WITH February designated as American Heart Month, there is no better time to focus on these important steps you can take to reduce your cardiovascular risk - smart eating and staying active as recommended by the American College of Cardiology (ACC) and American Heart Association (AHA), says the special report of the February 2014 issue of the Tufts University’s Health & Nutrition Letter.

“The first line of defense in preventing the development of heart disease should be to adhere to a healthy lifestyle, starting early in life,” says Alice H. Lichtenstein, DSc, director of Tufts’ HNRCA Nutrition Laboratory and a member of the ACC/AHA expert panel that developed the updated lifestyle guidelines.

“This includes both consuming a heart-healthy diet and engaging in regular physical activity.”

Whether your physician has prescribed statin medications or not, these Lifestyle Medication Guidelines can help protect your heart - when the ACC/AHA released new guidelines in November, the headlines all focused on their controversial recommendations for statin use, while another set of recommendations which looked at diet and physical activity were almost lost in the coverage, adds the health letter.

After the lifestyle-guidelines panel identified critical questions about lifestyle and cardiovascular-disease prevention, the experts developed eight dietary and two physical activity recommendations which are directed at patients with cardiovascular disease risk factors, such as unhealthy cholesterol levels, diabetes, hypertension or pre-hypertension.

However, that covers a majority of U.S. adults: 33.5 percent have elevated LDL cholesterol, 11.3 percent diabetes, 27.3 percent hypertension and 31 percent pre-hypertension, with risk increasing with age.

All adults, of course, are encouraged to follow heart-healthy nutrition and physical activity recommendations to prevent cardiovascular disease.

The 10 recommendations are divided into three groups:

A. Dietary advice for lowering LDL cholesterol,

B. Dietary advice for lowering blood pressure, and

C. Advice for physical activity for each health concern; which include:

1) Dietary advice for lowering LDL cholesterol - For adults who would benefit from lowering (serum) LDL cholesterol, the advice is:

1) Consume a dietary pattern that

a) emphasizes vegetables, fruits and whole grains;

b) includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts; and

c) limits intake of sweets, sugar-sweetened beverages and red meats.

The guidelines advise adapting this heart-healthy dietary pattern to appropriate calorie requirements, personal and cultural food preferences, and nutrition therapy for other medical conditions (including diabetes).

The experts add that this pattern can be achieved by following the DASH dietary pattern, the USDA Food Pattern, or the AHA Diet (, and, respectively.

2) Aim for a dietary pattern that achieves 5 percent to 6 percent from saturated fat - For most individuals, this means cutting saturated-fat intake roughly in half; the current average intake is 11 percent of calories, which is well below the 2010 Dietary Guide for Americans. In a 2,000-calories daily diet, 5 percent to 6 percent of calories would equal 100 to 120 calories a day from saturated fat - regardless of type of fat, each gram of fat contains 9 calories, so that translates to roughly 11 to 13 grams of saturated fat per day, or a little less than the saturated fat in two tablespoons of butter. Lichtenstein says achieving this goal “means limiting, as much as possible, sources of animal fat, such as meat and dairy.”

3) Reduce percent of calories from saturated fat - The experts concluded reducing saturated-fat intake lowers LDL cholesterol regardless of what is substituted for the saturated fat - carbohydrates, monounsaturated fats or polyunsaturated fats. However, favorable effects on cholesterol and other lipids are greatest when choosing polyunsaturated fat, such as liquid vegetable oils, followed by monounsaturated fat, and then carbohydrates (whole grains are preferable to refined grains).

4) Reduce percent of calories from trans fat - Most often made by partially hydrogenating vegetable oils to make them solid and more stable, these heart-unhealthy fats are found in commercial baked foods, fried foods and processed or packaged foods. The Food and Drug Administration moved to all but eliminate trans fats by ruling them no longer “generally recognized as safe” - since 2006, the agency has required labeling of products containing more than half a gram of artificial trans fats per serving.
B. Help for hypertension - For adults who would benefit from lowering high blood pressure, the Lifestyle Management Guidelines recommend:

5) Consume a dietary pattern with the same emphases as that recommended for lowering LDL cholesterol - These include reports of studies of the DASH dietary plan and various adaptations of the Mediterranean-style dietary pattern showing their effectiveness against high blood pressure. The anti-hypertension benefits of such dietary patterns are independent of weight and sodium intake, and are sufficient to prevent progression from pre-hypertension, says the health letter.

6) Lower sodium intake - The report says, “There is strong and consistent evidence that reducing salt intake lowers blood pressure” in adults with hypertension, as well as pre-hypertension - lowering sodium intake can both prevent progression from pre-hypertension and promote blood-pressure control in patients with hypertension without the need for medications. According to the American Heart Association, up to 75 percent of the sodium in the average American diet comes from salt added to processed or restaurant food. Tufts’ Lichtenstein advises opting for reduced-sodium products and aiming to cook more of your own food, to control added sodium, while relying less on processed, packaged and commercially prepared foods. She adds, “To save time, cook multiple healthy meals at once and freeze the extra or use for lunch the next day.”

7) Take other steps to limit sodium - a) Consume no more than 2,400 milligrams of sodium per day; b) Further reduction of sodium intake to 1,500 mg per day is desirable, since it is associated with even greater reduction in BP; and c) Reduce intake by at least 1,000 mg per day since that will lower blood pressure, even if the desired daily sodium intake is not yet achieved - the expert panel rated these recommendations only as “moderate.” 2,400 milligrams of sodium is roughly the amount in 13 strips of bacon, two-and-a-half eight-ounce bags of potato chips, four half-cup servings of chicken-noodle soup, or two quarter-pound cheeseburgers - this might sound like a lot of food, but keep in mind that 2,400 milligrams is the maximum for all the food you eat all day combined.

8) Combine the DASH dietary pattern with lower sodium intake - There is strong evidence that following the DASH plan plus reducing sodium, together, works even better against high blood pressure than either step on its own. While there is insufficient evidence to recommend increasing dietary potassium to control blood pressure at this time, Lichtenstein says, “The best way to increase your potassium intake is to increase your vegetable and fruit intake” - a good idea for heart health, in any case.
C. Get physical - For those looking to lower their LDL cholesterol and adults who would benefit from lowering their blood pressure, the advice is the same:

9/10) Engage in aerobic physical activity: three to four sessions a week, lasting on average 40 minutes per session, and involving moderate-to-vigorous intensity physical activity. The evidence that physical activity alone, not in combination with dietary changes or weight loss, can lower LDL cholesterol and blood pressure is moderately strong, according to the report. However, research on resistance training and blood pressure shows evidence to be limited and inconsistent; moreover, there is little research focused on the blood pressure benefits of combining resistance training and aerobic activity. Even if you can’t meet the goal of three to four 40-minute sessions of aerobic activity, experts repeated the 2008 federal guidelines on physical activity: “Some physical activity is better than none” and “For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency and/or longer duration.”

Tufts’ Lichtenstein has this parting advice: Bottom line is that diet and exercise really can make a difference in your cardiovascular health.

“Try making small changes to your diet and physical activity patterns that you feel can become permanent...think in terms of a lifetime, not short term.”

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