Lifestyle changes to lower heart disease risk - Harvard Health Blog

Last updated: 11-08-2019

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Lifestyle changes to lower heart disease risk - Harvard Health Blog

Nearly half of all premature deaths may be due to unhealthy lifestyle choices, such as insufficient exercise, poor diet, and smoking. These risk factors increase the risk of high blood pressure, diabetes, heart attack, and stroke.

The good news is that lifestyle changes can make a difference. In a study analyzing over 55,000 people, those with favorable lifestyle habits such as not smoking, not being obese, engaging in regular physical activity, and eating a healthy diet lowered their heart disease risk by nearly 50%.

The American College of Cardiology (ACC) and the American Heart Association (AHA) recently published guidelines detailing lifestyle and behavioral recommendations to reduce the risk of cardiovascular disease (CVD) in those who do not yet have it. The guidelines addressed diet and nutrition, exercise and physical activity, body weight, and tobacco use. They draw from existing evidence that healthier lifestyle choices can reduce the risk of premature death and disability due to heart disease.

The ACC/AHA guidelines included specific dietary recommendations such as eating a diet high in vegetables, fruit, legumes, nuts, whole grains, and fish. They also recommend limiting sodium, saturated fats, refined carbohydrates, sweetened beverages, and processed meats, and omitting trans fats.

A healthy lifestyle involves a range of healthy behaviors. One way to think about heart disease risks and corresponding lifestyle changes is the acronym ABCDES:

Let’s go through each of these elements.

While the benefit of light to moderate alcohol consumption is somewhat controversial, excessive alcohol consumption is associated with increased risk for death, heart disease, and liver disease. Studies show harm occurs when individuals consume more than 100 grams of alcohol, or about 7 drinks, per week. A standard drink — 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits — contains 14 grams of alcohol.

Following a healthy dietary pattern, such as the Dietary Approaches to Stop Hypertension (DASH) diet, can help to lower blood pressure. The DASH diet is specifically designed to lower blood pressure. It emphasizes fruits, vegetables, whole grains, low-fat dairy products, legumes, nuts, seeds, and lean meats. These foods are typically high in fiber and low in saturated fat, cholesterol, and sodium.

Studies suggest that the DASH diet can lower systolic blood pressure (the top number) by about 8 mm Hg and diastolic blood pressure (the bottom number) by about 4 mm Hg, and reduce mortality.

Elevated cholesterol is a risk factor for heart disease and is associated with higher risk of death. While genetics play a role, excessive weight, physical inactivity, type 2 diabetes, and excessive alcohol intake also contribute to high cholesterol.

Research suggests that reducing saturated fat in the diet and replacing saturated fat with polyunsaturated fat may lower cardiovascular risk. This means replacing butter, coconut oil, palm oil, shortening, or lard with olive, safflower, canola, corn, sesame, soybean, and sunflower oils.

The Mediterranean diet has been found to lower cholesterol and reduce CVD risk. This diet is rich in fruits, vegetables, nuts, seeds, and whole grains, with limited consumption of red meat and sweets. Olive oil is the main source of dietary fat.

Eating foods rich in omega-3 fatty acids, such as salmon, trout, tuna, herring, and mackerel, also helps to reduce heart disease risk.

Diabetes is a major risk factor for heart disease. Fortunately, lifestyle changes can help. For example, if you have prediabetes, losing at least 7% of body weight and engaging in 150 minutes or more per week of moderate-intensity physical activity has been shown to reduce the risk of progressing to diabetes.

Healthy diets, such as the Mediterranean diet and the DASH diet, and plant-based diets emphasizing foods higher in fiber and omega-3 fatty acids, and lower in glycemic load and saturated fats, are also recommended.

The Physical Activity Guidelines for Americans from the US Department of Health and Human Services recommend that all adults ages 18 to 64 engage in at least 150 minutes of moderate aerobic exercise per week or 75 minutes of vigorous aerobic activity per week — or an equivalent mix of the two. Activities such as brisk walking, running, swimming, biking, and other aerobic exercises are all good options.

As a general rule, being active is better than being sedentary. For example, taking at least 4,400 steps daily is associated with lower risk of death than taking only 2,700 steps per day.

Smokers have a higher heart disease risk than never-smokers, and two to three times the risk of death. The more you smoke, the higher your risk of death.

Quit-smoking medications like varenicline (Chantix) and bupropion (Wellbutrin), and nicotine replacement therapies, are generally safe and can effectively help people quit smoking.


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