One of the biggest contributors to heart disease is a lack of commitment to a heart-healthy lifestyle. By following these simple steps you can reduce all of the modifiable risk factors for heart disease, heart attack, and stroke.

Lifestyle modifications can help prevent heart disease

Heart disease shortens the lives of millions of people and diminishes the quality of life for millions more.

The good news is that few diseases are as preventable, or at least as modifiable by lifestyle choices, as heart disease. Though there are certain factors that you can't control, such as genes, they pale in comparison to the ones that you can.

Five simple behaviors can reduce the risk for heart disease by a number greater than the effect of any drug available:

• Eating a healthy diet.
• Maintaining a healthy body weight.
• Doing moderate physical exercise.
• Abstaining from smoking.
• Limiting alcohol consumption.

In the famous Nurses' Health Study, these five behaviors lowered the risk of heart disease by a staggering 83 percent. Look at what happened in the Lyon Diet Heart Study: Researchers divided approximately 600 participants at high risk for a heart attack into two groups. The first group didn't receive any specific dietary advice, but were merely told to "eat a prudent diet," which is code for the same old tired advice the American Dietetic Association has dished out for years: low fat, low cholesterol-the usual things.

The second group was put on the Mediterranean diet-they ate fish and poultry, not too much red meat, and a lot of vegetables, nuts, olive oil, omega-3 fats, whole grains, and moderate amounts of wine. Want to know what happened? They stopped the study. The group eating the Mediterranean diet got such outstanding results that the researchers felt ethically compelled to stop the study after a year and put everyone on the Mediterranean plan. After a four-year follow-up, those still following the Mediterranean-style diet had a 50 to 70 percent lower risk of heart disease.

And by the way, their cholesterol levels didn't budge much. What matters here is that by changing their diets, they were able to reduce their risk of cardiac death and nonfatal heart attacks by double digits.

Keeping Your Heart Healthy: Beyond Cholesterol

Cholesterol may not be the most important thing you need to pay attention to when it comes to protecting the heart. Emerging research is pointing in the direction of oxidation and inflammation as far more serious concerns than cholesterol. Cholesterol may accumulate at the site of injury, but if we want to slow aging and prevent damage we need to better understand (and prevent) the injuries in the first place. Blaming cholesterol for heart disease is like blaming the St. Bernard for the avalanche. That's why the true "heart-healthy" diet is not necessarily low in cholesterol. But it is high in anti-inflammatories and antioxidants.

Cholesterol doesn't become a problem until it's oxidized (i.e., damaged by free radicals). Plaque develops as the body attempts to repair injuries, usually caused by inflammation. So oxidative damage and inflammation are the real roots of the problem-not cholesterol. Addressing them seems to be number one with a bullet when it comes to keeping your heart young and vibrant. And it starts with the diet.

More than a low-fat diet, and much more than a low-cholesterol diet, an anti-inflammatory diet is of paramount importance in keeping you young. More good news: the foods that are loaded with anti-inflammatories also tend to be loaded with antioxidants. When you eat these heart-healthy foods, you get a double dose of protection, combating the twin enemies of oxidative damage and inflammation.

Cholesterol levels are actually a lousy predictor for heart disease when considered on their own. Fully half the people who have heart attacks have perfectly normal cholesterol, and half the people with elevated cholesterol do not. Using cholesterol levels as an independent risk factor to predict heart disease will give you slightly better results than using tea leaves to predict the weather.

The Five Principles of a Heart-Healthy Diet

So what exactly is a heart-healthy diet? In 2002, two distinguished professors at Harvard Medical School, Frank Wu, MD, and Walter Willett, MD, examined a massive amount of research in the area of diet and heart disease in an attempt to answer that very question.

Here are the five principles they came up with:

1. Increase your consumption of omega-3 fats from fish, fish oil supplements, and plant sources (such as flaxseeds).
2. Substitute nonhydrogenated, unsaturated fats for saturated and trans fats.
3. Eat a diet that is high in vegetables, nuts, fruits, and whole grains and low in sugar and refined grain products.
4. Avoid processed foods.
5. Choose foods, food combinations, and food preparation methods that are low on the glycemic index.