Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention (CDC).1
But the most common type, the hardening and narrowing of arteries known as atherosclerosis, could be as much as 90% preventable, said Erin D. Michos, MD. She’s the director of women’s cardiovascular health and an associate professor of medicine at Johns Hopkins University.
The more you know about your heart, the better you’re able to spot a problem. “It’s never too late to start treatment, but it’s much more effective if prevention starts earlier in life,” explained Dr. Michos.
Test your heart smarts with this quiz. See if you can choose correctly before scrolling down for the answer.
1. What’s the recommended amount of weekly aerobic exercise you need to reduce your risk of heart disease?
A. 20 minutes of any exercise
B. 150 minutes of moderate exercise
C. 30 minutes of vigorous exercise
D. 180 minutes of vigorous exercise
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Answer: B
Of course, any exercise is better than none. But according to the CDC, you should get at least 150 minutes of moderate aerobic activity a week or 75 minutes of vigorous aerobic exercise a week.2
Moderate exercise doesn’t have to be hard. Grab a friend and take a stroll. “Walking is really the best exercise for most people, especially those who’ve been sedentary, because it uses the large muscles of your body,” said Nathan D. Wong, PhD, a professor and director of the heart disease prevention program at the University of California at Irvine.
You can get your exercise done little by little throughout the day. Wong suggested parking at the back of the parking lot, so you have to walk more. And if you want vigorous exercise, just amp up the activity you do most often. Instead of walking, do a jog or run.
Now, how does exercise improve your heart health? It helps almost every part of your body, Wong said.
“Physical activity has a positive effect not only on weight but also on muscle tone,” he said. “That has a direct impact on insulin sensitivity, reducing your risk of diabetes and improving your lipids to raise your protective HDL cholesterol.”
But that’s not all: “Physical activity lowers levels of inflammation, which is a major contributor to heart disease in so many different ways,” he continued.
2. What’s the most common sign of a heart attack?
A. Tingling spine
B. Speeding pulse
C. Agonizing chest pain
D. Chest discomfort
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Answer: D
If you guessed chest pain (C), give yourself partial credit. Discomfort, though, is the most common symptom.3
“It may not be pain,” said Dr. Michos. “It can be a pressure, squeezing, heaviness or pinching.” The feeling might spread from your chest to your jaw, throat, arm or back. It might even feel like heartburn.
Other symptoms to watch for include shortness of breath, unexplainable sweating or fatigue, continued Dr. Michos. Women are more likely to have multiple symptoms.
“Those other symptoms can be distracting [from the true cause of heart attack],” said Dr. Michos. So, women are more likely to chalk it up to indigestion, stress or anxiety.
You should know these heart attack symptoms, even if you feel fine. While the majority of heart attacks are in people with risk factors, such as high blood pressure and high cholesterol, they sometimes happen in people with no warning signs.
For example, a type of heart attack called spontaneous coronary artery dissection can affect young people, mainly women, who have no traditional risk factors, said Dr. Michos. This occurs when a heart artery tears, often due to a predisposition from some unknown genetic risk factor and triggered by a stressful event.
3. What nutrient does the most to improve heart health?
A. Fiber
B. Protein
C. Saturated fat
D. Antioxidants
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Answer: A
Fruits and vegetables, whole grains, legumes and nuts are all foods to aim to eat every day.2 They’re high in fiber and low in saturated fat, said Dr. Michos, which is a good combination for reducing cholesterol.
She said that fish, while it doesn’t have fiber, is also a great food for heart health. It has healthy fats, which can benefit the cardiovascular system.
“These foods align well with a Mediterranean-style diet or a DASH-style diet,” said Dr. Michos. (DASH stands for dietary approaches to stop hypertension.) “And if you drop the fish, the foods also align with a healthy vegetarian or a vegan plant-based diet.”
It’s important to note that the antioxidants found in many fruits and vegetables that are part of a heart-healthy diet may also be beneficial. But, there isn’t enough evidence to support supplementation with antioxidants.4
As for foods to stay away from Dr. Michos suggested steering clear of processed meats, refined carbs, sweetened drinks and anything with trans fats. These can all raise your risk of heart disease.
4. How many heart disease deaths are linked to cigarette smoking?
A. 1 in 20
B. 1 in 10
C. 1 in 5
D. 1 in 4
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Answer: D
People who smoke are 15 to 30 times more likely to have lung cancer or die from it than those who don’t smoke, according to the CDC.5
Smoking can also damage the lining of the blood vessels, which raises the risk of heart disease, stroke and other health problems.6 Quitting smoking can cut your risk of heart disease in half or more.7
5. Which of these is the healthiest blood pressure?
A. 30/60 millimeters of mercury (mm Hg)
B. 115/75 mm Hg
C. 180/200 mm Hg
D. 220/320 mm Hg
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Answer: B
For most adults, a healthy blood pressure is 120/80 mm Hg or lower.8 Anything below 90/60 mm Hg is generally considered too low. But the bigger problem is blood pressure that’s too high. That’s a major risk factor for heart attacks, heart failure and stroke.
If your top number (systolic pressure) is between 120 and 129 and your bottom number (diastolic pressure) is under 80, that’s “elevated” blood pressure. People in this category are likely to have high blood pressure, also called hypertension, unless they take steps to manage it.
Stage 1 of high blood pressure is 130 to 139 (systolic) [or] 80 to 89 (diastolic), said Dr. Michos. If you’re at this stage and have an otherwise low risk of heart disease, sometimes lifestyle changes are enough to lower your blood pressure.
Start by limiting alcohol, cutting down on salt in your diet, exercising more and losing weight (if you are overweight).
“But if patients already have heart disease, kidney disease, or diabetes and their blood pressure stays above 130/80 mm Hg on three or more occasions, then we do recommend drug therapy in addition to lifestyle changes,” explained Dr. Michos.
Your doctor will probably suggest medicine if you have stage 2 high blood pressure, defined as 140/90 mm Hg and above. Possible medicines include:
- A thiazide diuretic, such as chlorthalidone
- A calcium channel blocker, such as amlodipine
- An angiotensin-converting enzyme inhibitor, such as enalapril
- An angiotensin receptor blocker, such as losartan
6. How does type 2 diabetes affect heart health?
A. It doesn’t. The conditions are unrelated.
B. Nobody knows for sure.
C. It increases the risk of dying from cardiovascular disease.
D. It has a small, indirect effect since it makes it harder to exercise.
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Answer: C
In a 2019 study in the Journal of the American Heart Association, researchers analyzed 8 years’ worth of data from nearly 1 million people.9 The researchers concluded that diabetes was associated with an 18% increase in death from heart disease.
The first thing people need to know about diabetes is that it’s not just a blood sugar problem, said Wong. It’s a heart problem.
If you have type 2 diabetes, work with your doctor to keep your blood sugar and hemoglobin A1C at a healthy level, another diabetes indicator. Also, watch your cholesterol and blood pressure. Fewer than 20% of people with type 2 diabetes have all these factors under management, Wong’s research suggested.10
Some medicines, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors (canagliflozin, dapagliflozin, and empagliflozin) and glucagon-like peptide-1 receptor agonists (such as oral semaglutide), can reduce blood sugar and the risk of cardiovascular disease, said Wong.
7. Which of these is considered a healthy total cholesterol count?
A. 30 milligrams per deciliter (mg/dL)
B. 60 mg/dL
C. 150 mg/dL
D. 350 mg/dL
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Answer: C
For adults, a total cholesterol of less than 200 is considered healthy, according to the CDC.11 But within that number are other details to know about, such as your LDL (bad) cholesterol and HDL (good) cholesterol levels. Knowing these can help you get a big picture of your risk. So, it’s important to work with a doctor to measure your cholesterol.
Should you take a statin medicine if your cholesterol is too high? Your doctor will consider other risk factors alongside your cholesterol profile to help you answer that question.
Statin medicines do more than just lower cholesterol, explained Dr. Michos. She thinks of them as prevention medicines. “They can help shrink plaque, decrease plaque inflammation, and make plaque more stable so that it is less likely to rupture,” she said. (Learn about the side effects of statins.)
People with very high cholesterol due to a genetic condition, or those at high risk who can’t lower their cholesterol enough with statins alone, may be prescribed a special monoclonal antibody treatment called PCSK9 inhibitors, Dr. Michos said.
These antibodies block a protein that’s involved in degrading the receptor for LDL cholesterol in the liver. As a result, more LDL receptors on the surface of your liver are available to remove the LDL circulating in your bloodstream.
In a recent study, a monoclonal antibody called evinacumab cut LDL cholesterol levels by more than 50% in a high-risk population.12
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8. How does obesity affect blood pressure?
A. It slightly lowers it.
B. It has no effect.
C. It increases the risk of high blood pressure, but only for men.
D. It increases the risk of high blood pressure for men and women of any age.
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Answer: D
There is much research linking obesity with high blood pressure and heart disease. Research suggests that having a higher body mass index (BMI) raised the risk of high blood pressure in men and women.13
A 2019 research review from Diabetology & Metabolic Syndrome explains that excess body fat increases inflammation, raises blood sugar, damages the lining of blood vessels, and throws off the balance of hormones that keep the cardiovascular system in check.14
Research also shows that any weight loss can be helpful. In one study, people who were overweight and lost 5% to 10% of their body weight had measurable improvements in blood sugar, total cholesterol, LDL cholesterol, and triglycerides, a type of fat that may contribute to hardening of the arteries or thickening of the artery walls.15
And the benefits were greater in people who lost even more weight. If you can’t keep a healthy weight, talk with a doctor about your choices.
9. Can pregnancy complications increase a woman’s risk of heart trouble later in life?
A. Yes
B. No
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Answer: A
People are often surprised to learn that a history of preeclampsia, gestational diabetes, or preterm delivery is associated with an increased risk for heart disease later in life, said Dr. Michos.
If you’ve had any of these complications, you should be extra vigilant about tracking your heart health. “I recommend that all doctors consider their patients’ reproductive history, which may influence their heart health, and ask women about prior pregnancies,” continued Dr. Michos.
10. Which of these is considered an ideal resting heart rate?
A. 30 beats per minute (bpm)
B. 60 bpm
C. 90 bpm
D. 120 bpm
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Answer: B and C
For most adults, 60 to 100 bpm is a typical resting heart rate, according to the American Heart Association.16 “But there’s so much variation from person to person,” Dr. Michos said.
The simplest way to find your heart rate is to count your pulse for 30 seconds and multiply the result by two. Many fitness trackers also have monitors, or you can use one that straps to your chest.
But don’t compare your heart rate to a friend’s heart rate. Instead, track how your own rate changes over time. With exercise, you should see the number start ticking down.
“As people get more active, their heart becomes more efficient, and their resting heart rate lowers,” said Dr. Michos.
Summary
Knowing how healthy your heart is can help you live a longer, stronger life. Your heart works hard every day, so it’s important to take care of it by eating healthy foods, maintaining a moderate weight and getting exercise often.
You can keep track of your heart health by checking things like your blood pressure, how fast your heart beats and how you feel when you’re active.
If something doesn’t feel right, like you feel dizzy or get short of breath, talk with your doctor. Taking care of your heart now helps keep it healthy in the long term.