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What can you do in four weeks that will improve how you feel, give you energy, even help you live longer? Give your heart a health makeover! With just a few painless changes you can significantly lower your cholesterol and blood pressure, prevent your arteries from narrowing, and strengthen your blood vessels.
"When you change your diet, exercise regularly, and manage your stress, your heart gets more blood flow," explains Dean Ornish, MD, founder and president of the nonprofit Preventive Medicine Research Institute, in Sausalito, California. "You'll quickly show health improvements -- and to a much greater degree than we once thought. Even people with heart disease get powerful benefits within a month."
If you don't know your heart numbers, start by seeing your doctor for a blood test to learn where you stand. Measure yourself against the target numbers on the next page, then use our plan to improve your scores. If you're diligent, you can make amazing progress in as little as four weeks.
This measures the force of blood against the walls of your arteries. The top number (systolic) is the pressure of blood flow when the heart beats; the bottom number (diastolic) is the pressure when your heart is relaxing. Too-high pressure makes the heart work harder and eventually weaken. A 40- to 69-year-old normal-weight woman with untreated hypertension doubles her risk of dying from a heart attack or stroke for every 20/10 mm Hg over normal her blood pressure reaches.
Aim for: 120/80 mm Hg or less
"A strong heart needs healthy blood vessels that have a smooth, Teflon-like lining," explains John P. Cooke, MD, PhD, associate director of the Stanford Cardiovascular Institute. "This lets blood move easily, not clot."
Aim for: Total cholesterol below 200 mg/dl; LDL cholesterol (can cause fatty plaque in the walls of the arteries) below 100 mg/dl; HDL cholesterol (removes excess LDL from the arteries and delivers it to the liver for disposal) above 50 mg/dl.
This blood fat fuels muscles but, in excess, is stored in the fat cells and in the liver.
Aim for: below 150 mg/dl
An estimated 25 million women have prediabetes, a condition now taken as seriously as type 2 diabetes. Someone with the precondition has a 1.5-fold higher risk of getting heart disease than a healthy person; if you have type 2 diabetes, the risk is two to four times higher.
Aim for: fasting glucose level of up to 100 mg/dl
The long-touted low-fat diet is yesterday's news. The latest nutrition research suggests that maintaining your arterial superhighway is not just about avoiding as much saturated fat and processed food as possible but also about fueling your tank with what many experts call "functional foods," those foods rich in nutrients with powerful heart-protecting (and anti-cancer) properties. "Focusing on low fat is overly simplistic," says Christopher Gardner, PhD, associate professor of medicine at the Prevention Research Center at the Stanford University School of Medicine. "When you combine natural high-fiber foods with plant sterols and unsaturated fats, you start to see cholesterol-lowering benefits."
Plant sterols and stanols are potent fatlike compounds that block absorption of unhealthy dietary cholesterol. The National Heart, Lung and Blood Institute recommends that adults eat a minimum of 2g daily. Wheat germ, soy products, walnuts, almonds, peanuts, cereals, and olive and vegetable oils are good natural sources. To ensure you get enough, try yogurt, cheese, bread, orange juice, margarine, supplements, and dark chocolate enriched with these compounds.
The payoff: Getting 2g of stanols or sterols a day can cut cholesterol up to 15 percent in as little as a month and also lower your blood pressure.
Get the Right Fats
Fats are a major source of energy and help fill you up so you don't overeat. In addition, your body uses fat to produce compounds that help regulate blood pressure and heart rate. A growing body of data suggests that it's the type of fat you eat each day -- rather than your total fat intake -- that has the biggest effect on your cardiovascular health. The American Heart Association's Nutrition Committee recommends limiting saturated fat to less than 7 percent of your total daily calories and trans fats to less than 1 percent. Make sure that your total fat intake is no more than 25 to 35 percent of your daily calories and eat primarily polyunsaturated fats (found in vegetable oils like corn, soy, safflower, cottonseed, and sunflower), monounsaturated fats (found in olive, canola, and peanut oils as well as avocados and most nuts), and foods rich in omega-3 fatty acids (fatty cold-water fish, such as salmon, herring, and mackerel; also walnuts, flax oil, and flax seeds).
The payoff: In one study, when women replaced 25g of saturated fat with unsaturated fat from vegetable and nut oils, their heart disease risk dropped by 16 percent in just 25 days. And substituting 2 tablespoons of monounsaturated olive oil a day instead of using that much saturated fat can lower your LDL cholesterol.
Fill Up on Fiber
Only one type of fiber helps your heart -- the viscous, or soluble, kind found in foods such as beans, oats, oat bran, barley, citrus fruits, eggplant, and okra. It helps to block absorption of cholesterol in the digestive tract and to regulate blood sugar. Also consider taking a daily dose of psyllium, a soluble plant fiber (Metamucil and Fiberall have it).
The payoff: Consuming 5 to 10g of soluble fiber a day can lower your LDL cholesterol by about 5 percent in as little as four weeks.
Cut the Salt
If you've got pre- or full-blown hypertension, consider trying the low-sodium DASH (Dietary Approaches to Stop Hypertension) diet recommended by the National Heart, Lung and Blood Institute. It's rich in fruits, vegetables, and low-fat dairy products and includes poultry, fish, nuts, and whole grains but only small amounts of red meat, sweets, and sugary drinks.
The payoff: If you are able to find ways to reduce your salt intake to 1,500mg a day (most women consume 3,300), you can lower your systolic blood pressure by as much as 11 mm Hg and your diastolic by 4 mm Hg in only 30 days.
Most movement is good for you but some types are better for your heart than others. And, surprisingly, aerobic activity isn't the only kind you need.
"Just three 10-minute walks a day are enough to provide enormous health benefits," says Steven Blair, PED, professor of exercise science, epidemiology, and biostatistics at the University of South Carolina. To get them you need to walk at a pace of 3 to 4 mph -- you'll be able to talk while you walk but not have a long conversation. If you're very fit you'll need to walk faster to see effects.
The payoff: If you've previously been sedentary you can lower your cholesterol within four weeks, explains Michael Joyner, MD, professor of anesthesiology and an exercise researcher at the Mayo Clinic. You'll also help your blood pressure. Studies show that in four weeks your systolic pressure can drop by 3 mm to 5 mm and your diastolic by 2 mm to 3 mm. "Exercise improves the flexibility of your arteries so that they're more efficiently pumping blood out to your muscles," says Nieca Goldberg, MD, medical director of the New York University Women's Heart Program and author of Dr. Nieca Goldberg's Complete Guide to Women's Health.
Weight-lifting isn't aerobic but it does help your heart in more ways than one. To get benefits you need to do at least two 20-minute sessions a week. (Push-ups and other resistance exercises also work, says Dr. Joyner.)
The payoff: Pumping iron helps control both diabetes and prediabetes. "When you contract muscles you improve their ability to use glucose and respond to insulin," says Dr. Joyner. "If you do one to three sessions of strength training a week, you can lower your blood sugar significantly, a profound anti-diabetic effect." And there's a blood pressure benefit, too. "We've recently learned that muscular strength protects you against high blood pressure," Dr. Blair notes.
Mental and emotional stress, depression, and social isolation can all take a toll on a woman's heart. Research shows that even brief periods of stress may cause plaque to build up in the arteries. Chronic tension between spouses raises the risk of heart disease by 25 percent, and high levels of stress on the job can double the risk of acute chest pain or a repeat heart attack in people who have already had one, according to two recent studies. No one's able to eliminate stress, particularly these days, but here are four ways to dial down your stress meter.
Breathe to the Music
Try doing 30 minutes a day of slow abdominal breathing as you listen to quiet music with a rhythmic beat (think classical, Celtic, raga). Take twice as long to exhale as to inhale; breathe in as you count slowly to 4, then out for a count of 8.
The payoff: You can reduce blood pressure by a few points after only one week, according to an Italian study of people with mildly high blood pressure. Doing deep breathing for four weeks cut pressure another point.
Strike a Pose
Doing yoga on a regular basis improves blood pressure, according to a review study by the University of Virginia Health Systems, in Charlottesville.
The payoff: The research showed that yoga produced a 5 to 24 percent drop in diastolic blood pressure and a 3 to 21 percent decline in systolic blood pressure. These health benefits appeared in only three to four weeks.
Transcendental meditation, a mind-body technique that allows you to enter a state of restful awareness and calm, involves the repetition of a word or phrase (known as a mantra) while seated in a comfortable position with your eyes closed. While many practitioners recommend that you meditate for 20 minutes twice a day, even one daily session can help you relax.
The payoff: Research reported in Hypertension shows meditation reduced systolic blood pressure by approximately 5 points and diastolic pressure by 2 points in a month.
Relax Your Muscles
Progressive relaxation, the technique of tightening, then releasing one muscle group after another from your head to your toes, can also stave off stress, according to a Cochrane Collaboration review. The easiest way to do this? Listen to a relaxation recording so that you can just close your eyes and follow instructions. Biofeedback and relaxation-focused cognitive therapy had similar effects.
The payoff: Relaxation techniques can cause up to an 8-point fall in your systolic and a 3-point drop in your diastolic blood pressure readings.
Smoking is a major risk factor for heart disease. The nicotine in tobacco can raise blood pressure by 10 mm Hg or more for up to an hour after you light up. If you smoke throughout the day, your blood pressure may remain consistently high.
Smoking also decreases blood supply to the heart by 20 percent, says Marianne J. Legato, MD, a cardiologist and founder of the partnership for Gender-Specific Medicine, at Columbia University. Quit and your heart health will improve within weeks.
For help or more information, check out the American Legacy Foundation (americanlegacy.org); American Lung Association (lungusa.org); or QuitNet (quitnet.com).
Sometimes, no matter how hard you try, diet and exercise don't get you where you need to be. Talk to your doctor about whether one of these meds is right for you.
Drugs that lower your cholesterol
Statins -- the best-known type -- do a remarkable job of lowering LDL cholesterol, healing the lining of the arteries, and slowing the buildup of plaque. If you already have heart disease, these drugs can reduce your risk of dying from a heart attack by 29 percent. And they start working within a month. Now a new study has found that the statin drug rosuvastatin significantly reduces heart attacks in men and women whose cholesterol was normal but who had elevated levels of high-sensitivity C-reactive protein (CRP), an inflammatory marker that's associated with increased cardiovascular risk. Statins, however, have little effect on HDL cholesterol and triglycerides, another blood fat. For those you may need to take prescription niacin, fibrate drugs, or FDA-approved fish oil supplements, which can increase HDL by up to 30 percent and lower triglycerides by as much as 45 percent, depending on the drug. Another option is a red yeast rice supplement, available in health food stores; it can cut LDL cholesterol by 42 percent. The product works like a statin, so don't take the two together, says Dr. Goldberg.
Drugs that lower your blood pressure:
If you make lifestyle changes and your blood pressure still registers as higher than 140/90 (well over the healthy maximum target of 120/80), your doctor may recommend that you take an ACE inhibitor or a betachannel, calcium-channel, or angiotensin receptor blocker. Or you can return to a popular older remedy -- diuretics. "They're very effective in lowering blood pressure and often start working within a few weeks," says Dr. Goldberg. "But people who are allergic to sulfa drugs may be allergic to them."
Are statins safe?
Some people get muscle pains, stomach upset, and other side effects from statins. One alternative that provides some of the benefits with a lower dose of the drug is the prescription medication Vytorin, a combination of the statin Zocor and the cholesterol-lowering drug Zetia. In January 2008, however, a two-year clinical trial found that Vytorin didn't work any better than a statin alone -- and that patients who took it had almost twice the plaque in their carotid (neck) arteries as those who took just Zocor. Vytorin may still make sense for some people, according to Sharonne Hayes, MD, director of the Women's Heart Clinic at the Mayo Clinic. "It does lower cholesterol," she says. "It's just not as good as statins alone at preventing heart disease." Another alternative is taking Zetia by itself rather than with a statin.
Originally published in Ladies' Home Journal, April 2009.