Top five habits that harm the heart

Avoiding them can help you prevent a cardiovascular apocalypse.

According to a centuries-old story, the Four Horsemen of the Apocalypse will announce the end of the world. According to hard data, five harmful habits herald the coming of heart disease. These five are smoking, being inactive, carrying too many pounds, eating poorly, and drinking too much alcohol.

Alone and together, they set the stage for artery-damaging atherosclerosis and spur it onward. They do this by deranging metabolism and changing how cells and tissues work. They also disturb the markers of health we worry about so much: blood pressure, cholesterol, and blood sugar. All too often, the end result of these five habits is a heart attack, stroke, peripheral artery disease, valve problem, aortic aneurysm, or heart failure. And the damage they cause isn't limited to the cardiovascular system, but extends to the kidneys, bones, and brain.

How much do these five habits contribute to a personal health apocalypse? A lot. In a study of 4,900 men and women in England, Wales, and Scotland, researchers tallied up the occurrence of four unhealthy habits — smoking, low intake of fruits and vegetables, little physical activity, and having more than 21 alcoholic drinks a week for men or 14 for women. Compared to participants with none of the habits, those with just one of them were 85% more likely to have died during the 20-year study, while the increase among those with all four was 349%, or more than threefold higher (Archives of Internal Medicine, April 26, 2010). By the researchers' reckoning, people with all four unhealthy behaviors were physically 12 years older than their chronological ages.

What can making better choices do for health and longevity? Consider this provocative finding from the Nurses' Health Study. Nonsmoking women with a healthy weight who exercised regularly, consumed a healthy diet, and had an alcoholic drink every other day were 83% less likely to have had a heart attack or to have died of heart disease over a 14-year period, compared with all the other women in the study (New England Journal of Medicine, July 6, 2000). The results were almost identical in a similar study in men. In these two studies, more than two-thirds of all cardiovascular events could be chalked up to smoking, excess weight, poor diet, and drinking too much.

Five strategies for change

Count on these five white knights to protect your heart, your arteries, and the rest of you. They will make you look better and feel better. And it's never too late to start.

1. Avoid tobacco. Smoke from cigarettes, cigars, and pipes is as bad for the heart and arteries as it is for the lungs. If you smoke, quitting is the biggest gift of health you can give yourself. Secondhand smoke is also toxic, so avoid it whenever possible.

2. Be active. Exercise and physical activity are about the closest things you have to magic bullets against heart disease and other chronic conditions. Any amount of activity is better than none; at least 30 minutes a day is best.

3. Aim for a healthy weight. Carrying extra pounds, especially around the belly, strains the heart and tips you toward diabetes. If you are overweight, losing just 5% to 10% of your starting weight can make a big difference in your blood pressure and blood sugar.

4. Enliven your diet. Add fruits and vegetables, whole grains, unsaturated fat, good protein (from beans, nuts, fish, and poultry), and herbs and spices. Subtract processed foods, salt, rapidly digested carbohydrates (from white bread, white rice, potatoes, and the like), red meat, and soda or other sugar-sweetened beverages.

5. Drink alcohol in moderation (if at all). If you drink alcohol, limit your intake — one to two drinks a day for men, no more than one a day for women.

Making change

Give yourself a gold star if you are in the small minority of Americans who follow all five healthy behaviors. You have built yourself a solid foundation for good health.

If you have one or more habits that are working against you, now is as good a time as any to set a course for better health. How? "Just do it" may be catchy advice, but it doesn't often work. Most of us need concrete help to make and sustain lifestyle changes. The American Heart Association recommends "cognitive behavioral strategies for promoting behavior change" (Circulation, July 27, 2010). They aim to help you think more positively about yourself as you make healthy changes. Here are some of those strategies:

Set goals. Having specific, achievable goals is a key strategy for successful change. Goals that involve behaviors ("I will eat three servings of whole grains a day") tend to work better than physiological goals ("I will lower my cholesterol").

Track your progress. With all the things you have to remember each day, it's hard to know whether you are meeting your daily goals. Keeping track of steps taken each day (if you use a pedometer) or pounds lost each week gives important feedback about your progress. Data from dozens of studies show that self-monitoring is an important attribute of successful changers. You can do this with a notebook, a computer, a smartphone, or an invention of your own.

Motivation. Changing a habit or behavior is easier if you have a good reason for doing it. Hearing your doctor say "You need to quit smoking" isn't nearly as compelling a reason to stop as having a family member or friend diagnosed with lung cancer. Motivation can be something big, like getting in shape for a walking trip with a grandchild, or small, like fitting into a slimmer suit for a wedding. The more personal the motivator, the better.

Get support. Starting a change isn't nearly as challenging as sticking with it. Support from family, friends, a doctor, or someone else — even from an online community — can provide feedback and encouragement, especially when you are feeling low. Sharing a daily walk or a weight-loss program with an exercise or diet "buddy" makes it more fun and harder to slack off.

Reward yourself. Change is hard work. So give yourself pats on the back along the way. These can be small things, like a new CD or a vase of flowers, or something bigger, like tickets to a play or a special trip. The pleasure you get from rewards loops back to reinforce the positive changes you are making.

Get back on track. To paraphrase poet Robert Burns, the best laid plans of cigarette quitters or new exercisers often go awry. It's to be expected — no one is perfect, and life can get in the way of even the most meticulous plans. Take a derailment in stride. Instead of berating yourself, summon the motivation and goals that got you started and use them to keep moving forward. It is during these so-called relapses that support is most helpful.

You don't need to aim for a complete transformation all at once. Small changes in diet, exercise, or weight can make a big difference in your health. Setting goals you can realistically achieve, and then meeting them, can snowball into even bigger improvements.

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