While heart disease is the leading cause of death in the U.S., it can also be silent and go undiagnosed until a person experiences signs or symptoms of a heart attack, heart failure or an arrhythmia. Moreover, high blood pressure and cholesterol, along with smoking, place patients at higher risk for heart disease. But through lifestyle changes—and medicine—people can reduce their risk and treat heart disease.

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"Patients with heart disease have more risk for hospitalization and ICU admission as well as death from COVID-19," said AMA member Cate Collings, MD, a cardiologist and president of the American College of Lifestyle Medicine. "Then in the other direction, COVID has been associated with myocarditis, which can lead to the development of heart failure and cardiac damage."

Dr. Collings offered six lifestyle-change recommendations that help prevent and treat heart disease.

"There are foods that increase inflammation and are considered pro-inflammatory … like meats, fried foods and processed foods," said Dr. Collings. "Certain foods have a high antioxidant and polyphenol content, and these are all things that reduce inflammation."

Look to dark green leafy foods, orange-colored vegetables, legumes, and fruits which are high "on the spectrum in terms of having positive effects on cardiovascular disease," she said.

Learn about four ways to help patients with chronic disease make dietary changes.

"What’s moderate for one person is hard for another and what’s moderate for someone else may be light for another—it is relative to the individual," said Dr. Collings. "Even short amounts of moderate exercise such as brisk walking, cycling or swimming can reduce your heart risk and boost immunity.

"We think that extreme exercise may also transiently suppress immunity in some individuals so extra caution may be needed at this time," she added.

Discover how patients can start—and stick with—key lifestyle changes.

A way to tame heart-damaging stress is to designate reflective, meditative or spiritual time each day," said Dr. Collings. While it is "just another thing on our list of to dos right now, you can have micro moments or one-minute moments of breathing, exercise or relaxation."

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"If you’re always on the stress side of things where you’re in the sympathetic system—the fight or flight—you need to go into the rest and digest, or rest and reflect, to wind down that sympathetic system to balance it out with the parasympathetic system," she said.

Find out why depression and anxiety are prevalent during COVID-19.

Thinking positively "has a direct effect on a person’s health. Some of the softer psychological risks can actually have hard outcomes," said Dr. Collings, adding that "humor is often the best medicine."

"There is data that show how we approach life in terms of positivity, how we interface with people in terms of creating connection and positive moments have direct physiological effects and health outcomes," she said.

Substance and alcohol abuse, as well as smoking, can increase a person’s risk for heart disease.

"The hardest thing—and hopefully it's going to improve over time—is that people have such a negative societal connotation when it comes to drugs, alcohol and certainly tobacco that people get into a cycle of shame and secrecy," said Dr. Collings. "The good news—and the message that you want to give—is that you're not alone.

"It is important to reach out, get help and not be ashamed," she added.

Adults who sleep less than seven hours each night are more likely to have health problems, including heart events. Some of these health problems can also raise a person’s risk for heart disease.

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Sleep "affects us physiologically, but also affects our emotional and mental state," said Dr. Collings. "It has direct physiological effects in terms of being restorative, but there’s a lot of sleep apnea that is not yet diagnosed and treated," which increases the risk for many health problems, including high blood pressure, arrhythmias, heart attack and stroke.

Additionally, "we don't often take into account those sleep hygiene steps like making sure the room is dark, the temperature is right, you haven't had any alcohol for two or three hours and you haven't had any caffeine for eight to 10 hours," she said.

Discover six things doctors wish patients knew about coronasomnia.

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