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What Factors Contribute to Heart Disease?

Cardiovascular diseases are a leading cause of mortality and disability worldwide, we provide four lifestyle steps to reduce the risk of CVD.

Cardiovascular diseases (CVD) are a leading cause of mortality and disability worldwide. A growing body of evidence makes the crosstalk between diet and health now unquestionable.

The current challenge is therefore to put available knowledge into practice and implement practical approaches to optimize the transition to healthy diets and habits to reduce the incidence of CVD in the general population. Medical schools and health education programmes usually provide nutritional lectures discussing aspects such as biochemical pathways of vitamins and lipids metabolism. The challenge for physicians might be to translate this biochemistry knowledge into patients’ everyday needs.

Many of the common questions that people might want to know when looking for strategies to reduce the risk of CVD are things like – “should I eat less meat?” “more greens?” “More olive oil?” “Less butter?” “Is white sugar bad?” “How often should I eat carbs?” “How do I lose weight?”

Herewith, we want to provide you with four practical key lifestyle steps that can dramatically help guide the discussion through healthy diets and habits when aiming to identify strategies to reduce the chances of developing cardiovascular risk factors and ultimately heart disease.

Healthy diets: focus on food, not nutrients.

Solid evidence from two large prospective studies, the Nurses’ Health Study and the Health Professionals Follow-up Study, showed that a healthy lifestyle pattern (healthy diet, physical activity and avoiding smoking) dramatically reduces the risk of cardiovascular events over a long-term follow-up.

For decades, researchers investigating the crosslink between diet and heart diseases dedicated most of their efforts on individual nutrients, mainly cholesterol and distinct types of fats. While these observations paved the way for current fundamental principles in nutrition, they have also generated some misconceptions and myths about what a heart-healthy diet is. What we should never forget is the fact that people eat food, not nutrients.

People with a diet rich in fruits and vegetables, fish, whole grains, nuts, poultry, and vegetable oils reduce the risk of heart disease by 30%, as well as a 33% lower risk of diabetes, and a 20% lower risk of stroke. Additionally, a healthy heart should contain only moderate consumption of alcohol, if any.

This diet pattern is similar to what is usually considered to be a Mediterranean diet, which was proven in a randomized controlled trial to lower the risk of major cardiovascular events amongst patients with cardiovascular disease. This was revealed over a follow-up period of almost 5 years when supplemented with extra-virgin olive oil and/or nuts. One of the important conclusions of this study relies on the observation that low-fat diets are not necessarily beneficial to individuals with heart conditions. Conversely, incorporating healthy fats (e.g., extra-virgin olive oil and nuts) can support heart health and facilitate weight loss.

Of course, one should also bear in mind that there is not just one specific Mediterranean diet. In fact, differences exist in terms of food choices, eating patterns, and lifestyles across the different parts of the Mediterranean regions. However, strong similarities in the eating patterns include a low intake of dairy products, red meat, processed meats, and sweets, counterbalanced by a high intake of olive oil, nuts, vegetables, fruits, and cereals.

A recent study published in 2020 analyzed the dietary scores of different eating patterns. Regardless of some differences in the scoring systems applied, the researchers found that eating patterns which include whole grains, vegetables, fruits, legumes, and nuts, as well as lower intakes of red and processed meats and sugar-sweetened beverages, were consistently associated with lower risk of cardiovascular events (such as coronary heart disease and stroke). Furthermore, the benefit was confirmed across racial and ethnic groups and other subgroups studied.

What does maintaining a healthy weight mean?

Excess weight and an extra-large waist size are major contributors to CVC and are risk factors for other conditions such as type 2 diabetes. Evidence supporting these facts come from decades of research.

Among others, the Nurses’ Health Study and the Health Professionals Follow-Up Study, a study including over one million women, showed that body-mass index (BMI) was a strong risk factor for CVC and that the incidence of coronary heart disease increases progressively with BMI. The study demonstrated that women who gained about 10 kg (22 pounds) were up to three times more likely to present with CVD, increased arterial blood pressure, diabetes, than those who gained about 2.5 kg (or five pounds) or less.

How can we translate the observations of this study into good practical advice?

First, we have to remember that weight and height are linked. The taller you are, the more you weigh. That’s why researchers use BMI as an easy measure to account for both these variables. A healthy BMI is under 25 kg/m2. Overweight is defined as a BMI of 25 to 29.9 kg/m2, and obesity is defined as a BMI of 30 kg/m2.

Secondly, along with BMI, waist size should be considered when assessing the risk for CVD. Indeed, assessing the waist size in some groups can be even more informative than BMI to predict the risk for future CVD events. This is the case, for instance, of people who cannot be classified as overweight according to their BMI. Men should aim for a waist size below 102 cm (40 inches) and women should aim for a waist size below 88 cm (35 inches).

Be active! But how much exercise per day?

Exercising is good for our wellbeing. Regular physical activity not only reduces the risk of CVD but it can also help improve sleep patterns and mood, as well as control blood pressure and keep weight in check. Besides, it has been shown that in the elderly population, physical activity improves cognitive function and reduces the risk of falling.

Having said that, how much physical activity should be recommended? All in all, while we should remember that getting any amount of exercise is better than none, people don’t need to have marathon training to achieve concrete health benefits. A 30-minute fast walk five days of the week will provide adequate important benefits for most people. Conversely, people with a sedentary lifestyle (such as those spending much time per each watching television, sitting, or riding in cars) showed an increased risk for CVD.

Do not smoke

Tobacco use (in any form) is an unhealthy habit significantly contributing to CVD. When analyzing in a prospective way more than 100,000 women, researchers found that more than 64% of deaths among active smokers were attributable to cigarette smoking. Importantly, they also observed that by quitting smoking, there is a reduced risk of CVD, reaching the level of “never-smoker” people 20 years after quitting.


In summary, how impactful can we be by suggesting the mentioned four key things?

Following a healthy lifestyle may reduce the risk of coronary artery disease by over 80% – definitely a solid investment for our future.

Authors: Dr. Savino Sciascia, and Dr. Gregory Winston Gilcrease.

© University of Turin
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