Nothing To Be Half-Hearted About: Heart Health Tips for Men Over 40

Most South Asian men over the age of 40 are unaware that they are facing a ticking time bomb — heart disease. A shocking 50% of heart attacks strike before the age of 50 and a quarter even earlier. The numbers show worsening heart health in men, with a rise in heart attacks among adults in their 30s and 40s.

The dramatic rise in heart disease mortality for Indians, a staggering 20%-50% higher than others, forces us to reconsider the role of ageing. It's clear that additional risk factors are significantly impacting heart health in Indian men.

With heart attacks causing up to 45% of deaths in adults between the ages of 40-60, let’s understand how various factors affect heart health in men. How does heart disease begin?

Atherosclerosis is the buildup of fats (lipids) in the walls of arteries. This buildup, called plaque, thickens over time, narrowing the arteries and reducing blood flow to organs — a condition known as Atherosclerotic Cardiovascular Disease (ASCVD).

• High blood pressure (Hypertension): It is often labelled a silent killer because it applies pressure on the inner linings of your arteries, slowly leading to damage and potentially severe cardiac issues.
• Diabetes: High blood sugar levels directly damage the nerves and blood vessels that regulate your heart.
• Obesity: Excess weight contributes to high blood pressure, diabetes, and high cholesterol, which together lead to a significant worsening of heart health.
• High cholesterol (Dyslipidemia): The balance between LDL (bad cholesterol) and HDL (good cholesterol) is crucial. High LDL leads to dangerous plaque buildup, while low HDL fails to clear cholesterol from your bloodstream.
• Cigarettes, e-cigarettes, cigars, and hookahs: How does smoking affect heart health? Smoking damages your arteries, raises your blood pressure, and reduces the oxygen your blood can carry — accelerating the path to heart disease.

“These risk factors often don’t trigger symptoms until they’ve done considerable damage, making regular check-ups and proactive health management vital,” says Dr Alok Shah, a Mumbai-based cardiologist. 

• For South Asians, including Indians, the risk of heart disease is even higher due to their genetics. Many have poor cholesterol profiles, marked by low HDL and high LDL levels. This imbalance makes them more susceptible to heart disease and related complications.
• Air pollution causes inflammation in the arteries, which can lead to plaque buildup, contributing to atherosclerosis.
• Lack of quality sleep can lead to heart-related problems by increasing blood pressure, triggering inflammation, and causing insulin resistance. These issues elevate the risk of developing heart disease. Additionally, poor sleep can result in weight gain and irregular heartbeats, further stressing the heart.
• Obstructive sleep apnea, characterised by nighttime snoring and daytime sleepiness, increases the risk of heart disease by disrupting breathing and sleep patterns.
• Studies found that sitting for over eight hours daily without exercise poses a death risk similar to obesity and smoking.
• Chronic stress can significantly impact heart health, leading to elevated blood pressure and cholesterol levels. Cortisol and other stress hormones activate the body’s fight-or-flight mechanism, which accelerates the heart rate and tightens blood vessels, potentially harming the heart and its arteries.

• Coronary artery disease impacts the heart's arteries, which can result in heart attacks.
• Cerebrovascular disease involves the brain's blood vessels, raising the chances of a stroke.
• Renovascular disease targets the kidneys' blood vessels, potentially causing chronic kidney disease.
• Peripheral vascular disease affects the blood vessels supplying the limbs, possibly causing limb pain and eventually may lead to gangrene (when body tissue dies due to a lack of blood flow).

“Cardio Kidney Metabolic Syndrome is a recently recognised condition that links diabetes, obesity, kidney disease, and heart disease, leading to faster progression of ASCVD and worse health outcomes,” continues Dr Shah.

If left untreated, ASCVD can lead to severe complications such as:

• Heart attacks that may result in death or cause heart failure
• Strokes that can cause permanent disability or death
• Chronic kidney disease that may require dialysis
• Limb gangrene that may require limb amputation

Maintaining heart health becomes increasingly important as men enter their 40s and 50s. Here are some key strategies to incorporate into your routine:

Strive to engage in moderate-intensity physical activities such as cycling, swimming, or brisk walking for at least 150 minutes each week. Additionally, doing strength training exercises 2-3 times a week is vital for maintaining a healthy heart.

A balanced diet of fruits, vegetables, whole grains, lean protein, and healthy fats is essential. Are there specific diets recommended for heart health? Consider the Mediterranean or DASH diet for inspiration, both known for their heart-protective benefits.

• Add leafy greens, berries, fish, nuts, and seeds to your diet. These choices contain antioxidants, omega-3 fatty acids, and other vital nutrients supporting heart health.
• Decrease consumption of processed items, red meats, sweet drinks, and snacks high in sodium. Such foods can lead to increased blood pressure, elevated cholesterol levels, diabetes, and various cardiovascular problems.
• Consuming too much alcohol can elevate blood pressure, disrupt metabolism, and heighten the risk of developing heart disease. Stick to the recommended guidelines: up to one drink per day for women and two for men.

Within a year, your risk of heart disease drops dramatically when you stop smoking. Various resources are available to help you quit, including counselling, medications, and support groups.

Include meditation, yoga, or deep-breathing exercises in your daily routine. Aim for 7-9 hours of good quality consistent sleep per night.

Regular checkups are your allies in maintaining heart health, especially as you enter your 40s and 50s. During these visits, discuss with your doctor the appropriate frequency for screenings and the specific tests you'll undergo.

Generally, men over 40 should have their heart health checked annually or as their healthcare provider recommends. Common investigations include: 

• Blood pressure measurement
• Blood work that includes a lipid profile to assess cholesterol levels (HDL, LDL), blood sugar for diabetes risk, and potentially a complete blood count and kidney function tests.
• Tests to analyse the heart's electrical activity.
• Tests that create images of your heart, assessing its function and structure.
• The treadmill (Stress Test) measures heart activity and electrical changes during physical exercise.
• Tests that measure the amount of plaque in the heart's arteries.

Pay attention to signs like chest pain, difficulty breathing, uneven heart rhythms, and tiredness. These can be early indicators of heart disease, and early detection and treatment are critical to managing heart health effectively. 

Don't let heart disease become your story. Take charge of your health today, and rewrite the future for a stronger, healthier you!