A man in his 50s who typically ate a large sausage hero for lunch and got little exercise visited New York University’s Center for the Prevention of Cardiovascular Disease. Overweight, with high blood pressure and cholesterol, he was a triple threat for a heart attack. Howard Weintraub, M.D., the center’s clinical director, put him on an exercise plan and a healthy diet, and preached portion control. In six months, the man’s blood pressure and cholesterol dropped to normal, he lost 11 pounds, and he felt so much better that he stuck with the plan, cutting his heart-attack risk.

Medication obviously plays a key role in preventing and treating heart disease. But a wealth of research shows the surprising success that simple lifestyle changes can make in helping along that effort. Those steps can even reduce and sometimes eliminate the need for medication and invasive procedures by stopping, slowing, or reversing the artery-clogging process. For instance, government-funded trials have shown that a diet low in salt and high in fruits, vegetables, and low-fat dairy products can lower blood pressure as well as commonly prescribed drugs. And a combination of exercise, weight loss, and dietary strategies raises the level of HDL (good) cholesterol at least as effectively as any drug.

Lifestyle measures can even outperform some medical treatments. A combination of weight loss, a healthy diet, and exercise, for example, is more effective than medication in preventing type 2 diabetes, a major risk for heart disease. And a 2004 German study found that volunteers with coronary heart disease who started a carefully regulated exercise program had fewer heart attacks and heart-related hospitalizations than those who underwent angioplasty, an invasive procedure to open blocked arteries.

People who adopt several key habits can see striking results. One study that followed more than 42,000 men for 16 years found that those who ate healthfully, managed their weight, didn’t smoke, drank moderately if at all, and exercised regularly had an 87 percent lower risk for heart disease than those who practiced none of those behaviors. A similar study among some 24,000 post-menopausal women showed that those who adopted the same measures had a 92 percent lower risk of heart attack over a six-year period.

Government guidelines urge lifestyle changes as the first step, either alone or, if you’re at high risk, with medication. Those measures can boost the benefits of drugs and minimize dosage, as well as reduce costs and side effects. But most Americans still don’t make needed lifestyle changes, in part because doctors are neither trained nor reimbursed to provide the necessary counseling. But you can kick-start your own program by following our five steps to heart health.

1. FEED YOUR HEART. A heart-healthy diet means more than just cutting back on fat. A two-year trial found that a diet high in produce, whole grains, nuts, legumes, fish, and healthy fats reduced artery-damaging inflammation better than the standard low-fat diet. It also more successfully eliminated the metabolic syndrome—a potent risk for heart attack and stroke characterized by excess belly fat, resistance to the blood-sugar-lowering effect of the hormone insulin, low levels of HDL cholesterol, and high triglycerides, a fat that increases coronary risk. Finally, many people found the diet more filling and palatable than just cutting back on fat. Here’s how to eat with your heart in mind:
   
   Get your fiber. That can lower LDL (bad) cholesterol, possibly by absorbing saturated fat in the gut. Good sources include fruits, legumes, nuts, whole grains, and vegetables. Soluble fiber, found especially in barley, beans, and oats, may be particularly effective.
   
   Eat fish. The omega-3 fatty acids in fish prevent blood clots and abnormal heart rhythms, and lower blood pressure and triglycerides. Aim for two servings a week of fish high in omega-3s but low in mercury, such as salmon, sardines, trout, and whitefish. People who already have heart disease should get 1 gram a day of omega-3s, an amount that usually requires fish-oil pills. But discuss the pills with your doctor, since high doses can cause bleeding and other problems.
   
   Favor vegetable oils high in unsaturated fat, such as canola, olive, safflower, and soybean oils.
   
   Avoid trans fats, or partially hydrogenated oil that lurks in margarines and many fast or packaged foods. Trans fats raise LDL, lower HDL, and inflame the arteries.
   
   Limit dietary cholesterol. If your LDL is elevated, consume less than 200 milligrams of cholesterol per day--the amount in one egg yolk, 8 ounces of skinless chicken breast, or 10 ounces of lean sirloin. Other people should keep their daily consumption under 300 mg.
   
   Cut back on salt. A 2007 study found that people at risk for hypertension who ate less salt suffered 25 to 30 percent fewer heart attacks, strokes, and invasive heart procedures over 10 to 15 years. Aim for less than 2,300 mg of sodium a day, the amount in a teaspoon of salt. If you already have high blood pressure, try to cut back to 1,500 mg.
   
   Drink moderately--if at all. A small daily dose of alcohol can raise HDL cholesterol, reduce inflammation and blood clots, and improve insulin sensitivity, which helps ward off type 2 diabetes. But even a little too much alcohol undermines the heart. So if you drink, drink moderately: one drink a day for women, one to two for men.
   
   Consider plant stanols or sterols from products such as Benecol and Take Control margarine and Minute Maid Heart Wise orange juice. Consuming two servings a day may reduce LDL by 5 to 17 percent.
   
   
2. GET A MOVE ON. Regular aerobic exercise protects against every major cardiac risk factor. It improves LDL and HDL cholesterol levels, reduces blood pressure, lowers the risk of type 2 diabetes, controls body weight, eases stress and depression, and may reduce arterial inflammation. Strength training offers some of the same benefits, and building muscle also boosts your fat-burning capacity. Here are updated recommendations from the American Heart Association and the American College of Sports Medicine:
   
   Aerobic activity. Do at least 30 minutes of moderate-intensity activity, such as brisk walking, five days a week, or 20 minutes of vigorous activity, like jogging, three days a week. Three 10-minute sessions count as a 30-minute workout.
   
   Strength training. Do one or two sets of exercises involving the major muscles in the arms, legs, and torso on two nonconsecutive days per week. Use sufficient resistance, from weights or exercise bands, so that you can do only 8 to 12 repetitions; if you’re over age 65, use less resistance so that you can do 10 to 15 repetitions.
   
   See a physician before starting an exercise program if you haven’t had a checkup in more than two years and are over age 45 or have been physically inactive for many years. Also see a doctor if you have hypertension, coronary heart disease, diabetes, or other chronic illnesses, or if you regularly take blood pressure or heart medications.
   
   
3. TRIM YOUR WAIST. Excess fat, especially around the belly, strains the heart, raises blood pressure, LDL, and triglycerides, lowers HDL, causes insulin resistance, and produces substances in the blood that can inflame the arteries. But you can lower your heart disease-risk by losing as little as 5 percent of your body weight.
   
   If your waist is larger than 35 inches (for women) or 40 inches (for men), you need to lose at least a little weight. A Consumer Reports survey found that most successful dieters lost weight without expensive programs, special foods, supplements, or drugs. Instead, follow the exercise and diet plans recommended above, along with these additional steps:
   
   
   • Eat slowly, take small portions, and avoid seconds.
     
   • Don’t skip meals, especially breakfast.
     
   • Avoid fried foods, full-fat dairy products, and refined carbohydrates such as white bread, white rice, desserts, chips, and soft drinks.
     
   • Start meals with a salad or broth- or bean-based soup, and eat main dishes that are full of vegetables and fruits.
     
   
   
   
4. COOL YOUR ANGER. People who have stressful personal relationships, job strain, or panic attacks tend to suffer more heart attacks and strokes, possibly because negative emotions can unleash hormones that trigger heart-threatening changes. Anger and stress, for example, speed up the heart, raise blood pressure, narrow and inflame arteries, provoke abnormal heart rhythms, and make the blood prone to clotting. Depression may contribute to clotting problems, insulin resistance, and type 2 diabetes. And curbing such emotions may offer almost as much heart protection as proper diet and exercise.
   
   Yoga, tai chi, meditation, and measured breathing can reduce stress. Programs that teach those techniques are now widely available at hospitals, medical schools, and universities. Regular aerobic exercise is another effective antidote. It provides a time-out from unpleasant thoughts, generates feelings of well-being, and reduces depression.
   
   Other helpful measures include recording troublesome thoughts and participating in religious or civic activities or volunteer work. If self-help fails or negative emotions are interfering with your functioning, seek professional help.
   
   
5. BE A QUITTER. Cigarette smokers have more than double the heart-attack risk of nonsmokers, but risk starts to drop as soon as you quit. Nicotine replacement products can ease withdrawal. If necessary, consider combining one of those products, especially the patch, with the antidepressant bupropion (Zyban and generic), which may stimulate some of the same brain chemicals as nicotine. But monitor your blood pressure if you take bupropion, since the combination can cause it to spike.

(This article first appeared in the February 2008 issue of Consumer Reports on Health.)