| Blood pressure | Watch this | ●●●Strong | RCT / meta-analysis | Each 20/10 mmHg higher usual blood pressure roughly doubles the risk of death from stroke and ischemic heart disease. | Lewington et al., Lancet 2002 (Prospective Studies Collaboration) (opens in a new tab) |
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| Blood pressure | Watch this | ●●●Strong | RCT / meta-analysis | Lowering blood pressure significantly reduces coronary heart disease, stroke, heart failure and cardiovascular death. | Blood-pressure-lowering meta-analysis, Lancet 2016 (opens in a new tab) |
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| Cardio / VO2max | Watch this | ●●●Strong | RCT / meta-analysis | Cardiorespiratory fitness is a quantitative predictor of all-cause mortality and cardiovascular events; each 1-MET higher fitness lowered risk substantially. | Kodama et al., JAMA 2009 (meta-analysis) (opens in a new tab) |
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| Cardio / VO2max | Watch this | ●●●Strong | Cohort / observational | Higher treadmill-measured fitness was inversely associated with mortality with no observed upper limit; the least-fit had multiples of the death risk of the fittest. | Mandsager et al., JAMA Network Open 2018 (n=122,007) (opens in a new tab) |
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| Cardio / VO2max | Watch this | ●●●Strong | RCT / meta-analysis | Higher treadmill-measured fitness was inversely associated with mortality with no observed upper limit; the least-fit had multiples of the death risk of the fittest. | Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis, JAMA 2009 (opens in a new tab) |
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| Magnesium | Eat enough of | ●●●Strong | Established clinical | Deficiency causes abnormal heart rhythms and coronary spasm; low status is linked to hypertension and cardiovascular disease. | NIH ODS – Magnesium (opens in a new tab) |
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| Movement (breaking up sitting) | Do this | ●●●Strong | RCT / meta-analysis | Total sitting above ~6-8 h/day increased cardiovascular mortality risk. | Patterson et al., Eur J Epidemiol 2018 (meta-analysis) (opens in a new tab) |
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| Movement (breaking up sitting) | Do this | ●●●Strong | RCT / meta-analysis | Sitting time raised mortality, an effect substantially attenuated by 60-75 min/day of moderate activity. | Ekelund et al., Lancet 2016 (harmonised meta-analysis, >1 million adults) (opens in a new tab) |
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| Movement (breaking up sitting) | Do this | ●●●Strong | RCT / meta-analysis | Sitting time raised mortality, an effect substantially attenuated by 60-75 min/day of moderate activity. | Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality?, Lancet 2016 (opens in a new tab) |
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| Phosphorus | Don't overdo | ●●●Strong | Established clinical | Hyperphosphatemia (chiefly in kidney disease, worsened by phosphate additives) drives vascular and soft-tissue calcification, arteriosclerosis and cardiovascular mortality; general-population high intake shows similar associations. | NIH ODS / StatPearls – Hyperphosphatemia (opens in a new tab) |
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| Phosphorus | Don't overdo | ●●●Strong | Established clinical | Hyperphosphatemia (chiefly in kidney disease, worsened by phosphate additives) drives vascular and soft-tissue calcification, arteriosclerosis and cardiovascular mortality; general-population high intake shows similar associations. | NIH Office of Dietary Supplements — Phosphorus (opens in a new tab) |
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| Potassium | Eat enough of | ●●●Strong | Established clinical | Hypokalemia delays cardiac repolarization, predisposing to arrhythmias (ectopy, atrial fibrillation, VT/VF) and, when severe, cardiac arrest/sudden death. | StatPearls – Hypokalemia (opens in a new tab) |
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| Potassium | Don't overdo | ●●●Strong | Established clinical | Hyperkalemia causes ECG changes (peaked T waves, widened QRS, loss of P wave) and life-threatening arrhythmias/cardiac arrest; from food alone it is rare unless kidney function is impaired or with K-sparing drugs/salt substitutes. | NIH ODS / StatPearls – Hyperkalemia (opens in a new tab) |
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| Potassium | Don't overdo | ●●●Strong | Established clinical | Hyperkalemia causes ECG changes (peaked T waves, widened QRS, loss of P wave) and life-threatening arrhythmias/cardiac arrest; from food alone it is rare unless kidney function is impaired or with K-sparing drugs/salt substitutes. | NIH Office of Dietary Supplements — Potassium (opens in a new tab) |
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| Resting heart rate | Watch this | ●●●Strong | RCT / meta-analysis | Each 10 bpm higher resting heart rate raised cardiovascular disease risk 15%, coronary heart disease 7%, heart failure 18% and stroke 6%. | Aune et al., Nutr Metab Cardiovasc Dis 2017 (87 studies) (opens in a new tab) |
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| Resting heart rate | Watch this | ●●●Strong | RCT / meta-analysis | Every 10 bpm increment in resting heart rate was associated with 8% higher cardiovascular mortality. | Zhang et al., CMAJ 2016 (46 studies, 1.25 million adults) (opens in a new tab) |
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| Saturated fat | Don't overdo | ●●●Strong | RCT / meta-analysis | Higher saturated-fat intake (via raised LDL) increases atherosclerotic cardiovascular disease; AHA advises <6% of calories (current US intake ~10.7%). | AHA Presidential Advisory (opens in a new tab) |
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| Selenium | Eat enough of | ●●●Strong | Established clinical | Severe deficiency causes Keshan disease, an endemic cardiomyopathy (heart failure, arrhythmia) in selenium-poor regions of China; selenium supplementation sharply reduced it. | NIH ODS / Keshan disease literature (opens in a new tab) |
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| Selenium | Eat enough of | ●●●Strong | Established clinical | Severe deficiency causes Keshan disease, an endemic cardiomyopathy (heart failure, arrhythmia) in selenium-poor regions of China; selenium supplementation sharply reduced it. | NIH Office of Dietary Supplements — Selenium (opens in a new tab) |
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| Sodium | Don't overdo | ●●●Strong | RCT / meta-analysis | Excess sodium raises risk of cardiovascular disease and stroke, chiefly via blood pressure. | NIH DRI / sodium-reduction meta-analyses (opens in a new tab) |
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| Sodium | Don't overdo | ●●●Strong | RCT / meta-analysis | Excess sodium raises risk of cardiovascular disease and stroke, chiefly via blood pressure. | Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials, BMJ 2013 (opens in a new tab) |
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| Thiamin (B1) | Eat enough of | ●●●Strong | Established clinical | Wet beriberi causes high-output heart failure with edema, cardiomegaly and tachycardia. | StatPearls – Thiamin (opens in a new tab) |
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| Tobacco / vaping — quit | Do this | ●●●Strong | Established clinical | Smoking causes coronary heart disease, stroke, heart failure and peripheral arterial disease. | US Surgeon General report / CDC (opens in a new tab) |
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| Tobacco / vaping — quit | Do this | ●●●Strong | Established clinical | Tobacco and e-cigarette aerosol drive endothelial dysfunction, thrombosis and atherosclerosis; smokers face 2-3x cardiovascular death risk and vaping is not harmless to vessels. | Smoking/e-cigarette cardiovascular studies (opens in a new tab) |
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| Tobacco / vaping — quit | Do this | ●●●Strong | Established clinical | Tobacco and e-cigarette aerosol drive endothelial dysfunction, thrombosis and atherosclerosis; smokers face 2-3x cardiovascular death risk and vaping is not harmless to vessels. | US Surgeon General — The Health Consequences of Smoking (opens in a new tab) |
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| Trans fat | Don't overdo | ●●●Strong | RCT / meta-analysis | Industrial (artificial) trans fat has no safe level and clearly raises CVD; WHO and FDA have moved to eliminate it. Small amounts occur naturally in ruminant dairy/meat. | Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol: a meta-analysis of 60 controlled trials, Am J Clin Nutr 2003 (opens in a new tab) |
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| Added Sugars | Don't overdo | ●●Moderate | Cohort / observational | A higher share of calories from added sugar is associated with substantially increased cardiovascular-disease mortality; sugary drinks also raise blood pressure. | Added-sugar CVD-mortality cohorts (opens in a new tab) |
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| Alcohol — cut back | Do this | ●●Moderate | RCT / meta-analysis | Each 100 g/week higher alcohol raised stroke risk 14%, heart failure 9% and fatal hypertensive disease 24%. | Wood et al., Lancet 2018 (599,912 drinkers, 83 studies) (opens in a new tab) |
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| BMI | Watch this | ●●Moderate | Established clinical | Obesity raises cardiovascular disease risk via hypertension, dyslipidemia and diabetes. | Obesity clinical review (opens in a new tab) |
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| Biotin (B7) | Don't overdo | ●●Moderate | Established clinical | High supplemental biotin caused a falsely LOW troponin result and a missed heart attack — the FDA reported one death; also distorts NT-proBNP and many hormone assays. | FDA Safety Communication (2017) – Biotin (opens in a new tab) |
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| Blood oxygen (SpO2) | Watch this | ●●Moderate | RCT / meta-analysis | Chronic hypoxemia and nocturnal desaturation strain the heart, raising cardiovascular risk. | "Association Between Obstructive Sleep Apnea and Cardiovascular Risk: A Systematic Review and Meta-Analysis", Medicina 2025 (opens in a new tab) |
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| Body Roundness Index | Watch this | ●●Moderate | Cohort / observational | BRI showed a U-shaped association with all-cause mortality, with elevated cardiovascular risk at high values. | BRI and mortality (JAMA Network Open 2024) (opens in a new tab) |
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| Calcium | Eat enough of | ●●Moderate | Established clinical | Severe hypocalcemia causes cardiac arrhythmias (QT prolongation). | NIH ODS – Calcium (opens in a new tab) |
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| Calcium | Don't overdo | ●●Moderate | RCT / meta-analysis | Some research links calcium SUPPLEMENTS (not dietary calcium) to increased cardiovascular disease risk and vascular calcification; evidence is contested. | NIH ODS – Calcium (supplement meta-analyses) (opens in a new tab) |
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| Chloride | Eat enough of | ●●Moderate | Established clinical | Hypochloremia (via alkalosis) can predispose to ventricular arrhythmias. | Critical-care chloride review (PMC10995984) (opens in a new tab) |
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| Chloride | Don't overdo | ●●Moderate | Established clinical | Hyperchloremia is associated with decreased cardiac output and impaired myocardial contractility; with sodium/fluid excess it contributes to hypertension, edema and heart failure. | Critical-care chloride review (PMC10995984) (opens in a new tab) |
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| Choline | Don't overdo | ●●Moderate | Mechanistic | High intake causes hypotension (the critical adverse effect; UL 3,500 mg set on this) and raises TMAO, which is dose-dependently linked to higher cardiovascular-disease risk. | NIH ODS / IOM DRI – Choline (opens in a new tab) |
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| Choline | Don't overdo | ●●Moderate | Established clinical | High intake causes hypotension (the critical adverse effect; UL 3,500 mg set on this) and raises TMAO, which is dose-dependently linked to higher cardiovascular-disease risk. | NIH Office of Dietary Supplements — Choline (opens in a new tab) |
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| Consistency (the weekly dose) | Do this | ●●Moderate | Established clinical | 150-300 min/week moderate aerobic activity plus muscle-strengthening 2x/week lowers cardiovascular mortality and incident hypertension. | WHO Guidelines on Physical Activity 2020 (opens in a new tab) |
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| Consistency (the weekly dose) | Do this | ●●Moderate | RCT / meta-analysis | Muscle-strengthening activity was associated with 10-17% lower cardiovascular disease risk, additive to aerobic activity. | Momma et al., British Journal of Sports Medicine 2022 (meta-analysis) (opens in a new tab) |
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| Folate (B9) | Eat enough of | ●●Moderate | Cohort / observational | Deficiency raises homocysteine, contributing to vascular endothelial dysfunction and cardiovascular/stroke risk. | StatPearls – Folate (opens in a new tab) |
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| Grip strength | Watch this | ●●Moderate | Cohort / observational | Grip strength predicted cardiovascular and all-cause mortality more strongly than systolic blood pressure. | Leong et al., Lancet 2015 (PURE study) (opens in a new tab) |
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| Grip strength | Watch this | ●●Moderate | Cohort / observational | Lower grip was associated with higher cardiovascular incidence and mortality and improved an office-based risk score. | Celis-Morales et al., BMJ 2018 (UK Biobank) (opens in a new tab) |
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| Inner circle (close ties) | Watch this | ●●Moderate | RCT / meta-analysis | Deficient social relationships raised coronary heart disease and stroke risk. | Valtorta et al., Heart 2016 (meta-analysis) (opens in a new tab) |
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| Iron | Don't overdo | ●●Moderate | Established clinical | Iron deposition in the heart causes cardiomyopathy and arrhythmias. | NIH ODS – Iron (hemochromatosis) (opens in a new tab) |
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| Loneliness — reduce | Watch this | ●●Moderate | RCT / meta-analysis | Poor social relationships raised coronary heart disease risk 29% and stroke risk 32%. | Valtorta et al., Heart 2016 (meta-analysis) (opens in a new tab) |
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| Magnesium | Don't overdo | ●●Moderate | Established clinical | Very high doses (laxatives/antacids or renal failure) cause hypermagnesemia → hypotension, irregular heartbeat, and, rarely, cardiac arrest (fatal cases reported). | NIH ODS – Magnesium (opens in a new tab) |
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| Sleep duration | Watch this | ●●Moderate | RCT / meta-analysis | Both short and long sleep are associated with coronary artery disease, heart failure, stroke, and cardiovascular and all-cause mortality. | Sleep-duration and cardiovascular disease meta-review + Mendelian randomization (opens in a new tab) |
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| Sleep duration | Watch this | ●●Moderate | RCT / meta-analysis | Both short and long habitual sleep were associated with higher all-cause mortality. | Cappuccio et al., Sleep 2010 (all-cause mortality meta-analysis) (opens in a new tab) |
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| Sleep regularity | Watch this | ●●Moderate | Cohort / observational | Each 1-hour increase in night-to-night sleep-duration variability raised major cardiovascular events 19% (myocardial infarction 23%, stroke 17%). | Huang et al., UK Biobank (accelerometer, n=86,219) (opens in a new tab) |
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| Sleep regularity | Watch this | ●●Moderate | Cohort / observational | Greater sleep regularity (Sleep Regularity Index) was associated with lower all-cause, cardiovascular and cancer mortality; regularity predicted mortality more strongly than duration. | Cribb et al., eLife 2023 (UK Biobank, n=88,975) (opens in a new tab) |
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| Sodium | Eat enough of | ●●Moderate | Cohort / observational | A U-shaped relationship: both low-normal sodium/hyponatremia and hypernatremia are associated with higher CVD events and mortality in older adults. | Cohort study (PMC4714622) (opens in a new tab) |
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| Total Fiber | Eat enough of | ●●Moderate | Cohort / observational | Low fiber intake is associated with higher cardiovascular-disease and all-cause mortality risk. | Fiber literature (opens in a new tab) |
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| Upper-body strength (push-ups) | Watch this | ●●Moderate | Cohort / observational | Men able to do >40 push-ups had far lower 10-year cardiovascular incidence than those doing <10 (5% vs 15%); push-up capacity predicted CVD better than a submaximal treadmill test. | Yang et al., JAMA Network Open 2019 (n=1,104 men, 10-yr) (opens in a new tab) |
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| Upper-body strength (push-ups) | Watch this | ●●Moderate | Established clinical | Push-up capacity - a simple, no-cost measure - meaningfully stratified future cardiovascular risk in active adult men. | American College of Cardiology journal scan (2019) (opens in a new tab) |
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| Upper-body strength (push-ups) | Watch this | ●●Moderate | Cohort / observational | Push-up capacity - a simple, no-cost measure - meaningfully stratified future cardiovascular risk in active adult men. | Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men, JAMA Netw Open 2019 (opens in a new tab) |
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| Vitamin D | Don't overdo | ●●Moderate | Established clinical | Excess is associated with soft-tissue and vascular calcification and cardiac arrhythmias. | NIH ODS / IOM (opens in a new tab) |
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| Vitamin D | Don't overdo | ●●Moderate | Established clinical | Excess is associated with soft-tissue and vascular calcification and cardiac arrhythmias. | NIH Office of Dietary Supplements — Vitamin D (opens in a new tab) |
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| Vitamin K | Eat enough of | ●●Moderate | Established clinical | Vitamin K-dependent proteins inhibit vascular mineralization; low status is associated with arterial (vascular) calcification and cardiovascular disease. | LPI / NIH ODS – Vitamin K (opens in a new tab) |
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| Vitamin K | Eat enough of | ●●Moderate | Established clinical | Vitamin K-dependent proteins inhibit vascular mineralization; low status is associated with arterial (vascular) calcification and cardiovascular disease. | NIH Office of Dietary Supplements — Vitamin K (opens in a new tab) |
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| Waist-to-height ratio | Watch this | ●●Moderate | Cohort / observational | Higher WHtR predicted cardiovascular hospitalization and all-cause and obesity-related mortality. | WHtR and mortality prospective cohort, Frontiers in Nutrition 2025 (opens in a new tab) |
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| Waist-to-hip ratio | Watch this | ●●Moderate | Cohort / observational | Waist-to-hip ratio was more strongly and consistently related to myocardial infarction than BMI across all ethnic groups (odds ratio 2.52, top vs bottom quintile). | INTERHEART study (waist-to-hip ratio, 52 countries) (opens in a new tab) |
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| Waist-to-hip ratio | Watch this | ●●Moderate | Cohort / observational | Higher waist-to-hip ratio was associated with all-cause and cardiovascular mortality in adults with diabetes. | Taiwan diabetes cohort (n=34,686) (opens in a new tab) |
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| alpha-Linolenic acid (omega-3) | Eat enough of | ●●Moderate | Cohort / observational | Higher omega-3 intake is associated with lower cardiovascular risk (arrhythmia control, lower triglycerides/BP); low intake forgoes this protection. | Omega-3 cardiovascular literature (opens in a new tab) |
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| alpha-Linolenic acid (omega-3) | Don't overdo | ●●Moderate | RCT / meta-analysis | High-dose omega-3 supplementation modestly increases the risk of atrial fibrillation in recent randomized trials. | High-dose omega-3 trials (opens in a new tab) |
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| Breath (how you breathe) | Watch this | ●Emerging | RCT / meta-analysis | Voluntary slow breathing lowers resting heart rate and blood pressure and raises baroreflex sensitivity. | Voluntary slow-breathing HR/BP meta-analysis, 2017 (opens in a new tab) |
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| Flexibility | Watch this | ●Emerging | Mechanistic | Poor trunk flexibility is associated with arterial stiffness, a cardiovascular risk marker (musculoskeletal-vascular link). | Yamamoto et al., Am J Physiol Heart Circ Physiol 2009 (opens in a new tab) |
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| Warmth & quality of ties | Watch this | ●Emerging | Cohort / observational | Satisfaction with relationships at age 50 predicted physical health at 80 better than cholesterol. | Harvard Study of Adult Development (opens in a new tab) |
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