Cardiovascular disease (CVD) kills one in three people in the UK. While there's no single cause and some contributing factors can't be altered, others are a consequence of our lifestyle, which we can change.

Irreversible factors that can lead to heart disease:

• getting older
• being male
• genetic/family history of CVD

Factors that are potentially reversible or could be modified:

• cigarette smoking
• increased levels of cholesterol, triglycerides, or low-density lipoprotein (LDL) in the blood
• being overweight
• waist circumference (above 32 inches form women, 36 inches Asian men and 37 inches European men)
• high blood pressure
• being inactive
• diabetes
• having a tendency for blood clotting

Making small changes to your diet is one of the simplest and most effective ways to reduce your risk of CVD. You can do this by:

• Reducing fat in your diet, especially saturated and trans-fats.
• Eating more fruit and vegetables, wholegrain foods and soluble fibre.
• Drinking alcohol in moderation.

Reducing the proportion of fat in your diet, especially saturated fat, can help to reduce blood cholesterol levels. There is a strong link between high blood cholesterol levels and the risk of heart disease. Normal blood cholesterol levels are below 5mmol/l (as measured by your GP). You should aim to consume no more than 35 per cent of your total calories from fat; less than 10 per cent of all calories should be from saturated fat.

Trans-fatty acids are a particular kind of fat produced when plant-based oils are hydrogenated to produce solid spreads, such as margarines. They are often found in confectionery and processed food like pastry, biscuits and cakes. They have been found to have the same effect on cholesterol levels as saturated fat and should be avoided as much as possible. Thankfully, many manufacturers have now modified processing techniques to keep these fats to a minimum. Check labels for hydrogenated fats.

When reducing total fat, it's important not to cut fat completely from your diet. It's the old message of everything in moderation. In fact, essential fatty acids such as omega-3s, which are found in oily fish, have been shown to further reduce the risk of CVD.

How to modify your fat intake:

• Use butter and other spreads sparingly.
• Choose lean cuts of meat.
• Grill, bake or steam foods rather than frying them.
• Swap saturated fats such as butter, lard and cream for poly- or monounsaturated fats such as sunflower, rapeseed or olive oil varieties.
• Limit your intake of trans-fats from processed foods .
• Eat two to three portions of oily fish each week.

Certain plant-derived compounds, called stanol or sterolesters and isoflavones, have been shown to reduce cholesterol levels. Certain products like spreads, yoghurts, drinks and soya 'dairy alternatives' are now available containing these products. Clinical trials show that when used on a regular basis they can reduce high cholesterol levels.

Fruit and vegetables are rich in many essential nutrients including vitamins C and E and carotenoids (which are all antioxidants). They have been shown to protect the heart by limiting the damaging effects of cholesterol on body tissues. Aim for at least five servings of fruit and vegetables a day.

A serving of fruit is:

• 1 medium size piece of fresh fruit e.g. half a large grapefruit, a slice of melon or 2 satsumas
• 2-3 small pieces of fruit e.g. plums, apricots
• 1 handful of grapes
• 1 medium banana
• 7 strawberries
• 3 heaped tbsp fruit (stewed or tinned in juice)
• 1 small glass fruit juice (150ml)
• 1 heaped tbsp dried fruit e.g. raisins, or 3 dried apricots

A serving of vegetables is:

• 3 heaped tbsp cooked vegetables e.g. carrots, peas or sweetcorn
• 1 side salad (the size of a cereal bowl)
• 1 tomato, 7 cherry tomatoes

Studies of large groups of people in the US have shown that diets rich in wholegrain foods can reduce the risk of CVD by up to 30 per cent. You can include wholegrain foods in every meal by choosing wholegrain breakfast cereals, wholemeal bread and wholegrain varieties of pasta and rice.

Soluble dietary fibre, found in oats, beans and pulses, can help to lower cholesterol, although the effect is modest. These should be included as part of an overall healthy balanced diet at least 2-3 times each week.

Consuming moderate amounts of alcohol - between one and two units a day - has been found to reduce the risk of CVD. This is because alcohol effects the amount of cholesterol in the bloodstream and makes it less likely that clots will form. However, high intakes of alcohol are associated with increased risk. It's also worth noting that saving up your weekly units for a weekend binge does not offer the same benefits.

A diet that includes at least 25g of soya per day has been associated with reductions in some forms of cancer and CVD. Soya protein is also an excellent substitute for meat and is available in a convenient and tasty form in many ready-made meals. Another good source of soya protein is soya milk and yoghurt.

The British Heart Foundation have an excellent range of resources giving information about reducing your risk of cardiovascular disease www.bhf.org.uk

This article was last medically reviewed by Dr Rob Hicks in September 2005.
First published in March 2001.