The insider’s guide to healthy Hawaii: 9 heart-healthy rules to live by

Cardiovascular disease and stroke are the leading causes of death in Hawaii, accounting for almost 4,000 deaths per year. Additionally, 18,000 hospitalizations are caused by cardiovascular disease annually. Statistics like these highlight just how important it is to take care of your heart.

The good news? “There are a number of basic tenets you can live by to keep your heart healthy,” says Rozy Dunham, MD, a cardiologist with Associated Cardiovascular Consultants, a part of Lourdes Cardiology in New Jersey. These principles, like quitting smoking and exercising regularly, have been shown time and again to help lower your risk of a heart attack or stroke.

The key, though, is to make these lifestyle changes for the long haul, says Dr. Dunham. “There’s no quick fix to getting heart healthy,” she says. “If you see a news story that says, ‘Drink 6 cups of coffee a day to lower your risk,’ it’s likely too good to be true.” Following these rules will take work, but it’s worth the effort. “Life is always getting in the way,” says Dunham, “but you have to find the time to take care of your heart.”

After a long day of work and sitting in traffic, exercise may be the last thing on your mind. But there are a number of reasons why it should be one of your top priorities. “Exercise increases your metabolism and helps you maintain a healthy weight, which in turn helps your blood pressure and blood sugar levels stay in a healthy range,” says Dunham. “Physical activity also helps increase the blood flow through your arteries, which then improves the health of your arteries,” she adds.

One study published in August 2018 in the Journal of the American Heart Association found that adults in their early 60s who exercised more and sat less had fewer indicators of cardiovascular disease (based on certain markers in the blood) than those folks who were more sedentary. Another study published in January 2018 in the journal Circulation suggests that regular exercise may even reverse certain negative effects that past sedentary behavior has had on the heart. A science advisory published in 2016 by the American Heart Association describing the link between sedentary behavior and heart disease risk underlined the point by urging, “Sit less, move more.”

How much movement is enough? Current guidelines for physical activity recommend that adults get at leasr 150 to 300 minutes per week of moderate-intensity activity or 75 to 150 minutes per week of vigorous activity. The report notes that even short bursts of exercise are beneficial as long as it gets you moving. It doesn’t have to be a specific kind of workout—you’ll want to do any type of exercise that will increase your heart rate, whether that’s brisk walking, swimming, dancing or aerobics, Dunham says.

Not sure how to get going? “Start small, and walk briskly for five minutes a day, then build up to 10 and go from there,” says Dunham. You can even split up your minutes throughout the day. “You should make movement a part of your regular routine, just like brushing your teeth,” she adds.

There’s a reason why the Mediterranean diet gets so much buzz—eating this way may come with heart perks. A study published in September 2018 in the journal Stroke showed that following a Mediterranean-style diet was associated with a lower risk of stroke in women over 40 (though not in men). Another study published in February 2018 in the journal Circulation found that Mediterranean and vegetarian eating styles could lower cardiovascular disease risk factors.

“Eating whole foods is the way to go for a healthy heart, so you’ll want to eat foods like legumes, nuts, whole grains, fish, fruits and vegetables—common staples in the Mediterranean diet—as well as avoid processed carbohydrates,” says Dunham. “Everything you put in your mouth should have a redeeming health benefit,” she adds. But foods made from refined grains that are heavily processed—like cookies and crackers—don’t: “They spike your blood sugar and make you gain weight, which could you put at risk for heart disease and diabetes.”

If you’re intimidated about overhauling the way you eat, Dunham suggests at first just trying to work one fruit or vegetable into every meal. “For breakfast, if you’re having cereal, throw berries on top, or try some veggies in an omelet,” she advises.

It’s easier said than done. But stress may have a real impact on your heart. “Stress can raise your blood pressure, which may in turn raise your risk of heart disease,” says Dunham.

A study published in August 2018 in the journal Circulation: Cardiovascular Quality and Outcomes found an association between anxiety and depression symptoms and an increased risk of heart attack and stroke among adults age 45 or older. “Not only can stress and anxiety cause your blood pressure to spike, but stress may lead to weight gain if you’re eating to help cope,” says Dunham. “And when you’re at a higher weight, you’re at an increased risk for heart disease and diabetes.” Coping with stress in other unhealthy ways—such as by smoking or drinking alcohol in excess—can also up heart disease risk.

On a day-to-day basis, it’s important to find ways to stay calm for your heart’s sake. “I am a big proponent of yoga and meditation to manage stress,” says Dunham. She also recommends hobbies like knitting to help relax.

One of a cardiologist’s worst nightmares? Cigarettes. “Smoking is a known risk factor for heart attacks, stroke and other vascular diseases,” says Dunham. “It’s not just lung cancer that smokers have to worry about.”

In fact, a review of research published in January 2018 in the journal BMJ found that people who smoked just one cigarette a day had a greater risk of coronary heart disease and stroke than the researchers expected: that one-a-day habit carried with it as much as half the risk of smoking 20 per day. In other words, even just a “light” habit can be extremely dangerous for your heart. As the researchers noted: “No safe level of smoking exists for cardiovascular disease.”

If you feel as if you’ve already done too much damage to your ticker, know that it’s never too late to quit. You’ll see a benefit almost immediately in terms of breathing, says Dunham, and if you quit at age 50, your overall risk for cardiovascular disease will reach the same level as non-smokers your age by 65.

“Light-to-moderate alcohol consumption is associated with a lower risk of stroke,” says Dunham. Current research on the potential health benefits of drinking alcohol is inconclusive though, and it’s not recommended that anyone start drinking as a means of promoting cardiovascular health. There are plenty of other things you can do to lower your stroke risk, such as getting regular exercise. Plus, drinking alcohol carries with it a host of other disadvantages—among them an increased risk of liver disease and certain cancers—that may cancel out any benefits.

If you do drink, the key is moderation, which the Centers for Disease Control and Prevention defines as one drink a day for women or two for men. It’s important to know the standard drink size too, which is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor. “Most people will do a generous pour and say, ‘That’s my one drink.’ But it could easily be more than that,” says Dunham.

Heavy drinking, meanwhile, can be detrimental to your heart. “Drinking in excess can lead to a number of heart issues, like cardiomyopathy, a condition that causes heart failure,” says Dunham. One study published in February 2017 in the Journal of the American Heart Association found that heavy drinking over the years may prematurely age arteries compared to consistent moderate drinking, especially in men, putting them at an increased risk for heart disease.

You have good friends, a great family and you live in the Aloha State. You’re pretty lucky, right? It’s important to remind yourself of these things regularly, both for your mental and physical health. Positive well-being (which includes positive emotions, optimism and life satisfaction) is associated with lower cardiovascular disease risk factors, suggests a review of research published in November 2017 in Current Cardiology Reports.

Why might this be so? Being grateful—and looking at the glass as half full—can help you better handle stress, the study notes, and stress is a risk factor for heart disease. “If you have a positive attitude toward life and are grateful and optimistic, you’ll likely have less stress in your life,” says Dunham. What’s more, people with more positive well-being tend to take better care of their health overall.

Do you aim for seven to nine hours of sleep, but always come up short? Here’s why you’ll want to get in the habit of logging sufficient sleep: Poor sleep quality and habits—like sleeping less than five hours per night or more than nine—are associated with a higher risk for early signs of heart disease, when compared with getting adequate, quality sleep, according to a study published in September 2015 in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

Why might sleep be so important for your heart? For starters, sleep plays a role in healing and repairing your heart and blood vessels, according to the National Heart, Lung, and Blood Institute. Another sleep-heart issue: “If you’re suffering from a chronic lack of sleep, you’re likely more stressed. The two go hand-and-hand,” says Dunham. Elevated stress levels can put you at increased risk for heart disease.

You may have heard the phrase “Know your numbers” in the month of February (which happens to be American Heart Month), but there’s good reason to be familiar with your heart-related data year-round. “Knowledge is power,” says Dunham.

Your doctor will use measures including blood pressure, cholesterol, blood sugar and BMI (body mass index) to help figure out your risk of developing heart disease. You should know these readings, too, so write them down in a safe place so you can personally keep track of your progress improving them.

“If patients are at the borderline of prediabetes, I’ve found that knowing their numbers gives them the motivation they need to get them on the right track,” says Dunham. Even people who are young or seem otherwise healthy need to be familiar with their heart numbers, she adds. “High cholesterol, for example, is silent in that it doesn’t come with any symptoms, so it’s important to know where you fall.”

Giving back can make you feel good, but it may also have an impact on your heart. In one study published in June 2013 in the journal Psychology and Aging, researchers asked participants (age 51 to 91 without high blood pressure) if they performed volunteer work, and if so, for how many hours a year. The subjects’ blood pressure was then checked four years later.

The results? Participants who said during the first interview that they volunteered for at least 200 hours per year were 40 percent less likely to have high blood pressure four years later than those who didn’t volunteer. It didn’t matter what type of volunteering people did, either. What mattered was the time spent doing so.

“Volunteering is going to be beneficial if it helps your mental state,” says Dunham. “Giving back, giving thanks and helping others—it all goes back to your mental well-being, which links to your overall health and blood pressure,” she notes. The study authors also noted that volunteering was associated with an increase in physical activity—another boon for the heart.

Not sure how to get started volunteering? Hawaii Blue Zones Project has various community events based on location and organizes various volunteer efforts. Join your local Hawaii Blue Zones Facebook page for more information on activities in your community.