According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States. It involves several types of heart conditions, the most common of which is coronary artery disease (CAD). CAD includes the narrowing of the arteries due to plaque buildup, leading to a higher risk of heart attacks and strokes. Lifestyle and dietary changes are often recommended for reducing heart disease risk, but a review of the evidence paints a slightly different picture. 

Risk Factors for Heart Disease 

  1. POVERTY: Over three-quarters of heart disease-related deaths occur in low- to moderate-income countries. Individuals who live below the poverty line are far more likely to experience symptoms of metabolic syndrome, a risk factor for developing heart disease that often occurs despite positive health behaviors. Metabolic syndrome includes at least three of the following: high blood pressure, high blood sugar, low HDL (“good” cholesterol), high triglycerides, and increased waist circumference. 
  2. CHRONIC STRESS: Long-term stress can lead to a build-up of inflammatory hormones called cortisol, which has been linked to the development of high blood pressure, diabetes, high cholesterol, and heart disease. Stress can be cumulative and is seen among people living with the experience of social discrimination, including racism, weight stigma, and gender discrimination. 
  3. LACK OF ACCESS TO AFFORDABLE HEALTHCARE: Individuals who are unable to afford or access quality healthcare tend to live with other forms of chronic stress, the effects of which are seen in higher rates of untreated hypertension, insulin resistance, and elevated cholesterol. Lack of access to resources such as safe places to walk or exercise or affordable, nutrient-dense foods contributes significantly to poor health. 
  4. GENETICS: Individuals who have a family history of heart disease and associated risk factors are at higher risk of developing these chronic diseases themselves. 
  5. WEIGHT STIGMA: Individuals who experience discrimination based on body size and weight are at risk for elevated cortisol, elevated cholesterol, elevated blood pressure, and insulin resistance, all of which increase the likelihood of developing heart disease. 
  6. WEIGHT CYCLING: Dieting is strongly linked to weight cycling, which is the process of losing and re-gaining weight with each consecutive weight loss attempt. Weight cycling, linked to decreased muscle mass and increased cortisol, is also correlated to the development of heart disease. One study demonstrated that, after a 10-year follow-up period, intentional weight loss did not improve cardiovascular disease risk. Intentional weight loss is largely unsustainable and will likely worsen health rather than improve it. 

Researchers evaluating the influence of behavior and lifestyle modification on overall health risk concluded that health-related behaviors are important; however, far less important than reducing societal health disparities. It is crucial to acknowledge these economic and social factors that benefit some while keeping those less privileged in states of poor health. As Ibram X. Kendi noted when discussing individual change versus societal change, “Americans have long been trained to see the deficiencies of people rather than of policy.” 

Nutrition and Lifestyle Interventions to Improve Heart Health 

Nutrition and lifestyle changes can improve overall heart health but cannot override social discrimination, poverty, and chronic stress. The good news: Nutrition and lifestyle interventions can help lower heart disease risk! Below are some places to start: 

  1. DO NOT DIET! As stated above, dieting has been linked to higher cardiovascular disease risk due to weight cycling. Both intentional AND unintentional weight loss have been linked to a higher risk of early death. Instead of dieting, ensure you eat enough throughout the day with regular meals and snacks, aiming for variety! 
  2. REGULAR PHYSICAL ACTIVITY: Studies show that regular physical activity and movement can improve cardiovascular risks, regardless of weight status! Engaging in regular movement that is both enjoyable and sustainable can lower LDL levels, improve insulin resistance, and increase HDL levels. Find ways to move your body that are enjoyable and feel good – any kind of movement counts! 
  3. INCREASED FIBER CONSUMPTION: Consuming adequate fiber (20-30 grams daily) can help reduce LDL cholesterol levels. Food sources of fiber include beans, peas, corn, whole grains, non-starchy veggies, and fruit. Consider having a serving of fruit, veggies, or whole grains with each meal! 
  4. FOCUS ON OMEGA-3 FATS: Omega-3 fatty acids have been shown to improve heart health by lowering cholesterol and improving triglycerides. Food sources of omega-3s include fatty fish (salmon/tuna), avocado, olive oil, canola oil, nuts, and seeds. A note on fats: low-fat diets have not been associated with improved health outcomes for most individuals. Instead of aiming for a low-fat diet, try incorporating more food sources of omega-3s! 
  5. REGULAR MEDICAL APPOINTMENTS: Regular physical exams, lab draws, and, at times, medication management can reduce the risk of developing heart disease. Schedule your annual wellness exams with a provider that you trust and who takes your concerns seriously! 
  6. ELIMINATE SMOKING: Smoking has been strongly linked to the development of heart disease. If you are working to stop smoking, ask your healthcare provider for referrals to smoking cessation programs that offer support and accountability! 
  7. REDUCE ALCOHOL CONSUMPTION: Recommendations for daily alcohol consumption for women are no more than one serving per day and no more than two servings per day for men. 

Many factors influence heart health, some of which are within our control and many more that are not. Taking a stand on equality and social justice issues while also focusing on individual behaviors is crucial to ensuring that health is accessible for all!

By Emily Gause, MA, RDN, LDN