When we talk about cardiovascular health, everyone thinks of cholesterol. Is it really the most important thing? What are the other risk factors? In 2019, what should we consider to reduce our risks? A recent study of 8941 people in Sweden (25 to 74 years old) over a 20-year period reports a significant reduction in cholesterol levels, 30% of which is due to ten times more use of medications (1, 4% vs 14.3% of the population) and 70% of the decrease is due to the improvement in lifestyle. We must ask ourselves where we should put our efforts (Eriksson et al, 2016).

The heart is the body’s central organ for delivering nutrients and oxygen to millions of our cells. It is the only organ that cannot momentarily fail or take a break. No wonder this is one of the most important health concerns.

Among the risk factors for cardiovascular disease, we find the four facets of longevity of centenarian populations: stress management, physical activity, social life and food. Without going over these facets in detail as to the multiple reasons for their impact on health, here are some explanations and some statistics that allow us to quickly understand their importance:

  • Stress is a state of emergency in the body that can allow it to respond more effectively to a danger. We talked about its connection to aging in a previous article (Stress, anxiety and aging). It is easy to think that for the heart, which must prepare by beating harder, faster, it is not very good to be too often and too long in a state of emergency. For example, in Japan following the earthquake that caused the tsunami in 2011, the rate of sudden death from a heart attack doubled for at least three weeks (Kitamura et al, 2013).
  • For physical activity, in women over the age of 65, starting to walk about 1.5 km per day can reduce the risk of cardiovascular disease, cancer or death from all causes by 50%.
  • The impact of social life is more difficult to assess, but it is obvious. A meta-analysis (analysis of data from a large number of studies) published in 2010 (Holt-Lunstad et al, 2010) concluded that those with good social relationships had a reduced risk of premature mortality by 50 %. It has a greater impact than obesity or physical inactivity.
  • In terms of food, it turns out that about 1/3 of the deaths could be avoided if food choices were of a higher quality. A recent study, published in January 2019, reported analyses of the World Health Organization data for 51 countries on cardiovascular deaths attributable to an unbalanced diet (in order of importance (Meier T. et al. 2019)):
  1. poor in whole grains = 429,000 deaths;
  2. low in nuts and seeds = 341,000 deaths;
  3. poor in fruit = 262,000 deaths;
  4. high in sodium = 251,000 deaths;
  5. poor in omega-3 = 227,000 deaths.

In general, a healthy diet and lifestyle can reduce the risk of heart attack by 81-94%, that is, virtually eliminate it, while medication can only reduce the risk by 20 to 30% (Kahleova et al, 2018).

In closing, it is also important to talk about sleep. Men 50 and under, with 5 hours of sleep a night are twice as likely to have a heart attack in the next 20 years. It is as important a risk as smoking or having diabetes at the age of 50 (Moa Bengtsson, 2018).

Remember that the heart is essential for the health of your whole body and all facets of health in your body are essential for the health of your heart.

For other articles and advice on your health, see the Vitoli blog:



  • Eriksson et al, 2016. Greater decreases in cholesterol levels among individuals with high cardiovascular risk than among the general population: the northern Sweden MONICA study 1994 to 2014. European Heart Journal, Volume 37, Issue 25, 1 July 2016, Pages 1985–1992.
  • Kitamura et al, 2013. The Great East Japan Earthquake and Out-of-Hospital Cardiac Arrest. N Engl J Med 2013; 369:2165-2166.
  • Holt-Lunstad et al, 2010. Social Relationships and Mortality Risk: A Meta-analytic Review. PLOS Medecine.
  • Meier T. et al. 2019. Cardiovascular mortality attributable to dietary risk factors in 51 countries in the WHO European Region from 1990 to 2016: a systematic analysis of the Global Burden of Disease Study. European Journal of Epidemiology (2019).
  • Kahleova et al, 2018. Vegetarian Dietary Patterns and Cardiovascular Disease. Prog Cardiovasc Dis. 2018 May – Jun;61(1):54-61.
  • Moa Bengtsson, 2018. Middle age men with short sleep duration have two times higher risk of cardiovascular events than those with normal sleep duration, a cohort study with 21 years follow-up. European Society of Cardiology.