How would you like to be "heart attack proof?" This term was introduced by Dr. Sanjay Gupta and later gained traction when it was iterated by Dr. Dean Ornish. While it's probably not possible to be completely heart attack proof, research shows us that it is possible to significantly reduce your risk by important lifestyle choices.
About five percent of U.S. adults over age 19 have coronary artery disease (CAD), the most common type of heart disease (1). This contributes to a heart attack rate of one every 40 seconds. We can do better.
Many of the biggest contributors to heart disease risk are well-known: high blood pressure, high cholesterol, and smoking. In addition, if you have diabetes or are overweight or obese, your risk increases significantly. Lifestyle factors, such as poor diet, lack of physical activity and high alcohol consumption are among the significant risk contributors.
This is where we can dramatically reduce the occurrence of CAD. Evidence continues to highlight that lifestyle changes, including diet, are the most critical factors in preventing heart disease. Dietary changes that have a significant impact include consuming dietary fiber, legumes, nuts, omega-3 polyunsaturated fatty acids (PUFAs), and chocolate.
Increase your dietary fiber
We can significantly reduce our heart disease risk if we increase our fiber consumption to recommended levels.
The more fiber you eat, the greater you reduce your risk. In a meta-analysis of 10 studies that included over 90,000 men and 200,000 women, results showed that for every 10-gram increase in fiber, participants experienced a corresponding 14 percent reduction in their risk of a cardiovascular event and a 27 percent reduction in their risk of heart disease mortality (2).
According to a 2021 analysis of National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2018, only 5 percent of men and 9 percent of women get the recommended daily amount of fiber (3). The average American consumes about 16 grams per day of fiber (4).
The Academy of Nutrition and Dietetics recommends 14 grams of fiber for every 1,000 calories consumed, or roughly 25 grams for women and 38 grams for men (5).
Good sources of fiber are fruits and vegetables eaten with edible skin or peel, beans, lentils, and whole grains.
Eat your legumes
In a prospective (forward-looking) cohort study, legumes reduced the risk of coronary heart disease by 22 percent (6). Those who consumed four or more servings a week saw this effect when compared to those who consumed less than one serving a week. The legumes used in this study included beans, peas and peanuts. There were over 9,500 men and women involved, and the study spanned 19 years of follow-up.
I recommend that patients consume a minimum of one to two servings a day, significantly more than the relatively modest four servings a week used to achieve statistical significance in this study.
Include healthy nuts
Why should you include nuts? In a study with over 45,000 men, consuming omega-3 polyunsaturated fatty acids (PUFAs) led to significant reductions in CAD. Both plant-based and seafood-based omega-3s showed these effects (7).
Good sources of omega-3s from plant-based sources include nuts, such as walnuts, and ground flaxseed. Of course, be cautious about consuming too many nuts, since they're also calorically dense.
Consume a modest amount of chocolate
In an analysis of six studies with over 336,000 participants, researchers found that eating chocolate at least once a week was associated with an 8 percent decreased risk of coronary artery disease when compared with consuming chocolate less than once a week (8).
The author notes that chocolate contains heart healthy nutrients such as flavonoids, methylxanthines, polyphenols and stearic acid which may reduce inflammation and increase good cholesterol. The study did not examine whether any particular type of chocolate is more beneficial or whether there is an ideal portion size.
An earlier study did show that two pieces of chocolate a week may decrease the risk of a heart attack by 37 percent, compared to those who consume less (9).
Both study's authors warn against the idea that more is better. High fat and sugar content and chocolate's caloric density may have detrimental effects when consumed at much higher levels.
I typically recommend that patients have one to two squares -- about one-fifth to two-fifths of an ounce -- of high-cocoa-content dark chocolate daily. Aim for chocolate labeled with 80 percent cocoa content.
You can also get chocolate's benefits without the fat and sugar by adding unsweetened, cocoa powder to a fruit and vegetable smoothie. Do not use Dutch-process cocoa, also known as alkalized cocoa; the processing can remove up to 90 percent of the flavanols (10).
References:
(1) cdc.gov. (2) Arch Intern Med. 2004 Feb 23;164(4):370-376. (3) nutrition.org (4) NHANES 2009-2010 Data Brief No. 12. Sep 2014. (5) eatright.org. (6) Arch Intern Med. 2001 Nov 26;161(21):2573-2578. (7) Circulation. 2005 Jan 18;111(2):157-164. (8) Eur J Prev Cardiol. 2021 Oct 13;28(12):e33-e35. (9) BMJ 2011; 343:d4488. (10) J Agric Food Chem. 2008 Sep 24;56(18):8527-33.