What if I told you that you could practically eliminate your chances of getting heart disease? The risk of mortality from heart disease has decreased by 30 percent over the last few decades, which is impressive. However, before we start celebrating, it is still the number one cause of death in the U.S. – in 2019, heart disease was responsible for one in four deaths.

The Seven Factors
The good news is that several key studies examine ways to reduce heart disease risk factors. If we improve seven key modifiable risk factors, the chance of heart disease goes down to about one percent.
These seven factors are smoking, body mass index, physical activity, diet, total cholesterol without medication, blood pressure without medication and fasting blood glucose without medication.
What did the researchers find?
In one study, researchers found that we are doing best with smoking cessation. The prevalence of nonsmoking ranged from 60-90 percent, depending on demographics. On the other hand, Healthy Diet Scores were not very good; from 0.2 to 2.6 percent of participants achieved ideal levels. Obviously, diet is an area that needs attention. This observational study involved 14,515 participants who were at least 20 years old.
How many participants actually reached all seven goals? About one percent. This means we have the ability to alter our history of heart disease dramatically. There is also a direct relationship between the effort you apply to attain these goals and your outcome of reduced risk.
In another study, those who had an optimal risk factor profile at age 55 were significantly less likely to die from cardiovascular disease than those who had two or more risk factors. These differences were maintained through at least age 80.
The lifetime risk of fatal heart disease or a nonfatal heart attack in the optimal group was less than one percent for women and 3.6 percent for men. In terms of sex differences, men were ten times less likely and women were eighteen times less likely to die from heart disease if they were in the optimal risk stratification group.
This was a meta-analysis of 18 observational studies with more than 250,000 participants.

Dietary Approaches
Several diets have shown dramatic results in preventing and treating heart disease, such as the Ornish, DASH (Dietary Approaches to Stop Hypertension), Mediterranean-type, and Esselstyn diets.
These diets all have one thing in common: they rely on nutrient-dense, plant-based foods. Both the Ornish and Esselstyn diets showed reversal of atherosclerosis in studies and, as we know, atherosclerosis (plaques in the arteries) is the foundation for heart disease.

Exercise’s Effects
For the most beneficial effects on preventing heart disease, both the ACSM (American College of Sports Medicine) and the US Department of Health and Human Services recommend that most Americans get at least 30 minutes of moderate aerobic exercise five times a week, for a total of 150 minutes, or 75 minutes of vigorous aerobic exercise per week.
Moderate aerobic exercise includes brisk walking, as demonstrated in the Women’s Health Initiative, a large observational study. This study showed a 28 to 53 percent reduction in heart disease risk in women ages 50 to 79.
Resistance training is also very important. The Health Professionals’ Follow-up Study showed at least 30 minutes a week resulted in a 23 percent heart disease risk reduction, and running for only 60 minutes resulted in a 42 percent risk reduction.
Interestingly, although medications may be important for people who have high levels of blood pressure, cholesterol and glucose, they do not get you to the lowest risk stratification. Lifestyle modification is the only way to approach ideal cardiovascular health.
Thus, if we worked on these factors to achieve the appropriate levels, this disease would no longer be at the top of the list for mortality.