Susan was just sixty when her cousin Nick became disabled
with vascular dementia. Always significantly overweight,
she nevertheless felt healthy. She was energetic, took no
medicines, and ran a small scrap-booking business.
However, she was also mildly hypertensive, had smoked like a chimney for twenty years, and was sedentary.
Nick’s disability affected her deeply, and at sixty-one, she
had a transient ischemic attack, which is like a small heart
attack in the brain. When she came to see me, I saw that she was mildly hyper-tensive, a borderline diabetic, had high triglycerides, and was at risk for a major stroke. She needed to make some changes.
Susan was a very picky eater: she had been raised on corn
casserole, peanut brittle, and beef, and she kept to those
foods. I recommended the Mediterranean diet, with its
higher healthy fats and fewer starches.
Susan had trouble changing her pattern of eating, because
she did not feel hunger (although she ate a lot, to deal with
stress). So I asked her to stop eating when her plate was 80 percent empty. I explained that it took eight weeks to
change how new foods would taste to her and that I’d like
her to try a rule of ten: try a food ten times over a year
before she decided she didn’t like it. I asked her to avoid
butter, shortening, cheese, and sugary foods and to commit
to eating up to six servings per day of fruits and vegetables, especially high-folate ones: one citrus (she chose oranges), one vitamin C–rich (red peppers), one leafy green (spinach), and three cruciferous (brussels sprouts, watercress, and broccoli). Just by making these changes in her diet, she reduced her risk of stroke by 55 percent.
She switched from beef to halibut (which has more folate), first twice a week and then every day. She upped her potassium level with baked sweet potatoes. She started a walking program, at first just around the block, then increasing her distance each week. And then she quit smoking cold turkey, munching on crisp jicama until the cravings passed. After four years, Susan is like a new person. She has lost seventy-two pounds, decreased her triglycerides, increasedher HDLs, and is smoke-free. She has drastically reduced her risk of stroke, and everymorning enjoys walking twenty blocks to her new job as a textile buyer for a major department store in Seattle.

WHAT IT IS: Heart disease means coronary artery disease. Its main cause is atherosclerosis, in which plaque builds up in the arteries and prevents the heart and vessels from getting enough blood.
• smoke
• are sixty-five or older
• are male
• are a postmenopausal woman
• are African American
• are physically inactive
• are overweight or obese
• are under chronic stress
• have diabetes mellitus
• have a family history of heart disease
• have high blood cholesterol
• have high blood pressure



• Tea, onions, and apples. They contain flavonoids, and a five-year study found men who ate the most flavonoids were at less than half the risk of coronary heart disease compared with those who ate the least. The flavonoids rutin and quercetin stabilize small blood vessels, and increase artery-dilating nitric oxide levels. And the risk of heart attack decreases by 11 percent with tea consumption of three cups or more per day.

• Alcohol.

A Finnish study found that when alcohol-containing beverages are drunk in moderation and with consistency, they reduce the risk of heart disease as they raise HDL cholesterol levels.

• Oily fish.

It reduces platelet aggregation, thereby lowering the risk of cardiovascular disease. (And does so more effectively as part of a low-fat rather than a high-fat diet.) A Chinese study showed that people who ate almost 2.5 pounds of fish a week had a 93 percent reduced risk of coronary atherosclerosis compared with those who ate little or none.

• Extra-virgin olive oil.

A Greek study showed that extra-virgin olive oil reduces the risk of acute coronary syndrome by 47 percent in people who cook with no other fats.
• Nuts, especially walnuts and almonds.

A seventeen-year study that followed more than twenty one thousand men showed that those who eat nuts twice a week or more cut their risk of sudden cardiac death almost in half, although we don’t know exactly why.

• Whole grains.

which contain antioxidants as well as fiber and B vitamins. People who eat the most whole grains have a 25 percent reduced risk of coronary heart disease compared with those who eat the least.

• Legumes.

A nineteen-year study found that people who eat foods such as beans, peas, and lentils four times or more a week have a 22 percent lower risk of coronary heart disease than those who only eat them once a week.

• Citrus fruit.

Their flavonoids reduce inflammation.
• Dark chocolate (eaten in moderation—about an ounce a day). Its flavonoids reduce LDL and increase HDL cholesterol, dilate the arteries, and inhibit platelet activity, which fights heart disease.
• Cocoa also reduces blood pressure, which reduces the risk of heart disease.

• Vegetables.

An Italian study showed that those who ate the most vegetables had a 21 percent reduced risk of heart attack and an 11 percent reduced risk of angina pectoris. Even increasing your intake by just an ounce and a half a day can make a difference in your risk of death from heart disease.

• The Mediterranean diet.

People who have already had a heart attack halve their risk of having a second by adhering to this eating pattern.

• Alcohol in excess. Men who binge drink raise their risk of cardiovascular disease by half.
• High-trans-fat foods. Women who eat foods with the most trans fats have levels of the inflammatory marker called C reactive protein in their blood that are 73 percent higher than women who eat foods with little or no trans fats. C reactive protein is a risk factor for cardiovascular disease.
• Red meat. A twenty-year study showed that its heme iron increases the risk of heart disease among women with type 2 diabetes by up to 50 percent.


• Salty foods.

especially for men who are overweight. In one study, participants who lowered their sodium intake reduced their risk of a cardiovascular event by 25 percent.

• Sugary foods.

Especially for those with diabetes or prediabetes.

• Potatoes.

bread, soft drinks, and sweets, if you are an overweight woman. These foods contribute most to glycemic load (a measure of how fast a carb-rich food raises your blood sugar and how much carbohydrate you eat) and probably to inflammation, part of the heart disease cascade. A study of more than seventy-five thousand women over ten years found that those who ate the most foods with a high glycemic load almost doubled their risk of cardiovascular disease compared with those who ate few or no such foods.
• Cioppino
• Sardine and Arugula Salad with Ratatouille
• Toasted Walnut and Creamy White Bean Pitas
WATER-COOLER FACT: Cocoa is rich in phenols, compounds that fight heart disease and aging.


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