comes to preventing cardiovascular diseases, lifestyle changes such as diet and
exercise are often mentioned. But a deeper dive into heart health shows other factors
such as sleep, stress management and proper screenings are just as important.
Foraker is a professor of medicine within the Division of General Medical
Sciences at Washington University in St. Louis (WUSTL), and the Deputy Director
for WUSTL’s Institute for Informatics. She helped co-author the American Heart
Association’s (AHA) Life’s Essential 8, a prescription of eight lifestyle
metrics for cardiovascular health. They include modifiable risk factors such as
diet, physical activity, nicotine exposure, sleep duration, body mass index,
blood lipids, blood glucose and blood pressure.
the AHA added sleep to their lifestyle recommendations. “Poor sleep has been
something we have suspected as a contributor to cardiovascular health for some
time,” Foraker says. “Sleep has been identified recently as a risk factor for
cardiovascular disease and other chronic diseases. Interrupted sleep is a
problem, because our body isn’t able to rebuild and recharge if we don’t have
adequate sleep. That’s a recent finding, and the evidence around that is
addition, research into how sleep patterns affect heart health is ongoing.
Experts are looking at when people are sleeping, and if it’s broken into three-
or four-hour increments. The demands of one’s occupation may lead to sleeping
during the day instead of at night, or broken sleep that may or may not lead to
a total of eight hours of sleep.
“Not managing stress well can be linked to
insulin resistance, gut issues, high blood pressure and inflammation, which
directly contribute to heart disease,” says Charlotte Nussbaum, M.D., a
functional medicine practitioner based in Medford, New Jersey. “That’s a
lifestyle factor that people need to address—and it can be the hardest one to address.
Even if you’re dialed in to a healthy diet and exercise routines, you’re not
going to keep yourself healthy if you have unresolved stress issues.”
Nussbaum further notes that unaddressed
childhood traumas can lead to unhealthy stress management techniques. She
encourages people to consult with a therapist or other practitioner to work
through childhood traumas. Try to identify and eliminate the stressor. If a job
is causing stress, we can’t always change jobs, but using techniques such as
yoga, meditation and mindfulness can help. She also recommends bodywork and movement,
breathing techniques, biofeedback and going outdoors and into nature as
effective stress relieving techniques.
notes that the Life’s Essential 8 framework has specifically called out mental
health and social determinants of health. These underlying factors can be
barriers to achieving ideal cardiovascular health. “Mental health can impact
depression and be a proxy for nicotine addiction and poor diet,” she says.
determinants may include living in a food desert without access to healthy
foods. Some people may not be able to achieve physical fitness because they
might live in a high crime area, preventing them from being physically active
outdoors. “Social determinants of health are often cost prohibitive to
achieving health goals,” Foraker reiterates.
nonprofits such as The Food Trust are helping to bring nutritious food to
low-income communities. The National Youth Sports Strategy, an initiative of
the U.S. Department of Health and Human Services, strives to expand children’s
participation in youth sports and encourage regular physical activity.
observes that while much attention is placed on lowering fat and cholesterol
for a healthier heart, what is more important is choosing fats that don’t
oxidize easily. When low-density lipoprotein (LDL) is oxidized, it can
lead to atherosclerosis, the buildup of plaque on the artery walls.
“Seed oils like canola oil, safflower oil,
sunflower oil or corn oil have been promoted as heart healthy, but those are
very easily oxidized because they contain linoleic acid, an inflammatory
omega-6 fatty acid that can contribute to heart disease,” Nussbaum says. “While
omega-6 is an essential fatty acid, we only need a small amount in our diets.
Our modern diet has become very high in omega-6.”
Nussbaum advises increasing omega-3 intake to
balance the omega-3s/omega-6 ratio. Cold water, fatty fish that’s low in
mercury, such as salmon, along with shellfish, are good sources of omega-3s.
For people that don’t eat seafood, marine algae provide omega-3s.
Polyphenols are plant-based foods that boost heart health and
immunity. Polyphenol-rich foods include green tea, citrus fruits, hibiscus
tea and turmeric. Nussbaum adds that organ meats such as liver are high in
antioxidants such as retinol and vitamin A.
Red meat has gotten a bad rap, but Nussbaum
notes how meat is sourced makes a difference. The nutritional quality of a fast-food
burger is much different than a cut of beef from grassfed cows that are
sustainably raised; the latter having a very different nutrition profile, along
cautions that consuming a low-fat diet may not lower risk of heart disease
because many low-fat diets substitute fat with carbohydrates. A
high-carbohydrate diet can lead to obesity and insulin resistance, which are
risk factors for heart disease.
Less Can Be More
It can be intimidating to start a workout
regimen, especially if time is limited. “What’s more important is not being
sedentary and finding ways to keep moving,” Nussbaum reassures. “Even if you
have a desk job, there are ways to incorporate short bursts of movement into
your day. Walking can be helpful.”
that high-intensity interval training—short bursts of intense exercise
alternated with low-intensity recovery periods—can be effective for those with
limited time. “Some of those workouts are only five to 10 minutes long but can
have just as much benefit as a 90-minute cardiovascular workout.”
and Advanced Testing Detect Underlying Issues
Dr. Yale (Yoel) R. Smith is a Florida-based
physician who is triple board-certified and an Advanced Fellow in Anti-Aging Metabolic and Functional
Medicine. “There are millions of people walking around with severe
cardiac disease that do not even know it, because heart attacks and death from
an acute coronary syndrome can kill someone without warning,” he cautions.
“Thus, preventing such an event with specialized testing can allow people to
live long lives with loved ones.”
emphasizes the importance of a complete lipid profile. “I see many patients
that come to me with incomplete lipid profiles,” he notes. They do not include
sensitive biomarkers that go beyond just total cholesterol, LDL, high-density
lipoprotein and triglycerides.
There’s a misconception that if one’s cholesterol
is within normal range, they need not worry about heart disease. “But someone
could have ‘unstable plaque’ just waiting to burst in a coronary artery that
kills the patient,” Smith explains. “When an unstable plaque ruptures in a
major vessel, the body senses it as bleeding and sends clotting factors to stop
the bleeding, thus creating the heart attack and death. We can look for this
with cutting-edge testing.”
Such testing includes Cleerly, which uses artificial intelligence to look within the
coronary arteries. It provides actual visualization of the patients’ vessels and
pinpoints locations of stenotic lesions, total plaque volume and unstable
plaque locations. “This is revolutionary and allows me to provide information
to the patient and the interventional cardiologist vital information before
catheterization,” Smith says.
Protein Unstable Lesion Signature test looks for cellular markers for high-risk
patients and determines risk for plaque rupture. The Vibrant Health CardiaX
allows doctors to look at 22 different genes that can contribute to various
heart disease issues.
“Family history is a
look into the future of your chance of developing heart diseases,” Smith
shares. “The genetics of a patient’s family is quite important, and genes can
jump a generation. Thus, the patient could have their grandfather’s or
grandmother’s genes that can put them at risk and lead to an early death.”
There are natural ways to control and reverse
heart disease, Smith reiterates, but he cautions against over-the-counter,
unregulated supplements marketed toward improving heart health. A comprehensive
workup and cardiovascular health plan should be monitored by a qualified
“Meditation and massage are beneficial to
lower stress,” Smith concurs. “Stress and high cortisol levels create a pathway
to heart disease, elevated blood pressure and other issues. Thus, anything that
can lower stress and create a happy lifestyle will help with heart health.”
American Heart Association confirms that practicing mindfulness and meditation
may help manage stress and high blood pressure, improve sleep and help us feel
more balanced and connected, which can help lower the risk of heart disease.
Meditation can be as simple as sitting quietly
in a calm place and focusing on breath. Other types include relaxation, Zen,
transcendental and mantra, and mindfulness-based stress reduction.