Heart disease and stroke

This page provides general information about diet-related ill-health. For individual advice always seek guidance from a qualified health professional.

What is heart disease and stroke?

Heart disease and stroke are major causes of death worldwide. In the UK, one in eight men and one in fourteen women die from heart disease.

The number of deaths from heart disease have been decreasing in recent years but it is still one of the major causes of premature death (before 75 years) in the UK and a leading cause of ill health.

But the good news is - both heart disease and stroke are largely preventable!

Eating a healthy diet can help reduce your risk of heart disease and stroke.

Together with being physically active, eating a healthy, balanced diet will help you maintain a healthy body weight. It will also provide your body with all the vitamins, minerals and other nutrients it needs to keep healthy.

Sara Stanner, Science Director, British Nutrition Foundation

What causes heart attacks and strokes?

The condition that causes most heart attacks and strokes is known as atherosclerosis.

Atherosclerosis is the build-up of fatty material inside arteries (blood vessels) like the coronary arteries that supply blood to the heart.
The build-up of fatty material causes a narrowing in the artery, and as these become more severe, they can restrict the flow of blood so not enough blood can reach the heart.
This can cause the symptoms of angina (such as chest pain and shortness of breath).
If the fatty material breaks down (or ruptures), a blood clot can form, which can completely block the artery and lead to a heart attack.
Strokes occur if blockages or ruptures occur in blood vessels in the brain.

It's important to make healthy diet and lifestyle choices when it comes to heart health.

Key Facts about heart disease and stroke

Giving up smoking is one of the best things you can do to protect your heart.
We need to keep active and should aim for at least 150 minutes a week of moderate physical activity.
We should not drink to excess – adults should drink no more than 14 units a week, with several alcohol-free days each week.
We should aim for a healthy body weight.

Eating a healthy diet can help reduce your risk

Cut down on saturated fats

We should replace them with unsaturated fats.

For example swap butter and coconut oil for olive and sunflower oils.

Eat fish twice a week

One portion should be an oily fish such as salmon or sardines.

Reduce our salt intake

We should aim for less than 6g a day.

Fibre and wholegrains

Our diets should include high-fibre and wholegrain foods like wholegrain breakfast cereals, wholewheat pasta and pulses.

Who is at risk of heart disease and stroke?

There are several risk factors for atherosclerosis and heart disease. A risk factor is something that increases your chance of getting a disease.

The more risk factors you have, the greater your personal risk. But there are many things you can do to reduce your overall risk and keep your heart healthy.

Risk factors for heart disease and stroke

High blood pressure (hypertension) - Having high blood pressure puts strain on your heart that can lead to your blood vessels becoming damaged, making them more at risk of heart disease.

Smoking - Quitting smoking is the single best thing you can do for your heart health.

High blood cholesterol - High levels of cholesterol (a type of fatty substance) in the blood can build up in the walls of the coronary arteries, restricting blood flow to the heart and rest of the body.

Diabetes - The increased levels of blood glucose that can occur in type 1 and type 2 diabetes can damage the coronary arteries, increasing the chances of heart disease developing.

Lack of exercise - Not exercising regularly increases the chance of high blood pressure, higher cholesterol levels and overweight and obesity. These are all risk factors for developing heart disease.

Being overweight or obese - Research shows that being overweight or obese can raise your blood cholesterol levels, increase your blood pressure and increase your risk of developing type 2 diabetes.

Family history of heart disease - You are considered to have a family history of cardiovascular disease (CVD) if your father or brother was under age 55 years when they were diagnosed with CVD, or your mother or sister was under age 65 years when they were diagnosed with CVD.

Ethnic background - For the South Asian population (Bangladeshis, Indians and Pakistanis), and people with an African Caribbean background, CVD risk can be higher than for the rest of the UK population.

Age - Your risk of developing heart disease increases with age.

Gender - Men are more likely to develop heart disease earlier than women.

How do I reduce my risk of heart disease and stroke?

Even though you cannot do anything to change some of these risk factors, there are several lifestyle behaviours which put you at increased risk that can be changed.

Smoking

You are nearly twice as likely to have a heart attack if you smoke compared to people who have never smoked. Therefore, giving up smoking is one of the most important things you can do to protect your heart. If you’re thinking about quitting smoking, find out more about what help and support is available from your local Stop Smoking Service on this NHS webpage.

Drinking too much alcohol

Regularly drinking more alcohol than we are recommended over a long period of time raises blood pressure, which is a risk factor for heart disease and stroke. It can also weaken the heart muscle so the heart cannot work as well. Binge drinking (drinking more than six units a day for women or eight units a day for men) is a risk factor for heart disease. The recommendations for alcohol to keep any health risks low are that: men should not drink more than 14 units of alcohol each week, the same level as for women. Men and women should have several alcohol-free days each week.

Lack of physical activity

Being inactive is a major health risk and one of the main causes of death and ill health in the UK. You should aim for 150 minutes of moderate intensity physical activity (when you feel warm and slightly out of breath) a week. Talk to your GP before starting on a new exercise programme, especially if you have a history of heart disease, stroke or other health problems.

A poor diet

Healthy diets that include wholegrains, fruit and vegetables, nuts and seeds, oily fish and choosing unsaturated fats (such as the Mediterranean diet) are important for good heart health.

These factors contribute to the risk of obesity, type 2 diabetes, high blood pressure and high cholesterol levels, which are some of the strongest risk factors for heart disease.

How do I maintain a healthy body weight?

Maintaining a healthy body weight can help to protect your heart.

People who are overweight or obese tend to have a higher risk of certain risk factors for heart disease, such as increased levels of blood cholesterol, high blood pressure and an increased risk of developing type 2 diabetes.

As well as body weight, your shape can affect your health risk.

If you are overweight and carry fat around the waist (apple–shaped), you are at greater risk than if you carry fat on the hips and thighs (pear-shaped).

If you are a man, your chance of developing health problems is higher if your waist measurement is more than 94cm (37inch), and higher still if it is more than 102cm (40inch).

If you are a woman, your chance of developing health problems is higher if your waist measurement is more than 80cm (31.5inch), and higher still if it is more than 88cm (34.5inch).

Type 2 diabetes prevalence is strongly associated with ethnicity. The International Diabetes Federation and South Asian Health Foundation agree that men from South Asian and Chinese ethnic groups are at increased risk of type 2 diabetes if waist size is greater than 90cm.

Foods and nutrients for good heart health

Food or nutrient	Importance for heart health	Top tips
Fish and oily fish	Eating fish, especially oily fish, may reduce risk of heart disease and stroke. But taking fish oil supplements doesn’t seem to be as beneficial as eating fish.	Aim to eat at least two portions (2 x 140g) of sustainably-sourced fish each week, at least one of which should be oily fish. Examples of oily fish include mackerel, salmon and sardines.
Saturated fat	Too much saturated fat in the diet can raise your cholesterol, which increases the risk of heart disease. Current UK government guidelines advise cutting down on saturated fat and replacing it with some unsaturated fat.	Tips to reduce saturated fat: Choose lean cuts of meat such as lean beef mince, trim off any excess fat from meat and remove skin from poultry. Grill, steam, poach, boil or microwave rather than fry or roast foods whenever possible to avoid adding fat when cooking. Remove the skin from chicken, duck and turkey. Replace some of the meat in dishes with pulses (like lentils, beans and peas), soya or Quorn. Cut back on fats and oils high in saturates such as lard, ghee, butter, palm oil and coconut oil and use oils and fats that are high in unsaturated fat, such as rapeseed, olive and sunflower oils/spreads. Choose semi-skimmed, 1% or skimmed milk rather than whole milk; opt for low- or reduced-fat dairy products such as, low-fat yogurt, low-fat soft cheese and reduced-fat hard cheese. Choose snacks that are lower in saturated fat and include some unsaturated fat instead of foods such as fried crisps, chocolate and pastries – try a handful of unsalted nuts and seeds or crispbreads with oily fish spreads and avocado.
Wholegrain and high-fibre foods	Scientific reviews have reported that increased intakes of fibre in the diet may reduce risk of heart disease.	Eat a mixture of different wholegrain and high-fibre products when possible, such as: Wholegrain breakfast cereals Wholegrain crackers/crispbread Wholemeal and wholegrain bread, pitta and chapatti Brown rice Wholewheat pasta Potatoes with their skins on Whole oats and barley Pulses (such as lentils, beans, peas) Fruit and vegetables Nuts and seeds Foods such as oats and barley contain a type of fibre known as beta-glucan, which may help to reduce cholesterol levels if enough is eaten.
Salt	Salt is the main source of sodium in the diet. A high intake of sodium is linked to high blood pressure. Adults should be aiming for no more than 6g of salt each day.	Most of the salt we consume is from salt added during the processing and manufacture of foods for flavour, texture and preservation, like bread, bacon, ham, cheese, soups and sauces. Try to choose foods with lower levels of salt by checking the salt content on labels and do not add any extra to cooking or at the table Instead of adding salt to food, try adding pepper, herbs or spices such as mint, basil or chilli to add flavour.
Fruit & vegetables	Eat at least five portions of a variety of fruit and vegetables every day. A portion of beans or lentils also counts towards one of your 5 A DAY.
Foods with added plant sterols and stanols	Foods with added plant stanols and sterols, eaten regularly to provide about 2g stanols/sterols per day, can help lower raised cholesterol levels.	These food products are targeted at people with high cholesterol levels, A variety of such products are now available including spreads, yogurts and yogurt drinks. These foods are not a replacement for a healthy, balanced diet or for any cholesterol lowering medication.

Top tips for South Asian, African and African- Caribbean diets

It is known that some population groups such as people from a South Asian (Bangladeshi, Indian and Pakistani), African or African-Caribbean background can have a higher risk of CVD than the rest of the UK population.

Here are some healthy eating tips for some of the foods used in South Asian, African and African- Caribbean diets to help you look after your heart.

Cut down on cooking with ghee, butter, palm oil or coconut oil/milk/cream, as these types of fat are high in saturated fat. Instead use oils that are high in unsaturated fat (monounsaturates and polyunsaturates), such as rapeseed, olive and sunflower oils and spreads.

Avoid adding ghee or oil to foods such as chapatis or dhal.

Use lean cuts of red meat such as lamb, beef, mutton and goat, as these varieties can be high in fat.

Only eat foods high in calories and fats occasionally, for example cakes, biscuits, samosas, pakoras and fried plantain. Savoury Indian snacks and sweets should also be limited in the diet as they are high in calories, sugars and fat.

Choose wholemeal or wholegrain varieties of starchy foods such as chapati, wholemeal pitta bread, boiled brown rice or potatoes instead of paratha, puri or fried potatoes.

Choose less salty foods such as salt fish, bacon and salty snack foods (such as crisps and salted nuts) and do not add salt when cooking.

Help reach your 5 A DAY by adding vegetables and pulses like okra, kidney beans and black-eyed peas to curries and stews.