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David Pong, M.D.

By: David Pong, M.D. on February 8th, 2022

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Heart Health: 5 Numbers You Should Know

Lifestyle & Wellness | School of Metabolic Health | School of Adrenal Health | Wellness

It's American Heart Month. Do you have a good grasp of your cardiovascular health? To do so, you should know and monitor a few key health metrics that provide a clearer picture of your heart health — blood pressure, blood sugar, LDL cholesterol, triglycerides, and waist circumference. 


1. Blood pressure

Blood pressure is straightforward. We put the cuff on your arm, we pump it up, and we measure the high number, which is the pressure inside the blood vessels when the heart pumps, and we measure the low number, which is the pressure that blood vessels feel when the heart is relaxed.

How does blood pressure work? 

Inside the blood vessel wall, these waves of blood come pushing through with each beat of the heart. And as those waves go through, they're pushing against the blood vessel walls. They're stretching them. Anywhere where there's a blood branch point, the wave comes and bangs into the branches.

The higher the systolic pressure, the higher the pressure when that pulse comes through, the more potential there is to damage the blood vessel walls.

When we're younger, the vessels are very elastic and they tend to stretch out with those pressure waves. As we get older, the vessels become stiffer and the pulse pressure stays higher as it goes through.

So higher systolic pressures cause more damage to the inside lining of the vessel, increasing the odds of making plaque and damaging the vessel.

You've also perhaps heard of aneurysms where blood vessels can stretch and sometimes dilate or rupture. And again, higher pulse pressures, higher systolic pressures, increase that risk.

The diastolic pressure is the lower number. And that number is the number that we measure when the heart is filling itself. It's the lowest pressure inside the system.

Diastolic pressure also has a role to play in terms of blood vessel health in the main vessels —the heart carotids, the heart arteries — but also in the kidneys, the back of the eyes, really anywhere where the blood is flowing in the arteries.

What are "good numbers" for blood pressure?

The normal numbers ideally would be down around 120 over 70. We usually like to be in the 120s and 70s, a little bit higher won't bring a lot of risk, but the higher you go, the risk rises exponentially. And we recommend trying to treat you if blood pressures are over 140 over 90.

How can you treat or manage high blood pressure? 

Treatment initially would be to eat a diet that has a lot of produce. Plants have higher potassium and potassium lowers blood pressure relative to sodium.

Sodium tends to be in the salt shaker. It tends to be in the meats we eat. We need to be careful with foods that have more sodium, so a diet with more plants and potassium and less meat and sodium is helpful.

It's very helpful to move every day. It's helpful to weigh less. So trying to move, eating a good diet, and trying to keep our sodium content down all tend to help blood pressure.

2. LDL cholesterol

The next number I'd like to talk about is LDL cholesterol.

How does LDL cholesterol work? 

LDL is the bad cholesterol. I like to think of it as the "L for lethal" cholesterol. The higher the LDL cholesterol, the higher the likelihood that that cholesterol will get pushed into the blood vessel walls and make plaque in the arteries.

That plaque can plug the arteries. It can rupture. It can cause us to have heart attacks or strokes.

LDL cholesterol often comes from animal fats. Also, interestingly, when we have higher sugars and starches in the diet and increased insulin levels, we'll tend to put more of our cholesterol into the LDL fraction and increase the risk.

How to manage or reduce LDL cholesterol? 

To try and lower the LDL, once again we try and eat a diet that has more plants and less refined carbohydrates. We also try and exercise consistently to keep our weight down. LDL cholesterol is a very strong risk factor for heart disease.

3. Triglycerides 

Another fat in the blood that we don't think about as often is triglycerides.

How do triglycerides work? 

Triglycerides are non-cholesterol fats. If you were to go to get a bag of French fries that said they cooked them in cholesterol-free oil, and you squeeze them, the oil that drips out is triglycerides.

Triglycerides don't play as strong of a direct role in heart disease when the values are lower, but high values can also contribute to plugging up arteries.

In addition, triglycerides are often a measure of insulin resistance, which is part of type two diabetes and higher triglycerides and diabetes certainly can contribute to heart disease.

How to manage or reduce triglycerides? 

Triglycerides are extra energy. They're the energy we've consumed in starches and fats that does not get burned.

And so if we want to lower our triglycerides, we increase the burn. Exercise more. Burn more of the calories you consume.

We try and bring more of our calories in as protein and produce and less of our calories as carbohydrates and fat. And we try and balance our calories so that we're burning about as much as we are eating. That way, we're not gaining weight, and we're not carrying a high level of triglycerides.

Triglycerides also can contribute to pancreatic inflammation and liver inflammation. So not just heart disease.

4. Blood sugar

Blood sugar, we always think of in terms of diabetes. A normal blood sugar should be below 100 milligrams per deciliter.

Fasting blood sugar matters because blood sugar is a reflection of insulin resistance and diabetes. And the more insulin resistance we have, the higher the blood sugars we have, the more inflammation goes on inside blood vessels.

Higher blood sugars and higher insulin levels tend to make us create worse or higher risk lipids and tend to encourage us to gain weight in the midsection, which tends to push up blood pressures.

All of these things contribute to a higher risk for vascular disease. If you look at the different risk factors and plug them into the algorithms that predict risk, when you go from being a non-diabetic to a diabetic, you double the existing risk based on all the other factors. So blood sugar is a major risk factor in diabetes and you want to have your blood sugar below 100 milligrams per deciliter.

5. Waist circumference

Finally, waist circumference. Waist circumference also is related to diabetes and related to insulin resistance.

The waist size is a measure of the fat we carry in the midsection, the fat we carry around the organs of the belly. This is called visceral fat.

As we gain body fat, it tends to be distributed throughout the body. But as we get higher and higher in fat, more of it will end up in the midsection and around the organs.

Unfortunately, visceral fat makes us much more resistant to insulin. The tissues, the fat itself, does not use insulin very efficiently. So when we have sugar to store, that sugar does not get put in easily without higher and higher insulin levels.

Again, like we talked about with blood sugar, this contributes to inflammation, contributes to irritation inside the blood vessel walls, and certainly to higher rates of heart disease.

Waist circumference should ideally be less than half of your height inches or, for women, less than 35 inches, and for men, less than 40 inches, when measured at around the level of the belly button or the obliques. Whichever number is lower is the goal, so less than half your height in inches or for women, less than 35 inches, and for men, less than 40 inches.

So again, five numbers to be aware of. Some of them you can measure on your own. Many of them are better measured in with your doc. We'd like you to pay attention to:

  • A blood pressure ideally in the 120s over 70s.
  • Having an LDL cholesterol level that is ideally less than 100 milligrams per deciliter,
  • Triglycerides less than 150 milligrams per deciliter
  • A blood sugar level that is less than 100 milligrams per deciliter
  • A waist circumference that is less than half your height in inches or, for women, less than 35 inches or, men, less than 40.

Schedule an appointment to find your numbers. 

And if you don't know your numbers, I'd encourage you to meet up with your doc and get some measurements done.

If your numbers are not where they belong, we'd love to help you get your numbers where they belong. This does not always require medication. The programs we have here with education and health coaching can certainly help you adjust your lifestyle to try to meet those goals, and we would love to help you do that. Give your doctor a call if you're interested.