Heart Disease is Predictable and Preventable

A new study published by the American College of  Cardiology has pointed  out that heart disease can be predicted and prevented.  (1)  This is excellent news.  It means that there is something that we can do in our own lives and without medical intervention to reduce our risk of developing heart disease.

Researchers analyzed the health records from two population-based prospective cohorts, the Korean National Health Insurance Service (with more than 9 million participants) and the Multi-Ethnic Study of Atherosclerosis (with more than 7000 participants).  Participant ages ranged from 20 to 84 years.  Researchers tracked individuals who had a first cardiovascular disease event, defined as coronary heart disease, heart failure, myocardial infarction (heart attack), or stroke.  Participants were followed for up to 20 years.

Four traditional modifiable risk factors for heart disease were measured to determine their prevalence before a participant experienced the onset of a cardiovascular event or disease and continuing during the long study follow-up time.   Senior author of this study, Philip Greenland MD, FAHA, FACC, RESC (Professor of Cardiology and professor of preventative medicine at Northwestern University Feinberg School of Medicine) stated that, if modifiable factors are actually present in almost all cases, then there is an opportunity for prevention.

The modifiable risk factors investigated in this study are defined by the American Heart Association’s definitions which state that non-ideal risk factor levels are the following:

• Blood pressure of 120/80 mmHg or over, or being on treatment for high blood pressure
• Fasting glucose (blood sugar) of 100 mg/dL (5.55 mmol/L) or over, or having a diagnosis of diabetes, or being on treatment for diabetes
• Total cholesterol of 200 mg/dL (5.17 mmol/L) or over, or being on treatment for high cholesterol
• Past or current tobacco use

 

Study Outcomes: (1)

Results showed that more than 99% of the participants, including men and women of all ages, who experienced coronary heart disease, heart failure or stroke had at least one of the four risk factors of high blood pressure, high fasting glucose, high cholesterol, or use of tobacco.  Also, between 93% and 97% of these participants showed two or more risk factors.

This research also indicated that 95% of women less than 60 years of age, a group usually considered to be at low risk for cardiovascular disease, showed prevalence of at least one non-ideal risk factor for heart failure and stroke.

Of the four risk factors studied, high blood pressure was the most common risk factor present with it affecting more than 95% of the South Korean participants and over 93% of the US participants.

In their conclusions, the study authors emphasized that at least one risk factor was nearly always present before the onset of cardiovascular disease.  This challenges the claims that cardiac events frequently occur without the presence of any major risk factor and highlights the importance of the prevention of cardiovascular disease.

 

Considering the Effects of Heredity and Epigenetics: 

Heredity can pose risks for heart disease. Congenital heart disease that runs in families and some genetic conditions such as Down syndrome and muscular dystrophy are linked to cardiovascular problems.  People with a family history of coronary artery disease have a significantly higher risk of developing the condition themselves.  Those with a family history of two or more early heart-related deaths have a three times higher risk of developing cardiovascular disease before the age of 50.  But this doesn’t mean that there is nothing that can be done about the situation.  It is currently considered that genetics account for only about 20 to 30% of the risk for heart disease.  (2)

What about epigenetics? Epigenetics is the study of how environmental factors and certain behaviors can cause changes in gene expression without altering the underlying DNA sequence.  Epigenetic changes affect the way genes work by turning genes “on” and “off”.   Each cell’s DNA is in essence the “instruction manual” for that cell, but epigenetic processes can instruct the cell to read or not read specific parts of the “manual” at certain times.  This means that genes can adjust their messages.  For instance, they can modify their production of proteins that control various cell functions.  Epigenetic changes are reversible.  Some epigenetic changes are very stable and can even be passed on from one generation to the next, still with no modifications in the DNA itself.  (3,4)  Recently, evidence has been found that epigenetic mechanisms may have evolved along with our own evolution due to the unstable availability of nutrients. (6)

Epigenetic changes can be negative too.  For instance,  environmental factors like chronic stress, poor diet, exposure to toxins and smoking can cause negative epigenetic changes.  They can also contribute to  health issues such as increasing the risk of cancer.  (10)

Perhaps it is time to start considering our genes as elements that can be positively (or negatively) influenced by factors such as our environment and our daily lifestyle choices.

What is happening in the body to create these gene alterations?  There are several ways by which a gene can undergo an epigenetic change.  Here are some common ones.  (3,4,5)

• A change in DNA methylation – This involves the addition of a methyl group to the DNA. A methyl group is a small molecule made up of one carbon atom bonded to three hydrogen atoms.  Adding it to DNA, proteins or other molecules in the body changes their activity, structure or function.  The methyl group can also be removed in a process called demethylation.
• DNA wrapping around certain histone proteins – Histone proteins are involved in the structural organization of the DNA. Covering these proteins will hide part of the gene code.
• Interruption of gene coding – Non-coding RNAs are derived from DNA but do not produce proteins. They can interact with DNA, RNA or proteins to influence whether the gene is active or silent.
• All of these processes alter the expression of a gene without changing the DNA sequence. (5)

 

How Can We  Encourage Positive Epigenetic Changes in our Own Bodies? 

Ongoing studies are identifying certain food nutrients that can induce epigenetic modifications and examining the ways in which those changes impact physiological function and disease.  Foods like cruciferous vegetables (broccoli, cauliflower, cabbage, kale, bok choy and Brussels sprouts among others) contain a bioactive component called sulforaphane which can alter DNA methylation.  Catechins found in green tea; and genistein from soy, fava beans or tea modify the activity of an enzyme involved in DNA methylation.  Resveratrol, found in blue and red-hued plants like blueberries and in red wine; sulforaphane from cruciferous vegetables; and curcumin have all shown their ability to produce histone-related gene modifications.  Scientists continue to examine the role of nutrition in epigenetic change and the ability of certain plant-sourced nutrients to increase the body’s natural defenses against chronic diseases like cardiovascular disease, cancer and diabetes. (5)

 

What Does Other Research Tell Us About the Effects of the Food That we Eat? 

Many studies have illustrated that a plant-based diet including nuts, soy and fiber reduces LDL-cholesterol by an average of 25% to 30% and is beneficial for preventing and treating a variety of chronic diseases including coronary heart disease, hypertension, diabetes, obesity, prostate cancer and breast cancer.  On the other hand, the AARP study of more than 500,000 subjects reported that eating red meat was significantly linked to increases in death due to cardiovascular disease, death due to cancer and death from all causes.  Foods sourced from plants have been found to contain more than 100,000 disease-preventing phytochemicals and more are being revealed as research progresses.  Plants are also low in harmful nutrients like saturated fats, trans-fats, sugar and dietary cholesterol. Choosing a lifestyle that includes eating mostly plants, exercising moderately, lowering stress and enjoying social support has been linked to stopping and even reversing the progression of coronary artery disease. (7)

A systematic review from 2025 noted that lifestyle elements such as diet, exercise, mindfulness and exposure to nature can play crucial roles in modulating genetic expression and impacting disease prevention. DNA methylation can be regulated through practicing mindfulness leading to reduced stress and inflammation and by eating healthier diets such as a Mediterranean or whole-food plant-based diet.  Engaging in physical activities can induce epigenetic modifications that improve metabolic function, insulin sensitivity and increase the production of new mitochondria.   Researchers noted that more investigation is necessary to understand the long-term effects of lifestyle factors on epigenetics and to optimize strategies for overall wellbeing and preventing disease.   (8)

Plant-based diets have repeatedly displayed their ability to alter hundreds of different genes.  In an 8-week intervention study, 102 healthy male smokers were randomized to eat either a diet consisting of  plants rich in antioxidant phytochemicals; a kiwifruit diet (the addition to a regular diet of 3 kiwifruits a day, another good source of antioxidant phytochemicals); or a control diet. Gene expression profiles were obtained and both antioxidant-rich intervention groups revealed increases in their defenses against cell stress such as  improved DNA repair, boosted immune processes and increased apoptosis (a process of programmed cell death that gets rid of harmful, damaged cells).  In other words, raising the level of antioxidant phytochemicals in the diet up-regulates genes that prevent disease and down-regulates genes that promote diseases like inflammation and cancer.  (9)

The bottom line is that even if you have some genes in your DNA linked to poor health, you have the power to choose healthier foods to eat and to alter your lifestyle to promote good health and prevent those genes from expressing their threatening message.

 

Takeaways;

Putting all these studies together presents us with the opportunity to take action to reduce our own risk of heart disease.  Consider adopting these possible activities;

• Follow your blood pressure at home. It is easy and not too expensive to buy a blood pressure machine and take a reading regularly to keep an eye on your blood pressure.
• If you haven’t had your blood work done recently, get an update. How are your blood lipid levels?  If your cholesterol and other lipids are not optimal, you can make your own dietary adjustments to help get them back to a healthy level.
• Get a blood glucose test done once in awhile to make sure that you’re not headed for diabetes. Once again, dietary changes can help to alleviate this risk factor.
• If you are a smoker, maybe this information will give you enough incentive to quit the habit.
• Bring positive epigenetics into your own personal picture.  Think about making a move towards eating more plant-based foods.  It doesn’t have to be an all-or-nothing situation.  Even small dietary changes help.  But, if you can alter your diet towards eating mostly foods sourced from plants, you will gain most of the health benefits that they offer and lessen your risk of developing cardiovascular disease.

You have the ability to shape your own environment.  Make it one that will raise your health to a new peak.

 

SOURCE:

1  Lee, H., Huang, X., Khan, S., et al. Very high prevalence of nonoptimally controlled traditional risk factors at the onset of cardiovascular disease. JACC. 2025;86(14):1017-1029.

2  https://mcpress.mayoclinic.org/healthy-heart/is-heart-disease-genetic/

3  https://www.cdc.gov/genomics-and-health/epigenetics/index.html

4  https://www.niehs.nih.gov/health/topics/science/epigenetics

5  Ideraabdullah, F.Y., Zeisel, S.H. Dietary Modulation of the Epigenome. Physiol Rev. 2018 Apr 1;98(2):667-695. Doi: 10.1152/physrev.00010.2017. PMID: 29442595; PMCID: PMC5966714.

6  Sarkies, P. Evolution beyond DNA: epigenetic drivers for evolutionary change? BMC Biol. 2023 Dec 29;21(1):272. Doi: 10.1186/s12915-023-01770-4. PMID: 38155359; PMCID: PMC10755928.

7  Ornish, D. Mostly plants. Am. J. Cardiol. 2009;104(7):957–958.

8  Ostaiza-Cardenas, J., Tobar, A.C., Costa, S.C.  REVIEW article: Epigenetic modulation by life–style: advances in diet, exercise, and mindfulness for disease prevention and health optimization.  Front. Nutr., 20 August 2025. Volume 12 (2025).  https://doi.org/10.3389/fnut.2025.1632999.

9  Bøhn, S.K., Myhrstad, M.C., Thoresen, M., Holden, M., Karlsen, A,, Tunheim. S,H, et al.  Blood cell gene expression associated with cellular stress defense is modulated by antioxidant-rich food in a randomised controlled clinical trial of male smokers. BMC Med. 2010 Sep 16; 8:54.

10 https://www.cdc.gov/genomics-and-health/epigenetics/index.html