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Change of Heart


Imagine a condition so devastating it strikes 800,000 people every year in America alone, and yet so silent that often the first symptom is death. Now imagine there’s a prescription for this condition that’s amazingly inexpensive, devoid of harmful side effects, and, if taken daily, would virtually eliminate the chance of losing your life. What would you do first: Call your doctor for a prescription or call your broker to invest in the company who makes it?


According to David Katz, MD, director of Yale University’s Prevention Research Center, if the way we’re leading our lives is any indication, we’d all be on the phone with our brokers.


While there’s certainly a genetic component to cardiovascular disease, more than 80 percent of coronary heart disease, the kind that causes heart attacks, is preventable. That means eight out of ten people with heart disease could be heart healthy by implementing a few simple lifestyle strategies.


“There’s no reason why our arteries need to get gummed up over the course of a lifetime,” says Katz. Even if you have a genetic predisposition to high blood pressure or diabetes, both huge risk factors for heart disease, modifying your lifestyle could actually wash out that history by changing the behavior of your genes.


What kinds of changes are we talking about? First, if you smoke, stop. Studies show that people who stop smoking for five years reduce their risk of having a heart event to the level of someone who never smoked. Then, reconsider the way you eat, move, and breathe.




Think of your body like an engine. The higher-octane fuel you put into it, the better it will run. A Mediterranean-style diet of fruits, vegetables, whole grains, fish and a daily glass of red wine is the highest-octane fuel you can get. Research shows eating this way lowers blood pressure, reduces inflammation, and protects the heart.


In one study of male heart attack victims, those who received specific advice about how to implement a Mediterranean diet had a 73 percent lower risk of dying from heart disease than those given the standard prescription to follow a low-cholesterol, low-fat diet A second study of middle-aged twins found that those who followed a Mediterranean plan had a lower risk of cardiac dysfunction than their matched twins. And a third study showed that people with the highest adherence to the Mediterranean diet had a 59 percent lower cardiovascular risk compared to those with the lowest adherence to the diet.


Here’s where it gets murky.


“There is no one ‘Mediterranean diet,’” says Jonny Bowden, PhD, CNS, co-author of The Great Cholesterol Myth. “There are hundreds of little towns all along the Mediterranean and they all have different staple ingredients. It almost seems as though a Mediterranean diet has become short hand for eating a lot of olive oil.” In fact, he argues, if you look at popular diets from Atkins to Ornish, they all fit into a so-called Mediterranean plan.


Indeed, studies show that high-carb, low-fat diets; low-carb, high fat diets; vegetarian diets; and vegan diets all prevent heart disease. So what’s the common denominator? “They’re all lower in sugar than the typical American diet,” says Bowden. “And sugar is toxic.” Put too much of it in the bloodstream, and it begins to glom onto proteins and make them sticky, like putting cotton candy in your gas tank.


Sugar also raises insulin levels, which starts a cascade of events that lead to fat storage. Not only do you gain fat, but high insulin levels lock fat cells into place, making it difficult to lose weight. Those fat cells don’t just sit on your hips, they’re active hormone factories releasing inflammatory proteins into the bloodstream.


Instead of trying to achieve the perfect Mediterranean diet, perhaps we should focus on preventing inflammation and oxidation, two root causes of heart disease. When you’re body is traumatized by infection, injury, or a poor diet, inflammation results. Oxidation is your body’s response to pollutants, chemicals, stress, and certain foods. It’s like a rusting of cells and tissues. So it’s no surprise eating anti-inflammatory and antioxidant foods can help prevent heart disease.


Fruits and vegetables are anti-inflammatory and antioxidant powerhouses. A study published in Circulation found that each additional daily serving of fruits or vegetables is associated with a 4 percent lower risk of heart disease. The more fruits and veggies on your plate, the more the risk drops. Experts claim eating 8-10 fruits and vegetables a day as part of a low-fat diet can lower blood pressure almost as much as most blood pressure medications. And yet, three out of four adults aren’t getting even half of the recommended 9-13 servings of fruits and vegetables daily.


Here’s the tipping point: No one ever got fat, one of the greatest inflammatory triggers, by loading up on leafy greens. Fruits and vegetables are low in calories, but high in water and fiber, so they fill you up much faster than your favorite doughnuts. Three baked cinnamon apples weigh in with the same calorie count as a candy bar.


The American Heart Association also urges Americans to eat fish. Containing almost none of the artery-clogging fats found in meat, fish is packed with vitamins, minerals, and heart healthy omega-3s. These healthy fats lower blood pressure, prevent blood clots, and reduce inflammation in the arterial walls much like aspirin but without the side effects. Consuming just one or two servings of fatty fish like salmon, mackerel, lake trout, herring, and sardines each week can slash the risk of dying from heart disease by 36 percent.


Wash it all down with a daily glass of red wine and you’ll also get a hefty dose of polyphenols, powerful disease-fighting chemicals that reduce inflammation, lower blood pressure, and thin out the blood, preventing dangerous blood clots.


Do this: Lose some of the sugar in your diet and replace it with the following foods: fruits, vegetables, garlic, fish, nuts, red wine, and dark chocolate. A study published in the British Medical Journal revealed that eating these seven foods daily, in the appropriate amounts, can reduce heart disease risk by 75 percent and add an average of six years to your life.




Exercise is the most important thing you can do to stave off heart disease. Physical activity lowers blood pressure, reduces insulin resistance, and dramatically improves heart health. In a study of women over 65, researchers found that those who regularly engaged in aerobic activity had lower blood pressure and better blood flow to their vital organs compared to women who didn’t exercise.


“The science is really persuasive that the human body has to be moving,” says Gretchen Reynolds, physical education columnist for The New York Times and author of The First 20 Minutes: Surprising Science Reveals How We Can Exercise Better, Train Smarter, Live Longer. Our Paleolithic ancestors were walking 20 miles a day in search of food. Our bodies haven’t changed much since then, but our lifestyles certainly have.


While scientists don’t understand all of the ways exercise impacts the heart, they do know it can instantly reduce your risk of heart disease no matter what your genetic predisposition. In a study of more than 6,000 people published in the journal Hypertension, researchers found that those who had a parent with high blood pressure but were highly fit had a 34 percent lower risk of developing high blood pressure themselves compared to those who had a low fitness level and the same parental history. Even a moderate amount of exercise — brisk walking for about 20 minutes a day — can provide a huge health benefit, particularly to people genetically predisposed to hypertension.


Unfortunately, most Americans substitute typing, texting, and surfing the Web for exercise. The biggest issue, claims Reynolds, is that Americans spend the majority of their time sitting. Surprisingly, “active couch potatoes” — those who work out 30 minutes daily, but sit for 7-8 hours a day have a higher risk of heart disease than those who don’t exercise at all but move around throughout the course of the day.


“Sitting causes genetic changes that are particularly bad for the heart,” says Reynolds. “And it happens quickly. Just being inactive for a couple of days reduces your body’s ability to break up fat in the bloodstream, and a certain amount of that fat goes to the heart.”


You don’t have to become a tri-athlete to benefit from exercise. All you need is a pair of shoes and the willingness to move.


“Any movement that increases your heart rate is fine aerobic exercise,” says Reynolds. “For someone who has been sedentary, getting up and walking around the room may increase their heart rate into a zone that counts as vigorous.” Of course, the more fit you become, the harder you have to work to exercise your heart.


Strength training is also critical to heart health. “Strength training ensures you maintain muscle mass and muscle mass uses glucose so it helps maintain blood sugar levels,” says Reynolds. And the right level of blood sugar promotes heart health.


One cautionary note: Talk to your doctor before starting a new exercise program, especially if you smoke, have high blood pressure, diabetes, high cholesterol, or other cardiovascular risk factors, such as advanced age or a family history of heart disease.


Do this: Stand up. Standing up for two minutes about every 20 minutes reduces your risk of heart disease. “The muscle contractions that hold you upright change the physiology in the body in ways that lessen circulating fat and reduce heart disease risk,” says Reynolds.




Stress is an epidemic especially when our already busy lives are complicated with travel, time changes, and botched up routines. While our bodies are remarkably capable of bouncing back from short bouts of stress, the long-term impact of tense muscles, blood pressure spikes, and a skyrocketing heart rate can seriously impact your ticker.


“Stress releases a whole host of hormones, particularly cortisol, that are damaging to cells in general, but especially to the heart,” says Reynolds. Studies show that stress, anger, and emotional turmoil can trigger heart attacks. There’s often a spike in the number of heart attacks around major sporting events and natural disasters. Even the stock market can influence heart health.


Worse, stress launches a negative chain reaction that leads to poor lifestyle habits.


“If you’re stressed, you’re not going to eat well and you’re not going to have time to exercise,” says Katz. So reducing stress levels is one way of mediating many risk factors for heart disease.


While it’s impossible to obliterate day-to-day stress, you can counteract some of its ill effects. Meditation is one silver bullet. Research shows that daily meditation not only reduces stress, lowers blood pressure, and promotes well-being, it also creates a surge in mood-stabilizing chemicals and feel-good hormones like serotonin. But many “Type A” personalities can’t sit still long enough to say “om,” much less focus on a mantra for 15 minutes.


“If you count yourself in that category, just focus on taking slow, deep, cleansing breaths,” suggests Bowden. “Close your eyes, breathe in for a count of four, hold your breath for another count of four, and then breathe out for a count of seven.” Even as little as five minutes of deep breathing can lower blood pressure, ease muscle tension, release concerns, and boost the immune system to say nothing of its effects on emotional health and well-being.


Sleep, laughter, sex, and even bubble baths all release tension and boost feel-good endorphins. But if you’re on deadline or stuck on a plane even just standing up and walking around for a minute or two can reduce stress hormone levels.


Do this: Find the things that nurture you and make you happy and do more of them.


When you eat unprocessed whole foods, get active and manage stress, you create a positive domino effect. Each good thing you do makes it possible to do another because when you eat better, you have more energy. Because you have more energy, you exercise. Because you exercise, you sleep better.


“You may feel like you don’t have time to fit these things in, but the reality is, you don’t have time not to fit them in,” says Katz. “When you’re in an ambulance, no one is going to ask you if you have time to go to the coronary unit.”




Historically, doctors relied on body mass index (BMI) to assess heart disease risk. Now research suggests waist circumference is more important. A study published in the Archives of Internal Medicine found that a high waist circumference (43.3 for women and 47.2 for men) was associated with a two-fold higher mortality risk compared to lower waist circumferences (29.5 for women and 35.4 for men) regardless of weight or BMI.


“BMI doesn’t separate fat from muscle,” says Francisco Lopez-Jimenez, MD, cardiologist at the Mayo Clinic in Rochester, Minnesota. “Some people are labeled as overweight when they have a lot of muscle mass but not a lot of fat. Even more concerning are people who have a normal BMI but have a significant amount of belly fat.”


Visceral fat (the fat between the gut and the organs) is more metabolically active than subcutaneous fat (the fat you can grab), so it spews inflammatory chemicals into the bloodstream, promoting clots and raising blood pressure. In fact, subcutaneous fat in the thighs and rear may be protective.


“That’s where the waist-to-hip ratio comes in,” explains Lopez-Jimenez. “A ratio higher than one represents an increased risk of heart disease and diabetes.” Unlike BMI, the waist-to-hip ratio separates the increased risk of a thick waist from the protective fat in the hips and rear. It also helps identify skinny people with thick middles who are at higher risk of heart disease than those who are obese, and even those who are obese with a one-to-one waist-to-hip ratio.


“People who are at a normal weight with a large waist-to-hip ratio have limited muscle mass, excessive abdominal fat and little protective fat,” says Lopez-Jimenez. That’s three strikes!


Not sure where your waist ends and your hips begin? Encircle your waist with a soft tape measure at the level of your belly button, so the tape measure is perpendicular to your legs. The tape measure should be snug but not tight (and make sure you’re not holding your breath!). Then encircle the tape measure at the widest point on your hips. If the first figure is higher than the second, you’re at greater risk.         AMY PATUREL


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