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. (Two of our favorites? Drink red wine and get a dog.) Here’s what you need to know about heart health, along with some of the best ways to improve and protect yours.
- Eat right
- Lower blood pressure
- Lower your cholesterol
- Know your blood sugar
- Maintain a healthy weight
- Don’t smoke
“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?
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:
- It enhances the cardiorespiratory system.
- It increases HDL cholesterol.
- It lowers triglycerides, a type of fat that circulates in the blood.
- It reduces blood pressure and heart rate.
- It lowers inflammation and improves blood sugar control.
- It increases insulin sensitivity.
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:
- 75 minutes of vigorous aerobic exercise a week.
- 2 sessions of at least 30 minutes each of resistance training a week.
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.”
IT DOESN’T HAVE TO TAKE LONG: 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.
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:
- Are older.The prevalence of the disease increases sharply with age, from 7.3 percent of people between 18 and 39 to as high as 65 percent of people 60 and over.
- Are black.About 40 percent of black adults have the condition, compared with 28 percent of non-Hispanic whites, 25 percent of Asian Americans and 26 percent of Hispanic adults.
- Have diabetes.Two thirds of adults with Type 2 diabetes have hypertension.
- Have other, complicating conditions,such as sleep apnea, kidney disease, obesity, high levels of stress and heavy alcohol consumption. When your blood pressure climbs above 120/80, you may have pre-hypertension. If your blood pressure reaches or exceeds 140/90, then you have full-blown hypertension. Blood pressure fluctuates throughout the day. It can rise or fall in response to caffeine, stress, alcohol or even the last meal you ate. So you need to measure it on at least two or more occasions to get an accurate idea of your average blood pressure. If your numbers are consistently high then the importance of getting your blood pressure down into the normal range can’t be overstated.
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.
HOW TO LOWER YOUR BLOOD PRESSURE: If you have hypertension, here are some things you can do to improve your numbers:
- Lose weight.The famous, long-running Framingham Heart Study found that excess weight accounted for roughly 26 percent of all cases of hypertension in men and 28 percent of cases in women. Being overweight increases the amount of work your heart has to do to pump blood throughout your body.
- Moderate your alcohol intake.Overconsumption can increase blood pressure. So try to consume no more than two drinks a day if you’re a man and one drink a day if you’re a woman.
- Not surprising, right? A meta-analysis of randomized controlled trials published in the Journal of the American Heart Association found that both aerobic exercise and resistance training significantly lower systolic and diastolic blood pressure.
- Watch your salt and your sugar intake.The World Health Organization recommends keeping your salt intake to no more than five grams per day to reduce hypertension. The average intake in many countries is double that amount. Studies have found that a high sugar intake is also linked to hypertension.
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:
- HDL cholesterol:This is considered protective. Higher HDL levels correlate with better cardiovascular health.
- LDL cholesterol:High LDL is strongly linked to heart disease. Low LDL is better for cardiovascular health.
- Triglycerides:A type of fat that circulates in your blood stream. You want this number to be low. Elevated triglycerides are linked to both heart disease and diabetes.
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.”
EAT YOUR WAY TO LOWER CHOLESTEROL: There are also many foods you can eat that can help improve your cholesterol levels. They include:
- Fatty fish,which lowers LDL and triglycerides.
- Walnuts, almonds and other nuts.They increase HDL and lower LDL.
- Soybeans, tofu and soy milk can slightly lower LDL.
- Apples, strawberries and citrus fruitscontain pectin, which helps reduce LDL.
- Olive oil and other unsaturated fats.
- Beans, vegetables and flaxseeds, which contain a lot of soluble fiber, and may lower LDL.
- If you have high triglycerides, then one simple dietary change you can make is to cut back on empty carbs. For most people,triglycerides are driven largely by carbohydrate consumption. Removing sugar, bread, pasta, fruit juices and other refined carbs from your diet should lower your triglycerides.
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:
- Not getting enough sleep.
- Being overweight or obese.
- Consuming alcohol or caffeine.
- Birth control pills, antidepressants, nasal decongestants and other medications.
- Hormonal changes during menstrual cycles.
- Chronic stress or illness.
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:
- A normal fasting blood sugar level is less than 100 milligrams per deciliter.
- A fasting blood sugar level between 110 and 125 mg/dL is considered pre-diabetes.
- If you have two separate blood sugar readings that are greater than 126 mg/dL than you may have Type 2 diabetes.
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:
- An A1C score below 5.7 is considered normal.
- An A1C in the range of 5.7 to 6.4 is indicative of pre-diabetes.
- A score of 6.5 or above indicates diabetes.
Foods that you should seek out and eat often:
- Plant life, such as nuts, seeds, legumes, whole grains, beans and avocados.
- Fruits and vegetableswith no added sugar or preservatives.
- Seafood, including shellfish and especially oily fish like wild salmon, sardines and mackerel. (Mercury levels can be high in some kinds of fish, so learn which types are of particular concern.)
- Fermented foods,like yogurt, kimchi and tempeh.
- Healthy fatslike olive oil.
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:
- Foods with added sugar,such as soft drinks, fruit juices and candy.
- Refined carbohydratessuch as breakfast cereals, granola, white bread, bagels, crackers and pasta.
- Processed meats,such as deli meats, salami, hot dogs and ham.
- Packaged foods that are loaded with salt, sugar, trans fats, preservatives and other additives and artificial ingredients.Some examples are frozen entrees, potato chips, chicken nuggets, granola bars, microwaveable meals, canned soups, instant noodles and boxed snacks.
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:
- Red meat
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..
- Low Risk: 31.5 inches or less
- Intermediate Risk: 31.6 to 34.9 inches
- High Risk: 35 inches or greater
- Low Risk: 37 inches or less
- Intermediate Risk: 37.1 to 39.9 inches
- High Risk: 40 inches or greater
Source: The New York Times