Cardiologists just cleared up 7 common – but inaccurate – beliefs about heart disease

Heart disease is the leading cause of death in Australia. Top heart doctors share the primary misconceptions many people still believe about this often avoidable disease.

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It’s true that heart disease risk is higher in men than in women – but only slightly, says Dr Eugene Yang, Chair of the American College of Cardiology (ACC) Prevention of Cardiovascular Disease Section.

Here’s what might be a main reason for the commonly held belief: “What we see is that the risk of heart disease tends to be lower in women when they are younger, but then women sort of catch up as they get older,” Dr Yang explains. According to research published in Biology of Sex Differences, this trend comes down to how oestrogen – the female sex hormone – works to protect the cardiovascular system. That’s why when oestrogen levels start to decline during menopause, female rates of heart disease start to match that of their male counterparts.

An added complication? Despite this phenomenon, women “continue to get less preventative care for heart disease,” says Dr Sonia Tolani, MD, a cardiovascular disease specialist and assistant professor of medicine. This is even more problematic because heart disease is actually more fatal for women than for men and kills three times as many women as breast cancer.

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A leaner pant size doesn’t always mean someone is in tip-top shape – perhaps especially when it comes to heart health. Research strongly suggests that weight alone is not a no-fail indicator of someone’s cardiovascular disease risk.

One well-known 2008 study by researchers at the Albert Einstein College of Medicine in New York City found that about half of people considered to be overweight showed blood pressure and cholesterol levels in a healthy range. Meanwhile, a quarter of those at a normal weight were at elevated levels for these two heart disease risk markers. This doesn’t mean there isn’t value in watching your weight, but it’s a reminder that a slim appearance alone doesn’t mean you’re in superior health.

What might? Regular movement. “Even if you are not overweight, there is no doubt that a sedentary lifestyle puts you at a greater risk for heart disease,” Dr Yang explains. Some experts recommend that you aim to get at least 150 minutes of moderate physical activity (like brisk walking) per week, regardless of your size.

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While younger people are statistically less likely to be diagnosed with heart disease, that doesn’t mean they don’t have risk factors that – if left unaddressed – can cause problems in the future, Dr Tolani says.

And, because such a large number of heart disease cases are considered to have been preventable, Dr Yang explains how important a concept called “primordial prevention” is for younger people. While the idea of primary prevention means treating and managing risk factors to prevent heart disease (like taking medication if you already have high cholesterol or blood pressure), primordial prevention is all about avoiding these risk factors from developing in the first place. “What we believe now is that the earlier you establish healthy habits, the less likely it is you’ll have a heart attack or heart-related problems later in life,” Dr Yang says. “So we focus on the things people have control over.”

That means adopting healthier lifestyle behaviours early on – think of avoiding smoking, staying active and optimising your diet for heart health.

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We’ve all heard the purported cardiovascular benefits of red wine, right? It seems like every few years, a study comes out suggesting a relationship between alcohol consumption and cardiovascular health, from how it may elevate “good” HDL cholesterol levels to its antioxidant protection. But Dr Yang explains that more recent research walks back most of these claims. “What we’re learning now is that alcohol seems to increase the risk of potentially dangerous heart rhythm problems, like atrial fibrillation – a major risk factor for strokes,” he says.

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Yes, cholesterol is considered a key indicator of your heart disease risk. “But you could have a normal cholesterol level and still have other risk factors,” Dr Yang explains.

In fact, a 2017 international study showed that about half of cardiovascular events occur in individuals who have normal cholesterol levels. That doesn’t mean keeping an eye on your cholesterol levels (and getting regular screenings) isn’t important. It’s just that getting a healthy cholesterol reading doesn’t clear you of all heart disease risk.

If your mother or father had heart-related issues, you may have some genetic predisposition or hereditary risk that elevates your risk, Dr Yang explains. But having a family history doesn’t exactly guarantee you’ll have heart problems. For example, if your parent has genetically high cholesterol, there’s typically a 50 percent chance that you’ll inherit the mutation.

And if you do express the same risk factors like your parents? Research from the New England Journal of Medicine suggests you may be able to reduce the likelihood of heart disease occurring by 46 percent just by making healthy lifestyle choices.

And many individuals with a known family risk of heart disease can also benefit from medication. For example, genetically high cholesterol – clinically known as “familial cholesterolemia” – occurs in about one in 200 people worldwide, Dr Yang says. For these people, medications like statins can reduce their risk of heart disease by half.

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Stenting and bypass surgery are common procedures to treat blocked arteries, a condition called atherosclerosis, that raises your risk of heart attack or stroke. But Dr Yang says a common assumption is that these invasive measures work to protect you from heart disease better than medication.

A recent study from the National Institutes of Health (NIH) found that, in most cases, these surgical procedures are no better than medication and lifestyle changes at reducing the risk of heart attack and death.

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Source: RD.com