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Angina Q&As

Published by Bupa's health information team, April 2009.

Answers to questions about angina

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

I have diabetes and I have heard this can give me angina. Do I need to take special precautions?

If you have diabetes, you have a higher risk of developing heart disease, and therefore angina. It's important that you monitor your blood glucose levels carefully and make sure that they are within recommended limits. Be more physically active, and if you smoke, stop. Have your blood cholesterol levels checked by your GP and try to reduce the levels of fat in your diet. Aim to have a healthy blood pressure (below 130/80mmHg) and try to lose any excess weight.

Explanation

If you have diabetes, you're more likely than other people to have high blood pressure and high levels of cholesterol in your blood. Diabetes can also affect the heart muscle itself, making it a less efficient pump and making it more likely that you will develop heart disease and angina. So, if you have diabetes, your GP will probably prescribe medicines to treat some of the risk factors that you may have. For example, he or she may give you medicine to lower your blood cholesterol level or aspirin to reduce the risk of blood clotting. Your GP will also encourage you to stop smoking.

If you have high levels of both triglycerides (fats) and cholesterol in your blood, you have a greater chance of developing angina. The risk is particularly high if you also have a low level of high-density lipoprotein (HDL or "good" cholesterol), which is more likely if you have diabetes. You may need to take a medicine known as a statin, such as simvastin (Zovor), to reduce your cholesterol levels, and perhaps another, such as bezafibrate (eg Bezalip), to control your triglyceride levels. Cutting down on fats in your diet, particularly saturated fats (which are found mostly in meat and dairy products), will also help.

High blood pressure is common in people with diabetes and it's essential to control it. If you have diabetes, you should aim to have a blood pressure below 130/80mmHg, or lower than that if your kidneys are already damaged. You may be able to control your blood pressure by losing excess weight, doing more exercise and cutting down on alcohol and salt, although you may also need to take medicines, such as a beta-blocker. Your GP will be able to advise you on weight-loss programmes that are suitable for you.

Always ask your GP or pharmacist for advice and read the patient information leaflet that comes with your medicine.

Being physically active may help to reduce the amount of medicine or insulin you need to take for your diabetes, and can help reduce your risk of angina. It's important to monitor your blood glucose carefully as you start to build up your level of physical activity, because you may need to change the dose of your medication. Get advice from your GP or practice nurse on how much exercise you can do without any problems, and gradually increase it over time.

Further information

Sources

  • Diabetes. British Heart Foundation. www.bhf.org.uk, accessed 15 October 2008
  • Angina. British Heart Foundation. www.bhf.org.uk, accessed 15 October 2008
  • Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008:138-144
  • Lipids management - background information. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 15 October 2008
  • Fats. Food Standards Agency. www.eatwell.gov.uk, accessed 9 September 2008
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How can the fats in my food cause angina?

Fat is a good source of energy but eating too much of the wrong types of fat increases your risk of angina and other heart diseases.

Explanation

Some fat is an essential part of a healthy diet but it's important that you don't eat too much fat and that you're careful of the type that you eat.

The fat in your blood is turned into cholesterol by your liver. The cholesterol then enters your blood to be transported around your body. Not all cholesterol is bad for you; there is a harmful form and a protective form. The harmful type of cholesterol is LDL or low-density lipoprotein (also known as "bad" cholesterol). The protective type of cholesterol is HDL or high-density lipoprotein (also known as "good" cholesterol).

You should reduce the amount of fat you eat to help reduce your cholesterol level. There are different types of fat in food.

  • Saturated fats, which increase cholesterol levels. Examples of foods high in saturated fat include cake and biscuits, pastry, meat products and hard cheese.
  • Mono-unsaturated fats, which help lower "bad" cholesterol levels. Examples of foods high in monounsaturated fats include olive oil and rapeseed oil.
  • Polyunsaturated fats, which lower both harmful and protective cholesterol levels. Examples of foods high in polyunsaturated fats include sunflower oil and soya oil.

When you're shopping for food, compare the labels so you can pick those with less total fat or less saturated fat. Try to choose lower fat versions of dairy foods, such as semi-skimmed or skimmed milk, and reduced-fat yoghurt, whenever you can.

Cutting down on saturated fats and replacing them with small amounts of unsaturated fats can help to reduce your cholesterol level by up to one-tenth.

There is a particular type of polyunsaturated fat called omega-3 which can help to reduce your risk of heart disease and angina. You can get omega-3 fats from:

  • oily fish such as kippers, mackerel, sardines and salmon
  • certain oils such as rapeseed, walnut and linseed oil
  • fish oil supplements

You should aim to eat at least one portion of oily fish per week.

Further information

Sources

  • Longmore M, Wilkinson IB, Rajagopalan S. Oxford Handbook of Clinical Medicine. 6th ed. Oxford: Oxford University Press, 2004: 120
  • What is a healthy diet? British Heart Foundation. www.bhf.org.uk, accessed 9 October 2008
  • Lipids management - background information. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 15 October 2008
  • Fats. Food Standards Agency. www.eatwell.gov.uk, accessed 9 October 2008
  • Polyunsaturated fats and monounsaturated fats. www.eatwell.gov.uk, accessed 9 October 2008
  • Fish and shellfish. Food Standards Agency. www.eatwell.gov.uk, accessed 9 October 2008
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I have been referred for a stress test. What is this?

An exercise tolerance test (stress test or exercise ECG) is a way of helping your doctor to confirm if you have angina and is particularly useful in determining if you need further tests. An electrocardiogram (ECG) is used to test your resting heart activity, but this can appear normal even if you have angina. A stress test usually involves you exercising on a treadmill or an exercise bike, while your heart activity is monitored by an ECG. Your doctor can also assess the severity of any symptoms of angina that develop during this exercise, which will help him or her to decide on the best treatment for you.

Explanation

An exercise tolerance test (stress test) helps your doctor to confirm if you have angina and can also be used to determine if you need to have any further tests. Your doctor will only recommend that you have a stress test after he or she has asked you about your symptoms and given you a physical examination, including a resting ECG.

A resting ECG tests your how well your heart is working, but this can appear normal even if you have angina. When you exercise, you put stress on your heart and this can cause symptoms of angina to appear. If you're referred for a stress test, it typically involves you exercising on a treadmill or an exercise bike. This allows your heart activity to be monitored by an ECG during physical exercise. Your doctor can then assess the time taken before any ECG changes occur, how severe they are and how long it takes your heart to recover after you have stopped exercising. Other measurements taken will include the time taken for any symptoms of angina to develop, along with changes in your blood pressure and heart rate. Your doctor will be able to assess the severity of any symptoms of angina that you get during exercise, which will help him or her to decide on the best treatment for you.

Exercise stress testing can also be used to test how effective medicines are in controlling your symptoms of angina. They can help your doctor to recommend a suitable level of exercise for you after your symptoms are under control.

Further information

Sources

  • Angina. Making a diagnosis. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 9 October 2008
  • The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Guidelines on the management of stable angina pectoris: executive summary. Eur Heart J 2006; 27:1341-1381. http://eurheartj.oxfordjournals.org
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: April 2009

 

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