Adopt a healthy lifestyle



Risk factors

While the mission of the Montreal Heart Institute is to treat heart problems, the Institute also has a duty to provide information on how to adopt a healthy lifestyle to prevent these diseases.

Coronary heart disease develops in the presence of predisposing factors. These factors are called “coronary heart disease risk factors.” The more factors you have, the greater your risk of developing a heart disease. It is therefore important to control these risk factors to prevent heart disease from developing and even to reverse its progression.


These risk factors are divided into two categories: non-modifiable risk factors and modifiable risk factors.

Non-modifiable factors

Modifiable factors

  • Heredity
  • Smoking
  • Age
  • Dyslipidemia
  • Sex
  • HDL (good cholesterol) that is too low
  • LDL (bad cholesterol) that is too low
  • High triglyceride level
  • High blood pressure
  • Diabetes
  • Obesity and high waist circumference
  • Sedentary lifestyle
  • Stress

It is essential for people to act on their modifiable risk factors.

In addition to preventing disease, good control of your risk factors can prevent heart problems from recurring in the future.


Why is tobacco bad for the heart?

  • It causes spasms in the arteries with each cigarette smoked.
  • It promotes the onset of certain types of arrhythmia.
  • It lowers good (HDL) cholesterol. 
  • It increases blood pressure and heart rate.
  • It doubles the speed at which coronary lesions develop.
  • It promotes the formation of blood clots.

However, it is encouraging to know that the risk of coronary heart disease decreases by 50% one year after smoking cessation.

How do I stop smoking ?

The ÉPIC Centre, which is affiliated with the Montreal Heart Institute, has a Smoking Cessation Clinic.

Top to page


What is cholesterol ?

Cholesterol is a fatty substance that the human body needs to make cells and hormones.

What is good and bad cholesterol ?

When we talk about good and bad cholesterol, we are referring to cholesterol transporters found in the blood and not to the cholesterol found in food. Just as oil does not mix with water, cholesterol does not mix with blood. To circulate in the bloodstream, cholesterol has to be carried by transporters. The two main blood cholesterol transporters are LDL and HDL.

LDL transporters carry cholesterol to the arteries and accumulate in the artery walls, which increases the risk of coronary artery disease. This is why LDL is called bad cholesterol.

HDL transporters help eliminate excess cholesterol and therefore help clean and protect the arteries. This is why HDL is called good cholesterol.
People with high LDL (or bad) cholesterol and/or low HDL (or good) cholesterol have a greater risk of developing coronary artery disease.

How do I control my levels of cholesterol (LDL and/or HDL) ?

  • Eat a balanced diet, such as the Mediterranean diet.
  • Exercise regularly.
  • Maintain good control of weight and waist circumference.
  • Stop smoking.
  • Take any prescribed medication.

What about triglycerides ?

A high level of triglycerides in the blood is a risk marker for coronary artery disease. In fact, a decrease in HDL is often accompanied by hypertriglyceridemia, which is also associated with other conditions such as abdominal obesity and type 2 diabetes.

How do I control my triglyceride levels ?

  • Eat a balanced diet, such as the Mediterranean diet.
  • Limit your intake of refined sugar and alcohol.
  • Maintain good control of weight and waist circumference.

For the target values for LDL, HDL and triglycerides, refer to the new guidelines from the Canadian Cardiovascular Society released in 2012.

Top to page

High blood pressure

High blood pressure is an abnormal increase in the pressure of blood as it flows through the arteries. High blood pressure generally does not cause symptoms and is only discovered by accident. However, it is a major risk factor for coronary artery disease. High blood pressure is very common in Canada, as 40% of people between the ages of 56 and 65 suffer from this condition. 

Risk factors for high blood pressure

  • Hereditary predisposition
  • Excess weight
  • Excess sodium (salt) intake
  • Significant alcohol intake 
  • Smoking (through the effect of nicotine)
  • Sedentariness
  • Uncontrolled anxiety

Why is high blood pressure harmful?

High blood pressure:

  • Makes the heart work harder, which tires it out and ages it more quickly.
  • Causes the arteries to harden and promotes atherosclerosis.

How do I measure my blood pressure ?

Blood pressure is expressed by two numbers (e.g., 140/90). The higher number represents the pressure that the blood exerts on the arteries when the heart contracts; this is called systolic pressure. The lower number represents the pressure that the blood exerts on the arteries when the heart is at rest; this is called diastolic pressure.

The target values are generally:

  • lower than 140/90
  • ideally 135/85
  • lower than 130/80 for diabetics

Regularly checking your blood pressure is the best way to ensure you are reaching these target values.

How do I control my blood pressure ?

  • Exercising regularly.
  • Controlling weight and waist circumference.
  • Eating a healthy diet with moderate sodium (salt) intake.
  • Drinking alcohol in moderation.
  • Quitting smoking for good.
  • Taking medication as prescribed.

Hypertension Clinic of the Montreal Heart Institute.

Top to page


Diabetes is a chronic disease characterized by glycemia (blood sugar) levels that are above normal values. It is estimated that approximately 700,000 people in Quebec are diabetic and that 200,000 people are unaware of their condition. The WHO has forecasted that the number of people with diabetes will double by the year 2025!

Types of diabetes

There are two main types of diabetes: type 1 and type 2. Diabetes can also develop during pregnancy.

Type 1: This type of diabetes starts in childhood, adolescence or early adulthood. It is characterized by a total lack of insulin production. People with type 1 diabetes depend on insulin injections to live.

Type 2: This type of diabetes occurs much later in life, generally around the age of 40 and over; however, it is more and more common to see this disease in younger people and even in children. This type of diabetes represents approximately 90% of diabetes cases. It is also described as an epidemic. In this case, the person's body does not produce enough insulin or resists the action of insulin.


Type 2 diabetes is increasingly related to a sedentary lifestyle and a poor diet. In 80% of cases, the disease is related to obesity (particularly abdominal obesity), which this type of lifestyle promotes.

Criteria for diagnosing diabetes


Fasting glycemia between 6.1 and 6.9
Glycated hemoglobin between 6% and 6.4%


Fasting glycemia equal to or above 7.0


Random blood glucose equal to or above 11.0


Glycemia after an oral glucose tolerance test equal to or above 11.1


Laboratory test result of glycated hemoglobin equal to or above 6.5%

When patients undergo more than one type of test and the results are conflicting, the positive test is repeated and the diagnosis is based on the results of this last test.

What are the complications of diabetes?

When poorly controlled, diabetes can lead to complications for the eyes, kidneys, nerves, heart and blood vessels.

A good control of blood sugar levels is essential to prevent the development of chronic complications.


Below are key factors for properly controlling blood sugar:

  • eating a healthy diet
  • controlling weight and waist circumference
  • exercising regularly
  • managing stress
  • self-monitoring your glycemia
  • taking medication as prescribed

Also remember that if you have diabetes, it is even more important to modify your other risk factors (e.g., blood pressure, smoking, cholesterol).

Metabolic/Diabetes Clinic of the Montreal Heart Institute.

Top to page


Obesity and overweight are defined by an excess of fat mass. Obesity, particularly in the abdomen, is a major risk factor for coronary artery disease, as it has a negative impact on the heart. For example, obesity:

  • increases blood pressure
  • increases LDL (bad) cholesterol, decreases HDL (good) cholesterol and increases triglycerides
  • increases the risk of diabetes

To determine if your weight is harmful to your health, you can use the two indicators below for a good assessment of your body category. These two indicators are body mass index (BMI) and waist circumference.

What is body mass index (BMI)?

BMI is a measure of body fat based on height and weight to determine whether a person is underweight, of normal weight, overweight or obese. BMI is a good indicator of a person's fat mass and related health risks.

BMI (kg/m2) = body weight (kg) / height (m)2
For example, an adult who is 1.70 m and weighs 80 kg has a BMI of 27.7 kg/m2
80 kg  (1.70 m X 1.70 m) = 27.7 kg/m2

The table below shows the health risks for each BMI category.

BMICategoryRisk of developing health problems
18,5 ou moinsUnderweightModerate
18,5 à 24,9Normal weightLow
25,0 à 29,9OverweightModerate
30,0 à 34,9Class I ObesityHigh
35,0 à 39,9Class II ObesityVery high
40,0 et plusClass III ObesityExtremely high

Warning! BMI should only be used for people aged 18 and over. It should not be used for athletes, body builders, pregnant or breastfeeding women, or people who are seriously ill. People aged 65 and over will also have a healthy weight that is slightly above the indicated values.

Why is it important to measure waist circumference?

Waist circumference is a complementary indicator to BMI. It helps us more accurately assess someone's risk of developing cardiovascular disease, diabetes or high blood pressure, as people who tend to accumulate abdominal fat are more at risk of these diseases than other people.

Apple shape and pear shape

Some people, especially men, tend to accumulate fat around the abdomen (apple shape), whereas women tend to accumulate it around the hips (pear shape). Excess abdominal fat is associated with increased health risks, whereas excess fat around the hips and thighs is less associated with health problems.
The table below shows the health risks related to your waist circumference.

Waist circumferenceRisk of cardiovascular disease, type 2 diabetes and hypertension

M < 94 cm or 37 in.
F < 80 cm or 32 in.

Abdominal fat

M between 94 and 102cm (37-40 in.)
F between 80 and 88 cm (32-35 in.)

Abdominal obesity

M ≥ 102 cm or 40 in.
F ≥ 88 cm or 35 in.


How much weight do I need to lose to improve my health?

If you are overweight, gradual weight loss can greatly improve your heart health. As you lose weight, remember that your waist circumference is essential and even more important than the number on the scale. Slowly but surely! To improve your health, you should aim for a slow and gradual weight loss of 5% to 10% of your initial weight over a period of 6 months. This slow method will provide you with considerable health benefits.

For example, a person who weighs 200 pounds and is overweight should lose approximately 10 to 20 pounds (5% to 10%) over 6 months. You can tell by your belt notches whether you have lost weight. In fact, you can forget the scale and simply concentrate on your waist size!

How should I lose weight?

A healthy diet and regular exercise are key factors in good weight management.

The principle of energy balance

When trying to lose weight, the first goal is to create a negative energy balance. To do this, you need to expend more energy than you take in to create a calorie deficit. You have three options to create this deficit:

  • Decrease your portions (calorie deficit through diet)
  • Increase your energy expenditure through physical activity (calorie deficit through exercise)
  • Adopt a healthy lifestyle by combining a healthy diet and regular exercise

If you want to go the first route and only modify your diet, consult a nutritionist instead of simply buying a “miracle” weight loss product. The nutritionist can take a personalized approach to ensure your diet is balanced and meets your needs.

Are you hoping to lose weight through physical activity alone without modifying your food behaviour? First of all, know that your energy expenditure has to be very high. To expend 9000 kcal**, or about 1 kg of fat**, someone with a limited fitness level (or a low aerobic capacity) will have to do over 30 hours of low- to moderate-intensity physical activity at an energy expenditure of approximately 5 kcal/min. For example: walking at a slightly quickened pace, biking at approximately 15 km/h, raking (the lawn or leaves), volleyball, etc.

However, people with a higher fitness level (or a higher aerobic capacity) can expend the same amount of energy in less time (in 10 hours), as they can reach higher intensities during physical activities, such as running at a pace faster than 10 km/h, cross-country skiing on a hilly trail, soccer, skipping, etc. To lose weight, your exercise intensity must be relatively high, hence the importance of including high-intensity interval training in your workouts. Above all, this type of training helps improve your effort capacity (your ability to perform aerobic exercise). If we can increase our exercise tolerance, we can achieve higher training intensities and increase our caloric expenditure. It's very important to gradually increase your level of physical activity (frequency, duration, type and intensity), particularly to prevent injury.

When we increase our physical activity, we may also start increasing our food intake for various reasons (e.g., as a post-workout reward). Look at the table below for an idea of the impact of these rewards or snacks and the amount of time it takes to burn these calories. If you are really craving that after-dinner treat, you have two options if you don't want to tip your energy balance the wrong way: 

  • Add additional minutes to your workout
  • Don't eat the treat!

This is the only way to ensure you have a negative energy balance at the end of your day or week. Every little bit adds up, and over time you will see the impact on your weight loss and lower waist size.

The combination of a healthy diet and an active lifestyle is THE solution to improve your health and eventually lose weight. If your ultimate goal is just to lose weight, you should remember one thing: slowly but surely! It’s definitely better to adopt a healthy lifestyle over the long term and make small modifications one at a time instead of obsessing over the scale and making radical and sudden changes, which often result in discouragement, fatigue, injury, loss of motivation and failure. Have fun exercising and eating healthfully!

Required exercise time to expend the calories in...

FoodCaloriesWalking at 4 km/hBiking at 16 km/h
Verre de vin (175 ml ou 6 oz)12033 min22 min
Ice cream cone375105 min69 min
Bag of chips (75g) Viva brand405112 min74 min
Bag of chips (75g) regular brand420117 min78 min

Whole-wheat carrot muffin (Tim Hortons brand)

410114 min76 min

**The amount of energy in 1 g of fat is approximately 9 kcal. You therefore need a deficit of about 9000 kcal to lose 1 kg of fat. However, since fat loss is also accompanied by water loss, a decrease of 1 kg of body weight requires a deficit of approximately 7700 kcal.


- Report of the Kino-Québec expert committee: L’activité physique et le poids corporel, 2006.
- Marielle Ledoux, Nathalie Lacombe, Geneviève St-Martin: Nutrition, sport et performance. Géo Plein Air, 2006.
- PasseportSanté.net: Prévenir et soigner l’obésité : comment relever le défi? Consulted March 2012.

Top to page


The risk of developing coronary artery disease is twice as high among sedentary people as among active people. A sedentary lifestyle is responsible for 1 out of 10 deaths in the world. The risk of coronary artery disease is considered to be just as high for inactive people as it is for people who smoke. In fact, a sedentary lifestyle has the same impact on health as smoking a pack of cigarettes a day!

We could prevent approximately 75% to 80% of chronic illnesses simply by eating well and exercising!

Survey: Are you sedentary?

  • In your spare time or when getting around, do you walk for at least 30 minutes at a good pace most days of the week (5 days or more)?
  • Do you play sports or exercise at least three times per week?
  • For your work, do you have to walk over long distances or pick up heavy items regularly throughout the day and every day?

If you answered YES to at least one of these questions, you can consider yourself as an active person. If you answered NO to all of these questions, you are probably sedentary.

Adopting an active lifestyle has many benefits for your health. For example, regular exercise can help you control your weight, decrease your blood pressure, decrease your blood sugar level, and improve your blood lipid profile (by increasing your HDL or good cholesterol and decreasing your LDL or bad cholesterol and your triglycerides). Improving these health indicators decreases your risk of coronary artery disease. Active people have a better handle on their health: they relax and rest; respond better to stress in emergency situations; are more productive at work; have better self-esteem; are more positive; and care about their quality of life, their environment and their diets by making healthy choices.

Not only does regular exercise give you a sense of well-being and satisfaction—it's also fun! And when we enjoy something, it's difficult to stop. Which is a good thing, since the benefits of physical activity gradually decrease if we go back to our sedentary ways. So don't forget to schedule physical activity on your daily agenda. This will greatly increase your chances of being active on a regular basis.

So get your shoes on and get active!

Adopting a healthy lifestyle: Physical activity

Top to page