This is the second is a series of articles on how to protect against heart disease and improve cardiovascular health.
Heart disease is the leading cause of death in the United States and globally. Though it affects people of all races and socioeconomic statuses, a 2021 Nature article found that “large differences in cardiovascular disease morbidity and mortality exist between migrant populations and host populations.” Migration itself “generally has an adverse effect on health, particularly cardiovascular and metabolic health, which is more pronounced among migrants moving to high-income countries.” According to a 2012 study in the Journal of Immigrant and Minority Health, immigrants to the United States may be less aware of their own risk factors and therefore less likely to seek help or change behaviors to reduce their risk of heart disease.
It’s important to address these disparities, and that starts with making sure people have the information they need to begin to change their lifestyles and behaviors to become healthier. To that end, we interviewed Dr. Deeb Salem, cardiologist and Professor of Medicine at Tufts University School of Medicine, about how to reduce the risk of heart disease. Dr. Salem poses the question: what’s the most important thing you can do to improve your heart health? The answer is simple. Don’t smoke, and if you already do, stop.
“I tell my patients that every cigarette they smoke is a minute off their life,” Dr. Salem says. A shocking twelve percent of the adult population of the United States still smokes cigarettes, and according to the CDC, cigarette smoking remains the leading cause of preventable disease and death in this country. You might associate smoking with lung cancer and other pulmonary diseases, but its effect on the heart is extremely detrimental and its role in causing cardiovascular disease should not be overlooked.
There is good news, however: the damage done to the heart soon starts to be repaired for most smokers who manage to quit. The CDC notes that even long-time smokers “can see rapid health improvements when they quit. Within a year, heart attack risk drops dramatically. Within five years, most smokers cut their risk of stroke to nearly that of a nonsmoker.”
Though not an easy task, quitting smoking is the number one priority if you want to improve your heart health. Now, if you succeed, or if you were not a smoker to begin with, what else can you do? Search “heart disease” on the internet and you will be bombarded with news and medical journal articles about how to lower your risk. The information can be overwhelming. Luckily, Dr. Salem offers some easy tips and bits of wisdom to remember.
Exercise is crucial, but you don’t need to be a long-distance runner or competitive weightlifter to improve your heart health. If you hate running (not uncommon – even runners hate running), you’re in luck. Dr. Salem points to research from the American Heart Association that found walking is just as good as running when it comes to reducing your risk of heart disease. Biking and resistance training are great exercises too, and can lower your blood pressure and LDL (“bad”) cholesterol levels and improve your mental health. With smartphones and smartwatches, tracking your daily activity is easier than ever, so get your steps in.
What about diet? Dr. Salem is quick to offer this advice: “everything in moderation – including moderation.” You don’t need to stop eating steak for the rest of your life, but reducing the amount of red meat you consume and focusing on other protein sources, such as chicken and fish, can be beneficial. Diet is also important for losing weight and controlling blood sugar, both of which can improve overall cardiovascular health. Obesity prevalence is now at 42% in the U.S., and is similar to smoking in terms of measurable impact on life expectancy. “We’re a chubby nation,” Dr. Salem says, and that needs to change.
Of course, there are some things you can’t change: namely, your genetic history. You may be at higher risk for cardiovascular disease because it runs in your family. You may have a healthy diet and you may exercise regularly, only to find that your blood pressure or LDL cholesterol levels are still high. Some people need to take medication to control these factors, and the last few decades have seen the development of some incredible therapeutics that help people at risk of heart disease. Statins are perhaps the most well-known example of drugs that can lower bad cholesterol and improve heart health, but Dr. Salem also points to newer drugs, such as PCSK9 inhibitors and SGLT2 inhibitors.
PCSK9 inhibitors such as Repatha work by enhancing the liver’s ability to filter LDL cholesterol from the blood, while SGLT2 inhibitors can improve the kidney’s capacity to remove glucose from the body through urine. SGLT2 inhibitors are FDA-approved for use in patients with type-2 diabetes, and its effects of lowering blood sugar can improve overall health. Given that both of these are prescription drugs and can be expensive, however, some may be concerned about affording them. Are there cheaper options on the market?
Dr. Salem is hopeful about “polypills”, which contain a combination of medications used to treat heart disease and high blood pressure. Though these polypills have lower doses of the medications than would be in individual versions, they seem to be effective at lowering blood pressure and cholesterol levels. Polypills are still being studied and are not yet available in the U.S., but research published in the New England Journal of Medicine is promising – it suggests that polypills can reduce cardiovascular events or later cardiovascular disease. And because they are a combination of other medications, they might be easier to take (only one pill a day as opposed to several) and more financially viable. We will likely need to wait a few years before polypills are widely available. In the meantime, there are plenty of simple things we can do to improve our heart health and reduce the risk of cardiovascular disease. Your journey will depend on your individual situation – you may need to think about quitting smoking, or perhaps talking to your doctor about starting a new medication. But for those of us who are able, a brisk walk or weightlifting session can do wonders, and as Dr. Salem points out, they don’t even require that you leave your house. He himself makes sure to get at least 3,000 steps and twenty to thirty minutes of exercise on a stationary bike each day. “After that, I feel pretty good,” he says.
