At Piedmont Atlanta Hospital in Buckhead, cardiac nurse practitioner Cindy Milligan sees the devastating consequences of heart disease every day. Working on the advanced heart failure transplant team, she witnesses firsthand the ravages of uncontrolled hypertension, diabetes and high cholesterol, conditions that disproportionately affect African Americans. Yet behind each critical case lies a story that often began years earlier, with seemingly small lifestyle choices that gradually accumulated into life-threatening conditions.
“The blood pressure has been high, their kidneys are in renal failure, or they’re coming in with a stroke or heart attack,” Milligan explains, describing the all-too-common scenario she encounters. These emergencies, she believes, represent the endpoint of a journey that could have taken a different path with earlier intervention and lifestyle modifications.
While medication adherence remains crucial for those already diagnosed with cardiovascular conditions, Milligan emphasizes that lifestyle changes can be equally powerful, especially for younger generations hoping to avoid the path taken by many of their elders. Through her work with patients across all demographics, Milligan has identified five essential lifestyle modifications that can dramatically improve heart health outcomes and potentially prevent the need for pharmaceutical interventions altogether.
Regular medical monitoring forms the foundation
The cornerstone of Milligan’s prevention strategy begins not with diet or exercise but with consistent medical care. “Going to, getting your yearly physical, making sure your labs are done checking your kidney function, your cholesterol levels,” she advises, emphasizing that these routine screenings can identify risk factors before they progress to disease.
For younger adults, especially those with family histories of heart disease, diabetes or hypertension, these regular check-ups take on even greater importance. “If there’s a predisposition of family history of any of those things that I just mentioned, diabetes, cholesterol and high blood pressure, just being cognizant of that,” Milligan cautions.
The reluctance to seek preventive care represents one of the most significant barriers to improving heart health outcomes. Whether stemming from historical mistrust of healthcare institutions, fear of potential diagnoses or simply the inconvenience of taking time for appointments when feeling healthy, this avoidance pattern has profound consequences.
“That has been one of the biggest things that I’ve seen in our community for a long time,” Milligan notes, reflecting on years of observing patients who delayed care until symptoms became severe. By then, the window for simple interventions has often closed, leaving fewer and more complicated treatment options.
Movement matters more than intensity
In an era dominated by desk jobs and digital entertainment, Milligan identifies our increasingly sedentary lifestyle as a major contributor to declining cardiovascular health. “We have a very sedentary lifestyle now of work, and then people sitting at home. Once they get home, they don’t really go out and walk, and we’re not outside anymore like we used to be,” she observes.
This shift away from regular physical activity has coincided with rising rates of obesity, diabetes and hypertension, creating a perfect storm for heart disease development. Yet Milligan’s recommendations for countering this trend are refreshingly accessible.
“It doesn’t have to be strenuous exercise,” she emphasizes. “Walking three to four times a week, twenty minutes a day, just making sure a healthy lifestyle of eating well and moving.”
This modest prescription stands in stark contrast to the high-intensity workout regimens often promoted in fitness culture. By focusing on consistency over intensity, Milligan offers an approach that feels attainable for patients of varying abilities and fitness levels. The goal isn’t athletic excellence but rather breaking the pattern of prolonged inactivity that has become normalized in modern life.
Dietary choices directly impact heart parameters
When discussing nutrition, Milligan takes a similarly practical approach, identifying specific dietary habits that directly influence cardiovascular health markers. “Shaking that extra salt after your food is cooked, it has a big effect,” she notes, explaining how even this small habit can contribute to elevated blood pressure readings.
Rather than advocating complete dietary overhauls, which many patients find unsustainable, Milligan suggests targeted modifications to cooking methods that can yield significant benefits. “Not frying your foods, baking your foods. It has a huge impact,” she explains. “That in fact is a direct correlation with the cholesterol levels.”
The shift from fried to baked foods represents more than just a calorie reduction, it fundamentally alters the lipid profile of meals. “If you’re eating fried foods, fast foods, it definitely has a huge impact,” Milligan warns. “It can make a big difference if you start baking your foods or oven pan frying your foods, and not all the greasy residue in frying the foods.”
For patients seeking more structured guidance, Milligan often recommends the Mediterranean diet, which emphasizes olive oil, fish, nuts, fruits, vegetables and whole grains while limiting red meat and processed foods. This eating pattern has been extensively studied and shown to reduce cardiovascular disease risk.
Education transforms medication adherence
For those already diagnosed with heart conditions, Milligan identifies a critical pattern that often leads to medical emergencies, the misconception that improved symptoms mean medication is no longer necessary.
“If their blood pressure gets better, they’re like, ‘Well, I’m cured. I don’t need to take it,'” she explains. “But that’s the whole reason you’re on it, so your blood pressure can improve, and you have to keep taking it so it’s not going to elevate again and keep causing those long-term issues.”
This misunderstanding highlights the importance of patient education as a lifestyle intervention in itself. “I think a lot of education,” Milligan emphasizes. “I love to do that with my patients and the families, just explaining these disease processes.”
By helping patients understand how their medications work and why continued treatment remains necessary even when symptoms improve, Milligan aims to transform their relationship with treatment. This educational approach addresses what she sees as one of the most common reasons for medication non-adherence, a fundamental misunderstanding of chronic disease management.
Acknowledging medicine’s uncomfortable truths
Perhaps most striking in Milligan’s approach is her willingness to address sensitive topics that patients might hesitate to raise themselves. When discussing medication adherence among male patients, she directly confronts an issue many healthcare providers avoid.
“One thing that I always question, especially in our community, a lot of the medications for high blood pressure, they affect a man’s libido,” Milligan reveals. “That is a question that I always ask, is this medication the reason you stopped it? Does it affect you in the bedroom?”
This candor represents a lifestyle intervention of a different sort, one focused on communication patterns between providers and patients. By creating space for discussions about sensitive side effects, Milligan opens pathways to solutions that might otherwise remain unexplored.
“Some people may get embarrassed, and they just don’t want to talk about it, but that is one of the number one reasons that a lot of men stop taking their blood pressure medicine,” she explains. The consequences can be severe, with patients returning “with strokes and heart attacks, and their blood pressures are 200s, 220s, 250s.”
By acknowledging these realities, Milligan offers an alternative. “If that’s the case, there’s other things that we can use to help control their blood pressure so they don’t have that,” she assures patients.
The lifestyle modifications Milligan advocates form an integrated approach to heart health, one that recognizes the complex interplay between behavior, biology and healthcare access. Rather than positioning lifestyle changes as alternatives to medical care, she presents them as complementary elements of a comprehensive strategy.
For younger generations concerned about their cardiac risk, these interventions offer a pathway to potentially avoid the health struggles faced by their elders. For those already managing heart conditions, they provide tools to maximize the effectiveness of medical treatments while improving overall quality of life.
Ultimately, Milligan’s message transcends specific recommendations about diet or exercise. It centers on empowerment through awareness, education and consistent small actions that, taken together, can redirect the trajectory of cardiovascular health for individuals and communities alike.
“There’s no age limit to where these things can affect people,” she reminds us. “We just have to be really mindful that age does not mean anything anymore, that all these things can affect all of us at any age.”
