I grew up on a farm, and there was a huge expectation that we played outside, looked after the horses, and helped out. I first trained to be a radiographer and worked as one for about nine months. While doing that, I got to work in the cath [cardiac catheterisation] lab, and from then, I knew I wanted to go to medical school. Like many people, I wasn’t as health-conscious in my late teens, and when I went to college, but going back to college
and studying medicine, and realising in my working life that you can’t burn the candle at both ends, definitely brought me back around to living a much healthier lifestyle. I went back to medical school in UCC, and did the graduate programme, then moved to the US for my postgraduate training. Once I’d started my postgrad training in internal medicine, I knew I wanted to be a cardiologist. I loved that you get to see patients in clinic and follow them longitudinally. You can do
procedures, read diagnostic studies, and take care of critically ill patients. I considered whether I’d stay in the US, but I’m married with two young kids, so we decided we wanted to come home to Ireland and be closer to family. We moved back last May. Being a cardiologist and knowing more about the risks of not following a healthy lifestyle has certainly made me much more conscious [of my choices] in recent years. As more information and data come out, it continues to influence
me to be healthier. The things we most commonly see in clinic are people presenting for management of high blood pressure and high cholesterol. We also frequently see patients who are being referred because they have a strong family history of heart disease. In terms of metabolic conditions, we often see patients who have obesity or type 1 or type 2 diabetes, which tend to feed into their overall risk profile for developing heart disease. Patients often think it is older men who tend to
be affected [by heart disease], when the reality is that men and women are at equal risk of developing it. And we often see heart disease developing in younger patients, in particular those who have underlying risk factors [such as] metabolic conditions, high blood pressure, high cholesterol, or a strong family history. Another major myth is that a lot of people think heart disease is related [only] to genetics. Genetics plays a part, whereas lifestyle factors play another large role. I think this sometimes surprises
patients. My top tips for maintaining a healthy heart as we age: 1. High blood pressure: It is one of the biggest risk factors for heart disease and tends not to cause symptoms. High blood pressure is very easy to pick up using home blood-pressure monitoring, or by getting in-office or 24-hour blood-pressure monitoring organised by your GP. There are some nuances to these [numbers], but if you’re monitoring your blood pressure at home, numbers that are consistently greater than 140 over 90 warrant further
workup, typically with a 24-hour blood pressure monitor. Lifestyle absolutely matters when it comes to blood pressure. One of the key things people can do is follow a low-salt diet. Wherever salt goes, water follows, and that raises blood pressure, so reducing salt is always recommended. Weight loss, where indicated and possible, can also have a dramatic impact on blood pressure and, in some cases, medications can be reduced. Exercise is also super important and has a real impact on lowering blood pressure. 2. High
cholesterol: A second major risk factor for heart disease — again, in the vast majority of patients, it will not have any external indicators, but it’s very easy to pick up on routine blood testing. In general, a total cholesterol greater than five or an LDL greater than three would be considered high. That doesn’t mean that you need to be on medication, but it warrants further discussion with your GP or cardiologist. Studies show that the Mediterranean diet helps reduce blood pressure, it improves
your cholesterol profile, and it lowers inflammation. It’s a great place for people to start. There are patients who will never get their high blood pressure or cholesterol under control just using diet and exercise. They need medication. We always recommend lifestyle modifications, but in conjunction with medications where indicated. 3. Manage your lifestyle: It’s one of the most important factors in prevention and long-term outcomes. Many of the largest risk factors for developing cardiovascular disease — like high blood pressure, high cholesterol, type 2
diabetes, obesity, and smoking — are strongly influenced by your daily habits. Regular physical activity, a balanced diet, good sleep, stress management, maintaining a healthy weight, avoiding or limiting alcohol, and avoiding smoking; all of these will, over your lifetime, reduce your risk of heart disease, of stroke, of other vascular diseases. If you can do a brisk walk outside for 30 minutes, three to five days a week, and you do that consistently, that’s going to have a dramatic positive impact on your cardiovascular
health over time. 4. Eat a Mediterranean diet: This diet is probably one of the most well-studied dietary patterns when we look at cardiovascular research, and there is evidence that consistently links it with improved heart health and lower cardiovascular risk. It emphasises fruits, vegetables, whole grains, legumes, nuts, olive oil, fish, and a moderate intake of dairy. There’s growing evidence that ultra-processed foods are detrimental to our health, so where possible, I recommend limiting them and cooking whole foods at home as much as
you can. 5. Get a good night’s sleep: The evidence is evolving to show that sleep is really important. Poor sleep [has] been associated with higher risks of high blood pressure, obesity, type 2 diabetes, heart disease, stroke and heart rhythm issues. Good-quality, consistent sleep should be viewed as one of the core pillars of preventative health, alongside diet, exercise, smoking cessation, and the other lifestyle modifiers. Look at things that are easy to fix, such as not using your phone or looking at screens
before bed, avoiding caffeine later in the day, and limiting alcohol intake. Exercise has been linked to an improvement in sleep health. If I have a patient who has poor sleep and has another risk factor for sleep apnoea, such as an elevated BMI or hypertension, I’ll send that person for a sleep study. 6. Women’s symptoms can be different to men’s: Women present differently to men in terms of symptoms of heart attack [and] underlying heart disease. Women tend to describe symptoms like fatigue,
decreasing exercise tolerance, or shortness of breath, whereas men will often describe chest pain. 7. Consider screening, if appropriate: Patients with a strong family history of early heart disease — parents or siblings who’ve had heart disease — should think about getting themselves screened and whether they have underlying risk factors that might further increase their chances of developing heart disease. And for women in particular, if they’ve had complications in pregnancy — high blood pressure in pregnancy, pre-eclampsia, eclampsia, gestational diabetes, or preterm labour
[before 37 weeks] — we know those patients are at an increased risk over time of developing underlying heart disease. Those patients warrant getting themselves checked out. Top tip: If I could tell patients one thing, it would be: do not smoke cigarettes. And if you do, quit. That’s probably the best thing you can do for your heart health and overall health.
cardiologist, heart health, high blood pressure, cholesterol, Mediterranean diet, sleep, smoking cessation, Ireland