When cardiologists speak about preventing heart disease, they typically refer to one of three categories of prevention: primary, secondary, and primordial prevention. All three have some similar components but vary in purpose and treatment.
Primary prevention of heart disease
The objective of primary prevention is to keep a person at risk of heart disease from having a first heart attack or stroke, needing surgery or angioplasty, or developing other forms of heart disease. Primary prevention targets people who have already developed cardiovascular risk factors like high cholesterol or high blood pressure. Primary prevention seeks to manage the risk factors through healthy lifestyle changes, and if necessary, taking certain medications. Developing cardiovascular risk factors means that inflammation, endothelial dysfunction, and/or atherosclerosis are most likely already at work and may not be reversible.
Secondary prevention of heart disease
Secondary prevention focuses on someone who has already had a heart attack or stroke, bypass surgery, angioplasty, or other events. Typically, it involves taking medications like aspirin and/or a cholesterol-lowering statin, quitting smoking, losing weight if needed, exercising more, and following a healthy diet. These steps can help prevent a second heart attack or stroke. They can stop the progression of heart disease and prevent early death. It bears repeating that the number 1 killer of individuals who survive a first heart attack is a second heart attack.
Primordial prevention of heart disease
The word “primordial” means existing from the beginning. Primordial prevention works to prevent atherosclerosis, inflammation, and endothelial dysfunction from developing in the first place. This helps prevent risk factors like high cholesterol, high blood pressure, excess weight, and cardiovascular events.
Primordial prevention is being discussed more, and it is a key element of functional medicine. The earlier you learn to practice primordial prevention, the more likely you are to help protect yourself from heart disease, which remains the number 1 cause of death in the United States.
Changes in 4 key lifestyle choices can significantly reduce your risk of developing cardiovascular risk factors and heart disease:
Follow a healthy diet
Early research that studied links between diet and heart disease focused on specific nutrients like cholesterol, types of fats, and individual vitamins and minerals. We have learned a lot from the early research, although it created some confusion about what makes a diet heart-healthy by focusing on specific nutrients rather than whole foods.
The best diet for preventing heart disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils; includes alcohol in moderation or not at all; and limits red and processed meats, added sugars, refined carbohydrates, sodium, and trans fats.
People with diets consistent with this dietary pattern had a 31% lower risk of heart disease, a 33% lower risk of diabetes, and a 20% lower risk of stroke.
A randomized controlled trial found that a Mediterranean diet supplemented with extra-virgin olive oil or nuts, both rich sources of unsaturated fat, reduced the incidence of major cardiovascular events among patients with cardiovascular disease over a 4.8-year follow-up period.
This study highlighted those low-fat diets are not necessarily beneficial to heart health, and that incorporating healthy fats can improve heart health and weight loss.
In general, a Mediterranean diet includes high consumption of olive oil, nuts, vegetables, fruits, and cereals; moderate consumption of fish and poultry; low consumption of dairy products, red meat, processed meats, and sweets; and wine in moderation, consumed with meals.
Sodium and potassium are two interrelated minerals that play major roles in regulating blood pressure and a healthy heart. Eating less salty foods and more potassium-rich foods may significantly lower the risk of cardiovascular disease. You will find potassium in fruits, vegetables, legumes, and low-fat dairy. But the reverse of eating a lot of sodium-rich foods especially processed bread, packaged snacks, canned goods, and fast-food meals while skimping on potassium can increase cardiovascular disease risk.
Maintain a healthy weight
Excess weight and an extra-large waist size both contribute to heart disease, as well as many other health problems. In a study of over one million women, body-mass index (BMI) was a strong risk factor for coronary heart disease. The incidence of coronary heart disease increases progressively with BMI.
In one study, middle-aged women and men who gained 11 to 22 pounds after age 20 were up to three times more likely to develop high blood pressure, type 2 diabetes, heart disease, and gall stones than those who gained 5 or fewer pounds. Those who gained over 22 pounds had an even greater risk of developing these diseases.
Waist size also raises the risk of developing heart disease. In people who are not overweight, waist size may be an even more telling warning sign of increased health risks than BMI. Men should aim for a waist size below 40 inches and women should aim for a waist size below 35 inches.
Exercise
Exercise and physical activity are excellent ways to prevent heart disease, but many of us get less activity as we get older.
Getting regular physical activity is one of the best things you can do for your health. It lowers the risk of heart disease, diabetes, stroke, high blood pressure, osteoporosis, and certain cancers, and it can also help control stress, improve sleep, boost mood, keep weight in check, and reduce the risk of falling and improve cognitive function in older adults.
Exercise and physical activity benefit the body, while a sedentary lifestyle does the opposite by increasing the chances of becoming overweight and developing a number of chronic diseases.
Research shows that people who spend more time each day watching television, sitting, or riding in cars have a greater chance of dying early than people who are more active. A 2013 study showed that among women ages 50-79 with no cardiovascular disease at the start of the study, prolonged sitting time was associated with increased heart disease risk regardless of the amount of time spent in leisure-time physical activity.
Not smoking
One of the best things you can do for your health is to not use tobacco in any form. Tobacco use contributes to heart disease.
In one study, researchers examining the link between cigarette smoking and smoking cessation on mortality during a study of over 100,000 women found that approximately 64% of deaths among current smokers and 28% of deaths among former smokers were attributable to cigarette smoking.
This study reported that much of the excess risk due to smoking may be significantly decreased after quitting. In addition, the excess risk for all-cause mortality decreases to the level of a “never-smoker” 20 years after quitting.
Final thoughts
You can help prevent heart disease by doing four key things and making them into habits:
- Follow a healthy diet
- Maintain a healthy weight
- Exercise; be active
- Don’t smoke (or quit if you do)
Many studies show that these lifestyle changes result in lowered risks of heart disease. Following a healthy lifestyle may prevent over 80% of cases of coronary artery disease, 50% of ischemic strokes, 80% of sudden cardiac deaths, and 72% of premature deaths related to heart disease. You can take control of your choices and help keep heart disease at bay.