Numbers to know for a healthy heart

Cardiovascular disease remains the leading cause of death worldwide. This is why Nicole Redmond, M.D., Ph.D., M.P.H., chief of the Clinical Applications and Prevention branch in NHLBI’s Division of Cardiovascular Sciences, is bringing attention to silent pieces of information, like elevated blood pressure or cholesterol. When they go unchecked, problems may manifest years later as heart failure, a heart attack, or stroke.

“The most challenging thing about heart health is that you can’t wait until you have symptoms to address it,” Redmond said. “By that time, it’s too late.”    

This is why for this American Heart Month American Heart Month, NHLBI is focusing on boosting heart-health literacy.

“One of my favorite phrases is ‘If you stay ready, you don’t have to get ready,’” said Redmond. “That’s really a prevention mindset.”

To adopt that prevention mindset, it’s essential to “know your numbers” – most importantly, your blood pressure, body weight, cholesterol, and blood sugar, Redmond said. When you keep these at normal levels, she added, you greatly lower your risk for heart problems, which may start with chest or upper body pain, fatigue, and shortness of breath, and even lead to unfortunate pregnancy outcomes.

Redmond noted that while most people know it’s important to exercise and eat a heart-healthy diet, the challenge is figuring out how.

That’s why researchers created “Life’s Essential 8,” an eight-point roadmap designed to help people of all ages reach and maintain optimal heart health. The guidelines include recommendations for creating heart-healthful meals, staying active throughout the week, getting a good night’s sleep, quitting or avoiding tobacco, and supporting a healthy body weight and blood pressure, cholesterol, and blood sugar levels.

Studies, such as the review published in Current Problems in Cardiology, show that people who start by taking steps, like getting more sleep each night or moving more throughout the day, can reap long-term benefits. For example, if an adult falls short of the recommended 7-9 hours of sleep each night but starts getting an extra hour of sleep, they could offset their long-term risk for heart failure or having a heart attack or stroke by about 10%. The same benefits apply to a person who begins moving more, such as doubling their daily exercise from 17 to 34 minutes.

Redmond encourages people looking for starting points to first think about their lifestyle.

Planning for daily nutrition and consistent exercise might look different for younger and older adults, men and women, people living in rural and urban environments, and for those focusing on preventing heart disease compared to preventing a second heart attack or stroke, Redmond explained. “It’s much easier to be process focused,” said Redmond. This includes thinking about steps people can take each day to support their health.

To help patients with this process, Natalie A. Bello, M.D., M.P.H., director of hypertension research in the Smidt Heart Institute at Cedars-Sinai, starts by reviewing Life’s Essential 8 during medical visits. “Eighty percent of cardiovascular disease is preventable,” she said. She goes through each of the guidelines and offers advice if a person finds one or more areas challenging.

If eating heart-healthy meals is an obstacle, Bello may offer grocery shopping tips. She advises her patients to shop the perimeter of the grocery store and “focus on picking fresh vegetables, fruit, dairy, and lean protein, while avoiding the center aisles.” If meal planning is a barrier, she recommends reserving time on Sunday to prepare ingredients for fresh meals, like salads, that can be easily assembled during the week. They can also stock up on portable items, such as yogurt, to create healthful meals or snacks on the go.

Bello offers similar advice for exercise. If someone working from home finds that physical activity is a challenge, she might recommend taking quick breaks to walk around the living room, or up and down stairs in their house or apartment building.

“Breaking up movement throughout the day supports cardiovascular health,” Bello said. “In addition to supporting the health of blood vessels and circulation, moving, even for a little bit, also supports concentration.”

Research published in Circulation echoes Bello’s approach to empowering patients, noting the effectiveness of starting with one change at a time, including what’s most meaningful to them.

Bello also looks for opportunities to work with patients early in life and encourages them to ask her and other healthcare providers questions. For example, “What does hemoglobin A1c mean?” could be a gamechanger for a person with a family history of diabetes who is wondering if they should get their fasting blood sugar, including hemoglobin A1c, checked.  

In Louisiana, researchers are adopting similar approaches to help adults manage and control risk factors for heart disease, including high blood pressure. Through an 18-month study taking place at 42 churches, health coaches will help more than 1,000 adults with at least one risk factor for heart disease find ways to reach personal health goals. 

This faith-based study, called Church-based Health Intervention to Eliminate Racial Inequalities in Cardiovascular Health (CHERISH), is supported by the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance. The objective is to help participants living in communities disproportionately affected by heart disease make heart-healthy lifestyle changes together. 

“For decades in New Orleans and other places, community-based initiatives, such as the Healthy Heart Community Prevention Project, have done risk-factor interventions in the community setting,” said Keith C. Ferdinand, M.D., a CHERISH co-investigator and the Gerald S. Berenson Endowed Chair in preventive cardiology and a professor of medicine at Tulane University School of Medicine. “We need to take it one step further.”

The goal, Ferdinand said, should still be educating and empowering patients, but partnering with community health workers and nurse practitioners to intervene long before disease, like heart failure, develops, or a person has a heart attack or stroke.

“It’s difficult in the 15 minutes of a usual primary care visit to control for conditions that are present 24 hours, all days of the year,” Ferdinand said. This is why it’s so important for physicians and communities to form collaborations, he explained.

One of the most effective models has been the Los Angeles Barbershop Blood Pressure Study, which helped Black men with high blood pressure control risk factors for heart disease. Men who offered to get their blood pressure taken while at the barbershop – and connected with an on-site pharmacist – lowered their blood pressure by about 20 mm Hg more than men who only received educational materials. The results were sustained after one year and proved cost-effective.

Other studies, including the Early Intervention to Promote Cardiovascular Health of Mothers and Children (ENRICH) and the Maternal Health Community Implementation Project (MH-CIP), are underway and were created to support the heart health of new parents and families.

“We have excellent lifestyle interventions and drug therapies to control cardiovascular risks,” Ferdinand said. “The goal should not only be to reduce risks for heart disease, but to decrease, if not eliminate, the longstanding disparities we see in life and in survival itself.”

To help people take the first step to protect their hearts, NHLBI is sharing new resources, including a Heart Smart Basics factsheet and a personal health tracker this February.

To learn more about heart-healthy living, visit https://www.nhlbi.nih.gov/health/heart-healthy-living.

To join NHLBI in celebrating American Heart Month, visit https://www.nhlbi.nih.gov/education/american-heart-month.