Imagine you were getting your car tuned up for a long road trip: you’d add oil, washer fluid, coolant, maybe rotate or replace the tires and perhaps check the brake pads. But all of that effort would be wasted if your car’s engine wasn’t working. That’s because without a functional engine, your car isn’t going anywhere.
That’s a fitting analogy for your heart: it’s the engine for your entire body. If your body’s engine isn’t operating optimally, your overall health may decline. In fact, according to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the U.S. In 2020, about 697,000 people died of heart disease—about one out of every five deaths.
The American Heart Association has identified eight ways you can improve your heart health, dubbed Life’s Essential 8™ —a checklist for heart-healthy factors and behaviors. First on the list is a healthy diet.
A Nourished Heart
Heart health experts acknowledge that the guidelines for heart-healthy nutrition have changed over the years.
“The nutrition guidelines have actually evolved quite a bit,” says Susie Hong-Zohlman, MD, MSc, a cardiologist and the medical director of echocardiography at the University of Maryland Medical Center.
“One major thing I recall as a child was the low-fat, high-carb recommendation, which resulted in people eating a lot of processed foods during that time. Unfortunately, this led to a rise in obesity and diabetes in the years that followed,” she explains.
This was followed by the Atkins diet, which prized protein and fat, and minimal carbs. “While the Atkins diet was effective in weight loss, it put people at risk for abnormal cholesterol levels and heart disease,” says Dr. Hong-Zohlman.
Today, there is a shift toward the paleo diet, which focuses on fruits and vegetables and limits processed foods. Another trend is the ketogenic diet, a low-carb, high-fat diet that claims to cause a metabolic state of ketosis—where your body gets its energy from fat.
But, Dr. Hong-Zohlman says, “It is rare that going from one extreme to another is a good thing. The problem with these diets is that they’re short-term and not sustainable. Instead, I advise incremental and manageable adjustments to lifestyle and being more conscientious and mindful of what you’re eating.”
Kate Elfrey, D.O., a cardiologist with The Heart Center at Mercy, adds, “Your diet should focus heavily on fruits, vegetables and natural foods. It should also include the good fats, like avocados and nuts. What we want to stay away from is anything processed, such as refined sugar and carbs. We have to live in moderation.”
An Active Heart
Second on the Life’s Essential 8™ checklist is being active. Your heart is a muscle. Like any muscle, the more you exercise it, the stronger it gets.
“Perhaps you’ve heard the saying, ‘Sitting is the new smoking’? Being sedentary has been proven to be really detrimental for cardiovascular health,” says Dr. Hong-Zohlman.
“I think a lot of people kind of get down on themselves for not getting to the gym every day,” adds Dr. Elfrey. “But there’s actually a shift here as well. Going to the gym is still wonderful, but we are focusing more on living an overall active lifestyle.”
A Substance-Free Heart
For many, another important step toward better cardiovascular health is to quit smoking. Life’s Essential 8™ also recommends quitting tobacco.
“Many people think smoking primarily causes lung cancer,” explains Dr. Hong-Zohlman. “But what they don’t realize is how terrible smoking is for the heart, and particularly for the blood vessels. I always remind my patients to stop smoking during each visit, although I know how difficult that can be.”
A Unique Heart
The remaining recommendations on the American Heart Association’s list involve managing sleep, weight, cholesterol, blood sugar and blood pressure.
While all these methods are helpful in prevention, it’s important to note that you may follow all the best cardiovascular advice and still be at risk for developing heart disease, depending on your unique medical profile. That’s why it’s incredibly important to find a trusted doctor who can work with you to prescribe medications that target your specific risk factors. Some patients, for example, may be more prone to high blood pressure or cholesterol.
But even with heightened risk, there’s hope for your heart. The medical field continues to produce advancements that make your heart’s future brighter.
For example, Dr. Elfrey is excited about the potential of two relatively new non-invasive imaging modalities: the CT Coronary Angiogram and the Cardiac MRI.
“It used to be if we really wanted to know if your arteries were blocked, we had to go inside and do a heart catheterization,” explains Dr. Elfrey. “But these new imaging options allow us to get a really great view of what’s going on in the heart without having to put the patient through an invasive procedure.”
Knowing Who to Trust
With so many medical breakthroughs and evolving guidelines, it can be tough for patients to navigate their treatment plan. When the prevailing advice changes, how can we know when to trust those changes, when to proceed with caution and when to consider our own experiences?
“I always want to give credit to my patients who are actually doing the background search and challenge me, and actually encourage them to do that,” Dr. Hong-Zohlman says. “Because, you know, a lot of it is an art and, as much as medicine is science, right? There is an art to it, and a lot of it is what your experience has been, you know what the outcomes have been.”
But without medical expertise of our own, we can miss essential context for the bigger picture.
A Forbes op-ed by Ethan Siegel—a Ph.D., astrophysicist, author and professor—urges patients to look for a scientific consensus, which means the overwhelming majority of qualified professionals hold the same professional opinion, when doing research.
Also, having a trusted doctor to go through that research with you, share opinions and monitor your health outcomes over time is key.
“Find a doctor who is positive and ready to develop a comprehensive treatment plan that includes medications and testing but also advocates a whole-body approach that includes health and wellness guidance,” advises Dr. Elfrey.
For American Heart Month, in addition to these heart-healthy tips, Dr. Hong-Zohlman leaves the following encouragement: “Today is the first day of the rest of your life. Starting better healthy habits today is better than starting them tomorrow. Control what you can, and don’t worry about the rest. It’s never too late to start being healthy.”