Heart expert Dr. Chiadi Ndumele answered questions from followers in a recent Facebook chat.

What can I do to lower cholesterol?

To lower cholesterol, I would recommend a diet with more fruits and vegetables, fish, whole grains and decreased simple carbohydrates and fried foods. Exercise and weight loss also help with lowering cholesterol.

Other medications are available for lowering cholesterol, such as ezetimibe, fibrates and niacin, but statins are the most powerful and generally the best tolerated. Other medications are currently being studied and may become available in the coming years.

What are some common barriers people face when trying to prevent and manage heart disease?

Some of the problems people most frequently mention are:

• Time to focus on heart health
• Money to engage in health activities
• Understanding of their heart condition

In general, there are often many other challenges and distractions that take our attention away from our health, but I strongly recommend taking the time to invest in yourself. Trying to make exercise and healthy eating convenient and part of our routine schedule help a lot.

There are many low cost ways to engage in healthy behavior, including using a pedometer and incorporating walking into your work or school day (with an initial goal of 5,000 steps and an eventual goal of 10,000 steps), taking the steps at work or finding the healthy options in your cafeteria.

Also, I recommend engaging with your health care provider and asking as many questions as you need to develop an understanding about how you can best improve your heart health.

How does a larger waistline (belly fat) affect the heart?

A larger waistline increases you risks for high blood pressure, abnormal cholesterol, diabetes and heart disease.

Exercise and weight loss can help to reduce these risks. For exercise, I would recommend some aerobic exercise (brisk walking, jogging and biking all count) for at least 30 minutes most days of the week. You should aim for a waist circumference of 88 cm for women and 102 cm for men.

Is it true for every 10 pounds you lose, you lose five points off of your blood pressure?

Weight loss does have beneficial effects on your blood pressure and other risk factors for heart disease. On average, if you are overweight losing 5 percent of your body weight (7.5 pounds if you're 150 pounds; 10 pounds if you’re 200 pounds) lowers your systolic blood pressure (top number) by three units and your diastolic blood pressure (bottom number) by two units. Additional weight loss has greater effects on lowering blood pressure.

What should I do if my blood pressure medicines aren’t working?

Sometimes people respond better to one combination of medications than another, so it's important to work closely with your doctor to find a medication combination that works best for you.

While you're doing that, monitoring your blood pressure at home with a blood pressure monitor is usually a good idea. Also, following a diet like the DASH diet can also help to lower your blood pressure. If you're on multiple medications for blood pressure (usually three or four) at high doses without a response, then you and your doctor can consider looking at other causes of high blood pressure.

Fish oil, krill oil and red wine: Are they really helpful in preventing heart disease?

Omega-3 fish oils do appear to have some beneficial effects. They appear to improve your cholesterol and triglycerides, lower blood pressure and may have some effects on blood vessel function. Some studies have suggested that they may reduce the risks of coronary heart disease, although more study is needed.

Krill oil also contains omega-3 fish oils but has a slightly different molecular makeup.

In terms of red wine, studies have shown that moderate alcohol use (one to two drinks per day for men; one drink per day for women) may have some beneficial effects on risk factors for heart disease. While some studies suggest that red wine may be most beneficial, we don't yet have definitive evidence on that issue.

Definitions

Blood vessels (veh-suls): The system of flexible tubes—arteries, capillaries and veins—that carries blood through the body. Oxygen and nutrients are delivered by arteries to tiny, thin-walled capillaries that feed them to cells and pick up waste material, including carbon dioxide. Capillaries pass the waste to veins, which take the blood back to the heart and lungs, where carbon dioxide is let out through your breath as you exhale.

Diastolic (die-uh-stah-lick) blood pressure: The second, or bottom, number in a blood pressure reading. Diastolic blood pressure measures the force of blood in the arteries when the heart is relaxed between beats. A healthy reading is usually below 80 mm Hg. Higher readings may indicate that you have high blood pressure or are at risk for developing it.

Systolic (sis-tall-ick) blood pressure: The top, or first, number in a blood pressure reading. Systolic blood pressure is the pressure in the arteries during a heartbeat. For most people, a healthy systolic blood pressure reading is below 120 mm Hg. Rising systolic blood pressure may indicate that arteries are becoming stiff or that there’s a build-up of plaque.

Whole grains: Grains such as whole wheat, brown rice and barley still have their fiber-rich outer shell, called the bran, and inner germ. It provides vitamins, minerals and good fats. Choosing whole grain side dishes, cereals, breads and more may lower the risk for heart disease, type 2 diabetes and cancer and improve digestion, too.