Weight And Heart Health

What is heart health?

Our heart is a muscle that continually pumps oxygenated blood to our organs and tissues keeping our bodies alive, protecting its health is imperative for our quality of life and longevity.  

Cardiovascular disease (CVD) is the general term for when our heart and its associated blood vessels become unhealthy, and encompasses many types of conditions (1). CVD is usually associated with a build-up of fatty deposits and cholesterol on the inside the blood vessels which can cause them to become blocked, another name for this is atherosclerosis. Blood clots can lead to angina, heart attacks, heart failure, strokes and peripheral arterial disease. 

Unfortunately cardiovascular disease is one of the leading causes of death worldwide and so keeping our hearts healthy is central to good overall health and wellbeing and longevity. 

Causes of cardiovascular disease 

There isn’t one specific cause of CVD but instead a number of risk factors that increase our risk of developing it. Some of these can be out of our control such as age and family history of heart disease, others however are what are talked about as modifiable risk factors, meaning they are something in our lifestyle that we can change such as stopping smoking. 

Weight and diet are 2 of these modifiable risk factors which we can control and go hand in hand to reducing the risk of developing or the progression of CVD (2). Early on in its progression, heart disease often doesn’t have noticeable symptoms, so taking control of our risk factors at an early stage of life can be a very important part of prevention. 

Weight and heart health

Carrying a higher amount of weight, in particular having a Body Mass Index (BMI) or over 30kg/m2, a strong predictor of developing CVD. Alongside being of a higher weight, where we carry our weight is also an important determinant for assessing CVD risk. Carrying a larger amount of weight around our abdomen or tummy, in particular increases risk of cardiovascular disease. 

Measuring your waist circumference as well as your BMI can help you to understand if you are carrying a high amount of abdominal weight. A waist circumference of >102 cm for men and >88 cm for women are risk factors for cardiovascular disease respectively. Not everyone with abdominal obesity will have a BMI in the obese category and vice versa and so using both is important. 

Carrying higher amounts of abdominal weight promotes a state of chronic inflammation which is fundamental in the development of atherosclerosis. Obesity, in particular abdominal obesity increases the risk of fat accumulating on our internal organs which leads to a dysregulation of our metabolism of both fat and glucose. This can lead to higher levels of bad cholesterol (LDL) and lower levels of good cholesterol (HDL). This situation promotes atherosclerosis. 

Being of a higher weight is also associated with hypertension (high blood pressure), impaired blood glucose control and insulin resistance all of which increase cardiovascular disease risk. 

Calorie restriction and exercise

Weight loss, even a modest amount can reduce risk of cardiovascular disease, losing a larger amount of weight however, in the region of 10kg can lead to a significant reduction in risk (3,4). 

Reducing calorie intake is an effective way to reduce overall weight as well as reducing abdominal fat (5). Combining dietary changes with increased physical activity may be the best option for CVD risk reduction (6). Aerobic exercise, in particular is associated with improved insulin sensitivity and a reduction in inflammation  as well as reduced abdominal obesity (7). Examples of aerobic activity are walking, running, swimming and cycling. Working towards meeting the current recommendations of doing 150 minutes of moderate intensity activity per week is an excellent target to set yourself.

Dietary modification for weight loss and weight loss maintenance

What we eat can also be as important as how much we eat. What we eat also has implications for maintenance of weight after weight loss. Keeping the weight off after losing a significant amount of weight is important for maintaining heart health. 

Consuming a diet low in sodium can lower blood pressure (8). Consuming a Mediterranean style dietary pattern, which includes lots of fruit and vegetables which are antioxidants, beans pulses legumes, lean meat and fish is also associated with reduced inflammation (9) and better cardiovascular health (10)

A diet that is high in saturated fat and sugars can further contribute to the pro inflammatory state and risk cardiovascular disease. Foods that are high in saturated fat and added sugar are often high calorie with a lower nutritional profile and are associated with weight gain (11–13). 

Diets higher in fibre, are associated with lower risk of cardiovascular disease and can also help us to control our weight as they keep us feeling fuller for longer (14). Fibre can be found in whole grains, legumes, fruit and vegetables, nuts, seeds, peas, beans and pulses. Consuming a diet higher in protein can also help us to lose and maintain weight through their effects on appetite (15). 

The bottom line

Aiming to achieve a healthy weight is one of the best ways to keep our heart healthy. Combining this with a healthy diet and lifestyle can help to maintain a healthy weight and reduce our overall risk of developing cardiovascular disease. 

References 

1. Cardiovascular disease – NHS [Internet]. [cited 2021 Jun 23]. Available from: https://www.nhs.uk/conditions/cardiovascular-disease/
2. Powell-Wiley TM, Paul Poirier C, Chair Lora Burke VE, Jean-Pierre Després F, Penny Gordon-Larsen F, Carl Lavie FJ, et al. Circulation On behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council Obesity and Cardiovascular Disease AHA SCIENTIFIC STATEMENT. 2021 [cited 2021 Jun 23];143:984–1010. Available from: http://ahajournals.org
3. Association of the magnitude of weight loss and changes in physical fitness with long-term cardiovascular disease outcomes in overweight or obese people with type 2 diabetes: a post-hoc analysis of the Look AHEAD randomised clinical trial. Lancet Diabetes Endocrinol [Internet]. 2016 Nov 1 [cited 2021 Jun 23];4(11):913–21. Available from: http://www.thelancet.com/article/S2213858716301620/fulltext
4. Sundström J, Bruze G, Ottosson J, Marcus C, Näslund I, Neovius M. Weight loss and heart failure: A nationwide study of gastric bypass surgery versus intensive lifestyle treatment. Circulation [Internet]. 2017 Apr 25 [cited 2021 Jun 23];135(17):1577–85. Available from: http://ahajournals.org
5. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of cardiology/American Heart Association task force on practice guidelines and the obesity society [Internet]. Vol. 129, Circulation. Lippincott Williams and Wilkins; 2014 [cited 2021 Jun 23]. Available from: http://circ.ahajournals.org/lookup/suppl/doi:10.1161/01.cir.0000437739.71477.ee/-/DC1.
6. Gallagher D, Heshka S, Kelley DE, Thornton J, Boxt L, Pi-Sunyer FX, et al. Changes in adipose tissue depots and metabolic markers following a 1-year diet and exercise intervention in overweight and obese patients with type 2 diabetes. Diabetes Care [Internet]. 2014 Dec 1 [cited 2020 Jul 20];37(12):3325–32. Available from: https://pubmed.ncbi.nlm.nih.gov/25336745/
7. Heffron SP, Parham JS, Pendse J, Alemán JO. Treatment of Obesity in Mitigating Metabolic Risk. Circ Res [Internet]. 2020 [cited 2021 Jun 23];126:1646–65. Available from: www.ahajournals.org/journal/res
8. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. N Engl J Med [Internet]. 2001 Jan 4 [cited 2021 Jun 23];344(1):3–10. Available from: https://pubmed.ncbi.nlm.nih.gov/11136953/
9. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: A randomized trial. J Am Med Assoc [Internet]. 2004 Sep 22 [cited 2021 Jun 23];292(12):1440–6. Available from: https://pubmed.ncbi.nlm.nih.gov/15383514/
10. Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean Diet and Cardiovascular Health: A Critical Review [Internet]. Vol. 124, Circulation Research. Lippincott Williams and Wilkins; 2019 [cited 2021 Jun 23]. p. 779–98. Available from: https://www.ahajournals.org/doi/suppl/10.1161/CIRCRESAHA.118.313348.
11. Stanhope KL, Goran MI, Bosy-Westphal A, King JC, Schmidt LA, Schwarz JM, et al. Pathways and mechanisms linking dietary components to cardiometabolic disease: thinking beyond calories [Internet]. Vol. 19, Obesity Reviews. Blackwell Publishing Ltd; 2018 [cited 2021 Jun 23]. p. 1205–35. Available from: https://pubmed.ncbi.nlm.nih.gov/29761610/
12. Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009 May 1;119(5):1322–34. 
13. Stanhope KL. Sugar consumption, metabolic disease and obesity: The state of the controversy. Vol. 53, Critical Reviews in Clinical Laboratory Sciences. Taylor and Francis Ltd; 2016. p. 52–67. 
14. Ma Y, Olendzki BC, Wang J, Persuitte GM, Li W, Fang H, et al. Single-component versus multicomponent dietary goals for the metabolic syndrome: A randomized trial. Ann Intern Med. 2015 Feb 17;162(4):248–57. 
15. Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND, et al. The role of protein in weight loss and maintenance [Internet]. Vol. 101, American Journal of Clinical Nutrition. American Society for Nutrition; 2015 [cited 2021 Jun 23]. p. 1320S-1329S. Available from: https://pubmed.ncbi.nlm.nih.gov/25926512/