How to prevent heart disease, according to science | Prof. Eric Rimm

How to prevent heart disease, according to science | Prof. Eric Rimm

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Heart disease is among the top five causes of death globally, and it’s the first in the United States and United Kingdom. In the U.S., it causes 1 in 5 deaths.

But what is heart disease, exactly? Can we take steps to avoid it? Prof. Eric Rimm, of the Harvard T.H. Chan School of Public Health, is here to enlighten us.

In today’s episode of ZOE Science & Nutrition, Jonathan and Eric explore what we can do to reduce our chances of getting heart disease.

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01:35 – Quick fire questions
02:33 – Biggest myth about Heart Disease
04:24 – What is Heart Disease?
09:03 – What is a stroke?
11:34 – What are the differences in Heart Disease symptoms between men and women?
14:03 – Did you know that…
15:41 – The multi-decade diet study
23:45 – The 4 ways to lower chances Heart Disease
30:55 – Weight and Heart Disease
35:12 – What can you do to reduce Heart Disease risk?
37:30 – Exercise and Heart Disease risk
40:30 – Body Weight and Heart Disease risk
41:16 – Diet and Heart Disease risk
44:28 – Sleep and Heart Disease risk
49:59 – What is the cutting edge research in Heart Disease?
53:21 – Summary
57:25 – Conclusion

Mentioned in today’s episode:

Optimal dietary patterns for prevention of chronic disease from Nature Medicine 2023

Frequency, Type, and Volume of Leisure-time Physical Activity and Risk of Coronary Heart Disease in Young Women from Circulation 2016

Diet, Lifestyle, Biomarkers, Genetic Factors, and Risk of Cardiovascular Disease from The Nurses’ Health Studies from American Journal of Public Health 2016

Is there a nutrition topic you’d like us to explore? Email us at and we’ll do our best to cover it.

Episode transcripts are available here:


  1. I am a stroke survivor. Is there any more general guidance that Zoe can provide — other than the podcasts which I enjoy! — as a guide for someone who has Behcet’s and a history of stroke (damage to the hypothalamus so I need all the help I can find)? I’m fascinated with microbiome health, not least because as a person with a compromised immune system, I end up on microbiome flushing (literally) antibiotics once a year or more.

    I understand that you don’t have a critical mass of Behcet’s/stroke survivors to study, lol. But a more concise set of recommendations for your salon des refuse folks would be grand.

  2. I thought I was golden after five months of carefully following my ZOE personalized nutrition plan and even tried some intermittent fasting…then I had a gout attack this past week! Why? Because I have long-term chronic high levels of uric acid (hyperuricemia). While recovering, I researched the topic, including Dr. Perlmutter’s book, Drop Acid, and learned that medical doctors do not routinely order uric acid level tests until a patient presents with gout, in spite of the fact that according to Dr. Perlmutter, high levels of uric acid can be the cause of hyperinsulemia, hypertension, diabetes, and a host of other head-to-toe conditions, including metabolic syndrome and systemic pain – so even after the gout pain recedes, hyperuricemia is still doing plenty of damage internally. I’m very happy with my ZOE personalized nutrition, but didn’t know until this past week that there was a missing puzzle piece for me – and I’m thankful for the gout attack because it was a wake up call and led me to a permanent solution instead of thinking that my pains (shoulder, finger, hip, thigh, ankle, foot, toe) were just something that comes with aging. I propose the ZOE team research and develop a podcast on the topic of hyperuricemia and potentially add a uric acid test to their CGM, blood fat and biome test kits. Thank you for all you do and for all the fantastic podcasts! The ZOE team is awesome!

  3. What about the genetic background? What research is being done in this area? And to a certain extent are we ‘doomed’ because of our family history?!
    Johnathan is so repetitive!

  4. Jonathan much as I enjoy these interviews you give I am constantly annoyed by you talking all over highly important answers that your wonderful guests keep trying to give! Please leave them space to answer in the same way that they leave you space to ask your questions.
    This isn’t BBC Today on R4 you know!

  5. 1-5 score…Exercise, diet, smoking, BMI…..that’s 4 elements. What is the 5th? Prior history of ♥️ disease/Cv event?

  6. Unbelievable no mention of heart disease, women and declining estrogen. Ridiculous interview.

  7. Stop cutting your guest off and let the guest finish, holy fuck. You do this every time and getting worse as if you care more about yourself making some half witted opinions. People want to listen to the guest during an interview, not the interviewer.

  8. If sitting down is now seen as the new smoking, surely parents are forever up and down, up and down, caring for their children. So that must be healthy for them, right. They don’t have the luxury of sitting. So I don’t get your point about parents not having time for the gym. They are exercising already. They don’t need the artificial exercise found in gyms.

  9. Biggest Myth is cholesterol. Reduce HYPERINSULI NIMIA is the culprit. Lean mass Hyper responders have very small if not zero calcium score with zero soft plaque.

  10. The mental side of being healthier is a critical issue. For many it’s a chicken and egg situation. If you aren’t healthy and live an unhealthy lifestyle, this affects mental health which in turn means that they are less likely to focus on better health.
    Modern ultra processed food diets play a big role in this process because they draw people into consuming more of them – they have an addictive element. Most people just aren’t aware what they are or just how damaging they can be physically and mentally.
    The key thing is knowledge- Zoe does great work in this respect. Even if you don’t agree at least you become aware of issues you maybe were previously ignorant of.
    Second point is being prepared to change your views. Change is good- change is life.
    Thirdly – it can be tough so don’t try and climb the wall in 1 go. Start with one thing. It is always better to do a something rather than nothing.
    Be patient, keep focus and hang on to the little wins. It’s the direction of travel that’s important

  11. Thank you Professor Rimm and Zoe, though I would have liked a more detailed interview about, say, one risk factor. Specifically for me, the increased risk of heart disease following menopause, and the pros and cons of HRT. I shall investigate further, plus the possible benefits of coffee to some people (I hope me!😊).

    My one major comment is, though, WE HAVE TO DIE OF SOMETHING! It’s like science is chasing the end of the rainbow 🌈. The end point always seems to be extending life, but having reached the age of 60, I watch friends and family becoming older, succumb to illness and disease, and truly become miserable and depressed. Someone once said, ‘We are not living longer, we are just taking longer to die’. Never a truer word spoken. So yes, it’s great that people investigate the causes of disease and how to prevent them, but PLEASE, take the emphasis from living longer, to living a happier life where you are able to enjoy doing the things you want to.

  12. A conversation missed information about statins & how they effect other systems in our bodies – a lot of people have issues with them including leg pain, memory issues etc

  13. Could we stop treating science as a 100% accurate? What we know today is not what will be discovered tomorrow and yet every time science gets presented as this completely accurate thing!

  14. Really find these discussions useful – they encourage me to take care of my health and also increase my understanding to human physiology. However, our society is aging and it would be helpful if discussions could cover a range of base-line age groups. Rightly, much attention is given to the over 50s as, for some health complaints, it may be possible to lessen health complaints or, even, irradicate them. But there must now be many more over-70s and -80s than in the past (otherwise we would not be living in an "aging population") so I, for one (at 82) would find it really helpful if some of the questioning included this "old" population. We are still "aging" but not nearly as quickly as in the past. So now that we are the new "old" how much can we reverse the ill fx of not only our own habits but poor medical advice (e.g. low fat diet)?

  15. I keep seeing smoking used as a leading cause for heart disease. But its mostly wrong.

    I know that this is American and its not popular to say the truth that all studies show saturated fat causes clogging of arteries despite this being as proven as the Earth being round.

    Refined sugars are also bad. Every other food is better.

    Regarding heart disease, inflammation can speed up progression, not cause it.

    …this keeps being shown in studies now and cannot be denied without denying the research.

    Basically smoking causes inflammation.

    Saturated fat is the cause. Stop trying to avoid mentioning the cause to prevent view drops


  17. How important is LDL-C if you’re metabolically healthy and have low VLDL, triglycerides, and good HDL?

  18. uninspired and uninspiring population health stuff. Harvard folk cant see the trees for the forest. I would have talked about an adaptive approach maybe include melatoning berberine nervines flor de manita reishi yarrow to name a few.

  19. I don’t like commenting twice but it sat with me that he said that butter was better than margarine…

    …so I looked up what kind of fat is in Margarine and found out that its usually PUFA which according to all studies that switch out Saturated fat significantly reduces heart disease risk.

    Please don’t turn into a Joe Rogan type of podcast where only the science that fits the American meat lobby narrative is propagated

  20. Not smoking is incredibly difficult for someone who is highly addicted. (I’m a lifelong non-smoker btw, but have worked with a lot of smokers to try to help them stop).

  21. I’m disappointed because you didn’t say a word about lowering cholesterol levels without statins. I’m 64, lean and fit, on a healthy diet, still my full cholesterol is 6,83 and my LDL is 4,20. What the heck should I do?

  22. The intro explains what you need to do, and the Prof didn’t mention anything about what you MUST eat, how refreshing.😂 but did elaborate later.

    Thank you for uploading and sharing.

  23. This is a very good podcast. I have been following Zoë for a long time, and it’s always fascinating. I recently had a heart scan, I was told one of the heart valves is not performing as they should. I am 68, I work both indoors and outdoors. I was walking, cycling 30 plus miles a week. Then three months ago, I was hit by an electric bike whilst cycling to work. I now have a fractured collarbone and it’s becoming a real menace…I slept well, 7/8 hours and follow a Mediterranean diet. From 1974 to 1986/87 I worked in the entertainment industry, I worked for hours, also eat a lot of coffee shop food. My life changed in 1987, an accident. A skull fracture with quite long term rehabilitation meant I needed to rethink what I was eating and also to rest a lot more. I relax more when I am out walking, rivers and in the woods.

  24. It is so easy to stay on a very lowfat diet and eat healthy and delicious food. This man is naive even though he is knowledgeable. He likes fat so he thinks no one can eat truly lowfat. He doesn’t know chef AJ.

  25. The professor mentioned 5 points but gave 4 factors (smoking, diet, exercise and BMI). Was the 5th sleep, alcohol consumption or something else? Thank you.

  26. Would really REALLY appreciate a podcast on new borns and baby’s, touching on formula milk and starter food etc. I know it may not be linked to your Zoe study due to age but would be invaluable advice. Thanks so much. Love all your content – almost gospel

  27. Taking statin increases the risk for heart attack and stroke. Remove carbs and sugar and reduce heart attack and strole

  28. Ok so I’m getting a bit sad that you keep saying “ even in your 50’s” for making changes. Shall I stop listening? Does this not apply to me ? Cause I am 70 and just been diagnosed with high blood pressure and would really welcome some advice !

  29. I had a triple bypass performed which was a surprise to me. After that, I became obsessed with becoming a nutritarian, vegetarian, and microbiome-dedicated. I have no cholesterol now, can I stop taking statins?

  30. I have very high cholesterol and was discovered when I was eating a plant based diet, running 20 miles a week, plus gym at weekends and ideal recommended BMI. As I’ve got older, my exercise routing has decreased, yet my cholesterol is slightly better than it was in my prime. Go figure!

  31. I’m a bit surprised that diabetes, prediabetes and metabolic dysfunction wasn’t emphasised more in this discussion. With reading I’ve discovered it is a major risk factor, up there with smoking. Because it is so prevalent (in my neighbourhood we seem to have an epidemic of amputees as a result of uncontrolled diabetes), we could reduce heart disease (and a bunch of other problems), by switching diet. Keto, low fat, whole plant food diets seem to have a positive effect. Getting rid of ultra processed food is a good first step.

    Also getting a Coronary Calcium Score is very helpful. Get one relatively early in mid life to get a baseline, then every few years to see how things are progressing. A bad score means action needs to be taken. On the other hand a zero score may mean the high LDL reading may not be so important.

    Finally getting labs early to establish baselines is important. Here in Canada we don’t really do them till we are in our 50’s and the damage is already done for many. Some need to take action in their 30’s and 40’s

  32. I hate the term "healthy diet" because there are so many conflicting version by supposedly experts: low fat, high carb, moderate protein; versus low carb, high fat, moderate protein; versus "plant-based" or vegan or lacto-ovo-vegetarian; versus "Mediterranean Diet (whatever that is); versus carnivore ketogenic diet; and so on. If anyone says "healthy diet", ask them to be specific.

  33. No excuses not to exercise when busy… it’s about priorities. You can easily exercise twice a day 30’ x 2, one session is perhaps a morning jog. The second is a strength lifting workout from home. It isn’t rocket science. You can also vary the workouts activity like a swim, run or bike, walk or bodyweight/gym, home gym. Important to find movement you enjoy – could be dancing..key is consistency and not overdo it.

  34. The only time I see someone smoking is when I visit Stepping Hill hospital near Manchester. Nurses and staff are outdoors smoking. The widening of the boundaries of the NO SMOKING area, means the nurses have to walk a little further before lighting their cigarette. Physicians heal thyself first.

  35. Jonathan I really noticed how you have trimmed down or toned up. (Those gym visits must be paying off)! 😊 I am also very impressed at your ability to listen so intently and summarise so well. I LOVE these podcasts! Thank you. I was one of those low fat high carb people from the 70’s & 80’s & ended up 30 kgs heavier by the 2000’s. Thankfully I am now 5kg away from what I was back then on a much healthier & more sustainable diet (sadly ZOEless)

  36. Great podcast, thanks! The exercise conversation ties in brilliantly with the work of Dr Doug McGuff, and like-minded strength training experts. The very slow-moving strength-training protocols developed by Ken Hutchins and colleagues can have profound positive impacts on cardiovascular health.

  37. Great video with much good advice. However I have one quibble about a piece of misinformation. Red meat won’t give you heart disease or diabetes if you are not eating large amounts of sugar and refined carbs. There is simply no convincing evidence for this assertion. Red meat, along with oily fish, is probably the single most healthy and nutrient dense food we can eat and cutting it out comes with multiple health risks.

  38. My mum had high blood pressure for years even on meds she died at 74 from congestive heart failure her autopsy showed a very enlarged heart

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