The Scale of the Problem
Heart disease remains one of Australia’s leading causes of death, and the statistics are sobering. More than one in five Australians aged 45 to 75 have an intermediate to high risk of heart attack or stroke in the next five years. Close to 40% of Australian adults carry three or more cardiovascular risk factors — many completely unaware. In fact, one Australian has a heart attack or stroke every four minutes. What concerns me most in my practice isn’t the people who know they’re at risk. It’s the people who’ve been told their results are “fine”, when the tests being used simply aren’t asking the right questions.
Weight, Metabolism, and Your Heart
Excess weight — particularly abdominal fat — is one of the most significant and modifiable cardiovascular risk factors. It drives insulin resistance, raises blood pressure and triglycerides, lowers HDL cholesterol, and promotes the chronic inflammation that underpins atherosclerosis. But I want to be careful here, because “lose weight” as advice is both obvious and unhelpful on its own. What matters clinically is metabolic health — and you can meaningfully improve that without achieving an ideal body weight. Even a 5–10% reduction in body weight produces measurable improvements in blood pressure, blood sugar, and cholesterol.
The most effective approach I’ve seen combines consistent movement (Zone 2 exercise is particularly useful here), balanced meals that support blood sugar stability, adequate sleep, and stress management. These aren’t separate lifestyle tips — they work synergistically, and they address the metabolic drivers of cardiovascular risk rather than just the number on the scale.
What Your Standard Tests Are Missing
I regularly see people who’ve had annual blood tests and been reassured that their cholesterol is normal. And yet when we dig deeper, there’s a very different picture. Standard lipid panels measure total cholesterol, LDL, HDL, and triglycerides. These are useful — but they’re not enough.
Here’s what I recommend discussing with your GP or specialist:
- ApoB and lipid subfractions — ApoB reflects the number of atherogenic (plaque-forming) particles in your blood, which is more predictive of cardiovascular risk than LDL alone.
- Lipoprotein(a) — Lp(a) is largely genetically determined and can significantly elevate risk even when standard cholesterol looks normal. It’s rarely tested unless you ask specifically.
- Homocysteine — This amino acid, influenced by B vitamin status and genetics, can damage blood vessels and increase clot risk when elevated.
- Insulin resistance markers — Fasting insulin, HOMA-IR, and HbA1c paint a clearer picture of metabolic health than glucose alone.
- Oxidative stress — Chronic inflammation and oxidative damage are the underlying drivers of atherosclerosis, and there are now accessible ways to assess this.
- CT Coronary Calcium (CAC) Score — This non-invasive imaging test directly assesses whether calcium deposits have built up in your coronary arteries. It can identify people at significant risk even when all their blood tests appear reassuring. If you have a strong family history of early heart disease, this is a conversation worth having with your doctor.
For home monitoring, a quality blood pressure cuff used consistently at the same time each day provides invaluable data. For those wanting more comprehensive insight, the Hilo device offers continuous 24/7 blood pressure monitoring — particularly useful for anyone whose clinic readings may not reflect their day-to-day patterns.
The Power of Omega-3s
One of the most well-researched and underutilised tools in cardiovascular prevention is omega-3 fatty acids. A large-scale analysis recently published in the European Journal of Preventive Cardiology, pooling individual-level data from three major prospective cohorts and an updated meta-analysis, found meaningful associations between circulating omega-3 levels and reduced cardiovascular disease risk. This adds to a substantial body of evidence supporting regular intake of EPA and DHA — found in oily fish like salmon, sardines, and mackerel, as well as in quality fish oil supplements.
Omega-3s work through multiple pathways: reducing triglycerides, lowering inflammatory markers, supporting endothelial function, and moderating blood pressure. In my practice, they are among the first nutrients I consider in cardiovascular risk management.
Zone 2 Exercise: The Underrated Prescription
Not all exercise is equal when it comes to heart health. Zone 2 training — moderate-intensity aerobic exercise performed at a pace where you can still hold a conversation, but feel your breathing deepen — has emerged as particularly powerful for cardiovascular and metabolic health.
You’re in Zone 2 when you’re working at roughly 60–70% of your maximum heart rate. A practical test: you can speak in full sentences, but you wouldn’t want to sing. Think brisk walking, easy cycling, swimming at a comfortable pace, or dancing. Aim for 150 minutes per week, and your heart, blood vessels, and mitochondria will thank you.
Smoking: The Single Biggest Thing You Can Do
If you smoke, stopping is the most impactful cardiovascular decision you can make — full stop. Smoking damages the lining of blood vessels, accelerates atherosclerosis, raises blood pressure, reduces HDL cholesterol, and dramatically increases the risk of heart attack and stroke. There is no “safe” level when it comes to your heart. The good news is that the benefits of quitting begin within hours and compound significantly over time. Within a year of stopping, your excess heart attack risk drops by half. Within 15 years, your cardiovascular risk approaches that of a non-smoker.
In my practice, I support smoking cessation with a combination of strategies — addressing the behavioural, nutritional, and stress related drivers alongside any medical support your GP recommends. If you’ve tried before and not succeeded, please try again. Most people need multiple attempts, and the right support makes an enormous difference.
For Women After Menopause: The Risk Shifts Significantly
If you’re a woman navigating perimenopause or post-menopause, I want to speak directly to you. The hormonal changes of this transition do far more than cause hot flushes — they fundamentally alter your cardiovascular risk profile.
As oestrogen declines, blood vessels lose much of their natural flexibility. Blood pressure tends to creep upward. Cholesterol metabolism shifts — LDL and triglycerides often rise, while protective HDL may fall. Abdominal fat increases, insulin resistance sets in, and inflammation becomes harder to regulate. Sleep disturbances and stress compound all of these changes.
What makes this particularly challenging is that many of these shifts are silent. There are no symptoms until disease is well established. This is precisely why, together with Dr Hazel Batten, I’ve developed a dedicated online module on cardiovascular health after menopause as part of my upcoming women’s health course — because this stage of life requires a more sophisticated, proactive approach to monitoring and prevention. See beyondthepause.com.au As always, the recommendations in this blog are for educational purposes. Please consult your GP or a qualified health professional before making changes to your health management.
What You Can Do This Heart Week
- Ask your GP about advanced lipid testing if you have risk factors or a family history.
- Start paying attention to your blood pressure at home.
- Consider whether your current exercise routine serves your heart best.
- Ask your naturopath about diet and supplements for a healthy heart – including omega 3’s.
Cardiovascular health is not a single test or a single number. It’s a picture built from many layers — and with the right information, most risk is preventable.