When it comes to cardiovascular health and longevity, nothing is more powerful than engaging in the simple daily activities that help people live longer and the evidence to support this is now very robust.

For people who have two major cardiovascular risk factors, the risk of having a cardiovascular event increases significantly. However, for people who have what’s called “optimal risk factors”, the risk of having a major cardiovascular event up to age 85 is actually less than 10%. When we talk about optimal risk factors, we’re talking about the big seven:

1. Non-smoker

2. Blood pressure less than 120/80

3. A healthy diet score

4. Cholesterol is less than 5 mmol /L (ideally without medication)

5. No diabetes

6. Not overweight- A healthy BMI

7. Exercise more than 150 minutes a week.

The point is that these factors are all lifestyle-related; there are no drugs involved. In fact, perhaps it’s time to return to a more hunter-gatherer sort of lifestyle and a diet high in fruit, vegetables and nuts. They had omega-3 fatty acids. They ate lean protein. They drank water and they incorporated physical activity as part of their daily routine.

Such an approach, however, must be in conjunction with low calorie intake, as the now well-known consequences of obesity include heart attack, stroke, diabetes, high blood pressure and depression. Every five kilograms people are overweight hastens a heart attack one and a half years earlier. Every five kilograms at age 21 increases the chances of someone dying before 90 by 10%.

Reviewing the American national weight control registry, for people who lost 15 kilograms and kept it off for more than a year, it’s apparent that almost all of them cut their calorie intake in half. Over 90% exercise for an average one hour a day, 75% weighed themselves more than once a week and kept track of where they were and a large majority of them watched TV for less than 10 hours a week. These are simple, practical steps that almost any patient could take.


It’s becoming clearer every day that food is one of the most powerful tools for keeping the body (and especially the heart) in optimum condition. Recent literature suggests a Mediterranean style diet reduces the risk of cardiovascular events by up to 40%.

While our bodies are not all equal, there are some fundamentals:

• Eat five serving of vegetables, two servings of fruit per day.

• Eat more fish. The DART trial looked at dietary interventions in 2,000 people who had prior myocardial infarctions. People eating at least two servings of fish a week, reduced their risk of having a subsequent event or death by close to 30%. In fact, it appears that one of the best types of diet we could recommend to someone is the ‘pesce-vegetarian’, which is primarily vegetarian with two to three servings of fish weekly.

• Eat less red meat. People who have a large amount of red meats had a 15% increased risk of having cardiovascular events.

• Avoid sugar-based drinks.

• Have a little dark chocolate. While good chocolate is often high in saturated fats and contains caffeine, there is a study that shows it does lower blood pressure and that the flavonoids in chocolate may lower LDL cholesterol. It also improves mood and happiness – which is important for longevity!


While it’s better from the plate than from the bottle, here are a few to routinely recommend:

• Omega-3 supplements. Omega-3 fatty acids (Polyunsaturated), and essential fats. People should eat good sources of fish (wild salmon, trout, sardines, anchovies, herring and mackerel) or take supplements in order to get their benefits. Ideally, 500mg to 1000mg day of EPA/DHA

• Fibre. It lowers cholesterol absorption, 25 g /day

• Plant Sterols.


Study after study shows that the level of fitness in middle age determines how long people will live. Each metabolic equivalent (exercise capacity) confers 12% improvement in overall survival, and it’s one of the most powerful predictors of mortality for cardiovascular disease amongst men and, to an extent, post-menopausal women.

Dr. Ken Cooper, of the Cooper Institute of Aerobic Research, found that exercise was associated with a 40 % reduction in heart attacks in females and a 60 % reduction in heart attacks in males. In another study, he found that people who were in the lower 20 % of cardiovascular fitness had a death rate that was three times higher than the fittest group. The study also showed that taking up exercise, even after the age of 60, would increase a man’s life expectancy.

For optimum health, people should burn between 3,500 and 6,500 calories a week (or 500-950 a day). They also need about 60 minutes a week of cardio training – that is, a cardiovascular activity that elevates the heart rate to 80% or more of the age-adjusted maximum (220 minus age) for an extended period of time.

The interval training necessary to obtain optimum health comes in the form of only three 20-minute workouts per week at a higher heart rate. However, recommend that your patients do physical activity for 20 minutes a day. That means 20 minutes of sustained activity that leads to being slightly out of breath, or to break into a sweat during that time.

If people are not able to exercise to the levels described above, they should try to do 10,000 steps a day – a wearable exercise tracker is a good friend in this regard.

As with many things, balance is the key. People can actually run too much. In our sports cardiology clinic we see an increase in arthrosclerosis in a number of marathon runners. Running marathons is inflammatory for the body and people who consistently put their body in this type of stress promote arthrosclerosis. The ideal is around 15 to 20 kilometres a week at about 9 to 10 kilometres an hour.


Married men live longer than unmarried, divorced and separated men. The tendency is not as obvious with woman, although there is a benefit. In addition, sexual activity is associated with decrease in death and cardiovascular events for men, although for the woman it’s not associated with longevity unfortunately. Many women with more than four children had higher arthrosclerosis and coronary calcium; the optimal number of children is somewhere between two and three.


1. Avoid anger and hostility. Learn relaxation techniques and meditation. Having friends one would never think of getting angry with can help people handle these damaging feelings in a healthier way.

2. Depression is bad for the heart! Seeking professional help and managing depression requires recognising it in onseself or friends; getting help or helping friends get help, results in reducing symptoms and consequences in just three months, by more than 90%. Seeking help, whether by taking and planning therapy or through medication, is a needed first step.

3. De-stress. Stress is the greatest ager of the body in general, especially the nagging, unfinished-tasks kinds of stress that hang around day after day, or the stress of things that are out of one’s control. Just as chronic stress can damage the heart, actively working at reducing stress will keep the heart healthier. The most consistent stress reducers that also help with heart disease, depression and anger include: exercising, meditating, and nurturing friendships.

4. Sleep. If people get less sleep than they need, it increases arterial aging and the risk of heart attack. The optimal amount is seven to eight hours per night for men, and six to seven hours for women. People have to be sleeping for about two and a half hours in a row before sleep becomes truly restorative. Poor or inadequate sleep causes depression and bad lifestyle habits. Ignoring bad sleep is like not fixing a hole in the roof!

5. Open the heart and develop lifelong friends. Be part of community and stay involved: these are the common traits amongst some of the world’s longest living people.

To sum it up, lifestyle management – with the cornerstone being diet and exercise – remains the most important factor in the prevention of cardiovascular disease. There is no shortcut for patients to long lasting health and longevity and one of our goals as doctors is to encourage patients to make the choices that will serve them throughout their life, not until the bottle of the next new wonder supplement runs out! Guest Bloggers – from time to time MUH invites our specialists to provide content on our MUH Blog. Please note that with all guest bloggers the views and opinions expressed in these articles are those of the individual and are not necessarily the views of Macquarie University Hospital.

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