Knowing you’re at risk of a cardiovascular event can be daunting, but you can mediate your chances with lifestyle changes.
Scientists are just learning about the role specific genes have on your risk of getting a heart attack. “Genes certainly load the gun for heart disease, giving people propensities to develop risk factors like high blood pressure or elevated cholesterol, or increased risk for diabetes,” says cardiologist Donald M. Lloyd-Jones, MD, an American Heart Association spokesperson and senior associate dean for clinical and translational Research at Northwestern University Feinberg School of Medicine in Chicago.
Although research is ongoing, what doctors know for sure is that having an immediate family member who had cardiovascular problems before 60 years old is concerning for your own health, says cardiologist Maryann McLaughlin, MD, medical director of the Cardiac Health Program and co-director of the Women's Cardiac Assessment and Risk Evaluation Program at Mount Sinai Health System in New York City.
“Some people will come into my office and say, ‘My father had a heart attack at age 50 but he smoked and he drank and he ate fatty foods,’ so they want to discount that,” Dr. McLaughlin says. “It may be true that his lifestyle had a bigger role in the heart attack, but we don’t know for sure.” If early heart problems have occurred in your family, she recommends you have your cholesterol, blood pressure, and blood sugar tested. (Here’s what your cholesterol numbers mean and what your blood pressure numbers mean.) Your doctor may recommend certain medications to help control blood pressure or cholesterol based on the results.
But along with getting checked out by a doctor, adopting heart-friendly habits is even more crucial in people with a worrisome family history. It is very possible that you can change the course of your cardiovascular health if you do so. “It is environment that pulls the trigger on the development of heart disease,” Dr. Lloyd-Jones says. “You can trump quite a bit of an adverse genetic profile through healthy lifestyle.” One study showed a 50 percent lower risk of coronary artery disease with a favorable lifestyle among people at high genetic risk.
Try these daily lifestyle recommendations to improve your chances if you’re at genetic risk of a heart attack:
1. Eat breakfast that's packed with fiber
Not surprisingly, one of the major ways to influence your chances of a heart attack is through diet. “People should try to construct a healthy eating pattern built mostly around vegetables and fruits making up the bulk of their food, with lean proteins such as fish and chicken, and whole grains and lean dairy products,” Dr. Lloyd-Jones says. You might not know, though, that fiber is especially important in reducing your heart disease risk, so be sure to consume enough in your daily diet (although you can spread it out over all your meals). Women should have 25 grams of fiber a day before the age of 50 and 21 grams a day after. Men should eat 38 grams before 50 and 30 grams after.
Fiber comes only from plant sources such as veggies, fruits and whole grains. It’s heart healthy because it keeps you full so you eat less and are more likely to maintain a healthy weight. It also helps lower cholesterol and helps keep blood sugar in a healthy range, reducing your diabetes risk.
2. Eat a dinner with 4.5 cups of veggies
Vegetables should have a prominent place on your plate throughout the day to reduce your heart attack risk. The healthiest diet is full of plants, according to Dr. McLaughlin. “The Mediterranean diet over years and years of examining this tends to be one of the most heart healthy or heart favorable, and that’s one that’s high in fruits and vegetables. Think about Greek food and big salads!” Here’s a super-quick explanation of how to follow the Mediterranean diet.
Beyond their fiber benefits, vegetables are high in vitamins and minerals and low in fat and calories. So by filling your plate with veggies, you’re less likely to eat other, more unhealthy, heart-damaging foods. “Most processed and packaged foods have way too much sodium and these types of foods represent about 80 percent of the sodium in our diet,” Dr. Lloyd-Jones says. “So sticking with vegetables and fruits, and cooking your own food, is a great way to control sodium.” Fresh fruits and vegetables are best, as canned or frozen may contain sugar or sodium as well.
3. Cut back on steak and burgers
Although fish and chicken can be part of your heart-healthy diet, avoid eating red meat regularly if you have a genetic risk of cardiovascular disease (an occasional indulgence is totally fine). “If you look at some populations such as the Japanese population, their diets are very low in red meat and they tend to have longer lifespans,” Dr. McLaughlin says. The problem with red meat is “related to the [saturated] fat and cholesterol levels,” which increases high blood pressure. “It’s all about like the lining of the blood vessels,” she says. “High blood pressure exerts toxins or increased pressure against the blood vessels, which makes them then unhealthy.”
The other issue with red meat is that the high fat content can lead to weight gain, Dr. McLaughlin says. So it’s especially important to avoid fried and processed meats as well reducing the amount of artery-clogging saturated fat and cholesterol.
4. Don't have more than one drink a day
You may have heard that wine, particularly red wine, is heart-healthy—but that’s not a reason to start drinking if you’re not already in the habit. “There is very little evidence that moderate alcohol intake reduces risk for heart disease,” Dr. Lloyd-Jones says. “Up to one drink per day for women and two for men perhaps may not be harmful, but more than that clearly can be very harmful to health—heart and otherwise.” Plus, alcohol provides extra calories with any nutritional value, so cutting it out can be a good way to reduce calories.
If you do drink at this moderate level you don’t have to stop even if you have a genetic heart disease risk, Dr. McLaughlin says. “A drink with dinner is fine,” she says. “But you can’t save them all up, have seven drinks in one night and not drink any other night and say that’s good for your heart health!”
5. Sweat for 30 minutes
You’re going to have to get off the couch to reduce your genetic risk of a heart attack, as a sedentary lifestyle is a major additional factor that ups your chances. “We say at least 30 minutes at least five days a week,” Dr. McLaughlin says. “For a cardiac benefit, aerobic exercise actually helps to condition the heart and make it a little bit more efficient, so even if you have blockages in arteries the other arteries can take over.” In addition, exercise increases oxygen levels to the heart and reduces stress hormones such as cortisol. “If people don’t exercise enough and they’re overweight, their cortisol levels tend to go high and it just causes a cascade of unhealthy things in the body,” she says.
Dr. Lloyd-Jones recommends talking with your doctor before starting a new exercise regime, particularly if it’s strenuous. But in general, “endurance aerobic activities like brisk walking, jogging, biking, rowing, elliptical, treadmill and similar activities provide the best benefits,” he says. “Mixing in some resistance activities can add some additional benefits,” such as building calorie-burning muscle. If you can’t yet meet the time guidelines, don’t let perfect be the enemy of good: Some exercise is better than nothing.
6. Meditate for five minutes
Emotional stress, both chronic and acute, can also lead to a heart attack, so stress reduction is crucial, especially if you have a genetic heart attack risk. “We do know that some heart attacks are definitely linked to stressful periods,” Dr. McLaughlin says. “Stress reduction techniques that have been found to be helpful are things like meditation and yoga—there have definitely been studies on both that show they reduce certain stress hormones and have an overall calming effect.” Meditating for even just five minutes has been shown to have heart benefits, but you can aim to work up to a 20-minute session for optimal impact.
Dr. McLaughlin says to remember, though, that what seems stressful to one person might not be to another. “It’s all about perceived stress,” she says. For example, a police officer might be able to handle tense situations without issue, but a hairdresser might become very stressed out if he runs behind schedule. It’s OK to be honest with yourself about how much stress you feel in your life, and take steps to modify it.
7. Hit the hay by 10:30 PM
There are definite links between sleep and heart health, so if you’re at increased risk you’ll want to make sure you’re getting to sleep early enough to get a full night’s rest. “Lack of sleep can definitely be linked to increase in blood pressure and increase in stress hormones such as cortisol, so it’s important to really try to really get seven hours,” Dr. McLaughlin says.
Lack of sleep can also make it hard to have energy to exercise, and may also mess up your hunger cues so you eat more when you’re tired. In a vicious cycle, weight gain can also lead to more problems sleeping such as snoring and sleep apnea. “Sleep apnea is an independent risk factor for having a heart attack or stroke,” Dr. McLaughlin says. In people who have the condition, “when they’re sleeping their airway is not opening as well as it should and their oxygen levels to the brain go down, so the brain is halfway arousing them to try to take a breath.” You may not even realize you’re getting such poor sleep, so if you’re unexplainably tired or have these sneaky sleep apnea symptoms, see your doctor.
8. Don't automatically rely on supplements
Research has been conflicting on whether supplements such as fish oil (omega-3s) or magnesium provide heart benefits. A better approach than stocking up on a cabinet full of vitamins, Dr. Lloyd-Jones says, is to get the nutrients you need from your diet.
“There have been many clinical trials assessing whether specific vitamins, multivitamins, or other supplements can reduce risk of a heart attack—none of them has worked to reduce risk for heart disease,” he says. “It is far, far better to get needed vitamins and minerals through a healthy eating pattern.” For example, it is better to eat fish or these food sources of omega-3s than take fish oil supplements, because fish has other nutrients as well. Plus, when you eat fish, you are not eating other things that are worse for you.