Cardiometabolic disease is the #1 cause of death across all populations, and understanding your risk factors—especially in middle age—is crucial.
My father had his first heart attack at age 36! I was pretty young at the time so as I got older and worked in the hospitals I started to realize I hadn't won the genetic lottery. However...understanding how lifestyle impacted heart health I dove into healthier habits and had new understanding that genetics were only a small fraction of the root cause.
The word “cardiometabolic” is used to combine cardiovascular and metabolic, understanding that there is a close link between inflammation in your blood vessels and inflammation related to excess processed carbohydrate intake.
Excess processed carbohydrates lead to inflammation. Downstream it causes disruption in your blood sugar, triglycerides, liver enzymes, blood pressure, uric acid metabolism, and deposition of dangerous visceral fat around your mid-section.
Ultimately, the goal is to decrease inflammation in the body.
To put it simply, we decrease inflammation by choosing whole foods in the right macro balance of protein, fat and fiber.
Choosing at least 30 minutes of zone 2 exercise (i.e. exercise that makes you a little breathless) most days along with 3-4 days per week of resistance training and one 20 minute session of HIIT (High Intensity Interval Training) per week on average.
Prioritizing sleep along with space for mental/emotional stillness to decrease stress in the body
Sounds simple right?
Simple doesn’t mean easy but well worth it.
Here are 7 key points that can help you mitigate and understand your risk for cardiometabolic disease. I feel the conversation in conventional medicine is way too reductionist...lower your cholesterol with a statin. There is so much more to the conversation my friends...
- Prioritize Protein & Fiber
Fiber supports stable blood sugar, lowers inflammation, and promotes healthy lipid levels by binding to cholesterol in the intestines which decreases absorption.
Amino acids in protein signal the intestines to release GLP-1, aiding in satiety. Adequate amino acid intake is crucial in our older years as we can’t make proteins as easily.
High-fiber sources: Lentils, chickpeas, flaxseeds, chia seeds, avocado, berries, apples, and cruciferous vegetables.
Protein-rich sources: Wild-caught fish, organic grass-fed beef, pasture-raised poultry, organic tofu/edamame/tempeh, and omega-3-rich eggs.
2. Monitor ApoB and TG, Not Just LDL
Apolipoprotein B is a more precise predictor of cardiovascular disease than LDL alone, offering a clearer picture of the lipoproteins that actually drive plaque buildup. ApoB carries all of the bad types of cholesterol - not just LDL - so it’s a more useful marker to track year to year. Only measuring LDL will soon become obsolete, and most physicians will monitor ApoB more closely. Ask your doctor now.
Likewise, know your triglyceride number. If your TG is higher than your HDL or > 85, it’s a sign that your body is having difficulty with the foods you are eating.
Cholesterol levels go up because of inflammation in the body from excess processed carbohydrate intake and stress, so if your levels are starting to rise, it’s time to examine why.
Here are 7 ways to address your heart health.
3. Strength Train & Walk More
Resistance training boosts HDL (the “good” cholesterol that scavenges bad cholesterol and brings it back to the liver), while walking improves lipid metabolism and insulin sensitivity.
Staying active throughout the day supports circulation, reduces stiffness, and benefits heart health and is more meaningful than just getting one burst of exercise once daily. Small habits—like taking the stairs or walking after meals—make a big impact.
I love strength training and encourage progressive overload (ie increasing your weight to reach muscle fatigue after 8-12 reps) to challenge your muscles. If you aren’t pushing yourself during your strength workouts, it’s time to level up.
4. Optimize Healthy Fats & Omega-3s
Unsaturated fats and omega-3s reduce inflammation and support optimal cholesterol balance by reducing triglycerides in the blood stream. Triglycerides are the type of cholesterol made from excess calorie intake and are stored for future use. Bad fats (like processed oils and fatty meat) and processed carbohydrates (like refined grains and sugar), or the combination of the two (like Doritos and prepared foods) also raise triglyceride levels.
Omega-3-rich foods: Wild-caught salmon, sardines, Alaskan mackerel, roe, anchovies, herring, trout, mussels, oysters, organ meat, and eggs. If you’re not eating sardines, you should be.
Heart-healthy fats: Extra-virgin olive oil, avocado, seeds (like flax, chia, hemp), raw nuts, and omega-3 sources. If you are interested in a quality Fish oil supplement click here
5. Dial in Your Sleep
Poor sleep disrupts lipid metabolism, increasing cardiovascular risk and affecting appetite, and ultimately this leads to more inflammation in your body. Aim for 7-9 high-quality hours per night to regulate your hunger and satiety cues.
When we are rested and in alignment with our circadian rhythm (meaning we are getting morning sunlight and avoiding excess light closer to bedtime), our cortisol and ghrelin signals, which help maintain satiety, function properly.
6. Check Your Calcium Score
A coronary artery calcium (CAC) scan is a CT that measures hardened arterial plaque. If your LDL and ApoB are high but CAC is zero, you may need more advanced testing to evaluate for soft plaque. If ApoB and CAC are high, it’s time to act.
7. Go Beyond a Standard Lipid Panel
To fully understand your heart health it is recommended to test at least twice a year, especially around the time of changing hormones. If you are actively making changes, then testing labs every 3 months may be more appropriate.
Here are the key markers to test:
ApoB – Key marker for cardiovascular risk and carrier of bad cholesterol that rises in response to inflammation
Lp(a) – Genetic risk factor often missed that significantly increases risk of heart attack and stroke
hs-CRP – Early marker specific to cardiac inflammation
LpPLA2 - Later marker specific to cardiac inflammation
HemoglobinA1C - Reflects the last 3 months of glucose control
Fasting Insulin – Crucial for metabolic health, as fasting insulin levels rise when the body is overwhelmed with sugar intake. Hemoglobin A1C can be high and this can be low indicating other reasons for differing numbers.
Omega-3 Index – Low levels are associated with higher risk of cardiometabolic disease
Homocysteine – Linked to arterial damage and positively influenced by B vitamin intake, especially if you have a genetic methylation defect
Uric Acid - Higher levels are linked with the development of metabolic syndrome and directly related to dietary choices
Most of these tests your PCP can order for you but if you run into difficulty there are other ways, like an integrative doctor or functional medicine to have these tested and interpreted.
Thanks for being here... and here's to a happy healthy heart!
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Together we can make the world a happier, healthier place.
In best health,
Karen
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