Heart Health Starts Early! Lifestyle Matters

With COVID-19 on our minds so much these days, it is easy to forget that people are still dying of cardiovascular disease (CVD). The new heart disease and stroke statistics are out for 2022, and there is some good news and bad news (Tsao et al., Circulation, 2022). Let’s get the bad news out of the way first: CVD is still the leading cause of death in the United States, accounting for ~30% of all deaths regardless of sex and ethnicity. While deaths from CVD began dropping in the 1970s, the bad news is that since 2010 the rates have begun to rise again. Based on the latest data available from 2017-18, the average total cost of CVD in the United States is $378 billion per year.

Now for the good news

Although CVD is still a major cause of death in the U.S., we have so many tools to lower one’s risk for CVD and the burden on the U.S. economy. The initiating event in CVD is endothelial dysfunction, where the arteries are damaged due to any number of factors, including physical inactivity, poor diet, hypertension, diabetes, obesity, stress and smoking, just to name a few. We also know this process can begin early in life, so that by the time a child is 18 years old, they can already have the beginnings of endothelial damage (Juonala et al., Pediatrics, 2020). So, what can we do to lower our risk of CVD and the risk of our children and family members?

We now have so much data that clearly indicates that a healthy lifestyle will lower our risk of CVD, even if we have a family history of heart disease. To simplify the message, the American Heart Association (AHA) has developed “Life’s Simple 7” (Tsao et al., Circulation, 2022). Using these approaches, you, your family and your clients can lower the risk of CVD, regardless of genetic factors. These seven evidence-based approaches — four health behaviors and three health factors — are listed below (Tsao et al., Circulation, 2022):

1. Be active: Aim for 150 minutes of aerobic physical activity per week, and add two days of strength training per week. The Physical Activity Guidelines for Americans can provide more guidance. Remember, every little bit helps. Individuals ≥ 60 years who are physically active have a 25-40% lower risk for CVD.
2. Keep a healthy weight: If you are overweight, even a 5-10% reduction in weight can improve blood lipids, glucose and blood pressure (BP).
3. Eat a heart-healthy diet: Eat more whole grains, fruits, vegetables, nuts, legumes and unsaturated oils. Decrease saturated fats, refined grains and added sugars. Use low-fat dairy and lean proteins. Eat less red meat. Add fish, especially fatty fish, to the diet. Drink in moderation. Select low-sodium options. Learn to plan and cook meals at home. Eating just five servings of fruits and vegetables each day can lower your risk of CVD by 12%. See more guidance below, under “Healthy dietary patterns.”
4. Do not smoke or use smokeless tobacco: Stop smoking. Don’t start.
5. Know your blood cholesterol level: Know your low-density lipoprotein cholesterol (LDL-C) level. Keep LDL-C levels below 100 mg/dL.
6. Keep your BP healthy: AAim for a healthy BP pf ≤ 120/80 mmHg, where hypertension or high BP is defined as 140/90 mmHg or higher. Keeping BP low can get harder to do as one ages, so monitor your BP frequently and notice when changes begin to occur. Being physically active, maintaining a healthy weight and lowering sodium intake can help BP management. See more on sodium intake below.
7. Learn about blood glucose (e.g. blood sugar) and risk of diabetes: The American Diabetes Association recommends keeping your A1c levels < 7%. A1c gives you a picture of your average blood sugar level over the past two to three months. This is especially important to track if you have a family history of diabetes.

The goal is that we all learn to live a heart-healthy lifestyle across the lifespan. This means that adults need to help children learn heart-healthy habits and need to set an example in their own lives. Even making small changes in some of these factors will lower your lifetime risk of CVD.

Healthy Dietary Pattern – at every stage of life

Regardless of your age, food preferences and cultural traditions, it is possible to eat a diet that can improve health and lower your risk for CVD. The Dietary Guidelines for Americans (DGA) outlines the core elements needed for building a healthy dietary pattern for you and your family.

1. Vegetables of all types: Eat vegetables of all colors, especially dark greens, red and orange; beans, peas and lentils; and other starchy vegetables. Start your day with a plan for how you can add veggies to your meals and snacks.
2. Fruits: Eat whole fruits whenever possible. They taste great and make you feel full, thus helping to manage appetite. Learn to pack easy-to-carry fruits with you for a snack.
3. Grains: Choose whole grains whenever possible, with at least half your grains being whole grains. Swap brown rice, whole wheat bread and pasta for white, and explore adding new whole grains in your diet like quinoa, oatmeal or whole-grain cereals.
4. Dairy: Use low-fat and fat-free milk, yogurt and cheese, and/or lactose-free versions or fortified soy beverages and yogurt as alternatives.
5. Protein foods: Use lean meats, poultry and eggs; seafood, beans, peas and lentils; and nuts, seeds and soy products. Try adding meatless meals to your week.
6. Oils: Use vegetable oils and oils in foods over saturated fat alternatives.

Foods to limit in the diet

With better food labeling and learning to cook at home, you can begin to limit foods or food ingredients that might increase your risk of CVD. Once you have added the health foods listed above, your diet won’t have much extra room for additional calories. Thus, monitoring your intake of the following foods or ingredients will help to lower your risk of CVD:

1. Added sugars: New labeling allows for easier monitoring of added sugars in the foods we buy. The goal is that < 10% of our daily calories come from added sugar starting at the age of 2. For most of us, this means eliminating sweetened beverages and consuming fewer desserts and other high-sugar foods.
2. Saturated fat: Again, the goal is to keep saturated fat intake to < 10% of daily calories starting at age 2. This means less animal-based foods and baked/fried goods that are typically higher in saturated fat. If you consume 2,000 calories daily, this means < 22 g/day of saturated fat. To put this number in perspective, a large serving of fries (~3.5 g saturated fat) with a 3 oz hamburger patty (5 grams) topped with 1 oz of cheddar cheese (6 grams) will be more than half your saturated fat intake for a day (total = 14.5 g).
3. Sodium intake: Keeping sodium intake < 2,300 mg per day; this means paying attention to processed and prepared foods with added salt and using the salt shaker sparingly at home. Americans consume ~3,400 mg of sodium per day, with most of our sodium coming from the salt added during commercial food processing or prepared foods in restaurants.
4. Alcohol intake: Choose not to drink or drink in moderation (< 2 drinks/day for men and < 1 drink/day for women). Drinking less is better for health and helps with weight management. Some individuals, such as pregnant women, should not drink.

Adapting a heart-healthy lifestyle

Making change isn’t easy, but selecting to follow a few of the recommendations above will help move you toward a heart-healthy lifestyle. It is never too late to start: just open the door and take a walk, plan some healthier food options into your day and learn the joy of cooking. We all have to start somewhere — you can start today!

References:

• Tsao CW, Aday AW, Almarzooq ZI et al. Heart disease and stroke statistics – 2022 Update: A report from the American Heart Association. Circulation, 2022;145 (in press, on-line).
• Juonala M, Wu F, Sinaiko A, et al. Non-HDL Cholesterol levels in childhood and carotid intima-media thickness in adulthood. Pediatrics 2020, 145(4);1-9.

Related links: Handout | Women and Heart Disease
Video | How to Perform a Blood Pressure Assessment
ACSM Position Stand | Exercise and Acute Cardiovascular Events: Placing the Risks into Perspective


Melinda M. Manore, Ph.D., RD, FACSM, is a Professor Emeritus in Nutrition at Oregon State University (OSU) where her research focuses on the interaction of nutrition and exercise for obesity and chronic disease prevention, health and performance. She has especially focused on active women over her research career. Although retired, she continues to do research, write textbooks and keeping in touch with colleagues and former students.