Recent guidelines from the NHLBI state that people with systolic blood pressure of 120-139 mm Hg or a diastolic blood pressure of 80-89 mm Hg should be considered as prehypertensive. A reading of 124/84, which previously was considered “normal,” may not be favorable for preventing heart disease. What do you make of this statement?

Answer: The word “normal” is assessed in epidemiological circles as belonging in the museums of history. Normal has all too often been equated with what is common in the population. Blood pressure levels that are common in the general population—as well as cholesterol levels, saturated fat and cholesterol intakes, and smoking rates—are not normal. Common is what prevails in a society at a given point in time. Common is often a measure of high-risk status of the whole population. In the 1960s, serum cholesterol of 245 was common. Today we know a favorable cholesterol level is less than 200 and an optimal level is under 180. The focus needs to be on favorable and optimal and making that common in the population.

What should people do to help end the heart disease epidemic?

Answer: We need first and foremost to improve nutrition. Nutrition is key for preventing rise of blood cholesterol and blood pressure to adverse levels - the common pattern from youth through middle age at present. Eating right, along with exercise, can prevent obesity and along with not smoking can help to prevent heart disease.

How does eating right help?

Answer: Eating right can serve to maintain favorable levels of blood total cholesterol, LDL-cholesterol (which is harmful for the arteries), blood sugar, blood pressure and weight. Also, eating right may raise “protective” high-density lipo-protein (HDL), have anti-clotting effects and overall have positive effects on the heart. We have moved somewhat in that direction. Total fat intake is down. It was 40-45% of calories in the 1950s, and is now 32-33%. It needs to be lower—20-27% as in the DASH [Dietary Approaches to Stop Hypertension] diet, which is about as good a diet recommendation as we can make. Sixteen to 17% of calorie intake in the 1950s consisted of saturated fat; it’s now 12% and needs to be below 10%. Cholesterol intake used to average 700 milligrams per day, and now is about 300-350 milligrams, but needs to be 250 milligrams or less.