**By J. Susie Woo, MD**
As a cardiologist, I diagnose and treat heart disease – our country’s leading cause of death – across a broad spectrum of patients. Although the goal is to always individualize treatment based on a person’s unique condition, there are commonalities everyone should be aware of and follow to achieve optimal heart health.
Knowing your risk
Although there are a handful of things everyone can and should do over the course of their lives to lower their risk of heart disease, people’s genetic makeup can place them at higher risk no matter what they do. Since medical science is proving more and more that genetics plays a role in heart disease, one of the most important steps in preventing an event, like a heart attack or stroke, is knowing whether you have a family history of cardiovascular disease.
The most relevant family history is that of your first-degree relatives: your biological parents and siblings. Early heart disease in those family members, or in more distantly related family members, are the most concerning signs of an inherited predisposition toward cardiovascular disease or sudden death.
Here is what your physician wants to know:
- Is there any family history of heart disease, heart attack or stroke?
- Is there any family history of high blood pressure, especially at an early age?
Most importantly, is there any history of a heart attack in a male before age 55 or a female before age 65?
Six healthy habits
Beyond knowing your family history of heart disease, people who adhere to six recommended health behaviors are about 80 percent less likely to die from heart attack or stroke than those who follow none of the actions, according to a study that included nearly 45,000 U.S. adults. However, the study also revealed that few adults follow all of these behaviors as recommended by the American Heart Association:
- Not smoking and limiting consumption of alcohol
- Having normal cholesterol levels
- Eating a healthy diet
- Having normal blood glucose
- Being physically active
- Having normal blood pressure
Not smoking and limiting consumption of alcohol
If you are one of the estimated 40 million Americans who still smoke, quitting as soon as possible should be your highest priority. Smokers are two to three times more likely to develop heart disease than non-smokers, but that increased risk reverses to that of a non-smoker after just three years of abstinence. Your doctor can help provide you with stop-smoking aides and information about local smoking-cessation resources.
A little alcohol can be good for your heart, but after that, the health benefits are lost and it simply results in empty calories. If you choose to drink, physicians recommend an average of no more than one drink – preferably a glass of red wine – a day for women and two drinks per day for men.
Having normal cholesterol levels
Cholesterol levels should be measured at least once every five years in everyone over age 20. More frequent screening is performed in men over age 35 and women over age 45, especially if there is a history of high cholesterol. Cholesterol levels are measured by a blood test called a lipid profile under fasting conditions. The lipid profile includes:
- Total cholesterol
- LDL (low-density lipoprotein, also called “bad” cholesterol)
- HDL (high-density lipoprotein, also called “good” cholesterol)
- Triglycerides (fats carried in the blood from the food we eat). Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.
Results of your blood test will come in the form of numbers. It is important to know that the numbers by themselves are not enough to predict your risk of heart disease. They are, instead, one part of a larger equation that includes your age, your blood pressure, your smoking status, and whether you use blood-pressure medications. Your doctor will use this information to calculate your 10-year risk for serious cardiovascular problems. You and your doctor will then develop a strategy for reducing that risk.
High LDL cholesterol leads to atherosclerosis (build-up of cholesterol plaque) on the walls of your arteries and increases your chances of developing angina (chest pain) or heart attack. The lower your LDL cholesterol number, the lower your risk. If your LDL is 190 or more, it is considered very high and your doctor will most likely recommend a statin (medicines that can help lower cholesterol levels), in addition to healthy lifestyle choices.
You may also need to take a statin even if your LDL is below 190. After calculating your 10-year risk, your physician will recommend a percentage by which you should try to lower your LDL through diet, exercise and medication, if necessary.
When it comes to HDL cholesterol, a higher number means lower risk. This is because “good” cholesterol removes the “bad” cholesterol from your blood and keeps it from accumulating in your arteries. A statin can slightly increase your HDL, as can exercise.
Eating a healthy diet
A healthy diet is not only a key component to your heart health, it is instrumental to your overall health. A great place to start is by reducing consumption of foods that come from cows. Other heart-healthy diet changes include:
- Substitute red meat with proteins such as fish, chicken and soy several times every week
- Include a combined seven servings of fruits and vegetables in your diet every day
- Eat foods made from whole grains instead of processed grains
- Avoid non-nutritious calories and snacks, including packaged foods, fast food and sugary drinks
- Stop eating when you are no longer hungry, instead of eating until you are full
Having normal blood glucose
Maintaining normal blood glucose levels is important to prevent diabetes and sustain heart health throughout your life. The blood test measuring a fasting blood glucose is often part of an annual physical. The amount of glucose (or “sugar,” measured in mg/dL) in your blood changes throughout the day and night, depending on when and what you have eaten, and whether or not you have exercised. Normal blood glucose levels include:
- A normal fasting (no food for eight hours) blood sugar level of between 70 and 99 mg/dL
- A normal blood sugar level two hours after eating of less than 140 mg/dL
Being physically active
Research has shown that people can increase their lifespan by two hours for every hour of exercise. Regular aerobic exercise is one of the best ways to get and stay healthy. Current recommendations are for you to get 30 minutes of moderate-intensity exercise at least five days a week, both for your heart and overall wellness. To maximize the heart-health benefits of your workouts:
- Find an aerobic activity you enjoy, such as brisk walking, swimming or cycling. These activities get your heart beating and your big muscles moving
- Work out at the same time every day so it can more easily become part of your daily routine
- Exercise enough to break a sweat and increase your heart rate, but keep in mind that you don’t need to be out of breath to benefit
- If you have not been exercising, start slowly with just 10 minutes of aerobic activity daily, which is still enough to reduce your risk of premature death
Having normal blood pressure
A normal blood pressure is 120 on top (systolic) and 80 on the bottom (diastolic). If your blood-pressure numbers are much higher than that, you should see your doctor and take medications if necessary. High blood pressure significantly increases your risk for a heart attack, stroke, heart failure and kidney failure.
To keep track of your blood pressure, especially if it is high or borderline high, consider purchasing a home blood-pressure monitor. Recording occasional blood-pressure measurements at home, especially after a medication or lifestyle change, is a healthy habit that can help you and your doctor get your numbers under control.
Lastly, it’s important to keep in mind that even small, incremental changes in these areas will have a cumulative effect and lower your risk for cardiovascular disease and stroke. Over time, repetition of these six habits will become routine and lead to a healthier lifestyle and overall sense of wellbeing.
J. Susie Woo, MD, FACC, is board certified in Internal Medicine and Cardiovascular Disease. Her specialties include echocardiography, nuclear cardiology, advanced heart failure and preventive cardiology. She practices at Virginia Mason Bellevue Medical Center and Virginia Mason Hospital & Seattle Medical Center.