women's heart smarts: top ten list for a heart healthy life

Heart Disease Number one killer of women.

Kills 1 in 2 women (1 in 3 men).

Often undiagnosed and undertreated.

A very dangerous, but very preventable problem.

"Women are like teabags; you never know how strong they are until they're put in hot water." — Eleanor Roosevelt

Top Ten List

Women’s Heart Smarts:Top Ten List for aHeart-Healthy Life

Shawn Patrick, MD

April 29, 2011

10. Get a Good Night’s Sleep

Risk of high blood pressure increases when you sleep less than 7 hours per night.

The risk doubles when you get less than 5 hours per night. If you have high blood pressure and sleep less than 7 hours per night,

your risk for heart attack is increased. REM sleep is responsible for reducing stress. Muscle tissue repair increases during sleep. Have good sleep habits. If you have sleep apnea, TREAT IT!

Sleep Apnea

Sleep Apnea Associated with… Coronary artery disease

Atrial fibrillation

Pulmonary hypertension

Hypoxic brain injury

Sleep Apnea An estimated 20 to 30 percent of Americans have some degree of

sleep apnea.

If you have sleep apnea, wear your CPAP.

Weight loss is often curative.

Sleep apnea affects men and women.

Sleep Apnea

Get plenty of sleep

9. Know and Manage Your Blood Pressure

The risk for stroke is decreased 30% by lowering the systolic blood pressure from greater than 140 mmHg to 130 mmHg.

Only 30% of patients being treated for high blood pressure in the United States actually have control.

The ideal is less than 120/80.

Blood pressure higher than 130/80 should be treated.

Prevalence of High Blood Pressure in Americans Age 20 and Older by Age and Sex NHANES IV: 1999-2000

p18

Source: Health, United States, 2003, CDC/NCHS.

Note: NA = data not available. Prevalence estimates for women ages 20-34 are considered unreliable.

Hypertension Prior to 1990 the incidence of hypertension was declining. Data from 1999-2002 showed that the incidence had risen to

28.6% of the US population. As of 2006, only one-third of Americans with hypertension had

control of their blood pressure.

Treating Hypertension Weight loss

Medications

Diet changes

Exercise

8. Eat a Smart, Healthy Diet

Always eat breakfast, it can save you from a heart attack.

Avoid processed foods, especially foods with High Fructose Corn Syrup (HFCS).

When in season, shop at a farmer’s market at least twice per month or join a Community Sponsored Agriculture.

Avoid fast food.

Avoid saturated and trans-fats.

Fast Food Fast food is designed to be fast, not nutritious.

Fast food is often cooked in oil and the amount of sugar, salt, and fat is maximized to increase flavor.

Fast food is usually eaten by hand and is quickly consumed allowing customers to eat greater quantities (supersize) before they realize they are full.

Processed Food Many foods are now processed to contain corn products such as HFCS,

which increase caloric load.

Processing often introduces chemicals designed to trigger parts of the brain to crave that particular food.

Many foods are predigested with enzymes or are tumbled to make them easier to eat.

7. Know and Manage Your Cholesterol Weight loss Medications Diet changes Exercise Know your numbers

> Total> Triglycerides <150> HDL >40 men, >50 women> LDL <70 with DM CAD, <100> Total/HDL <5.0

Cholesterol LDL particles cause atherosclerosis. LDL concentration (gm/dl) is measured. LDL particles may be large or small, so the concentration does not

tell the number of particles present. If LDL is mostly small particles, more particles are present, greater

risk for atherosclerosis.

6. Make Three Little Choices Every Day

Conscious decisions to do something good for your health.

Simple choices: walking, taking the stairs, turning off the TV earlier, fruit for dessert, extra 30 minutes of exercise.

These little choices add up to have a huge impact.

They also confirm your dedication to good health.

5. Maintain a Healthy Weight

Age-Adjusted Prevalence of Obesity in Americans Ages 20-74 by Sex and Survey NHES, NHANES I, NHANES II, NHANES III, NHANES IV: 1960-62, 1971-74, 1976-80, 1988-94 and 1999-2000

Note: Obesity is defined as a BMI of 30.0 or higher.

p33Source: CDC/NCHS.

Prevalence of Overweight Among Students in Grades 9-12 by Sex and Race/Ethnicity United States: 2001

p33

Note: Overweight is defined as BMI 95th percentile or higher by age and sex of the CDC growth chart.

Source: YRBS, MMWR, Vol. 51, No. SS-4, June 28, 2002, CDC/NCHS.

Weight For thousands of years, weight had been stable with no significant

change. In 1960, the average weight of the American woman aged 20-29

was 128 lbs. By 2000, the average weight was 157 lbs. As of 2007, 74.1% of Americans were overweight or obese. WHY???

WHY??? Fast food

Processed food

Lack of exercise

4. Quit Smoking

Prevalence of High School Students Using any Tobacco Product Within the Last 30 Days by Race/Ethnicity and Sex United States: 2001

p27

Source: YRBS, MMWR, Vol. 51, No. SS-4, June 28, 2002, CDC/NCHS.

A Smoking Problem Approximately 25% of Americans smoke (27% men, 22.6%

women). 1 in 2 chance of smoking-related death. Average life years lost from smoking: 12 Cancers: lung, mouth, larynx, throat, oral, esophagus, urinary

tract, kidney, pancreas, and cervix. Most smokers die of heart disease first.

Smoking Quit

Use whatever means is necessary

Replace the activity

If not for you, for those around you

3. Avoid or Cure Diabetes

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1990

No Data Less than 4% 4% to 6% Above 6%

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1991-92

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

No Data Less than 4% 4% to 6% Above 6%

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1993-94

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

No Data Less than 4% 4% to 6% Above 6%

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1995-96

No Data Less than 4% 4% to 6% Above 6%

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1995

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

No Data Less than 4% 4% to 6% Above 6%

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1997-98

Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

No Data Less than 4% 4% to 6% Above 6%

Source: Mokdad et al., Diabetes Care 2001;24:412.

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1999

No Data Less than 4% 4% to 6% Above 6%

Source: Mokdad et al., J Am Med Assoc 2001;286(10).

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 2000

No Data Less than 4% 4% to 6% Above 6%

Source: Mokdad et al., J Am Med Assoc 2001;286(10).

Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 2002

No Data Less than 4% 4% to 6% Above 6%

Diabetes Now and in the Future 2010 National Incidence: 14%

Projected Incidence 2050: 33%

Normal Type 2 Diabetes

Courtesy of Wilfred Y. Fujimoto, MD.

Visceral Fat DistributionNormal vs Type 2 Diabetes

Diabetes Do you have diabetes?

Are you sure?

Metabolic Syndrome: “Pre-Diabetes”3 of These 5 Risk Factors

Risk Factor Defining Level

Abdominal obesityMenWomen

Waist Circumference>102 cm (>40 in)>88cm (>35 in)

Triglycerides >150 mg/dl

HDL-CMenWomen

<40 mg/dl<50 mg/dl

Blood Pressure >130/>85 mmHg

Fasting Glucose >110 mg/dl

Diabetes If you have metabolic syndrome, high probability of developing

diabetes within 5 years.

Metabolic syndrome and diabetes have the same cardiovascular risk as established coronary artery disease.

Are you still sure?

Treating (and Curing!) Diabetes Weight loss

Medications

Diet changes

Exercise

2. Drink Plenty of Water

Americans far under-consume water.

Water is essential for every system in the body to function normally.

Consuming alcohol or sweetened soft drinks often defeats the purpose of drinking and adds empty calories.

Water helps us maintain normal body weight.

Rule of thumb: eight 8oz glasses per day, more with exercise, warm weather, altitude, or thirst.

1. Exercise

5 to 7 days per week.

Minimum of 30 minutes, more is better.

Exercise: Aerobic activity and strength.

Leisure-time Physical Activity (PA) Patterns Among Overweight Adults by Race/Ethnicity and Sex BRFSS: 1998

p31Source: MMWR, Vol. 49, No. 15, April 21, 2000, CDC/NCHS.

Walking the dog

Exercise Lowers blood pressure.

Improves cholesterol, lowers LDL and raises HDL.

Can help treat/cure diabetes.

Can help weight control.

Improves endothelial function and reduces risk of heart attack and stroke.

Improves lean muscle mass and bone density.

Design an Exercise Program Pick activities you enjoy

Start slow, build as you go

Do it more days than you don’t

Sequester your exercise time

Get a partner, if you need one

Follow your progress

If it helps, think of exercise as medicine

Check Your Progress Compare objective data

> Weight, BP, cholesterol, glucose control

> Speed, strength, endurance

Compare subjective data> How do you feel?

Conclusion

10. Get plenty of sleep.

9. Know and manage your blood pressure.

8. Eat a smart, healthy diet.

7. Know and manage your cholesterol.

6. Make 3 little choices every day.

Conclusion

5. Maintain a healthy weight.

4. Quit smoking.

3. Avoid or cure diabetes.

2. Drink plenty of water.

1. Exercise

"I am what I am today because of the choices I made yesterday" — Eleanor Roosevelt

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