Did you know the health of your heart is not simply down to living a good lifestyle, healthy eating, regular exercise and stress levels? Two other big yet lesser known factors are your gender and whether you live in a city. In 2014, the European Study of Cohorts for Air Pollution Effects (ESCAPE) found that long-term exposure to particulate matter is strongly linked to heart attacks and angina.
Heart attacks are caused by a blocked artery and the route to a successful recovery is to open that artery as quickly as possible. Behind the cancer grouping, cardiovascular disease is the main cause of death in women in the UK.
There's emerging evidence that air pollution and high levels of particulate matter i.e. from vehicle exhausts and dust in the air, can be linked to worse heart health and a higher incidence of heart attacks and heart conditions. When living in a built up area, pollution is definitely a factor in terms of heart health. Alongside this, people also have to deal with the stresses and strains that come with living in a big city.
Most of our cities have some fantastic open spaces, fantastic opportunities to cycle, run, walk and do all sorts of exercise, so I don't think we can use it purely as an excuse. So while I do believe environmental factors have a role in the health of our hearts, there are all the opportunities you could want in the city to take care of yourself.
Men vs women
There is definitely some disparity between cardiac disease in men and women. This extends to when patients develop the disease, how they present and how they are treated. Historically, women have been undertreated with procedures that have been shown to reduce symptoms and even extend life. You were far more likely to get a coronary bypass operation or a stent if you were a man rather than a woman.
Interestingly at age 55, though men and women have similar lifetime risks of heart disease, the first signs differ considerably. Men are more likely to show symptoms of coronary heart disease as a first event, such as chest pain and shortness of breath, while women are more likely to have a stroke or develop progressive heart failure as their first event. For this reason and others, doctors are still more likely to take chest pain seriously in a man rather than a woman as cardiac disease is more common in men. As there are now robust risk assessment tools, which include gender among other variables, patients are being assessed in a more objective way.
Urgent care is essential
When I first started my career 20 or so years ago, a patient with a heart attack would be given drugs to try and unblock an artery and then wait 10-15 days for another test called an angiogram to see if further treatment to the arteries supplying the heart was needed. Now, a patient who has a heart attack will be transferred directly to a cardiac centre by the emergency services, and can receive treatments to unblock the offending artery in a matter of minutes. The speed that we can deliver treatments, and subsequently reduce the amount of damage to the heart muscle caused during the heart attack, has important implications not only for the patient's survival, but also the quality of life they may experience after a heart attack.
For those reading with interest, I ask: Do you know your cholesterol level, or how to measure your pulse rate? These are important questions to accurately calculate the age of your heart or learn if you are at risk of a stroke. Visit this page to take the test and learn more about your heart.
Dr Ajay Jain, Consultant Cardiologist at The London Clinic
 Peters A et al (2014) 'Long-term exposure to ambient air pollution and incidence of acute coronary events: perspective cohort study and meta-analysis in 11 European cohorts form the ESCAPE project.' British Medical Journal http://www.bmj.com/content/348/bmj.f7412