Our advice: Act on this wisdom. Sixty percent of young adults who did—by eating right, working out, keeping their BMIs in check, avoiding smoking, and going easy on the booze—kept their heart-disease risk low well into middle age, according to a new study from Northwestern University. Of people who ignored these basics, less than 5 percent stayed in the low-risk category. "Your environment and the choices you make influence your risk more than genetics does," says study author Donald Lloyd-Jones, M.D., chairman of Northwestern's preventive medicine department. "This is true even of the choices you made as far back as your youth and early adulthood."
We placed our finger on the pulse of heart research to find out which new approaches were most likely to improve your cardiovascular health. Follow our experts' advice and you'll be a lifelong member of the low-risk club, too.
Starting point: Estimate your risk
In the past century, researchers have begun trying to predict heart-disease risk by manipulating key numbers. The Framingham Heart Model—an algorithm that factors in your age, blood pressure, cholesterol, and other figures—remains a widely used prediction tool. "If you know your basic numbers, you can run an estimate yourself online and bring a printout to your doctor," says Michael Steinman, M.D., an assistant professor of medicine at the University of California at San Francisco. "It's important to know at least your estimated risk."
New rule: Broaden the equation. Current research suggests that the Framingham Heart Model has some limitations: It doesn't consider family history, lifestyle, and body mass index. And according to a recent study published in BMC Medicine, roughly a third of heart trouble occurs in people labeled as low risk by common prediction models. So if you use the online tool, don't place a lot of stock in the results until you and your doctor have fully analyzed your family history and any bad habits you have, such as smoking or excessive drinking.
Furthermore, be careful about which Framingham model you use. There's a more complex equation-based version and a simpler points-based version. In a 2010 study, Dr. Steinman and his colleagues found that the points-based system was the less accurate one: It classified 17 percent of men into treatment categories that differed from ones they would have wound up in had the equation-based model been used. "For some people on the borderline, this can make a difference in how aggressive their treatment will be," says Dr. Steinman.
Starting point: Train with intervals
Swimming, running, biking: They're all terrific for your heart. And inserting periods of ultra-heavy heart pumping into your cardio routine (i.e., interval training, during which you reach 90-plus percent of your maximum heart rate) further boosts your heart's efficiency over time. "You're pushing the mitochondria in your cells to perform and adapt at a higher level," says Conrad Earnest, Ph.D., director of exercise biology at Pennington Biomedical Research Center in Baton Rouge, Louisiana. Intervals boost your heart's stroke volume as well as its efficiency, which is measured by peak oxygen uptake, or VO2 max. The impact is huge: After training with intervals, participants in a 2010 study in the International Journal of Sports Medicine saw an average improvement of 23 percent in stroke volume and a 17 percent increase in VO2 max. "Someone with a higher VO2 max tends to have a lower risk for metabolic and heart diseases," Earnest says.
New rule: Throw your weights around too. You can snare additional heart benefits by incorporating resistance training into your routine, says Earnest. According to a 2010 study in the Journal of Strength and Conditioning Research, weightlifting may improve bloodflow throughout your extremities, which eases your heart's workload. The study also found that your post-workout blood-pressure dip tends to last longer after weightlifting than after cardio exercise. Researchers speculate that the improved bloodflow could be the result of a boost in endothelial function, a measure of the health of your blood vessels. In the weight room, go for circuit training, during which you alternate between different muscle groups with minimal rest between them. "There tends to be a larger circulatory response with circuit training," Earnest says.
Starting point: Cut cholesterol with fiber
Oatmeal, barley, and psyllium are rich sources of soluble fiber, which can help reduce your cholesterol. Barley and oatmeal contain betaglucans, soluble fibers that help lower your LDL cholesterol by preventing it from being absorbed into your bloodstream. Psyllium, found in cereals and fiber supplements, may slash your LDL by triggering an increase in your body's excretion of bile acid, the digestive fluid that cholesterol is converted into.
New rule: Add tomatoes. Okay, maybe not to your oatmeal. But pour yourself a daily glass of tomato juice; it's rich in lycopene, a nutrient that may cut your body's production of LDL cholesterol. People who drank about a glass and a half of tomato juice and ate 2 tablespoons of ketchup every day for 3 weeks reduced their LDL levels by an average of 8.5 percent, according to a study in the British Journal of Nutrition. Make sure you opt for low-salt varieties of ketchup and tomato juice, since sodium can raise blood pressure.
Starting point: Watch your stress
That 60-hour-a-week job could send you to the ER. In a study in the journal Stress, researchers measured levels of the stress hormone cortisol in hair samples from 56 men who'd been hospitalized for heart attacks and from 56 men hospitalized for other reasons. For 3 months before the test, the heart-attack victims had cortisol levels that were a third higher than the control group's. "It's a high-stress world," says John Ratey, M.D., an associate clinical professor of psychiatry at Harvard medical school. "People are willing to take on more than ever." If stress is making your head spin, walk up and down a short flight of stairs three times, he suggests. The exercise will release a calming concoction of chemicals in your brain, so you'll be more focused when you return to your desk.
New rule: Banish the blues as well. Stress can kill, but so can depression. After studying twins with genetic predispositions for depression and heart disease, researchers at Washington University in St. Louis concluded that depression—past or present—raises a man's risk of heart disease more than genetic or environmental factors do. "The higher risk may come from the inflammation that certain mental health problems can cause," says Men's Health advisor Prediman K. Shah, M.D., director of the division of cardiology at the Oppenheimer Atherosclerosis Research Center at Cedars-Sinai Medical Center. Seek help for your head and you might help your heart: People who took SSRIs, a class of antidepressants, showed improved bloodflow as a result of slower platelet clumping, according to a 2010 study from Loyola University medical center.
Starting point: Go for a blood test
Prescription statins are the gold standard for reducing cholesterol. For people at risk of heart disease, statins can lower the chance of having a heart attack by as much as 30 percent, according to the British Medical Journal. The trick is determining when you need to start popping the pills. "For people with borderline cholesterol, the situation is murky," says Michael Blaha, M.D., a cardiology fellow at Johns Hopkins University. Many doctors use a blood test that measures C-reactive protein (CRP), an inflammatory marker, to help make the final call. Your body makes more CRP when there's inflammation, which can be caused by the plaque buildup in your arteries. High cholesterol could be the culprit.
New rule: Also consider a CT scan. The problem with the CRP test: Cholesterol may not be the only cause of inflammation, or even its main cause. Arthritis or a sinus infection, for example, can also inflame your insides, Dr. Blaha says. A 2010 study he coauthored shows that if you have borderline LDL and an elevated CRP, you should consider, well, another final call: a CT scan. This test can take the guesswork out of diagnosing atherosclerosis by allowing your doctor to see firsthand whether arterial buildup is a problem. The study concluded that many patients who'd been prescribed statins because of elevated CRPs may not have needed the drugs after all.
If your doctor's analysis does ultimately suggest that statins should be part of your treatment plan, he or she might give you 6 months to reduce your cholesterol before writing out a scrip. If that's the case, circle back to the cholesterol-reduction strategies mentioned earlier in this article, and work on bringing those levels down without an Rx. Hey, the clock's ticking...