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Tara Dall, MD, FNLA
Clinical Pearls
Top "15" List
For Heart Disease and Stroke Prevention

1. Know your numbers and ask for advanced lipid testing. Optimal Blood pressure <120/80, consider investing in a home blood pressure meter and bring to your appointments.  Beyond the standard lipid panel (cholesterol, LDL-C, HDL-C, triglycerides) advanced lipoprotein testing is a much more accurate measure of true heart disease risk. Optimal LDL particle concentration  (NMR lipoprofile) <700-1000, Apo B <70. Fasting glucose <100. If these numbers are above “optimal” do something about it, a change in diet, increased exercise or weight loss will help.  Triglycerides >100 and/or small dense LDL particles may be an early window into your risk for diabetes (before the traditional tests are abnormal). High HDL cholesterol (>50) is NOT a guarantee for protection against heart disease.  Get yourself and your children screened as early in life as possible.

2. If you smoke, quit.  1-800-QUITNOW

3. Everything in moderation, alcohol not more than 1 serving/day for women or 2 servings/day for men.  Higher intake will increase heart disease risk.  It may be best to avoid completely especially if on multiple medications. 

4. Move as much as possible. Get a pedometer: goal 10,000 steps/day, more needed if weight loss desired. If you have less than 5,000 steps/day you are officially “sedentary”.  Try to sweat at least twice/week and add resistance or weight training 2 additional days week, if your doctor approves. 

5. Know your family history. Is there anyone with heart disease or stroke before the age of 55 for men or 65 for women? Is there diabetes in the family? Do your relatives carry additional weight around their middle section (increases risk for heart disease and diabetes)? Update your family history at all your preventive care visits. You may be a candidate for further testing if you have family history of premature disease. (hsCRP, lipoprotein (a), Apo B or LDL particle concentration, MTHFR genotype)

6. Know the signs and symptoms of heart disease in women and men (they are different). Get medical help as soon as possible, if you think you may be having a heart attack, call 911. Time is of the essence. Don’t tough it out.

7. Eliminate trans fat, high fructose corn syrup, and artificial sweeteners. NO TRANS FAT/ PARTIALLY HYDROGENATED OIL (read the ingredient lists and if you can’t pronounce any of the ingredients assume it is not natural and may not be good for you). Avoid high fructose corn syrup and other simple sugars. A diet high in sugar is more likely to cause weight gain than one higher in the good fats.  Artificial sweeteners can have a similar effect as regular sugar and also increase inflammation.  Stevia or Truvia may be a more natural, safer alternative but always better to learn to enjoy foods that are less sweet.  “Insulin resistance” is a big contributor to heart disease and stroke as well as dementia risk.  Sugar drives insulin resistance.

8.  Care for your gut and the healthy bacteria that live inside you.   Consider taking a probiotic supplement or eating foods rich in probiotics especially if you have a history of using antibiotics frequently in your life.  A good supplement contains at least 15-25 billion CFUs and 7-10 strains of the beneficial lactobacillus and bifidobacterium. Consider eliminating foods that contain gluten and wheat as they may be a source of inflammation.  Other common food sensitivities and potential triggers for inflammation include soy, corn, and dairy. Interestingly when our gut becomes “leaky” it impacts our risk for heart disease and worsens autoimmune disease. Simple diet changes may be life changing.  FOOD IS MEDICINE.

9. Incorporate fiber 25-30 grams/day (mix of soluble and insoluble) and good fats. Eating fiber with every meal helps reduce spike in insulin and blood sugar. Complex carbohydrates (veggies and fruits, berries especially) and good fats such as olive oil, coconut, avocados and fatty fish are an essential part of our diet.

10. Avoid preservatives and chemical additives in foods and also body products that could be absorbed. Use Environmental Working Group EWG.org for up to date information on foods that are best to eat organic because you want to avoid unnecessary exposure to pesticides.  EWG.org also a great source for finding cosmetics and lotions that don’t have chemicals that can cause harm.  Anything we put on our bodies, including creams, lotions, soaps etc. can be absorbed and trigger inflammation and ultimately heart disease. 

11. Keep a list of all of your medications. This includes over the counter medications and diet supplements, the doses, and how often you take them. Supplements are medicines too and you need to keep your doctor informed.  Some are safe and some are not. Keep this with you and bring to all your medical appointments.

12. Get enough sleep. People who sleep less than 6 hours per night have higher risk for heart disease than those who get 7-8 hours per night.  Avoid exposure to TV and other electronic screens before bedtime that shut off our bodies’ natural ability to produce melatonin.

13. Supplements to consider:  Vitamin D3 and Omega 3 (EPA/DHA) Most patients with autoimmune disease are deficient in vitamin D and low vitamin D increases risk for heart disease.  I recommend Vitamin D3 supplements to reach “optimal” levels of 50-90. Omega 3 is very beneficial and most people don’t get enough in their diet (wild caught Alaskan salmon).  There are prescription omega 3 supplements available which may be appropriate if higher doses are needed.  I use 3000-4000 mg EPA/DHA for patients.  This dose also lowers triglycerides and reduces inflammation (may help arthritis) and can act to reduce clotting risk.  It does not lower cholesterol and may raise it if high doses are being used.  Make sure you check with your doctor regarding any supplements before you take them. 

14. Supplements to AVOID:  Phytosterols, supplements promoted to “lower cholesterol naturally”.  Unless you know your sterol absorption status they may not be safe to take.  The benefit is very minimal in regards to ability to lower cholesterol. If you happen to be a person who can absorb these sterols it can cause increase in heart disease risk.  Most doctors and patients are unaware of this fact.  Sterols found in food however are generally safe as the doses are much lower than when taken in pill form.  Sterol testing is available from labs that do advanced testing but my general advice is to avoid these supplements.   

15. Find ways to reduce stress in your life. Exercise, try not to hold in anger, forgive, journal, spend time with people who support you, smile and laugh as much as possible, pray, dance, believe you are worth living

Copyright Tara Dall, MD (2006) 2015



Tara Dall
Tara L. Dall, MD