Do I have to give up fat to protect my heart?
No. But you probably do have to cut back on saturated fat, the kind that comes primarily from animal foods. The goal is to reduce your level of LDL or bad cholesterol, which can cause a sticky plaque to build up in your arteries, narrowing and hardening them so that your blood can't flow properly. The American Heart Association recommends that you aim for a total cholesterol count of under 200, including your LDL and HDL cholesterol (the good kind). But the real key is to keep your LDL down. If you have heart disease or diabetes, your LDL goal is less than 100. If you have at least two risk factors for heart disease -- such as high blood pressure, smoking, or a family history of heart trouble -- you need to get your LDL cholesterol level below 130. If you have just one other risk factor or none at all, anything below 160 should be safe enough. Talk with your doctor about the right cholesterol goal for you.
One way to do this is to hold the calories you get from all fats to no more than 25 to 35 percent of your total calories for the day. The American Heart Association recommends keeping saturated-fat calories under 7 percent and trans fat calories under 1 percent. (This includes people who already have heart disease, but not everyone benefits from an extremely low-fat diet. Check with your doctor.) You don't have to give up meat, poultry, and dairy products altogether. Just try to choose lean cuts, remove the skin from chicken, and use low-fat and nonfat milk, cheese, and yogurt. Other fats to avoid include partially hydrogenated oils and tropical oils like coconut and palm oil. You'll find them primarily in margarine, cookies, desserts, and crackers, as well as some peanut butters. Check the ingredients list on the label.
Try to get most of your fat calories from poly- and monounsaturated fats. They're actually good for your heart because they can lower your LDL and increase your HDL. Trade in the butter and sour cream for olive oil and guacamole, and you'll be doing your heart a big favor. Also, some fish contain heart-healthy fatty acids called omega-3s. In one study, heart-attack survivors who started eating fatty fish such as salmon, mackerel, or sardines once a week cut their relative risk of another heart attack in half.
What else can I do?
Eat more fruits, vegetables, legumes, and whole grains. Many of these foods, especially apples, oat bran, peas, and beans, contain soluble fiber, which prevents cholesterol from being absorbed into your bloodstream. Soy protein appears to reduce cholesterol, too. A 2008 review of 152 studies on the effect of soy protein on cholesterol, published in the American Heart Association's journal Circulation, found clear evidence that soy protein helps to reduce cholesterol. If you want to try soy, sprinkle unflavored soy protein powder into fruit smoothies, soups, casseroles, and sauces. Or cube a cake of tofu and stir-fry it with vegetables a few times a week. Watch your weight, too, particularly if you carry most of it around your middle (that is, if you're apple-shaped). This puts you at higher risk for heart disease than people who are bigger around the hips (or are pear-shaped).
Masley, S.C. Dietary therapy for preventing and treating coronary artery disease. American Family Physician. March 15, 1998.
American Academy of Family Physicians. Good nutrition can prevent and treat coronary artery disease. American Family Physician. March 15, 1998.
Cholesterol Levels. AHA Recommendation.
American Heart Association. What Are Healthy Levels of Cholesterol?
Smith SC et al. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update. Circulation. 113:2363-2372. May 2006.
American Heart Association. Association releases new diet and lifestyle recommendations. June 2006.
Samuel, P. et al. Meta-Analysis Confirms Soy Protein's Cholesterol-Lowering Efficacy. Circulation. 2008; 118: S-1122.
American Heart Association. Knowing Your Fats. September 28, 2009.