How to improve your heart health after 40

A woman makes a heart symbol using her hands.

As you find yourself hitting 40, you may start thinking about health issues you previously didn’t concern yourself with. Should heart health be one of them?

As age increases, the risk of heart disease rises steadily.

It’s no coincidence that many studies on heart health recruit participants between 40 and 75 years old.

Granted, there's no specific change that happens on your 40th birthday, but 40 is a round number that can start to motivate many to consider heart disease risk and how to lower it with lifestyle "tune-ups" and/or medications.

Many of us start asking what we can do live a healthier life, and the heart is a great place to start. Here are a few things to know about your heart and how to keep it healthy.

Talk to your physician about your heart health — and know what to ask

Make it a priority to talk with your physician about your heart. If you don’t have a primary care provider, now’s the perfect time to get established with one. Often when we see our health care providers, the conversation can be dominated by a checklist of other concerns, such as hair loss, weight gain or a nagging ache, and the topic of heart and vascular risks gets pushed to the bottom of the list. You should plan to make it a specific item on the agenda of your next visit to discuss your risk for heart attack and stroke. Simply let your health care provider know that you’d like to devote five minutes to discussing your risk.

Ask questions, share your concerns, and know your risk.

There are risk calculation tools, such as the ASCVD Risk Estimator + (acc.org), that can provide a good starting point in terms of whether certain preventive measures such as statin therapy (medications used to lower cholesterol and heart attack risk) can be beneficial.

Special factors such as family history and inflammatory disorders aren’t captured by the calculator, so that’s an example of how a health care professional's opinion can be helpful in individualizing your risk estimate and action plan. Sometimes, we use complementary screening tools such as the coronary artery calcium scan, to further hone the risk estimate, especially among those with family history of premature heart disease.

Commit to an active lifestyle

Making a commitment to physical activity is an important component to a healthy heart, and you don’t have to put on Spandex or purchase an expensive gym membership to accomplish it. It can involve moderate activities done through the course of your day.

The American Heart Association recommends 150 minutes of activity accumulated over a week. Activities such as walking at a moderate to brisk pace or bicycling on level terrain are a great place to start. You may be able to work up to jogging or more vigorous activity, such as jumping rope.

As age increases, the maximum predicted heart rate provoked by vigorous exercise tends to decrease. The rough rule is that one's age-predicted maximum heart rate is 220 minus the age, so a 50-year-old would have maximum predicted HR of 170 bpm. For most people, achieving 60-80% of that age-predicted maximum can correlate with a moderate to vigorous workout (in the case of the 50-year-old, about 100 to 140 bpm), but the actual heart rate ranges that one can achieve at a given level of exercise can vary widely even among similar-aged individuals.

If you’re curious about safe and beneficial heart rate ranges for exercise, you could consider undergoing an exercise stress test to help define your personalized "exercise prescription.”
Don’t discount the benefits of activities we do in our daily lives, either. You can park a little farther away, take the steps instead of the elevator, use a push mower instead of riding, and carry your laundry up the stairs. Those things accumulate and add to your overall volume of physical activity. It all impacts your overall fitness and extends beyond heart and vascular benefits. It benefits the whole body.

And don’t discount the benefits of wearable fitness devices. It can be motivating to close those rings, get those steps in, and commit to physical activity.

Consider reframing your diet

Diet can be a challenging aspect of a good discussion regarding heart health, and it’s a conversation we constantly have at Ohio State’s Cardiovascular Risk Reduction and Lipid Clinic, where we counsel patients on managing their diet and other risk factors that lead to cardiovascular disease. I recommend focusing on reframing your diet to seek out more healthy options instead of worrying about what you can’t eat.

For example, change your expectation of including a meat with every meal. Try substituting red meat several days each week with poultry, fish or plant sources of protein. Cutting down the amount of red and processed meats in our diet is a good thing for the heart and cardiovascular system. If there’s a food to consciously avoid, for most it would be processed carbohydrates. This is the rapidly absorbed food such as white rice and white bread that can lead to blood sugar increases and weight gain among susceptible people, including those with prediabetes or diabetes. Whole grain options generally have gentler absorption and more fiber, both of which offer health benefits.

Also, reduce the number of calorie-containing beverages in your diet. Sweetened sodas and fruit juices contain a great deal of sugar. Artificial sweeteners found in diet colas can help decrease the excess sugar content in our beverages, but such sweeteners may have their own detrimental health effects. Naturally unsweetened drinks such as fruit-infused club soda or brewed iced tea would be the best options.

As many approach their 40s, weight loss can become a major focus. However, some diets can have an unforeseen impact on heart health. Take the ketogenic, or keto, low-carb diet for example.

While carbohydrate reduction can help many people lose weight effectively, you have to be careful what you’re replacing those carbs with. For most, the healthful way to do it is to consume more plant oils, plant proteins, fish and seafood. When someone on a keto diet replaces carbs with too many animal products containing saturated fat (most often meat), their LDL (bad) cholesterol can really rise. Discuss any dietary change with your physician to make sure you don’t negatively impact your heart health or trigger other conditions such as digestive or kidney diseases.

Add other elements of a heart-healthy lifestyle

There are a couple more things to consider to keep your heart healthy.

Heart disease risk rises steadily with age. Of course, one's own risk is highly dependent on the burden of risk factors that they have been exposed to such as amount of tobacco use, severity/duration of diabetes, high blood pressure, and/or high cholesterol, as well as issues such as family history or presence of chronic inflammatory disorders (e.g. psoriasis, rheumatoid arthritis, etc.)

Tobacco avoidance is key to good heart and lung health. Smokers have a tremendously higher risk of developing cardiovascular disease, so if you’re smoking at 40, consider putting stopping smoking at the top of your list of lifestyle changes.

While tobacco avoidance is an absolute, moderation is key for so many other things in life. We’ve already discussed moderation in our diet. Now let’s talk about moderation in alcohol consumption.

Drinking too much alcohol can increase your risk for many health problems, including high blood pressure and stroke. So, try to keep it to one to two drinks per day for men and one drink a day for women. Any higher than that can reach at-risk levels of drinking that can have implications for blood pressure, body weight, and certain other heart conditions such as atrial fibrillation or heart failure.

Your heart is in the right place

Learn more about advances in care and treatment for patients at The Ohio State University Heart and Vascular Center

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