as much impact as reducing saturated fat. The body needs a certain amount of cholesterol to keep everything running - it is the basis of steroid hormones, and is the glue that holds all our cell membranes together. The biochemical pathway in the body that produces cholesterol is, up to a point, the same one that produces coenzyme Q 10, required for mitochondrial energy production, especially in muscles. So - use the muscles more > more requirement for coQ10 > more of the pathway diverging towards production of coQ10 --> less going towards making cholesterol.

Moderate exercise can help restore blood sugar balance as well; but he needs to start gently (especially because of the high BP) and preferably under some supervision - unless it's just to take a brisk walk, about 30 minutes, as many days in the week as he can manage.

Sorry, missed the line about going to the gym and playing football! so how much exercise is that in a week?

Reading with interest, as have slight family history and already take Ramipril for borderline high BP.

And just had cholesterol results back at 6.2
Mind you, I had the test at Xmas, worst possible time for diet

Thing is, apart from too many chocolates over the holidays (a LOT too many) I eat pretty healthily. Don't smoke. Don't eat butter or cream, or much cheese. Do'nt drink. Don't eat much salt. Walk the dog and run around after the kids. Weight under 9st (5'4").

What else is there?

Will add the plant products and try CoQ10 though.....and, good luck to all the dhs on here.

You've had good advice but you need/he needs to be accurate with what you are saying he does and doesn't do :)

Exercise- a minimum of 30 mins 5 x a week is recommended. Going to the gym once or twice and lifting a few weights etc is okay but not enough. he needs a mix of aerobic and resistance workouts.

How often does he go and what does he do?

salt- I would not go down the route of using low sodium salt as some has high potassium- far better if he cuts it out gradually altogether.

Cholesterol- again, exercise should help, but are you looking at hidden fats in cakes, biscuits, etc and not simply fatty or fried foods?

Good fats like olive oil are healthy and he must eat oily fish 2 x a week! If he doesn't eat fish, is he eating red meat every day?

I do understand that there is a family history BUT it doesn't necessarily mean he will go the same way...

my mother is almost 85 and fit- touch wood- but her brother died at 51 from CHD ( smoker, over weight, no exercise) and her mother had a heart attack at 60.
She though has done everything she can to stay fit.

So- there is hope!

The "not overweight much" can be deceiving too. A lot of fat in the body can be stored as internal fat around the vital organs- and you can't see it. But it does damage.

many men who are slim think they are healthy but are not aware of the fat that is around the liver, kidneys, and heart.

What is your Dhs BMI by the way?

In the short term it's his BP that is the worry- that needs to be sorted soon and the cholesterol is 2nd.

I think if you/he kept a food diary of the amount of fat and salt in his diet you might be surprised. Even a few slices of bread can tip you over the 5gms a day limit for salt, so it's worth really looking at his diet carefully, and salad doesn't contribute much nutritionally- he needs lots of foods that are high fibre.

Good news about your Mum, AmeliaGrey

Oh thanks! She had a tiny stroke at almost 80 but is fighting fit again (I hope!) she does 6 mile walks with the WI now.

What is his weight and height?

If it saves his life a BMKI of even 18.5 is not unhealthy.

What does he eat most days?

this book is very good on keeping your heart healthy book

My mum is 84, AG, and also fighting fit - though lazy

In her case, its more luck than determination. Her mother lived till 102 (though her father died at 56 from an embolism).

Her brother - my uncle - did have angina and mini stroke/s about 10 years ago, but changed his diet drastically, took more exercise, and is fine at 79. He does have very good doctors, and plenty of check ups, and walks a lot but also takes it easy.

I just ate half a mushroom pizza (saturday night DVD-and-pizza tradition with the dds) and a chocolate cookie

Not at all worried about weight, or BMI, but nonetheless - cholesterol needs to come down. So confusing.

Elibean do you count fat content /look at labels for fat content in food?
I was amazed TBH when I bought a ready made rissotto once- more than a daily rec. allowance in one portion.

The rec. amount of fat for a woman is 20gms a day- even a couple of sausages can give you a half or more of that ( and I mean good quality ones), so I suggest you read the labels and try to work out what you are eating.

I very rarely eat anything pre-prepared, or processed. Maybe quiche, once a month - and a bit of bacon in half-fat creme fraiche carbonara every couple of weeks (home made).
But have never measured grams of anything - will try and pay more attention!
I have two young children (old mum!) and little time, but do eat flora, olive oil, fish, rather than red meat, butter or cheese. Have done for years and years, hence my confusion about the cholesterol going up over the past year...maybe chocolate has caught up with me?!