good for your heart

If you want to know how to achieve and maintain a healthy heart, ask a cardiologist—preferably a healthy one.  Dina R. Katz MD, FACC, FASNC, is a senior attending cardiologist at Phelps Hospital Northwell Health and an inaugural member of Northwell’s Katz Institute for Women’s Health. And boy, is she healthy.

A former college athlete, Katz is a self-confessed gym rat and runner who works out at least an hour a day, seven days a week. Why? “Because it makes me feel great, and it might help me live longer,” she says. After years of following a heart-healthy diet of mostly fish, nuts, seeds and pressed oils, Katz recently switched to a plant-based diet that she swears by. “The health benefits are massive, primary among them a lower risk of heart disease and certain cancers,” she says.

But what about us mere mortals? What does it take for a person to willingly adopt a heart-healthy lifestyle that includes regular exercise and eliminates guilty pleasures from our diet?

Unfortunately, it usually takes a health scare.

Typically, Dr. Katz sees a patient for the first time after they or someone in their life has had a heart attack or received a dire warning from their primary care physician. While a fair number of her patients are over 60, with symptoms or conditions that put them at higher risk for heart disease, that population has been shifting slightly. Patients of all ages come to her for prevention, bringing in articles they’ve read or questions about their risk factors. They, too, may be motivated by a health scare—if not their own, then that of a relative or co-worker. “They start to realize they are vulnerable,” says Katz. “They want to do better.”

Katz asks new patients four questions: Have you had any chest pain, shortness of breath, palpitations or fainting? These major indicators of heart disease almost always frighten people into thinking about their heart health, some for the first time in their lives.

Katz reviews their personal and family health history, ferreting out the four major risk factors for heart disease: high blood pressure, high cholesterol, diabetes and obesity. Some risk factors can be lowered through changes to diet and lifestyle, while others—say, a family history of diabetes—cannot. (Note: Several studies have shown that, while you can’t change the cards you are dealt by your genes, improved habits may help alter your health outcomes.)

For some very sick patients, treatment might require medication or a surgical intervention. But Katz never waits long before having The Talk. Every patient she sees, no matter their age, health condition or risk factors, must confront their lifestyle choices. “It’s easy to place a stent in a clogged artery to get blood flowing again,” she says. “The hard part is sitting down together to figure out what got them into this mess and begin to treat it.”

Katz asks four more questions to determine her strategy. First up: Do you smoke? “If the answer is yes, I ask when they want to quit.” Katz educates her patients on the benefits of quitting, using “an arsenal of tools” to help them do so. These range from medications that help ease psychological dependence to nicotine replacements that allow them to taper off tobacco. Some prefer to quit cold turkey, or want to try acupuncture or another method, but she never proceeds without a firm commitment. “If I don’t get a definite ‘yes,’ I tell them to call me when they have a quit date,” she says.

Next she’ll ask: What do you do for exercise? The most common answer is, not enough. While authorities like the American College of Cardiology and the American Heart Association recommend all adults exercise a total of 150 minutes per week, that’s a lot to ask of someone who’s been sedentary. After taking a detailed exercise history, Katz follows up at subsequent visits to review how it’s going, “to keep them accountable,” she says. The key is to start small and build a habit gradually until they become hooked on the benefits. 

As a cardiologist, Dr. Katz sees a lot of people who hate to exercise. But regardless of a patient’s health status or risk factors, she always starts a conversation about diet and exercise early, “before taking out the prescription pad.”
While the generally accepted guideline for most able-bodied Americans is 150 minutes a week of moderate exercise (75 minutes if the activity is vigorous), Katz knows better than to rigidly insist on such a lofty goal from someone who’s been sedentary for decades.
Ever the cheerleader, she tells her patients to pick something they enjoy and commit to it for six weeks. She recommends a minimum of 20 minutes a day, which they can break into 10-minute increments.
Her theory: Give me six weeks and I guarantee you’ll be hooked. She says her patients who try actually start to look forward to the exercise and hate to miss it. They love how they feel. “That’s how you develop a healthier lifestyle,” asserts Katz.
If they need more motivation, this cardiologist reminds her patients: “Regular exercise helps you move better, it strengthens your muscles and eases your joints, reduces stress so you can sleep better, and helps your heart pump more efficiently.” And she’s not just talking the talk.
Katz exercises every single day, rain or shine. She likes to mix up her workouts, incorporating stints on her Peloton bike (or her road bike, depending on the weather), along with yoga, Pilates, strength training, tennis and the occasional swim “if I’m injured.”
Many readers might wonder who’s got that kind of time. “I hear that a lot,” she says. “So I tell my patients to sneak it in. If you’re not the type to hit the gym before or after work, stash a pair of sneakers in your desk and walk or run on your lunch hour.”
People who have retired face a different problem, says Katz. “Ironically, without a structured daily routine, it’s almost impossible to find the time to exercise.” She coaches her schedule-fluid patients in setting up a routine that includes moderate activity, getting them outdoors whenever possible. “I tell my patients to put it in their schedule and make it an enjoyable part of every day.”
How much exercise is too much? Katz’s definitive reply: “In the general population, over-exercise should not be an issue.” She maintains the benefits of exercise far outweigh the risks. Rare incidents of a workout bringing on a cardiac event are more commonly attributed to high performance athletes. “Exercise should be challenging but never painful,” says Katz. “If something doesn’t feel right, stop and discuss with your physician.”

Katz’s next question can be a game-changer for many: What do you eat? Regardless of the answer, she encourages every patient to see a nutritionist after keeping a food log for a few days. If their eating habits are unhealthy, now they can see it in black and white, and the nutritionist can craft an individualized nutrition plan they can stick with.

Finally, she asks about stress, reviewing mitigating factors such as adequate sleep, strong relationships, and activities that bring joy, connection and meaning to their lives. “I cite studies that show yoga and meditation can lower blood pressure and improve heart rate variability. I recommend free apps they can use any time of day—before bedtime, in their car before going into work. Even just a few minutes a day can help,” she says.

Though she spends a good half hour with every patient, Katz says these conversations about smoking, diet and exercise are “just the tip of the iceberg.” If poor habits are deeply ingrained or include several risk factors, she encourages them to start with small steps. “A big part of my job is being a cheerleader. I tell them, it took you X number of years to get to this point, so don’t expect all that to change overnight. Be patient with yourself.”

Coming from a board-certified cardiologist, Katz’s next piece of advice may be unexpected. An avid consumer of research studies, she mentions several that show a link between prayer and a lower risk of heart disease. People who believe in something—whether it’s a deity or marriage or friendship or community connections—fare better. “I tell my patients, surround yourself with people who make you feel good. Do things you enjoy. Think about what gives meaning and makes you happy. It’s good for your heart.”


If you have a family history of heart disease, it’s case closed, right?
Not necessarily, says cardiologist Dina R. Katz, M.D.
At a 2017 conference at the Nestlé Research Center in Switzerland, an esteemed body of health experts convened to explore the epigenetic impact of diet and lifestyle on individual health. Epigenetics is the study of the ways in which different biological and environmental signals affect gene expression. The group posited the idea that various components of diet send these signals throughout the body and may influence gene expression. Scientists are now investigating how eating habits might impact the inherited genetic structure we are born with.
Dr. Katz puts it more plainly, “Even though you can’t change the genes you’ve inherited, you can influence your gene expression through better nutrition and exercise.” To illustrate, an individual with an inherited gene that produces LDL, or “bad” cholesterol, is not necessarily doomed to a heart attack. By cutting out red meat and saturated fats, she can lower her cholesterol and thus her risk for heart disease. “So don’t give up the ship just because of your family history,” concludes Katz.

Latest posts by Donna Moriarty (see all)