Bottom line: For a clean bill of health, the major health associations (including the AHA and the American College of Sports Medicine) suggest a minimum of 150 minutes of moderate-intensity physical activity each week—say, brisk walking that boosts your heart rate. This translates into 30 minutes of exercise on five days of the week. Twice-weekly strength training of eight to 10 exercises, up to 12 reps each, is also on their to-do list.
Whiteson at NYU Langone Medical Center suggests that those who don't have heart disease should bump that recommendation up to 60 minutes a day, five days a week of vigorous activity, where you're breathing pretty heavily and sweating. But he offers a concession: "You can break it up" into, say, three 20-minute sessions per day, since "the effect of aerobic exercise is cumulative." He also thinks those without heart disease should do strength training thrice weekly. Individuals with heart disease should always discuss a new exercise regimen with a doctor first, he says.
Sex. This one might get your attention. Envision the seemingly virile, and it's typically those in excellent physical condition. There may be some scientific backing for this. For example, having trouble getting or keeping an erection, or erectile dysfunction, is a risk factor for heart disease. The connection seems to come down to blood flow, not only in the arteries that supply the heart but also those that supply the penis. Sometimes erection trouble is an early sign of heart disease.
And Whiteson points to a study published in the American Journal of Cardiology that found that men who had little sex also had a higher risk of cardiovascular disease. Indeed, men who had sex once a month or less were 45 percent more likely to have heart disease than men who had sex at least twice a week.
Bottom line: Does this translate into a prescription for sex to bolster heart health? Not necessarily. It's hard to know how to interpret such a finding, says Whiteson. Unhealthy people simply may not be motivated to have sex because they don't feel particularly well, have low libido, or feel depressed. But, he says, other research has shown that, because orgasm helps reduce stress hormones, sexual activity may have a positive effect on the autonomic nervous system, which regulates the breathing rate and blood pressure.
Cigarettes. A 2009 study of Norwegians found that heavy smokers—those who puff at least 20 cigarettes per day—were 2.5 times more likely to die over a 30-year period than nonsmokers. But the cardiovascular risks associated with smoking aren't just seen in chain smokers.
The more nuanced message that doesn't always get across is the risk that the occasional smoker is exposed to. Even 10 minutes of secondhand smoke exposure may affect cardiovascular function. Just because you might not smoke a pack a day or even a week doesn't mean you're in the clear. "There is no safe level of exposure" to tobacco smoke, says Yancy.
Bottom line: To protect against heart disease (not to mention cancer, stroke, and reproductive problems), the goal is to smoke exactly zero cigarettes.
Blood sugar. Over time, high blood sugar levels associated with diabetes can damage nerves and blood vessels. This can spur the buildup of fat on blood vessel walls, which can impede blood flow and promote atherosclerosis. Having diabetes increases one's risk of cardiovascular disease considerably. Three quarters of those with diabetes die of heart or blood vessel disease.
Your body's ability to use glucose (blood sugar) properly can be tested by getting a fasting blood glucose test, which is a snapshot of your blood sugar at the time, or by getting a hemoglobin A1C test, which measures overall blood glucose over the previous three months. Both can be insightful. "There is data to suggest that there is a significant decrease in the risk of heart and vascular disease with every 1 percent reduction in hemoglobin A1C," says Whiteson.