You probably already know the basics of how to prevent heart attack – don’t smoke, eat nutritious food, maintain a healthy weight, and get regular exercise – but are there other things that matter? Given that as much as 80% of heart disease is preventable, identifying risks before they cause a problem is huge! We also know that even those with an elevated risk of heart disease due to genetics can reduce their risk by adhering to healthier habits.
But above and beyond kicking that cigarette habit to the curb (which, by the way, if you haven’t yet – please get on that STAT), what specific things can we do to take our heart health to the next level? Let’s go beyond the basics and explore specific, actionable ways we can optimize our heart health
1. Don’t just focus on cardio
I’m a cardio junkie too, so I know how tempting for many of us it is to go for a run or jump on the Peloton. But too few of us are also engaging in strength training.
Aerobic exercise remains the cornerstone of maintaining a healthy heart, and we should all be aiming to get 150 minutes of moderate-intensity exercise a week (with further health benefits likely seen all the way up to 300 minutes of moderate-intensity exercise a week). However, a balance of both aerobic and resistance (or strength training) is important for optimal cardiovascular risk reduction.
As I discussed in detail here, strength training is particularly important for not only improving muscle strength and bone health, but it may be superior to pure aerobic exercise in reducing visceral fat (the kind most closely linked with cardiovascular disease), insulin resistance, and blood pressure. Combination exercise programs incorporating both aerobic exercise and resistance training may be the most effective of all.
If you don’t already, consider incorporating 2-3 days per week of resistance or strength training into your exercise plan.
2. Minimize air pollution
Air pollution, while widely recognized as a major cause of lung disease, is shockingly responsible for nearly 20% of cardiovascular death globally.
Fine particulate matter, in particular, is a major cause of heart disease according to the American Heart Association (as well as many other national and international organizations). Short-term exposure increase the risk for heart attack, stroke, and sudden death, while chronic, long-term exposure has been associated with increased risk of premature heart disease and progression of atherosclerosis (heart blockages).
Importantly, research has demonstrated that air pollution impacts heart health even at very low levels, lower than most national standards.
How air pollution causes increased risk for heart disease is complex, and the result of the interplay of increased inflammation, endothelial dysfunction, clotting, hormonal changes, and increased sympathetic tone.
While global, policy-level changes are clearly crucial, studies have shown that personal-level approaches can lead to improvements in cardiometablic risk factors such as blood pressure, inflammation, and insulin sensitivity. These include
N95 respirators during times of particularly poor air quality outdoors (ie wild fire season)
indoor air purifiers with HEPA filters
adequately ventilating the kitchen when cooking with gas or switching to induction stovetops
exercise and a healthy diet as there is some evidence that these healthy habits can at least partially mitigate the negative effects of air pollution
3. Analyze nutrition labels
While it’s a good idea to focus on eating as much unprocessed, whole foods as possible, packaged food is often unavoidable. Learning to distinguish which packaged foods are ultra-processed, and thus typically high in salt, sugar, and saturated fat, while being low in the good stuff like fiber, is huge.
When you do reach for processed foods, try to stick with foods that are made with whole grains, nuts, and seeds and limit heavily refined products.
Make a habit of studying the nutrition label. Things to keep an eye on include added sugar (a woman’s daily limit is 6 teaspoons or 25 grams per day!), salt, and saturated fat (even from sources like coconut oil!).
Sneaky sources of added sugar and salt include canned foods (particularly canned soups), marinara sauce, bread, frozen entrees, granola, condiments, flavored yogurt, and dressings. Organic, gluten-free, vegan, and GMO-free products do not necessarily mean they are healthy if they are high in sugar, salt, or saturated fat!
On the other hand, you want your foods to be high in fiber (I often have my patients track this using something like Chronometer!), omega-3s, protein, as well as vitamins and minerals such as potassium.
4. Spend time in nature
Many of us are aware that spending time in nature has been shown to improve mood, relieve stress and anxiety, and decrease fatigue.
However, aside from the well established benefits to our mental health on spending time outdoors, several studies have also found a positive association with time spent in nature and improved cardiovascular health. Individuals who have access to greenspaces have lower levels of cortisol (the stress hormone), blood pressure, and heart rate – all of which likely translate to lower risk of heart disease.
If possible, aim to get your exercise outside, whether it’s a family hike, walk, or jog. However, the link between mental health and body-heart health is also increasingly becoming clear. Thus, other outdoor activities like sitting on the beach watching the waves, meditation in the park, or forest bathing, may also provide benefit.
5. Minimize sitting and maximize daily movement
Sedentary lifestyle (ie prolonged sitting time) has been identified as an independent risk factor for the development of premature heart disease.
The increased risk of cardiovascular disease appears to emerge fairly consistently at between 8 to 10 hours of sedentary time a day. As I discussed in depth here, the risk of prolonged sedentary time appears to be independent of time spent in formal exercise. This means that the risk associated with sitting for prolonged periods of time still applies to you even if you exercise regularly. So, you may not be off the hook even if you get in your 30 minute work outs every day.
If possible, consider a stranding desk, walking meetings, pace while talking on the phone, breaking up your day with errands, and even a fitness tracker to motivate you to get in those 7,500 steps a day.
6. Eat more fiber
Fiber is a type of carbohydrate that isn’t digestible. It’s been shown to help lower cholesterol, blood pressure, glucose and risk of heart disease.
The American Heart Association recommends that women eat at least 21 to 25 grams of fiber a day, and men at least 30 to 38 grams a day, but evidence suggests more can have additional beneficial effects. As I detailed in this post, 20 grams of soluble fiber alone (meaning more like 40 grams of total fiber a day) is recommend to lower LDL cholesterol by 5-10%.
With most Americans getting somewhere around 16 grams of fiber a day, it’s a safe bet that most of us are far from our target!
Fiber is found in – you guessed it – plants. It’s particularly high in legumes, many fruits and veggies, and whole grains. If you make one single dietary change, this is the one I would start with!
7. Check for genetic cholesterol issues like Lp(a)
While most of us have probably had our “cholesterol” checked at some point, this is usually just a basic lipid panel. While informative, it may not be the whole story.
While LDL-cholesterol (the bad cholesterol) is our primary target for cholesterol lowering in order to reduce risk of heart disease, for many individuals, LDL-cholesterol may in fact be less predictive of heart disease risk than other markers such as LDL particle number and apolipoprotein B.
Additionally, as I discussed in detail here, lipoprotein (a) – an LDL-like particle that also causes heart disease – is also not routinely checked. Genetically determined, it increases risk for premature heart disease by twofold and is shockingly common, affecting 1 in 5 individuals.
How to prevent a heart attack – the next level
While some of the most important measures you can take to improve your heart health remain the basics of a healthy diet, regular physical activity, and quitting smoking, optimizing beyond these fundamentals is increasingly being recognized for ideal cardiovascular health. Environment, lifestyle choices, and genetics contribute to our risk in complex ways – being aware of these risks, and then taking concrete, actionable steps to mitigate them, is critical. Did any of these surprise you? Which have you had checked?