Show Some Love for Your Heart

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February 1, 2024

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After decades of decline, fatal coronary heart disease may rise again unless Americans modify three major risk factors: smoking, drinking, and obesity, according to a new study out of Rutgers University. For musicians, hectic schedules, late-night gigs, rehearsals, and touring often mean less time devoted to diet and exercise.

Between 1990 and 2019, the US age-standardized coronary heart disease mortality rate per 100,000 fell from 210.5 to 66.8 for females (4% decline per year) and from 442.4 to 156.7 for males (3.7% decline per year). The decline has slowed significantly since 2011, say researchers.

“The overall numbers are good. We saw a substantial decline in deaths from all types of coronary heart disease for both females and males,” says Cande Ananth, MD, MPH, lead author of the study. “However, because we examined how these three modifiable risk factors affected mortality rates, we can see that there is room for considerable improvement.”

Tobacco usage is already headed in the right direction: The percentage of Americans who smoked tobacco fell to 14% in 2019 from 26% in 1990. Obesity rates, on the other hand, rose sharply during the study period to 43% in 2019 from 12% in 1990. Alcohol usage rose slightly during the study period.

Although heart attacks can happen without warning, two major types of coronary heart disease—chronic ischemic heart disease (narrowing of arteries) and atherosclerotic heart disease (plaque build-up inside arteries)—can be diagnosed and treated years before heart damage occurs.

Know the Numbers

Monitor your blood pressure. High blood pressure, or hypertension, rarely has symptoms. A score of 120/80 is optimal, and 140/90 is normal for most people. Higher readings mean that arteries are not responding properly to the force of blood pushing against artery walls (blood pressure), directly raising the risk of heart attack or stroke.

Low-density lipoprotein (LDL) transports cholesterol particles throughout your body and builds up in the walls of your arteries, called atherosclerosis or hardening of the arteries. High-density lipoprotein (HDL) picks up excess cholesterol and takes it back to your liver. For an adult, the ideal overall cholesterol number is 200 mg/dl or lower.

Heart Disease Affects Women Differently

Women may not experience “classic” symptoms, such as chest pain and tingling. Many patients say they experienced anxiety, sleep disturbances, and unusual or unexplained fatigue. What’s more, 80% of the women in one study reported experiencing symptoms for at least a month before their heart attack occurred.

Hormone changes may affect a woman’s risk for coronary heart disease. Before menopause, estrogen provides women with some protection against heart disease, possibly because estrogen keeps the arteries flexible or because estrogen may have beneficial effects on blood lipids. As women age, their risk for coronary heart disease increases, and menopausal hormone therapy may further increase that risk. Women who experience early menopause, especially after a hysterectomy, are more likely to develop heart disease than women of the same age who have not yet experienced menopause.

The size and structure of the heart is different for women and men. A woman’s heart and blood vessels are smaller, and the muscular walls of women’s hearts are thinner. Women are more likely to have heart disease in the smaller arteries of the heart, called coronary microvascular disease, which can make the disease harder to identify and cause delays in treatment.

What You Can Control

Rethink your diet. The American Heart Association (AHA) recommends aiming for a dietary pattern of 5% to 6% of calories from saturated fat. For example, if you need about 2,000 calories a day, no more than 120 should come from saturated fat, about 13 grams of saturated fat per day. Nuts, especially walnuts, have more cholesterol-reducing omega-3 fatty acids that supply healthy unsaturated fats. Eating just five ounces of nuts per week is linked to decreased cardiovascular disease.

Say no to sodium and excess sugar. Government dietary guidelines recommend consuming less than 2,300 mg of sodium per day. Dietary Guidelines for Americans (DGA) calls for no more than 12 teaspoons of sugar per day from any source. Note: A typical 12-ounce can of soda has 150 calories and roughly nine teaspoons of sugar. The recommended amount of alcohol is zero, but if you do drink, it’s one drink or less per day for women or two drinks or less for men.

Move every day. Moving even 20 minutes a day, for example, taking a brisk walk, improves every other heart health measure and disease risk. Try to get in some form of exercise at least four times a week.

Watch Your Fats

Saturated and trans fats can be especially harmful to your heart and arteries. A heart-healthy diet is low in these harmful fats but includes moderate amounts of healthy fats. Mono- and polyunsaturated fats, especially omega-3 fats, are good for your heart. Recent research conducted at the Karolinska Institutet in Sweden and published in The Journal of Clinical Investigation, found that a receptor activated by substances formed from omega-3 fatty acids plays a vital role in preventing inflammation in blood vessels and reducing atherosclerosis.

Butter, cheese, red meat, and other animal-based foods all contain saturated fat. In general, eating more fruits, vegetables, and whole grains—taking in more fiber and fewer calories—are key to a heart-healthy diet. Stick to tried-and-true food substitutions. Add some guacamole to your tacos, instead of cheese. Spread natural peanut butter or almond butter on your toast. Sauté vegetables in a teaspoon of olive oil instead of butter.

When Stress Enters the Equation

There is no shortage of “stressors” that dominate everyday life. Stress can increase inflammation in your body, which in turn can lead to high blood pressure. Chronic stress can also affect your heart indirectly. You tend to lose sleep and exercise less. You might rely on fast food over healthy options, which over time will increase LDL cholesterol and lower the “good” HDL cholesterol.

Recharge to keep stress at bay. Walk it off or practice yoga, meditation, or deep breathing. Take measures to relax and avoid undue stress. Sleep yields big dividends for a healthy heart. Seven to eight hours per night is recommended.