updated 10/7/2007 12:18:20 PM ET 2007-10-07T16:18:20

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If you're like most, you might turn to fad diets, such as Atkins, or simply hope that eating more walnuts will make a dent in your cholesterol.

Those approaches may help, but experts say they don't go far enough. If you really want to prevent cardiovascular disease, you need to make long-term changes to your overall diet and find a way to lose the excess pounds.

"What I find happens is that people tend to focus on one thing," says Riska Platt, a registered dietitian and spokesperson for the American Heart Association. "They just add in fish to their diet and feel that they've taken care of everything. There are selected foods that have excellent properties in the management of heart disease but you've also got to look at your total diet."

That means not only eating oily fish such as salmon and mackerel at least twice a week, but also consuming a variety of fruits and vegetables, whole grains, fat-free and low-fat dairy products and lean meats, according to the American Heart Association Nutrition Committee's 2006 diet and lifestyle recommendations.

By focusing on the big picture, you're more likely to get the mix of nutrients you need and make sure some of the things you're adding, like those heart healthy but high-fat nuts, don't make you gain weight. You also may end up getting a bigger bang for your buck, since heart healthy food components such as omega-3 fatty acids, found in fish, and plant sterols, present in fruits, vegetables, nuts and seeds, are thought to work together better than on their own, Platt says.

Drop those pounds
While cardiologists still recommend cutting back on salt and fat, in the past few years their advice has shifted for the average patient. Rather than encouraging people to eat certain healthy foods, doctors, more than anything, want patients to slim down.

"The point for people in the U.S. is to eat less," says New Jersey-based Dr. Augustine E. Agocha, lead physician at Advanced Heart, Lung and Vascular Care and chief of cardiology at Deborah Heart and Lung Center. "It's about calories."

Agocha says too many people who attempt a high-fiber diet, for instance, overdo it and give up after two months. He tells men to limit themselves to 2,500 calories a day, and women 2,000. If you can't resist a cheeseburger, that's OK, he says, as long as you cut back the rest of the day. You can always buy yourself more calories by exercising, too.

This is important because excess weight negatively affects cardiovascular risk factors, increasing LDL, or bad cholesterol, triglyceride levels, blood pressure and blood glucose levels and lowering HDL, or good cholesterol. It also increases the risk of coronary heart disease, heart failure, stroke and cardiac arrhythmias, according to the American Heart Association.

"Weight isn't the only thing that determines whether you get heart disease," says Dr. Thomas H. Lee, editor in chief of the Harvard Heart Letter and professor of medicine at Harvard Medical School and the Harvard School of Public Health. "But if I were to be given one wish with patients, my first wish would be that they maintained normal body weights."

Risky business
Of course not everyone will be able to affect their heart health through their dinner choices. Some risk factors, such as if your father or brother had a heart attack before age 55, or your mom or sister had one before age 65, can't be changed. In these cases doctors often recommend statins, medications, which lower the level of cholesterol in the blood by reducing the liver's production of cholesterol.

But taking a statin doesn't mean you can tuck into whatever you want, Platt says. Eating ice cream every night will make you need more medication, which can have side effects.

The bottom line is that, if you want a healthy heart, you're going to have to make some changes. And you've got to think big.

"It can't be a fad approach," Platt says. "This has got to be something that you're going to do permanently."

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