There’s good news and bad news when it comes to your risk of developing heart disease, which is the leading cause of death in the U.S. Let’s start with the bad. Several factors raise a person’s risk for getting heart disease — a term used to describe a range of conditions that affect the heart — including some that can’t be controlled, such as family history, and others that are more complex, like having access to good-for-you foods and safe, affordable housing.
That said, there's a lot you can do to prevent heart disease and, in certain cases, reverse it. Some of these actions, however difficult to achieve, are obvious: Get active, eat better, lose weight, and stop smoking. "Lifestyle changes are difficult for everyone," concedes Sabra Lewsey, M.D., a cardiologist and assistant professor of medicine at Johns Hopkins Medicine, "but they are profoundly important and can make lifesaving gains in your health."
Others are more surprising.
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Here are 10 habits to avoid if you’re hoping to improve your heart health.
1. Being a couch potato
Not moving enough, especially on a regular basis, is risky for your health. Inactivity has been linked to cognitive decline, more frailty and even an increased risk of death. Fortunately, almost any sort of activity that raises your heart rate is a good place to start.
It’s important to move your body and elevate your heart rate for at least 150 minutes every week. You should also throw in twice-weekly strength training sessions, according to the Physical Activity Guidelines for Americans, established by the U.S. Department of Health and Human Services (HHS).
That may seem like a lot of exercise, but it doesn't need to be done all at once. As long as you get your heart rate up for 15 minutes or more at a time, it counts. Also, "activity" doesn't just mean a walk or a gym class or a bike ride. It could be gardening, shopping, walking the dog or cleaning.
"You don’t have to go from doing nothing to running marathons," says Quentin Youmans, M.D., a cardiology fellow at the Northwestern University Feinberg School of Medicine. "In fact, the biggest leap in benefit comes from doing nothing to doing something. Just start by dedicating yourself to doing some activity every day to get your body moving."
Yet a 2014 survey found that over a quarter (27.5 percent) of people older than 50 said they did no physical activity (other than their job) in the past month. Among the older age group — 75 years and up — just over one-third (35.3 percent) of people said the same thing.
2. Drinking too much alcohol
"Not everyone recognizes the connection between heart health and alcohol," Youmans says. But drinking too much alcohol can raise blood pressure, cause irregular heartbeats “and even have a direct toxic effect on the heart.”
In fact, imbibing too much "can lead to heart failure or a weakening of the heart," says Amber Johnson, M.D., a cardiologist and assistant professor at the University of Pittsburgh.
How much is too much? Women should have up to one drink per day, and men should limit their intake to two drinks or fewer, according to HHS guidelines.
3. Skimping on sleep
Not getting your seven (or eight or nine) hours of shut-eye a night will slowly, but quite reliably, damage your health, including your heart.
"Poor-quality sleep or untreated sleep apnea can lead to high blood pressure and affect heart health," Lewsey cautions. Lack of sleep has also been associated with diabetes and weight gain, which negatively affect heart health, too.
What’s more, sleep apnea can "cause abnormal heart rhythms," Johnson points out.
4. Opting for unhealthy foods
A heart-healthy diet includes a panoply of delicious options: fruits, vegetables, lean protein, nuts and whole grains. Data suggest that a so-called Mediterranean diet — mostly plants, with “good fats” like walnuts, almonds, olive oil and avocados — supports good heart health. This style of eating limits red meat; fish and poultry are OK, as long as you keep these proteins to under 5.5 ounces per day.
Swap sodas for water — a lot of water. Watch out for processed, sugary and fried foods, and be mindful of what you eat and drink at restaurants. Food full of saturated and trans fats, salt and cholesterol is best reserved for special occasions, rather than on the daily.
"Avoiding high sodium is really important," Johnson adds. The American Heart Association recommends that most adults consume fewer than 1,500 milligrams of sodium per day, with 2,300 mg as an upper limit.
Pay attention to those numbers from your routine blood tests, too. Watch out for an excess of bad cholesterol (LDL) and/or triglycerides and not enough good cholesterol (HDL). Also, high blood sugar can damage your blood vessels. In fact, people with diabetes are twice as likely to develop heart disease; plus, they're more likely to experience heart failure.
So try not to "overindulge with food," Youmans warns. "We all love that slice of pizza or juicy hamburger, and, in fact, occasionally, those foods can be OK. But when our diets consist of foods high in fats and sugars all the time, it starts to affect our heart health negatively. A Mediterranean diet is a great alternative,” he says, adding that it can be tasty.
5. Living a lonely life
It's so important to have a group of friends and family to lean on. Unfortunately, it's not as common as you may think. More than one-third of adults 45 and older are lonely, and nearly one-fourth of those 65-plus are considered to be socially isolated, research shows. This circumstance is often terrible for your health, including your heart.
That's why it’s crucial to find a group of people who will support you and make you feel fulfilled. Try to "seek community resources and support groups to help you with these lifestyle changes," Lewsey says, and work to "build a network of support" to help you along the way.
Some populations are more at risk for social isolation, including immigrants, LGBTQ individuals, minorities and victims of elder abuse, according to the Centers for Disease Control and Prevention (CDC). Ideally, the health system would be set up to be more inclusive, Johnson says, so "we are better able to provide services ... that are culturally sensitive, so that we can reach more people."
The CDC lists a number of resources that people who are feeling lonely or socially isolated can use. Among them is AARP and its Community Connections tool, which works to connect adults with others in their community.
6. Smoking tobacco
Whether you vape or smoke cigarettes or cigars, tobacco is terrible for your health. Secondhand tobacco smoke is, too. Most people know this, but what you may not realize is that tobacco doesn't just ravage your lungs and cause cancer: Your heart is also a victim.
"Even in someone who has been a long-term smoker, there are immediate and long-lasting cardiovascular benefits of quitting smoking," Lewsey says.
What can you do? "Set a quit date," Youmans says. "Let your friends and/or loved ones know so that they can hold you accountable, and use nicotine replacement or other medicines to help you quit with the help of your doctor."
You can find tips and other help on the CDC’s website.
7. Minimizing your mental health
Managing your stress is key for maintaining good health. If anxiety gets out of control, we're more likely to do things that are damaging. What’s more, stress raises your blood pressure. To combat this, try to find something you enjoy that will help you calm down and breathe better. For some people, it's meditating. Others enjoy hiking, cooking or playing board games with friends.
Can anxiety or panic attacks damage your heart? Not usually. Rarely, though, heartbreak can truly hurt your ticker. The condition is colloquially known as broken heart syndrome, and it's "a type of heart failure," Johnson explains. "If you are under very intense stress, like if you are in a car crash or your loved one dies suddenly, that can cause a weakening of the heart," she says.
The solution is often medication (such as beta blockers) plus a plan to manage stress in a healthy way.
8. Waiting to lose weight
Carrying around extra weight, especially around your waist, is bad for your heart.
Obesity itself is a risk factor for heart disease. Researchers have found that the heavier you are, the higher your risk is for heart disease — it's a so-called silent heart injury, even if you feel healthy, even if your numbers look good.
It's also true that being overweight or obese can spike your cholesterol levels, your blood sugar, your triglycerides and your blood pressure. All of these factors damage your heart and raise your risk for developing heart disease. Obesity is commonly linked with diabetes, as well.
"One tip is to buy a scale, as knowledge is power, and this will help you keep track," Youmans suggests. "To help to move the scale in the right direction, remember that you need to burn more calories than you consume, so try getting more active and eating fewer calories."
Your doctor may track your body mass index (BMI), which has been cited as an imperfect and even problematic metric. No matter how you track it, if you're overweight or obese, a 5 percent to 7 percent weight loss will likely have a positive impact on your health, including the numbers that affect your heart: blood pressure, cholesterol and blood sugar (including diabetes).
9. Neglecting your teeth
Though a clear scientific link between dental hygiene and coronary health hasn't been established (it's still an open question), some researchers say there is an association between the two. That is, poor oral health often means poor heart health. Gum disease is associated with heart disease, and bacterial infections and inflammation appear to play a part, too.
"Good dental health, with regular cleanings, is also important [for] overall heart health," Lewsey says.
Despite that benefit, nearly 40 percent of people 65 and older haven't seen a dentist in the past year, according to a 2016 "National Health Interview Survey."
10. Giving up too soon
Good heart health is often difficult to achieve and even harder to maintain — especially when everyone around you is continuing to do things you know aren't good for you.
"A lot of these health behaviors that we have found to be important vary from community to community or culture to culture," says Johnson, who works in Pittsburgh. "Certain cultures may not eat the foods that are considered heart-healthy [...] so there may be some disparities."
Above all, it's important not to give up. And, hey, try to be patient.
"Habit change is hard," Youmans says. "It can take some time to break them, particularly if they are enjoyable."
He adds, "Anything that is worth having, takes time. Making a small change that you can sustain for a long period is much more important than a bigger change that may be harder to sustain."
And every day is an opportunity to get healthier, whether it's walking past the candy jar, meditating or taking the stairs. Make your lunch the night before, instead of grabbing fast food. Set up a weekly social group. Get 15 more minutes of sleep. Do it again, again and again.