How can you keep your heart in good working order? The four most common types of cardiovascular disease (CVD)—coronary heart disease (which includes heart attack and chest pain), stroke, high blood pressure, and heart failure—and their causes are discussed in detail in this article. By learning more about each, you will know how to lower your risk of ever developing them. For example, simply living a sedentary lifestyle is a strong risk factor for heart disease, and you can lower or remove this risk by becoming physically active.

Similarly, many blood fat abnormalities such as elevated cholesterol levels (another risk factor) can be managed through greater consumption of fish and dark chocolate, drinking moderate amounts of alcohol, and sensibly approaching the use of medications for cholesterol, blood pressure, and diabetes. Here, you’ll learn to love your healthy heart. By taking better care of it, you can enhance your longevity and increase your odds of living a long and healthy life with your heart and arteries throughout your body in good working order.


Which Cardiovascular Diseases Are Most Common?

Taken all together, cardiovascular events are the leading cause of death for Americans, accounting for about half annually. Individually, heart disease and stroke are the most common CVDs, ones that often lead to a lower quality of life, an older biological age, and a shortened life span. More than 70 million Americans currently live with some form of CVD.

Although these health conditions are more common among people older than sixty-five, the number of sudden deaths from heart disease among people between fifteen and thirty-four years old has recently increased with declines in health attributable to unhealthy lifestyle choices. The good news is that if lifestyle choices are causing an increased incidence of such problems, then these problems more than likely can be prevented or reversed by similar means: by improving diet and increasing physical activity.


What Is Coronary Heart Disease?

Heart disease is caused by atherosclerosis, which occurs when the inner walls of the coronary arteries become narrowed due to a buildup of plaque filled with fat, cholesterol, calcium and other substances. Atherosclerosis comes from the Greek words athero, meaning “gruel” or “paste,” and sclerosis, meaning “hardness.” When this process causes a partial or complete blockage of the arteries feeding the heart (the coronary arteries), it results in what is known as coronary artery or coronary heart disease. Plaque formations can grow large enough to significantly reduce the ability of the blood to flow through an artery, but most heart damage occurs when plaque becomes fragile and ruptures, causing blood clots to form. A clot that blocks a blood vessel feeding the heart causes a heart attack. Such clots often occur in coronary vessels that are less than 50 percent blocked, which means heart attacks can happen even if your plaque accumulation is not significant. If a clot blocks blood flow for long enough, the part of the heart muscle that is not receiving enough blood through the blocked artery ends up infarcting, or dying.

If blockage is detected early enough, physicians may use balloon angioplasty to force arteries open or implantable steel screens called stents, which are mechanical devices to hold open clogged vessels, in an attempt to restore more normal blood flow through affected coronary arteries. Many individuals with diagnosed heart disease are put on cholesterol-lowering drug therapies and may also be advised to make dietary and exercise lifestyle improvements.


Tips for Better Health

You can lower your risk for developing heart disease by preventing, reversing, or controlling the main causes that are modifiable. These risk factors include cigarette smoking, elevated blood levels of bad cholesterol and triglycerides, high blood pressure, diabetes, obesity, and physical inactivity.


Major risk factors for heart disease include both modifiable ones that you can potentially improve and others that you can’t change. For example, advancing age is a no modifiable risk factor, while diabetes is modifiable by improving your blood glucose control. Similarly, the risk of developing problems caused by cigarette smoking is greatly reduced by quitting cigarette consumption. Other modifications you can make to limit or lower your risk are discussed later in this article.


How Peripheral Artery Disease Can Affect the Legs

Peripheral artery disease (PAD) is a common circulatory problem that limits blood flow to the legs and arms. Plaque can form in any artery around the body, not just in the ones feeding the heart and the brain, and PAD usually occurs in peripheral arteries in the legs. Pain in the lower legs during walking is a common symptom, but you should also be aware that PAD can be a sign of widespread plaque formation in other arteries around the body. If plaque formations in leg arteries rupture, a blockage can occur, limiting or cutting off blood supply to the lower legs, and resulting in pain, changes in skin color, sores or ulcers, difficulty walking, and even gangrene.

PAD can be diagnosed by measuring your leg blood pressure and comparing it to measurements made on your arm. If they’re unequal, you may have blockage in your lower limbs raising the pressure there. You can get your PAD under control and maintain your normal activities. Walking or other daily exercise is a key to maintaining optimal circulation in your legs, along with a healthy diet and smoking cessation. In addition, certain medications can cause dilation of your leg arteries, and surgery can be done to improve blood flow to your legs by bypassing blockages.


What Do You Need to Know About Strokes?

Every forty-five seconds, someone in America has a stroke, and about every fourth one is fatal. As mentioned, a stroke results from cardiovascular disease in the arteries leading to and within the brain. The brain is an extremely complex organ that controls various body functions. When a blood vessel carrying oxygen and nutrients to the brain is either blocked by a clot or bursts, part of the brain doesn’t get the blood and oxygen it needs, resulting in a stroke in the affected region.

Strokes can have different origins. Flow blockages from clots cause ischemic strokes (which account for about 83 percent of all cases), while ruptured blood vessels that leak blood (i.e., hemorrhage) into the brain cause a hemorrhagic stroke. This second type is usually caused by either an aneurysm (a ballooning out of a vessel) or a vessel malformation. A stroke’s impact can vary; only the functions normally controlled by the affected part of the brain will be impaired. One that reduces blood flow to the back of your brain, for instance, is likely to negatively impact your vision. Other areas of the brain control movement, speech, memory, and problem-solving ability.


Tips for Better Health

Ischemic strokes are the most common type. If blood flow to an area of the brain is reduced for any reason, normal functions controlled by that area will be impaired. If you have any symptoms of stroke, get to a hospital as quickly as you can to receive tPA (a clot-busting drug for ischemic stroke) for the best possible outcome.


The most promising treatment for ischemic stroke is the FDA approved clot-busting drug tPA (tissue plasminogen activator), which must be administered within a three-hour window from the onset of symptoms to work effectively. If you have stroke symptoms, get to a hospital quickly to get this drug in time. To prevent strokes in the first place, you should consider taking antiplatelet agents such as aspirin and Plavix (clopidogrel) or anticoagulants like Coumadin (warfarin) that lower the risk of blood clot formation. If you have stomach ulcers or already take other anti-inflammatory drugs such as Advil or Motrin (ibuprofen), you should take no more than a baby aspirin (75 mg) a day. For most other people, taking 325 milligrams of a coated aspirin (Ecotrin) is good for stroke prevention.


Is a Transient Ischemic Attack a Form of Stroke?

Transient ischemic attacks (TIAs) are minor or warning strokes that usually result in typical stroke symptoms. Normal blood flow to the brain is only reduced for a short time and tends to resolve by itself. Even though the symptoms disappear after a short time, TIAs are strong indicators of a possible major stroke in the future.

You should heed the warning and take steps immediately to prevent an actual, more damaging stroke, including seeking medical care by starting on clot-preventing medications and controlling high blood pressure.


React Quickly to Warning Signs of Heart Attack or Stroke

The most common heart attack symptom is chest pain or discomfort, but women are somewhat more likely than men to experience other symptoms, including shortness of breath, nausea and vomiting, and back or jaw pain (see the sidebar “Heart Attack Warning Signs”). Even if you’re busy, you should stop to determine the source of mild chest pain rather than potentially ending up with a more damaging heart attack. In other words, always take any chest pain or discomfort seriously. When your heart is not receiving enough blood, lactic acid begins to build up, leading to pain or discomfort; lack of oxygen to your heart (and often to the other parts of your body) can cause additional symptoms, which should be a sign to you that something is wrong. People with diabetes can often suffer from symptom-free heart attacks, so even a sudden onset of extreme fatigue is a symptom that needs to be checked out.


Heart Attack Warning Signs


Lasting or intermittent chest discomfort in the center of the chest: It sometimes feels like bad indigestion, or it can feel like uncomfortable pressure, squeezing, fullness, or acute and stabbing pain.

Pain or discomfort radiating down one or both arms, back, neck, jaw, or stomach: This symptom is due to “referred pain,” which is actually originating in the heart due to lack of adequate amounts of oxygen.

Shortness of breath, particularly when unusual or unexpected: It can occur along with chest discomfort or without it.

Other symptoms: Sudden sweating, nausea and vomiting, lightheadedness, or undue, unexplained fatigue are also warning signs.


Heed these warning signs, and seek medical attention immediately for the best possible outcome. If detected early, blood clots can often be dissolved, resulting in less lasting damage to your heart or other areas of your body. Don’t wait more than five minutes after your symptoms start to call for help, and don’t waste precious minutes by having someone drive you to a hospital. Using emergency medical services (EMS) by dialing 9-1-1 is the fastest and most effective way to get lifesaving medical attention. If you are with someone who loses consciousness and stops breathing, he or she is experiencing cardiac arrest. Activate EMS, preferably by having someone else call for you, and begin cardiopulmonary resuscitation (CPR) until help arrives.


Tips for Better Health

Know the usual warning symptoms of heart attack or stroke. Don’t delay in seeking immediate medical attention, preferably through activating EMS by calling 9-1-1. Lifesaving treatment in the first few minutes is critical for surviving and thriving with a minimum of lasting problems after a major cardiac event.


For stroke, the key word to describe its symptoms is sudden. If someone experiences any or all of the symptoms listed in the sidebar


Stroke Warning Signs


• Sudden numbness or weakness, especially on one side of the body (affecting the legs, arms, face, or elsewhere)

• Sudden confusion

• Sudden trouble with normal speaking or understanding

• Sudden loss of vision in one or both eyes

• Sudden trouble with walking, loss of balance, or lack of physical coordination

• Sudden onset, severe headache and dizziness


“Stroke Warning Signs,” such as sudden numbness down one side of the body or trouble speaking, immediately call 911 or 102 in India (or your local EMS number, if different) to summon an ambulance with advanced life support. Taking immediate action is critical because if given within three hours of the start of symptoms, the clot-busting drug tPA can improve the long-term outcomes for most individuals.


Tips for Better Health

High blood pressure is a silent killer that you can control before it’s too late. Lower your blood pressure readings by engaging in regular exercise, cutting back on salt, and taking prescribed medications to keep your systolic values less than 160 mm Hg.


Why Is High Blood Pressure a Silent Killer?

Blood pressure is defined as the force of the blood pushing against the walls of your arteries, which is recorded as two numbers, such as 122 over 78 mm of mercury (122/78 mm Hg). The first number is the higher, systolic, pressure exerted during heartbeats, which is the contraction of the heart muscle that forces blood into arteries. The second represents the lower, diastolic, pressure that occurs when your heart is resting between beats. High blood pressure, or hypertension, describes a condition in which your blood travels through your vasculature at pressures consistently above normal, usually diagnosed at 140/90 mm Hg for adults less than seventy years of age.

In older individuals, elevations of the systolic blood pressure are very common, and most studies have shown that simply keeping it below 160 mm Hg when you’re getting older decreases stroke risk. Actually, over time people with low blood pressure often have poorer health, making a systolic pressure between 140 and 150 ideal for most individuals reaching their seventies (and even higher in their eighties). Blood pressure should be a little more tightly controlled in people with diabetes of any age, however, due to their greater risk of heart problems.

Almost one in three American adults have high blood pressure, but as there are no blatant symptoms, nearly one-third are undiagnosed, making it a silent killer. In fact, many people have high blood pressure for years without knowing it. The only way to find out is to have your blood pressure checked annually, particularly if you’re at higher risk. Age is a definite risk factor for hypertension (about 64 percent of people ages sixty-five to seventy-four have it), along with race (higher incidence in African Americans). Other important risk factors include obesity, diabetes, and a family history of high blood pressure. If you have even one of these, it pays to have your blood pressure checked on a regular basis, What’s more, you should seek early treatment of the condition as soon as you are diagnosed. Undetected or untreated, high blood pressure can cause you to develop some serious health problems over time, such as hardened arteries, heart failure, kidney failure, stroke, or heart attack. Also follow up to make sure that your selected treatment is actually effective. By way of example, one research study reported that only 45 percent of people known to be hypertensive were being treated with medications in 2002, and just 29 percent of them had the condition under control, even though it’s well-known that controlling it effectively greatly reduces the risk of all of these potential problems.


Understanding Heart Failure

Each side of your heart is made up of two chambers: the atrium, or upper chamber; and the lower ventricle. Both atria, which are found on the top right and left sides of the heart, receive blood into the heart from either the whole body or the lungs, and the ventricles pump it where it needs to go, out to the lungs or to the entire body. Heart failure occurs when even one of these chambers loses its ability to keep up with pumping out the whole amount of blood coming into it.


Heart failure can involve either side of your heart; however, it usually affects the left side first. If the left ventricle loses its ability to contract normally, this is systolic failure, where the heart can’t pump with enough force to push adequate amounts of blood into the circulation. If the ventricle loses its ability to relax normally because the muscle has become stiff, this is diastolic failure, meaning that the heart can’t properly fill with blood during the rest period between each beat. Blood coming into the left chamber from the lungs may back up, causing fluid to leak into the lungs, a condition known as pulmonary edema.

As the heart’s ability to pump decreases, blood flow slows down everywhere, causing fluid to build up in various tissues, including the lungs. This excess fluid or congestion explains the term congestive heart failure used to describe this condition. Left heart failure leads to edema of the lungs, while loss of pumping power on the right side causes blood to back up in veins, resulting in swelling in legs and ankles.

This condition commonly occurs after damage to part of the heart muscle during a heart attack and is associated with a lower quality of life and usually a shortened one. To optimize the rest of your life, particularly if you have already suffered a heart attack, watch out for symptoms of this condition (e.g., shortness of breath or swelling in your lower legs), and talk to your doctor about possibly controlling them with prescribed medications. Heart failure can be treated with varying drugs, including diuretics to drain excess fluids out of the body and others aimed at increasing the pumping power of the heart.


Moderate Your Major Cardiovascular Risk Factors

Major risk factors for cardiovascular problems have been determined (see the sidebar “Major Cardiovascular Risk Factors”). Generally speaking, the more risk factors you have, the greater your chance of developing heart disease or some other form of CVD. Some factors can’t be modified, treated, or controlled (e.g., age or sex), while others can. As discussed in the last step, control- ling your level of abdominal obesity usually helps more than worrying about your overall weight. You should also keep in mind that simply having an elevated degree of a particular risk factor increases your overall chances. For example, if your total cholesterol level is 300 milligrams per deciliter (mg/dL), your risk is higher than for someone whose cholesterol runs 245 mg/dL, even though both of you are considered to be in the same high-risk category. Likewise, you can stop or at least reduce cigarette smoking and lower your risk, given that the relative risk of stroke in heavy smokers (more than forty cigarettes a day) is twice that of light smokers (less than ten).

While you can’t modify all of your risk factors to protect yourself from future problems, you can certainly take steps to moderate their potential impact on your health and longevity. In the remainder of this article, we discuss some of these risk factors that you can control in more detail and the steps you can easily take to prevent the onset of cardiovascular problems.



Major Cardiovascular Risk Factors


• Age

• Sex

• Family history of CVD (close male relative younger than fifty five or close female relative younger than sixty-five)

• Elevated blood fats

• Cigarette smoking

• Hypertension

• Physical inactivity

• Diabetes

• Obesity


Change Your Sex?

Your sex isn’t a modifiable risk factor, but a greater knowledge about how it affects your risk will allow you to make informed decisions related to your sex that can somewhat alter your chances of developing CVD. For instance, compared to men, most women are somewhat protected from coronary heart disease, heart attack, and stroke before reaching menopause, which usually occurs in their early fifties. Once women have gone through menopause, their risk begins to rise and keeps rising, making it incorrect to assume that women always have a lower risk and require less aggressive treatment. In reality, within one year after a heart attack, only 62 percent of women compared with 75 percent of men are still living, and more men also survive strokes. Stroke is a leading cause of long-term disability and loss of quality of life for many older females. All types of cardiovascular events are particularly problematic among minority women, especially African Americans. To optimize health and longevity, women can benefit simply by being aware that they likely need to be more aggressive about lowering cardiovascular risk factors after experiencing menopause.


Which Elevated Blood Fats Should Cause Concern?

Cholesterol is a waxy substance made by the liver and also supplied in your diet through animal products, including meats, poultry, fish, shellfish, and dairy products, but it’s not found at all in plants. Some cholesterol is needed in your body to insulate nerves, make cell membranes, and produce certain hormones. The total amount of cholesterol in your bloodstream comprises both healthful and harmful types, the majority being high-density lipoproteins (HDL) and low-density lipoproteins (LDL).

HDL is touted as the good type of cholesterol, meaning that it is supposed to protect against heart disease. It has the ability to remove excess cholesterol and may actually take some out of arterial plaques and slow their growth. High levels are associated with a reduced heart attack risk. In fact, low levels of HDL, along with elevated triglycerides (fat), appear to be a stronger predictor of heart-disease-related problems in women than in men. Luckily, you can raise HDL levels and lower triglycerides naturally with increased physical activity. Moderate alcohol consumption, whether it consists of wine, beer, or distilled spirits, apparently cuts the risk of nonfatal heart attacks as well, likely related in part to the beneficial elevations in HDL it causes. Ideally, your HDL levels should be as high as possible. Aim for HDL levels that are higher than 40 mg/dL in men and 50 mg/dL in women for optimal cardiovascular health.


Tips for Better Health

Your total cholesterol levels don’t matter as much as the levels of good and bad types that you have. Small, dense forms of LDL are best lowered, but large, fluffy LDL is relatively benign, while most HDL is beneficial. Have your types and subtypes measured before deciding whether to start taking cholesterol-lowering medications.


Conversely, LDL is considered mostly as the bad type of cholesterol. In particular, oxidation of LDL may contribute most to the development of plaque in coronary and other arteries. A high level of LDL cholesterol (more than 160 mg/dL) reflects an increased risk of heart disease. However, it is now known that there are two types of LDL: a small, dense LDL (sd LDL), which often ends up being taken up into arterial walls and rapidly oxidized, and a large, fluffy LDL that is relatively benign. High levels of the latter type are common in centenarians, while sd LDL is often associated with high triglycerides and heart disease. Thus, sd LDL is the “bad-bad” type of cholesterol, and large, fluffy LDL is the “good-bad” cholesterol. Before being treated for elevated LDL cholesterol levels, have your doctor measure your levels of both types. If you mainly have the good-bad form, then treatment with medications may not be recommended. You may also ask your doctor to measure your blood levels of lipoprotein (a) and Apo lipoprotein B, both of which are protein markers for bad-bad cholesterol, to find out more about the types that you have.

Finally, most cholesterol-related recommendations currently suggest that levels be reduced to excessively low values—despite little scientific evidence that doing so is truly beneficial, even for younger individuals. We recommend keeping your LDL at no higher than 120 mg/dL, particularly if you have mostly sd LDL and your HDL levels are less than 70 mg/dL. Aggressively lowering cholesterol levels at ages older than sixty-five, though, should likely be limited to people who have evidence of heart disease, diabetes, or high levels of sd LDL or lipoprotein (a). The drugs of choice for lowering cholesterol levels these days are statins (e.g., Lipitor), which appear to be cardio protective beyond their lipid lowering effects by blocking cytokines that damage artery walls and increase plaque formation.


Boost Your Antioxidant Status to Lower Cholesterol’s Effects.

Antioxidant vitamins—E, C, and beta-carotene, which is a precursor of vitamin A—have potential health-promoting properties. Be careful not to take too much vitamin E, as recent studies have shown that high supplemental doses of vitamin E may actually increase your risk of heart disease. Vitamins consumed naturally through foods are almost always better for you than supplemental ones. So consume more fruits, vegetables, whole grains, and nuts to boost your vitamin E and other vitamin intake. A recent study of the French concluded that each additional fruit or vegetable consumed daily above the minimal recommended intake could cut the risk of heart disease by as much as 4 percent.

Tips for Better Health

Some easy ways to improve your heart health and lower cholesterol levels through dietary means include eating more fish, drinking moderate amounts of any type of alcohol, eating more vegetables and fruits high in antioxidants, and consuming dark chocolate in limited quantities.


In addition, omega-3 fats found in fish may prevent sudden death or fatal cardiovascular events by regulating heartbeat and preventing irregular rhythms. Cold water fish, such as salmon, tuna, and mackerel, are recommended as good sources of omega- 3 fatty acids to be eaten four times a week. Fish oil supplements at a dose of about 1 gram a day may also reduce the heart rate and normalize heart rhythms in people with and without heart disease.

Likewise, the cacao plant, from which chocolate and cocoa are derived, boosts the immune system and restricts formation of the cholesterol type that damages the coronary vessels. It naturally contains antioxidants called cate chins and phenols, as well as over six hundred other plant chemicals. The fat content in dark chocolate comprises equal parts of oleate, a heart-healthy fat also found in olive oil; stearate, which has a neutral effect when eaten in chocolate; and palmitate, which can elevate cholesterol but only comprises one-third of chocolate’s fat. Recent studies have indicated that 22 grams of cocoa powder and 16 grams of dark chocolate daily actually can raise HDL cholesterol levels by 10 percent while lowering oxidation of LDL, thereby reducing sd LDL, but milk chocolate may not be nearly as heart healthy, as more of its fat is saturated. Stick with moderate intake of darker types to optimize the workings of your cardiovascular system.


Poorly Controlled Diabetes Causes Heart Disease

Diabetes cases have reached epidemic proportions worldwide and are expected to keep rising during this century. Unfortunately, as far as staying young for longer is concerned, this disease—especially when blood sugars remain poorly controlled—accelerates aging, making the average person with diabetes ten years older biologically than his or her actual chronological age. By itself, diabetes also constitutes a major risk factor for heart disease and stroke. Older diabetic adults have two to four times the normal risk of suffering from a life-ending heart condition than their non-diabetic peers. Overall, up to 80 percent of people with diabetes die from cardiovascular complications, and their life spans are typically shortened by ten years or more. The statistics are even more disheartening for adults who develop type 2 diabetes at a younger age (by eighteen to forty-four years old): they’re fourteen times more likely to have a heart attack, up to thirty times for a stroke. However, such dismal outcomes are largely preventable by lifestyle choices. Regular physical activity, better food choices, reduced levels of insulin resistance, and more tightly controlled blood glucose levels reduce the risk of developing type 2 diabetes in the first place, help control it more effectively, and lower the chances of ultimately experiencing cardiovascular problems precipitated by it.


Physical Inactivity Decreases Vital Heart Health

Physical activity plays a role in cardiovascular health, given that a sedentary lifestyle in itself increases your risk of all forms of CVD. For instance, less fit people have a 30 to 50 percent greater risk of developing high blood pressure and subsequent strokes, and sedentary people have twice the chance of developing life-shortening heart disease. Regular activity also lowers your risk of developing type 2 diabetes, which by itself is a huge risk factor for CVD. While regular exercise does not guarantee that you won’t get heart disease or other related problems, it can considerably reduce your chances. Doing any physical activity is far better than none, and even low-intensity activities can help prevent heart problems.

Tips for Better Health

Remaining sedentary is likely the greatest risk for heart problems that you can have. While regular exercise does not guarantee that you will never experience any heart disease, your chances are far less if you’re active. Do both aerobic and resistance work to optimize your insulin action and reduce inflammation.



Cardiovascular problems can make you biologically older than your chronological age, thereby reducing your overall health and quality of life. Act immediately to get medical help if you experience any of the usual symptoms of a heart attack or stroke, for the best possible outcome. To stay younger, also take steps to modify or reduce your risk of such events, such as using dietary and exercise interventions to manage high blood pressure, lower blood cholesterol levels, control diabetes, and limit plaque formation in arteries. In addition, you can use medications to control your blood pressure and cholesterol levels, but don’t treat your cholesterol levels too aggressively without first checking your subtypes of LDL cholesterol.