Introduction

 Preventing Heart Disease and Stroke

Heart disease is the leading cause of death in the United States. Maybe you have a family member or friend who is suffering from heart disease. It's sad to see someone suffer, take lots of medicines, go to the doctor often and even be hospitalized. Wouldn't it be wonderful if that person could have stayed healthier and felt better longer? Did you know that you can take steps to prevent this from happening to you and your family?

This lesson focuses on the steps you can take to prevent heart disease and stroke.

Heart disease is a chronic disease that can be prevented or delayed by adopting a healthy lifestyle. Stroke is defined as the brain not receiving oxygen due to an artery blockage and can also be prevented or delayed by adopting a healthy lifestyle. A healthy lifestyle includes adopting a healthier diet and including physical activity as part of a normal day.

Making the following lifestyle changes can help prevent heart disease and stroke:

1. Eat a heart-healthy diet: Practice balance, variety and moderation when planning and eating meals by using the USDA MyPlate and 2010 Dietary Guidelines. Select foods that are low in total fat, saturated fat, trans fat, sodium and dietary cholesterol. Include a variety of vegetables and fruits, low-fat dairy products and whole grains for a healthier diet.

2. Exercise: Regular physical activity should be an important part of your daily routine. Try to get 30 minutes of physical activity every day. It does not need to be done all at once, but can be done in shorter segments that total 30 minutes for the day.

3. Keep a healthy weight: Lose weight if necessary or avoid gaining weight. Follow a sensible plan for a slow weight loss to help keep the excess weight off permanently.

4. Be a non-smoker: Smoking creates free radicals that cause a lot of harm in the vascular system. When a person stops smoking, benefits occur immediately!

5. Refrain from alcohol or consume only moderate amount: Alcohol consumption is not recommended. Alcohol, like cigarettes, causes free radical damage in the body. If consumed, limit alcoholic beverages to no more than two drinks a day for men and one for women. It is illegal for children and adolescents under the age of 21 to consume alcohol. One drink is 12 ounces of beer OR 5 ounces of wine OR 1.5 ounces of 80-proof distilled spirits.

Each of these behaviors should be part of your and your family's lifestyle. You will reap the benefits through feeling better and helping to prevent heart disease and stroke.

Heart disease goes by many names: coronary heart disease, coronary artery disease, atherosclerosis, ischemic heart disease and cardiovascular disease, to name a few.

 

Risk Factors

Risk factors are characteristics that are associated with your having a greater chance of developing a disease. The more risk factors you have and the more severe they are, the greater your chances are of getting that disease. For example, a middle-aged man with high blood pressure and high blood cholesterol and who smokes would be more likely to die from heart disease than a man who has normal cholesterol level, is a nonsmoker and exercises regularly.

Risk factors for heart disease may be:

1. High blood cholesterol levels, especially LDL cholesterol

2. Low HDL cholesterol levels

3. Diet high in saturated fat, trans fat and cholesterol

4. Strong family history of heart disease

5. A diet low in fruits, vegetables and whole grains

6. High triglyceride levels

7. Smoking

8. Lack of physical activity

9. Overweight/obesity, particularly abdominal obesity

10. Type 2 diabetes

11. Age (45 years old and over for men and 55 years old and over for women)

12. High homocysteine levels (Lower levels by eating lots of B vitamin foods like fruits, vegetables and whole grains.)

Major heart disease risk factors for women include:

• High blood lipids and lipoproteins
• Excess body weight (overweight or obesity)
• Hypertension (high blood pressure)
• Cigarette smoking
• Menopause – low estrogen level

Some risk factors can be changed with medicine or by other medical treatments, or some can be changed by adopting a healthy lifestyle (good nutrition and increased physical activity). Changing modifiable risk factors reduces your chances of getting heart disease. We will focus on the risk factors you can change.

 

Cholesterol

 What is cholesterol? Cholesterol is a fatty-like substance found in animal tissues. Your body produces cholesterol, but you also get it from foods such as meats, organ meats, egg yolks, milk, butter, cheese and other dairy products. Cholesterol is used by your body in digestion and the production of some hormones. However, high levels of cholesterol are associated with increased risk of heart disease. To be heart-healthy, your total blood cholesterol should be less than 200 mg/dl. High cholesterol is 240 mg/dl or higher.

Total blood cholesterol is made of three parts, some good and some bad!

1. LDL-C (low density lipoprotein cholesterol) – this is also called "bad cholesterol." Lipoprotein is a protein that carries fat around in the blood, bringing it to the right places needed in the body.

High LDL levels can lead to clogging and hardening of the arteries (atherosclerosis), and this is also a primary cause of heart attacks. LDL cholesterol level should be LOW in your blood! An LDL level of less than 100 mg/dl is heart healthy.

You can keep LDL low by:
(1) keeping your fat and calorie intake within a healthy range appropriate to your body size
(2) losing weight if necessary
(3) exercising regularly
(4) increasing foods high in dietary fiber such as whole grains (oats, breads, cereals), vegetables and fruits

2. VLDL-C (very low density lipoprotein cholesterol) – this level should also be low in your blood.

You can keep VLDL-C low by eating seafood that contains omega 3-fatty acids (sardines, tuna, trout, salmon, mackerel), soybean oil, margarine with soybean oil and black walnuts. The fatty acids (parts of the fat) in seafood oils also help your heart maintain a regular heartbeat and prevent irregular rhythm (cardiac arrhythmia). You should eat fish 2-3 times per week to get these helpful seafood oils.

3. HDL-C (high density lipoprotein cholesterol) – this is a "good cholesterol" to have in your blood.  HDL-C helps remove harmful cholesterol from your body. HDL-C should be higher than 60 mg/dl in your blood. Less than 35 mg/dl is too low.

Remember: Keep the low-density cholesterol (LDL-C and VLDL-C) LOW and the high-density cholesterol (HDL-C) HIGH!

What can you do to improve your cholesterol?

1. Have your doctor check your total blood cholesterol, LDL-C (bad cholesterol) and HDL-C (good cholesterol). Are they within the heart-healthy limits? If your blood cholesterol is healthy, go back to be rechecked every two years. If it is too high, get rechecked according to your doctor's recommendation.

2. If any of your cholesterol levels are not heart-healthy, you can:

• Reduce your total fat intake, saturated and trans fat intake, and dietary cholesterol intake.
• Eat a diet that follows the USDA MyPlate, a food guide, or the DASH diet plan: eat lots of whole grains and breads, fruits and vegetables, and low-fat dairy products. These foods are high in fiber and low in calories, fat, saturated fat, trans fat and cholesterol.
• Exercise regularly – light to moderate physical activity for a minimum 30 minutes per day for adults and 60 minutes a day for children.
  

3. If you are overweight, reduce your weight to a healthy level by eating right and exercising. Eat a heart-healthy diet and maintain a healthy weight to help prevent heart disease. An 11-pound weight loss is associated with a decline of about 10 mg/dL in total cholesterol.

 

High-Saturated Fat, High-Cholesterol Diet

 To be heart-healthy, you should:

1. Limit your intake of foods high in saturated fat, trans fat and cholesterol. You should limit your total fat calories to 20-35% of total daily calories. Choose low-fat meats, reduce the amount of butter and margarine you use, choose low-fat dairy products and switch to heart-heatlhy oils, such as olive oil.

2. Reduce calories, when necessary, to maintain a healthy body weight. Small bites make a difference in the long run. Leave food on your plate, take smaller portions, and share meals with someone to reduce total calories.

3. Have a moderate salt intake, less than 2,300 mg per day. Watch for sodium content of products using the Nutrition Facts Panel. Choose lower-sodium versions of products whenever possible. Eliminate the salt shaker from the table. Visit this link for tips on sodium reduction.

4. Have moderate alcohol intake, if any at all.

5. Eat more fruits (2 or more cups a day), vegetables (2.5 or more cups a day) and whole-grain breads and cereals (3 or more servings a day).

6. Enjoy a high-fiber diet: 14 g for every 1,000 calories (about 28g fiber for a 2,000 calorie diet).

 

High Blood Pressure (Hypertension) & Heart Disease

Hypertension contributes to nearly 1 million heart attacks each year.

Reducing hypertension (high blood pressure) has been shown to lower the incidence of stroke, coronary heart disease and heart failure.

What is blood pressure?

Blood flowing through blood vessels creates a pressure against the vessel wall. Blood pressure is a measure of that pressure taken at two stages. The higher number, called the systolic pressure, is the pressure exerted when the heart contracts and pumps blood through the vessels. The lower number, called the diastolic pressure, is the pressure exerted when the heart relaxes between beats. Blood pressure rises when blood vessels become narrow and hard (due to plaque build up), leaving less room for blood to flow. The heart has to work harder to move the blood.

An optimal blood pressure reading is: systolic below 120, diastolic below 80.

What are the classifications of blood pressure?

Blood pressure readings are not always the same. They vary depending on physical activity, emotional state and other factors. If your blood pressure reading is high for a long period of time though, it becomes a medical concern.

What are the dangers of high blood pressure?

Uncontrolled high blood pressure can cause complications in several bodily organs, including the heart, blood vessels, brain, nerves, kidneys and retinas (eyes).

1. Enlargement of the heart: When blood vessels are damaged, the heart must strain to meet the body's need for blood and the oxygen that blood carries. Over time, the heart will become enlarged and weak, leading to heart failure.

2. Atherosclerosis: High blood pressure can damage the inner linings of the arteries, creating rough areas where fatty deposits can build up. This condition is called atherosclerosis or hardening of the arteries. When the arteries harden, it is harder for the body to regulate blood pressure.

3. Stroke: High blood pressure can damage vessels that supply blood to the brain. Damaged blood vessels can disrupt the flow of blood to the brain, causing a stroke.

4. Coronary heart disease (CHD): Coronary heart disease occurs when the arteries that supply blood to the heart become blocked. Hypertension is a CHD risk factor.

5. Kidney damage and failure: High blood pressure for a long time can damage blood vessels in the kidneys, eventually leading to kidney failure.

6. Eye damage: High blood pressure for a long time can damage blood vessels on the retina, eventually leading to blindness if untreated.

What are some hypertension risk factors?

1. Aging: About 52% of Americans in their 60s have high blood pressure.

2. Family history: If one or both of your parents have high blood pressure, you have a greater chance of becoming hypertensive.

3. Race: The risk factor for African-Americans developing hypertesnsion is twice that of the average Caucasian.

4. Overweight or obese individuals: Overweight or obese individuals have a higher risk of becoming hypertensive than individuals that are at a healthy body weight.

What can you do?

1. Have your blood pressure measured by a health professional every two years.

2. Keep your blood pressure under control: Less than 120/80.

3. If you have hypertension, take medication prescribed by your doctor, maintain a healthy body weight, exercise regularly, cut down on your salt intake and quit smoking.

Cigarette Smoking

A tremendous amount of evidence shows that cigarette smoking is the most important risk factor for coronary heart disease. Cigarette smoking increases the triglyceride (fat) levels and lowers the HDL-C (good cholesterol) levels in your blood. When a person stops smoking, benefits occur immediately! After one year of not smoking, the coronary heart disease risk is lowered by 50% compared with those who continue to smoke.

What can you do?

1. Participate in formal smoking cessation programs to help you quit smoking.

2. Encourage family members who smoke to quit also.

Factors Leading to Development of a Blood Clot (Thrombus)

Blood is made up of cells that move in a liquid called plasma. There are three types of blood cells: red blood cells, white blood cells and platelets. Platelets help to stop bleeding. If a blood vessel is cut, platelets stick together, forming a blood clot. Blood clotting keeps you from bleeding to death when you have a cut. Scabs are clots on the surface of the skin.

Sometimes, a clot may occur in a blood vessel. If the vessel is already clogged with plaque from too much cholesterol, the blood clot may block the flow of blood to your tissues. If the clot blocks one of the heart's arteries, it can cause a heart attack. If the clot blocks an artery to the brain, a stroke may occur.

Doctors now prescribe aspirin to patients who have had a heart attack to help keep them from having another one. It also helps prevent men from having a first heart attack. Take aspirin only upon your physician's recommendation, since aspirin is also a blood thinner and you may bleed more easily if you take aspirin regularly.

Heart Disease Risk Factors

• Type 2 diabetes
• Physical inactivity
• Obesity
• Postmenopausal status without hormone replacement – hormones help prevent heart disease
• Psychosocial factors – stress, hostility or social isolation
• Elevated homocysteine level – you can reduce your homocysteine level by getting lots of B vitamins in your diet. Good sources of B vitamins include whole grains, fruits, vegetables and lean meats.
• Oxidation of LDL-cholesterol – eating foods high in vitamin E, an antioxidant, can prevent this. Good sources of vitamin E include grains, fruits, vegetables and vegetable oils.

 

Website Assignments

Explore the websites listed below. Each of these sites has activities for you to complete to practice what you have learned.

Help Guide. Look over the information about the different kinds of fats and how to choose foods that contain healthful fats.

American Heart Association. Check out the American Heart Association's website to learn more about how to live heart-healthy lives.

Heart and Vascular Disease. Visit this website for lots of great information on heart disease.

 

Summary

You can do five important things to prevent heart disease and stroke!

1. Eat a heart-healthy diet! Practice balance, variety and moderation when planning and eating meals, using MyPlate and the 2010 Dietary Guidelines. Select foods that are low in total fat, saturated fat, trans fats and cholesterol.

2. Exercise! Regular physical activity should be an important part of your daily routine.

3. Watch your weight! Always strive to maintain a healthy body weight.

4. Be a non-smoker! When a person stops smoking, benefits occur immediately!

5. Moderate intake of alcohol or refrain from alcohol.

Each of these behaviors should be part of your and your family's lifestyle. You will reap the benefits by feeling better and helping to prevent heart disease and stroke.