Worldwide, heart disease and strokes are the leading causes of death. They’re also the leading killers of Americans, accounting for one out of every three deaths in the United States. But there’s good news, too. About 80 percent of all cases of cardiovascular disease are preventable. You can lower your risk markedly by making some changes to your lifestyle including doing some things that are easy, simple, and even enjoyable.
Here’s what you need to know about heart health, along with some of the best ways to improve and protect yours.
The following article was published by Anahad O’Connor in the October 21st edition of the New York Times.
Good news. There are many things that you can do to lower your heart disease risk.
In 2010, a committee of experts with the American Heart Association came up with a strategic plan to reduce cardiovascular disease in the United States. The committee pored over the scientific literature and identified seven of the most important behaviors people can follow to protect their cardiovascular health.
“What accrues to people who maintain that package of seven things at more optimal levels is really quite amazing – it’s sort of like the fountain of youth,” said Dr. Donald Lloyd-Jones, a cardiologist at the Northwestern University Feinberg School of Medicine and the chairman of the heart association committee. “They are much healthier and they have a substantially better quality of life.” So what are the major things you can do?
Regular exercise improves nearly every aspect of your health.
A Magic Pill
Dr. Michael Emery, a sports cardiologist, tells his patients that there is one magic pill that can improve nearly every aspect of your health and well-being, and especially your cardiovascular health. “It’s just that you can’t swallow it, you have to earn it,” said Dr. Emery, an assistant professor of clinical medicine at the Indiana University School of Medicine.
That magic pill is exercise.
Scientists have long known about its ability to protect heart health. Some of the first hints came in the 1950s when studies showed that the conductors of London’s double-decker buses had lower rates of coronary heart disease than the drivers, and that English mail carriers had less heart disease than sedentary telephone operators at the same company. Since then large studies have consistently found a strong and inverse relationship between physical activity and heart disease. Clinical trials have also shed light on the precise reasons exercise strengthens the heart:
Best of all, exercise is the type of medicine that appears to produce benefits no matter how small the dose.
Anything is better than nothing. But the ideal dose of exercise for adults, according to the Centers for Disease Control and Prevention, is as follows:
You can spread the aerobic activity throughout the week however you like, such as 30 minutes five days a week, or 50 minutes three days a week. Examples include running, swimming, brisk walking, riding a bike, playing basketball or tennis, and doing yard work.
As for strength-building activities, ideally, you should set aside at least two days a week for 30 minutes of exercise that works the major muscle groups, such as the legs, back, shoulders and arms. What counts as strength training? Lifting weights, using resistance bands, doing bodyweight exercises like yoga, push ups and sit ups, and even heavy gardening with a lot of digging and shoveling.
If you’re ready for more intense workout sessions, you should aim for:
Vigorous exercise should get your heart rate up to 70 to 85 percent of your maximum heart rate. Not sure what that is? Here’s how to calculate it.
Exercises like running, swimming laps, playing basketball or cycling fast are good options. If these amounts sound like a lot more than you’re used to, keep in mind that you’re not alone. Only half of Americans get the recommended amount of aerobic exercise each week, and only 20 percent meet the guidelines for both aerobic and resistance exercise. But studies show that people who do just 50 minutes of vigorous aerobic exercise each week (instead of the recommended 75 minutes) still lower their risk of dying from cardiovascular disease by half compared with people who avoid it altogether. People who do small amounts of moderate exercise that fall short of the guidelines see benefits, too.
“Any amount improves cardiovascular morbidity and mortality, even if it’s just getting out of your chair and taking a walk,” said Dr. Emery. If you can’t get to the “sweet spot,” he said, that’s “not a reason to not do it because you’re still gaining way more benefit than if you were sitting on the couch and not doing anything.”
Let’s say you’re so busy it feels as if you couldn’t possibly find the time to do the recommended amount of exercise each week. Or maybe you just hate exercise, period. There’s a solution to that, too. Research has shown that even a few minutes of exercise leads to benefits. It’s all about increasing the intensity. Our exercise columnist, Gretchen Reynolds, has written about the growing science behind super-short interval workouts.
You could try the scientific 7-Minute Workout, which fulfills the mandates for a high-intensity workout. It involves just 12 body-weight exercises and requires only a chair and a wall.
Another study found that just a single minute of intense exercise included within an otherwise easy 10-minute workout could also provide cardiovascular benefits. The point is that any amount of exercise, no matter how short, is better than nothing, even if it’s doing a few rounds of bodyweight exercises while watching Netflix or hustling up a few flights of stairs. It’s especially true if you already have some form of heart disease. Dozens of clinical trials have found that heart patients who are assigned to participate in exercise programs live a lot longer than patients in non-exercise programs. One analysis found that heart failure patients involved in exercise programs were 25 percent less likely to be hospitalized again. Another found that heart attack survivors assigned to exercise-based rehab programs had a 25 percent lower mortality rate than other patients.
Make sure your heart isn’t working harder than it should be.
Avoid High Blood Pressure
High blood pressure, also known as hypertension, puts mechanical stress on the walls of your arteries, causing them to narrow and stiffen. The stress can increase the development of plaque and ultimately cause your heart muscle to get weaker and thicker over time. It can also cause blood vessels in your brain to rupture, leading to a stroke. Ideally your blood pressure should be no higher than 120/80. The top number is your “systolic” pressure, the pressure when your heart is contracting, and the lower number is your “diastolic” pressure, when your heart is at rest. Keeping those numbers in check is critical. Hypertension is a leading cause of heart attacks, and the single-most important risk factor for strokes. Almost a third of the adult population in the United States has the condition but about 20 percent of them don’t know it.
You’re especially vulnerable to hypertension if you:
A large study published last year in The Lancet found that for every decrease of 10 in your systolic blood pressure reading, you lower your risk of stroke by 27 percent, your risk of heart failure by 28 percent and your risk of heart disease by 17 percent.
If your doctor finds that your blood pressure requires treatment with medication, then you have a number of options. Some of the drugs available include ACE inhibitors, calcium channel blockers, diuretics and beta-blockers. Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill Cornell Medical College in New York City, has found that many people respond well to some drugs but not to others. Often it depends on the factors contributing to their high blood pressure.
If you have hypertension, here are some things you can do to improve your numbers:
While cholesterol is not the only thing that matters to your heart health, it’s important to keep an eye on your levels.
Understanding the Numbers
Cholesterol isn’t the only driver of heart disease. But it plays a big role, and you should know whether your numbers put you at high risk. The heart association recommends getting your cholesterol levels measured every four to six years.
Here’s what you should look for:
When Do You Need Statins?
In the past there was a disproportionate amount of attention paid to cholesterol. Doctors would typically prescribe cholesterol-lowering drugs like statins based on a person’s LDL cholesterol number alone. But the most recent guidelines call for doctors to take a more holistic and personalized approach, one that views cholesterol as just one factor along with things like age, gender, race, blood pressure and smoking history when determining a person’s cardiovascular risk.
In fact, if you’re 40 or older, you can use your cholesterol numbers, blood pressure and other personal information to determine your 10-year risk of having a heart attack or stroke by typing them into the American College of Cardiology’s risk calculator. Be warned, though, the risk calculator isn’t perfect. Some leading cardiologists argue that in certain cases it can overestimate a person’s risk, leading many people to mistakenly think they need statins.
If you have high cholesterol, then you should discuss it with your doctor. Diet, exercise and lifestyle changes can improve your numbers. But it may not be enough. And when that’s the case, then a doctor can help you interpret your numbers, your family history and your personal risk to determine whether or not a statin makes sense. “That discussion is an important one to have,” said Dr. Lloyd-Jones. “I think statins are incredibly effective and safe. But they’re not one size fits all. We need to put them in the right context as we’re doing the decision-making.”
There are also many foods you can eat that can help improve your cholesterol levels. They include:
Routinely checking your fasting blood sugar can help you monitor another factor in your heart disease risk.
How to Lower Your Blood Sugar
So what should you do if your blood sugar levels raise some red flags? The first thing you should do is consult with your doctor to determine whether you have a medical issue. But there are also things you can do on your own to improve your blood sugar control – and they’ll sound familiar: exercise and eating smart.
There are also some surprising things that can contribute to chronically high blood sugar or throw off a test.
Here are some to be aware of:
Get All the Numbers
Your routine blood tests should measure not only your cholesterol and triglycerides, but also your fasting blood sugar levels. That’s because many rigorous studies have found that chronically high blood sugar increases mortality and increases the risk of heart attacks and strokes. A high fasting blood sugar level can also signal that you have Type 2 diabetes or its precursor, pre-diabetes. And diabetics are four times more likely to die from heart disease.
Your blood sugar levels should be measured after you’ve fasted for at least eight hours overnight. According to the Cleveland Clinic, here’s what you need to know:
One of the drawbacks of a fasting blood sugar test is that it provides only a snapshot of your glucose levels at a single point in time. Another test that offers a better indication of your average blood sugar levels over time is the A1C test. It measures the amount of glycated hemoglobin in your blood, which indicates your average blood sugar levels over the past three months. A1C tests are often used to diagnose diabetes.
Here’s what you need to know:
Don’t get confused by conflicting studies on the best foods to eat – keep things simple with a straightforward system.
Understanding the Research
Nutrition and its effects on heart health tends to ignite heated debate. The problem is that many of the claims about which foods and diets are best for you are based on weak evidence. But there is a way to simplify things that cuts through all the noise and confusion, said Dr. Dariush Mozaffarian, a cardiologist and dean of the Tufts Friedman School of Nutrition Science and Policy. Dr. Mozaffarian has published numerous studies on foods and cardiovascular risk and has singled out foods that are backed by hard data from rigorous clinical trials. Ultimately he has found that most foods can be separated into three categories:
Foods that you should seek out and eat often:
You’ll see that the “good” category contains a lot of plant-based foods. “These are foods that contain bioactive phytochemicals that are there to help protect a plant’s new life,” Dr. Mozaffarian said. “They have things that our bodies need as we age. We need their anti-inflammatory, pro-health phytochemicals and nutrients.” This first category also contains some other foods that have been shown in compelling studies to be strongly beneficial, like fish, which contains omega-3 fatty acids, and yogurt, which has probiotics that support gut health.
Foods to avoid:
The foods in this “bad” category are those that you should limit because there is strong evidence that they negatively impact cardiovascular health, Dr. Mozaffarian said. It consists of three groups: starch and sugar, highly processed meats and packaged foods. Most people understand that sugary drinks and other sources of added sugar can be harmful. But Dr. Mozafarrian calls starchy, refined carbohydrates like bagels and pasta “the hidden sugar in the food supply” because they contain long chains of glucose that essentially act like sugar in the body (sugar contains glucose and fructose). “And there’s five times more starch in the food supply than sugar,” he said.
Foods to be consumed in moderation:
This final category consists of foods that you don’t have to avoid, but should consume in moderation, like butter, Dr. Mozaffarian said. It’s fine to cook or bake with it. But you don’t need to have it at every meal. And olive oil is a good alternative. “Make sure you eat the good foods, minimize the bad, and then these other foods you can use to fill out the rest of your diet,” he said. “We can’t only be eating the good things. Otherwise your diet will get boring.” These foods contain saturated fat, which has long been vilified. But research by Dr. Mozaffarian and others has shown that saturated fat isn’t the dietary boogeyman it was long thought to be. For example, one major study in Annals of Internal Medicine that Dr. Mozaffarian co-authored with a team of international scientists in 2014 found no evidence that saturated fat increased heart attacks and other cardiac events.
Try the Mediterranean Diet
The best example of a heart healthy diet is one that follows a Mediterranean approach. A large clinical trial published in The New England Journal of Medicine in 2013 found that people assigned to a Mediterranean diet had significantly fewer heart attacks, strokes and deaths from heart disease than a group assigned to follow a conventional low fat diet. The foods that formed the bulk of the Mediterranean diet were things like olive oil, nuts, seafood, fruits, poultry, beans and vegetables.
The National Institutes of Health has a free cookbook you can download with dozens of delicious recipes designed to promote heart health. Some of the recipes are Mediterranean-inspired. But there’s also plenty of Latin, American and Asian flavors.
It’s not just excess fat, but the type of excess fat that contributes to your heart risks.
Another Reason to Reduce Your Pounds
Excess body fat isn’t just dead weight. Fat cells release many substances that increase inflammation, promote insulin resistance and contribute to atherosclerosis, the hardening of arteries. So it should be no surprise that obesity is among the leading causes of cardiovascular morbidity and mortality. That is especially the case for people who have a lot of visceral fat, the type that accumulates deep inside your abdomen around your internal organs. Visceral fat is much more dangerous than subcutaneous fat, the kind that resides just below your skin (you can pinch your subcutaneous fat with your fingers). It’s not entirely clear why but visceral fat is far more toxic to your body and especially to your cardiovascular system. An easy way to get a sense of the amount of visceral fat you carry and your risk is by measuring your waist circumference. According to Harvard Medical School, here’s how to interpret your waist circumference to determine if you’re in the healthy range.
Why B.M.I. Doesn’t Always Work
Another barometer you can use to determine your amount of visceral fat is your body mass index, or B.M.I. This calculation estimates your body fat based on your height and weight. You can determine your number by using the N.I.H.’s B.M.I. calculator.
The American Heart Association defines an optimal B.M.I. as one that is below 25, which is the threshold for being overweight. But keep in mind that B.M.I. is a blunt instrument. People who have a lot of muscle mass, for example, might have a B.M.I. over 25 even if they have a low body fat percentage. And people who are thin but carrying a lot of visceral fat might have a B.M.I. under 25 even though they are technically high risk.
Having a normal B.M.I. is a good starting point but it doesn’t necessarily mean you’re in the clear. Dr. Gina Lundberg, an assistant professor of medicine at Emory University School of Medicine and clinical director of the Emory Women’s Heart Center, said she has patients who are “skinny fat”: They have a normal B.M.I. but their blood pressure is high, they have low muscle tone and their cholesterol and other heart disease risk factors are out of whack. Dr. Lundberg said that having a normal B.M.I. does not mean you don’t have to be health conscious. “Just because someone looks healthy on the outside does not necessarily mean that they’re healthy,” she added. “They still have to go to the doctor, have an examination and be evaluated.”
Smoking and the use of tobacco products isn’t just bad for your lungs, it’s bad for your heart, too.
Just Don’t Smoke
This one should be a no-brainer. But it can’t be stressed too highly because it’s still an extremely common cause of heart disease. In fact, the American Heart Association found that many top experts rank smoking and use of tobacco products as the most important cardiovascular risk factor. The rate of tobacco use in the United States peaked more than a half century ago, when almost one in two adults were smokers. Decades of public health efforts have helped lower that number significantly. But today roughly 36.5 million Americans – equivalent to about 15 percent of the population – continue to smoke. That is still a lot of people.
It’s the reason smoking remains the single largest preventable cause of death and disease in the country. Nationwide, it causes about one in every five deaths annually. If you’re among those who smoke or use tobacco, even occasionally, then cutting the habit could drastically improve your health. Smoking causes emphysema, cancer, gum disease, and harms nearly every organ in your body. And it’s particularly toxic to the heart. Tobacco smoke damages blood vessels. It increases blood pressure, lowers your HDL cholesterol and causes peripheral artery disease and atherosclerosis. Smokers have double the risk of having a heart attack, and triple the risk of having a stroke compared with nonsmokers. E-cigarettes have also been linked in preliminary research to increased cardiovascular risks.
Quitting will immediately lower your risk. Studies have found that smokers who have heart disease experience a 50 percent reduction in subsequent heart attacks or sudden cardiac death when they quit.
Try to Quit
To find resources that can help you or any friends or family members quit, you can contact the following health groups:
Working to prevent heart disease doesn’t mean focusing only on the big things. There are plenty of other things you can do – some small, some fun, some weird, and some mundane – that can boost your cardiovascular health.
Get a Pet
Several years ago a panel of heart experts reviewed decades of data on the cardiovascular benefits of owning pets. They concluded that there was evidence from both large observational studies and small clinical trials that owning pets, and dogs in particular, could lower your risk of heart disease. Why? It could be a lot of things. For one, people who own dogs are more likely to get outside and take walks. But studies have also found that dog and cat owners tend to form such strong bonds with their pets that being around them lowers their heart rates and blunts the owners’ responses to stressful events.
Stress is normal. It’s a part of life and can even be good for you in small doses. Exercise for example is a type of short-term stress that improves health. But chronic stress, especially the mental and emotional kind, can take a toll on your heart. It can depress your immune system, increase your risk of high blood pressure, and eventually contribute to heart attacks and strokes. While stress is unavoidable in modern life, it doesn’t have to make you sick.
Optimize Your Sleep
Do you snore? Do you find yourself tired and fatigued throughout the day? Do you have difficulty concentrating, irritability and decreased alertness? Do you find you can’t get through the day without a steady stream of caffeine? These are some of the signs that you might have a sleep disorder, an issue that afflicts an estimated one-third of the country. A sleep disorder can not only impair your quality of life, but significantly impact your cardiovascular health. Sleep apnea in particular – a condition in which a person experiences pauses in breathing at night – is strongly linked to heart disease. According to Harvard Medical School, untreated sleep apnea can increase your risk of dying from heart disease nearly fivefold.
Dr. Lundberg at Emory said that the importance of getting a good night’s sleep to protect your heart is often overlooked. “If you wake up not feeling refreshed or your partner says they hear you snoring, that needs to be evaluated at the doctor,” she said. “It could be causing serious heart problems.”
In recent decades, many studies have looked at the effects of meditation on cardiovascular risk factors. While the research is not definitive, there is some evidence that meditation can lower blood pressure and blunt the body’s response to stress. The best part about meditation is that it’s easy to learn and has no side effects. It can also help with many other aspects of health (including sleep). So why not give it a try?
Get to Know Your Dentist
Most people don’t think there’s any connection between their oral health and their cardiovascular health. But they’d be wrong. Many studies have found that gum disease increases your likelihood of having heart disease. A systematic review and meta-analysis published in The Journal of General Internal Medicine found that periodontal disease increases the risk of coronary heart disease by 24 to 34 percent. One reason might be the presence of harmful bacteria in the mouth, which not only causes gum disease but also promotes systemic inflammation throughout the body. Whatever the mechanism, it’s a good idea to get regular dental checkups.
Eating plants is clearly good for your heart. But drinking them in the form of tea isn’t so bad either. Many large studies have linked regular tea consumption to cardiovascular benefits. And smaller studies have suggested it may have something to do with the unique and potent compounds tea often contains, especially varieties like green, oolong and herbal teas. For example, researchers have found that there are compounds in tea that lower inflammation, protect the endothelial cells that line the arteries, and have favorable effects on blood lipids. If you have a habit of drinking sugary beverages or diet drinks throughout the day, consider swapping those beverages with unsweetened tea.
Wine Before Beer (Or Other Alcoholic Beverages)
In 2015, a clinical trial published in Annals of Internal Medicine confirmed what many health experts had long suspected: Drinking wine could modestly improve heart health. The study was carried out over two years and involved 224 people with Type 2 diabetes. During the trial the subjects were randomly assigned to drink a glass of mineral water, white wine or red wine with dinner nightly. At the end of the research, the people assigned to drink wine, especially red wine, had slight improvements in HDL cholesterol and other cardio-metabolic risk factors compared with those assigned to drink only water. Most of the research on alcohol suggests that wine is the most beneficial type, perhaps because of the antioxidants and other plant compounds it contains. If you do drink alcohol, do it in moderation. According to the American Heart Association, that means one drink a day for women, and no more than two daily for men.
Take a Hike … in the Forest
The Japanese have a term, shinrin-yoku, that loosely translates to “forest bathing.” It involves taking a leisurely visit to a forest and walking among the trees and plants; it is promoted as a way to achieve relaxation. They also believe that plant compounds circulating in the forest air provide a number of health benefits. The practice has been put to the test in many studies over the years and scientists have found some evidence that walking in nature can lead to slight cardiovascular benefits, like reduced blood pressure and lowered stress hormones and pulse rates. Whether it’s a result of the aerobic exercise alone, the mental relaxation, or the plant compounds in the air – or a combination of all three – is unknown. But taking a walk in the park is certainly good for your heart.
Even if you’re doing all you can to avoid cardiovascular disease, you should still know how to recognize the symptoms of a heart attack or stroke.
The classic symptoms of a heart attack are unbearable pain or discomfort in the center of your chest that lasts several minutes, and which comes and goes in waves. This is also known as the Hollywood heart attack, which is depicted in films as someone clutching their chest and dropping to the floor. But that’s not always the warning sign. In fact according to the American Heart Association there are many other common symptoms to look for, including the following:
For a long time, doctors thought that men and women experienced different heart attack symptoms. But then it was discovered that men and women actually experience many of the same symptoms – they just tend to describe them differently, said Dr. Lundberg. “Men would point right to their chest and say they have pain,” she said. “Women would say different things. They’d say, ‘I have pressure and tightness in my chest or burning.’” As a result, it was not uncommon for doctors to dismiss the symptoms described by women as heartburn or indigestion. But experts are trying to educate both doctors and the public to recognize the differences in what to look for in men and women.
“One of the important things we’ve done was to re-educate physicians so that when they’re talking to women about possible symptoms, they know to ask them more than, ‘Are you having chest pain?’” said Dr. Lundberg. “You have to say, ‘Are you having chest tightness, pressure, heaviness or shortness of breath?’ It’s not the same thing as saying, ‘Are you having chest pain?’”
The classic symptoms of a stroke are typically very striking. The American Stroke Association uses the acronym FAST to describe them:
There could also be other signs that a stroke is occurring. A person may experience a very severe and sudden headache, confusion and trouble seeing out of one or both eyes. Or the person may feel dizzy and have a loss of balance or coordination and difficulty walking.
If you suspect that you or someone else is having a stroke or a heart attack, the critical thing is to act fast. Have your symptoms checked by a doctor or call 911. The heart association says that calling paramedics is often the smartest thing you can do because they can begin treatment up to an hour sooner than if you drive to a hospital by car, and they can revive someone whose heart has stopped.
About the author:
Anahad O’Connor is a bestselling author and staff reporter for The New York Times who writes about nutrition, medicine and consumer health and wellness. https://www.nytimes.com/guides/well/how-to-prevent-heart-disease