When it comes to preventing coronary heart disease, simple lifestyle changes can go a long way.

In Singapore, 23 people on average die from cardiovascular disease (heart diseases) and stroke every day.

Cardiovascular disease accounted for 31.4% of all deaths in 2022. This means that almost 1 out of 3 deaths in Singapore is due to heart diseases or stroke.

Fortunately, basic lifestyle changes can go a long way towards keeping coronary heart disease at bay.

Clinical Associate Professor Tan Swee Yaw, Senior Consultant from the Department of Cardiology and Director of Cardiovascular Rehabilitation and Preventive Cardiology at National Heart Centre Singapore (NHCS), a member of the SingHealth group, offers practical advice on what you can do to lower your risk of heart disease.

5 Simple lifestyle changes to make to prevent heart disease

1. Eat healthy - make it a habit!

“By choosing foods low in fat, cholesterol, sodium and sugar but high in fibre, you can reduce your risk of developing heart disease and other chronic illnesses,” advises Prof Tan. Here are the basic ways you can improve your diet for the sake of your heart:

• Adopt a high-fibre diet. Take at least 2 servings of fruits and 3 servings of vegetables daily (1 serving = 100 grams). Choose oats, beans, bran, whole-grain bread, and wheat germ. Avoid deep fried foods, adopt low-fat cooking methods and choose lean meat. Stir-frying, boiling or even steaming methods of food preparation will significantly lower the fat content of your dishes.

• Choose low glycaemic index (GI) foods instead of high GI foods. These include brown rice, low-sugar soya bean milk, orange. Low GI foods release sugar slowly rather than rapidly, helping to control blood sugar.

• Avoid foods with trans fats. Limit hard margarine, deep fried food, pastries, cakes and foods made with vegetable shortening, hydrogenated or partially hydrogenated oils.

• Opt for healthier sources of protein. Choose fish, skinless poultry, lean white meat, nuts, bean products and low-fat dairy products. Avoid red meat.
  

• Limit consumption of saturated fats. Avoid visible fat and animal fats (butter, cream, ghee, lard) and poultry skin. Also, limit use of palm oil and coconut oil. Replace coconut milk with low fat/skimmed milk when cooking curry dishes.
  

• Cook with healthier cooking oils (unsaturated fat) such as sunflower, soya bean, olive, peanut and canola oil.
  

• Eat healthier snacks. Take 4 handfuls of nuts (preferably roasted or unsalted types) per week. Walnut, almond, pecan, and hazelnut are best for the heart (other nuts such as pistachio, peanut and cashew are fine too).
  

• Reduce salt intake, especially if you have high blood pressure (hypertension). If you cook, use less salt and monosodium glutamate. Foods with hidden salt such as preserved vegetables should be consumed in moderation. A salt-free diet can potentially lower systolic blood pressure by up to 8 mmHg.
  

• Reduce your cholesterol intake. Limit your consumption of organ meats, shellfish, prawns and crabs.
  

• Consume less sugar. “Choose plain water, plain tea or coffee instead of highly sweetened fruit-flavoured and syrup drinks,” says Prof Tan. Processed drinks and fruit juices are “hidden calories”. Recent studies have demonstrated that up to 22 per cent of our dietary calories may come from sweetened drinks and fruit juices.
  

• Limit alcohol intake to no more than 1 glass (wine) or 1 can (beer) a day.
  

2. Exercise regularly - make this a habit too!

Exercise is an essential component in maintaining a healthy heart. This holds true for healthy individuals and patients with existing coronary artery disease.

Aerobic exercises such as brisk walking, jogging or swimming, is the best type of exercise for heart health. Walking is the safest form of exercise to start if you are uncertain of the level of intensity.

Healthy adults should ideally complete at least 150 minutes a week of moderate intensity exercise (e.g. brisk walk). Seek your doctor’s advice for suitable physical exercise tailored to your condition.

Inactive adults should start gradually, with light or moderate intensity at a shorter duration (<10 min), with sessions spread throughout the week.

Regular physical activity, especially those types that involve large muscle groups such as swimming, walking, Pilates and yoga, produces cardiovascular adaptations that increase exercise capacity, endurance and strength.

Besides fending off cardiovascular disease and other death-causing disorders, regular exercise also helps you to:

• Lose weight effectively. Combining dieting with regular exercise is the most effective way to burn excess kilos.

• Relieve stress. Feel-good brain chemicals called endorphins are released during exercise, helping to combat anxiety and depression. Although blood pressure is elevated during exercise (which is normal), after the activity, the blood pressure is generally lower as most of our blood vessels are dilated. Exercise will generally lead to a lower blood pressure, helping you to keep it under control.

• Sleep better. With regular exercise, you’ll fall asleep faster and have little trouble staying awake during the day.

Generally it is advised to partake in 30 minutes of moderate exercise daily to experience the above health benefits.

3. Maintain a healthy weight

Excess weight is associated with a higher incidence of high cholesterol, high blood pressure (hypertension) and type 2 diabetes (diabetes mellitus) – all of which contribute to the onset of heart disease. For every 10 kg of weight you lose, you can potentially reduce your systolic blood pressure by 20 mmHg.

The Body Mass Index (BMI) is a good way to check if your weight is in the healthy range. The BMI formula is:

Having a BMI between 18.5 to 22.9 kg/m² is considered ideal.

Your risk for heart disease is also influenced by your body shape. Accumulation of fat around the waist (central obesity or so-called “apple” body shape) has been linked to a higher cardiovascular disease than fat accumulated around the hips and thighs (“pear” body shape).

Beyond your general body shape, your body fat distribution can also be assessed by the following waist-to-hip ratio (WHR) formula:

The healthy ratio for males should be less than 1. 

In females, it should be less than 0.8. 

Studies have shown that individuals of an acceptable weight but with central obesity are at a 3 times higher risk of heart disease compared to individuals with no accumulation of fat around their abdomen.

4. Manage your stress

Apart from causing headaches, insomnia and digestive problems, stress can also raise blood pressure and cholesterol levels, as well as encourage you to eat too much and smoke more.

“Recent research shows that within two hours of an angry outburst, a person’s risk of heart attack nearly gets multiplied by 5,” says Prof Tan.

While no one can eliminate stress entirely, you can learn to cope with stress better.

• Exercise regularly as it offers a calming effect that lasts longer than the exercise itself.

• Take a short walk or have a quiet moment alone when stress starts to build.

• Get enough sleep. Studies have shown that sleeping less than 4 hours or more than 10 hours daily is associated with an increase in risk of coronary artery disease. Ideally one should sleep for 6-8 hours each day
  

5. Stop smoking (if you haven't) 

Everyone knows cigarette smoking causes lung cancer but did you know that smokers are 3 times more likely to have a heart attack than to develop lung cancer? “If you’ve had a heart attack (and was a smoker prior to the attack), the single most important thing you can do to prevent a second one is to quit smoking,” says Prof Tan. 

Smoking up to 5 cigarettes daily increases the risk of a heart attack by 40 per cent. This would effectively cancel the protective effects conferred by taking medication.

How smoking affects the heart

Inhaled nicotine causes blood vessels to clamp down, forcing the heart to pump harder and faster to push blood through the smaller vessels. This affects the lining of the blood vessels making it easier for fat and calcium deposits to accumulate, further narrowing the arteries. The carbon monoxide in cigarette smoke also reduces the oxygen supply in tissues. Lung irritation and breathing difficulties further strain your heart.

Tips to quit smoking

• Make a conscious effort to cut down smoking over 2 or 3 weeks and then stop smoking altogether. At first, you may want to change your daily routine if you associate smoking with specific activities.

• Begin by giving up the first cigarette of the day. Subsequently, give up the second, then the third. Every day, try to go a little longer without a cigarette.

• Take more fluids, fresh fruits and vegetables. If you are used to having a cigarette in your mouth, have non-sugar lozenges or low -calorie sweets instead.

• Tell your friends and family that you’re quitting, and politely (but firmly) decline when invited for ‘smoke breaks’. During the first days, try spending more time with non-smokers.

• Speak to your doctor. Your doctor may refer you to a specialist smoking cessation clinic which has been shown to improve your chances of quitting the habit. There are also medications, special nicotine patches and chewing gum that can help someone kick the smoking habit.

Studies have shown that giving up smoking lowers the risk of heart attack by up to 50 per cent, regardless of how long you’ve smoked.

Ref: I23 (ed)

Check out other articles on heart health:

Worst Foods for Your Heart

10 Super Foods Good for Your Heart

3 Best Exercises for the Heart

Atherosclerosis (Plaque Buildup): How to Prevent

6 Great Ways to Lower Triglycerides

11 Ways to Strengthen Your Heart