Prepare yourself for a statistic that might make your heart a bit heavier: In the time it will take you to read this paragraph, another American will have suffered a heart attack. That adds up to a yearly total of 805,000 people. And heart disease—which includes heart attacks, arrhythmia, heart failure, and the like—is the No. 1 cause of death in the United States. If you’re concerned about health and longevity, you should be concerned about heart disease.

But maybe you’re not too concerned because you’ve never been diagnosed with heart disease. Well, a new study published in Circulation, the journal of the American Heart Association, shows it’s very possible you have heart disease even if you haven’t been diagnosed. The scientists used precise testing on more than 25,000 people ages 50 to 64 without diagnosed heart disease. They found that 42 percent of them had atherosclerosis, the buildup of the fatty plaque that narrows arteries and leads to heart attack. Earlier research from the Cleveland Clinic, which included older participants, showed that people over 50 have an 85 percent likelihood of atherosclerosis.

Bottom line: You should assume you have life-threatening heart disease and do everything scientifically proven to prevent a heart attack.

Know your numbers

There are several important risk factors for heart disease.

  • Cholesterol. The blood fat cholesterol is the main component in artery-­clogging plaque. For every 40 points you lower total cholesterol, you cut your risk of heart disease by up to 50 percent. Total cholesterol should be less than 200, and for patients with heart disease, less than 160.
  • Blood pressure. High blood pressure damages arteries and is a major risk factor for heart disease. Lowering blood pressure to normal levels can reduce the risk of a heart attack by 64 percent. Normal blood pressure is a systolic (top reading) of less than 120 and a diastolic (bottom reading) of less than 80.
  • Resting heart rate. The most protective level is 60 beats per minute (bpm) or less. A patient with heart disease who lowers their resting heart rate from 90 to 60 bpm lowers their risk of a heart attack by 90 percent.
  • Hemoglobin A1c. This is a measurement of average blood sugar levels over the previous three months. Higher A1c is strongly linked to a more rapid progression of atherosclerosis. Healthy A1c levels are 4 to 6 percent. People with diabetes and individuals with cardiovascular disease should strive for values below 7 percent.

You can modify these risk factors with four simple lifestyle changes: a healthier diet, regular physical activity, losing weight, and not smoking. But if those lifestyle changes don’t work, talk to your doctor about the right cardio­protective medications for you. The most effective are cholesterol-­lowering statins, beta-blockers to lower high blood pressure and resting heart rate, ACE inhibitors to lower high blood pressure, and aspirin to thin the blood and prevent the blood clots that cause most heart attacks.


Eating a heart-protective diet is simple:

  • Try to get six to seven servings of fruits and vegetables every day. Add some to every meal and snack.
  • Reduce your consumption of red meat, particularly processed meats like hot dogs and lunch meat.
  • Eat no more than 1 to 2 grams of trans fat per day. Minimize commercial baked goods, like cakes, cookies, fried foods, nondairy coffee creamer, and stick margarine.
  • Limit salt from processed foods by following the 1:1 rule. The food should have approximately the same number or fewer milligrams of salt as calories per serving.

Physical activity

When it comes to protecting your heart, a little physical activity goes a long way. If you’re sedentary, don’t worry about meeting the government guidelines of 30 minutes of activity most days of the week. Instead, start at a level of activity you’ll actually do, like 10 to 15 minutes three days a week. Once you get started, you’ll slowly but surely increase your daily activity level. Physical activity is particularly protective against heart disease if you’re overweight or obese—and not because it helps you lose weight, but because it improves aerobic fitness.

If you’re tracking daily steps, don’t worry about getting to 10,000 steps per day. The newest research shows that getting 7,000 steps per day lowers the risk of all-cause mortality (dying from any cause, including heart disease) by 50 to 70 percent compared with those who don’t get 7,000 steps daily.

If you want to get even greater cardiovascular benefits from physical activity, monitor your metabolic equivalents (METs)—a measurement of how much energy your body expends. You’re at 1 MET when you’re sitting still. To protect your heart, you want to achieve a capacity to exercise at five METs—which is attained by exercising regularly above 3 METs. That corresponds to walking on a treadmill at 3 mph on a 0 percent grade or at 2 mph on a 3.5 percent grade. If this is too strenuous, gradually achieve that level of activity over time. As a general rule, the exercise should feel “fairly light” to “somewhat hard,” and not evoke chest pain or excessive shortness of breath.

Weight control

People with a body mass index (BMI) of 18.5 to 24.9—so-called normal weight—are at a much lower risk of heart disease than people who are overweight (BMI 25 to 29.9) or obese (BMI 30 or higher). It’s particularly important to lose weight if your BMI is 32 or higher, a level that puts you at much higher risk for heart disease. But you don’t have to lose a lot of weight to benefit. Losing just 5 percent of your body weight dramatically lowers risk.

Don’t smoke

Long-term smoking reduces life expectancy by 10 to 12 years, on average. Cigarette smokers are two to four times more likely to get heart disease than non-smokers. And living with a smoker is bad for you, too. Research shows that frequent exposure to secondhand smoke increases the risk of heart disease by 30 percent.

Take personal control

Don’t rely on your primary care physician to take responsibility for your heart health. Eating right and exercising regularly are your responsibility.

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