Seven ways to prevent heart disease

Quit active smoking and long-term second-hand/third-hand smoke exposure, complete 150 minutes of moderate-intensity aerobic exercise per week, limit daily added sugar intake to less than 5% of total calories, maintain long-term blood pressure levels below 130/80mmHg, complete a basic heart-related physical examination including blood lipids and high-sensitivity troponin once a year, limit processed red meat intake to less than 500g per week, and maintain regular sleep of 7-9 hours a day. Next, we will explain the details and misunderstandings of these methods based on clinical practical experience and differences in different studies. Without memorizing complicated formulas, ordinary people can reduce the risk of coronary heart disease by more than 60%.

Don't underestimate these few spoons of invisible sugar. Many people think that the way to prevent heart disease is to add less oil and less salt, and they don't take sugar seriously at all. Last year, I met a 42-year-old corporate salesperson in the outpatient clinic. He does not smoke or drink, and his weight is within the normal range. His blood lipids are only slightly higher than low-density lipoprotein. He does not usually have symptoms of chest tightness. However, a routine physical examination and a coronary CT revealed that 32% of his coronary arteries were blocked. After asking about his dietary history, I found out that he added 3 pumps of syrup to his two cups of iced Americano every day. He also drank a cup of pearl milk tea when he felt sleepy in the afternoon. His daily intake of added sugar was almost 80g, which was more than four times the recommended amount. There has been controversy in the nutrition community before, believing that as long as the total calories do not exceed the standard, the source of sugar is not important. However, the 12-year follow-up data of 100,000 people published in the Journal of the American College of Cardiology in 2023 directly breaks this misunderstanding: people whose daily added sugar intake accounts for more than 10% of their total calories have a 31% higher risk of coronary heart disease than those who consume less than 5%. In particular, added sugars such as fructose and fructose syrup will directly damage the vascular endothelium and are much more harmful than the same amount of starch.

When it comes to vascular damage, we can’t avoid the “old rival” of blood pressure. Nowadays, many people's blood pressure control threshold is still stuck at the old standard of 140/90mmHg. They think that 135/85mmHg is a "normal high value" and should not be ignored. In fact, there are indeed differences in the recommendations of different guidelines: China's 2023 version of the hypertension guidelines also considers 140/90mmHg as a "high normal value". This is the threshold for diagnosis, but for high-risk groups with a family history of heart disease, being overweight, and long-term smokers, we clinically recommend lowering the control target to below 130/80mmHg and taking medicine without needing to go up. Many people can lower it as long as they walk for 40 minutes a day for three consecutive months and stay up less late at night. I used to have a young doctor in the same department. When he first joined the job, he often worked night shifts and his blood pressure fluctuated at 138/89mmHg. Later, he adjusted his duty rhythm and walked around the hospital twice after get off work every day. Now it is stable at 125/78mmHg without any drug intervention.

Many fitness friends get a headache when they hear that they need to control red meat. In fact, there is an important point here: what we are talking about is "processed red meat", that is, bacon, sausage, cured fish and bacon, braised red meat, etc., not fresh lean beef or lean pork. The current controversial point in the academic circle is actually the intake of fresh red meat: the American Heart Association believes that it is best to control the intake of fresh red meat within 300g per week, while the Chinese Nutrition Society recommends that it is fine within 500g. You don’t have to worry about this difference. As long as you don’t eat half a pound of braised pork every day, it is perfectly fine to eat fresh lean red meat two or three times a week. On the contrary, vegetarian friends should pay attention to supplementing vitamin B12, otherwise homocysteine ​​will increase, which will increase the risk of heart disease.

In addition to diet and indicators, many people don’t take the impact of sleep on the heart seriously. Last year, a 28-year-old Internet employee came for a physical examination. All other indicators were normal. Only the high-sensitivity troponin was two times higher than the normal value. After further questioning, I found out that he went to bed at 2 a.m. and woke up at 7 a.m. every day for half a year. He only slept 5 hours a day. This was equivalent to having his heart spinning continuously for half a year, and he had suffered slight myocardial damage. Here is a counter-intuitive conclusion: not everyone has to go to bed early and get up early. Current research shows that as long as you have a fixed sleep rhythm, even if you go to bed at 2 a.m. and wake up at 10 a.m. every day, as long as you sleep 7-9 hours, the risk of heart disease is not significantly different from that of people who go to bed early and get up early. You don't have to force yourself to change your "night owl" habit. Instead, you will be more anxious because you can't sleep every day, which will do more harm to your heart.

Oh, by the way, there is also the exercise that everyone often talks about. You really don’t have to force yourself to run a marathon or practice high-intensity intervals. Just 150 minutes of moderate-intensity exercise every week, such as brisk walking, cycling, swimming, and even square dancing. It’s just enough to get to the point where you’re slightly sweaty and can speak normally but can’t sing. Previous studies have shown that the benefits of high-intensity exercise are similar to those of moderate-intensity exercise. However, for middle-aged and elderly people who have never exercised before, we recommend starting with brisk walking. Sudden high-intensity exercise may induce heart problems. It is most important to act within your ability.

Many people think that if they are not feeling uncomfortable, their heart is fine. In fact, there are basically no obvious symptoms when the coronary arteries are narrowed below 50%. By the time chest tightness and chest pain occur, the coronary arteries are often blocked to more than 70%. A routine physical examination once a year, plus a high-sensitivity troponin and blood lipid test for more than ten yuan, can identify risks in advance. There is no need to spend thousands every year on coronary CT and cardiac MRI. Unless you already have high blood pressure, diabetes, or a clear family history of heart disease, routine examinations are completely sufficient, and there is no need to over-medicalize.

Finally, let me talk about something that everyone knows but many people cannot do: quit smoking, including avoiding second-hand and third-hand smoke. There used to be an aunt who didn’t smoke, but her husband had smoked for 40 years. Last year, it was found that her coronary arteries were blocked by 40%. A 2022 Lancet study showed that people who are exposed to secondhand smoke for a long time have a risk of coronary heart disease similar to that of people who smoke 5 cigarettes a day. If you don’t smell the cigarette smoke, you’ll be fine. The harmful particles in the smoke will stick to your clothes and sofa and remain there for hours. If you have a smoker at home, it’s best to let him smoke outdoors or install an air purifier with a HEPA filter. Don’t make fun of the heart health of the whole family.

In fact, there is no threshold for these 7 methods. The difficult thing is to persist in the long term. You don’t have to force yourself to do them all at once. For example, start by changing milk tea to unsweetened tea, and slowly add the habit of walking for half an hour every day. It is much better than changing too much at once and being unable to persist. After all, heart protection is a lifelong matter, and if you take your time, it will be faster.