Straight from the heart: the advice that cardiologists actually live by for good heart health

But when a workout doesn’t happen, Suwanna doesn’t punish herself with the next one. She takes a similarly pragmatic approach to stress. “No one is worth my cortisol,” she says—a personal rule for refusing to let other people dictate her stress response.

Sleep is where she draws a harder line. “Medical personnel and sleep don’t mix well, and I won’t pretend I always get as much as I’d like. But I always aim for sleep quality, even when quantity is out of my control.” Current medical standards emphasise this: sleep duration now sits alongside diet, exercise and blood pressure in the American Heart Association’s Life’s Essential 8, which recommends seven to nine hours nightly for adults. Furthermore, a 2025 AHA scientific statement on sleep health adds that regularity, timing, satisfaction and quality matter too.

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Suwanna’s most unexpected priority sits outside cardiology altogether. “Gum disease is consistently linked with cardiovascular disease, yet few people think of their dentist as part of their heart care,” she says.

In fact, a 2025 AHA statement found growing evidence linking periodontal disease to atherosclerotic cardiovascular disease, including heart attack and stroke, but stopped short of showing that gum disease causes heart disease, or that treating it prevents cardiac events. The two conditions share risk factors, and researchers are still working out how directly they’re connected.

Still, it’s a reminder that the body rarely sorts itself into the tidy specialties medicine assigns it.

Suwanna was an early adopter of continuous tracking and now wears her devices round the clock. What she doesn’t do is compare her numbers to anyone else’s. “Your trend always matters more than competing with someone else’s numbers,” she says.

She checks monthly patterns in heart rate, heart-rate variability, activity and sleep rather than reacting to daily swings—a persistent, unexplained change is worth a conversation; one bad night usually isn’t.

Heart-rate variability (HRV) is a good example of why: different devices calculate it differently, and an American College of Cardiology review warns against reading too much into a single number. Trends over time, read alongside a person’s history, may be more useful.

And some things override the device entirely. “If you notice palpitations or an irregular heartbeat, see a doctor, whatever your device says,” Suwanna says. Certain wearables can screen for atrial fibrillation with high sensitivity and specificity, but remember: an irregular-rhythm alert still needs clinical context—it isn’t a diagnosis on its own.

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Suwanna is just as comfortable with newer testing. “I’m not a conservative tester,” she says, pointing to proteomics-based risk prediction and genetic testing as tools with growing roles in cardiovascular medicine.

Proteomics remains an emerging area: recent research has explored whether patterns of circulating proteins can improve cardiovascular-risk prediction, though its clinical role is still developing. Other measures have already moved closer to mainstream practice. Current guidelines recommend checking lipoprotein(a) at least once in adulthood, using ApoB selectively to sharpen risk assessment and considering coronary artery calcium scoring when the result can help clarify risk and guide treatment.

Genetic testing is where Dr Polakit Teekakirikul enters the picture. A cardiologist and medical geneticist also at Bumrungrad International Hospital, his special interests include cardiovascular genetics and genomics, inherited cardiomyopathy and precision medicine.

Both doctors apply a similar filter to additional testing: there should be a reason for doing it. For Suwanna, the question is simple: “Will this result change what we do?”

The clinic follows two rules, she says: start with the published evidence and avoid testing for information that cannot be acted on. “If it won’t, more testing just produces more information, along with anxiety and follow-up cascades, without a better decision.”

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Dr Polakit takes the same targeted approach to genetics. Genetic testing can be useful when the clinical or family history points towards an inherited condition, including some cardiomyopathies and heart-rhythm disorders. It is less useful as an indiscriminate way of trying to predict everything that might happen to someone’s heart.

“Genetic testing is not a crystal ball that tells you, ‘You will have a heart attack,’” he cautions. “Rather, when used in the right situation, it can help us understand why a heart problem is appearing in a family and who else might be at risk.”

Suwanna sees people lose perspective around testing more often than they lose discipline: repeating niche tests too frequently, stacking supplements without considering what they need or how those supplements interact, and trying to optimise every available parameter while more established measures receive less attention.

Among the things she thinks people still neglect are “blood pressure measured properly at home, proven medication when it’s indicated, and sleep”. Current hypertension guidance likewise supports home monitoring with a validated cuff device while cautioning against relying on cuffless options such as smartwatches for diagnosis or treatment decisions.

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For Polakit, useful risk assessment can begin before any test is ordered. “I often tell my patients: your genes are not your destiny, but they are part of the instruction manual,” he says.

The first step is knowing the details of your family history. Saying that heart disease “runs in the family” leaves out the information that matters most: who was affected, what condition they had and how old they were when it happened. “A parent or sibling having a heart attack at 45 is very different from a grandparent developing heart disease at 85,” Polakit says.

A strong family history of premature cardiovascular disease can influence how early someone’s risk factors are assessed and how closely they are followed. In families with unexplained sudden death, cardiomyopathy or certain inherited rhythm conditions, more specialised cardiac assessment or genetic investigation may also be appropriate.

The point is to use family history to sharpen the questions being asked. It may prompt earlier attention to cholesterol, blood pressure or other risk factors, or suggest that a particular inherited condition deserves investigation.

“Know your family history,” Polakit says. “Your family tree may contain more information about your heart than you realise.”

Between them, Suwanna and Polakit both focus on what is useful enough to act on. In other words, the value of a test, a wearable metric or a family-history clue lies in whether it changes what happens next.

Suwanna wears two trackers, follows heart-rate zones and is interested in emerging risk tools. Polakit works in cardiovascular genetics and precision medicine. Neither approaches prevention as a rejection of newer technology. Their choices instead keep returning to whether information is useful enough to change what happens next.

A wearable trend may be worth discussing. A family history may justify looking earlier or more closely. A test may refine a treatment decision. Alongside all of that, there are familiar measures that remain easy to overlook: regular exercise, adequate sleep, properly measured blood pressure and treatment when it is needed.

Preventive cardiology can now tell us more than ever about risk. Suwanna and Polakit’s approach is to ask what that information is for. If a test, trend or family-history clue changes what happens next, it has earned its place.

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