Secrets to a Healthy Heart
En español | When it comes to heart health, you probably know what the American Heart Association (AHA) offers as its top diet advice: Eat a good balance of fresh, fiber-rich fruits and veggies; whole grains; and healthy proteins, such as nuts, skinless fish and poultry. But recent studies have also named specific cardiovascular all-stars that are worth adding to your rotation. Here are a few standouts to add to your grocery list.
Why: Beets deserve a badge of honor in the veggie family, says Jorge A. Brenes-Salazar, M.D., a geriatric cardiologist and assistant professor of medicine at the Mayo Clinic. That’s due to their high doses of nitrates, which help keep blood vessels dilated and healthy. A 2018 review of a decade’s worth of studies identified beet juice consumption as an effective way to control blood pressure in both healthy and hypertensive adults.
Also know: When it comes to heart health, it pays to see red — or orange or yellow. “Fruits and veggies with those colors have carotenoids and flavonoids,” pigments known for their heart-healthy antioxidant properties, Brenes-Salazar explains. Try these other blushing nutrient-rich veggies and fruits: carrots, sweet potatoes, acorn squash, oranges, cantaloupe and papaya.
2. Pumpkin seeds and walnuts
Why: A study presented in 2019 at the AHA’s Hypertension Scientific Sessions found that eating pumpkin seeds may help lower blood pressure. According to the AHA, pumpkin seeds are rich in fiber and a variety of nutrients, particularly heart-healthy magnesium (a quarter cup contains 42 percent of the mineral’s RDA). As for walnuts, a 2022 research review found that consuming foods like walnuts that are rich in alpha-linolenic acid was linked to a 10 percent lower risk of cardiovascular disease. And 2021 research published in the American Heart Association’s journal Circulation found that eating a half-cup of walnuts a day for two years modestly lowered the subjects’ LDL cholesterol.
Also know: “Any nuts are good sources of monounsaturated fats,” says Kate Patton, lead outpatient dietitian at the Cleveland Clinic. “For people who don’t eat fish, they are a good way to get in those omega-3 fats.” A 2019 study presented at the European Society of Cardiology showed that eating nuts two or more times a week was associated with a 17 percent lower risk of death from heart disease. But remember one word: moderation. These are calorie-dense foods, so keep portions modest and avoid added salt, sugars and oils. Penny Kris-Etherton, distinguished professor of nutrition at Pennsylvania State University, advises limiting yourself each day to “an amount that will fit in the palm of your hand.”
Why: Researchers at Harvard Medical School and Brigham and Women’s Hospital reported in 2020 that a study of more than 200,000 people found a link between consuming isoflavone-rich tofu more than once a week and an 18 percent lower risk of heart disease. Beyond that, tofu is a great source of plant protein, so it’s a smart substitute for red meat or pork. “It also has phytosterols — plant cholesterols that actually improve the cholesterol in our own bodies,” Brenes-Salazar says.
Also know: A 2021 Chinese study found that eating soy four or more days of the week was associated with a significantly lower risk of death from heart attacks. The USDA dietary guidelines recommend around 5 to 6 ounces of protein — from meat, chicken, eggs, fish, nuts or soy products — a day, Kris-Etherton says. “When people are heavy meat eaters, they need to slowly find ways to replace the meat with other healthy foods, and tofu is one.”
4. Olives and olive oils
Why: If you’ve heard of the Mediterranean diet (and who hasn’t?), then you know all about olive oil. It not only boosts good, heart-protective cholesterol but also staves off diabetes and strokes. Recent research confirms its salubrious effects: A 2020 European study found that patients who had had heart attacks and subsequently followed a Mediterranean diet high in olive oil had better repair of the arterial linings; a 2022 study published in the Journal of the American College of Cardiology found that consuming more than a half tablespoon of olive oil a day — or replacing about 10 grams a day of margarine, butter, mayonnaise or dairy fat with olive oil — is linked to a lower risk of death by heart disease.
Try to follow the USDA guidelines of 27 grams (about two tablespoons) a day. “Remember,” Kris-Etherton says, “olive oil is calorically dense.” As for olives, make sure to buy the low-sodium variety, available at many big-box stores. Speaking of oils, Brenes-Salazar warns against the recently voguish coconut oil; instead, he suggests using either olive or pecan oil, which is neutral in flavor, rich in monounsaturated fats and low in saturated ones.
5. Garbanzo beans
Why: First, they’re full of fiber, which can help lower your bad LDL cholesterol. Second, “beans are an underappreciated source of good-quality protein,” Brenes-Salazar notes. Adds Patton: “All members of the legume family are super healthy because they are full of plant-based protein and the kind of fiber that lowers cholesterol and helps to stabilize your blood sugar levels.”
Also try: other heart-healthy legumes — pinto beans, red beans, kidney beans and black beans. But remember, canned beans can be high in salt, so either rinse them thoroughly in water or use dried beans.
Why: “Despite avocados’ high fat content, the fat is heart healthy and monounsaturated,” says Christine Rosenbloom, a registered dietitian and coauthor of Food & Fitness After 50. “Avocado is also rich in fiber, potassium and magnesium, all nutrients associated with heart health. Avocados are sodium-free ... a plus for those with high blood pressure, and avocado oil has a high smoke point and a neutral taste, making it good for pan-searing foods.”
A 2022 study, published in the Journal of the American Heart Association, of almost 70,000 women and more than 40,000 men — all free of coronary heart disease — linked a higher avocado intake with a lower risk of heart disease.
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Why: Touted for its healthy properties for a half-century, fiber-rich oatmeal cuts down on cholesterol absorption and contributes to gut health. “Oatmeal is a good source of healthy fiber, healthy fats and protein,” Patton explains. “Soluble fiber is really important for our digestive tract and keeping blood sugar levels stable.” A meta-analysis published last year in the European Journal of Nutrition found that adding oats to the diet was linked to lower cholesterol levels.
Also try: quinoa, whole-grain rices (brown, black and wild), or whole-grain bread and cereal. “Look at the nutrition label and make sure ‘whole-grain’ is the first ingredient,” Kris-Etherton says.
Why: The AHA has long recommended eating fish — especially salmon and other oily fishes high in omega-3 fatty acids — twice a week to help stave off the risk of heart failure, stroke and other coronary disease. And a study published in 2022 in the AHA’s journal recommended eating three grams a day of omega-3 fatty acids like those found in salmon. It may not be just the omega-3s that are good for you; a 2018 study found that an ingredient in fish and other seafood called trimethylamine N-oxide (TMAO) may also reduce hypertension-related symptoms.
Also try: The AHA recommends lake trout, herring, albacore tuna, sardines and mackerel.
Why: They’re high in soluble fiber and polyphenols (those antioxidants that absorb free radicals) and vitamin C.
Also try: All berries — strawberries, raspberries, blackberries — have heart-healthy credentials for their fiber as well as their flavonoids and antioxidants. Hate berries? Consider red grapes, which are high in resveratrol, a heart-healthy antioxidant.
10. Broccoli and brussels sprouts
Why: Though most veggies are great for cardiovascular health, broccoli and brussels sprouts are ace players. A 2020 Australian study found that these and other cruciferous vegetables, including cabbage, are linked to a decline in blood vessel disease. They’re high in disease-fighting flavonoids and carotenoids as well as cholesterol-lowering fiber. Plus, like all veggies, their low caloric density means you can eat a lot without tipping the calorie scale. “You want to aim for such foods as part of a balanced diet because they're going to help with satiety,” Brenes-Salazar says.
Also try: spinach, kale, baby greens, Swiss chard and collard greens. “The consensus is that three servings a day of dark-green leafy vegetables will reduce your total risk of cardiovascular disease or diabetes,” Patton says. A 2021 study out of Edith Cowan University found that eating around two cups of nitrate-abundant leafy greens per day can lower blood pressure and reduce the risk of heart disease by 12 to 26 percent.
11. Chili peppers
Why: These hot little guys are high in a substance called capsaicin. It’s what sets your mouth on fire — but it also has anti-inflammatory, antioxidant and blood-glucose-regulating effects. That’s good news for your heart: A 2020 study of 570,000 people found that those who ate chili peppers had a whopping 26 percent lower relative risk of cardiovascular mortality than those who rarely or never ate the peppers.
What’s more, though not nearly as rich in capsaicin as the super-hot variety, sweet green and red peppers are also a good source of the mighty C.
Should You Bother With Fish Oil?
We've heard for years that fish oil supplements (and their omega-3 fatty acids) are magic pills against heart disease — in fact, at least 10 percent of Americans take them. But recent research has cast doubt on their efficacy, including a study presented in November 2020 at the AHA's scientific meeting. It found that for 13,078 people who had heart disease (or were at high risk of it), fish oil pills did not reduce their risk of cardiac events compared with those on a placebo. Not only that, but atrial fibrillation, a potentially dangerous abnormal heart rhythm, occurred more often in those taking the supplement.
Brenes-Salazar of the Mayo Clinic notes that the AHA study just adds to a growing consensus: “The story of omega-3 fatty acids is one we've seen many times in the history of cardiology — an oversimplification of the dietary effects of certain foods,” he notes. “There is good evidence that regular consumption of fish can be associated with reduced cardiovascular risk. But when we isolated components, they failed to demonstrate the same effect as consumption of the whole fish. The advice I now give patients is this: Take a jar and label it ‘Fresh fish.’ Put in there all the money you would have spent on fish oil supplements. Then enjoy fresh fish, which is a lot better than swallowing several yellow translucent capsules.”
Bottom line: Fish is still good for you, but skip fish oil in pill form.
Editor's Note: This story, first published January 27, 2021, has been updated with new information.