With heart disease still topping the list of causes of death in the U.S., heart health is a worthy area of focus for all of us hoping to live long lives full of the activities that bring us joy. Why do we seem to struggle with this so particularly in America? The typical modern Western diet certainly isn't helping. We discussed heart health, heart disease, and how to give your heart the best chance of staying on beat through the years ahead with Dr. Larry Gassner, our friend and physician (check out previous articles we wrote with Dr. G here and here).
Don't Go Breaking Your Heart
Lifestyle factors account for about 70% of heart health, with medication-based interventions making up the other 30%. That means there's a lot you can do on your own to keep your heart in the best shape it can be, but it also means that sometimes you need to take what the doctor has prescribed. The health components that can affect your risk of heart disease might sound familiar: weight management, blood pressure, cholesterol, physical fitness, and inflammation.
Obesity, or even just carrying excess body fat, are associated with the development of cardiac issues both directly and indirectly. For example, directly, adipose tissue (a.k.a. fat tissue) secretes hormones that increase inflammation. Indirectly, extra body fat is associated with hypertension, type 2 diabetes, and sleep disorders.
Speaking of hypertension, high blood pressure is also associated with heart disease, because your heart has to work so much harder to move blood throughout your body. Resulting changes in the cardiac muscle can progress to heart failure if left untreated.
High levels of LDL cholesterol and low levels of HDL cholesterol are associated with increased cardiac risk. What's high and what's low? An LDL over 100 and an HDL less than 40 are the indicators that you need to make some changes. If you are genetically predisposed to higher cholesterol, or if lifestyle changes don't help get your levels to a healthier range, you may be a higher risk person who needs more aggressive treatment to prevent the development or progression of heart disease.
Physical fitness is super important for heart health both for how it affects the above factors, but also for its strengthening effect on your heart itself—after all, the heart is a muscle. Regular moderate- and vigorous-intensity physical activity improves your heart's ability to pump blood throughout your body. Better blood flow means more oxygen gets where it needs to go and more waste can be removed.
Last but not least, inflammation is hugely related to heart health, in particular vascular inflammation. But inflammation is inflammation, so if you have other conditions associated with increased inflammation in your body, vascular inflammation is something you'll want to keep an eye on as you age. We'll discuss inflammation and how to track it a bit later on.
Your Eatin' Heart
As we've previously discussed, the typical modern Western or American diet is one that is unfortunately not very aligned with good nutrition. Packaged, processed foods from the center aisles of the grocery store are abundant when what we really need more of are the fresh, whole foods from the produce section and the perimeter of the store.
How did we get here? Without going too deep down the rabbit hole of how our current dietary landscape came about, let's just say motives beyond public health have been at play with dietary guideline campaigns in the past century, like the food pyramid many of us became familiar with in the latter decades of the 20th century. It turns out that eating 6-11 servings of carb-heavy foods may not be the best idea for your long-term health after all, especially if the carbs in question are from ultra-refined and processed sources.
So which dietary guidelines should you follow? The Mediterranean diet, which puts fresh vegetables and lean protein front and center, is a much healthier rubric to use when planning your meals. Avoiding excessive simple carbohydrates (e.g. refined grains like white flour and white rice, foods with added sugars like candy and sodas, honey, and processed breakfast cereals) is the main rule of thumb, plus aiming for a colorful plate of oranges, greens, and reds (from veggies, not gummi worms 😉).
Why avoid simple carbs? Aren't all carbohydrates energy? Depends on what kind of energy you're looking for. Simple carbs are called "simple" because your body can digest and absorb the sugars from them much faster than the "complex" carbs found in foods like veggies and whole grains. That fast absorption leads to a blood sugar spike and crash that can not only leave you feeling hungry and tired sooner, but also contributes to the inflammation associated with increased risk of heart disease. Not to mention the increased odds of developing type 2 diabetes.
Foods that are refined and/or have added sugars are also usually lacking in the vitamins and minerals that our bodies need, unless they're fortified. Although an apple contains naturally occurring sugars, it's always going to be a healthier choice than a packaged cookie because it's also providing your body with fiber and other necessary nutrients you can't get from straight sugar. Your body will take longer to digest that apple and its sugars will thus enter your bloodstream at a slower rate, helping you feel full longer and keep your energy level on a more even keel. That whole "an apple a day" thing? You might still need to see the doctor eventually, but you'll have fewer issues to bring to the doc if you've eaten apples instead of cake every day.
Listen to Your Heart: Tracking Inflammation
One of the best ways to assess how your lifestyle choices are affecting your health is to keep track of levels of inflammation in your body, especially vascular inflammation. There are noninvasive markers of inflammation you can test with your doctor, like cholesterol levels, but these aren't one-and-done tests: you need to know your baseline levels and then track how they change over time.
Seeing how your inflammation markers progress in response to lifestyle changes can help you and your doctor make further decisions about your health. While a healthier lifestyle significantly decreases your risk of heart disease, if your vascular inflammation levels remain high despite making the changes you can, that is when medical interventions may become necessary, like beginning statin therapy.
Beyond testing and tracking inflammation levels, you can also be tested for the genetic marker Lp(a), which, if positive, puts you at a much higher genetic risk of developing heart disease, and would thus warrant more aggressive treatment if you began showing signs of heart disease. A family history of early onset heart disease can be an indication that you should be tested for this genetic marker.
Even if you do everything right, the risk of heart disease is never zero and it does increase with age for everyone. But by making efforts to reduce inflammation through lifestyle choices, you can reduce your relative risk.
Symptoms of a Heart of Glass
Knowing the signs of heart disease is extremely important so that you can respond appropriately and involve your doctor. The classic symptoms in both men and women are a noticeable decrease in exercise tolerance, cardiac pain or a heartburn sensation that goes away when you stop exercising, and fatigue.
Cardiac pain is a pressure sensation that feels kind of like someone is sitting on you and won't get off, like maybe a particularly annoying (and heavy) sibling or cousin. In women, it can manifest instead as a heartburn feeling, which can be confusing. If you taste stomach acid, it's probably safe to say it's regular heartburn, but if in doubt, don't wait to get it checked out. Even if it ends up being heartburn after all, you and your doctor will be relieved to have ruled out cardiac pain.
Once you are symptomatic with heart disease, your doctor will likely put you on medication to help prevent further progression, and may refer you for additional testing to determine if there are any blockages of blood to your heart. Alongside medical interventions, it's important to be actively involved in your treatment by making diet and exercise choices that support your heart. Don't forget: lifestyle factors account for 70% of heart health and medicine only covers the other 30%.
Make Sure Your Heart Will Go On and On
No matter what your family history or health background may be, you can take your heart health into your own hands by making healthier decisions each day and collaborating with your doctor to check in on how those decisions are working for you. Especially as we age, it's so important to catch potential heart problems early, so you can avoid falling apart in a Total Eclipse of the Heart.
We built the Restart! app to help folks of all ages and abilities strengthen their hearts with regular, accessible physical activity. The app is coming soon; get on the list to be notified as soon as it's available for download or join the Restart! beta program below!
