“Nobody’s ever really talked about cardiovascular health,” says Donald Lloyd-Jones. “We’ve always focused on cardiovascular disease.”

At six feet eight, the cardiologist Donald Lloyd-Jones is literally a big booster for heart health. The chairman of the Department of Preventive Medicine at Northwestern University’s Feinberg School of Medicine, he served as the lead author of the new strategic goals for 2020 from the American Heart Association (AHA), an assignment that won him the organization’s Chairman’s Award. In this edited interview, Lloyd-Jones discusses the obesity epidemic, the effects of smoking and salt on cardiovascular health, and the First Family as role models for healthful living.

How are the new AHA goals different from last decade’s?
The [older] goals were focused on reducing the impact of cardiovascular disease in people who already had it and, to a certain extent, in people with known risk factors like high blood pressure, diabetes, and high cholesterol. The AHA achieved its 2010 impact goals—to decrease morbidity and mortality from cardiovascular disease by 25 percent—by 2008, so it was a huge success story. Beginning about 2007, the AHA wanted to define new goals for the next decade and focus on this cardiovascular-health concept. Nobody has ever really talked about cardiovascular health; we’ve always focused on cardiovascular disease.

Some of the steps seem tricky, such as consuming fewer than 1,500 milligrams of sodium a day. What can Americans do besides put down the saltshaker?
Know their numbers. Have ideal levels of cholesterol under 200, a blood pressure less than 120 over 80, and a fasting blood sugar less than 100. Very few people at present in this country do achieve ideal levels [on everything]. So we created a spectrum. There are poor, intermediate, and ideal levels for each. The whole goal here is to get everyone to take at least one step forward.

How can we specifically tackle smoking?
A national indoor smoking ban would be wonderful. After an indoor smoking ban, there is on average a 30 percent reduction in [hospital] admissions for heart attack.

Has the number of deaths related to heart disease gone down?
From 1968 to the present, we’ve seen huge declines in cardiovascular mortality. But within the last decade, death rates among 35- to 54-year-olds have remained the same—and 35- to 54-year-old women have actually increased in cardiovascular death rates.

Why?
I think it’s obesity. We’ve had enough of the obesity epidemic to see that uptick in cardiovascular death rates. It’s going to be a tsunami if we don’t turn it around. We were poised to win this battle, and now we’re poised to lose it.

Why is limiting salt such a big deal?
The evidence on salt is unequivocal. In terms of your health, lower blood pressure is always better. Sodium taste is a [learned] taste. Cut it out of your diet for as little as a week and you become averse to its taste.

I have very low blood pressure. Is it OK if I salt away?
For now, yes. But in the long term, probably not. Blood pressure goes up on average a point per year after the age of 25. Ninety percent of Americans will develop hypertension before they die. On average, most Americans get about 4,000 milligrams of sodium a day. Very little of that, less than 20 percent, is salt that people actually add to their food. Over 80 percent is in the processed foods we get. So absolutely we need to be activist about partnering with food companies to reduce sodium. It’s going to take legislation and incentives to reward companies.

You also want us to eat less and weigh less.
We are exposed to an unbelievably calorie-dense environment. We eat out more than we should. We eat many more processed foods than we should. When you really focus on whole foods, you get much more fiber, you get much more full, and you eat far fewer calories. Right now it is cheapest for food companies to buy high fructose corn syrup because we subsidize corn and soy products. Why not change what we’re subsidizing because it will improve the health of our population and reduce our health-care expenditures? There are many other things—beans, legumes, and berries in particular—that are incredibly good dietary sources. Finland changed its incentives to focus specifically on berry production. It did a number of other things, including smoking cessation campaigns—and from the early 1970s to 2000, Finland saw an 80 percent decline in coronary fatalities.

It doesn’t seem as though two-thirds of Americans are overweight or obese.
We’ve completely shifted what we view as normal. Overweight now is considered the new normal.

How can we slow down the childhood obesity epidemic?
We need to get meaningful physical education into the schools. There are only eight states that require it. Illinois is one of them. We need to improve the foods that kids are exposed to in school. It’s terrible how much sodium they get.

Won’t some people skip the exercise and dietary changes and just take a pill to lower their cholesterol and blood pressure?
We do have many effective therapies that, by improving blood pressure or cholesterol, can reduce risk. But they never come close to reducing risk back to someone who always had good levels. Staying lean, stopping smoking, being physically active as often as possible, and eating a heart-healthy diet are the fountain of youth for the whole body. It’s far more efficient to maintain weight by taking in fewer calories than by burning them off later.

What about the idea that you can be fit and fat?
You can be fit while being fat. You’d still be better off being lean and fit than fat and fit. There are some people who can modify some of the adverse consequences of obesity by being fitter. But all things being equal, it’s always better to be leaner.

What about concerns that we’re going to make eating disorders worse?
We’ve gone from a lean society to an overweight and almost obese society. That’s our major public-health problem now. We can’t let that be derailed by concerns we’re going to cause more eating disorders. Obesity is a public-health problem, and we can’t confuse the two.

Are Chicago residents really as fat and unhealthy as people say?
We’re not Colorado. Have you seen the obesity maps? Mississippi, unfortunately, always leads because of poverty, and many of the Appalachian states follow. But Illinois is right behind those.

Why? Because it gets too cold to go out and exercise?
Absolutely. It does limit our ability to be as active as we’d like to be because we can’t be outside often for five months of the year. Historically, we haven’t necessarily developed the healthiest foods, as represented by the hot dog. While they’re tasty, if that’s our sort of city food, it epitomizes a lot of things that aren’t healthy.

Sarah Palin brought a plate of cookies to a school and said kids should have the right to eat them.
Of course they have the right to eat cookies. You’ve got to make sure that’s not all they’re eating. I bristle when people take this to mean we’re going to legislate what they eat. Though I was appalled to hear Rush Limbaugh talking about weight loss through eating Twinkies.

Michelle Obama has taken on childhood obesity, and Barack Obama is always out playing basketball.
They’re terrific role models. They’re both lean, they’re active, and they’re champions for heart health and overall health. It takes that level of intervention and involvement to get people to be aware. It’s a tough position to be role model in chief.

(To learn more about the AHA’s seven steps to heart health, go to mylifecheck.heart.org.)

Photograph: Anna Knott