A healthy diet and daily exercise are extremely valuable for maintaining cardiac health.

Prevention of heart disease has never been more important in the history of our country. We have reached an era in which physicians can offer a great deal of benefit in terms of surgical, interventional, and drug therapies. However, as people live longer, it has become increasingly clear that lifestyle profoundly affects patient outcomes, regardless of age or infirmity. A recent Harvard School of Public Health study, lead by Dr. Walter Willett, confirmed that the impact of lifestyle is dramatic. Improvements in lifestyle have the added benefit of improving patient health at no cost—a real consideration, as health-care expenditures could mushroom out of control in an aging population.

Prevention of heart disease can never start too soon. For the most part, we have a population of people born with normal hearts and arteries. There is evidence that cholesterol streaks can begin to appear in the aorta as early as age three. A study of the relative development of coronary plaque among Americans, Japanese, and Spanish directly correlated nationality and socioeconomic status to levels of saturated fat—with the United States taking the lead in arterial disease, followed by Japan, and finally Spain as the nations' respective post–World War II economies recovered.

In other words, heart disease is clearly an acquired disease related directly to lifestyle. We need to address strategies that decrease the risk of developing the disease in the first place—whether through the gradual accumulation of coronary plaque, or from the more sudden damage caused by an irregular heart rhythm. This preventive strategy should involve the patient on a very primary level, with the aggressive support of the physician.

The American Heart Association recommends a diet low in saturated fat, combined with regular exercise and a lean body weight. To date, the most successful diet has been the more aggressive program advocated by Dean Ornish. Patients who follow his approach reduce their saturated fat intake to ten percent. Dr. Ornish has also added components of daily exercise and stress reduction through meditation and relaxation techniques. A similar and even more restrictive diet has been published by Caldwell Esselstyn of The Cleveland Clinic. Mediterranean diets with reduced carbohydrates, such as the South Beach Diet, have also been popular and effective.

Patients can achieve success if they manage to reduce their saturated fat and caloric intake. They can also avoid smoking and engage in regular aerobic exercise. It's never too late to start. A 75-year-old man with heart disease who walks three miles a day at three miles an hour reduces his heart attack rate considerably within 12 months. We've learned that the duration of exercise is more important than the actual intensity; longer sessions seem to bring a multiplier effect.