Aiming for ideal improves heart health

Positive markers mean better heart health, less disease.

In 2010, the American Heart Association (AHA) added a new page to its playbook against the leading causes of death and disability in the United States. Instead of focusing solely on cardiovascular disease, the AHA is broadening its mission to include improving cardiovascular health.

It's a timely shift. The impressive decline in death rates from heart disease since 1970 is threatened by climbing rates of obesity and diabetes, the aging of the population, and early signs of heart disease in adolescents.

The AHA defines "ideal cardiovascular health" as the combination of four healthy behaviors and three health measurements:

  • not smoking

  • maintaining a healthy weight

  • exercising regularly

  • eating a healthy diet

  • total cholesterol under 200 milligrams per deciliter (mg/dL) without treatment

  • blood pressure under 120/80 millimeters of mercury without treatment

  • fasting blood sugar under 100 mg/dL without treatment.

Evaluating "ideal"

Researchers with the Atherosclerosis Risk in Communities (ARIC) study applied the seven criteria to 12,000 of the study's middle-aged participants who didn't have heart disease in 1987. Only 17 of them (0.1%) fit the definition of ideal cardiovascular health. About 12% had five or more of the ideal measures, while 42% had two or fewer (Journal of the American College of Cardiology, April 19, 2011).

Similar numbers were seen in the Heart Strategies Concentrating on Risk Evaluation study. Just one of its 1,933 participants (0.1%) had all seven measures, while 58% had two or fewer (Circulation, March 1, 2011).

To see if the measures matter, ARIC researchers tracked cardiovascular problems. Over 19 years of follow-up, the ARIC participants racked up more than 3,000 heart attacks, strokes, diagnoses of heart failure, and deaths from heart disease. None of the ideal-ists were affected — all 17 remained free from cardiovascular disease. From there, as the number of ideal health measures went down, the rate of cardiovascular problems went up (see table).

Ideal measures and heart risk

Number of ideal measures

Events per 1,000 people

Increase

7

0

6

3.9

5

6.4

64%

4

8.6

34%

3

12.0

39%

2

16.0

33%

1

21.9

57%

0

32.1

47%

As ideal measures decrease, cardiovascular risk increases by the percentages listed in the boxes.

One step at a time

Ideal cardiovascular health is an excellent benchmark and a goal to strive for. It's also the kind of measure that can discourage change — "I'll never get there, so why bother?"

Aim for what's possible instead of what's perfect. If you don't currently qualify for any of the seven ideal categories, working to achieve one of them will improve your odds of avoiding a heart attack, stroke, heart failure, or other cardiovascular event. Once you've met one criterion, there's nothing stopping you from adding more.

If you're in middle age or beyond, is it too late to try? Not at all. Making healthy changes at any age can turn back the clock for your heart and arteries.