The Heart’s Performance Outweighs All Others

February 1, 2025

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Given the heart’s unremitting workload—it beats about 2.5 billion times over the average lifetime—it’s a wonder it performs so well, for so long. Like a finely tuned instrument, you will continue to get perfect sound as long as it’s taken care of and protected.

But it can also fail, brought down by a poor diet and lack of exercise, smoking, infection, unlucky genes, and more.

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.

Although many people develop some form of cardiovascular disease (a catch-all term for all the diseases affecting the heart and blood vessels) as they get older, it’s not inevitable. A healthy lifestyle, especially when started at a young age, goes a long way to preventing cardiovascular disease. Lifestyle changes and medications can nip heart-harming trends—like high blood pressure or high cholesterol—in the bud before they cause damage. And a variety of medications, operations, and devices can help support the heart, if damage occurs.

Tobacco usage is already headed in the right direction. The percentage of Americans who smoke 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, researchers note.

Women and Heart Disease

Women often do not experience classic heart attack 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 women in one study reported experiencing symptoms for at least a month before their heart attack occurred.

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.

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 it 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.

What’s New

In 2024, several notable strides were made in the ability to assess cardiovascular risk, identifying predictors of disease much earlier in life that offer greater opportunities for prevention. The pressing need for prevention was driven home by research revealing a shift in national health trends, as cardiovascular disease burdens that had been falling, reversed course and began an upward climb.

Investigators also made major strides in developing strategies to reduce heart failure-related events and deaths, explored new therapies for bleeding strokes, and found wide-ranging benefits for anti-obesity drugs and ways to lower the life-threatening risks of cardiogenic shock.

What Can You Do?

Know Your 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.

Check your cholesterol regularly. Low-density lipoprotein (LDL) transports cholesterol particles throughout your body and builds up in the walls of your arteries, called atherosclerosis and often referred to as 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.

Rethink Your Diet—The American Heart Association (AHA) recommends aiming for a dietary pattern of 5-6% 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 per day. Nuts, and 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, experts say.

Limit sodium and 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.

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.

Butter, cheese, red meat, and other animal-based foods all contain saturated fat. 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: less mayo, more guacamole and extra virgin olive oil over butter.

Keep Moving—Moving even 20 minutes a day results in huge benefits. Taking a brisk walk improves every heart health measure and reduces disease risk. Work in some form of exercise at least four times a week.

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

Read More About Dietary Guidelines and Ongoing Research:

• American Heart Association             www.heart.org
• Million Hearts           www.millionhearts.hhs.gov
• National Heart, Lung, and Blood Institute    www.nhlbi.nih.gov
• CDC Wise Woman    www.cdc.gov/wisewoman
• National Council on Aging (NCOA)            www.ncoa.org

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