Reduce your risk for heart disease with 10 simple steps from Dr. Philip Ades, author of EatingWell for a Healthy Heart Cookbook.

Reduce your risk for heart disease with 10 simple steps from Dr. Philip Ades, author of EatingWell for a Healthy Heart Cookbook.

It was the spring of 1969 and the phone in Philip Ades's dorm hallway was ringing. He was a freshman pre-med student at the University of Maryland, 17 years old and, at the time, preoccupied with winning a spot as catcher on the varsity baseball team, passing organic chemistry, and girls. But there, on the phone, was a friend of the family's, telling Phil that he had to hop a plane home to Brooklyn, that his father was ill.

"I don't think I really asked any questions," says Ades (pronounced AY-diss), recalling the event. "But I must have known something was up." For one, he never remembered his dad ever getting sick; he was a trim, active 50-year-old who worked six days a week in a warehouse to support his wife and two sons. He could not remember his dad ever missing a day of work. And the plane, well, that seemed like an unnecessary luxury; Ades usually traveled between home and school by Greyhound.

As the cab from the airport pulled up to the house, the young Ades noticed a long line of cars parked outside. His brother and a close family friend emerged, embracing him and telling him the sad news: his father had died of a massive heart attack.

That day, Ades was left with two profound thoughts. One was that he had not told his dad he loved him since he was about four years old. The other was that he was "programmed" to die at age 50. Recall that this was 40 years ago. Back then, most people believed that a family history of heart disease was a death sentence.

Fast-forward to today. As a cardiologist and director of a cardiac rehabilitation clinic in South Burlington, Vermont-which Gary J. Balady, M.D., director of Preventive Cardiology at Boston Medical Center, calls "one of the best in the country"-Ades no longer believes that "programming" business. Modern research has shown that a healthy diet and active lifestyle can go a long way toward preventing cardiovascular disease-and conditions, such as high cholesterol, high blood pressure and diabetes, that predispose one to developing it. Even people who've already had one heart attack are not doomed to die of cardiovascular disease, says Ades. "I can look patients in the eye and say that they are going to live and live well-if they follow this advice." (Start with Step #1, Know your numbers.)

Heart disease affects about 9 million American adults, killing one every 37 seconds. Traditionally considered a "man's disease," heart disease is also the number-one cause of death in U.S. women. In fact, a 40-year-old woman is eight times more likely to die of heart disease than of breast cancer in her lifetime.

But the good news-which Ades has made it his mission to spread-is that heart disease is mostly preventable. For example, according to the Nurses' Health Study, an epidemiological study of more than 84,000 women, if all women were to follow five behaviors, they'd prevent over 80 percent of heart attacks. These behaviors include: 1) not smoking; 2) maintaining a healthy body weight; 3) exercising an average of 30 minutes each day; 4) eating a nutritious diet (high in fiber, fish, leafy vegetables, polyunsaturated fats and low in saturated fats and processed carbohydrates); and 5) drinking alcohol in moderation (about 3.5 drinks per week).

Ades has helped about 10,000 heart patients implement these healthful habits. Now, in his new book EatingWell for a Healthy Heart, Ades extends his message and encouragement to the masses and shares his favorite EatingWell heart-healthy recipes.

Physician in the kitchen

At home on a weekend evening, Ades is bustling in the kitchen, cooking up a dish from a Sephardic cookbook written by a woman from his old Brooklyn neighborhood. His youngest child, Anika, a slim 15-year-old, and wife Deborah Rubin, M.D., a petite radiation oncologist, nibble on whole-grain crackers and hummus as Ades puts the finishing touches on the meal. The two older Ades children-22-year-old Jimmy and 24-year-old Rebecca-are away at college and working, respectively.

Ades brings a plate of grape leaves stuffed with lamb and brown rice to the table, along with a skillet of simmering Israeli couscous and fattoush, a Middle Eastern salad made with chopped greens, tomatoes, onions and grilled flatbread. Dessert is a moist almond cake that Rubin has made, substituting almond oil for the butter the recipe called for.

Ades admits that some people find him "extreme" about his diet-years ago he jettisoned butter from his home (he jokes that Anika doesn't know what butter is) and stopped using mayo in his frequent tuna salad sandwiches. Butter and mayonnaise, Ades points out, are rich sources of the saturated fats that elevate levels of low-density lipoproteins (LDL), a.k.a. "bad" cholesterol. These, in turn, contribute to plaque buildup and narrowing of the vessels to the heart. Ades favors fish, poultry and vegetables over red meats and full-fiber whole grains over refined (see Step #6: Fill Up on Fiber). "If I go to a meeting and lunch is served, I'm not above taking the sandwich apart, throwing away the cheese, ditching the piece of bread with the butter or mayo on it, and eating it like that," he says. "Yeah, people look at me funny. Too bad." He counsels his patients not to keep butter in the house. "I realize that a teaspoon or so can be used to finish a dish and add flavor," he says. "But I think if you have heart disease you should avoid the temptation."

At the same time, Ades also firmly believes that "no one can lose weight if they are always hungry"; thus, it's best to burn more calories with exercise. Ades runs almost daily. He also cycles and, in winter, cross-country skis. He took up running soon after his student days, when he quit organized sports (baseball and lacrosse) and began packing a few pounds onto his 5'7" frame. "I was up well over 150 pounds," says Ades, now a trim 145. "And I thought, ‘How am I going to keep fit?'" Adding runs a few times a week to a background of squash, tennis and basketball was the answer. He frequently competes in 5Ks and 10Ks and, in a few years, hopes to commemorate his 60th birthday by running his sixth marathon.

Ades is trim (which helps keep his LDL within healthy ranges), but he knows that his regular physical activity helps his heart in other ways as well. Research shows that regular physical activity also reduces triglycerides, another type of "bad" fat in the blood, and raises high-density lipoproteins (HDL), the so-called "good" cholesterol that scientists believe carries LDL back to the liver so the body can remove it from the blood. (And some scientists speculate that HDL may even extract LDL that's already deposited into the plaque lining arteries.)

On a rainy day, Ades can be seen putting in his miles on the treadmill. "Phil doesn't preach, but when people look out the window and see him taking off on his run, or look over and see him on the treadmill, it sends a powerful message," says Patrick Savage, M.S., the senior exercise physiologist at Ades's clinic.

Changing lives

Richard Farnham hit his stride on the treadmill. Farnham, a former university athletic director, had had a career full of all-you-can-eat sports banquets and endless opportunities to snack. He wound up, at 50, "closer to 300 pounds than I would have liked," with high blood pressure and a blockage in an artery that left him short of breath and required a stent.

"It wasn't very dramatic; I only missed a day of work," he says of the cardiac procedure. Nevertheless, it changed his life-because he sought Ades's help in changing his habits. On Ades's recommendation, Farnham enlisted the aid of his wife, children and close friends and drastically modified his diet, going heavy on vegetables, poultry and fish and light on red meat. "My biggest realization was that I was eating too many refined carbohydrates," said Farn­ham. (Consuming processed grains-white breads, pastas and the like-may contribute to heart risk by elevating triglycerides and blood glucose levels.) "Now, I know that I don't need to have a sandwich on two pieces of white bread for lunch every day and I stay away from regular [white] pasta." Farnham began exercising-every day, for a minimum of 30 to 45 minutes. In a little less than one year, he lost 50 pounds. Over the same period, he saw his total cholesterol drop nearly 40 percent, from a borderline-high 209 mg/dL to a healthy 131 mg/dL. He lowered his triglycerides from 178 mg/dL (considered borderline high) to 86 mg/dL (well below the 150 mg/dL threshold that defines the upper limit of healthy).

Farnham reduced his blood glucose levels most dramatically. Before his lifestyle overhaul, his fasting blood glucose was 243 mg/dL-anything beyond 126 mg/dL is considered a diagnosis for diabetes. Now, it's 109 mg/dL. "Making the changes hasn't been easy," he said, "but it's been worthwhile."

When it comes to Ades's patients, Farnham's story is the norm, not the exception. For example, "ZR," a 53-year-old woman Ades writes about in EatingWell for a Healthy Heart, lost 8 of the 10 pounds she gained after menopause by following his healthy eating and exercise plan for just three months. In that time, she also improved triglycerides from a high 250 mg/dL to a "borderline" high 199 mg/dL, boosted her "good cholesterol" 5 points and lowered her total cholesterol from 235 to 213. "I feel more in control of my own health than I have in years," she said. "I keep thinking of one day enjoying grandchildren as

my reward."

Living well

Today, Phil Ades is where he wants to be. He combines research time with clinic time, and manages to spend nearly every evening with his family. He has held a number of national posts in cardiology, among them president of the American Association of Cardiovascular and Pulmonary Rehabilitation and editor-in-chief of the Journal of Cardiopulmonary Rehabilitation, recently renamed-due to his efforts-the Journal of Cardiopulmonary Rehabilitation and Prevention. He now calls a risk of heart disease a "call to arms," rather than a "death sentence."

And, perhaps best of all, in April he celebrated his 57th birthday, in perfect health.

Marialisa Calta, a nationally syndicated food columnist, is a contributing editor for EatingWell.