The American Heart Association and the American College of Cardiology caused a ruckus late last year when they issued new guidelines that, by some measures, would double the number of people who should be taking a cholesterol-lowering drug.
Lost in the ensuing uproar was a less controversial but in some ways more far-reaching recommendation from the same organizations: a renewed emphasis on the power of lifestyle changes in preventing and treating heart disease.
Another advantage of focusing on lifestyle: The heart-protective effects go beyond cholesterol reduction. You can lower your blood pressure, lose weight and perhaps reduce inflammation in the arteries, a risk factor increasingly linked to heart attacks and strokes. In fact, Consumer Reports’ medical experts say, making lifestyle changes can eliminate the need for drugs.
The five steps highlighted here yield important health benefits — and show that it’s never too late to make changes.
How it helps: People who exercise regularly have a 30 to 40 percent lower risk of heart disease than those who don’t, the research suggests. Exercise strengthens your heart muscle at the same time that it controls inflammation and helps keep weight, cholesterol and blood pressure at healthy levels. Strength training improves heart health, too, because more muscle equals a faster metabolism, which makes it easier to keep weight off.
What to do: It doesn’t take a lot. Aim for 75 minutes of vigorous exercise a week (such as two Zumba classes or jogging at a 7-mph pace) or 21 / 2 hours of moderately intense activity (equal to walking at 4 mph), which comes out to 30 minutes a day, five days a week. Even just standing up can help: Recent research suggests that prolonged sitting lowers levels of HDL (good) cholesterol, raises artery-clogging triglycerides and decreases the insulin sensitivity that boosts the risk of Type 2 diabetes.
How it helps: Vegetables and fruit, whole grains, nuts and beans have each been linked to a healthier heart. Those foods are high in protective nutrients such as potassium and fiber, and free of or very low in saturated fat. And those are the same nutrients that are plentiful in the DASH (Dietary Approaches to Stop Hypertension) diet, which was highlighted in the new guidelines and can lower heart-disease risk by 18 percent, research shows.
What to do: Make plant foods and fish the centerpiece of your meals. When you do eat meat or poultry, stick to three-to-four-ounce portions and choose lean cuts. Include a variety of fruit and vegetables with a host of colors. That ensures that you’ll get the complete array of nutrients that have been linked to good health. In addition, replace foods rich in saturated fat, such as butter, with canola, olive oil and other unsaturated oils.
How it helps: Some research suggests that emotional stress can be almost as bad for your heart as more-familiar risk factors such as high blood pressure. Negative emotions trigger the release of hormones that can threaten your heart. People in rocky relationships, for example, are more prone to heart disease.
What to do: Develop your own portfolio of coping strategies. Exercise helps, in part because it appears to reduce levels of stress hormones and can keep your blood pressure down when you’re under duress. Yoga and tai chi are particularly good options because they lower blood pressure and heart rate. And be sure to schedule some time each day to unwind, whether it’s with meditation, massage or music.
How it helps: Moderate drinking can raise a low HDL (good) cholesterol level, and it reduces the risk of death from heart disease by about 25 percent. It may also help prevent Type 2 diabetes and ischemic strokes, the kind caused by blood clots.
What to do: It doesn’t seem to matter much what kind of alcohol you consume, as long as you keep it to two drinks a day for men or one a day for women. The benefits appear to be highest among people at increased risk of heart disease, notably men older than 40 and women older than 50. If you don’t drink, though, don’t start.
How it helps: Smokers are two to four times as likely to develop heart disease as nonsmokers. But once you quit, you can eventually lower your risk to that of someone who has never smoked.
What to do: The most successful strategies for most people include counseling, nicotine-replacement products or both. Those products are most helpful for the first two to three months of quitting, when the risk of a relapse is greatest. Using them for longer than that should occur only under the supervision of your doctor, because there is a risk of becoming addicted to the replacements themselves.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.