Cardiovascular disease is a significant risk for men. And for men of any age. But heart disease should not be seen as something that is inevitable. The time to developing cardiovascular disease can be significantly delayed through diet and lifestyle changes, starting around age 40 when the damage starts to accumulate.
A real problem: the leading cause of death in men
Cardiovascular disease is the leading cause of death for men.
More surprisingly, cardiovascular disease is the leading cause of death for men at all ages. If a man dies at 30 then there is a 20.8% chance it was due to heart disease; if a man dies at 75 then there is a 22.3% chance it was heart disease.
Even more surprising are the statistics for serious cardiovascular events in younger men. Half occur before age 65 and one quarter occur before age 54 (Sinderman, Thanassoulis et al., 2016).
Despite these statistics, other aspects of men’s health seem to get a lot more attention. For example, prostate cancer accounts for 2-3% of all deaths in men across the ages 30 to 75 years, colon and rectum cancer accounts for 1-2%, accidents and injury account for 3-8%. (Fyi, all cancers combined are around 20%). Suicides, I am not sure.

These statistics are shocking because there are things men can and should starting doing now, long before symptoms arise.
The first step all men should take is simple: see their GP
Being proactive is key to preventing or delaying heart disease.
Doing nothing - watching and waiting - is not a great strategy.
Once men are over 40 years of age they should see their GP who is likely to order a basic blood test to look at the fats in their blood (a lipid panel). This is a basic test that 'checks everything is in order'.
Unfortunately most men rarely or never see their GP. Unlike women, they seem to have fewer touchpoints with the medical system in their younger years (e.g. pregnancy, contraception, cervical smears).
Help. My GP told me my cholesterol is high!
Many men who have a blood test men will be told their 'cholesterol is high'. This is usually the first sign that things are not in order. If cholesterol is 'high' a GP may recommend losing weight, exercising more, or sometimes they will tell men to eat less cholesterol.
The first two pieces of advice are great in theory, but hard to implement in practice. Most people have been trying to lose weight and exercise more for years without success. Targeted behaviour change techniques can be helpful here.
The third piece of advice warrants discussion because eating less cholesterol will not impact your cholesterol levels. For years my poor grandfather begrudgingly avoided eggs and ate special margarines to manage his high cholesterol. But this was misguided advice.

The science is clear that foods high in cholesterol will not influence your cholesterol levels, unless you are a rabbit or a chicken. We actually knew this back in the 1960s… but like smoking/tobacco, sometimes health messages take a while to become common knowledge. Dietary cholesterol does not matter because your body makes its own cholesterol and it will adjust production to meet your body’s needs. Cholesterol you eat through food has no impact.
Other foods do matter for your cholesterol and heart health. But specifically which foods should be included or excluded depends on how your cholesterol is being carried and factors personal to you (e.g. genetics, family history, diet, exercise etc).
How do you know which diet is for you?

Know how your cholesterol is being carried
Your GP may have described your cholesterol as 'good' or 'bad'. But this is only part of the story. LDL cholesterol is usually referred to as 'bad', while HDL is referred to as 'good'.
The traditional ‘bad’ cholesterol test for LDL only tells you the amount of cholesterol carried by LDL particles. It doesn’t tell you how many LDL particles are needed to carry that total cholesterol amount (or hoard).
We now have countless tools at our disposal to identify how your cholesterol is carried and therefore which diet changes might be needed for you to fine tune your cardiovascular health.
Is one ginormous LDL particle carrying the entire cholesterol hoard? Or is it thousands of little LDL particles carrying the cholesterol hoard? This matters because a smaller number of large fluffy LDL particles are ‘healthy’; a higher number of small dense LDL particles are very ‘unhealthy’. Small dense LDL particles can damage the walls of your blood vessels, get stuck and oxidise causing damage.
The new kid-on-the-block in the heart disease testing world is Apo(B). Apo(B) is helping us to know whether we have the large fluffy molecules or the small dense ones. Apo(B) is like a ‘flag’ that sits on each of the LDL particles. When we count the total number of Apo(B)s in our blood, then we count the number of LDL particles floating around in our body carrying the cholesterol hoard. Apo(B) is far more important than the total cholesterol number.
This is great news. A simple blood test that gives insightful data on heart health tactics.
But… to get this test you must see your GP or a health professional and you may have to ask for it. Like I said Apo(B) is the 'new kid on the block' when it comes to cardiovascular disease testing.
Diet and lifestyle changes that may help
A few small changes in the diet can have a dramatic impact on the level of cholesterol in the blood.
Obvious changes involve reducing alcohol and cutting out junky sugary foods like biscuits and cakes. This should improve most health markers and help you to lose weight.
But there are other more specific diet and lifestyle changes that may be tailored to the unique profile of your blood test markers.
As a general rule, saturated fat increases cholesterol and swapping saturated fats in your diet to poly- or mono-unsaturated fats lowers cholesterol. Sugary foods lower triglycerides - another marker of heart health captured by the blood lipids test. Oily fish reduces ‘bad’ cholesterol if triglycerides are high. Foods high in soluble fibre (like oats) should lower your cholesterol but may have an adverse impact on your blood sugars. Balancing the risk between blood sugar balance and heart disease is important because poor blood sugar balance may in itself damage blood vessel walls.
Garlic has been shown to reduce cholesterol. Did you know that crushing it 20 minutes before using it will activate its enzyme and increase its potency?
The list of things to do is endless, but the application is nuanced. Everyone is different.
Don't wait: be proactive about your health
Cardiovascular disease is a real risk for men of any age. Don’t wait for your GP to contact you – because it doesn’t work like that. Go and see your GP. Get some blood tests (make sure to ask for Apo(B)). Get in touch with me. Learn what you can do to tweak your diet and lifestyle. Be proactive about heart health. Be targeted with diet and lifestyle changes. Whatever you do, please do something.

References:
Carson, J. A. S., Lichtenstein, A. H., Anderson, C. A. M., Appel, L. J., Kris-Etherton, P. M., Meyer, K. A., Petersen, K., Polonsky, T., Van Horn, L., & American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Peripheral Vascular Disease; and Stroke Council (2020). Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association. Circulation, 141(3), e39–e53. https://doi.org/10.1161/CIR.0000000000000743
Marston, N. A., Giugliano, R. P., Melloni, G. E. M., Park, J. G., Morrill, V., Blazing, M. A., Ference, B., Stein, E., Stroes, E. S., Braunwald, E., Ellinor, P. T., Lubitz, S. A., Ruff, C. T., & Sabatine, M. S. (2022). Association of Apolipoprotein B-Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without Atherosclerosis: Distinguishing Between Particle Concentration, Type, and Content. JAMA cardiology, 7(3), 250–256. https://doi.org/10.1001/jamacardio.2021.5083
Sniderman AD, Thanassoulis G, Williams K, Pencina M. Risk of Premature Cardiovascular Disease vs the Number of Premature Cardiovascular Events. JAMA Cardiol. 2016;1(4):492–494. doi:10.1001/jamacardio.2016.0991
US Mortality Files, National Center for Health Statistics, Centers for disease Control and Prevention.
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