The Heart Health Myths You Should Stop Believing

Fact: Many women still find themselves worrying more about the heart health of the men in their lives than about their own. But the statistics show that many women in Canada have at least one heart disease or stroke risk factor. Women who are menopausal or have diabetes are at an increased risk. In a 2008 survey, cardiovascular disease accounted for 28 percent of all male deaths in this country and 29.7 percent of all female deaths.

In recent years, there has been increased public education about women’s risk of heart disease, so hopefully this is one myth that is well on its way to being history.

Myth 2: Everyone should take an Aspirin a day to support heart health.

Fact: It may surprise you to know that the common routine of taking a baby Aspirin each day to support heart health might do more harm than good for some people.

The main issue here is primary prevention versus secondary prevention. Primary prevention means preventing a first event (the first heart attack or stroke), whereas secondary prevention means preventing those who have already experienced an event from having another. In the case of Aspirin, there is a good track record for using a daily low dose in secondary prevention; here it does appear to make a meaningful and measurable difference in reducing secondary events.

However, when it comes to primary prevention, the evidence is less consistent. For women, Aspirin probably has little effect on heart attack prevention but may produce small decreases in risk of ischemic stroke. For men, there is no benefit for ischemic stroke, but there may be a small decrease in chance for heart attacks. On the other hand, there is a well-known increase in risk of serious gastrointestinal (GI) bleeding with long-term Aspirin use in both men and women.

Because of this, the decision to use Aspirin for primary prevention remains controversial and needs to be carefully evaluated for each individual to see if small potential benefits outweigh the known risks. Factors that increase GI bleeding risk include gender (men are twice as likely to suffer a GI bleed than women), increasing age, use of other NSAIDs, and history of gastric ulcer or GI bleeding. Aspirin also carries an increased risk for hemorrhagic stroke in men (about 1.7 times the risk of those not using Aspirin).

Overall, the decision to use Aspirin in primary prevention needs to be based on individual risk factors and fully discussed with your qualified health care practitioner.

Myth 3: People with high blood pressure or cholesterol have symptoms.

Fact: In most cases, these conditions have no symptoms. They are discovered only when checked. A new study has estimated that more than half of people with high blood pressure are unaware of their condition. Many with high cholesterol also go undiagnosed because they have not been screened. Both high blood pressure and high cholesterol are important risk factors for cardiovascular disease.

Blood pressure should be checked, in healthy adults, every two years. If you have a family history of either of these risk factors, or are a man over the age of 40 or a woman over the age of 50 (or postmenopausal), you should have your cholesterol levels checked. While you are at it, have your blood sugar levels tested as well. Type 2 diabetes is another important risk factor for CVD and is another condition that often has few symptoms early on.

Myth 4: Heart attacks always start with severe chest pain.

Fact: Although the most common symptom of heart attack (for both men and women) is chest pain, it is not always present. Even for those who do experience chest pain, it can be mild and feel more like pressure or discomfort.

In the real world, a heart attack may not look or feel like you expect it to, but there are some common symptoms (other than chest pain) to watch out for, including

• nausea
• sweating
• dizziness
• shortness of breath
• jaw, arm, back, neck, or shoulder pain

The sudden and unusual occurrence of any of these symptoms should prompt concern and a call for help.

Myth 5: If heart disease runs in my family, I’ll also get it.

Fact: Genetics play an important role in the risk of many diseases, including heart disease, but they are not the whole story. There is a complex relationship between our genes, lifestyle, and nutrition that is still far from being fully understood. What seems clear so far is that our diet, lifestyle, and environment have a big impact on how our genes are expressed.

So, just having a family history of heart disease does not mean you are absolutely destined to suffer from heart disease. But it may mean that you need to be all the more vigilant when it comes to other modifiable lifestyle and nutritional risk factors.

Myth 6: Younger women are not at risk of cardiovascular disease.

Fact: Women over 50 are generally at higher risk for heart disease, but younger women can also be at risk depending on their situation. Here are some risk factors to consider.

• Use of birth control pills may increase the risk of blood clots or high blood pressure for women with high blood pressure, or who smoke.
• Pregnancy can significantly increase the risk of dangerously high blood pressure for some women. The risks are more prevalent in women who already have high blood pressure, are obese before pregnancy, have diabetes, or who have a history of certain autoimmune conditions such as rheumatoid arthritis.

Lifestyle and dietary choices made earlier in life can also have a major impact on heart health later on, so younger women (and men!) who are not at risk now still need to be conscious of how their choices will affect their heart health down the road.

Myth 7: I eat a low-fat diet, so I’m safe from heart disease.

Fact: A decrease in overall fat intake is not associated with meaningful decreases in cardiovascular disease. What is more important is the type of fat consumed as well as what other nutrients are being used in place of fat. There are three main types of fats to consider: saturated, unsaturated, and trans fats.

Saturated fats have long been tagged as “bad” and reducing their intake has been promoted for weight loss, CVD prevention, and other health benefits. The truth is, saturated fats are an important part of the diet and we need them. The problem is that many consume too much, too often, and at the expense of other important nutrients. One of the problems that has arisen in labelling saturated fat as universally bad for us is that food manufacturers have replaced them with other, often less healthy, substitutes such as trans fats and refined carbohydrates.

Trans fats are not naturally found in large amounts in foods, but certain processing and cooking methods can dramatically increase them. There is a strong link between trans fats and CVD, and trans fats are known to raise unhealthy cholesterol (LDL) while also reducing healthy cholesterol (HDL). Efforts are therefore being made by several countries to remove industrially produced trans fats from the food supply.

The real stars in the fat debate are the polyunsaturated and mono-unsaturated fats, an increase of which has been associated with positive heart health outcomes.

Myth 8: Eggs are high in cholesterol andare therefore bad for heart health.

Fact: A 2013 review of 16 separate studies on the issue of eggs and cardiovascular disease found that there was no increased risk of heart disease in healthy people eating an egg a day compared to those who rarely or never ate eggs.

However, the review also found that high egg consumption was associated with an increased risk of coronary heart disease in type 2 diabetics. Of course, type 2 diabetics are already at increased risk of heart disease.

This shows that the case for eggs is not as black and white as some may believe and may have as much to do with the person eating the egg as the egg itself. Overall, a moderate intake of free-range eggs is likely fine for most healthy people.

Myth 9: People with heart disease should avoid exercise.

Fact: Exercise is health promoting for pretty much everyone. We are designed to move, and the list of exercise’s health benefits is long. In the case of cardiovascular disease, a recently published review of more than 300 studies found that exercise is as good as, if not better than, current drug treatments for preventing second episodes of heart attack, recovering after stroke, and preventing diabetes.

Myth 10: I am not overweight, so I won’t develop heart disease.

Fact: People of any shape or size can be at risk of heart disease. Although obesity is a major risk factor for heart disease, there are several other key risk factors that have nothing to do with weight. For example, stress, smoking, and lack of exercise can increase the risk for heart disease regardless of body weight.

The above are some of the most common myths and misunderstandings that continue to circulate about heart disease. Heart attack and stroke are the leading cause of death for adults in North America, but it does not have to be this way.

Many of the key factors that increase heart attack and stroke risk (diet, exercise, smoking) are modifiable; we can do something about them in order to produce a meaningful decrease in our overall risk. Because heart disease can affect almost anyone, it is important for all Canadians to be aware of the risk factors, to be able to separate the myths from the facts, and to take action to reduce our risk.