As the arrival of February sees heart awareness month kicking off across many countries, it is important to consider how we can prevent heart disease through living a healthy lifestyle and avoiding potential harms that could negatively impact heart health.

One such harm could be testosterone supplementation, which is increasingly being promoted in older men to improve muscle mass, libido and overall wellbeing. While these potential benefits of testosterone therapy have been well-documented, much less is known about the possible risks associated with sex hormone supplementation, and emerging evidence suggests it could be harmful to the heart.

In a systematic review and meta-analysis published in BMC Medicine, Lin Xu and colleagues demonstrated that testosterone therapy significantly increases the risk of adverse cardiovascular events, with a greater association seen in clinical trials not funded by the pharmaceutical industry.

The specific types of adverse cardiovascular events have been explored further in a study by Rebecca Vigen and colleagues, who showed that receiving testosterone is linked to an elevated risk of heart attack, stroke and overall mortality in male veterans.

Together, these findings highlight that despite the potential advantages of testosterone supplementation in terms of improving wellbeing, there could be serious adverse effects, and experts recommend that until larger randomized studies have been carried out to ascertain the risk:benefit ratio, doctors and patients should be aware of the potential cardiovascular risks when considering testosterone therapy.

In addition to avoiding substances that could be harmful to the heart, exercising regularly, eating a healthy diet and encouraging children to be “heart healthy” are key in preventing cardiovascular disease (CVD), and a number of recent articles published in BMC Medicine have demonstrated the importance of these lifestyle factors.

Exercise

In a research article, David Jiménez-Pavón and colleagues identified that CVD risk factor clustering – the presence of more than one risk factor in the same individual –  can occur in inactive children aged between two and six, concluding that current physical activity guidelines for children are insufficient.

Robert McMurray recommends that clinicians should advocate various degrees of physical activity on a case-by-case basis in children at risk of CVD, in an early childhood approach to heart disease prevention.

Diet

Turning to diet, another essential factor in maintaining a healthy heart, Sabine Rohrmann and colleagues demonstrated that eating too much processed meat is linked to a greater risk of death from cardiovascular disease in a study from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Dariush Mozaffarian and colleagues emphasize that eating large amounts of processed meats should be avoided, including those marketed as “low fat”, and instead we should eat more fish, nuts, legumes, fruits, and vegetables. These foods are all considered to be part of the Mediterranean diet, which has been linked to a healthy heart and longevity.

As part of the PREDIMED (Prevención con Dieta Mediterránea) trial, Marta Guasch-Ferré and colleagues showed that nut consumption is linked to reduced mortality risk, and Estefania Toledo and colleagues revealed a beneficial effect of the Mediterranean diet on blood pressure. Taken together, these results provide further evidence for eating a Mediterranean-style diet and reducing processed meat consumption for good cardiovascular health.

Blood pressure

Elevated blood pressure is an important sign of early CVD development, and regular checks are recommended to ensure prompt detection of blood pressure changes.

In a meta-analysis, Yuli Huang and colleagues demonstrated that even slightly elevated blood pressure, termed “prehypertension”, increases CVD risk, and in an accompanying commentary, Pascal Meier and colleagues discuss the implications of reclassifying hypertension ranges to incorporate prehypertensive patients.

Once elevated blood pressure has been identified, one way it can be controlled in order to reduce CVD risk is by taking antihypertensive drugs. Atle Fretheim and colleagues carried out a systematic review and meta-analysis to identify the most appropriate antihypertensive drug to reduce the incidence of CVD in at-risk individuals, revealing that there were no differences in cardiovascular outcome for most drug classes. The authors conclude that alpha-blockers and beta-blockers may not be the drugs of choice to lower blood pressure, because they were not superior to other drug classes for any outcomes in this study.

Taken together, all of these studies published in BMC Medicine explore how to reduce the risk of heart disease from many different angles. We look forward to further insights into how different dietary and exercise approaches can be optimized to prevent the development of cardiovascular illness, and recognize the importance of a multidisciplinary approach in maintaining a healthy heart.