Preventing heart disease: 10 questions (& expert answers)

Maintaining a healthy heart after age 50 doesn’t require running marathons or eating kale for every meal. But it may be time to step back and plan a more strategic approach to your choices. As your body changes, the rules for staying healthy evolve, too.

We gathered insights from cardiologists, nutritionists, and movement experts to answer some of the most popular questions about preventing heart disease.

Are you moving your joints or just your muscles?
Before you hit the heavy weights or treadmill, you need to check under the hood. Brian Murray, founder of Motive Training, suggests that people over 50 should start with controlled, joint-focused movement.

“We use controlled articular rotations (CARs) to help clients understand how their joints move,” he said. “CARs are slow, deliberate movements, like drawing the biggest possible circle with your hip or shoulder without compensating elsewhere.”

By focusing on mobility first, you reduce stiffness that often leads to injury, which in turn reduces activity, which isn’t great for heart health. Once your joints are functioning properly, you can safely incorporate strength and conditioning work, he said.

Spend about 150 minutes each week engaging in moderate activity, like brisk walking or cycling; add more movement (stairs, walking breaks) to reduce sitting time.

Is muscle the secret to longevity?
Cardio gets all the heart-health glory, but Dr. Jason Winkelmann, chronic pain specialist at True Health Centers, said that strength training is just as vital. Plan two days of strength training per week.

“This age group should start prioritizing strength and resistance-based exercises,” he said. “When bone and muscle strength falter, debilitating injuries are much more likely. We become sedentary for longer, which is the absolute worst thing you can do for your health.”

Can you eat your way to a younger heart?
The general advice to eat healthy is far too vague. Experts recommend specific, actionable shifts.

Avoid (or, let’s be realistic here, eat in moderation) the 5 CHs. Dr. Stephen Fenton, a preventive cardiologist and author of the forthcoming book The 5CH Lifestyle: Lower Your Cholesterol Without Medication, Reduce Your Risk of Heart Attack, and Achieve Long Term Wellness, recommends skipping chops, cheese, chips, chicken skin, and chocolate to significantly reduce saturated fats and toxins.
Prioritize fiber. Dr. Andrew Rubin said that while our ancestors ate up to 150g of fiber daily, the average American only gets about 15g. “Increasing fiber is one of the three most important dietary changes for heart health,” he said.
Count color, not calories. Dr. Deanna Minich, chief science officer at Symphony Natural Health, suggests eating from each of the rainbow’s seven colors daily to ensure you get a broad spectrum of phytonutrients.
Lean into anti-inflammatory foods. Minich said, “Build most meals around whole, anti‑inflammatory foods: leafy greens, berries, herbs and spices, beans and lentils, nuts and seeds, and omega‑3 sources such as salmon, sardines, mackerel, walnuts, chia, or flaxseed. These foods help calm chronic inflammation that contributes to plaque buildup and insulin resistance.”

A Mediterranean-style diet works well because it’s rich in vegetables, fruits, beans, whole grains, nuts, olive oil, and fish. Limit the intake of red and processed meat, sugar, and refined carbs.

Why does belly fat matter more now?
Abdominal (or visceral) fat is biologically active and inflammatory. “Abdominal fat becomes more problematic after age 50 because visceral fat stored around the organs drives inflammation and metabolic dysfunction,” said Murray.

Minich recommends incorporating polyphenols, such as those found in green tea, walnuts, and duckweed, into a Mediterranean diet. One study found that this diet actually helped people double their visceral fat loss. Limiting ultra-processed foods and sugary drinks reduces blood pressure, cholesterol levels, and the risk of diabetes.

“This age group should start prioritizing strength and resistance-based exercises,” he said. “When bone and muscle strength falter, debilitating injuries are much more likely. We become sedentary for longer, which is the absolute worst thing you can do for your health.” — Dr. Jason Winkelmann

How should I manage high blood pressure or type 2 diabetes?
“Adhere to a more heart-healthy diet that’s lower in salt, sugar, carbohydrates, and saturated fats,” said Dr. Louise Spadaro, cardiologist at St. Francis Hospital. We become more susceptible to the effects of processed foods as we age.

“Drink water to keep hydrated and avoid sodas and sugary drinks.” If you take medications for blood pressure, diabetes, cholesterol, or other health issues, be diligent with your regimen. Don’t skip doses. Take as prescribed. If you have difficulty taking them, tell your provider to see if there’s an alternative.”

“Prioritize wild-caught fish and organic, grass-fed meats, which are high in anti-inflammatory omega-3 fatty acids,” said Dr. Winkelmann. “Farmed fish and conventionally raised meats are high in omega-6 fatty acids, which are inflammatory.”

Could sleep be your missing heart strategy?
If you think skipping sleep just makes you grumpy, think again. Dr. Winkelmann said that the most heart attacks occur during daylight saving time — a startling statistic. Each hour of lost sleep can place unrelenting physical stress on your heart.

Murray said that chronic stress and poor sleep keep your body in a constant “on” state, raising blood pressure and slowing recovery. He recommends reducing caffeine intake earlier in the day and using mobility work or walking to unwind before bedtime.

Try for 7-9 hours of consistent, high-quality sleep; seek evaluation for loud snoring, gasping, or significant daytime sleepiness, which may indicate sleep apnea (and increased risk of heart disease).

Are you ignoring your body’s check engine light?
Angina is the medical term for chest pain, but heart distress doesn’t always resemble a movie version of a heart attack. Dr. Bradley Serwer, an interventional cardiologist and chief medical officer at VitalSolution, said you should not ignore any of these symptoms:

Shortness of breath
Palpitations or “fluttering”
Fatigue and lightheadedness
Dizziness or fainting

If these symptoms are consistent and recurring, he recommends scheduling a comprehensive evaluation as soon as possible. Serwer also said, “Familiarize yourself with your family history, identify any cardiac problems among your relatives, and understand the types of issues they’ve experienced. Address common risk factors (high blood pressure, diabetes, smoking, high cholesterol) proactively and aggressively. It’s more advantageous to treat the risk factors than to treat coronary disease after damage has occurred.”

Should you take aspirin every day?
The baby aspirin rule has changed. Dr. Fenton said that for those with no history of heart events, there’s no convincing evidence of a benefit — and in some cases, taking aspirin daily can cause stomach bleeding.

Michelle Routhenstein, cardiology dietitian at EntirelyNourished.com, said that people 60 and older should generally not start aspirin for primary prevention. She recommended that you consult your doctor before starting any regimen. “There’s no one-size-fits-all supplement for heart disease,” she said. “Only your healthcare team should recommend supplements, specifically your registered dietitian, who can review your medical history, medications, labs, kidney and liver function, and diet to determine what you need and at what dose, and weigh risks and benefits while ensuring proper monitoring and adjustments.”

Which blood tests matter?
While a basic lipid panel is standard for evaluating your heart health, several experts recommend looking deeper.

Dr. Andrew Rudin suggested checking Lp(a), homocysteine, and hsCRP. He also prioritizes a fasting insulin level, as insulin can be elevated for a decade before blood glucose or A1C shows a problem.
Dr. Fenton recommends a CT coronary calcium score for men over 50 and women over 60 to look for calcified plaque.
Rothenstein emphasized that every adult should test for lipoprotein(a) once to establish a baseline cardiovascular risk assessment.

Can you nourish your way off medication?

If you’re managing multiple conditions like arthritis and blood pressure, “pill burden becomes a real concern. Rothenstein suggests shifting your mindset from restriction to nourishment.

“Optimize calcium-rich foods from whole-food sources,” she said. “Adequate calcium supports blood pressure regulation, especially when paired with potassium and magnesium from foods like yogurt and kale.”

Working with a registered dietitian specializing in heart disease can often reduce the need for medications by addressing root causes through nutrition. However, keep taking prescribed statins or other cholesterol-lowering agents if you have high LDL, diabetes, or an elevated overall risk, since they lower heart attack and stroke risk. Also, don’t stop taking your blood pressure meds without medical guidance if your current lifestyle alone isn’t controlling your hypertension.

A quick summary for the 50+ heart

Focus area	Advice
Diet	Increase fiber and omega-3s; avoid (or eat sparingly) the 5CHs
Movement	Start with joint mobility and then add strength training and cardio
Sleep	Aim for consistency; avoid late-night caffeine and eating after sundown
Testing	Ask your doctor about fasting insulin and Lp(a) tests

Bonus recommendations

Dr. Andrew Rudin, a cardiologist with Natural Heart Doctor, focuses on other prevention strategies people can realistically stick with, especially regarding lifestyle, diet, and reducing everyday sources of inflammation. He suggests limiting avoidable exposures that contribute to oxidative stress over time, like microplastics.

“Heart disease prevention is about stacking small wins,” said Rudin. “Simple steps like avoiding plastic food storage when possible, choosing safer cookware, increasing soluble fiber intake to support gut health, and prioritizing daily movement and sleep all work together to lower cardiovascular risk.”

Daily Heart Attack Risk-Reduction Checklist

Food & drink

Fill half my plate with vegetables and fruits at most meals.
Include beans, lentils, or other plant proteins several times per week.
Choose whole grains (oats, brown rice, whole‑wheat bread) over refined grains.
Use olive or canola oil instead of butter or shortening when possible.
Eat fish (especially fatty fish like salmon or sardines) 1–2 times per week.
Limit red and processed meats (bacon, sausage, deli meat, hot dogs).
Cut back on sugary drinks and sweets most days.
Keep alcohol modest if I drink, and skip it when advised to avoid it.

Movement & weight

Get at least 30 minutes of moderate activity (like brisk walking) on most days.
Do strength or resistance exercises at least 2 days per week.
Break up long sitting time with short walking or stretching breaks.
Work toward or maintain a healthy waistline and body weight with sustainable habits, not crash diets.

Tobacco, vaping, and substances

Do not smoke cigarettes.
Do not vape nicotine or use other tobacco/nicotine products.
If I use nicotine, I am actively following a quit plan (program, counseling, or medications).

Know your numbers

Know my usual blood pressure and check it as often as my clinician suggests.
Aim to keep blood pressure near the target set by my clinician (often under about 130/80 mm Hg).
Know my latest cholesterol panel (total, LDL, HDL, triglycerides).
Know whether I have prediabetes or diabetes and my most recent A1c if applicable.
Have discussed my long‑term heart risk with a clinician using a risk calculator.

Medications & medical care

Take prescribed blood pressure medications exactly as directed.
Take prescribed cholesterol‑lowering medications (such as statins) consistently.
Take diabetes medications as prescribed if I have diabetes.
Have reviewed with a doctor whether low‑dose aspirin is appropriate for me (do not start or stop on my own).
Have asked about newer options (like GLP‑1 or SGLT2 drugs or bariatric surgery) if I have obesity, diabetes, or very high risk.
Keep routine visits with my primary care clinician and cardiologist if I have risk factors or known disease.

Sleep & stress

Aim for 7–9 hours of consistent sleep most nights.
Have talked with a clinician if I snore loudly, gasp, or feel very sleepy during the day.
Use at least one healthy stress‑management practice most days (walks, breathing exercises, meditation, yoga, hobbies, or time outdoors).
Avoid using alcohol, smoking, or overeating as my main coping tools.

Mental health & relationships

Pay attention to signs of depression or anxiety (persistent sadness, loss of interest, constant worry).
Seek counseling, therapy, or other support if my mood or stress feels unmanageable.
Make time for social connection with friends, family, community, or faith groups.

Environment & prevention

Minimize exposure to secondhand smoke.
Avoid exercising next to heavy traffic or during poor outdoor air‑quality alerts when I can.
Keep up with vaccines recommended for me (such as flu and COVID‑19).

Know warning signs & emergency steps

Recognize possible heart attack symptoms: chest pressure or pain, discomfort in arm, jaw, neck, or back, shortness of breath, sudden sweating, nausea, or unusual fatigue.
Call emergency services immediately if symptoms suggest a heart attack — do not drive myself or “wait it out.”