The answer for most people isn’t drugs, but simple changes in the way you eat and exercise
The American Heart Association and the American College of Cardiology caused a ruckus late last year when they issued new guidelines that, by some measures, would double the number of people who should take a cholesterol-lowering drug. Lost in the ensuing uproar was a less controversial, but in some ways more far-reaching, recommendation from the same organizations: a renewed emphasis on the power of lifestyle changes in preventing and treating heart disease.
“We did perhaps the most comprehensive review of the effects of diet and exercise on heart disease ever, and concluded that there really is good evidence that it helps and that it’s doable,” says Robert Eckel, M.D., co-chairman of the guideline-writing committee and professor of medicine at the University of Colorado Anschutz Medical Campus in Aurora.
Another advantage of focusing on lifestyle: The heart-protective effects go beyond cholesterol reduction. You can lower your blood pressure, lose weight, and perhaps reduce inflammation in the arteries, a risk factor increasingly linked to heart attacks and strokes. In fact, our medical experts say that making lifestyle changes can eliminate the need for drugs.
And it’s not just the new guidelines that recognize the benefit of heart-healthy habits. Medicare is so impressed with Dr. [Dean] Ornish’s Program for Reversing Heart Disease—an aggressive plan that combines a very low-fat vegetarian diet with a tailored exercise program, meditation, smoking cessation, and group therapy—that it now covers the treatment for those with diagnosed heart disease.
Even better: Although concerted efforts such as the Ornish program can be quite effective, growing research shows that more modest (and less rigid) steps, such as the five we highlight here, yield important health benefits—and show that it’s never too late to make changes.
- Get moving. How it helps: People who exercise regularly have a 30 to 40 percent lower risk of heart disease than those who don’t, the research suggests. Exercise strengthens your heart muscle at the same time that it controls inflammation and helps keep weight, cholesterol, and blood pressure at healthylevels. Strength training improves heart health, too, because more muscle equals a faster metabolism, which makes it easier to keep weight off. What to do: It doesn’t take a lot: Aim for 75 minutes of vigorous exercise a week (such as two Zumba classes or jogging at a 7-mph pace) or 2.5 hours of moderately intense activity (equal to walking at 4 mph), which comes out to 30 minutes a day. Even just standing up can help: Recent research suggests that prolonged sitting lowers levels of HDL (good) cholesterol, raises artery-clogging triglycerides, and decreases the insulin sensitivity that boosts the risk of type 2 diabetes.
- Eat more plants. How it helps: Vegetables and fruit, whole grains, nuts, and beans have each been linked to a healthier heart. Those foods are high in protective nutrients, such as potassium and fiber, and free of or very low in saturated fat. And those are the same nutrients that are plentiful in the DASH (Dietary Approaches to Stop Hypertension) diet, which was highlighted in the new guidelines and can lower heart-disease risk by 18 percent, research shows. And a recent Harvard University study found that people who eat eight servings of fruit and vegetables daily— especially dark-green vegetables, orange fruit and vegetables, and citrus fruit—have a 17 percent lower risk of heart disease compared with those who consume two servings. What to do: Make plant foods and fish the centerpiece of your meals. When you do eat meat or poultry, stick to 3- to 4-ounce portions and choose lean cuts. Include a variety of fruit and vegetables with a host of colors. That ensures that you’ll get the complete array of nutrients that have been linked to good health. Research has found that it’s the full complement of those nutrients, perhaps working together, that explains why eating whole foods is better than taking supplements of individual nutrients. In addition, replace saturated fat, such as butter, with canola, olive oil, and other unsaturated oils.
- Relax. How it helps: Some research suggests that emotional stress can be almost as bad for your heart as more familiar risk factors, like high blood pressure. Negative emotions trigger the release of hormones that can threaten your heart. People in rocky relationships, for example, are more prone to heart disease. And those with stressful jobs are more likely to have high blood pressure and, if they return to work too soon after a first heart attack, to have a second one. What to do: Develop your own portfolio of coping strategies. Exercise helps in part because it appears to reduce levels of stress hormones and can keep your blood pressure down when you’re under duress. Yoga and tai chi are particularly good options because they lower blood pressure and heart rate. And be sure to schedule some time each day to unwind, whether it’s with meditation, massage, or music.
- Drink (in moderation). How it helps: Moderate drinking can raise a low HDL (good) cholesterol level and reduces the risk of death from heart disease by about 25 percent. It may also help prevent type 2 diabetes and ischemic strokes, the kind caused by blood clots. What to do: It doesn’t seem to matter much what kind of alcohol you consume, as long as you keep it to two drinks a day for men or one a day for women. The benefits appear to be highest among people at increased risk of heart disease, notably men older than 40 and women older than 50. If you don’t drink, though, don’t start.
- Quit smoking. How it helps: Smokers are two to four times more likely to develop heart disease than nonsmokers. But once you quit, you can eventually lower your risk to that of someone who has never smoked. What to do: The most successful strategies for most people include counseling, nicotine-replacement products, or both. Those products are most helpful for the first two to three months of quitting when the risk of a relapse is greatest. Using them for longer than that should be done only under the supervision of your doctor because there is a risk of becoming addicted to the replacements themselves.