Heart-Healthy Living

Your risk of heart disease is higher if you:

• Have high blood pressure
• Have high blood cholesterol
• Are overweight or obese
• Have prediabetes or diabetes
• Smoke
• Do not get regular physical activity
• Have a family history of early heart disease (your father or brother was diagnosed before age 55, or your mother or sister was diagnosed before age 65)
• Have a history of preeclampsia (a sudden rise in blood pressure and too much protein in the urine during pregnancy)
• Have unhealthy eating behaviors
• Are older (age 55 or older for women or age 45 or older for men)

Each risk factor increases a person’s chance of developing heart disease. The more risks you have, the higher your overall risk.

Some risk factors cannot be changed. These include your age, sex, and a family history of early heart disease. But many others can be modified. For example, being more physically active and eating healthy are important steps for your heart health. You can make the changes gradually, one at a time. But making them is very important.

Women generally get heart disease about 10 years later than men do, but it’s still women’s #1 killer. After menopause, women are more likely to get heart disease, in part because estrogen hormone levels drop. Women who have gone through early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age who have not gone through menopause. Middle age is also a time when women tend to develop other risk factors for heart disease, such as high blood pressure.

Preeclampsia (high blood pressure during pregnancy) raises your risk of developing coronary heart disease later in life. It is a risk factor that you can’t control. However, if you’ve had the condition, you should take extra care to monitor your blood pressure and try to lower other heart disease risk factors.

Risk factors such as high blood pressure or cholesterol generally don’t have obvious signs or symptoms. A crucial step in determining your risk is to see your doctor for a thorough checkup and risk assessment. Your doctor may use a risk calculator to estimate your risk of having a heart attack, having a stroke, or dying from a heart or blood vessel disease in the next 10 years or throughout your lifetime.

For example, the Atherosclerotic Cardiovascular Disease (ASCVD) Estimator considers your cholesterol levels, age, sex, race, and blood pressure. It also factors in whether you smoke or take medicines to manage your high blood pressure or cholesterol.

Your doctor can be an important partner in helping you set and reach goals for heart health. Ask about your risk for heart disease at your annual checkup. Since your risk can change over time, keep asking each year.

Questions to ask your doctor at your annual checkup

1. What is my risk of developing heart disease?
2. What is my blood pressure? What does it mean for me, and what do I need to do about it?
3. What are my cholesterol numbers? What do they mean for me, and what do I need to do about them?
4. What is my body mass index (BMI) and waist measurement? Do I need to lose weight for my health?
5. What is my blood sugar level, and does it mean I’m at risk for diabetes?
6. What other screening tests for heart disease do I need? How often should I return for checkups for my heart health?
7. How can we work together to help me quit smoking?
8. How much physical activity do I need to help protect my heart?
9. What is a heart-healthy eating plan for me? Should I see a registered dietitian or qualified nutritionist to learn more about healthy eating?
10. How can I tell when I’m having a heart attack?

If you already are being treated for heart disease or heart disease risk factors, discuss your treatment plan with your doctor. Ask questions if you do not understand something or need more information. You may want to write down questions before your appointment as well.

Questions to discuss about your heart disease prevention and treatment plan

1. How does my treatment compare with what is recommended in the latest guidelines?
2. How well is my treatment plan working for me?
3. Are my risk factors for heart disease in a good range or getting better?
4. If your doctor recommends medicine or a medical procedure, ask about its benefits and risks.

Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps blood. If this pressure rises and stays high over time, it can damage your heart and your blood vessels and lead to plaque buildup.

Most adults should have their blood pressure checked at least once a year. If you have high blood pressure, you will likely need to be checked more often. Talk with your doctor about how often you should have your blood pressure checked.

Your doctor will measure your blood pressure to see if it is higher than is recommended. The reading is made up of two numbers, with the systolic number above the diastolic number. These numbers are measures of pressure in millimeters of mercury (mm Hg). Learn more about getting your blood pressure measured in this video.

Your blood pressure is considered high when you have consistent systolic readings of 140 mm Hg or higher or diastolic readings of 90 mm Hg or higher. Based on research, your doctor may also consider you to have high blood pressure if you are an adult or child age 13 or older who has consistent systolic readings of 130 to 139 mm Hg or diastolic readings of 80 to 89 mm Hg and you have other risk factors for heart disease.

If your blood pressure is high, your doctor will suggest lifestyle changes and may prescribe medicines. Learn more about high blood pressure. You can track your progress with our Tracking Your Numbers worksheet and bring it with you whenever you have your blood pressure taken.

High blood cholesterol is a condition in which your blood has unhealthy levels of cholesterol—a waxy, fat-like substance.

Many factors affect your cholesterol levels. For example, age, sex, eating patterns, and physical activity level can affect your cholesterol levels. Children also can have unhealthy cholesterol levels, especially if they’re overweight or their parents have high blood cholesterol.

A blood test can show whether your cholesterol levels are healthy. Talk with your doctor about having your cholesterol tested and how often you need it tested. Your cholesterol numbers will include total cholesterol, “bad” LDL cholesterol and “good” HDL cholesterol, and triglycerides. Ask your doctor what your numbers mean for you.

If you have unhealthy cholesterol levels, your doctor may suggest the lifestyle changes discussed in this topic. If heart-healthy lifestyle changes alone are not enough, your doctor may prescribe a statin or other medicine to help manage your cholesterol levels.

The following foods are the foundation of a heart-healthy eating plan.

• Vegetables such as leafy greens (spinach, collard greens, kale, cabbage), broccoli, and carrots
• Fruits such as apples, bananas, oranges, pears, grapes, and prunes
• Whole grains such as plain oatmeal, brown rice, and whole-grain bread or tortillas
• Fat-free or low-fat dairy foods such as milk, cheese, or yogurt
• Protein-rich foods:
  • Fish high in omega-3 fatty acids (salmon, tuna, and trout)
  • Lean meats such as 95% lean ground beef or pork tenderloin or skinless chicken or turkey
  • Eggs
  • Nuts, seeds, and soy products (tofu)
  • Legumes such as kidney beans, lentils, chickpeas, black-eyed peas, and lima beans
• Oils and foods high in monounsaturated and polyunsaturated fats:
  • Canola, corn, olive, safflower, sesame, sunflower, and soybean oils (not coconut or palm oil)
  • Nuts such as walnuts, almonds, and pine nuts
  • Nut and seed butters
  • Salmon and trout
  • Seeds (sesame, sunflower, pumpkin, or flax)
  • Avocados
  • Tofu

A heart-healthy eating plan limits sodium (salt), saturated and trans fats, added sugars, and alcohol. Understanding nutrition labels can help you choose healthier foods. Visit How to Understand and Use the Nutrition Facts Label from the U.S. Food & Drug Administration (FDA) to learn more.

Limit sodium

Adults and children over age 14 should eat less than 2,300 milligrams of sodium a day. Children younger than age 14 may need to eat even less sodium each day based on their sex and age. If you have high blood pressure, you may need to limit sodium even more. Talk to your doctor or healthcare provider about what amount of sodium is right for you or your child.

Try these shopping and cooking tips to help you choose and prepare foods that are lower in sodium:

• Read food labels and choose products that have less sodium for the same serving size.
• Choose low-sodium, reduced-sodium, or no-salt-added products.
• Choose fresh, frozen, or no-salt-added foods instead of pre-seasoned, sauce-marinated, brined, or processed meats, poultry, and vegetables.
• Eat at home more often so you can cook food from scratch, which will allow you to control the amount of sodium in your meals.
• Flavor foods with herbs and spices instead of salt.
• When cooking, limit your use of premade sauces, mixes, and instant products such as rice, noodles, and ready-made pasta.

For more ways to limit your sodium, visit Living With the DASH Eating Plan or print this handout, Tips to Reduce Salt and Sodium.

Limit saturated fats

Saturated or “bad” fats come from animal sources such as butter, cheese, and fatty meats and should make up less than 10% of your daily calories. Read food labels and choose foods that are lower in these fats and higher in unsaturated fats. Unsaturated fats are also known as “good” fats and are found in vegetable oils and nuts.

Limit saturated fats by:

• Eating leaner, lower-fat, and skinless meats instead of fatty cuts of meat and chicken with skin.
• Consuming lower-fat dairy products instead of whole-milk.
• Using certain vegetable oils (such as olive and canola oil) instead of butter, lard, and coconut and palm oils.

Learn more about limiting saturated fat from the U.S. Food & Drug Administration.

Limit trans fats

Limit trans fats as much as possible by:

• Limiting foods high in trans fats. This includes foods made with partially hydrogenated oils such as some desserts, microwave popcorn, frozen pizza, stick margarines, and coffee creamers.
• Reading the nutrition labels and choosing foods that do not contain trans fats.

Dairy products and meats naturally contain very small amounts of trans fats. You do not need to avoid these foods because they have other important nutrients.

Limit added sugars

You should limit the amount of calories you get each day from added sugars. This will help you choose nutrient-rich foods and stay within your daily calorie limit.

Some foods, such as fruit, contain natural sugars. Added sugars do not occur naturally in foods but instead are used to sweeten foods and drinks. They include brown sugar, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, raw sugar, and sucrose.

In the United States, sweetened drinks, snacks, and sweets are the major sources of added sugars.

• Sweetened drinks include soft drinks or sodas, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic drinks, and favored waters. Sweetened drinks account for about half of all added sugars consumed.
• Snacks and sweets include grain-based desserts such as cakes, pies, cookies, brownies, doughnuts; dairy desserts such as ice cream, frozen desserts, and pudding; candies; sugars; jams; syrups; and sweet toppings.

Lower how much sugar you eat or drink by:

• Choosing drinks without added sugar such as water, low-fat or fat-free milk, or 100% vegetable juice.
• Choosing unsweetened foods for snacks or dessert.
• Eating sweetened drinks, snacks, and desserts less often and in smaller amounts.

Limit alcohol

Talk to your doctor about how much alcohol you drink. Your doctor may recommend that you reduce the amount of alcohol you drink or that you stop drinking alcohol. Alcohol can:

• Add calories to your daily diet and possibly cause you to gain weight.
• Raise your blood pressure and levels of triglyceride fats in your blood.
• Contribute to or worsen heart failure in some people, such as some people who have cardiomyopathy.
• Raise your risk of other diseases such as cancer.

If you do not drink, you should not start. You should not drink if you are pregnant, are under the age of 21, taking certain medicines, or if you have certain medical conditions, including heart failure.

Read the 2015–2020 Dietary Guidelines for Americans to learn about what is considered one alcoholic drink and how calories vary by drink.

You should eat the right amount of calories for your body, which will vary based on your sex, age, and physical activity level. Remember that some healthy foods, including oils and dairy, can still have a lot of calories. Some fruits can have a lot of natural sugar, especially when they are dried. Develop a personalized food plan at Get Your MyPlate Plan.

You can visit the U.S. Department of Health and Human Services’ and U.S. Department of Agriculture’s 2015–2020 Dietary Guidelines for Americans for more information about healthy eating and to read about their recommendations for the following healthy eating patterns.

• Healthy U.S.-style eating pattern
• Healthy Mediterranean-style eating pattern
• Healthy vegetarian eating pattern

The more body fat that you have and the more you weigh, the more likely you are to develop heart disease, high blood pressure, type 2 diabetes, breathing problems, and certain cancers.

If most of your fat is around your waist rather than at your hips, you are at a higher risk for heart disease and type 2 diabetes. This risk may be high with a waist circumference that is more than 35 inches for women or more than 40 inches for men.

To correctly measure your waist circumference, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out.

If you have been diagnosed with overweight or obesity, it’s important to follow your doctor’s recommendations for losing weight. Health professionals recommend losing 5% to 10% of your initial weight over the course of about 6 months. Even before you reach this goal, a loss of just 3% to 5% of your current weight can lower triglycerides and glucose levels in your blood, as well as your risk of developing type 2 diabetes. Losing more than 3% to 5% of your weight can improve blood pressure readings, lower “bad” LDL cholesterol, and increase “good” HDL cholesterol.

Sleep helps heal and repair your heart and blood vessels. It also helps:

• Maintain a healthy balance of the hormones that make you feel hungry or full
• Support healthy growth and development
• Support a healthy immune system

Over time, not getting enough quality sleep, called sleep deficiency, can raise your risk of heart disease, obesity, high blood pressure, diabetes, and stroke. Get inspired with this video.

You can take steps to improve your sleep habits. First, make sure that you allow yourself enough time to sleep. Learn strategies for getting enough sleep in the Sleep Deprivation and Deficiency Health Topic.

It may help to:

• Spend time outside every day, if possible, and be physically active.
• Avoid nicotine and caffeine.
• Avoid heavy or large meals within a couple hours of bedtime. Also, avoid alcoholic drinks before bed.
• Go to bed and wake up at the same time every day.
• Use the hour before bed for quiet time. Avoid exercise and bright light.
• Take a hot bath or use relaxation techniques before bed.
• Keep your bedroom quiet, cool, and dark.

For more information about healthy sleep habits, visit Your Guide to Healthy Sleep.