Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States, according to the CDC. One person dies every 34 seconds from cardiovascular disease. Most of the risk comes from habits, though, and the big studies that followed people for decades keep landing on the same short list.
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The five habits that keep showing up
Researchers at Harvard pulled together two long-running studies, the Nurses’ Health Study and the Health Professionals Follow-up Study. Between them they followed more than 123,000 people for up to 34 years. They looked at five low-risk habits: never smoking, a body mass index between 18.5 and 24.9, at least 30 minutes a day of moderate to vigorous exercise, moderate drinking, and a diet in the top 40 percent for quality.
People who had all five were far less likely to die of heart disease. Their risk of dying from cardiovascular disease was 82 percent lower than people who had none of the five. The researchers turned that into years of life. At age 50, a woman with none of the habits could expect about 29 more years. A woman with all five could expect about 43. For men it was about 25.5 years against 37.6. That works out to roughly 14 extra years for women and 12 for men. The study was published in Circulation in 2018.
What the Nurses’ Health Study found
An earlier paper from the same group looked only at women. It followed 77,782 nurses who were 34 to 59 years old and free of heart disease and cancer in 1980, and tracked them for 24 years. During that time 8,882 of them died, 1,790 from cardiovascular disease.
Every one of the risk factors predicted death on its own. Smoking, being overweight, getting little exercise and eating a poor diet each made a difference. Put together, the numbers were striking. Women with all five risk factors were about eight times more likely to die of cardiovascular disease than women with none. The authors estimated that 55 percent of the deaths in the study could be traced to smoking, excess weight, inactivity and a low-quality diet. That study, published in the BMJ in 2008, was led by Dr. Rob van Dam.
Heart attacks in men
A Swedish study published in the Journal of the American College of Cardiology in 2014 asked a narrower question. It followed 20,721 men aged 45 to 79 who had no heart disease, diabetes, high blood pressure or high cholesterol at the start. Over 11 years, 1,361 of them had a heart attack.
The researchers defined five low-risk behaviors. One was a healthy diet. Another was drinking moderately, 10 to 30 grams of alcohol a day. The men also had to not smoke, keep their waist under 95 centimeters (about 37 inches), and stay active. Active meant walking or cycling at least 40 minutes a day and exercising at least an hour a week.
Men who did all five had 86 percent fewer heart attacks than men who did none. Only 1 percent of the men managed all five. The authors estimated that almost four out of five heart attacks in this group could have been prevented.
Where exercise fits
Each of these studies counted exercise differently, but the amounts aren’t extreme. Thirty minutes a day of moderate activity was enough to count in the Harvard studies. In Sweden it was walking or biking to get around, plus an hour a week of real exercise.
That lines up with the federal Physical Activity Guidelines for Americans, which call for at least 150 minutes a week of moderate aerobic activity and muscle-strengthening work at least two days a week. Brisk walking counts. So does biking, swimming or a spin class. If you’re starting from zero, the easy exercises for seniors are a gentle place to begin, and exercise helps with stress and mood too, which is covered in exercise and depression.
Where to start
Only 1 percent of the Swedish men managed all five habits, so nobody should expect to fix everything at once. In the Nurses’ study each habit mattered on its own, which means one change is still worth making. Pick the one you’re furthest from. If you smoke, quitting is the place to start. If you sit most of the day, a walk after dinner is a fine first step, and you can build toward 150 minutes from there. Swapping a few things on your plate counts as well.
Walking is the easiest place to start
I’d encourage anyone to start by walking 5,000 to 10,000 steps a day. You don’t need a gym membership to do it, and you get a real cardio benefit while burning calories. It’s also great for building your lower back muscles. Walking longer distances has a lot of benefits.
The hardest habit is the social one
For a lot of people the hardest habit to change is alcohol, because of the social side of it. It’s so common to go out to eat and have a drink with your meal. Try skipping it and ordering iced tea with lemon instead. It’s also hard to be the only one not drinking at parties and family gatherings. You feel weird, so you cave in and drink anyway.
Losing weight isn’t the same as being healthy
You could lose weight with a big calorie cut, or by burning a lot of calories with excessive workouts, and still not eat a balanced diet. A diet full of processed foods can keep your body from being as healthy as it could be, even when the scale goes down.
The American Heart Association’s checklist
In 2022 the American Heart Association updated how it measures heart health and called the new version Life’s Essential 8. It scores eight things from 0 to 100: diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose and blood pressure. Sleep was the new addition. Several of the eight are numbers only a doctor’s visit can give you, which is a good reason to get blood pressure, cholesterol and blood sugar checked on a regular schedule.
What these studies can’t tell you
These are observational studies. They follow people and record what happens, so they show a strong link between habits and heart disease, not proof that one causes the other. People who manage all five habits may differ in other ways too, like income or access to care. The Nurses’ Health Study and the Health Professionals study were also made up mostly of white health professionals, so the numbers may not match every group exactly.
Alcohol is the shakiest piece. Both the Harvard and Swedish studies counted moderate drinking as low risk, but later research has questioned whether alcohol protects the heart at all. Nobody is advised to start drinking for their heart. If you don’t drink, the other habits carry the benefit.
When to see a doctor
Lifestyle changes work best alongside regular checkups, not instead of them. High blood pressure and high cholesterol usually have no symptoms. If you have chest pain or pressure, shortness of breath, or pain spreading to your arm, jaw or back, call 911.
Where to get help
Stay in touch with a doctor you can trust, and get a second opinion when you need one. It can also help to work with a professional nutritionist to dial in your diet, and to get blood work done so you can track your results. These are good places to start:
- American Heart Association: warning signs of a heart attack, so you know when to call 911.
- American Heart Association: Life’s Essential 8, a checklist of the eight things that drive heart health, with tools to track them.
- NHLBI: heart-healthy living, free guidance from the National Institutes of Health.
- Academy of Nutrition and Dietetics: Find a Nutrition Expert, to find a registered dietitian near you.
- Smokefree.gov, free tools and support if you want to quit smoking.
- The SAMHSA National Helpline (1-800-662-HELP), free and confidential, if cutting back on alcohol is harder than you expected.
Where this page came from
Fitness Rocks started as a podcast by the doctor I bought the site from. In 2008 and 2009 he covered heart disease prevention more than once, including interviews with Dr. Rob van Dam on lifestyle and mortality and Dr. Dariush Mozaffarian on lifestyle and heart disease. Those episodes are long gone, so this page picks up the subject with the research that has come out since.
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