It takes a one-two punch to lower these risks for heart disease, heart attack, and stroke.
High cholesterol has long been known as a bad actor in heart health. Too much LDL (bad) cholesterol in your blood can lead to fatty deposits in your arteries and the formation of artery-narrowing plaque (atherosclerosis), heart attacks, and strokes.
But LDL doesn't act alone. Chronic inflammation -- a persistent activation of the immune system -- also fuels heart attack and stroke risks. That means you must address both high LDL levels and chronic inflammation to protect your health.
Many approaches fight high LDL and chronic inflammation at the same time.
Eat a healthy diet. What you eat can contribute to both chronic inflammation and high LDL levels. Offenders include saturated fat (the kind in red meat, foods fried in animal fat, or cheese), sugary foods and drinks (like soda and baked goods), and processed foods (like chicken nuggets, frozen dinners, or hot dogs).
A heart-healthy, anti-inflammatory diet -- such as a Mediterranean-style diet -- includes vegetables, fruits, legumes, whole grains, nuts and seeds, lean proteins (fish and poultry), low-fat dairy foods, and olive oil.
"It's not a specific nutrient that confers benefits, but a pattern of eating including fresh, leafy vegetables with antioxidants; fiber that may help lower cholesterol; and olive oil that may have an antioxidant function, lower triglycerides and thereby fight inflammation, and reduce cardiovascular problems," says Dr. Peter Libby, a cardiologist at Harvard-affiliated Brigham and Women's Hospital.
Control your weight. Being overweight increases the risks for high LDL levels, heart attack, and stroke. One reason why: "Fat tissue is teeming with cells that trigger chronic inflammation," Dr. Libby notes. "We have incontrovertible evidence that abdominal obesity is bad for heart health."
To control weight, Dr. Libby suggests thinking about how much you eat, not just what you eat, and reducing your portion sizes if necessary. "Even a 5% reduction in body weight will increase your heart health," he says.
Increase physical activity. A sedentary lifestyle has many risks, including higher levels of chronic inflammation and lower levels of HDL (the good cholesterol that helps remove LDL from your arteries). This is true even if you are a healthy weight.
On the flip side, an active lifestyle helps reduce LDL, high blood pressure, stress, and body weight, and improves triglyceride levels, blood vessel function, and the body's use of insulin (which shepherds blood sugar into cells).
Physical activity may also be involved in taming white blood cells. "If you take mice and exercise them in a laboratory, it can quiet the overproduction of inflammatory cells in the bone marrow, while preserving the ability to fight infection," Dr. Libby says.
How much should you exercise? Don't think of it that way, Dr. Libby advises. "Just start doing more," he says. "Can you increase walking from once a week to twice a week? You'll make a difference in cardiovascular health with incremental change."
Address sleep and stress issues. Interrupted sleep and high stress levels may contribute to obesity, physical inactivity, and poor food choices -- which can lead to high LDL levels. Dr. Libby says poor sleep and high stress may also send signals to bone marrow to increase production of white blood cells, fueling chronic inflammation.
That makes it crucial for heart health to reduce stress (yoga or meditation can help) and see a doctor if you suspect you have sleep apnea (pauses in breathing during sleep) or any other kind of sleep difficulty.
Partners in crime
As cholesterol deposits damage artery walls, the immune system sends in a cavalry of white blood cells and other inflammatory cells in a vain attempt to remove the deposits. A fibrous cap grows over the mess, enabling plaques to grow larger. "It's a chronic inflammatory response that's slow and happens over months, years, or decades," says Dr. Peter Libby, a cardiologist at Harvard-affiliated Brigham and Women's Hospital.
When lifestyle change isn't enough
A number of medications can treat high LDL and chronic inflammation. The first line of defense: statins, which substantially lower heart attack and stroke risk. "The ability of statins to lower LDL and to quiet inflammation are equally important in reducing the risk of heart attack and stroke," Dr. Libby says. And now we know that some medications that treat only inflammation may also help reduce heart attack risk.