For the majority of people, diet and lifestyle remain the cornerstones of the prevention of cardiovascular disease.
There is very clear evidence that a Mediterranean-style, plant-based diet is one of the best diets for cardiovascular disease prevention and even reversal of disease. This was the basis of the PREDIMED study, published in the New England Journal of Medicine in 2013 and re-analysed in 2018.
The Mediterranean Diet recommends that the majority of your diet should be from plants, including plant-based protein sources; that you limit your consumption of processed red meat; and only have a small to moderate consumption of foods like dairy and eggs. Simplified, mostly eat fruits, vegetables and wholegrains.
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Interestingly, recent meta-analyses have found that people who drink coffee live longer. When we drink more than a few cups a day it can affect both our heart rate and our ability to sleep at night, as well as stress our adrenals, but it has not been associated with many adverse cardiovascular outcomes. I'm more concerned about the things that are consumed with the typical Australian coffee - that extra pastry or even too much milk in the coffee.
In middle age our level of cardiovascular fitness is prognostic, meaning the fitter we are the longer we are going to live. That remains true for whatever risk factors you may already have. Being fit should be part of everyone's program for preventing heart disease. It also aids in the prevention of cognitive decline
Australian recommendations for physical activity are 150 minutes per week of moderate physical activity, or 75 minutes of vigorous activity where you're getting your heart rate between 70-85% of its maximum (usually defined as 220 - your age).
It would be remiss of me not to talk about sleep as well, with studies this year showing an adequate amount of sleep of around seven-to-eight hours per night can help prevent coronary atherosclerosis. People at a high risk of heart disease will still need medication, as well as the assistance of a doctor to decide on the best course of action, but maintaining a good diet and lifestyle remains important.