OTHER RISK FACTORS FOR CORONARY HEART DISEASE

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 recognize 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 management 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 away from 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'!

I have read about type A' and 'B' personalities having an effect on the heart. What is the difference between them?

Some psychiatrists divide the world into two groups, type A and type B people. Type A people are competitive, intense and driven by success. Type B are relaxed, unhurried and content with their lives and achievements. Type A personality has been linked to heart disease but several studies have failed to establish a direct connection. It may well be the consequences of a type A personality that establish a relationship with heart problems, reflecting the degree of anger and frustration that these people feel rather than their attitudes and activities alone.

Do different emotions affect the heart adversely?

Anger appears to be the most dangerous emotion, increasing heart strain by raising blood pressure and increasing heart rate. If you are angry, write a letter about the person or problem, expressing your anger, then tear it up. (Don't send it!) Yell and shout at a mirror, then laugh at yourself as you regain perspective. Learn to count to 10 slowly, while breathing deeply.

I feel that I am stressed at the end of the day. What can I do?

You are probably overdoing things and overcommitted. Look at your day: can you organize it better?

• Does anyone or any issue stress you more? If so, bring it into the open.

• Walk some of the way to work and try to get out at lunch time.

• If you feel trapped in your home all day, make the effort to go out - go window shopping, walk round a shopping mall if it is raining; walk in the park if it's fine.

• Complete the day with deep breathing exercises, have a warm soak in the bath, clean your teeth and freshen up.

• Read a book, do a crossword, work on a hobby project, or 'surf the net' and think about your priorities.

• If you have a pet, pat it or stroke it - play with the cat, or walk the dog.

Stress is usually present when emotions are bottled up and everything gets out of perspective.

 
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