What are the best practices for maintaining heart health in a general adult population without specific medical conditions?

Heart Health: Evidence-Based Lifestyle Priorities

The most important actions to protect your heart are to stop smoking completely, exercise at least 150 minutes weekly at moderate intensity, eat a Mediterranean-style diet rich in vegetables, fruits, whole grains, fish, nuts, and olive oil, maintain a healthy weight (BMI <25 kg/m²), and control blood pressure below 120/80 mmHg. 1

Smoking Cessation: The Single Most Critical Action

• Complete tobacco cessation is mandatory—this includes avoiding all secondhand smoke exposure at home and work 1
• Ask your healthcare provider for counseling, referral to cessation programs, or pharmacotherapy to assist with quitting 1
• No amount of smoking is acceptable; this is a Class I recommendation (strongest evidence level) 1

Physical Activity: Non-Negotiable Daily Movement

• Perform at least 150 minutes per week of moderate-intensity aerobic activity, or 75 minutes of vigorous-intensity activity, spread throughout the week 1
• Each exercise session should last at least 10 minutes 1
• This recommendation applies even to patients historically told not to exercise, including those with heart failure 2
• Physical activity reduces cardiovascular events by improving lipid profiles, blood pressure, and glucose control 1

Dietary Pattern: Mediterranean-Style Eating

Focus on the overall dietary pattern, not isolated nutrients—this is the key to reducing atherosclerotic plaque formation 1, 3

Foods to Eat Daily:

• Vegetables and fruits: at least 4.5 cups per day combined 1, 3
• Whole grains: at least 3 servings daily (replace all refined grains) 1, 3
• Nuts: 15-30 grams (small handful) of unsalted nuts daily—this reduces coronary artery disease risk by 24% 3, 4
• Extra-virgin olive oil as your primary fat source—reduces atherosclerosis progression 3
• Legumes: up to 400g weekly as a replacement for red meat 3

Foods to Eat Weekly:

• Oily fish: 1-2 times per week (at least two 3.5-oz servings) 1, 3
• Fermented dairy: yogurt daily, cheese 3 servings per week 3

Foods to Strictly Limit or Avoid:

• Saturated fat: less than 7% of total calories 1
• Trans fats: less than 1% of total calories—minimize partially hydrogenated oils 1
• Dietary cholesterol: less than 300 mg daily 1
• Sodium: less than 1500 mg daily (ideally) or no more than 6g salt daily 1
• Sugar-sweetened beverages: less than 450 kcal per week 1, 3
• Processed and red meat: replace with legumes or poultry 3, 5

Critical caveat: The Southern dietary pattern (fried foods, added fats, organ meats, processed meats, sugar-sweetened beverages) increases heart disease risk by 56% and stroke risk by 30%—avoid this pattern entirely 5

Weight Management: Achieve and Maintain Healthy BMI

• Target BMI less than 25 kg/m² with no central obesity 1
• Balance caloric intake with physical activity to achieve weight loss when needed 1
• If necessary, enroll in a formal weight-loss program 1
• Weight reduction is particularly important for blood pressure control 1

Blood Pressure Control: Lower is Better

• Optimal blood pressure is less than 120/80 mmHg 1
• If blood pressure reaches 140/90 mmHg or higher, lifestyle modifications plus drug therapy are required 1
• For those with diabetes, target is even lower: less than 130/80 mmHg 1
• Lifestyle modifications alone should be attempted for 6-12 months before adding medications if blood pressure is 140-159/90-99 mmHg 1

Cholesterol Management: Know Your Numbers

• Total cholesterol should be less than 200 mg/dL 1
• LDL cholesterol should be less than 100 mg/dL 1
• HDL cholesterol should be greater than 50 mg/dL 1
• Triglycerides should be less than 150 mg/dL 1
• Statin therapy is indicated based on your 10-year cardiovascular risk, which your physician can calculate 1

Alcohol Consumption: Moderation Only

• If you drink alcohol, limit to 1 drink daily for women, 2 drinks daily for men 1
• One drink equals 12 oz beer, 5 oz wine, or 1.5 oz spirits 1
• Do not start drinking alcohol for heart health benefits 1

Blood Glucose Control: Essential for Diabetics

• Maintain HbA1c less than 7% if you have diabetes 1
• Fasting blood glucose should be less than 100 mg/dL 1
• Diabetes automatically places you at high cardiovascular risk, requiring aggressive management of all other risk factors 1

Implementation Strategy: Practical Algorithm

The evidence shows that multifactorial lifestyle interventions reduce fatal cardiovascular events by 18% 6

1. Immediate actions (start today):

   • Stop all tobacco use 1
   • Begin 30 minutes of daily physical activity 1
   • Add a handful of unsalted nuts to your daily diet 3, 4

2. Within one week:

   • Transition to Mediterranean dietary pattern with extra-virgin olive oil 3
   • Eliminate sugar-sweetened beverages 1, 3
   • Replace processed/red meat with fish, legumes, or poultry 3

3. Within one month:

   • Schedule appointment to check blood pressure, cholesterol, and glucose 1
   • Calculate your 10-year cardiovascular risk with your physician 1
   • Establish weight loss plan if BMI is 25 or higher 1

Common pitfall: Many patients focus on isolated nutrients (like cholesterol intake) rather than overall dietary patterns—the evidence clearly shows that the Mediterranean dietary pattern reduces cardiovascular events by 30%, which is far more effective than targeting single nutrients 3, 7

Another critical caveat: Even with acceptable glucose control, patients with diabetes remain at high cardiovascular risk and must aggressively manage blood pressure, cholesterol, weight, and lifestyle factors 8