Heart Disease: Prevention & Reversal

Is heart disease preventable?

Yes, in many cases, you can prevent heart disease or delay its progression. Heart disease refers to a group of conditions that impact the function or structure of your heart. The most common form of heart disease is coronary artery disease (CAD). It’s also the form of heart disease many people hope to prevent.

If you have CAD, that means you have plaque buildup in your coronary arteries. These are the arteries that supply oxygen-rich blood to your heart to keep it pumping day after day. Plaque can limit or block blood flow to your heart, leading to symptoms like stable angina or, ultimately, a heart attack.

It’s not always possible to prevent plaque buildup in your arteries. In fact, the process of plaque formation (called atherosclerosis) usually begins when you’re a child or teen. But it can be possible to slow its progression so you avoid or delay complications. The first step is learning the risk factors for heart disease. Then, you can take action to lower those risks.

What are the risk factors for heart disease?

There are many risk factors for heart disease. Some you can’t change, but some you can. The risks are generally the same regardless of your sex. But people assigned female at birth (AFAB) have some risks unique to them, compared with people assigned male at birth (AMAB).

Risk factors you can’t change

You might hear your healthcare provider mention “nonmodifiable risk factors.” These are risk factors that you can’t modify (change). They include:

• Age. As you get older, your risk for heart disease goes up. About 4 in 5 people who die of coronary artery disease are age 65 or older.
• Family history. Your risk goes up if your biological parents, siblings or children have heart disease. Their age at diagnosis matters, too. Your risk is higher if they were diagnosed early (premature). Premature heart disease in people AFAB is before age 65. In people AMAB, it’s before age 55.
• Menopause. After menopause, people AFAB face a higher risk of heart disease.
• Race and ethnicity. You may face a higher risk of heart disease and other forms of cardiovascular disease due to your racial or ethnic background. Health disparities within society play a role.

Even though you can’t change these risk factors, it’s helpful to know if you have them. That’s because risk factors become more dangerous as they add up. The more you have, the greater your overall risk. So, if you have nonmodifiable risk factors, it’s even more important that you target risk factors related to your lifestyle.

Lifestyle risk factors

Fortunately, there are many risk factors you may be able to change. These are called “modifiable risk factors.” They include:

• Drinking too much alcohol (more than one drink per day for people AFAB, or more than two drinks per day for people AMAB).
• Eating an unhealthy diet (including foods high in sodium, saturated fat, trans fat and sugar).
• Not getting enough exercise (healthcare providers recommend at least 150 minutes of moderate intensity exercise per week).
• Smoking, vaping or using other tobacco products.
• Using recreational drugs (like marijuana, cocaine and amphetamines).

If you have some of these risk factors, you’re not alone. Many people have one or more lifestyle risk factors. And it doesn’t always feel easy to make changes. But keep in mind that even small lifestyle changes can make a huge difference. Talk with your healthcare provider about how to make small, simple changes that will add up over time.

Health conditions that raise your risk

Some health conditions raise your risk of heart disease. These include:

• Atrial fibrillation.
• Chronic kidney disease.
• Diabetes Mellitus (both type I and type II).
• Diseases of chronic inflammation (like autoimmune disease or HIV).
• Gestational diabetes.
• High blood pressure.
• High cholesterol.
• Peripartum cardiomyopathy.
• Preeclampsia and other pregnancy complications that increase your risk of atherosclerotic cardiovascular disease.
• Sleep apnea.
• Vascular dementia.

If you have any of these conditions, talk with your healthcare provider about how to lower your heart disease risk.

How can I prevent heart disease?

There are many things you can do to prevent heart disease. Often, you can prevent heart disease naturally through lifestyle changes. In some cases, your healthcare provider may recommend medications or other treatments, too.

The list below offers lifestyle changes that can help you prevent heart disease or delay its onset.

Avoid smoking, vaping or using other tobacco products

Tobacco use is the most preventable risk factor for heart disease and stroke. People who smoke have more than twice the risk of a heart attack compared with people who don’t smoke. Smoking is also the biggest risk factor for sudden cardiac death. Even one to two cigarettes a day greatly increases your risk of heart attack or stroke. Secondhand smoke also increases your risk.

Quitting isn’t easy. But it’s one of the most important things you can do to protect your heart and blood vessels. If you use tobacco products, talk with your healthcare provider about how to quit. Ask how you can connect with community resources and support groups.

If you haven’t started using tobacco products, don’t start. Plus, avoid secondhand smoke.

Limit alcohol

Drinking too much alcohol can lead to heart and blood vessel problems including:

• Atrial fibrillation.
• Heart failure.
• High blood pressure.
• Stroke.

If you choose to drink, limit your intake:

• People assigned male at birth should have no more than two drinks per day.
• People assigned female at birth should have no more than one drink per day.

Make sure you know how much alcohol counts as a drink.

Eat a heart-healthy diet

Some foods help your cardiovascular system function at its best. Other foods make your heart and blood vessels work harder to send blood through your body.

A heart-healthy diet gives you nutrients that support your heart. It also limits or gets rid of ingredients that can raise your blood pressure, clog your arteries or cause other problems. The Mediterranean diet is one such diet with proven benefits.

The chart below includes some general tips for heart-healthy eating.

Add to your diet	Reduce or get rid of
Foods rich in omega-3 fatty acids (healthy fats). These include tuna, salmon, flaxseed, almonds and walnuts.	Processed foods (like prepackaged meals) and fast foods. These are often high in saturated fat, trans fat and sodium. Also, avoid red meats. Replace them with lean chicken or fish.
Fresh fruits and vegetables. These foods provide many nutrients. Plus, they’re often high in soluble fiber, which lowers your risk of heart disease.	Sodium intake. Take the salt shaker off your table. Avoid adding salt when you cook. Look for low-sodium versions of your favorite products.
Healthy oils like extra virgin olive oil. Use in moderation for cooking or salad dressing.	Sugar intake. Many fat-free foods seem healthier but are high in sugar. Read labels and opt for sugar-free desserts or fresh fruit.
Whole grains. Try to eat whole wheat bread instead of white bread, or choose brown rice instead of white rice.	Less healthy oils like palm oil or coconut oil. These are high in saturated fat and may raise your LDL cholesterol. Also, avoid hydrogenated oils found in some margarines and shortening.

Talking with a dietitian may help if you’re looking to make some changes to your diet. A dietitian will help you evaluate your current ways of eating and find changes you can make right away.

Lower your total cholesterol, LDL (bad) cholesterol and triglyceride levels

Lipids are fats that circulate in your blood. They include cholesterol and triglycerides. But not all lipids are the same. LDL cholesterol is “bad” because it contributes to plaque buildup in your arteries (atherosclerosis). So, you don’t want too much of it. Plus, scientists have linked high total cholesterol and high triglycerides with a higher risk for heart disease.

Your healthcare provider can check your numbers through a simple blood test called a lipid panel. Your lipid panel shows your cholesterol numbers and triglyceride level. Talk with your provider about what these numbers mean. If they’re not in the healthy range, discuss what you can do to improve them.

In general, aim for:

• Total cholesterol below 200 mg/dL.
• LDL cholesterol below 70 mg/dL if you have cardiovascular disease.
• LDL cholesterol below 100 mg/dL if you have a high risk for cardiovascular disease.
• LDL cholesterol below 130 mg/dL for everyone else.
• Triglycerides below 150 mg/dL.

Raise your HDL (good) cholesterol

HDL is the helpful cholesterol. It helps your body get rid of the extra LDL (bad) cholesterol circulating in your blood.

High HDL levels may protect you against heart disease. Low levels may put you at risk.

When it comes to HDL cholesterol, aim for:

• At least 45 mg/dL for people assigned male at birth.
• At least 55 mg/dL for people assigned female at birth.
• Above 60 for all adults to gain ideal protection from heart disease.

Manage high blood pressure

Blood pressure is a measurement of the force inside your arteries each time your heart beats. High blood pressure makes your heart and kidneys work harder. Over time, this raises your risk of:

• Heart attack.
• Heart failure.
• Kidney disease.
• Stroke.

Aim for blood pressure at or below 120/80. Your provider might change your blood pressure goal depending on your age and past medical history.

To manage your blood pressure:

• Eat a low-sodium diet.
• Keep a healthy weight.
• Limit alcohol consumption.
• Take medication if your provider prescribes it.

Manage diabetes

People with diabetes have a higher risk of heart disease. That’s because diabetes makes you more likely to have:

• High blood pressure.
• High cholesterol.
• High LDL (bad) cholesterol.
• High triglycerides.
• Low HDL (good) cholesterol.

Keeping diabetes well managed is essential to lower your heart disease risk. Talk with your provider about what your ideal blood sugar and hemoglobin A1C numbers should be.

Keep a weight that’s healthy for you

Carrying extra weight can put extra stress on your heart and blood vessels. It may cause you to develop:

• High blood pressure.
• High cholesterol.
• High triglycerides.
• Increased risk for diabetes.

The distribution of your weight throughout your body is also important. People who carry their weight in the middle have an increased risk of developing heart disease.

Your provider may use the following measurements to see if you’re carrying extra weight:

• Body mass index (BMI).
• Waist circumference.

In general, aim for:

• A BMI between 18.5 and 24.9. (The target BMI varies by ethnicity. Talk to your provider about what your target should be.)
• A waist circumference of less than 40 inches for people assigned male at birth.
• A waist circumference of less than 35 inches for people assigned female at birth.

Talk with your provider about what weight is healthy for you.

Move around more

You’re probably familiar with the advice to exercise more to help your heart. But why is that the case? Physical activity is so important in preventing heart disease because it:

• Improves how well your heart pumps blood through your body.
• Helps you prevent or manage many heart disease risk factors. These include high blood pressure, high cholesterol and overweight/obesity.

Adults should aim for 30 minutes of moderate-intensity exercise five days per week. This could include brisk walking or swimming. Or, aim for 25 minutes of vigorous exercise (like running) three days per week. You still gain benefits if you exercise in several shorter chunks of 10 to 15 minutes each.

Plus, find ways to add more movement to your daily routine:

• Get up and stretch or walk around for a few minutes every hour.
• Park farther from the door when you go shopping.
• Take the stairs instead of the elevator.
• Walk instead of drive whenever possible.

Talk with your provider before starting any new exercise plan or changing your activity level. In general, it’s safer for you to gradually increase your activity level.

Take your medications as prescribed

Your goal may be to prevent heart disease naturally. But it’s important to recognize when medications can help supplement your lifestyle changes. Sometimes nonmodifiable risk factors (the ones you can’t change) play a bigger role than your lifestyle risk factors. And if that’s the case, you might need medications to help manage conditions like high blood pressure or high cholesterol that put you at risk.

If so, talk with your provider about the medications you need and why you need them. Also, follow your provider’s guidance on when and how to take your medications. You need to take medications at the same time each day and follow other guidelines to get the most benefits.

Reach out for resources

Human bodies are complex, and everyone interacts with their environments in complex ways. It’s possible to lower your heart disease risk through your own actions, but individual willpower and a desire to make changes aren’t always enough. People live as part of communities that shape – and sometimes limit – the choices each person can make. Medical histories, family genetics and other factors can also make it harder to prevent developing heart disease.

Limited access to healthy food and other resources can impact your ability to make heart-healthy choices. And stress or social factors may make it harder for you to quit using tobacco products. Plus, if you’ve been diagnosed with heart disease, you may encounter depression or anxiety as you try to navigate your new normal.

Whether or not you face barriers to heart disease prevention or risk management, it’s a good idea to talk with your provider. Share what you’re experiencing and ask what community resources are available to you. Your provider may be able to connect you with:

• Community meals or food banks.
• Counseling.
• Dietitians.
• Resources on cooking and meal planning.
• Support groups.

Get a yearly checkup

Make an appointment with your healthcare provider each year. Your provider will check your vital signs and evaluate your overall health. They’ll also let you know how often you need blood tests to measure your cholesterol, blood sugar and other important levels.

Keeping up with your appointments allows your provider to catch signs of heart disease early. As with most health conditions, early diagnosis gives you the best chance of successful treatment.

Can heart disease be reversed or cured?

You can’t reverse coronary artery disease once you have it. And there’s no cure. But lifestyle changes and medications as discussed above can slow or stop the progression. Scientists continue to investigate new medications and therapies every day. For now, there are still reasons to be optimistic:

• You can do a lot to prevent or delay heart disease.
• Treatments can help you live longer and enjoy a vibrant quality of life.

Prevention is key when it comes to heart disease. But like in a relay race, when prevention can’t go any further, treatment picks up the baton. It’s not always possible to prevent heart disease. This is because some risk factors can’t be changed. Plus, we all face limitations to our own prevention efforts. Those limitations might be time, money, community resources or personal responsibilities.

It’s important to learn how to prevent heart disease, and take whatever steps you can in that direction. But know there’s a safety net of treatments available to you if you need them.

A note from Cleveland Clinic

The knowledge that you can prevent or delay heart disease is empowering. But if your best efforts don’t lead to the results you want, you may feel discouraged. Some people check off all the boxes on the prevention list yet still develop heart disease.

Resist the tendency to blame yourself if your prevention efforts don’t seem to “work.” Instead, talk with your provider about other changes you could try. Discuss how nonmodifiable risk factors are playing a role. And ask whether medications could help bridge the gap between where you are and where you need to be.