A long life free of heart disease does not come just from controlling the standard measures like blood pressure and cholesterol. Sure, keeping tabs on these indicators is essential to gauging your heart's health, but a few other numbers—some surprising—can be meaningful as well.
It's awareness worth having. The American Heart Association (AHA) noted in its annual review for 2011 that while the death rate due to cardiovascular disease in the United States fell between 1996 and 2007, the burden of the disease is still high. One in nearly three deaths was related to heart disease in 2007.
U.S. News consulted with cardiology experts to round up the target numbers you should strive for to keep your ticker in good shape over the long haul.
[See: Best Heart-Healthy Diets]
Alcohol intake. Those fond of tipple may be dismayed, but the science on alcohol as an agent to promote heart health is just not definitive. "If you have heart disease, alcohol plays no role in your medicine cabinet; if [you do] not, alcohol is not the right way to reduce your risk," says Jonathan Whiteson, director of the Cardiovascular Rehabilitation Program at New York University Langone Medical Center. Some research has suggested that drinking red wine may increase one's HDL, or "good" cholesterol, but Whiteson notes that the boost is minimal. "Exercise [offers] a better increase in HDL," he says.
While he's not against a drink in a social setting, it's certainly not something folks—especially those with heart disease—should engage in with the idea that it will offer a heart benefit, says Whiteson. In fact, medications' effectiveness can be either hampered or heightened by alcohol, sometimes to a dangerous extent. (Common herbal supplements can interact with heart drugs, too). And drinking too much can lead to high blood pressure or increased blood levels of triglycerides, a type of fat.
Bottom line: The AHA suggests that otherwise healthy individuals who drink should do so in moderation. That's defined as one to two drinks per day for men and one drink per day for women. And be careful with that pour: The AHA defines a drink as one 12-ounce beer, a 4-ounce glass of wine, 1.5 ounce of 80-proof spirits, or 1 ounce of 100-proof spirits.
Salt intake. Some experts say that the pervasive use of sodium in the American diet is wreaking havoc on our cardiovascular systems. "Sodium causes retention of fluid within the circulation, and if you're sodium-sensitive, it expands your blood volume and can contribute to high blood pressure, stroke, and other heart disease," explains Clyde Yancy, chief of cardiology at Northwestern University Feinberg School of Medicine.
A report in the New England Journal of Medicine suggested that if Americans reduced daily salt intake by 3 grams, we could significantly lower the annual number of new cases of coronary heart disease (by between 60,000 and 120,000), stroke (by 32,000 to 66,000), heart attack (by 54,000 to 99,000), and even the number of deaths from any cause (by 44,000 to 92,000). The paper's authors noted previous research that showed the average American man consumes 10.4 grams of salt daily, while the average American woman gets 7.3 grams.
Bottom line: The AHA recommends Americans limit salt intake to 1.5 grams daily. Be wary: Sodium creeps in via unexpected sources, and it's not so much the salt shaker on our table that's to blame. Research suggests we get as much as 80 percent of our daily salt intake from processed foods. Some surprising foods loaded with salt include miso soup, cottage cheese, salsa, and dill pickles.
Sugar intake. It's not just the savory flavors that'll get you; sweets, too, can ultimately become a cause for concern, says the AHA. Like salt, sugar creeps into the processed foods that make up much of the American diet, and sweetened beverages—soda, juices, and sports drinks—are especially loaded with the stuff. Here's some disturbing math for you: A 12-ounce can of soda has about 8 teaspoons (or 33 grams) of added sugars, totaling about 130 calories. (A gram of sugar translates into 4 calories.)
A can of Coke or Pepsi, then, basically takes you to the AHA's upper limit on the recommended amount of added sugar Americans should ingest on a daily basis. The association's primary concern is the number of excess calories that added sugars sneak into our diets and pile onto our waistlines, which can contribute to metabolic changes that increase the chances of developing a host of diseases.
Bottom line: According to the AHA, women should get no more than 100 calories per day of added sugars and men should stop at 150 calories per day. Watch out for surprising foods where sugar lurks, like fortune cookies, baked beans, ketchup, and flavored popcorn.
Resting heart rate. How hard does your heart have to work—and how fast does it have to pump—to get oxygen-rich blood throughout your body? A lower number suggests your cardiovascular system is more efficient at doing this. Thus, a highly trained athlete can have a resting heart rate in the 40s, says Whiteson.
And while the research is still emerging on what one's resting heart rate predicts about heart disease risk, a picture is beginning to take shape. "There is certain evidence to support [the idea that] a higher resting heart rate is associated with heart disease," especially ischemic heart disease, he says, which involves reduced blood flow (and oxygen) getting to heart arteries and the heart muscle. This effect seems to be more pronounced in women than in men, but a study in the Journal of Epidemiology and Community Health suggested that in women up to the age of 70, every 10-beats-per-minute increase in resting heart rate boosted the risk of dying from ischemic heart disease by 18 percent. In men, the risk was increased by 10 percent for every extra 10 beats per minute, and age didn't have an impact. The study also found that women who got high levels of physical activity were able to reduce their risk of death considerably, compared with those who did little or no activity. The same effect was not found in men, but the researchers suggest the results may have been skewed because men tend to overestimate how much exercise they get.
Bottom line: A normal resting heart rate is between 60 and 100 beats per minute. Check yours by finding your wrist's pulse, counting the beats in a 15-second period, then multiplying by four.
Hours of sleep per night. An overcaffeinated America seems to perpetually crave more shut-eye. And evidence is cropping up to suggest that a poor night's sleep is not only felt the next day but could have implications for one's heart over the long term. It is well established that sleep apnea, which results in numerous interruptions to breathing while asleep, is associated with stroke and coronary artery disease.
The reason is not clear, says Whiteson, but it's been hypothesized that people with disrupted sleep breathing have higher blood pressure overall because they don't get the restorative sleep that normally allows blood pressure to go down and gives the cardiovascular system a break during slumber. And a study in the Journal of the American Medical Association showed that middle-aged people who got five hours of shut-eye or less a night had a greater risk of developing coronary artery disease than those who got eight hours. The clue was the beginnings of calcium buildup in their arteries, found by CT scanning long before the disease process would normally be picked up.
Bottom line: Get eight hours of sleep per night. Making it happen isn't easy, we know.
Exercise. You've heard it a thousand times over, and the message stays the same: Regular, heart-thumping exercise offers a multitude of health benefits, particularly for cardiovascular fitness. Perhaps clinicians (and health writers) keep bashing us over the head with that fact because of the eye-popping number of American adults who reported getting zero vigorous activity in a 2008 Centers of Disease Control and Prevention survey: 59 percent.
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.
Bottom line: The more controlled, the better. The normal range for a fasting blood glucose test is typically less than 100 milligrams per deciliter; prediabetes is indicated by a level between 100 and 125 mg/dL and diabetes by a reading of 126 mg/dL or above. A normal hemoglobin A1C level is below 6 percent, and those with diabetes should aim to keep it under 7 percent.
C-reactive protein. Inflammation is a process our body uses to fight off an assault, like a cold or injury, in order to heal. But over the long term, chronic inflammation plays a detrimental role to health because the nasty byproducts—inflammatory molecules like cytokines—are believed to be part of several disease processes, including atherosclerosis, obesity, and Alzheimer's disease. In the realm of heart disease, much ado has been made of c-reactive protein, a marker for one's level of inflammation that can be picked up through a blood test called hs-CRP, for high-sensitivity c-reactive protein.
Who should get the test, and what are doctors to do with the results? Those are matters of considerable debate. "We can't treat high [c-reactive protein]," says Whiteson. It's an indicator of potential heart trouble, but medicine doesn't have the tools, via mediations or procedures, to bring an elevated c-reactive protein down to normal. It is possible, however, to directly treat other critical risk factors like high blood pressure and high cholesterol. Doing so can bring down the risk of future cardiac events and death. A landmark study from late 2008 found that subjects who did not have heart disease and had normal cholesterol and who took statins had a lower risk of heart attack and stroke and also had fewer angioplasties and bypass surgeries over the course of the study, compared with the group who took a placebo. But too many questions remain about the study to make a blanket statement that folks should be taking statins more liberally.
Bottom line: According to the AHA, an hs-CRP measure of 1 mg/L means you are at low risk of developing cardiovascular disease, a measure between 1 and 3 mg/L means you are at average risk, and levels above 3 mg/L means your risk is high. Getting the test may be helpful, says Yancy, if you are at intermediate risk for heart disease based on other risk factors and your doctors would like another data point to determine treatment. But "there is no need to check CRP if a person already has high risk or truly is in the healthy bracket," he says.
Waist circumference. While not a direct measure of heart disease, a high waist circumference tracks with increased risk for high blood pressure, high cholesterol, and diabetes—all of which have a direct impact on heart health. And the bigger the belly, the heavier one tends to be. Obesity, of course, is a well-known risk factor for a range of diseases, including heart disease.
Importantly, a higher waist circumference indicates distribution of fat around the abdomen and packing fat around vital organs, which research has indicated is more dangerous than carrying weight in the thighs or buttocks. Be sure you're measuring properly. The correct waist circumference measurement is taken by wrapping a measuring tape around the natural waist at the belly button, not around the hips.
Bottom line: Men should have a waist circumference of less than 40 inches. The figure for women is less than 35 inches.
Body mass index. Your weight matters, but it has to be considered in the context of how tall you are. Body mass index takes the two numbers into account. Like waist circumference, BMI is an indirect measure of risk, but a higher measure correlates with greater risk. The catch, however, is that it is not always entirely accurate. A person in excellent condition who has a lot of muscle mass may have a high BMI.
Too much excess weight is associated with diabetes, heart disease and stroke, some cancers, sleep apnea, osteoarthritis, fatty liver disease, and complications in pregnancy.
Bottom line: People with BMIs less than 18.5 are underweight. Target BMI range is between 18.5 and 24.9. Overweight is considered between 25 and 30, and a BMI above 30 puts you in the obese category.
Blood pressure. This one is critical to heart health. According to the National Heart Lung and Blood Institute, 1 in every 3 Americans has high blood pressure. When a nurse wraps the cuff around your arm, she's taking a reading of the force on the walls of your arteries, which is subject to fluctuating pressure as the heart beats to push blood through your body. The trouble is, high blood pressure doesn't have any telltale symptoms, so a person might be living with hypertension unknowingly. Over the long haul, elevated blood pressure can damage organs and fuel a cascade of problems.
Action to lower blood pressure can include medications, but diet and exercise can really beat those numbers back into submission. The DASH diet (Dietary Approaches to Stop Hypertension)—high in veggies, fruit, fish, and whole grains but low in red meat fat and sugar—has been shown to lower blood pressure significantly. And research has suggested that the DASH diet packs an especially powerful wallop when people simultaneously work to reduce salt intake, a known blood pressure booster.
Bottom line: "The only number that really matters is 120 over 80," which is the cutoff for a normal blood pressure reading, says Yancy. The more one's blood pressure surpasses that level, the more damage to the vascular system, heart, and kidneys. The top number is called systolic blood pressure and is the measure of pressure while the heart beats. The bottom number is called diastolic and is the measure of pressure between heart beats. A reading above 120/80 but below 140/90 is considered prehypertension; anything above that is high blood pressure. Both require attention and steps to bring the blood pressure back under control.
Cholesterol. Your cholesterol level is a measure of the fats circulating in your bloodstream. With out-of-whack cholesterol levels comes greater risk for coronary artery disease and stroke. Reducing saturated fat, trans fat, cholesterol, and total fat can help bring down your cholesterol level. And exercise, says Whiteson, "is one pill that treats all ills. It can touch all risk factors for heart disease," including reducing weight, reducing stress, improving blood sugar profiles, bringing down high blood pressure, and lowering total cholesterol, lowering LDL (the "bad" cholesterol), increasing HDL (the "good" cholesterol), and lowering tricglycerides, a type of fat in the blood.
Bottom line: You're aiming for total cholesterol below 200 mg/DL; above 240 mg/DL puts you at twice the risk of coronary artery disease as a person within the normal range. HDL should be above 40 mg/DL for men and above 50 mg/DL for women (women tend to have higher HDL before menopause); above 60 mg/DL is categorized as protective to your heart. LDL ideally should be below 100 mg/DL, though up to 129 mg/DL is near optimal. High LDL is considered 160 mg/DL or above. Triglycerides should be below 150 mg/DL; a measure above 200 mg/DL is considered high.
Updated on 3/15/12 by Angela Haupt.