Two experts reveal the simple secrets of heart health

Tim Gardner, the immediate past president of the American Heart Association, and the medical director of the Center for Heart and Vascular Health at Christiana Care Health System in Wilmington, sighs heavily when he hears of quick fixes and magic bullets for healthy hearts.

Pomegranate juice, odd herbs, exotic supplements, TV-ad exercise equipment - it's all tiring.

"Keeping a healthy heart means making lifestyle choices," said Gardner. "When people realize that it isn't just what you do today, but for a long time, they are much better off."

Similarly, physiologist Joseph Libonati, assistant professor at the University of Pennsylvania School of Nursing, said nothing beats the old mantra: Keep moving and cut calories.

Gardner and Libonati elaborated on their views of heart health in the 21st century.

Question: What is new in promoting heart health in recent years?

Gardner: There is no new medication, but I do think there is a sort of new two-tiered concept that many physicians are trying to promote. First is to emphasize certain behaviors - the bedrocks being not smoking, staying physically active, pursuing a healthy diet, and avoiding being overweight. Do all four.

Second is to know all your numbers: blood pressure, blood sugar, cholesterol. You need to know them and know when they are abnormal and treat them. People should know these numbers as they know their height and weight.

It's not revolutionary, but we want everyone to be conscious of it, so in that way, it is new.

Libonati: Two things are substantially different, in the last few years at least. It used to be, if you had a heart attack, the advice was stop moving, stay put. Now it is the opposite. People have to start moving. Hospitals have cardiac-rehabilitation centers, getting people back in shape. That is an important shift.

Second is how much you need to do to become more physically fit. The no-pain-no-gain mentality is no longer generally accepted. If, for 20 years, you have been a couch potato, the next step is not to join a gym and start exercising vigorously. It is baby steps. Walk outside for 20 to 30 minutes a day. Don't expect to do a marathon soon, or you will be disappointed and never get up to a good level of fitness.

Q: What about statins, vitamins, supplements - the proven, not the fad stuff?

Gardner: Statins have been very effective drugs, but you need your doctor's help on which kind and how much. You should only take a statin after you have determined your cholesterol level remains abnormal after diet and exercise.

Only a few people can't tolerate a statin - some have muscle pains and others have liver toxicity. There are no apparent long-term consequences. Now, there will be plenty of people taking statins for 20 or 30 years.

The vitamin stories have been extensive, but no one vitamin - not B1, not B12, not D - will make your heart any healthier than another. If you are eating a normal diet, you are just fine. And there are no convincing studies to prove that any supplement is beneficial either. I don't get into an argument with patients who think that some substance is helping them. But it is probably the case that by being conscious of heart health in that way, they are probably doing a lot of other things right, which is more important.

Libonati: My main belief is that you have to control calories. Overweight is a bigger factor in heart disease than whether you have proteins or carbohydrates - save that you shouldn't have saturated fats. Consuming fewer calories, however you do it, far outdoes any alleged magic bullet.

Q: What do you do to keep heart health? How do you make yourself an example?

Gardner: As someone who strives for good health, I try to avoid excessive fats and excessive sugar. I try to eat five fruits and vegetables a day and eat smallish portions - a sensible diet that is balanced. The heart association has a book, "No-Fad Diet," which doesn't require someone to be totally vegetarian or avoid all foods that have some sugar in them. Being a fanatic isn't always the best road to health.

Libonati: I am an Italian guy, so I go with the Mediterranean approach. They have lifestyle characteristics, and it is no secret that it is what works to have a healthy heart. They keep stress low. They take naps every day. They work in their gardens - get out and move around. They have a somewhat high level of religiosity or spirituality to keep that stress down. And they eat in moderation. It is a celebration, but it is in moderation. You don't self-medicate with food, like you do when you are stressed.

It is a simple thing, but difficult to achieve in our tense environment, especially over time.

Q: What about alcohol, or other things that might seem antithetical to heart health?

Gardner: There are a number of studies, especially from Europe, that have shown apparent benefit of small amounts of alcohol in reducing heart events. The consensus of these studies is that no more than one or two glasses of wine or beer per day are protective. In general, many doctors are very cautious about promoting routine alcohol use, since substance abuse is such a problem for so many people. I would still say there are many other ways, such as daily exercise and a good consistent diet, to maintain heart health without having to take up regular drinking.

Libonati: I would say it is the concept of play. Some might say that playing, especially as adults, would only get in the way of heart health, but I like the commercials that show NFL players sponsoring 60 minutes a day of play for kids. If it is just playing a game with your kids, that is just fine. Any time moving is better than any time sitting. It is a cumulative effect over time. Take your kid out in a stroller and laugh with him. He will see Mom and Dad walking, and he will advance his heart health, too.

Q: Is it ever too late? Are we stuck with our history?

Gardner: You don't ruin yourself for life being a fat kid, but you increase your risk factors if you don't change your lifestyle. But it is absolutely true that you can be on a normal life-expectancy track by changing to a good lifestyle at any age. There is a sort of health redemption for people willing to make the effort. If you lose weight and get on the straight and narrow, even smokers who stop smoking can pretty much reverse their negative cycles and revitalize their lungs, arteries, and heart.

Libonati: I think what is more important is not to get discouraged, and I blame things like The Biggest Loser that will promote things like that. Lose 40 pounds in three weeks? That is nuts. You will gain it back in a moment. Then you will get depressed and become resigned to being fat, out of shape, and unhealthy.

You have to be willing to do a lifestyle change. One or two pounds a week is wonderful. A couple of hundred calories and moderate exercise, and you can lose that. In no time, you will be happier, which is good for your heart, and certainly healthier. Start at 40. Start at 50. It will be worth it.

Q: Any other small secrets?

Gardner: There is some evidence that chronic periodontal disease does increase a person's risk of developing coronary heart disease by causing inflammation of the lining of the arteries in the heart. Good dental health and especially the elimination of chronic periodontal disease are important components of maintaining good heart health.

Also, salt intake has to be lowered. It is the silent killer, I think. I applaud companies ... who are trying to promote low-sodium lines of food. High salt levels lead to high blood pressure, which leads to strokes and heart disease. And by the way, having a good heart-healthy lifestyle will always help prevent stroke, so you get a two-for-one.

Libonati: Don't make excuses. Sure, genes can make a difference, but that doesn't constitute the whole organism. Your environment, too, affects the hands of cards you are dealt. You play the one you choose to play, and you can win the game. You make an excuse about the hand, and you will lose every time.

Get in shape and eat well, and you will have a good heart. No excuse.