Medical Compass: Keep Your Heart Healthy

Medications and lifestyle changes can reduce your risk

By David Dunaief, MD.

Dr. David Dunaief

With all the focus on infectious disease prevention over the past couple of years, many have lost sight of the risks of heart disease. Despite improving numbers in recent years, heart disease still accounts for one in four deaths in the United States, making it the leading cause of death (1).

Heart disease is on the decline due to a number of factors, including increased awareness in the lay and medical communities, improved medications, earlier treatment of risk factors, and lifestyle changes. We are heading in the right direction, but we can do better. Heart disease is something that is completely preventable.

Reduce your basis risk

Important risk factors for heart disease include high cholesterol, high blood pressure, and smoking. In addition, diabetes, being overweight and excessive alcohol consumption increase your risk. Unfortunately, obesity and diabetes are on the rise. For patients with type 2 diabetes, 70% die from cardiovascular causes (2).

Inactivity and the standard American diet, which is high in saturated fat and calories, also contribute to heart disease risk (3). The underlying culprit is atherosclerosis, fatty streaks in the arteries.

Another potential risk factor is a resting heart rate above 80 beats per minute (bpm). In one study, healthy men and women had an 18% and 10% increased risk of dying from a heart attack, respectively, for every 10 bpm increase over 80 (4). A normal resting heart rate is usually between 60 and 100 bpm. So you don’t need to have a racing heart rate, just an elevated-normal rate. All of these risk factors can be overcome.

The role of drugs in risk reduction

Cholesterol and blood pressure medications have been shown to reduce the risk of heart disease to some extent. Unfortunately, according to data from the 2018 National Health and Nutrition Survey (NHANES), only 43.7% of people with high blood pressure have it under control (5). Although the projected reasons are complex, a significant problem among those who know they have hypertension is failure to consistently take prescribed medications or non-compliance with medications.

In terms of lipids, statins have played a key role in primary prevention. Statins are effective not only in lowering lipid levels, including total cholesterol and LDL — the “bad” cholesterol — but also levels of inflammation that contribute to the risk of cardiovascular disease. The JUPITER trial showed a combined 55% reduction in heart disease, stroke and cardiovascular disease mortality in healthy patients – those with mildly elevated levels of inflammation and normal cholesterol profiles – with statins.

The downside of statins is their side effects. Statins have been shown to increase the risk of diabetes at high dosage, compared to moderate dosage (6).

Unfortunately, many people on statins also suffer from myopathy (muscle pain). I have had a number of patients complain of muscle pain and cramping. Their goal is to reduce and eventually quit their statins by following a lifestyle modification plan involving diet and exercise. Lifestyle modification is a powerful ally.

Do Lifestyle Changes Really Help?

The Baltimore Longitudinal Study of Aging, a prospective (prospective) study, surveyed 501 healthy men and their risk of dying from cardiovascular disease. The authors concluded that those who ate five or more servings of fruits and vegetables a day with less than 12% saturated fat had a 76% reduction in their risk of dying from heart disease compared to those who did not. did not consume (7). The authors hypothesized that eating more fruits and vegetables helped remove saturated fat from the diet. These results are impressive, and to achieve them, they only required a modest change in diet.

The Nurses’ Health study shows that these findings are also seen in women, with lifestyle modification reducing the risk of sudden cardiac death (SCD). Often this is the first manifestation of heart disease in women. The authors looked at four lifestyle modification parameters, including a Mediterranean-style diet, exercise, smoking, and body mass index. The decrease in SCD was dose-dependent, meaning that the more factors incorporated, the greater the risk reduction. The risk of SCD was reduced by up to 92% when all four parameters were tracked (8). Thus, it is possible to almost eliminate the risk of SCD for women with lifestyle modifications.

Monitor your risk of heart disease

To track your progress, cardiac biomarkers are revealing, including inflammatory markers like C-reactive protein, blood pressure, cholesterol, and body mass index.

In a cohort study of high-risk participants and people with heart disease, patients implemented a significant lifestyle change: a whole, plant-based diet along with exercise and stress management (9). Results showed improved biomarkers, as well as cognitive function and overall quality of life. Most exciting is that the results occurred in a very short period of time – three months after the start of the trial. Many of my patients have experienced similar results.

Ideally, if the patient needs to use medication to address risk factors for heart disease, it should be short-term. For some patients, it may be appropriate to use medications and lifestyle changes together; for others, lifestyle modifications may be sufficient, as long as the patient takes an active role.

By focusing on developing heart-healthy habits, we can improve the likelihood that we’ll be around for a long time.

The references:

(1) Diabetes care. 2010 February; 33(2):442-449. (3) lancet. 2004;364(9438):93. (4) Community Health J Epidemiol. 2010 Feb;64(2):175-181. (5) Hypertension. 2022;79:e1–e14. (6) NEVER. 2011;305(24):2556-2564. (7) J Nutr. 2005 Mar 1;135(3):556-561. (8) NEVER. 2011 Jul 6;306(1):62-69. (9) Am J Cardiol. 2011;108(4):498-507.

Dr. David Dunaief is a speaker, author, and local lifestyle medicine physician who focuses on the integration of medicine, nutrition, fitness, and stress management. For more information, visit