I grew up in Sicily, starting each morning with a walk around my tranquil town, before devouring a breakfast spread prepared by my mother, with fresh coffee,
buckwheat bread, yoghurt and fruit. Our diet was simple and rich in fresh whole foods: a dinner of grilled fish or baked chicken with fresh salad or vegetables, always doused in a generous glug of olive oil.

My family and I always ate at the dining table, where our conversations would stretch late into the balmy Sicilian evening. Looking back, I realise that my childhood there shaped everything that I now know about the powers of preventative medicine and the heart. My community shared an intrinsic understanding that how you live – how you eat, how you rest and who you spend time with – shapes your health in a way that no prescription can replicate.

After training as a cardiologist in Italy, I moved to the United States and spent a number of years researching cardiovascular physiology at Harvard, before settling in London. The next eight years were spent working as an associate specialist cardiologist at an NHS Trust, before I founded The National Heart Clinic on Harley Street.

In all my learnings about the heart, I believe that heart disease isn’t a genetic fate for most people. Rather, it is the result of thousands of small daily choices, made consistently over decades. Many of my patients believe they are doing everything “right” – without realising that skipping breakfast, sitting at their desk all day or going to sleep at a different time each night is silently damaging their cardiovascular health.

These are the key mistakes I see patients make in midlife – and my top tips for a strong and healthy heart.

1. Going to bed at a different time each night

Poor sleep is a genuine cardiovascular risk factor. Not getting enough quality sleep raises cortisol, elevates blood pressure, drives inflammation and reduces the body’s sensitivity to insulin – all of which elevate heart disease risk over time.

In fact, a recent study conducted in Finland found that people in midlife who slept for less than eight hours per night – and had an irregular sleep schedule – faced twice the risk of a major cardiovascular problem (such as stroke or heart failure), compared to those with a more consistent routine.

Going to bed at a different time every night can disrupt the body’s natural circadian rhythm, potentially causing high blood pressure, inflammation and metabolic issues. I treat sleep as a clinical priority, not a lifestyle preference, and maintain a regular sleep schedule throughout the week, aiming for seven to nine hours per night. Phones are banned from my bedroom, as we know that blue light exposure disrupts the body’s natural sleep signals and can suppress melatonin, which acts as a protective antioxidant for your blood vessels. Less melatonin means more oxidative stress in your arteries over time.

Additionally, scrolling through the news and emails before bed can heighten your nervous system at the precise moment it should be winding down. If you aren’t quite ready to say goodbye to your phone at night, try placing it face down and set to silent at least 45 minutes before going to sleep.

2. Underestimating the hidden salt in ‘healthy’ foods

Many of my midlife patients have cut the obvious offenders – crisps, takeaways and ready meals – out of their diet, but are regularly eating shop-bought soups, smoked salmon, bread, deli meats and sauces that are surprisingly high in salt. Just half a can of soup can contain up to 1.5g of salt, while a single slice of ham may contain 0.3g or more, marking it red on UK health traffic-light labels.

Eating too much salt can result in high blood pressure, which remains the single biggest modifiable risk factor for both stroke and heart disease. When I analyse my patients’ diets, many of them are genuinely shocked to discover they are well above the recommended 6g a day without even picking up a salt shaker.

I follow a Mediterranean-style diet, which is naturally low in sodium and has powerful health benefits. One review published in Circulation Research found that those who strictly follow the diet pattern had better cardiovascular health outcomes, including clinically meaningful reductions in rates of coronary heart disease, ischaemic stroke and total heart disease.

Extra-virgin olive oil is my primary fat source, as it is rich in healthy monounsaturated fats and powerful antioxidants. These are anti-inflammatory and may help reduce your risk of chronic disease.

3. Thinking a morning workout cancels out hours of sitting down

I often tell my patients that “sitting is the new smoking”. Many of us spend long, uninterrupted stretches of the day sitting at a desk or reclining on the sofa. This sedentary behaviour quietly lowers good cholesterol, raises blood sugar and promotes changes in the blood that increase the risk of clotting.

One 2024 study published in the Journal of the American College of Cardiology found that sitting, reclining or lying down for more than 10 hours each day is significantly linked with future heart failure and cardiovascular death, even among those meeting recommended levels of exercise. This means your morning workout may not be enough to protect your heart.

During a busy day of desk work, I set reminders on my phone to stand up and move for two or three minutes every 45 minutes. I know it sounds trivial, but the evidence behind this habit is solid.

Additionally, I start most days with a morning walk, cycle, mobility or bodyweight exercises. The specific exercise matters less than the consistency. Regular aerobic exercise is the single most powerful cardiovascular tool we have. It lowers resting heart rate, improves the health of artery walls, raises good cholesterol, reduces blood pressure and makes the body far more responsive to insulin. Nothing I can prescribe comes close to replicating those effects.

4. Choosing ‘fat-free’ products

Many of my patients who are on weight-loss journeys will opt for “fat-free” products wherever possible, believing that they are the healthier alternatives to “full-fat” yoghurts, salad dressings, cheese spreads and cereal bars.

Yet, the truth is that low-fat and fat-free products are likely to raise insulin and blood sugar levels faster, as manufacturers replace the fat with added sugars, sweeteners and sodium to maintain taste and texture. These substitutions can also lead to elevated triglycerides and lower levels of “good” HDL cholesterol, increasing the risk of type 2 diabetes and weight gain.

Therefore, it is best to stick to full-fat and minimally processed products, as these are known to have neutral or potentially beneficial effects on heart health when consumed as part of a balanced diet.

5. Using a strong mouthwash

As you get older, you may be tempted to reach for a powerful mouthwash in an attempt to undo years of habits that have left your teeth damaged and stained.

However, many people do not realise that some strong antibacterial mouthwashes can wipe out the beneficial bacteria in the mouth, which help convert food compounds into nitric oxide. This vital molecule helps to keep your blood vessels flexible and able to relax when needed.

This was demonstrated in a 2019 study in which researchers found that the beneficial blood pressure-lowering effect of exercise was significantly reduced when people rinsed their mouths with antibacterial mouthwash rather than water – demonstrating the importance of oral bacteria in cardiovascular health.

Instead of a powerful mouthwash, it may be worth considering a specialised oral probiotic, oil pulling or natural rinses (such as a saltwater rinse or green tea) to keep your mouth and teeth healthy without damaging your heart.

6. Eating dinner an hour before bed

Some of my patients are living such busy lives that they don’t get home until 8pm, end up eating around 9pm, and are in bed an hour later. This can place extra stress on the sympathetic nervous system, which is activated during digestion, to process nutrients, manage energy metabolism and maintain blood pressure levels at a time when it should be resting.

By fasting three hours before bed, you reduce endothelial stress and improve vascular flexibility, meaning there is less oxygen demand on your heart, which can recover more efficiently during sleep. This was demonstrated in a 2026 study which found that middle-aged and older adults who extended their overnight fasting window by at least two hours had a healthier blood pressure and heart rate overnight, with improved daytime blood sugar control.

If you are prone to any of these mistakes, I hope you do not feel disheartened – there are so many small changes we can make in our daily lives to reduce heart disease risk, even in midlife when some damage has already been done. The arteries are far more responsive to changes in our behaviour than most people realise.

What I eat in a day

Breakfast

I always start the day with a large glass of water. Blood is slightly thicker first thing in the morning because of overnight dehydration, making it harder to pump, which can increase the strain on your cardiovascular system.

After morning exercise, I drink a cup of warm organic bone broth, followed by breakfast with at least 30g of protein. This might be eggs and avocado on buckwheat toast, drizzled with Sicilian extra-virgin olive oil, or a bowl of full-fat Greek yoghurt with berries and seeds.

Lunch

I try to enjoy lunch without any screens or work. In Sicily, we never rushed our meals – and I have tried to continue that practice here. Eating quickly affects digestion, satiety and how the body manages stress around meal times.

Lunch is usually a salad or mixed vegetables with legumes (such as chickpeas or black beans) and oily fish (such as salmon or tuna), drizzled with olive oil.

Dinner

My wife is a nutritionist, which means I am lucky enough to end the day with a fresh, healthy and delicious dinner. This might be a salad with a mixture of leafy greens, tomatoes and onions, topped with olives, salmon and olive oil. Other days, we might have vegetables roasted in olive oil with white fish, legumes, herbs and spices.

– As told to Ella Nunn