A healthy ticker

The heart’s workload is never ending and essential to healthy functioning, so this vital organ must be kept healthy.[1]

Achieving and maintaining heart health involves sustaining a healthy lifestyle, eating a balanced diet, exercising regularly, avoiding smoking and other unhealthy habits, and managing any existing medical conditions. It also includes monitoring blood pressure, cholesterol levels and other risk factors associated with cardiovascular disease.

According to community pharmacist and master herbalist Gerald Quigley, when we talk about heart health, we generally mean cardiovascular health, because it relates to the entire cardiovascular system – the health of the heart (the pump) as well as the blood vessels – working “incredibly hard” in servicing the needs of the body. So, it’s important to keep the system healthy, he says, and help avoid anything that can contribute to poor cardiovascular health, including inflammation of the blood vessels, hypertension, and high cholesterol.

Of the many factors that can increase the risk of poor cardiovascular health, some are modifiable and others not. The modifiable factors include blood pressure, cholesterol levels, body weight, diabetes, diet, physical activity, smoking status, and alcohol consumption.[2] Non-modifiable factors include age, gender, ethnic background, and family history.[3]

“The lifestyle factors include stress, lack of exercise, poor nutrition, poor sleep, shift work – anything that interferes with your normal,” Mr Quigley said. “There’s no doubt that a combination of stress, smoking, alcohol, and poor sleep can increase the pressure on your cardiovascular system.

“Once there’s a breakdown in the whole system, it’s like a stack of cards. The general message is that if you haven’t had a check-up and you’re about 50 years old, then it’s time to do so. Getting all those risk factors checked and knowing where you sit compared with others in the same age group is more important than ever.”

An important risk factor for poor cardiovascular health is high blood pressure, often referred to as the silent killer.

“In Australia, the threshold for diagnosis of hypertension [or high blood pressure] is a systolic blood pressure higher than 140mmHg and/or a diastolic blood pressure higher than 90mmHg,” said Associate Professor Francine Marques, Head of the Hypertension Research Laboratory, Senior Medical Research Fellow at the Sylvia and Charles Viertel Charitable Foundation and National Heart Foundation Future Leader Fellow. “These are equivalent to the maximum and minimum blood pressure that’s pumping through the body when the heart contracts and then relaxes.”

She adds that similar to overall cardiovascular health, blood pressure is regulated by a combination of genetic elements and lifestyle factors – including salt and alcohol intake, smoking status, exercise, sleep, and stress.

“More recently, there’s evidence that our gut microbes contribute to blood pressure regulation, too,” she said. “Thus, management of lifestyle is essential to reducing the risk of high blood pressure.”

Professor Marques continued: “High blood pressure is the number one cause of death globally, as it’s a key risk factor leading to cardiovascular morbidity and mortality. This is because, over time, elevated blood pressure leads to several diseases, including stroke, heart attack and heart failure, kidney failure, aortic aneurysm, and even vascular dementia. This is a huge issue as globally one in three adults have high blood pressure, and we know that the vast majority don’t have their blood pressure under control – that is, under 140/90mmHg.”

It’s important to help customers manage their blood pressure, given its role as a risk factor in cardiovascular disease development. This can be achieved through diet and lifestyle changes and adhering to medical management where required.

“Lifestyle advice and changes are always key to blood pressure management,” Associate Professor Marques said. “These include a healthy diet – salt and alcohol reduction, increase in fibre – weight loss, smoking cessation, and exercise.

One way to help customers in this space is by recommending and educating on regular blood pressure monitoring at home.

“I’m a great fan of home blood pressure monitoring,” Mr Quigley said. “It gives a truer reading of where you sit.”

He adds that it also provides more accurate results compared with an isolated reading – “which really means nothing”.

“It’s important to take three readings [across the day] and record the third, and you do this for five days,” he said. “Then you can go along to your doctor and say, ‘here are my blood pressure readings – I know your machine might be different, but here are five days of consecutive readings’.”

Using this range of readings gives the GP a better understanding of your blood pressure, says Mr Quigley, and the ability to “assess where [your blood pressure] is, compared with others in the same age group”.

He believes this can be “a great point” of customer engagement for pharmacists, where they can make a real difference to someone’s health.

“I’m surprised more pharmacists aren’t proactive in selling blood pressure monitors,” he said.

In terms of dietary intervention, along with an overall heart-healthy diet, limiting alcohol consumption and reducing salt intake, ensuring adequate fibre is also key, says Associate Professor Marques, who points to a connection between fibre intake, gut health, and heart health.

“The gut is the primary site for absorption of several medications – including those that lower blood pressure – while our gut microbes have a key role in digesting some foods for us,” she said.

“One example is fibre from our diet. We cannot digest fibre ourselves, so fibre reaches the gut intact. There, certain types of fibre, called fermentable fibre, feed bacteria. In turn, bacteria produce … short-chain fatty acids. These can have a localised effect, helping our gut stay healthier, but they can also be found in our blood.”

Associate Professor Marques continued: “Increasing fibre intake, particularly of fermentable fibres, may help to lower blood pressure. This is an important point, as globally the intake of fibre is approximately 11g a day, while dietary guidelines recommend 25g-plus a day for women and 30g-plus a day for men.”

She adds that fermentable fibres can be found in green bananas, legumes (such as beans), uncooked oats, barley, nuts (such as cashew nuts and pistachios), and cooked and cooled-down pasta and potatoes – with the cooking and cooling down process changing the structure of the starch and making these good for the gut microbes.

To help with fibre consumption, Mr Quigley suggests Betaglucare breakfast fibre, which contains beta-glucan[4] – a type of soluble fibre also found in oats, wheat and barley that has been linked to reducing cholesterol levels, decreasing inflammation levels and improving blood glucose levels. Other supplements Mr Quigley suggests that help with cardiovascular health include aged garlic extract, which “helps carotid artery strength”, and Ubiquinol (coenzyme Q10).

Through raising awareness, educating, and offering support to customers, pharmacies have a major opportunity to make a difference in the space of cardiovascular health, Mr Quigley says.

Associate Professor Marques added: “Pharmacies have an essential role in our community contributing to better blood pressure control. They can do this via:

  • “Supporting patients to take their prescribed blood pressure lowering medication, and asking if they have questions about it.
  • “Talking to customers about lifestyle modifications that can help them lower their blood pressure, as medication alone is not always enough.
  • “Asking customers when they last had their blood pressure measured and encouraging them to check their blood pressure regularly. This can be at the pharmacy itself or via a home blood pressure monitor. The key here would be for pharmacists to help customers identify validated monitors.
  • “They can also teach customers how to measure their blood pressure properly.”


  1. health.harvard.edu/topics/heart-health
  2. heartfoundation.org.au/bundles/for-professionals/key-statistics-risk-factors-for-heart-disease
  3. heartresearch.com.au/heart-disease/risk-factors/
  4. healthline.com/health/beta-glucan-heart-healthy#what-it-is

This feature was originally published in the June issue of RPA e-magazine