Heart & Cardiovascular Health

Evidence-ranked approaches to cardiovascular and arterial health, from diet to supplements, ranked by trial strength by named physicians.

Every claim below carries an evidence grade. What do these grades mean?

EVIDENCE HEART HEALTH

High-dose fish oil raised atrial fibrillation risk across 7 trials

Strong

Fish oil is sold as heart protection, but pooling 7 large trials, omega-3 supplements were associated with more atrial fibrillation, an irregular heartbeat: about 12 percent more at 1 gram a day or less, and 49 percent more in trials testing more than 1 gram a day, in people averaging 65 years old. If you take an omega-3 supplement, ask your clinician whether it suits you, and do not stop a prescribed one without asking.

EVIDENCE HEART HEALTH

More sauna sessions, lower heart death risk

Moderate

A 20-year Finnish cohort of 2,315 men found 4 to 7 sauna sessions a week linked to roughly 50 percent lower cardiovascular mortality than once a week. Large observational cohort with a clear dose-response, but not an RCT, and the original sample was Finnish men only, not yet confirmed causal or tested broadly in women.

PETER ATTIA HEART HEALTH

Lower your apoB early, not late

the expert's own view, educational, not medical advice, not endorsed by us

StrongapoB particle count is the causal driver of arterial plaque, not just a marker
ModerateLowering it early and aggressively changes the disease course more than lowering it late
ModerateMeasure apoB directly rather than inferring risk from LDL-C alone

HEART HEALTH

Build your endurance engine

1Accumulate 3 to 4 hours of zone 2 (3 to 4 sessions of 45 to 60 min per week; beginners can start at 20 to 30 min and build)
2Set the right intensity (Highest effort where you can still hold a conversation (nasal-breathing borderline), heart rate steady)
3Measure lactate (advanced) (Finger-stick lactate around 1.8 to 1.9 mmol/L, taken after about 10+ min steady)

What to buy

Handheld lactate meter ~$130

Indoor cardio machine ~$349

Chest-strap heart-rate monitor

BLOOD SUGAR

Blood Sugar Balance Protocol

1Cut added sugar and refined carbs (Remove added sugar, flour and ultra-processed foods and cut back on refined grains; this is the single biggest lever on insulin)
2Protein, fiber, healthy fat and non-starchy veg every meal (Anchor each meal with quality protein and healthy fat, and fill most of the plate with non-starchy vegetables; a whole-food protein shake is an easy breakfast)
3Take PGX fiber before eating (2 to 5g PGX (glucomannan) fiber about 15 minutes before meals with a large glass of water)

What to buy

Prebiotic fiber ~$11

Chromium ~$11

Cinnamon extract ~$14

Jarrow Formulas Alpha Lipoic Acid ~$18

HEART HEALTH

Know your real health numbers

1Test Lp(a) one time (A single Lp(a) test; it is largely genetic and stable for life (NIH cites optimal under about 14 mg/dL))
2Track ApoB (Discuss your target with a physician; longevity targets are stricter than standard (commonly under 90 for primary prevention, under 60 to 65 with risk factors))
3Fasting insulin plus glucose (HOMA-IR) (Attia favours fasting insulin well under about 5 to 8 uIU/mL; pair with glucose to compute HOMA-IR)

What to buy

Lp(a) blood test

ApoB / advanced lipid panel

Fasting insulin + glucose panel

HbA1c test

HEART HEALTH

Boost your endurance and VO2 max

1Separate Zone 2 from VO2 max (Different days, different intensities)
2Build a Zone 2 base (1 to 2 sessions/week, 30 to 60+ min at a conversational pace)
3Push VO2 max once a week (1 hard session: e.g. Norwegian 4x4 (4 min hard / 3 min easy x4))

What to buy

Beta-alanine ~$20

Heart-rate chest strap monitor ~$90

Rowing machine ~$900

HEART HEALTH

Train now to stay strong at 90

1List the physical things you want to do at 85 to 90 (Pick ~10 concrete tasks (lift a grandchild, hike, carry luggage, get off the floor); these set your training targets)
2Maintain aerobic base work (Roughly 3+ hours/week of zone 2 (conversational pace); see Attia's Endurance Base protocol)
3Add zone 5 intervals weekly (~1x/week: hard 3 to 4 min efforts near max, equal recovery, repeated 4 to 6 times (e.g. a 4x4 protocol))

What to buy

Kettlebell / dumbbells ~$25

Heart-rate monitor

VO2 max test

HEART HEALTH

The Omega-3 Protocol

1Test your omega-3 index (A red-blood-cell omega-3 index test; aim for 8% or higher (US average is far lower))
2Get omega-3s from food first (Several servings/week of wild, low-mercury fish (salmon, sardines, anchovies); salmon roe is rich in EPA/DHA)
3Add a quality fish oil to reach target (~2 g/day EPA+DHA for most to move the index toward 8%; Patrick personally takes ~4 g, EPA am / DHA pm. See the dose-response safety step below before matching that higher amount.)

What to buy

Nordic Naturals Ultimate Omega ~$32

Algae oil ~$40

Omega-3 index test

HEART HEALTH

Tadalafil as a Longevity Medicine

1Treat this as medicine, not a supplement (Tadalafil is prescription-only; using it for longevity is off-label and a decision to make with a doctor, not on your own)
2Read the numbers as associational (The mortality, heart, stroke and dementia reductions come from one observational study; they show association, not proof, and are confounded by who gets prescribed the drug)
3Understand why it might help (As a PDE5 inhibitor it widens blood vessels and improves circulation, the proposed basis for cardiovascular and brain benefits)

BLOOD SUGAR

Reduce Visceral Fat

1Remove ultra-processed food, refined carbs and seed oils (Eliminate ultra-processed products, sugary drinks, refined flour and industrial seed oils for 30 days, then reassess)
2Eat whole foods with fermented foods daily (O'Mara favours a meat-forward, whole-food base; add 1 to 2 tablespoons of fermented foods (kimchi, sauerkraut, kefir) per meal. You do not need full carnivore (see cautions))
3Do short, all-out sprints (~2 to 3 sessions/week of 20 to 30 second near-maximal efforts with full recovery; build up gradually and get cleared first)

What to buy

Thorne Magnesium Bisglycinate ~$32

HEART HEALTH

The Omega-3 Protocol (fix your ratio)

1Take EPA/DHA (A common corrective range is ~2 to 3g combined EPA and DHA daily from a quality fish oil or algae oil (some take less for maintenance). Take with a meal containing fat. See the dose-response safety note below before going toward the higher end.)
2Understand how atrial fibrillation risk scales with dose (A meta-analysis of 7 randomized trials (n=81,210) found omega-3 supplementation raised atrial fibrillation risk overall (hazard ratio 1.25), with the risk still significant at 1 g/day or less (hazard ratio 1.12) and rising further above 1 g/day (hazard ratio 1.49).)
3Read your own bottle's actual EPA plus DHA dose (Find the EPA line and the DHA line on the Supplement Facts panel and add them together; that sum, not the front-of-bottle '1000 mg' fish oil weight, is your real dose. A typical 1,000 mg fish oil capsule commonly delivers about 300 mg combined EPA plus DHA.)

What to buy

Nordic Naturals Ultimate Omega ~$32

Omega-3 index test

HEART HEALTH

Work to reverse heart disease

1Eat well: build meals around whole plants (A whole-foods, plant-based diet: mostly fruit, vegetables, whole grains, beans and soy in their natural forms. Keep it low in fat and sugar, and low in animal protein and refined carbs. On the strict reversal version, total fat is roughly 15 to 35g a day.)
2Move more: about 30 minutes a day (Around 30 minutes a day of moderate activity like brisk walking, plus some gentle strength work. Pick something you enjoy so you actually keep doing it.)
3Stress less: a daily calm-down practice (Set aside time each day for stress management: meditation, gentle yoga, stretching and slow breathing. Even a short daily practice counts.)

HEART HEALTH

Eat to reverse heart disease

1Build every plate around whole plants (Fill your plate with vegetables, fruit, whole grains, beans, lentils and soy foods in their natural, unprocessed forms.)
2Cut added fats and oils right down (Keep total fat low. On the strict reversal diet that is roughly 15 to 35g of total fat a day, mostly from whole foods rather than added oils. Skip fried food and go easy on nuts, seeds and oils.)
3Drop sugar and refined grains (Avoid added sugar, white flour, white rice and other refined carbs. Choose whole grains instead.)

What to buy

Nordic Naturals Ultimate Omega ~$32

HEART HEALTH

Stress Less the Ornish Way

1Practice a short daily meditation (Sit quietly for even 5 to 15 minutes a day and focus on your breath or a simple word. Longer is fine once it becomes a habit.)
2Do some gentle yoga or stretching (Move slowly and gently: easy yoga poses, stretches and relaxation. The goal is to unwind, not to work out.)
3Use slow breathing when stress hits (Breathe slowly and deeply, making your out-breath longer than your in-breath, for a minute or two. Use it whenever you feel wound up.)

Inigo San Millan

HEART HEALTH

Build your aerobic base

1Keep it genuinely easy (Work at an effort where you can still speak in full sentences but would struggle to sing. It should feel almost too easy. Many people ruin Zone 2 by going too hard.)
2Go long enough (Aim for at least 45 minutes of continuous easy effort, working up to 60 minutes or more. The benefits build with time in the zone.)
3Build up your weekly volume (Start with what you can manage and build toward roughly 150 to 300 minutes a week across 3 or more sessions. San Millan pushes serious trainees higher still.)

What to buy

Heart-rate chest strap monitor ~$90

Inigo San Millan

BLOOD SUGAR

Zone 2 for Metabolic Health

1Do easy cardio most days (Aim for Zone 2 on most days of the week, even 45 minutes at a time. Consistency matters more here than any single hard workout.)
2Stay in the fat-burning zone (Keep the effort easy enough to hold a conversation. This is where your body burns the most fat and lactate stays low.)
3Pair it with fewer refined carbs (Support your training by cutting back on sugar and refined carbs and eating more whole foods, which eases the load on your metabolism.)

What to buy

Heart-rate chest strap monitor ~$90

HEART HEALTH

Artery Plaque Supplements: Evidence vs Hype

1Discuss prescription-strength EPA (icosapent ethyl) with your physician if you have elevated triglycerides on a statin (Prescription icosapent ethyl 4g/day (as in EVAPORATE/REDUCE-IT); a prescription drug, not an OTC fish-oil dose)
2Consider standard-dose omega-3 (EPA/DHA) as general cardiovascular support (Per general cardiology guidance; discuss with your physician)
3Aged garlic extract is the best-supported true OTC option (Per product label)

What to buy

Nordic Naturals Ultimate Omega ~$32

HEART HEALTH

Your Walking Pace May Predict Your Biological Age

1Walk with intensity, not just steps (Aim for a pace that noticeably raises your breathing and heart rate, roughly 3+ mph, a pace where talking is easy but singing isn't, rather than only counting daily steps)

What to buy

Weighted vest ~$45

HEART HEALTH

The 5 Supplements That Made My List

1Creatine monohydrate, dosed to your body weight (0.1 g per kg of body weight per day (about 5 g at 50 kg, 7 g at 70 kg, 9 g at 90 kg))
2Omega-3, counted as combined DHA plus EPA (At least 1 g per day of DHA plus EPA combined)
3A high-quality protein powder, as a backup to food (Enough to help reach at least 1.6 g of total protein per kg of body weight per day)

What to buy

Prebiotic fiber ~$11

Multivitamin ~$30

Nordic Naturals Ultimate Omega ~$32

Thorne Creatine ~$40

Longevity Physician · Early Medical

PhD, Biomedical Science · FoundMyFitness

Exercise Physiologist · Parker University

Human Biologist · The Ultimate Human

Visceral Fat Researcher · Performance & Health Optimization (MRI-based)

Lifestyle Medicine Physician · Preventive Medicine Research Institute

Inigo San Millan

Exercise Physiologist · University of Colorado School of Medicine

Nutritionist & Physiotherapist, MSc · The Proof

MD, FACLM · Founder, NutritionFacts.org

Compare experts on Heart & Cardiovascular Health

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Experts behind Heart & Cardiovascular Health protocols

Follow to get their new protocols in My Protocols

Gary Brecka portrait

Contested claims

Gary Brecka

Human Biologist

9 protocols · 3M

Rhonda Patrick portrait

Rhonda Patrick

PhD, Biomedical Science

5 protocols · 1.1M

Andy Galpin portrait

Andy Galpin

Exercise Physiologist

4 protocols · 364K

Dean Ornish portrait

Dean Ornish

Lifestyle Medicine Physician

4 protocols · 117K

Peter Attia portrait

Peter Attia

Longevity Physician

4 protocols · 2M

Simon Hill portrait

Simon Hill

Nutritionist & Physiotherapist, MSc

3 protocols · 1M

Inigo San Millan portrait

Inigo San Millan

Exercise Physiologist

2 protocols · 33K

Sean O'Mara portrait

Sean O'Mara

Visceral Fat Researcher

1 protocol · 141K

Michael Greger