The ABCs of heart health and prostate health
Thanks to good screening measures, most cases of prostate cancer are caught early, and the prognosis is among the best out of all cancers.1 So, if you have had a diagnosis, managing other aspects of your health is essential to help you live longer and enjoy a good quality of life.
Looking after your heart health is a great place to start. If you’ve had a prostate cancer diagnosis, you could be in the two-thirds of recently diagnosed men who are also at risk of cardiovascular disease.2 This is in part due to the high overlap of risk factors for both diseases.3 Adding to this risk, hormone therapy for prostate cancer induces metabolic changes, such as increased blood cholesterol, increasing the likelihood of cardiovascular events.4
The term cardiovascular disease describes several conditions affecting the heart or blood vessels, including heart disease and stroke. It is typically caused by an accumulation of “bad” cholesterol inside the blood vessels that supply the heart and brain. Cardiovascular disease has now surpassed prostate cancer itself as the leading cause of death for men with prostate cancer,5 so managing this risk is crucial to living well after a diagnosis.
The good news is that making healthy lifestyle changes can substantially cut your risk of cardiovascular disease.6 As a bonus, the recommended lifestyle changes for managing heart health are beneficial for prostate health too,3 and can help you to feel better mentally and physically.
Many doctors now apply the “ABCDE” approach to help patients reduce their risk of heart disease.7,8 This approach combines screening measures and lifestyle changes in the following categories:
Blood pressure management
Diet and weight management
Here we describe the most impactful strategies across each of these categories that can help to look after your heart.
Awareness is all about being informed of your increased risk of cardiovascular disease and being able to recognise the symptoms of heart disease. These include:
- Chest pain while exercising
- Shortness of breath while exercising
- Feeling tired easily
If you notice any of these factors, it’s important to talk to your doctor so they can investigate further. Importantly, if you notice any of the following symptoms, it could be a sign of a heart attack, and you should seek immediate medical attention:
- Sudden onset of chest pain
- Shortness of breath
- Pain in the jaw, neck, back, arm or shoulder
Nausea or light-headedness
A daily low dose of aspirin can decrease the risk of heart disease by preventing blood clots from forming in your arteries. While this can be an effective prevention method for people with a high risk of heart disease, it does come with an increased risk of stomach ulcers and gastrointestinal bleeding. The risks vs. benefits should be discussed with your doctor to decide if it’s the right approach for you.
High blood pressure is a key risk factor for heart disease. Also known as hypertension, high blood pressure puts strain on the heart and blood vessels over time. It can narrow and harden the arteries, restricting blood flow, and it can exert extra strain on the heart, putting it at risk of heart failure. It’s possible to have high blood pressure without knowing it, as there are no obvious symptoms. We recommend working with your doctor to understand whether your blood pressure is in a healthy range, or if you may need to manage it through healthy lifestyle changes or medication.
Cholesterol is a fat-like molecule that is essential for processes in your body, such as building cells and making vitamins and hormones. But too much cholesterol results in a build-up of fatty deposits in the bloodstream, narrowing the blood vessels and putting you at risk of problems such as stroke, heart failure or a heart attack.
The food you eat has a large influence over your cholesterol levels. But not all cholesterol is made equal. Low-density lipoproteins (LDLs, otherwise known as “bad cholesterol”) are linked to heightened risk of heart disease, while high-density lipoproteins (HDLs, or “good cholesterol”) can actually reduce the risk. Opting for a diet low in saturated fat can help to reduce your bad cholesterol levels, while healthy choices such as whole grains, fruits, vegetables, nuts and legumes can boost your good cholesterol.
Smoking is a hard-to-break habit, but giving up is the best thing you can do for your health – and especially for your heart. Within weeks of quitting, a rapid increase of good cholesterol in the blood occurs, helping your body to rid the excess bad cholesterol from your arteries.9 After quitting, your risk of heart disease, stroke, or heart attack will drop gradually over time. Within 4-5 years, your risk is halved, and over a period of 5-15 years your risk can drop to that of someone who has never smoked.10 So, it’s never too late to quit!
Diet and weight management:
Making healthy dietary choices can help you to manage your weight, your heart health, and your prostate health. Often described as the best diet to prevent cardiovascular disease,11 the Mediterranean style diet can cut risk of heart disease by 31%.6
“Eat food. Not too much. Mostly plants .”
A Mediterranean diet is composed mostly of plant-based sources, with plenty of fruits, vegetables and wholegrains, and only small quantities of animal-based foods. By minimising foods from animal sources, the diet is low in saturated fat, and focuses on healthy unsaturated fats, such as those found in olive oil and nuts. Minimising saturated fat is well recognised as the key to a heart-healthy diet,12 but the Mediterranean diet is also thought to lessen cardiovascular risk by reducing inflammation13 and maintaining steadier blood sugar levels.14 For a guide on creating healthy balanced meals that follow these dietary patterns, take a look at Harvard School of Public Health’s Healthy Eating Plate.
Adjusting the amount you eat can help to maintain a healthy weight, which could further reduce your risk of cardiovascular disease. For those of us looking to lose weight, the prospect of this can be daunting. If you can relate to this, you’re not alone. Over half of adults in Europe have a body mass index (BMI) that exceeds the healthy range,15 and this is a key contributor to cardiovascular disease.16,17 Maintaining a healthy weight can be even more difficult if you are going through hormone therapy, as it presents an added challenge of decreased metabolism and weight gain as a side effect.
While BMI is used as a gauge of cardiovascular risk in the general population, for men over 65, body fat distribution may be a more reliable indicator.18 Men who carry excess weight around their middle can lower their risk by reducing their waistline. Making healthy choices like our exercise and nutrition recommendations in this article are a great place to start, whether to reduce BMI or to lose weight around your middle. Not only can these lifestyle changes help you to get (or stay) in shape and cut your risk of cardiovascular disease, they can help you to enjoy a better quality of life and could even slow the progression of prostate cancer. If you want help to make changes to your diet, asking your doctor for a referral to a dietician is a good place to start.
Diabetes is a significant risk factor for heart disease, doubling the risk in comparison with someone without diabetes.19 It’s worth asking your doctor for a diabetes screening, to identify if you have high blood sugar and might be at risk of diabetes. This is even more important if you have undergone ADT, as the treatment can alter your metabolism. Fortunately, lifestyle changes and/or medication are effective ways to manage blood sugar levels.
“if exercise was a pill, everyone would be taking it”
Being active is great for your heart. Whether you’re heading out running or doing the housework, getting your body moving can keep your heart healthy. Even late in life, taking up exercise is effective at reversing age-related or heart failure-related changes in your heart and blood vessels.20
Patient guidelines suggest a minimum of 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous exercise.21 The peak benefit is seen at 50-60 mins of vigorous activity (such as running) per day, but moderate levels of exercise (such as brisk walking) are still associated with a considerable reduction in CVD risk.20 However, even short 1-2 minute bouts of vigorous activity, such as climbing the stairs or walking briskly, repeated throughout the day are shown to substantially reduce risk.22
Understanding what kind of exercise, and how much exercise, is right for you is a personal choice and will be affected by your cancer stage, treatment, and existing fitness. We recommend talking to your doctor for further advice.
If you are ready to make lifestyle changes and would like additional support, we recommend talking to your doctor. They should be able to help by providing you with advice tailored to you, and can refer you to a specialist dietician or exercise physiologist.
Information you can trust
With so many opinions out there, it can be hard to know who to follow. At Oncolifestyle we do our best to provide you with evidence-based information that has been carefully researched with your health in mind.
Where is this information coming from?
Where is this information coming from?
- Cancer Today. https://gco.iarc.fr/today/online-analysis-multi-bars?v=2020&mode=cancer&mode_population=countries&population=900&populations=900&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=0&include_nmsc_other=1&type_multiple=%257B%2522inc%2522%253Atrue%252C%2522mort%2522%253Atrue%252C%2522prev%2522%253Afalse%257D&orientation=horizontal&type_sort=0&type_nb_items=%257B%2522top%2522%253Atrue%252C%2522bottom%2522%253Afalse%257D.
- Leong, D. P. et al. Cardiovascular Risk in Men with Prostate Cancer: Insights from the RADICAL PC Study. J. Urol. 203, 1109–1116 (2020).
- Moyad, M. A. Preventing Lethal Prostate Cancer with Diet, Supplements, and Rx: Heart Healthy Continues to Be Prostate Healthy and “First Do No Harm” Part I. Curr. Urol. Rep. 19, 104 (2018).
- Nguyen, P. L. et al. Adverse Effects of Androgen Deprivation Therapy and Strategies to Mitigate Them. Eur. Urol. 67, 825–836 (2015).
- Ye, Y., Zheng, Y., Miao, Q., Ruan, H. & Zhang, X. Causes of Death Among Prostate Cancer Patients Aged 40 Years and Older in the United States. Front. Oncol. 12, (2022).
- Chiuve, S. E., McCullough, M. L., Sacks, F. M. & Rimm, E. B. Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men: Benefits Among Users and Nonusers of Lipid-Lowering and Antihypertensive Medications. Circulation 114, 160–167 (2006).
- Hsu, S. et al. A Clinician’s Guide to the ABCs of Cardiovascular Disease Prevention: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and American College of Cardiology Cardiosource Approach to the Million Hearts Initiative: ABCs of CVD Prevention. Clin. Cardiol. 36, 383–393 (2013).
- Guan, J. et al. ABCDE Steps for Heart and Vascular Wellness Following a Prostate Cancer Diagnosis. Circulation 132, (2015).
- Forey, B. A., Fry, J. S., Lee, P. N., Thornton, A. J. & Coombs, K. J. The effect of quitting smoking on HDL-cholesterol – a review based on within-subject changes. Biomark. Res. 1, 26 (2013).
- General, U. S. P. H. S. O. of the S. & Health, N. C. for C. D. P. and H. P. (US) O. on S. and. The Health Benefits of Smoking Cessation. Smoking Cessation: A Report of the Surgeon General [Internet] (US Department of Health and Human Services, 2020).
- Lichtenstein, A. H. et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation 144, (2021).
- Kris-Etherton, P. M., Petersen, K. & Van Horn, L. Convincing evidence supports reducing saturated fat to decrease cardiovascular disease risk. BMJ Nutr. Prev. Health 1, 23–26 (2018).
- Itsiopoulos, C., Mayr, H. L. & Thomas, C. J. The anti-inflammatory effects of a Mediterranean diet: a review. Curr. Opin. Clin. Nutr. Metab. Care 25, 415–422 (2022).
- Ahmad, S. et al. Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet. JAMA Netw. Open 1, e185708 (2018).
- World Health Organization. Regional Office for Europe. WHO European Regional Obesity Report 2022. (World Health Organization. Regional Office for Europe, 2022).
- Bogers, R. P. Association of Overweight With Increased Risk of Coronary Heart Disease Partly Independent of Blood Pressure and Cholesterol LevelsA Meta-analysis of 21 Cohort Studies Including More Than 300 000 Persons. Arch. Intern. Med. 167, 1720 (2007).
- Berrington de Gonzalez, A. et al. Body-Mass Index and Mortality among 1.46 Million White Adults. N. Engl. J. Med. 363, 2211–2219 (2010).
- Rimm, E. B. et al. Body Size and Fat Distribution as Predictors of Coronary Heart Disease among Middle-aged and Older US Men. Am. J. Epidemiol. 141, 1117–1127 (1995).
- Barrett-Connor, E., Wingard, D., Wong, N. & Goldberg, R. Heart Disease and Diabetes. in Diabetes in America (eds. Cowie, C. C. et al.) (National Institute of Diabetes and Digestive and Kidney Diseases (US), 2018).
- Nystoriak, M. A. & Bhatnagar, A. Cardiovascular Effects and Benefits of Exercise. Front. Cardiovasc. Med. 5, 135 (2018).
- Segal, R. et al. Exercise for People with Cancer: A Clinical Practice Guideline. Curr. Oncol. 24, 40–46 (2017).
- Stamatakis, E. et al. Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nat. Med. 1–9 (2022) doi:10.1038/s41591-022-02100-x.