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How to Prevent Cardiovascular Disease

• Disparities
• Risk Factors

Contributing Factors

Cardiovascular disease (CVD), also known as heart disease, is the leading cause of death worldwide. CVD includes conditions such as hypertension , stroke , peripheral artery disease , and more.

Prevention is an important strategy to reduce death and suffering from CVD. It relies on managing risk factors and starting preventive medications for those with elevated risk. Yet, inequities exist in CVD rates , risk factors , treatment , and prevention.

This article discusses risk factors for CVD, health disparities, prevention strategies, and ways to advocate for treatment.

Jochen Tack / Getty Images

Disparities in Cardiovascular Disease

Heart disease does not affect all groups equally. Race and ethnicity, gender, geography, genetics, and socioeconomic status have all been associated with variable outcomes.

Communities that often experience barriers to care that lead to worse health outcomes include:

• Black and Brown people
• People with lower socioeconomic status
• People with lower education levels

The reasons for this are complex, with many contributing factors.

Race and Ethnicity

Race and ethnicity are socially constructed labels based on ancestral and cultural characteristics. While some genetic factors are linked to ancestry, science makes it clear that race is not biological.

When considering how race and ethnicity relate to CVD, it's important to note that many of the differences are not due to genetic predisposition, but to environmental conditions known social determinants of health . These include things factors like:

• Financial stability
• Access to health care
• Social stigma and discrimination
• Neighborhood and community factors

While social determinants of health increase CVD rates through an increase of risk factors, they are not the only cause of racial disparities in CVD. Access to healthcare, biases within the healthcare community, and the ways bias within health care have broken community trust in the system also contribute.

Some examples of these outcomes include:

• In the United States, Black adults have the highest rates and highest mortality from CVD. According to data from the Centers for Disease Control and Prevention (CDC), CVD mortality rates of non-Hispanic Black Americans are double that of non-Hispanic Asian or Pacific Islander.
• Black Americans have the highest rates of peripheral artery disease (PAD), a condition in which atherosclerosis affects blood supply to the lower extremities. Incidence of PAD in Black Americans is double that of White Americans. Furthermore, compared to White Americans, Black Americans more often undergo amputation instead of procedures to open up the artery, even after correcting for socioeconomic status.
• Evidence suggests that certain minority communities receive worse care for CVD. For example, Black and Latino people presenting with stroke were less likely to receive certain treatments compared to White patients.
• People of South Asian heritage living in the United States have increased rates of atherosclerosis and worse outcomes with hospitalization and death than other groups.

Gender discrepancies in CVD are also prevalent. CVD is the leading cause of death regardless of gender, but differences in diagnosis and treatment contribute to variable outcomes.

• While mortality rates for CVD have declined over the past few decades, cisgender women have seen less of a decline than cisgender men.
• One study showed that in prehospital care for chest pain and cardiac arrest , cisgender women less often received recommended aspirin, and were less often transported with lights and sirens in the ambulance.
• Another study showed that one year after hospitalization for heart attack , cisgender women were less likely than cisgender men to be on appropriate medications. This was attributed to not being prescribed the appropriate treatments, rather than self-discontinuing treatment.
• Members of the transgender community may experience higher rates of CVD and mortality, as longstanding evidence links social discrimination and stigmatization, which trans people experience, to poor CVD outcomes. While studies show transgender people undergoing hormone therapy have higher incidence of heart attacks, evidence of a direct relationship between higher heart attack incidence and undergoing hormone therapy remains inconclusive.

Within the United States, disparities also exist based on geography. These disparities can be regionally-based, or exist based on rural vs. urban environments. For example:

• Residents of rural areas experience higher death rates from CVD, partly due to reduced access to healthcare.
• Southern states have the highest rates of CVD and CVD-related mortality.

Socioeconomic Status

Socioeconomic status, which includes income, education, employment, and environmental factors, is a major driver of CVD incidence and outcomes.

• Studies have shown an association with lower levels of income, lower education levels, and unemployment with CVD and mortality.
• Worldwide, low- and middle-income countries account for 3 in 4 deaths from CVD.

Disparities in CVD Risk Factors

Health disparities also exist for individual CVD risk factors. Those belonging to groups that are widely discriminated against and socially stigmatized may be more likely to have a particular risk factor, be affected at a younger age, and diagnosed later in the course of disease.

High Blood Pressure

Hypertension , or high blood pressure, is one of the leading risk factors for CVD, and affects some groups more than others.

• Non-Hispanic Black Americans have the highest rates of hypertension and are less likely than White adults to have their blood pressure adequately controlled.
• Low socioeconomic status is associated with higher rates and worse control of hypertension.
• Rates of hypertension are highest in the southeastern U.S.

Diabetes is another common risk factor for CVD. Rates of diabetes and level of blood sugar control are worse in certain groups.

• Diabetes is most common in people of American Indian/Alaskan Native origin, who have nearly double the rates of diabetes compared to White Americans. Non-Hispanic Black and Hispanic-Latino Americans also have higher rates of diabetes.
• Those with lower education levels have higher rates of diabetes and are less likely to receive recommended preventive care, like eye and foot exams.
• People living in the southeastern U.S. have higher rates of diabetes.

High Cholesterol

High cholesterol is a major CVD risk factor that affects groups unequally. Furthermore, some groups are less likely to receive appropriate therapies to control cholesterol numbers.

• People of South Asian descent have a higher incidence of high cholesterol, which contributes to their increased risk of and earlier onset of atherosclerosis.
• Studies suggest that therapies given to cisgender women are less aggressive than those given to cisgender men. This is also the case for Black Americans compared to White Americans. Black cisgender women were 19% less likely to be treated for high cholesterol compared to White cisgender men.

People belonging to socially stigmatized groups and those with lower income, education, and socioeconomic status have higher tobacco-related risk.

• Those with lower income and lower education have higher smoking rates.
• People who identify as LGBTQ+ have higher smoking rates than those identifying as cisgender and heterosexual.
• Secondhand smoke exposure is highest for Black Americans than any other racial or ethnic group.
• Smoking cessation rates are lower for those with lower education and those in urban areas.

Other Risk Factors

Other CVD risk factors with disparities in prevalence and treatment across minority groups and geographic location include:

• Chronic kidney disease
• Excessively overweight
• Sedentary lifestyle

Disparities in CVD Prevention

To add to the inequities in CVD and its risk factors, prevention of CVD has its own share of problems. The following are just some of the issues that contribute.

• The ASCVD risk calculator, which the American Heart Association and the American College of Cardiology guidelines recommend for estimating ASCVD risk, doesn't accurately convey risk in Hispanic and Asian populations.
• Black adults who meet recommendations for starting statins are less likely to have them prescribed.
• Research on transgender people, CVD outcomes, and CVD prevention remains limited.
• Cisgender women who meet recommendations for starting statin therapy are less likely to have them prescribed, or have adequate doses prescribed.
• Studies suggest that people of East Asian descent have more adverse effects from statins.

Social determinants of health account for many of the disparities of CVD, risk factors, and prevention. They include the following:

• Insurance status and ability to afford medications
• Language barriers
• Health literacy
• Nutrition status (access and ability to afford nutritious food choices)
• Cultural diet preferences
• Ability to exercise, including a safe space for exercise
• Stress , including chronic stress related to all forms of systemic oppression

In addition, systemic factors, such as biases within the healthcare system, contribute to inequalities. For example, many clinical studies were done on White men, leaving out Black, Brown, and gender oppressed people.

Further, members of some socially stigmatized groups distrust the healthcare system. This is in part due to historic and current racist, sexist, cisgender normative, and heteronormative practices.

The Tuskegee Syphilis Study

One example of historic racism in medicine is the unethical Tuskegee syphilis study that took place in 1932. In the study, Black patients were deliberately not treated for syphilis in order to study its long-term effects. There are many other studies that suggest ongoing racism and biases in medical practice, with certain groups receiving less effective care.

What Can Be Done?

While advancements in treatment and prevention of CVD have come a long way in the last several decades, it's disheartening that such significant disparities still exist. Fortunately, the scientific community is more aware of health disparities. More research is being done on this topic, with goals being set to improve healthcare equity.

While large-scale change is needed to improve health equity, it's also important that each individual is empowered to be an advocate for their own health.

The first step of CVD prevention is awareness of increased risk. Next steps involve specific actions, which can include personalized lifestyle changes, understanding the role of prescribed medication, and conversations with the healthcare team.

Lifestyle Factors

Certain risk factors for CVD are called "modifiable," because they are able to be changed by individual behaviors. These include:

• Diet high in saturated and trans fats, sodium, processed foods, and sugar

Other modifiable risk factors can be improved with both individual behaviors and medical therapy, like diabetes, high blood pressure, and high cholesterol.

For modifiable risk factors, some measures can be taken to help reduce a person's risk of developing CVD:

• Exercise : While not everyone has the same ability to exercise, getting some form of exercise for those who are able has immense heart health benefits. If you have angina or have had a heart attack, you may benefit from cardiac rehabilitation, which is a structured program that incorporates exercise, counseling, and education. Ask a healthcare provider for more information or a referral, if possible.
• Diet : A heart-healthy diet (like the Mediterranean diet ) includes a high intake of vegetables, fruits, whole grains, nuts, and beans, and is low in processed foods, sweetened beverages, salt, and saturated and trans fats. Unfortunately fast food, which has trans fats and is loaded with salt, is cheaper than healthier options. Finding and affording fresh fruits and vegetables may not be possible. Canned or frozen fruits and vegetables are a more affordable alternative, and can be just as healthy (just watch out for sugar and sodium content). Beans are an inexpensive, accessible healthy protein source. Replacing sweetened beverages with water is another healthy step.
• Stress : Stress is another contributor to CVD. Stress management can improve quality of life. Affordable ways to relieve stress include meditation , breathing exercises, journaling, exercise, time in nature, and connection with others.

Medications

After lifestyle changes, the cornerstone of CVD prevention is statin therapy.

Guidelines from the American College of Cardiology and the American Heart Association recommend calculating a risk score, called ASCVD Risk Estimator, which assigns a 10-year and lifetime risk of ASCVD.

When risk is high, a statin is indicated. Those with borderline or intermediate risk may benefit from a statin, depending on other factors.

What Are Statins?

Statins are drugs that improve cholesterol and have anti-inflammatory effects. Many studies have proven the profound benefit of statins for preventing heart attacks, strokes, and death from CVD.

The following are steps that individuals can consider taking in order to play an active role in prevention of heart disease and stroke:

• Ensure you have had appropriate screening tests, like a cholesterol panel and hemoglobin A1c to check for diabetes.
• Confirm whether or not you should be on a statin and whether your cholesterol is where it should be.
• Know your ASCVD risk and what it means for you. ASCVD may under or overestimate risk in certain ethnicities. Ask a healthcare provider if your risk is accurately reflected.
• If your ASCVD risk indicates that you have intermediate risk and you are not on a statin, discuss this with a healthcare provider. Tests like coronary artery calcium score can sometimes help with the decision to start statins.
• If you are not tolerating any of your prescribed medications, speak with a healthcare provider about alternative medications or dosing strategies. For example, some people who experience side effects on one statin will tolerate another statin. Others have success with a lower dose or taking it every other day.
• Let a healthcare provider know if you are having difficulty affording medications. Oftentimes more affordable alternatives exist. If you have insurance, sometimes one medication will be covered when a similar medication is not.
• Other medications that have a role in CVD prevention are high blood pressure and diabetes medications. If you have either of these conditions, ask your healthcare provider if your numbers are where they should be.
• If you think you could benefit from seeing a nutritionist , weight management specialist, or diabetes specialist, ask a provider for a referral. Of course, not everyone has access to these services, but for those who do, they can be extremely valuable.

While cardiovascular disease can affect anyone, health disparities contribute to higher incidence and worse outcomes for certain groups. This is in part due to differences in CVD risk factors and prevention.

Social determinants of health are responsible for many of these inequalities. Continued research to understand these risk factors, as well as societal and institutional commitment, are necessary to achieve health equity in CVD prevention.

A Word From Verywell

Because of health inequities, it's important to be an advocate for your health. It's also important to play an active role in CVD prevention in areas that you can control. Understanding and following treatment plans for CVD and its prevention are essential. Never feel afraid or embarrassed to ask a healthcare provider questions, and speak up if you are having any issues getting or taking medications.

World Health Organization. Cardiovascular diseases .

Mazimba S, Peterson PN.  JAHA spotlight on racial and ethnic disparities in cardiovascular disease . J Am Heart Assoc . 2021;10(17):e023650. doi:10.1161/JAHA.121.023650

U.S. Department of Health and Human Services: Healthy People 2030. Social determinants of health .

Centers for Disease Control and Prevention. Health, United States spotlight: racial and ethnic disparities in heart disease .

Hackler EL 3rd, Hamburg NM, White Solaru KT. Racial and ethnic disparities in peripheral artery disease . Circ Res . 2021;128(12):1913-1926. doi:10.1161/CIRCRESAHA.121.318243

Arya S, Binney Z, Khakharia A, et al. Race and socioeconomic status independently affect risk of major amputation in peripheral artery disease . J Am Heart Assoc. 2018;7(2). doi:10.1161/JAHA.117.007425

Cruz-Flores S. Racial and ethnic disparities in stroke care . Stroke . 2019;50(9):2288-2289. doi:10.1161/STROKEAHA.119.026208

Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association .  Circulation.  2018;138(1). doi:10.1161/CIR.0000000000000580

Wilmot KA, O'Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women . Circulation . 2015;132(11):997-1002. doi:10.1161/CIRCULATIONAHA.115.015293

Lewis JF, Zeger SL, Li X, et al. Gender differences in the quality of EMS care nationwide for chest pain and out-of-hospital cardiac arrest . Womens Health Issues . 2019;29(2):116-124. doi:10.1016/j.whi.2018.10.007

Smolina K, Ball L, Humphries KH, Khan N, Morgan SG. Sex disparities in post-acute myocardial infarction pharmacologic treatment initiation and adherence: problem for young women . Circ Cardiovasc Qual Outcomes . 2015;8(6):586-592. doi:10.1161/CIRCOUTCOMES.115.001987

Panza GA, Puhl RM, Taylor BA, Zaleski AL, Livingston J, Pescatello LS. Links between discrimination and cardiovascular health among socially stigmatized groups: A systematic review .  PLoS One . 2019;14(6):e0217623. doi:10.1371/journal.pone.0217623

Caceres BA, Streed CG, Corliss HL, et al. Assessing and addressing cardiovascular health in LGBTQ adults: a scientific statement from the American Heart Association . Circulation . 2020;142(19). doi:10.1161/CIR.0000000000000914

Cross SH, Mehra MR, Bhatt DL, et al. Rural-urban differences in cardiovascular mortality in the US, 1999-2017 .  JAMA.  2020;323(18):1852–1854. doi:10.1001/jama.2020.2047

Casper M, Kramer MR, Quick H, Schieb LJ, Vaughan AS, Greer S. Changes in the geographic patterns of heart disease mortality in the United States: 1973 to 2010 . Circulation . 2016;133(12):1171-1180. doi:10.1161/CIRCULATIONAHA.115.018663

Schultz WM, Kelli HM, Lisko JC, et al. Socioeconomic status and cardiovascular outcomes: challenges and interventions . Circulation . 2018;137(20):2166-2178. doi:10.1161/CIRCULATIONAHA.117.029652

Centers for Disease Control and Prevention. Every heart counts .

American College of Cardiology. Racial disparities in hypertension prevalence and management: a crisis control? .

Shahu A, Herrin J, Dhruva S, et al.  Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) . J Am Heart Assoc.  2019;8(15). doi:10.1161/JAHA.119.012277

Centers for Disease Control and Prevention. Facts about hypertension .

Centers for Disease Control and Prevention. Prevalence of diagnosed diabetes .

Centers for Disease Control and Prevention. National and state diabetes trends .

Makshood M, Post WS, Kanaya AM. Lipids in South Asians: epidemiology and management .  Curr Cardiovasc Risk Rep . 2019;13(8):24. doi:10.1007/s12170-019-0618-9

Safford MM, Gamboa CM, Durant RW, et al. Race-sex differences in the management of hyperlipidemia: the Reasons for geographic and racial differences in stroke study .  Am J Prev Med . 2015;48(5):520-527. doi:10.1016/j.amepre.2014.10.025

Centers for Disease Control and Prevention. Cigarette smoking and tobacco use among people of low socioeconomic status .

Centers for Disease Control and Prevention. Lesbian, gay, bisexual, and transgender persons and tobacco use .

Centers for Disease Control and Prevention. African Americans and tobacco use .

U.S. Department of Health and Human Services. Smoking cessation: a report of the Surgeon General .

Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, Palaniappan LP. Atherosclerotic cardiovascular disease risk prediction in disaggregated asian and hispanic subgroups using electronic health records .  JAHA . 2019;8(14). doi:10.1161/JAHA.118.011874

Dorsch MP, Lester CA, Ding Y, Joseph M, Brook RD. Effects of race on statin prescribing for primary prevention with high atherosclerotic cardiovascular disease risk in a large healthcare system . J Am Heart Assoc . 2019;8(22). doi:10.1161/JAHA.119.014709

Nanna MG, Wang TY, Xiang Q, et al. Sex differences in the use of statins in community practice: patient and provider assessment of lipid management registry .  Circ: Cardiovascular Quality and Outcomes . 2019;12(8). doi:10.1161/CIRCOUTCOMES.118.005562

Newman CB, Preiss D, Tobert JA, et al. Statin safety and associated adverse events: a scientific statement from the American Heart Association .  Arterioscler Thromb Vasc Biol . 2019;39(2). doi:10.1161/ATV.0000000000000073

Centers for Disease Control and Prevention. The Tuskegee timeline .

American Heart Association. The American Heart Association's 2024 goal .

American Heart Association. What is cardiac rehabilitation? .

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines . Circulation . 2019;140:e563–e595. doi:10.1161/CIR.0000000000000678

Centers for Disease Control and Prevention: Million Hearts. The scoop on statins: what do you need to know? .

By Angela Ryan Lee, MD Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.

Preventing Heart Disease

When heart experts talk about prevention, they usually refer to one of three types: secondary, primary and primordial prevention. [1] All three have similar elements, but different starting times and different effects.

• Secondary prevention. These efforts are started after someone has a heart attack or stroke , undergoes angioplasty or bypass surgery, or develops some other form of heart disease. It involves taking medications like aspirin and/or a cholesterol-lowering statin, quitting smoking and losing weight if needed, exercising more , and following a healthy diet. Although secondary prevention may sound like “closing the barn door after the horse has gone,” it isn’t. These steps can prevent a second heart attack or stroke, halt the progression of heart disease, and prevent early death. It may be obvious, but the number one killer of individuals who survive a first heart attack is a second heart attack.
• Primary prevention. Primary prevention aims to keep an individual at risk of heart disease from having a first heart attack or stroke, needing angioplasty or surgery, or developing some other form of heart disease . Primary prevention is usually aimed at people who already have developed cardiovascular risk factors, such as high blood pressure or high cholesterol. As with secondary prevention, primary prevention focuses on controlling these risk factors by making healthy lifestyle changes and, if needed, taking medications. That said, the appearance of worrisome cardiovascular risk factors means that inflammation, atherosclerosis, and/or endothelial dysfunction are already at work and, in most cases, aren’t reversible.
• Primordial prevention. The word “primordial” means existing from the beginning. Primordial prevention involves working to prevent inflammation, atherosclerosis, and endothelial dysfunction from taking hold, and thus prevent risk factors such as high blood pressure, high cholesterol, excess weight, and ultimately cardiovascular events. Once rarely discussed, primordial prevention is now the cornerstone of the American Heart Association’s definition of ideal heart health and efforts to help people achieve it. [1] As its name implies, the sooner you can start practicing primordial prevention—ideally from childhood on—the more likely you are to achieve it and protect yourself from heart disease.

Steps for the primordial prevention of heart disease

Five key lifestyle steps can dramatically reduce your chances of developing cardiovascular risk factors and ultimately heart disease:

1. Not smoking

In fact, researchers examining the relationship between cigarette smoking and smoking cessation on mortality during a decades-long perspective study of over 100,000 women found that approximately 64% of deaths among current smokers and 28% of deaths among former smokers were attributable to cigarette smoking. [2]

• This study also reported that much of the excess risk due to smoking may be drastically lowered after quitting. Additionally, the excess risk for all-cause mortality—that is, death from any cause—decreases to the level of a “never-smoker” 20 years after quitting.

The nicotine that tobacco products deliver is one of the most addictive substances around. That makes tobacco use one of the toughest unhealthy habits to break. But don’t get discouraged; many smokers do quit! In fact, in the United States today there are more ex-smokers than smokers. [3] Learn more about the hazards of smoking, the benefits of quitting, and tips for quitting from the Centers for Disease Control and Prevention .

2. Maintaining a healthy weight

In a study of over one million women, body-mass index (BMI) was a strong risk factor for coronary heart disease. The incidence of coronary heart disease increases progressively with BMI. [7]

In the Nurses’ Health Study and the Health Professionals Follow-Up Study, middle-aged women and men who gained 11 to 22 pounds after age 20 were up to three times more likely to develop heart disease, high blood pressure, type 2 diabetes, and gallstones than those who gained five pounds or fewer.

• Those who gained more than 22 pounds had an even greater risk of developing these diseases. [4,8-11]

Weight and height go hand-in-hand. The taller you are, the more you weigh. That’s why researchers have devised several measures that account for both weight and height. The one most commonly used is BMI .

• You can calculate your BMI by dividing your weight in kilograms by your height in meters squared (kg/m 2 ). You can also use an online BMI calculator or BMI table .
• A healthy BMI is under 25 kg/m 2 . Overweight is defined as a BMI of 25 to 29.9 kg/m 2 , and obesity is defined as a BMI of 30 kg/m 2
• Waist size matters , too. In people who are not overweight, waist size may be an even more telling warning sign of increased health risks than BMI. [12] An expert panel convened by the National Institutes of Health identified these useful benchmarks: Men should aim for a waist size below 40 inches (102 cm) and women should aim for a waist size below 35 inches (88 cm). [13]

3. Exercising

• Getting regular physical activity is one of the best things you can do for your health. It lowers the risk of heart disease, diabetes, stroke, high blood pressure, osteoporosis, and certain cancers, and it can also help control stress, improve sleep, boost mood, keep weight in check, and reduce the risk of falling and improve cognitive function in older adults.
• It doesn’t take marathon training to see real health gains. A 30-minute brisk walk five days of the week will provide important benefits for most people. Getting any amount of exercise is better than none.
• Exercise and physical activity benefit the body, while a sedentary lifestyle does the opposite—increasing the chances of becoming overweight and developing a number of chronic diseases.
• Research shows that people who spend more time each day watching television, sitting, or riding in cars have a greater chance of dying early than people who are more active. [17-19] A 2013 study showed that, among women ages 50-79 with no cardiovascular disease at the start of study, prolonged sitting time was associated with increased heart disease risk regardless of the amount of time spent in leisure-time physical activity. [16]

4. Following a healthy diet

• The best diet for preventing heart disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils; includes alcohol in moderation, if at all; and goes easy on red and processed meats, refined carbohydrates, foods and beverages with added sugar, sodium, and foods with trans fat.
• People with diets consistent with this dietary pattern had a 31% lower risk of heart disease, a 33% lower risk of diabetes, and a 20% lower risk of stroke. [20]
• This study highlighted that low-fat diets are not beneficial to heart health, and that incorporating healthy fats – such as those included in the Mediterranean diet –  can improve heart health and weight loss.
• There isn’t one exact Mediterranean diet, as this eating style takes into account the different foods, eating patterns, and lifestyles in multiple countries that border the Mediterranean Sea. However, there are similarities that define a Mediterranean eating pattern, including: high intake of olive oil, nuts, vegetables, fruits, and cereals; moderate intake of fish and poultry; low intake of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals. [21]
• The study found that those who adhered most to healthy eating patterns had a 14% to 21% lower risk of cardiovascular disease when compared with those who adhered least. The findings also showed that these different healthy eating patterns were similarly effective at lowering risk across racial and ethnic groups and other subgroups studied, and that they were statistically significantly associated with lower risk of both coronary heart disease and stroke. [22]
• Sodium and potassium are two interrelated minerals that play major roles in regulating blood pressure and a healthy heart. Eating less salty foods and more potassium-rich foods may significantly lower the risk of cardiovascular disease. [29]  Potassium is found in many foods, especially fruits, vegetables, legumes, and low-fat dairy. But the reverse of eating a lot of sodium-rich foods especially from processed breads, packaged snacks, canned goods, and fast-food meals while skimping on potassium can increase cardiovascular disease risk.

5. Improving sleep health

• Sleeping for too short or too long a stretch is associated with heart disease and can negatively affect other heart-related risk factors like dietary intake, exercise, weight, blood pressure, and inflammation. [30]
• There are various reasons causing poor sleep, including clinical sleep disorders, working overnight shifts, or poor sleep hygiene. Talk with your doctor if you have frequent restless nights or do not feel adequately rested during the day. Improving sleep habits can make a difference. Examples include setting a sleep schedule and sticking to it, having a calming bedtime ritual like doing stretches or meditating, getting regular exercise, stopping use of electronic devices an hour before bedtime, and avoiding heavy meals, caffeine, and alcohol several hours before bed.

Other factors to consider

Along with these five practices, the American Heart Association recommends controlling cholesterol, managing blood sugar, and managing blood pressure as additional factors for improving and maintaining cardiovascular health. Learn more at the American Heart Association’s “Life’s Essential 8.”

Supportive policy change

Putting it all together

You can help prevent heart disease by doing five key things and making them into habits:

• Don’t smoke (or quit if you do)
• Maintain a healthy weight
• Exercise; be active
• Follow a healthy diet
• Improve sleep health

Strong studies make it possible to link reductions in risk to these habits. Following a healthy lifestyle may prevent over 80% of cases of coronary artery disease, [24, 25] 50% of ischemic strokes, [26] 80% of sudden cardiac deaths, [27] and 72% of premature deaths related to heart disease. [28] In other words, a healthy lifestyle is a good investment in a longer, healthier life.

• Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation . 2010;121:586-613.
• Kenfield SA, Stampfer MJ, Rosner BA, Colditz GA. Smoking and smoking cessation in relation to mortality in women. JAMA . 2008;299:2037-47.
• Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults – United States, 2000-2015. MMWR. Morbidity and mortality weekly report . 2017;65:1457-64.
• Willett WC, Manson JE, Stampfer MJ, et al. Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range. JAMA .  1995;273:461-5.
• Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than 300 000 persons. Archives of internal medicine . 2007;167:1720-8.
• Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med . 2010;363:2211-9.
• Canoy D, Cairns BJ, Balkwill A, et al. Body mass index and incident coronary heart disease in women: a population-based prospective study. BMC Med . 2013;11:87.
• Rimm EB, Stampfer MJ, Giovannucci E, et al. Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. American journal of epidemiology . 1995;141:1117-27.
• Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med . 1995;122:481-6.
• Huang Z, Willett WC, Manson JE, et al. Body weight, weight change, and risk for hypertension in women. Ann Intern Med . 1998;128:81-8.
• Maclure KM, Hayes KC, Colditz GA, Stampfer MJ, Speizer FE, Willett WC. Weight, diet, and the risk of symptomatic gallstones in middle-aged women. N Engl J Med . 1989;321:563-9.
• Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality: sixteen years of follow-up in US women. Circulation . 2008;117:1658-67.
• National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report . Bethesda, MD; 1998.
• Ford ES, Caspersen CJ. Sedentary behaviour and cardiovascular disease: a review of prospective studies. International journal of epidemiology . 2012;41:1338-53.
• Matthews CE, George SM, Moore SC, et al. Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. The American journal of clinical nutrition . 2012;95:437-45.
• Chomistek AK, Manson JE, Stefanick ML, et al. Relationship of sedentary behavior and physical activity to incident cardiovascular disease: results from the Women’s Health Initiative. Journal of the American College of Cardiology . 2013;61:2346-54.
• Dunstan DW, Barr EL, Healy GN, et al. Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation . 2010;121:384-91.
• Patel AV, Bernstein L, Deka A, et al. Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. American journal of epidemiology . 2010;172:419-29.
• Warren TY, Barry V, Hooker SP, Sui X, Church TS, Blair SN. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc . 2010;42:879-85.
• Chiuve SE, Fung TT, Rimm EB, et al. Alternative dietary indices both strongly predict risk of chronic disease. The Journal of nutrition . 2012;142:1009-18.
• Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine. 2018 Jun 13.
• Shan Z, Li Y, Baden MY, Bhupathiraju SN, Wang DD, Sun Q, Rexrode KM, Rimm EB, Qi L, Willett WC, Manson JE, Qi Q, Hu FB. Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease. JAMA Intern Med . Published online June 15, 2020.
• Yu E, Malik VS, Hu FB. Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series. Journal of the American College of Cardiology . 2018 Aug 21;72(8):914-26.
• Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med . 2000;343:16-22.
• Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation . 2006;114:160-7.
• Chiuve SE, Rexrode KM, D. S, Logroscino G, Manson JE, Rimm EB. Primary prevention of stroke by healthy lifestyle.  Circulation . 2008;118:947-54.
• Chiuve SE, Fung TT, Rexrode KM, et al. Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA .  2011;306:62-9.
• van Dam RM, Li T, Spiegelman D, Franco OH, Hu FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ . 2008;337:a1440.
• Ma Y, He FJ, Sun Q, Yuan C, Kieneker LM, Curhan GC, MacGregor GA, Bakker SJ, Campbell NR, Wang M, Rimm EB. 24-Hour Urinary Sodium and Potassium Excretion and Cardiovascular Risk.  New England Journal of Medicine . 2021 Nov 13.
• Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, Rosamond W; American Heart Association. Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation . 2022 Jun 29:101161CIR0000000000001078.

Last reviewed August 2022

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