Using a salt substitute — in place of regular salt — may significantly decrease the risk of developing high blood pressure.

The Chinese martial art of tai chi may help to reduce blood pressure and improve heart health even more than intense cardio.

And just when many have embraced the Mediterranean diet, a new study shows possible greater health benefits from the so-called “Atlantic diet.”

These are a few of the findings making headline news on heart health in just the last week.

The breadth of available information on heart health is overwhelming at times, but stands to reason: Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.

According to the Centers for Disease Control and Prevention one person dies every 33 seconds in the U.S. from cardiovascular disease. In 2021, nearly 700,000 Americans died from heart disease. That’s 1 in every 5 deaths.

And it’s no longer a chronic illness affecting older age groups: More than 18 million Americans over the age of 20 suffer from coronary heart disease. About 2 in 10 deaths from coronary artery disease happen in adults under 65 years old.

February is American Heart Month, a good time to tune up your ticker.

PennLive spoke with Dr. Ashley Zinda, a cardiologist at UPMC, and asked her to outline some basic best-practices guidelines, most of them simple and affordable, to achieve heart health.

DIET: A healthy diet is imperative, Zinda said. The guidelines have not changed drastically in recent years — centering on maintaining a diet that is low in saturated fats; high in whole grains, lean proteins, fruits, nuts and vegetables.

“We know these to be golden heart health advice,” Zinda said. “What we know is that to decrease the risk of having a cardiac event or even preventing another episode, we always talk about maintaining a healthy diet that eliminates saturated fats. Things found in red meat, dairy, coconut oil.”

(Coconut oil has been embraced in recent years as a healthy fat, but Zinda cautions that it has a high saturated fat content, and therefore, may be an unhealthy option for many people.)

The golden medical directive remains almost unchanged in recent years: Eat more low-calorie, nutrient-rich foods, such as fruits and vegetables; eat smaller amounts of high-calorie, high-sodium foods, such as refined, processed or fast foods.

In addition to eating more vegetables and fruits, increase the amount of whole grains in your diet. Whole grains are good sources of fiber and other nutrients that play a role in regulating blood pressure and heart health.

As you limit saturated and trans fats, think about increasing consumption of foods that actually will decrease the risk of heart disease. These include unsaturated fats, which is the healthy fat found in nuts, avocado, olive oil; at the same time increasing fruits and vegetables.

“These foods are great for weight loss,” Zinda said. “They have a lot of fiber in them. A lot of soluble fiber helps decrease bad cholesterol and increase good cholesterol. And they slow down the digestion leaving you feeling full for longer so you are less likely to be hungry and overeat. Diet is a good foundation. I think a lot of people still to this day don’t pay attention to it but it’s a good building block.”

Curious about the Atlantic Diet? It’s one of the newest buzz findings on the heart health front, and is largely based on the dietary traditions of northwest Spain and northern Portugal.

A new study found that people who live in that part of the world have some of the lowest incidences of heart disease.

The diet is similar to the Mediterranean Diet and includes fresh fish, particularly cod, with some red meat and pork products, dairy, legumes, fresh vegetables, potatoes typically eaten in vegetable soups, whole-grain bread, and moderate wine consumption. The Atlantic diet places emphasis on home-cooked meals — and in particular the social interactions at mealtimes. Sharing meals with friends and family and mindful eating are tenets of this diet.

Any sensible heart-health diet, like DASH or the Mediterranean diet, is beneficial. The key is adoption.

“I think people know what they should be eating,” Zinda said. “The information is out there but I think it’s just getting the information and applying it to yourself and incorporating it, it’s still something that some people may struggle with or may think it’s something that doesn’t apply to them.”

EXERCISE: This one is a no-brainer. We’ve heard it ad nauseam: One of the simplest ways to promote heart health is to get adequate exercise. Despite decades of public service education, however, Americans fall woefully short of meeting healthy standards when it comes to physical inactivity.

A 2020 study found that approximately 36 percent of adults do not engage in any leisure-time physical activity. The study found that even among patients who have had a heart attack and who undergo cardiac rehabilitation, less than 15 percent participate in cardiac rehabilitation following discharge.

“We as Americans are very sedentary people,” Zinda said. “A lot of us have jobs that have us seated at a desk behind a computer for long periods of the day. We are finding that a lot of people are not getting exercise or they are unsure as to if what they are doing is considered exercise.”

This one couldn’t be simpler: The key thing is to move, Zinda said.. It doesn’t have to be intense and it doesn’t have to be drawn out.

Zinda said the standard rule is to aim to get 150 minutes of moderate, low-intensity physical activity per week.

“It can be as simple as going for a brisk walk a few days a week,” Zinda said. “Or even increasing to something more high intense like running or jogging. It’s about making a habit or considering it a regular habit like brushing your teeth. You may not like it, but you do it for your health.”

If you are able to walk, start there. Walking can lower blood pressure. Research shows that for every 1,000 daily steps taken, you could lower your systolic blood pressure by .45 points. That means if you clock in 10,000 daily steps, your systolic blood pressure is likely to be 2.25 points lower than someone else who walks only 5,000 daily steps.

A study in The New England Journal of Medicine found that people who walked enough to meet physical activity guidelines had a 30% lower risk of cardiovascular events compared with those who did not walk regularly.

For older adults, every 500 additional steps taken daily has been associated with 14% lower risk of heart disease, stroke or heart failure.

Besides the cardio perks, walking has a slew of other health benefits, including improved mental health.

“Getting people to move is really important,” Zinda said.

STRESS REDUCTION: Financial stress. Workplace woes. Family matters. The news. All can generate stress and that poses a major risk factor for heart disease.

Medical researchers have long found that stress can raise the risk of serious heart problems. And it’s not all anguished circumstances: stress related to enjoyable events — such as watching your sports team play an important game — may raise your risk of a heart emergency. Zinda urges everyone to reduce stress in mindful ways.

“We have a lot of stress,” she said. “There’s been a lot that has added stress to our lives within the past few years. We’ve had covid, we had changes to our work environment, we’ve had changes to our social lives.”

Stress increases the risk of coronary artery disease and leads to increased inflammation in the body, Zinda said. Increased levels of cortisol can increase blood sugar, which can lead to diabetes, and weight gain. Stress can predispose people to reach for comfort and typically unhealthy foods.

“A lot of people don’t consider stress as a medical concern or issue,” Zinda said. “But it’s just as bad as things like smoking or being overweight or eating an unhealthy diet when it comes to heart health.”

There are many ways to cope with — and reduce stress — in your life, mindfully. These include:

• Taking a break from the news; disconnecting from your phone and computer screen;
• Self care, including eating healthy, exercising, getting plenty of sleep, mindful breathing;
• Connecting with others.

SLEEP: The American Heart Association now recognizes sleep as one of the critical metrics that could enhance heart health and predict heart disease risk among middle-aged and older adults.

Findings from a study show that sleep, like diet and physical activity, is a health behavior linked to not only the risk of heart disease but also to the risk factors that lead to cardiovascular disease.

Unfortunately, too many people are sleep deprived.

“We don’t get enough sleep. It’s how we are,” Zinda said. “If you are not getting enough good quality sleep that in itself can lead to weight gain, diabetes and high blood pressure. So make sure you are getting that good night’s sleep and that you are getting off the iPhone and off the computer screen and allowing yourself time to wind down and getting a solid 6 to 8 hours of sleep. That is very beneficial to heart health.”

WHAT IS NEW?

Zinda notes that in the past few years, the medical community has recognized that having COVID-19 is an independent risk factor for coronary disease.

“Studies looking at COVID have found that it can increase inflammation within the vessels of the body, including the vessels going into the heart, the coronary arteries.. Increased inflammation could lead to the acceleration of plague or fatty deposits that could block up the arteries of the heart leading to things like coronary artery disease or even heart attack or stroke,” she said.

The medical advice: Protect yourself from COVID.

IT’S NEVER TOO LATE:

If you are one of the millions of Americans who have spent years with an unhealthy diet and sedentary lifestyle, take heart: It’s never too late to improve your health, and even, reverse some of the damage.

“Certainly some damage can be done but some of that damage is potentially reversible,” Zinda said. “Some patients feel as if they have missed the bus. But there are a lot of changes that they can implement to help prevent future incidents or decrease their risks.”

Zinda said she has had a lot of patients who have had high blood pressure or high cholesterol, and just making small changes like losing weight, adopting a healthy diet and incorporating exercise, they have been able to come off medication or decrease their doses.

“It’s never too late,” Zinda said. “Heart health is a lifetime commitment.”

KNOW YOUR NUMBERS:

Get your blood pressure checked regularly. Can’t always get to a doctor? Routine home blood pressure monitoring can be one of the most effective ways to help manage hypertension. The reading you get when you visit your doctor, is only a snapshot taken at that single moment. A home monitor more accurately captures your blood pressure over time and gives your doctor a better understanding of your average daily reading.

Family First Health, a federally qualified health center, has partnered with the American Heart Association on an initiative called Target: BP. The program provides blood pressure kits to eligible patients at no cost.