How to eat your way to cardiovascular wellness

At the age of 32, Joe Piscatella had to pick himself up from the operating table after emergency bypass surgery and learn to recover his full cardiac health through diet and lifestyle. It is now 28 years later, and Piscatella shares his advice in “The Road to a Healthy Heart Runs Through the Kitchen.” Here's an excerpt:

Chapter Two: Assessing Your Risk
Coronary heart disease would be a lot easier to manage if we could trace it to a virus or some other single source. Instead, we’re dealing with a disease that involves more than 250 risk factors. Some of these factors may seem relatively obscure. For instance, research suggests that men who are severely bald on top have up to a 36% greater risk of heart attack than those with full heads of hair. But other factors are out there in plain sight as possible risks that we all have to take into consideration. Elevated cholesterol is one of the best examples. According to data from the Framingham Heart Study, a 1% rise in your total cholesterol level can produce a 3% rise in heart attack risk.

Focus on Diet
Some of the most important cardiac risk factors are influenced by what and how much you eat. These factors include not only total cholesterol, but also LDL and HDL cholesterol, triglycerides, weight, blood pressure, diabetes, coronary inflammation, blood clotting and metabolic syndrome. And that’s good news because it means that once you know your risk levels, you can neutralize many factors that can penalize cardiovascular health by taking the right steps to change your diet.

Total Cholesterol
High cholesterol levels have long been viewed as a major cardiac risk factor, and rightly so. Indeed, Dr. Robert Levy, former director of the National Heart, Lung and Blood Institute, points to elevated cholesterol as “the chief factor for heart attack.” But just as higher cholesterol levels increase the risk for heart attack, decreased levels forecast a reduction in risk.

Workman Publishing

The amount of cholesterol in the blood is determined by a blood test and is expressed as the number of milligrams (mg) of cholesterol in one deciliter (dl) of blood. (For example, a person with 210 milligrams of cholesterol in a deciliter of blood has a cholesterol level of 210 mg/dl, popularly expressed as a cholesterol “count” of 210.) Initial cholesterol readings should not be etched in stone. Many health professionals now recommend a second test within one to eight weeks of the first. If the readings are within 30 points of each other, use the average of the two values; otherwise, a third test should be performed and the average of all three tests used. You should also be aware that exercise, stress, dieting, body weight change, medications and the phases of a woman’s menstrual cycle can affect total cholesterol readings. Morning levels are usually higher than those later in the day. Smoking before a test can cause higher readings, as can failure to fast for 12 hours beforehand. And lying down for a test can cause lower readings, while sitting up tends to produce higher ones.

The National Cholesterol Education Program, in collaboration with the American Heart Association and a number of other medical authorities, has issued the following guidelines for assessing total cholesterol levels:

Total Cholesterol      Risk Classification
Below 200                Desirable
200 to 239               Borderline high
240 and above          High

If your total cholesterol level is somewhere around 200, you’re considered “normal” (think “average”) by today’s standards. But that’s not the best level for cardiac health. The optimal, or ideal, level is actually around 150 and below, particularly for heart patients.

There are a number of tried-and true dietary actions that you can take to control cholesterol effectively:

• Cut down on foods rich in saturated fat (such as red meat and whole-milk dairy products) and trans fat (products made with hydrogenated oils) in favor of foods with fats that promote heart health (olive oil, seafood and walnuts).
• Increase foods rich in complex carbohydrates (such as fruits and vegetables), soluble fiber (oat bran, oatmeal and beans), bioflavonoids (strawberries and eggplant) and antioxidants (foods rich in vitamins C and E and beta-carotene).
• Choose cardioprotective foods. Substitute soy protein for animal protein; consider using cholesterol-lowering margarines containing sterol or sterol esters.
• Use portion control to moderate caloric intake (along with increased physical activity) to lose weight, if necessary.

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