Heart disease is the leading killer of both men and women in the United States. The American Heart Association estimated that about 71 million Americans have some form of heart disease. The most common form of heart disease is hypertension, or high blood pressure, followed by coronary artery disease. These conditions contribute to the more than 7 million heart attacks that occur every year, and high blood pressure is also a leading contributor to the more than 5 million strokes that occur annually.
Considering the prevalence of cardiovascular disease, and the dangers of it, people are urged to do everything possible to promote heart health. Researchers recognize that heart health is a complicated issue. There are many factors that contribute to heart health, including uncontrollable factors such as heredity and controllable risk factors such as diet and exercise habits. While we cannot change our family histories, there are many healthy steps everyone can take to reduce their risk of suffering from debilitating heart disease. These healthy lifestyle choices are recommended by experts to help maximize cardiovascular health.
Besides taking active lifestyle steps to improve cardiovascular health, it is also important to know your family medical history, especially of cardiovascular disease and stroke. This information will be important to any physicians who are involved in your health care, and it can be used to help compile a coronary risk profile. The coronary risk profile is a tool developed by the American Heart Association that helps people calculate their long-term risk for suffering a heart attack. It takes into account both uncontrollable and controllable risk factors.
The controllable factors of maintaining heart health include diet and exercise. A balanced diet of complex carbohydrates, healthy fats and lean protein is important for overall heart health. Diets that are high in unhealthy fats, such as saturated fats and trans fats, are linked to elevated cholesterol and triglyceride levels, both of which are closely associated with increased risk for heart attack. By contrast, a high-fiber, low-fat diet rich in fruits and vegetables is associated with higher levels of protective cholesterol and reduced risk for heart attack. Adequate intake of vitamins and minerals can also help the heart.
The importance of regular exercise for heart health also cannot be overstated. Exercise has wide-ranging and profound benefits. It has been shown to help lower blood pressure, reduce body fat and lower the risk of diabetes, which reduces the risk of heart attack and stroke. In addition, exercise directly strengthens the heart muscle. New guidelines unveiled by government health agencies recommend that people get between 60 and 90 minutes of exercise on most days of the week.
Other controllable factors include certain lifestyle factors. Quitting smoking and limiting alcohol intake each can improve the likelihood of heart health. Most people associate smoking with lung cancer, but it is also a major risk factor for cardiovascular diseases. Excessive alcohol use can be damaging for everyone, and even moderate alcohol use may be a problem for people who have already had a heart attack. Conditions such as daily stress also affect the heart. Stress can contribute to higher blood pressure, which is damaging. Stress can also lead to other emotional problems, such as depression, which in turn, affect the cardiovascular system.
Medication and supplement use should be monitored for heart health. All medications should be taken as prescribed. Supplements are not regulated in the United States and may interact with medications or may not have consistent quality levels. Patients should discuss all medication or supplement use or changes with their physicians.
Family history
A family medical history is detailed information about the past and present health of your family members. It is important to know your family medical history because it can provide major insight into your risk of developing certain medical conditions, such as heart disease. Learn as much as you can about the medical diagnoses of your biological parents, grandparents, siblings, aunts, uncles and cousins. Your children will also need to know as much as they can about the family medical histories of both parents.
Information that needs to be recorded in a family history includes:
Any known congenital or hereditary disorders
Major illnesses
Chronic ailments or risk factors (such as smoking, obesity or alcohol problems)
The cause of death and age at the time of death of any deceased relatives
All medical information should be recorded. Even illnesses that do not seem important to the patient may ultimately allow a physician to make a more accurate diagnosis or begin screening for certain conditions as soon as possible. A little documentation can go a long way toward preserving your health, prolonging your life and preventing the development of certain familial illnesses such as young-age heart attack.
Coronary risk profile
If you already have heart disease, then a coronary risk profile can help measure your risk of having one of the following conditions in the next 10 years.
Angina (certain type of chest pain, pressure or discomfort)
Heart attack
Heart-related death
Risk can never be a firm measurement, and future disease cannot be either predicted or definitively ruled out, but knowledge of risk potential and appropriate preventive measures can be helpful to both patients and physicians.
The coronary risk profile is based on data from the Framingham Heart Disease Epidemiology Study, which revealed certain controllable and uncontrollable risk factors for heart disease. Uncontrollable risk factors include:
Race
Advanced age
Family history of heart disease
Controllable risk factors include:
Smoking
Lack of exercise
Eating an unhealthy diet
Unhealthy cholesterol ratio
Obesity
Poorly controlled high blood pressure or diabetes
Points are assigned to any risk factors you may have, and the total of your points indicates your statistical likelihood of having angina, heart attack or heart-related death in the next 10 years.
To calculate your own coronary risk profile, you will need to know your levels of HDL (“good”) cholesterol, LDL (“bad”) cholesterol and triglycerides. This information can be obtained from the results of a blood fat profile, which is a type of blood test. You will also need to know your height and weight.
Heart-healthy diet
Information about healthy diets changes frequently, usually based on new studies and their results. This section offers three simple things to remember about eating a heart-healthy diet:
Plan balanced meals. The American Food Guide Pyramid, created by the United States Department of Agriculture, was significantly updated in 2005 to reflect new research into diet and health. The new food pyramid, which can be located at www.mypyramid.gov, is an interactive and personalized tool that helps people create an optimal diet. The food pyramid recognizes six categories of food: grains, vegetables, fruits, milk, meat and beans, oils, and discretionary calories. By entering gender, age and activity level into the pyramid, people can receive nutritional and calorie recommendations best suited for them.
Cut down on fat. Most experts recommend that fats comprise between 20 and 35 percent of overall calorie intake. However, it is crucial to draw a distinction between unhealthy fats and healthy fats. Healthy fats, which are monounsaturated fats such as olive oil and fish oil, have been shown to promote heart health. By contrast, unhealthy fats, such as saturated fat and trans fat, promote heart disease and obesity.
Saturated fat, which is found in animal products, is solid at room temperature, as shown by the marbling effect of beef or the firm consistency of butter. Eating saturated fat raises the level of fats (e.g., cholesterol and triglycerides) in your bloodstream, which can dramatically increase your risk for heart disease and stroke. Therefore, no more than 10 percent of your total daily calories should come from saturated fat.
Trans fat is found in any processed product that contains hydrogenated or “partially hydrogenated” oil. Hydrogenation is a manufacturing process used to render liquid fats such as vegetable oil as solids, which increases their shelf-life. Partially hydrogenated oils are used in everything from potato chips and other snack foods to margarine and shortening to fast food. In the body, trans fat has been shown to be just as dangerous a risk factor for heart disease as saturated fat, without any of the benefits of the essential fatty acids found in naturally occurring polyunsaturated fats. Because of the dangers associated with trans fat, and its lack of any health benefits, there is no recommended safe level for trans fat consumption. In fact, most health experts recommend completely avoiding foods that contain high levels of trans fat.
Get your daily supply of vitamins and minerals. Not all studies are consistent, but a wealth of evidence suggests that antioxidants (vitamins A, C, E and selenium) may have heart-healthy benefits. Three B-vitamins (vitamins B-6, B-12 and folic acid) have also been shown to keep homocysteine levels in check, which might significantly reduce the risk of heart disease. Therefore, it is important to fulfill your Dietary Reference Intakes every day.
Exercise program
Some experts have proposed that not exercising is as damaging to your cardiovascular system as smoking. Exercise strengthens the heart muscle, helps it to work more efficiently, helps to maintain a healthy blood pressure, improves the cholesterol ratio, helps to keep the blood vessels free of blood clots and plaque buildup, and may even reverse the process of atherosclerosis (“hardening of the arteries”).
Exercise is also essential for achieving and maintaining a healthy weight. Therefore, it is vital that you talk to your doctor about picking a healthy and enjoyable form of exercise, and then start a regular exercise program.
Cholesterol levels
The results of a blood test called a blood fat profile will include your total cholesterol level, which is the sum of your LDL (“bad”) cholesterol, your HDL (“good”) cholesterol, and one-fifth of your triglycerides (HDLs + LDLs + 1/5 triglycerides). In general, the lower your LDL and higher your HDL, the more heart-healthy you are. Directly measuring LDL cholesterol is both difficult and expensive. Fortunately, LDL can be reliably calculated by directly subtracting HDL and triglycerides (which are easier to measure) from the total cholesterol, as long as triglycerides are under 400. However, this formula becomes unreliable when triglyceride levels are over 400, in which case LDL must be directly measured. The National Cholesterol Education Program classifies cholesterol levels as follows:
Total cholesterol levels less than 200 are desirable.
Total cholesterol levels between 200 and 239 are borderline-high.
Total cholesterol levels that are equal to or above 240 are high.
HDL levels should be 40 or greater for men and 50 or greater for women.
LDL levels should optimally be less than 100. Levels greater than 129 are considered borderline-high and levels higher than 159 are considered high.
Typically, test results will also include the ratio of your total cholesterol to your HDL cholesterol. This ratio should be 5:1 or less. Strategies for improving this ratio include lowering cholesterol, lowering triglycerides and increasing HDL cholesterol.
Quit smoking
Cigarette smoking is the leading contributor to preventable deaths in the United States. According to the U.S. Centers for Disease Control and Prevention, more than 440,000 deaths in the United States are due to tobacco use each year, with more than 110,000 deaths from cardiovascular diseases alone. Smoking has also been linked to stroke, a leading cause of adult disability. In fact, a report by the United States Surgeon General determined that smoking negatively affects every organ system in the body.
A main constituent of cigarette smoke, nicotine, acts on the body’s central nervous system, requiring only seconds to reach the brain. Its alternate stimulant and calming properties are responsible for the physical and emotional need to continue smoking, and for the challenges associated with withdrawal. As a result, people may continue to experience nicotine cravings for months after they have quit smoking. The power of this smoking addiction helps explain why many people know all the risks of smoking (e.g., heart disease, stroke, lung cancer, emphysema) but still smoke – even after the onset of disease.
Limit alcohol
The effect of alcohol on health is complicated. For some people (e.g., those with a personal or family history of alcoholism), even mild alcohol use carries risks. In some cases, moderate alcohol use may offer a degree of protection against heart disease. For some people (e.g., those who had a heart attack), moderate alcohol use can further damage the heart muscle. And for all people, excessive alcohol use is extremely dangerous to both the drinker and people around him or her.
Recent research has suggested that moderate alcohol use (defined as one drink a day for women and one to two drinks a day for men) may afford some heart-healthy effects. This does not mean that non-drinkers should begin to drink, or that people should increase their consumption of alcohol. Nor does it mean drinkers can “save up” their drinks by foregoing alcohol for five days, followed by a day of consuming 10 drinks. Alcohol use should be limited to avoid alcoholic cardiomyopathy and other potential health problems.
Control conditions, stress and depression
Rates of both diabetes and high blood pressure are on the rise in all age groups, and African Americans are particularly at risk. Both conditions increase the risk of heart attack, stroke and early death.
According to the American Diabetes Association, up to one-third of people with diabetes may not know they have the condition, and many others either have trouble controlling their blood sugar or give up trying. According to the American Heart Association’s 2004 Heart and Stroke Statistical Update, more than 30 percent of Americans with high blood pressure are unaware that they have this potentially life-threatening condition, and another 25 percent are on medication, but do not have their blood pressure under control.
Chronic stress or depression can affect the cardiovascular system. Long-term stress has been associated with an increased risk of high blood pressure, heart attack and stroke. Long-term depression has been linked to high blood pressure, heart attack and dying from heart disease.
Medications and more
Take all your medications exactly as prescribed, and do not abruptly stop taking any medication without first contacting a doctor.
If you choose to take herbal supplements and/or over-the-counter medications (e.g., aspirin), keep in mind that these substances are not for everyone and can interact with other herbs or medications. Therefore, you should talk to your doctor before taking any of them regularly. Also keep in mind that herbs are less regulated in the United States than they are in other countries. The unregulated herbal remedies on the market may have contaminants and may not meet the standards of the United States Pharmacopeia (USP). Check with a pharmacist about the purity and reliability of an herbal product before buying it.
Because herbs and dietary supplements are less regulated in the United States, it can be very easy to overdose on a supplement or other over-the-counter substance if you are not familiar with it. For example, the recommended daily allowance (RDA) of vitamin B6 is 2 milligrams, and a form of nerve damage known as neuropathy has resulted from taking more than 50 milligrams per day in some studies. However, some bottles of vitamin B6 are sold in amounts of 200 or 250 milligrams per tablet. Those who intend to take a supplement are advised to take only the recommended dose, or the dose prescribed by a physician, because serious health risks can arise when there is too much of any given substance in the body.
Prevent blood clots
Many cardiovascular conditions can benefit from the prevention strategies described in this article. However, there are still other specific strategies that can be used to prevent deep vein thrombosis (DVT). DVT is a condition in which a blood clot (thrombus) has formed in one of the deep veins. If the clot breaks loose, it could cause a pulmonary embolism or other possibly fatal event. Regular exercise is an excellent strategy for preventing DVT because it promotes strong muscles and good circulation.
Because there is always a small risk of DVT associated with surgery, you should perform calf and leg exercises before surgery and resume activity as soon as possible after surgery. If you are confined to a bed or chair, regular stretching and leg movement are vital, especially if you sit at a desk all day or travel on long trips. You should avoid smoking, sitting with crossed legs and wearing tight garments below the waist such as garters or knee-high hosiery. Maintaining a healthy weight is equally important.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful conversations with their physicians about their conditions. Patients may wish to ask their doctors the following questions about ways to keep a healthy heart:
I do not know much about my family history. Can you determine my risk of heart disease without that information?
Many of my relatives have coronary artery disease. Will I get it as well?
I quit smoking years ago. Can that still affect the condition of my heart?
I eat a healthy diet but my cholesterol level is still high. Is this a problem?
I am in general good health with few risk factors for heart disease. Is there anything else I should do to protect my heart?
If I am taking medications to lower cholesterol, do I still need to change my diet?
How much do I need to exercise to help my heart?
I have already had a heart attack. Will any changes prevent another one?
