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Benefits of Adopting a Heart-Healthy Lifestyle Early
By Rosanne Rust, MS, RDN
As the leading cause of death in the United States, heart disease risk reduction is a pressing topic worth discussing with clients. Parts of the country, including the south, are harder hit than others. Factors leading to increased risk include genetics and social determinants of health (SDoH). SDoH are the nonmedical factors that influence health outcomes, such as the conditions under which people are born, live, grow, work, and age.
Currently, the University of Alabama is spearheading an effort to work with local health care providers to implement programs and resources designed to reduce risk factors for heart attacks, strokes, and other issues stemming from poor cardiovascular health.1 The results of this type of research, while targeting local rural areas, benefit other at-risk segments of the population, including men over age 45, individuals with a family history of heart attack or stroke, and postmenopausal women.
Women and Heart Disease
Women often are underdiagnosed with heart disease. Researchers note that education about heart health is especially important after menopause as the risk of heart disease increases. While menopause doesn’t directly cause CVDs, certain changes that occur in women’s bodies during this transition can impact heart health.2 The abundance of estrogen during a woman’s reproductive years offers natural protection against heart disease, which is why heart disease surfaces later in life, more so for women than men. However, other changes beyond the shift in hormones gradually increase a woman’s risk. Many women experience increased blood pressure, higher LDL cholesterol, and elevated triglycerides, which all can affect heart health.2,3 The value of having more research and health information available about perimenopause and menopause is that it highlights the need for women to pay attention to their health during the postmenopausal years.
Evidence for Heart-Healthy Diets
A heart-healthy dietary pattern benefits the entire population, not only women.
Several years of research support a diet rich in fruits, vegetables, legumes, whole grains, and lean protein sources, as well as limiting processed foods, trans fats, and sugar-sweetened beverages as cardioprotective. This is why dietary patterns such as the Mediterranean diet and DASH diet are ranked as “best diets” year after year, based on their evidence to mitigate disease risk.
When evaluating risk and need for lifestyle modifications, clinicians should consider the American Heart Association’s Life’s Essential 8 guidelines.4 In addition to adopting a heart-healthy dietary pattern, these guidelines include engaging in regular physical activity, improving sleep quality, quitting smoking or avoiding nicotine exposure, and managing body weight, blood lipids, blood glucose, and blood pressure.
Heart-healthy dietary patterns also are good for brain health. New research shows that middle-aged women who maintain a diet designed to lower blood pressure are 17% less likely to report memory loss and other signs of cognitive decline decades later.5
Overall, the best approaches to heart-healthy diets include appropriate lifestyle modifications and dietary patterns in line with the evidence-based Mediterranean diet and DASH diet, as well as a plant-based or vegan diet.6 Other emerging dietary patterns, such as ketogenic-style diets or intermittent fasting approaches, have limited evidence and need further research.7
Notably, the Mediterranean, DASH, and plant-based diets have much overlap. Each of these dietary patterns is built on plenty of fruits and vegetables, including nuts, seeds, and legumes, and limited amounts of sugars and saturated fat. Generally, the Mediterranean diet is a bit more liberal in added unsaturated fats and less restrictive in sodium than the DASH diet. Both meal plans allow for small portions of poultry, beef, pork, and lamb. The DASH diet also recommends two to three servings of low-fat dairy daily and restricts sodium to 2,300 mg or less per day, in line with the Dietary Guidelines for Americans’ recommendations.
Putting It Into Practice
While the evidence is clear, how can dietitians help clients put these dietary patterns into practice? As practitioners, RDs often may hear that “healthful eating is expensive.” Certainly, there are many barriers to healthful eating, including lack of convenient access to healthful foods, transportation, and SDoH.
Dietitians can encourage men and women to adopt heart-healthy diets by shifting their focus to eating more fruits, vegetables, beans, and other legumes like soy, says Liz Weiss, MS, RDN, founder of LizsHealthyTable.com and the podcast EAT, DRINK, LIVE LONGER.
Clients may perceive fresh produce as superior to canned and frozen options, but canned and frozen fruits and vegetables often are more available, affordable, and have longer shelf lives. Someone on a fixed budget may not want to purchase fresh vegetables that may go to waste, so offering clients choices within their reach will encourage them to meet recommendations for fruit and vegetable intake.
A report in the journal Circulation found that people who ate five servings of fruits and vegetables per day had a 12% lower risk of death from CVD compared with those who ate just two servings per day.8
“The research found that brighter, more vibrant-colored fruits and veggies had the most benefit,” Weiss says. “Fruits and veggies provide fiber, vitamins, minerals, and antioxidants.
Dietitians can remind clients and patients to get at least five servings of fruits and veggies per day. Their choices could include a rainbow of options and preparations, such as a 1/2 cup of broccoli, 1 cup of leafy salad greens, one medium pear, 1/2 cup of frozen or canned fruit, and 1/2 cup of canned beans,” Weiss continues. “Beans provide nutrients like potassium, magnesium, and fiber, and the benefits of eating beans vary from lowering blood cholesterol levels to helping with weight control.”9
Offering clients simple recipes that don’t require many ingredients or skill may help encourage intake of these heart-healthy foods. Encourage clients to try Liz’s Black Bean Soup recipe, or my Tofu Bowl, Creamy Macaroni, or Salmon Patties.
— Rosanne Rust, MS, RDN, is the owner of Rust Nutrition Services, which provides nutrition communications content to clients. She created her Chew the Facts brand to clear up food and nutrition misinformation and share the science in understandable terms. Words are her jam. To that end, she’s published several consumer books, including the second edition of DASH Diet for Dummies® and Zero Waste Cooking for Dummies®. You can find her on social media @chewthefacts or visit rustnutrition.com.
References
1. Jones A. UA reaching rural areas to improve cardiovascular health. University of Alabama News Center website. https://news.ua.edu/2023/10/ua-reaching-rural-areas-to-improve-cardiovascular-health/. Published October 2, 2023.
2. Jones A. Postmenopausal heart health: what to expect. University of Alabama at Birmingham News website. https://www.uab.edu/news/health/item/13439-postmenopausal-heart-health-what-to-expect. Published February 27, 2023.
3. Ryczkowska K, Adach W, Janikowski K, Banach M, Bielecka-Dabrowa A. Menopause and women’s cardiovascular health: is it really an obvious relationship? Arch Med Sci. 2022;19(2):458-466.
4. Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life's Essential 8: updating and enhancing the American Heart Association's construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18-e43.
5. Women with a heart healthy diet in midlife are less likely to report cognitive decline later. NYU Langone Health website. https://nyulangone.org/news/women-heart-healthy-diet-midlife-are-less-likely-report-cognitive-decline-later. Published October 24, 2023.
6. Song Y, Wu F, Sharma S, et al. Mid-life adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and late-life subjective cognitive complaints in women. Alzheimers Dement. 2024;20(2):1076-1088.
7. Diab A, Dastmalchi LN, Gulati M, Michos ED. A heart-healthy diet for cardiovascular disease prevention: where are we now? Vasc Health Risk Manag. 2023;19:237-253.
8. Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and vegetable intake and mortality: results from 2 prospective cohort studies of US men and women and a meta-analysis of 26 cohort studies. Circulation. 2021;143(17):1642-1654.
9. Bazzano LA, He J, Ogden LG, Loria C, Vupputuri S, Myers L, Whelton PK. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med. 2001;161(21):2573-2578.