These five habits can save your heart — heres how

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Healthy Eating for a Healthy Heart
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Despite major advances in drugs and medical treatments, maintaining a healthy diet, being physically active, and not smoking are still the best approaches to preventing heart disease. In this Special Health Report, Healthy Eating for a Healthy Heart, find out how improving your diet lowers your risk for heart disease in many ways, including helping to lower high cholesterol, blood pressure, and blood sugar and insulin levels, as well as preventing obesity and improving the function of your heart and blood vessels. Fortunately, a heart-healthy diet is relatively easy to define, and you don’t have to give up great-tasting food.

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These five habits can save your heart — here's how

According to hard data, five harmful habits herald the coming of heart disease. These five are smoking, being inactive, carrying too many pounds, eating poorly, and drinking too much alcohol.

Alone and together, they set the stage for artery-damaging atherosclerosis and spur it onward. They do this by deranging metabolism and changing how cells and tissues work. They also disturb the markers of health we worry about so much: blood pressure, cholesterol, and blood sugar. All too often, the end result of these five habits is a heart attack, stroke, peripheral artery disease, valve problem, aortic aneurysm, or heart failure. And the damage they cause isn't limited to the cardiovascular system, but extends to the kidneys, bones, and brain.

What can making better choices do for health and longevity? Consider this provocative finding from the Nurses' Health Study. Nonsmoking women with a healthy weight who exercised regularly, consumed a healthy diet, and had an alcoholic drink every other day were 83% less likely to have had a heart attack or to have died of heart disease over a 14-year period, compared with all the other women in the study. The results were almost identical in a similar study in men. In these two studies, more than two-thirds of all cardiovascular events could be chalked up to smoking, excess weight, poor diet, and drinking too much.

Five strategies for change

Count on these five white knights to protect your heart, your arteries, and the rest of you. They will make you look better and feel better. And it's never too late to start.

  1. Avoid tobacco. Smoke from cigarettes, cigars, and pipes is as bad for the heart and arteries as it is for the lungs. If you smoke, quitting is the biggest gift of health you can give yourself. Secondhand smoke is also toxic, so avoid it whenever possible.
  2. Be active. Exercise and physical activity are about the closest things you have to magic bullets against heart disease and other chronic conditions. Any amount of activity is better than none; at least 30 minutes a day is best.
  3. Aim for a healthy weight. Carrying extra pounds, especially around the belly, strains the heart and tips you toward diabetes. If you are overweight, losing just 5% to 10% of your starting weight can make a big difference in your blood pressure and blood sugar.
  4. Enliven your diet. Add fruits and vegetables, whole grains, unsaturated fat, good protein (from beans, nuts, fish, and poultry), and herbs and spices. Subtract processed foods, salt, rapidly digested carbohydrates (from white bread, white rice, potatoes, and the like), red meat, and soda or other sugar-sweetened beverages.
  5. Drink alcohol in moderation (if at all). If you drink alcohol, limit your intake — one to two drinks a day for men, no more than one a day for women.

Making change

If you have one or more habits that are working against you, now is as good a time as any to set a course for better health. How? The American Heart Association recommends "cognitive behavioral strategies for promoting behavior change." They aim to help you think more positively about yourself as you make healthy changes. Here are some of those strategies:

Set goals. Having specific, achievable goals is a key strategy for successful change. Goals that involve behaviors ("I will eat three servings of whole grains a day") tend to work better than physiological goals ("I will lower my cholesterol").

Track your progress. With all the things you have to remember each day, it's hard to know whether you are meeting your daily goals. Data from dozens of studies show that self-monitoring is an important attribute of successful changers. You can track your exercise or pounds lost with a notebook, a computer, a smartphone, or an invention of your own.

Motivation. Changing a habit or behavior is easier if you have a good reason for doing it. Motivation can be something big, like getting in shape for a walking trip with a grandchild, or small, like fitting into a slimmer suit for a wedding. The more personal the motivator, the better.

Get support. Starting a change isn't nearly as challenging as sticking with it. Support from family, friends, a doctor, or someone else — even from an online community — can provide feedback and encouragement, especially when you are feeling low.

You don't need to aim for a complete transformation all at once. Small changes in diet, exercise, or weight can make a big difference in your health. Setting goals you can realistically achieve, and then meeting them, can snowball into even bigger improvements.

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Living Well with Diabetes
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Living Well with Diabetes helps you better understand and manage your diabetes. It includes detailed, updated information about medications and alternative treatments for diabetes, and a special section on weight-loss strategies. You’ll also learn the basics of how your body metabolizes sugar, how and when to monitor your blood sugar, and how to cope with both short- and long-term complications of the disease. Most importantly, you’ll see that it’s not just possible to live with diabetes — it’s possible to live well.

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Will thiazide diuretics increase my chances of getting diabetes?

Q. Thiazide diuretics are often recommended as the first medication to use to control blood pressure, but I've heard that a large study called ALLHAT found an association between thiazide diuretics and diabetes. Is this something to be concerned about?

A. You're right about thiazide diuretics being the first choice if you need to take a drug to bring high blood pressure under control. National guidelines recommend them as initial therapy for most people with hypertension — that's another term for high blood pressure — although often more than one medication will be needed to bring blood pressure under control. Numerous studies have shown that thiazide diuretics are effective for preventing heart attacks, strokes, and other cardiovascular consequences of hypertension, and it's reducing the risk of those complications that makes control of hypertension so important. In this country, hydrochlorothiazide is the most commonly prescribed thiazide diuretic.

The ALLHAT study you mention is probably the most influential study of blood pressure medication ever conducted. The study included 33,000 people who were randomized to take one of three blood pressure–lowering medications: a thiazide diuretic, a calcium-channel blocker, or an ACE inhibitor. The rate of heart attacks and deaths from heart disease was similar in all three groups, but the thiazide group had a lower rate of heart failure.

Researchers analyzed the ALLHAT data to see how the three different medications affected blood sugar levels. They found that all three were associated with an increase in blood sugar, but more people in the thiazide group (11.6%) were diagnosed with diabetes than those assigned to take the calcium-channel blocker (9.8%) or the ACE inhibitor (8.1%). This modest difference in the risk for developing diabetes did not, however, translate into more heart attacks or other problems. So, on balance, the benefits of thiazide diuretics — controlling and preventing hypertension-associated events — outweigh the risk of developing diabetes.

I think the thiazide diuretics remain an excellent first choice for most people with high blood pressure, and the small increased risk of developing diabetes seen in the ALLHAT study shouldn't deter patients from taking them or physicians from prescribing them.

— Nancy Keating, M.D.
Brigham and Women's Hospital, Boston

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