How can I reduce my risk of heart disease?

How to Reduce Your Risk of Heart Disease

Adopt a comprehensive heart-healthy lifestyle centered on dietary modification, regular physical activity, weight management, smoking cessation, and blood pressure control—these evidence-based interventions can prevent the majority of cardiovascular disease in Western populations.

Dietary Modifications: Your First Line of Defense

Consume a dietary pattern emphasizing vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts while limiting sodium, sweets, sugar-sweetened beverages, and red meats 1. This approach can be achieved through established patterns such as the DASH diet, USDA Food Pattern, or AHA Diet 1.

Specific Dietary Targets:

• Eat fish, especially oily fish, at least twice weekly to obtain cardioprotective omega-3 fatty acids 1, 2
• Limit saturated fat to <7% of total energy intake, trans fat to <1% of energy, and dietary cholesterol to <300 mg/day by choosing lean meats, plant-based alternatives, and fat-free or low-fat (1% fat) dairy products 1
• Minimize intake of partially hydrogenated fats (the primary source of trans fats) 1
• Choose whole-grain, high-fiber foods over refined carbohydrates 1, 2
• Minimize beverages and foods with added sugars 1
• Prepare foods with little or no salt 1

The evidence strongly supports replacing saturated fats with polyunsaturated vegetable oils, which reduces CVD by approximately 30%—similar to the reduction achieved by statin treatment 3. In contrast, simply replacing saturated fat with refined carbohydrates provides no cardiovascular benefit 3.

Physical Activity Requirements

Engage in at least 150 minutes per week of moderate-intensity aerobic physical activity (such as brisk walking), or 75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of both 1, 4, 2.

Implementation Details:

• Perform aerobic activity in episodes of at least 10 minutes, preferably spread throughout the week 1
• For blood pressure reduction specifically, aim for 3-4 sessions per week, lasting on average 40 minutes per session, involving moderate- to vigorous-intensity physical activity 1
• Add strength training at least twice weekly for comprehensive cardiovascular protection 4
• Target 60-75% of maximum heart rate for moderate intensity 4

The dose-response relationship is clear: any physical activity is better than none, and additional benefits occur with increased intensity, frequency, and duration 1.

Weight Management

Achieve and maintain a body mass index (BMI) of 18.5-24.9 kg/m² 4, 2. For those with excess weight, this requires balancing caloric intake with physical activity expenditure 1.

Practical Approach:

• Target waist circumference <102 cm (40 inches) in men and <88 cm (35 inches) in women to avoid central obesity 4, 2
• To lose weight, create a caloric deficit by consuming fewer calories than you expend daily 1
• Consider enrolling in a formal weight-loss program if needed 1

Tobacco Cessation

Completely eliminate all tobacco use and avoid exposure to secondhand smoke 1, 4, 2. This is non-negotiable—smoking cessation is essential for cardiovascular disease prevention and should be assessed at every healthcare visit 2.

Blood Pressure Control

Maintain blood pressure below 120/80 mmHg (optimal) or at minimum below 140/90 mmHg 1, 2. If you have diabetes, target stricter control at <130/80 mmHg 2.

Lifestyle Interventions for Blood Pressure:

• Reduce sodium intake 2
• Increase consumption of fruits and vegetables 2
• Maintain regular physical activity as outlined above 2
• If blood pressure remains ≥140/90 mmHg despite lifestyle changes, antihypertensive medication should be initiated 4

Cholesterol Management

Target total cholesterol <200 mg/dL (5.0 mmol/L), LDL cholesterol <100 mg/dL (3.0 mmol/L), HDL cholesterol >50 mg/dL in women, and triglycerides <150 mg/dL 1, 2.

Dietary Strategies:

• Limit saturated fat and dietary cholesterol intake as specified above 2
• Increase intake of foods rich in soluble fiber 2
• Replace saturated fats with polyunsaturated and monounsaturated oils 4, 3

Saturated and trans-fatty acids are the strongest dietary determinants of elevated LDL cholesterol 4.

Diabetes Management (If Applicable)

If you have diabetes, optimize glycemic control with HbA1c <7% through dietary improvements and meeting exercise recommendations 2. Diabetes automatically places you at high cardiovascular risk, requiring more intensive preventive measures 1, 2.

Alcohol Consumption

If you consume alcohol, do so in moderation 1, 2. This means no more than 1 drink per day for women and 2 drinks per day for men.

Risk Assessment and Monitoring

If you are aged 40-75 years, undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation 2. Those at higher risk (>15% 10-year risk) may require more intensive interventions and possibly medication 2.

Common Pitfalls to Avoid:

• Don't focus solely on reducing total fat intake—the type of fat matters more than the total amount 5, 3
• Don't replace saturated fats with refined carbohydrates or sugars—this provides no cardiovascular benefit 3
• Don't assume small amounts of physical activity are worthless—any activity is better than none, with a clear dose-response relationship 1
• Don't ignore these recommendations when eating away from home—consistency is critical 1

Implementation Strategy

Apply these lifestyle modifications simultaneously rather than sequentially 4. Multidisciplinary behavioral approaches combining professional dietary counseling, exercise programs, and behavioral support are more effective than isolated interventions 4. Even low-intensity interventions using print or web-based materials with tailored feedback can provide measurable benefits 4.

The evidence demonstrates that these dietary and lifestyle modifications, when adopted throughout the life-course, can prevent the majority of cardiovascular disease in Western populations 5, 6.