Now that we’re halfway through 2021, take a moment to think back on the resolutions you may have set for yourself at the beginning of the year. Did they involve promises about eating better, losing weight, exercising more and stressing less? What about prioritizing sleep and curbing the booze? If your goals included one or all of the above, you might as well have just said this is the year you resolve to prevent heart disease. Because each of those resolutions takes you one step closer to the formidable task of keeping your heart healthy.
Heart disease isn’t necessarily something on your radar—but it should be. “Heart disease is the number one cause of mortality in the U.S.,” says interventional cardiologist Anuj Shah, M.D., founder of the APEX Heart and Vascular Care Centers in northern New Jersey. “It’s something you should take seriously, no matter what your age or if you think you are in good health.” In fact, one in four American deaths this year will be caused by cardiovascular disease, according to the Centers for Disease Control and Prevention (CDC)—that translates to one person every 36 seconds. Treating heart disease once you get it is possible, but not always easy. Your best route for living well into your golden years is to prevent it in the first place. Start with this guide.
Understanding Heart Disease Causes
You’ve seen the movie: Man stands up from dinner table, clutches chest, collapses to the floor and dies. In reality, heart attacks are just one of many forms of heart disease, and dramatic attacks are less common than Hollywood would have you think (one in five heart attacks are “silent,” meaning there are virtually no indications it’s happening at all). Still, heart attacks remain one of the most visible forms of heart disease, affecting 800,000 people in the U.S. every year.
Heart attacks are usually caused by the buildup of cholesterol and plaque in the arteries that impedes your body’s ability to pump blood to and from the heart. While the solution to this might seem obvious (eat less high-cholesterol food), the factors leading to heart disease are more complex. They vary slightly depending on your specific form of heart disease, but in general a bad diet, lack of exercise, excessive stress, poor lifestyle habits (like skimping on sleep and smoking) and being overweight are all major contributors.
To understand how these factors can lead to heart disease, imagine your heart is a pump, about the size of your fist. Its job is to collect the blood in your body, pump it to your lungs where it is injected with fresh oxygen, then re-collect the O2-rich blood and circulate it to your organs, muscles, and other tissues that keep you alive. Anything that interferes with this pumping mechanism sets the wheels in motion for heart disease.
What’s Stress Got to Do with It?
On the list of top triggers for heart disease, stress is a big one. You may have heard of the body’s fight-or-flight response. It’s an internal system set up to handle dangerous or anxiety-inducing situations, by turning on all the switches in your body to overcome the stressor. In the prehistoric days, that meant alerting you that an angry lion was outside your cave and pumping you full of adrenalin to help you either battle the beast or outrun it. In modern times, it might mean sending your body into overdrive to get you to a meeting on time.
In either case, the stress response does two things: raises your heart rate and elevates your blood pressure as it kicks your body into sixth gear. That’s fine in the short-term (you escaped the lion, you made your meeting). But over time, living in a chronic state of panic keeps your blood pressure and heart rate raised to unhealthy levels, placing strain on your heart. And it’s not just physical stress: A 2017 study in the medical journal, The Lancet, found that emotional stress causes changes in the brain directly related to inflammation of the arteries and cardiovascular events.
If there’s a silver lining, it’s that modern-day stress tends to be as much a perception of a situation as an actual threat. There are no lions anymore, but there are annoying bosses, screaming kids, and, well, COVID-19. How you perceive those challenges can determine your stress level, and therefore your heart health. For that reason, many experts suggest activities like meditation and yoga, which has been shown to lower blood pressure, to help you keep calm and carry on.
Healthy Teeth, Healthy Heart?
It’s unlikely that you’re thinking about your heart when you brush your teeth at night. Good breath, yes. Pearly whites, sure. But taking care of your ticker? Yet good oral hygiene plays a prominent role in preventing heart disease. In fact, a study in the journal Circulation found a 28 percent increase in heart attacks among people who had periodontal disease. Other studies show that people who experience tooth loss due to poor dental care are at heightened risk for both strokes and heart attacks.
One possible reason: Poor dental health leads to increase in oral plaque that may travel to your arteries, as well as the release of something called a C-reactive protein, which causes inflammation in the arteries and is a known marker for heart disease. A report in the American Journal of Medicine found that regular brushing with plaque-removing toothpaste significantly lowered the risk of cardiovascular events.
Eat This for Heart Protection
So now that you know what can cause heart disease, what can you do about it? No surprise, what you eat for breakfast, lunch and dinner plays a major role in determining whether or not your ticker stays healthy. It’s not quite as simple as “eat this, not that,” but there are definite winners when it comes to which foods to favor. “We used to believe carbs and fats were the enemy, but we now know that eating a moderate amount is OK,” says Dr. Shah. You’ll get two-for-one in this department if you follow the Mediterranean diet, he adds, which emphasizes things like fish for protein, whole grains for carbs and olive oil for healthy fats. Good-for-you snacks include nuts, fruits and vegetables that have high levels of antioxidants.
You don’t have to do the Mediterranean diet, though, to improve your heart health. There are plenty of ways to modify your favorite recipes, from Mexican to home-baked cookies, to be lower in fat, cholesterol and sodium—some of the major culprits in heart disease. For instance, cooking with olive oil instead of vegetable oil is a good idea, and skipping the salt while adding spices can help cut sodium content in half. It’s less about what you eat at any one meal and more about how you eat in the long haul that will make a difference.
Wine for Heart Health
Cliché but true: “When it comes to heart health, it’s everything in moderation,” says Dr. Shah. That means keeping it to one to two glasses of red wine for men daily and one glass of wine for women, according to the American Heart Association. “Moderate amounts of wine have been shown to improve good cholesterol, or HDL, in your body, which in turn helps cardiovascular health,” he explains.
On the other hand, different people react differently to alcohol, so don’t rush out and stock up on vino with the belief it’s a cure-all. “Alcohol is not a substance intended to be part of a medical plan to prevent heart disease,” says cardiac electrophysiologist Adrian Baranchuk, M.D., a professor of medicine at Queen’s University in Ontario, Canada, who has researched the effects of wine on cardiovascular health extensively. “Alcohol is not a medicine. Depending on how much you drink, you may get some cardiovascular benefit, but nobody should prescribe drinking, in any amount, to anybody to prevent heart disease.” The reason: Excessive amounts of drinking are associated with an increased risk of certain cancers, hypertension, liver disease and depression (not to mention alcoholism).
Still, research increasingly indicates that ethanol and polyphenols, compounds found in red wine, may offer protective benefits for the heart when consumed in moderation. (These findings appear unique to compounds in wine, not other alcoholic beverages—sorry, beer lovers.)
Can Supplements Help Your Heart?
Wouldn’t it be ideal if heart disease could be controlled by popping a pill? “People have been looking at vitamins and supplements for heart disease for ages,” says Dr. Shah. “Unfortunately, nothing has been robustly proven.” For instance, one study in the Journal of the American Heart Association found that people who consumed the highest amount of overall calcium were 27 percent less likely than those who consumed the lowest amount to develop heart disease. However, those who got their calcium through supplements instead of food actually were 22 percent more likely to develop heart disease.
Other scientists are curious if the compounds in red wine—namely, something called resveratrol—can be beneficial in supplement form. “For just resveratrol alone, there are 133 registered clinical trials,” notes Dr. Baranchuk, who points out the challenges of learning the long-term effects of supplements on heart health: “If I give you a pill to see if it makes you live longer, that’s at least a 25-year study. There is no quick answer here.”
Bottom line here: Numerous studies, including research in the Annals of Internal Medicine, conclude that there are no known supplements or vitamins that directly prevent heart disease. But some, like fish oil, garlic and fiber supplements, may improve heart-disease-associated risk factors, like high blood pressure and elevated (bad) cholesterol numbers.
Aspirin: Good or Bad for Your Heart?
You probably remember that saying, “An aspirin a day keeps the doctor away.” Well, it turns out things aren’t that simple. “The recommendations on aspirin for heart health have been reversed,” says Dr. Shah, acknowledging the American Heart Association’s revised position in 2019, suggesting that aspirin not be taken for heart disease without explicit doctor approval.
Here’s the good part about aspirin: Heart disease is caused by the buildup of plaque in your arteries. When plaque breaks loose from an arterial wall or ruptures, a blood clot forms. If the clot is big enough, it can cut off blood supply to parts of the body, leading to a heart attack or stroke. Aspirin is a blood thinner, so it helps prevent such clots.
Here’s the bad part: “Just blanket putting everyone on aspirin—even if you are someone with no risk factors for heart disease—raises the risk of bleeding, so we no longer recommend it,” says Dr. Shah. “It’s not a question of whether or not aspirin is effective, it’s an issue of benefits versus risks.”
If you do have risk factors for heart disease or you have a history of heart attacks or strokes, talk with your doctor about whether taking aspirin is advisable. If so, you’re best off taking a low dose of 81 mg, or a baby aspirin, according to the Cleveland Clinic in Ohio.
Putting the Cardio in Cardiovascular Health
Along with eating better and stressing less, exercise plays a major role in the prevention of heart disease. Your heart is what’s known as a muscular organ. It behaves much like other muscles in your body in that it gets stronger when you use it, and weaker when you don’t. In fact, a sedentary lifestyle is a major contributor to heart attacks.
So how much do you need? The U.S. Department of Health and Human Services, as well as some fitness organizations, call for 30 minutes a day, five days a week (you can split it up into three 10-minute daily sessions if it’s easier) to ward off heart disease. In truth, it’s less important what you do or how long you do it for, than the mere act of doing something. “This issue isn’t whether you went for a walk around the block, ran a marathon, or lifted weights at the gym,” says Dr. Baranchuk. “The guy I’m worried about is the one still sitting on his couch, eating chips and watching TV.”
In fact, a team of Australian physiologists found that as little as four minutes of exercise, four times daily, can have a positive effect of people’s vascular function, blood sugar control, and body composition—all risk factors for heart disease. The catch? You have to Go. Hard. Known as high-intensity interval training, or HIIT, this form of exercise pushes your cardio capacity to the max, with moves like jumping jacks, stair running and the like. Short it is, but sweet it’s not. Still, you’re getting a major heart-health bang for your proverbial four-minute buck.
Related: HIIT Workouts for Beginners
How Sleep Helps Your Heart
All that exercise probably has you primed for a good night’s sleep—but are you getting it? Even before pandemic stress reared its ugly head, most Americans weren’t getting a lot of zzz’s: More than one in three of us fail to reach the seven-hour-per-night minimum needed for optimal health, according to the CDC.
Sleep plays a critical role in heart health. For instance, during sleep, your blood pressure naturally drops 10 to 20 percent—important for people with high blood pressure. The fewer hours you sleep, the longer blood pressure stays elevated, raising your heart disease risk with it. What’s more, sleep has been shown to improve blood sugar control, a key component to keeping diabetes (another heart disease risk factor) in check.
Given all this, you might be ready to crawl under the covers for a nice, long snooze-fest. Not so fast. South Korean researchers found that people who slept nine or more hours a night had 70 percent more calcium buildup in their coronary arteries—a precursor to having a heart attack—than those who nightly numbers came in around the seven-hour mark. It’s worth noting that the study did not find cause and effect—that is, while excessive sleep and heart disease are clearly correlated, the study did not determine if one causes the other.
So what’s a New Year’s resolution-loving person to do? Clearly, tackling heart disease takes more than a 30-day-and-done plan. More likely, you’ll want to make a commitment to being a little bit healthier in all your choices in 2021. Have the pasta, but drizzle it with olive oil. Enjoy your wine, but just a glass. Move—more often than you sit—and hit the sack in time to clock your seven to nine hours nightly. A little bit, docs say, goes a long way when it comes to taking charge of your heart health.
Next up, discover the 12 symptoms of an unhealthy heart.