Beat That: 12 Easy Tips For Maintaining A Healthy Heart
Medically reviewed on Mar 6, 2018 by L. Anderson, PharmD.
Throw Out the Smokes
OK, we admit: this one is not easy. But if you smoke, know that quitting is the number one thing you can do to help protect your heart. Not only is smoking bad for your heart, it can:
- Lead to lung cancer
- Cause COPD
- Boost your stroke risk
- Take a major toll on your wallet.
But you can reverse some of the damage. Boycotting tobacco can add years to your life.
Group support, counseling, and treatments such as:
- Bupropion (Zyban)
- Varenicline (Chantix)
- Nicotine replacement therapies like Nicorette, Habitrol, or Nicoderm CQ
may be effective ways to boost your chances for successful smoking cessation.
And this is not just idle talk -- the benefits of smoking cessation have been demonstrated in clinical trials in a wide range of patients. Cigar and pipe smoking is also linked with cardiovascular disease, and smokeless tobacco is highly addictive and can lead to oral cancers.
Fish Oil and Omega-3 Fatty Acids
Fish oil is not just a fad; clinical trials have shown that fish oil supplementation may improve several heart risk factors for patients with established coronary heart disease, including fatal heart attacks. Higher doses of fish oil, roughly 3 to 4 grams per day, can also lower triglyceride levels. It may be worth discussing this option with your doctor.
In patients without heart disease, fish oil supplements do not appear to lower the risk of death from heart disease, heart attack or stroke, according to a 2018 study in JAMA Cardiology.
Fish oil supplementations, which should include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), should be taken at a dose of roughly 200-800 mg/day of EPA/DHA. You can also get EPA/DHA in 1 to 2 weekly servings of oily fish such as:
- Atlantic salmon
Pregnant women should follow their doctors order on fish consumption, as many fish are high in mercury.
Modest fish oil consumption (roughly 250 mg/day EPA+DHA) may reduce the risk of coronary heart disease death and sudden cardiac death, with little if any risk. Nausea and a "fishy taste" are often the most common side effects of fish oil.
Know Your Heart Age
Just hit your 50th birthday? Congrats! But how old is your heart?
Many Americans have a heart older than their age would suggest. The Centers for Disease Control and Prevention (CDC) has developed a 'Heart Age' Calculator to help you determine this number. The Heart Age calculator is meant to be used by individuals 30 to 74 years old who have no history of cardiovascular disease (e.g., heart attack, stroke, peripheral artery disease, or heart failure).
You can adjust it to see how changing your BMI, weight, or blood pressure might affect your heart age. Then it makes sense to discuss this with your doctor, who can provide meaning and advice behind the numbers.
To Drink or Not to Drink?
It's always best to talk to your doctor first to determine the risks and benefits of alcohol use in your specific case. If you don't drink, it's best not to start just because studies say it might be good for your heart.
Some (but not all) studies have shown positive benefits of moderate alcohol use on heart health. This means no more than two drinks a day for men, and one drink a day for women.
One drink is considered:
- 12 ounces of beer
- 5 ounces of wine (about 150 mL)
- one shot (1.5 ounces) of 80-proof liquor (about 50 mL).
Obviously there are many reasons for people to avoid alcohol all together -- underage drinking, driving while impaired, pregnancy, alcoholism, liver disease or other health conditions, and possible drug interactions.
Moderate to high alcohol consumption (three or more drinks/day) are also linked with elevated risks for breast cancer in women. There is consistent evidence that breast cancer risk is higher for women consuming moderate to high levels of alcohol (three or more drinks per day) compared with abstainers. Compared to women who don't drink at all, women who have three alcoholic drinks per week have a 15% higher risk of breast cancer, according to Breastcancer.org. And a recent study from May 2017 from the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF) suggests even one drink per day can elevate the risk for breast cancer.
Again, if you don't drink, starting for health benefits is not recommended.
De-stress for Success
Life is stressful. Work, money, kids, household chores and bills can all add up. That's why it's important to make time to de-stress.
Aim for a few changes in your life to boycott stress:
- A daily 30 minute walk or run, yoga, meditation, prayer, or even a warm aromatherapy bath can do wonders to ease the tensions of daily life.
- Have a warm cup of tea.
- Extra time with friends or family to discuss the days events, hopes, and future aspirations. Focus on the good.
- Limit caffeine intake, especially later in the day, to boost the chances for a restful sleep (this includes soda).
- Put the electronics away -- at least 30 minutes before bedtime -- and that means the TV positioned right in front of your bed, too.
See what works for you best. Choose at least one change.
It's Time to Fiber-Up
The US diet contains way too little fiber, thanks mainly to processed foods found on the grocery shelves. On average, we should be eating abut 25 to 30 grams of fiber per day. Fiber is great to help you feel full and keep your weight down, which is healthy for your heart. Plus, fiber helps to prevent constipation and straining.
Where to get fiber?
- Whole grain breads, oatmeal, brown rice, high-fiber cereals
- beans and other legumes
- green peas
- berries like raspberries and boysenberries
- whole wheat pastas
all have significant amounts of fiber.
Fiber supplements like Fiberall (polycarbofil) or Benefiber (wheat dextrin) can also be added to a diet to boost fiber grams. Bloating and gas can be side effects, so start slowly with fiber supplements and work your way.
Look at the nutrition labels at the store to find foods high in fiber (try to aim for 3 grams of fiber or higher per serving), and be sure to drink at least 6-eight ounce glasses of fresh water daily, too.
What About Salt?
One teaspoon of salt contains roughly 2,300 milligrams (mg) of sodium. For years, the American Heart Association (AHA) has recommended a low sodium diet, 1,500 mg or less, for patients with high blood pressure. In fact, the AHA still recommends these low levels, suggesting no more than 2,300 mg a day for an average person, and an ideal limit of no more than 1,500 mg per day for most adults. The average American eats more than 3,400 milligrams of sodium each day, about 50% more than what experts recommend.
In a controversial study published in Lancet in 2016, researchers found a direct link between high blood pressure, high sodium intake (urinary sodium excretion of 7 grams per day or more), and heart disease and death, increasing the risk by 23%. However, the study also suggests that a low-salt diet (urinary sodium excretion of 3 grams per day or less) increases the risk of heart attack or stroke by 26% for people without high blood pressure and 34% for people with high blood pressure. High salt intake in people with normal blood pressure was not linked to heart disease or death. The takeaway message was that lowering sodium intake is "best targeted at populations with hypertension who consume high sodium diets." The AHA disagreed with the conclusions and research design of the study, which assigned participants to high or low sodium groups based on a single urinary measure of sodium. The AHA still recommends low to moderate salt intake for everyone.
What to do? If you've been told to limit sodium don't change your intake until you've spoken with your doctor. If cutting back on sodium is still recommended for you, try to buy fresh vegetables, meats, and frozen foods without salt added. Cut back on salt slowly but daily, avoid fast food, and try to substitute with salt-free herbs, spices, and fresh lemon juice. Avoid monosodium glutamate (MSG). Check labels for other sources of hiddem sodium. In 2016, the FDA called upon the food industry to lower salt in processed food.
Be careful with salt substitutes that contain potasium chloride unless your healthcare provider agrees that you can safely use them. Some salt substitutes can be dangerous to your health and heart, and have drug interactions with certain medicines, like Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARBs). ACEI and ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion.
Don't Snooze Over Your Sleep Apnea
Does your significant other complain about your snoring? Are you tired all day, wishing for a nap at 2 PM?
Snoring and daytime sleepiness may be a sign of a more serious problem, known as obstructive sleep apnea. If you think you might have sleep apnea, it's important to talk to your doctor and schedule a sleep study. Sleep apnea can increase your risk of a variety of heart-related problems -- from high blood pressure to heart failure to stroke -- so a diagnosis is key.
Talk to your doctor about the various treatments options, including:
- continuous positive airway pressure (CPAP)
- certain sleep apnea oral appliances fitted by a dentist
- upper airway surgery
CPAP is the most commonly used and studied treatment.
Keep A Check on Your Blood Sugar
Diabetes is not just hard on your kidneys. Preventing type 2 diabetes can help to lower your risk for heart disease, heart attack, stroke, dialysis, and possible amputation.
A regular adult check-up may include a blood sugar (blood glucose) test. High blood sugar can be the sign of pre-diabetes. Your doctor might order a random or fasting blood glucose test, an oral glucose tolerance test, or a hemoglobin A1c test to evaluate your blood sugar.
If you have pre-diabetes, it is important to:
- make changes in your food choices
- quit smoking
- take your prescribed medications as directed
- get at least 30 minutes of exercise every day to help ward off full-blown diabetes.
Your doctor may decide to put you on a medication known as metformin (Glucophage), too, and effective and commonly used type 2 diabetes medication.
High blood pressure and high cholesterol do not usually produce any symptoms. Not until there is chest pain, heart attack, or stroke.
If you're over 40, you should have your blood pressure checked at least yearly by your doctor; more often if your doctor determines you need it.
Men should be screened for high cholesterol at least by age 35 and women by 45 (but earlier if risk factors exist). Risk factors might include:
- high blood pressure
- a strong family history of heart disease.
Ask you doc about the need for a heart "stress test", too. If you doctor prescribes medications to lower your blood pressure or cholesterol, it's important to take them. Remember, heart disease is often a "silent" killer.
Aspirin: Is It Always the Wonder Drug?
Aspirin is not for everyone. Low dose (81 mg) aspirin may be used to lower the occurrence of a potentially fatal heart attack, and can also fight off colon cancer in patients 50 to 60 years of age, according to the April 2016 USPSTF recommendations.
Your doctor may decide that the benefits of daily low-dose aspirin for primary prevention (to lower the chance of a first heart attack or death) outweigh its risks if:
- You are 50 to 69 years of age
- Have a 10% or greater 10-year cardiovacular disease risk
- Are not at a high risk of bleeding
- Have at least a 10-year life expectancy
- You are willing to take low-dose aspirin daily for at least 10 years.
Evidence is insufficient to recommend aspirin for primary prevention in people younger than 50 years or older than 70 years.
Aspirin can cause bleeding, and it's especially dangerous in the stomach. So it's important to take a daily aspirin for your heart ONLY if recommended by your doctor. Your doctor can weigh your risks of aspirin use compared to it's benefits; this decision is always made on a patient-by-patient basis, looking at health conditions, other medications, and family history.
And don't forget about other prevention measures: healthy blood pressure and cholesterol levels also reduce the risk of heart disease, and regular screening -- a colonoscopy -- can help prevent colon cancer.
Antioxidants and Vitamins: Worthwhile or Weak Evidence?
Antioxidants have been touted as having the ability to rid the body or toxic free radicals and lower the risk for heart disease, but studies do not support this notion.
Most clinicians do not recommend external high-dose vitamin or antioxidant supplements (beta-carotene, vitamin A, C and D) in healthy adults. In fact, beta-carotene has been shown to increase the risk of lung cancer in some patients who smoke. In addition, the USPSTF recommends against the use of β-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer.
The fat-soluble vitamins -- A,D,E and K -- can be toxic in excessive doses; always ask your doctor before you use a fat-soluble vitamin. In fact, a well-balanced diet that includes fresh vegetables and fruits, dairy with vitamin D and regular sun exposure should be adequate for vitamin D and anti-oxidant levels in most people. However, older patients may need vitamin D supplementation. Some people do need vitamin supplements in certain situations, too, such as pregnancy or in severe vitamin deficiencies.
Finished: Beat That: 12 Easy Tips For Maintaining A Healthy Heart
- Up to Date. Patient education: Aspirin in the primary prevention of cardiovascular disease and cancer (Beyond the Basics). Updated Nov. 1, 2016. Accessed March 6, 2018 at https://www.uptodate.com/contents/aspirin-in-the-primary-prevention-of-cardiovascular-disease-and-cancer-beyond-the-basics
- Mente, Andrew et al. Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies. The Lancet 2016; 388: 465-75. Accessed March 6, 2018 at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30467-6/fulltext
- World Cancer Research Fund. American Institute for Cancer Research. Continuous Update Project Report. Diet, Nutrition, Physical Activity, and Breast Cancer 2017. Accessed March 6, 2018 at http://www.aicr.org/continuous-update-project/reports/breast-cancer-report-2017.pdf
- Wang C, Harris WS, Chung M, et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr. 2006;84(1):5.
- Stead LF, Koilpillai P, Fanshawe TR, et al. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Mar 24;3:CD008286. doi: 10.1002/14651858.CD008286.pub3. Accessed 3/6/2018 at http://www.ncbi.nlm.nih.gov/pubmed/27009521.
- Mohiuddin SM, Mooss AN, Hunter CB, et al. Intensive smoking cessation intervention reduces mortality in high-risk smokers with cardiovascular disease. Chest 2007; 131:446-52. Accessed 3/6/2018 at http://www.ncbi.nlm.nih.gov/pubmed/17296646.
- UpToDate. Patient information: High cholesterol treatment options (Beyond the Basics). Updated 11/2015. Accessed 3/6/2018 at http://www.uptodate.com/contents/high-cholesterol-treatment-options-beyond-the-basics
- UpToDate. Fish oil and marine omega-3 fatty acids. Updated Aug. 24, 2016. Accessed March 6, 2018 at https://www.uptodate.com/contents/fish-oil-and-marine-omega-3-fatty-acids
- Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol. 2011;58:2047-67. Accessed 3/6/2018.
- Vivekananthan DP, Penn MS, Sapp SK, et al. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomized trials. Lancet. 2003;36:2017-23. Accessed 3/6/2018.
- Vitamin Supplementation to Prevent Cancer and CVD: Preventive Medication. U.S. Preventive Services Task Force (USPSTF). Release date: Feb. 2014. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/vitamin-supplementation-to-prevent-cancer-and-cvd-counseling