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When a heart-healthy diet, regular exercise and avoidance of tobacco products become lifestyle habits, the risk of a coronary event can be significantly reduced, Dr. Bernard Gros, cardiologist at UCF Health, told an audience of community members during a recent seminar entitled “Your Healthy Heart: From Diet to Statins.”“Healthy eating is an essential component of cardiovascular fitness,” Dr. Gros said. “It helps lower blood pressure and lipids, as well as future risks for heart attacks and strokes. When looking for diet plans to follow, he often encourages patients to consider the DASH diet and a Mediterranean-style diet.

Originally created to control blood pressure, the DASH diet has a multitude of health benefits because it emphasizes:

  • Grains – 6 to 8 servings per day
  • Vegetables – 4 to 5 servings per day
  • Fruits – 4 to 5 servings per day
  • Dairy – 2 to 3 servings per day
  • Lean meat, poultry and fish – 6 or fewer servings per week
  • Nuts, seeds and legumes – 4 to 5 servings per week
  • Fats and oils – 2 to 3 servings per day
  • Limited sweets – 5 or fewer servings per week

As one of the first diets to focus on sodium intake, the standard DASH diet recommends no more than 2,300 mg. of sodium per day. The low-sodium version recommends no more than 1,500 mg. per day. And since alcohol can increase blood pressure, men should limit consumption to two or fewer drinks per day, and women to one or less.

The Mediterranean diet, which has gained popularity in recent years, has proven to be moderate on total fat consumption (32-35 percent total calories), relatively low in saturated fats (9-10 percent of total calories), high in poly-unsaturated fats (Omega-3s) and high in fiber (27-37 grams per day). It recommends:

  • Eating plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
  • Replacing butter with healthy fats, such as olive oil
  • Using herb and spices instead of salt to flavor foods
  • Limiting red meat to no more than a few times per month
  • Eating fish and poultry at least twice a week
  • Drinking red wine in moderation (optional)

While both diets have shown to lower blood pressure, more scientific studies have indicated that the DASH diet has been successful in this respect, said Dr. Gros. He also said the DASH diet has been successful at lowering LDL, the bad cholesterol.

Dr. Gros explained that it’s important to understand the role of carbohydrates in the diet. Broken down into two categories, carbohydrates are either “simple” or “complex.”

Complex carbohydrates include those that have insoluble fiber, which may help with weight loss and reduce the risk of heart disease and heart failure. Examples include wheat bran, whole grains, seeds, nuts, legumes and fruits. They also include carbohydrates with soluble fiber, helpful for lowering cholesterol and reducing blood pressure. These include dried beans, oat bran, barley, apples and citrus fruits. Complex carbohydrates that are considered starches—like pasta, flour and white potatoes—should be eaten in greater moderation. Simple carbs are sugars (glucose, fructose, galactose and dextrose) and should definitely be limited, or in some cases, avoided altogether.

Dr. Gros stressed the role of sodium in a healthy diet. This is especially critical since nine out of 10 Americans consume too much salt, which can lead to multiple cardiovascular problems like high blood pressure, damage of the heart and kidneys, and blood vessel damage. In fact, the average American consumes more than 3,400 mg. of sodium daily, significantly higher than the recommended amount of 1,500 mg. per day.

“Only about 10 percent of our sodium intake comes from home cooking. Most Americans get about 65 percent of their salt from processed foods and about 25 percent from restaurants. This causes a great deal of confusion because most people have no idea of how much salt they’re getting on a daily basis,” said Dr. Gros. Unless you’re running a marathon in the middle of summer, one half teaspoon of salt is all most individuals need, regardless of age.

The top foods that contain hidden salt, or the “salty six,” include:  breads and rolls, cold cuts and cured meats, pizza, poultry (depending upon the preparation), soup (once cup of canned soup can contain 100 to 1,000 mg. of sodium), and sandwiches (especially the fast food variety).

Eliminating all salt from your diet is virtually impossible and not recommended since it’s important for maintaining a healthy blood pressure, as well as nerve and muscle function. However, you can greatly reduce your intake by buying and preparing fresh, healthy foods at home so you can control the salt content.

If you’re on several medications, Dr. Gros also recommends talking to your pharmacist about the amount of sodium in your medications. Some vitamins even contain salt. He also cautioned that high salt intake can inhibit the effectiveness of many blood pressure medications.

Also critical for your heart’s health is exercise. In fact, Dr. Gros explained that the combination of diet and exercise has been shown to lower the systolic blood pressure by 10 points—generally equivalent to the use of medication. Additionally, exercise can help with weight loss and improve the lipid profile by reducing the LDL (bad) cholesterol and increasing the HLD (good) cholesterol.

The general rule of thumb for exercise is 150 minutes of moderate aerobic physical activity, like a brisk walk, for 150 minutes per week. That can be broken into 30-minute sessions five times a week, or 40-minute sessions four times a week. For those engaged in vigorous exercise activities like running, 75 minutes per week is recommended. If health issues limit your performance, consider shorter, more frequent exercise sessions of 10 minutes each.

“During medical checkups, healthcare providers should determine what can be done to reduce the risks of future health issues,” Dr. Gros said. Atherosclerosis, or plaque build-up in the arteries, is the number one health issue, and is responsible for a significant number deaths and disabilities. Common health conditions related to atherosclerosis include:

  • Heart attacks (Myocardial infarctions)
  • Angina (Heart pains due to inadequate blood flow to the heart muscle)
  • Strokes (Brain infarcts)
  • TIAs (Transient neurologic events)
  • PAD (Peripheral artery disease)

Throughout the past few decades, treating cholesterol levels have been effective at reducing the risk of future cardiac events, especially among high-risk individuals.

People who benefit from statin therapy, a class of drugs used to lower cholesterol, include those who are known to have atherosclerosis; those with LDL (bad) cholesterol levels greater than or equal to 190mg/dl; those with diabetes age 40 to 75; and those who have a calculated 10-year ASCVD (arteriosclerotic cardiovascular disease) risk greater than or equal to 7.5 percent, determined through a risk assessment.

Target cholesterol numbers have been removed from the guidelines, and based on patients’ individual risks, their statin therapy is now maximized in one of three categories—high-intensity, moderate-intensity and low-intensity. Dr. Gros explained that higher dose statins were shown to do more good than the lower ones prescribed in the past.

Despite all the available drugs, it’s hard to beat the benefits of lifestyle modifications. Eat right, get regular exercise, avoid tobacco products and maintain a healthy weight. And don’t forget to see your doctor regularly to have an open and honest discussion about the many ways to maintain your healthy heart.

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