A Guide to Heart Health.

This is a synopsis of comprehensive guide published in the New York Times.


Did you know that heart disease and strokes are the leading causes of deaths worldwide? However, it’s within  our control to change that — 80 percent of all cases of cardiovascular disease are preventable.

In 2010, a committee of experts with the American Heart Association came up with a strategic plan to reduce heart disease in the United States. The experts identified seven behaviors that are necessary to protect one’s cardiovascular health:

  1. Exercise
  2. Eat right
  3. Lower blood pressure
  4. Lower your cholesterol
  5. Know your blood sugar
  6. Maintain a healthy weight
  7. Don’t smoke

Here are some recommended changes you can make that will improve your overall health and substantially lower your risk of heart disease and stroke:



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. 

Clinical trials have proven that exercise strengthens the heart. And, despite how brief your exercise session is, experts concur that any movement is better than no movement. Just a little exercise will foster these changes in the body:

  • 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. 

The Centers for Disease Control and Prevention recommends 150 minutes of “moderate-intensity aerobic exercise” per week and 2 sessions (30 minutes each) of resistance training per week.

Or, if you’ve been exercising for a while and you’re ready for more, the CDC suggests 75 minutes of vigorous aerobic exercise (reaching 70 to 85 percent of your maximum heart rate) per week and 2 sessions (30 minutes each) of resistance training per week.

If you find yourself too busy to exercise for the recommended allotment, you’re in luck. Research has demonstrated that you’ll reap the full benefits of exercise, simply by increasing your intensity with short intervals of movement.


Lower Your Blood Pressure

“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.”

High blood pressure (hypertension) creates stress on the walls of the arteries and accelerates the development of plaque, which weakens and thickens the heart. This can cause blood vessel ruptures in the brain, leading to stroke.

You’re susceptible to hypertension if you are older, are black, have diabetes or other conditions such as sleep apnea, kidney disease, obesity, endure high-levels of stress, or consume large quantities of alcohol.

A safe blood pressure reading is 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.

If you have high blood pressure, you can reduce the stress on your heart by losing weight, decreasing your alcohol intake, exercising regularly and watching your salt and sugar consumption.


Know Your Cholesterol Numbers

The American Heart Association recommends getting your cholesterol levels checked every four to six years. So, what do those numbers mean?

  • 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.

Diet, exercise and lifestyle changes can improve your numbers, but you may be a candidate for statins. Although, recent guidelines are asking doctors to take a more comprehensive, individualized approach to determining whether or not a patient is a candidate for statins and/or at risk for cardiovascular episodes or disease. The factors considered include age, gender, race, family history, blood pressure and smoking history.

Even if medication is necessary, there are many foods that can help lower cholesterol levels such as fatty fish, nuts (walnuts and almonds), soy products (soybeans, tofu and soy milk), fruits (apples, strawberries and citrus), beans, vegetables and flaxseeds. Cutting down on carbohydrates helps to lower triglyceride levels as well.


Know Your Blood Sugar Level

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. 

Having your fasting blood sugar levels tested often, is an effective way to reduce your risk of heart disease. If your levels rise, consult with your doctor, who will most likely give you the magic prescription: exercise and eat well.

A few factors that cause high blood sugar are lacking sleep, being overweight, drinking alcohol and caffeine, taking certain medications (birth control pills, antidepressants, nasal decongestants and other meds), hormonal changes during menstrual cycles, and chronic stress or illness.


Eat Well 

Dr. Dariush Mozaffarian, a cardiologist and dean of the Tufts Friedman School of Nutrition Science and Policy, has published many studies on cardiovascular health risks and their correlation to food. He’s created three categories for foods, based on hard data from rigorous clinical trials: foods that are good for your heart, foods that are bad for you and foods that are neutral to your wellbeing. 

Dr. Mozaffarian’s recommendation for foods that are good for your heart include plant life (nuts, seeds, legumes, whole grains, beans and avocados), fruits and vegetables, seafood (shellfish and fatty fish like wild salmon, sardines and mackerel), fermented foods (yogurt and kimchi) and healthy fats (olive oil).

Foods to avoid include sugar, refined carbohydrates, processed meats and packaged foods. Dr. Mozaffarian recommends eating butter, cheese, red meat, milk and eggs in moderation. Although, one major study in the Annals of Internal Medicine, co-authored by Dr. Mozaffarian and a team of international scientists in 2014 found no evidence that saturated fat increased heart attacks and other cardiac events.

What is the best diet to follow? The Mediterranean Diet consisting of olive oil, nuts, seafood, fruits, poultry, beans and vegetables. A 2013 clinical trial published in the New England Journal of Medicine found that people who followed a Mediterranean diet had “significantly” fewer heart attacks, strokes and deaths from heart disease than those who ate a “conventional low-fat diet.”


Maintain a Healthy Bodyweight

Obesity is one of the main causes of “cardiovascular morbidity and mortality.” Excess fat cells cause an increase in inflammation, raise the likelihood of insulin resistance and influence the hardening of arteries, especially in those who’ve amassed a large amount of visceral fat (fat surrounding the internal organs).

According to Harvard Medical School, an easy way to tell if you have an unhealthy amount of visceral fat, is to measure your waist circumference. Here’s how to interpret your waist circumference to determine if you’re in the healthy range:

For Women

  • Low Risk:  31.5 inches or less
  • Intermediate Risk:  31.6 to 34.9 inches
  • High Risk:  35 inches or greater

For Men

  • Low Risk:  37 inches or less
  • Intermediate Risk:  37.1 to 39.9 inches
  • High Risk:  40 inches or greater

Another method to measure your amount of visceral fat is your body mass index (B.M.I), which estimates your body fat based on your height-to-weight ratio. Determine your B.M.I. here: N.I.H.’s B.M.I. calculator.

The American Heart Association states that an optimal B.M.I. is below 25 (25 is the threshold for being overweight). Be aware that your B.M.I. may not be an accurate measure for cardiovascular risk. For instance, some people who may be very thin and have a B.M.I. well under 25, but have a high percentage of fat would actually be at high risk, while a body builder who may have very low body fat, but a high body weight will be low risk, but measure above the 25 threshold.

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 that having a normal B.M.I. does not give you a hall pass from being healthy: “Just because someone looks healthy on the outside does not necessarily mean that they’re healthy. They still have to go to the doctor, have an examination and be evaluated.” 


Quit Smoking


The American Heart Association reports that most experts rank smoking (and the use of tobacco products) as the number one red flag for cardiovascular risk. Yet, smoking remains the most preventable cause of death and disease.

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.”

But, there’s good news! As soon as you quit, you immediately lower your risk, according to experts.

Schedule an appointment with 4C Medical for Behavioral Therapy to work with a professional counselor. Here are more resources to support you or someone you know who may be trying to quit:

American Cancer Society Toll-free hotline: 1-800-227-2345
American Lung Association Toll-free hotline: 1-800-586-4872
National Cancer Institute Toll-free hotline: 1-877-448-7848


Read the full heart health guide here.

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