4 steps to achieving and maintaining a healthy heart

Maintaining a healthy heart and preventing cardiovascular disease comes down to a few basic practices, says Falmouth cardiologist David Rancourt, DO, MPH, FACC: Diet, exercise, not smoking and limiting alcohol.

The American College of Cardiology (ACC) provides the latest guidelines on the data-driven advice on how people can reach and stay in the best cardiac shape, he said. Below, Dr. Rancourt discusses each of the practices he suggests to patients.

Diet

“Diet is key to get started with,” he said. “We’ve known for a long time that to go from a classic American-style diet to one that centers around chicken, fish and vegetable intake, you get a real reduction in cholesterol and inflammatory markers.”

The initial studies around diet have been revisited in recent years and it was found that in certain patients who had an even higher intake in vegetables and lower intake of animal protein, their cholesterol and inflammatory markers were even lower. There may also have been a trend towards fewer cardiovascular events, like heart attacks, he said.

“It seems to me that diet is one of those things that almost anyone in the community can do to reduce their risk of having a cardiac event,” Dr. Rancourt said. “That means lots of vegetables, prepared in a healthy way; reducing your animal protein across the board, focusing mostly on eliminating red meats, like beef and pork, but even choosing meals that are purely vegetarian.”

Many of his patients are open to dietary adjustments in their life, but it can be hard to change because it’s a cultural shift for some people, he said. “It’s not just taking a pill or seeing the doctor for ten minutes. It’s something you have to do every day,” he said. “It’s just one of the more difficult things for patients to accomplish.”

But when patients see the secondary rewards of changing their diet, like weight loss, it makes sticking to it easier, he said. He has had patients who lost up to 50 pounds when they switched to a more heart-healthy diet. When they lose weight, patients then see other improvements, like better blood pressure and cholesterol numbers, as well as diabetes numbers in certain patients. This, in turn, can lead to a reduction in medications to control those things.

“I have a patient who found an exercise program he liked and lost something like 60 pounds. He told me, ‘I feel like a brand new person,’ and we were able to drop off his blood pressure and cholesterol meds because those numbers were dropping like a stone.

“He was happy, he was feeling better, and that’s what I wish for my patients: a healthy diet, reasonable weight, good exercise programs, not smoking, not drinking too much and being on less medications.”

Exercise

The recommendation from the ACC is to do 150 minutes of moderate physical activity a week, broken up along the week, according to Dr. Rancourt.

“I always tell my patients, if you don’t use it, you lose it,” he said. He also cautions them that, as we get older, we naturally start to lose muscle mass. It’s essential for staying mobile, independent and out in the community, he said.

Keeping muscle mass starts with maintaining muscle mass in your legs and hips, Dr. Rancourt said. This can be attained by starting a walking program, working out at home or in a gym, cycling, or other exercise program.

“I tell my patients to get out there and be active for at least 30 minutes a day, if you can,” he said.

While exercising, you should be pushing your heart rate up. He suggests patients increase their heart rate to 65 percent of their age-predicted heart rate.

“What I usually tell my patients is to go off how you’re feeling and how you’re breathing. If you’re out there on a walk with a friend, you don’t want to have a full conversation with them because that means you’re not really pushing it hard enough. Alternatively, if your friend asks you a question, you don’t want to have to answer in one-word answers, gasping in between,” he said. “Find something where you can answer in a full sentence, but not conversation.”

Smoking

“Smoking is one of the most powerful negative predictors of cardiac health,” said Dr. Rancourt. “It increases inflammation, stroke risk, heart disease, heart attacks and, obviously, lung disease and cancer.”

In the cardiac world, the data shows there is an all-or-nothing effect from smoking, he said. Even one cigarette seems to charge up the inflammatory markers for a while, so the ACC recommendations are that you just need to quit smoking, to improve your cardiovascular health.

When patients are also smokers, he discusses ways they could quit, whether it’s nicotine replacement aids, or just cold turkey. But he recognizes how hard it is for many people to eliminate cigarettes, especially suddenly. So he has come up with an approach that has worked for many of his patients, which he calls “methodical reduction.”

“Say that you smoke a pack a day, which is 20 cigarettes, and you’ve been smoking that way for 20 years. What I tell them is to start on Monday and you get 20 cigarettes per day to do whatever you want with them. Then, every Monday, you’ll mark one number lower from the week before, repeating every Monday until you’re down to zero. When you start reducing numbers, you’re already making headway.”

There is no data on whether this approach is effective, but Dr. Rancourt has found it has worked for many of his patients.

“It’s kind of like an exercise program. You don’t just run a marathon tomorrow; you’re going to build yourself up to it. This is just smoking in reverse.” 

Alcohol

The ACC guidelines currently say that males should limit their intake of alcoholic beverages to two or less per day, and females should limit their intake to one or less per day. Heavier alcohol consumption can lead to cardiac issues, such as cardiomyopathy, or a weakening of the heart muscle, Dr. Rancourt said.

“So my advice to people is to try to keep your alcohol intake in check. Try to stay below the recommended limit. Less is more,” he said. “It’s OK to go out to dinner and have a glass of wine, but I feel better if they don’t have a daily intake.”

Other Suggestions

The ACC guidelines also touch upon general stress reduction as a measure to improve heart health, but there is not as much data backing that up as there is with diet, exercise, smoking and alcohol, Dr. Rancourt said.

“Certainly I wouldn’t go as far as to say you should be on an anti-anxiety or anti-depressant to improve your heart health. That data doesn’t exist,” he said. “But general stress, yes, can cause symptoms like chest pain, palpitations, fluttering and fatigue.”

For patients who, after some investigation he finds have particularly demanding lives, he works with them on approaches to reduce their stress.

Again, the four key elements of a heart-healthy life: diet, exercise, not smoking and limiting alcohol, are often the best ways to reduce stress as well, he said. Getting the right amount of sleep consistently is also important, he said.

Dr. Rancourt encourages his patients to share the elements of their lifestyle with him, including any use of dietary supplements, even though it is not something he regularly recommends.

“There are no large studies that have shown too much benefit from any of the supplements on the market,” he said. Data on the cardiovascular benefits of omega-3 supplements “kind of waffles back and forth,” he said. “It doesn’t seem to be super beneficial or harmful.”

Since his goal is to help patients reduce their need to take a tablet or pill, he does not encourage introducing other types of pills, like supplements, he said. “If they research and they find they like some of these things, I tell them, ‘fine, if you’re feeling good. It’s just that the data and testing (on them) is limited.”

Calculating Risk

Dr. Rancourt is working with the electronic medical record provider at Cape Cod Healthcare, Epic, on making a module in the EHR that will be able to calculate your 10-year risk of a cardiovascular event, such as a heart attack or stroke. The 10-year risk estimator is already available and the ACC recommends that everyone between the ages of 40 and 75 be screened.

The new module will be embedded in the EHR system and physicians within the system will have it available for their patients. It will use data from patients’ records to produce the results and show their risk. The estimator uses things like age, blood pressure, cholesterol panel, smoking history and medication use to compile the results.

“That information can help us guide interventions, whether they’re natural or pharmaceutical, to reduce long-term risk,” he said. “It will give (patients) one more piece about how they’re doing and how, if you start early and get on top of things sooner, it’s easier to manage long term.”