YOUR GUIDE TO LIVING WITH
A BOOK ABOUT:
CORONARY ARTERY DISEASE AND HEART ATTACK
This book is a must read for anyone who is concerned about maintaining a strong, healthy heart. That’s why we hope you’ll share it with your family and close friends.
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© 2020/ 2021, Hospital Educators Resource Catalogue, Inc. dba HERC PUBLISHING The purpose of this book is to provide information on coronary artery disease. The content is not intended to be used in place of professional medical care. Readers are advised to consult a physician or trained medical personnel when diagnosis or treatment is needed.
Order number 14-9
TA K E C A R E O F Y O U R H E A R T Your healthcare provider has told you that you have coronary artery disease. Coronary artery disease is sometimes called coronary heart disease or heart disease. Both of these terms describe a condition in which blood flow through your coronary arteries to your heart muscle is partly or completely blocked. When your heart does not get all of the blood and oxygen it needs, a heart attack can occur. You may have just learned that you have coronary artery disease or you may have had a heart attack. Either way, you probably have some questions about what happened and what changes you may need to make to prevent another heart attack or future heart problems. This book provides you with many of the tools you need to manage heart disease. Learn all that you can about your heart and the factors that put you at risk for a heart attack or other heart problems. As you read through this book you will learn that there are many things you can do to improve the health of your heart and blood vessels and your overall health. Let your friends and family members know that you are trying to make some healthy lifestyle changes. If they know these changes are important to you, they will give you the encouragement you need to move forward. Tell them what they can do to be helpful. Encourage your loved ones to learn about coronary artery disease. When they know more, they will be better able to support you in a positive way. Use this book as a step-by-step guide on how to take care of your heart so your heart can take care of you.
About your heart Coronary artery disease Angina Nitroglycerin Heart Attack Early treatment Tests Procedures
4 6 7 8 9 10 11 12
Home Recovery Activities Medications Emotions
13 14 15 16
Risk factors Use of tobacco High blood pressure Abnormal blood lipids Overweight Lack of exercise Diabetes Stress Other factors Sleep apnea
17 19 21 24 41 42 45 46 47 40
Heart healthy eating Lowering cholesterol Limiting added sugars Lowering triglycerides Food guide Food labels Label claims Cooking with less fat Alcohol
31 26 29 30 33 37 38 39 40
ABOUT YOUR HEART Learning more about your heart will help you understand how coronary artery disease affects your body. Your heart is made up of muscle. With each heartbeat, blood is pumped to all parts of your body. Blood travels from your heart to your body through blood vessels called arteries. Inside your heart there are four chambers. The upper chambers (atria) collect blood that is returning to the heart from the body. They send this blood to the lower chambers (ventricles). The lower chambers pump blood out of the heart to the body. Four valves regulate blood flow within the heart. Blood that has nourished your body enters the upper right chamber. This blood is low in oxygen. From the upper right chamber, blood passes through the tricuspid valve to the lower right chamber. The lower right chamber pumps blood through the pulmonary valve to the lungs. As blood passes through the lungs, it picks up a fresh supply of oxygen. The oxygen-rich blood then flows from the lungs into the upper left chamber. The blood passes through the mitral valve to the lower left chamber. The lower left chamber pumps blood through the aortic valve and out the aorta to the body. Right side of the heart
To the body
Left side of the heart
To the lungs From the lungs Upper chamber Upper chamber Mitral valve
CORONARY ARTERIES Your heart needs a constant supply of oxygen and nutrients. The bloodstream supplies these nutrients to your heart through the coronary arteries, the blood vessels that lie on the surface of your heart. The right coronary artery supplies blood to the right side and bottom part of your heart. The left coronary artery has two branches: Left main coronary artery
â€˘ the left anterior descending artery (supplies blood to the front left side of your heart) â€˘ the circumflex artery (supplies blood to the back of your heart)
Right coronary artery
Circumflex Left anterior descending artery
These coronary arteries have many branches. As long as the coronary arteries stay healthy, your heart gets all the blood it needs. Healthy coronary arteries Healthy arteries have smooth flexible walls allowing blood to flow freely through them. Blood carries oxygen and nutrients to all parts of the body. Unhealthy coronary arteries The health of our arteries is affected as we age. Over time, arteries harden and lose some of their ability to expand. Artery health also is affected when the inner lining of the artery is damaged. The damage is often due to a risk factor such as smoking. When the artery is damaged, fat (cholesterol) and calcium build up inside the lining of the artery, forming a substance called plaque. In time, plaque buildup narrows the artery and blocks blood flow through it. It also is possible for plaque to rupture or erode. If this happens, blood clots can form over the rupture site. Blood clots can completely block an artery and result in a heart attack or stroke. 5
AT H E R O S C L E R O S I S The buildup of plaque in the arteries is called atherosclerosis. Atherosclerosis can develop in the arteries anywhere in the body. If you have atherosclerosis in one of your arteries, there is a good chance that you have it in other blood vessels throughout your body. Coronary artery disease When atherosclerosis develops in the coronary arteries is called coronary artery disease. Atherosclerosis decreases blood flow to the heart causing chest discomfort called angina, or it can completely block blood flow, which causes a heart attack. Atherosclerosis does not develop overnight. It is a slow process that can take many years. In fact, this condition usually happens after years of lifestyle behaviors, such as smoking, physical inactivity and poor eating habits. Many people do not know that they have coronary artery disease. In time, however, symptoms occur in most people. The most common symptom is angina. Fortunately, you and your doctor can manage coronary artery disease with lifestyle changes and, possibly, medications. It is also possible that a procedure, such as angioplasty, may be needed to increase blood flow within your heart. See page 12 for procedures you may need. See page 17 for information on risk factors and healthy lifestyle changes. Work closely with your healthcare provider. Ask questions if you are unsure about any of the guidelines you are given.
ANGINA ANGINA SYMPTOMS
For a while, coronary artery disease causes no symptoms. But over time, when your heart is not getting all of the blood it needs, you may have temporary discomfort known as angina. Angina is not a heart attack. It does not cause permanent damage to the heart, but it is a symptom of coronary artery disease. Angina often occurs when the heart is pumping harder and needs more blood than usual. Physical activity, cold weather, a large meal, or an exciting or stressful event can trigger angina. Angina also can occur while you rest. Here are some areas where angina may occur:
■ pressure, tightness or heaviness in the chest, back, arms, neck, or shoulders ■ indigestion or a feeling of fullness ■ burning or aching in the throat, jaw, or chest ■ numbness or tingling ■ shortness of breath ■ fatigue ■ nausea ■ sweating Women may experience other less common symptoms. These symptoms may include pain or aching in the jaw, ear, shoulder or back, or abdominal pain.
Left of the breastbone
The entire upper chest area
Mid-chest, neck or jaw area
Even if you only have angina once in awhile and nitroglycerin relieves your symptoms, you should let your doctor know. Changes in angina may mean that immediate treatment is needed. Call your doctor if angina comes on more quickly, lasts longer, or occurs more often than usual.
Shoulder or inside one or both arms
Upper abdomen (may feel like indigestion)
Back and between shoulder blades
By working closely with your healthcare provider, you can relieve the symptoms of angina and reduce your risk of a future heart attack.
Call your doctor right away if angina comes on more quickly, lasts longer, or occurs more often than usual. 7
N I T R O G LY C E R I N Nitroglycerin is sometimes called NTG or nitro. It is often prescribed for people who have angina as a result of coronary artery disease. Nitroglycerin dilates (widens) blood vessels so more blood can get to the heart. It can be taken as a tablet or a spray. It is placed or sprayed under the tongue. How to take nitroglycerin Before you take your nitroglycerin, sit or lie down. Nitroglycerin may cause dizziness. Place the tablet or spray under your tongue. Do not chew or swallow the tablets. Nitroglycerin gets into your body through the arteries under your tongue. If you have angina: • sit or lie down • place a nitro pill or spray under your tongue (do not chew or swallow it) • wait 5 minutes If your angina is not relieved, or if the discomfort increases or intensifies: • call 911 or your local emergency number • take one more dose of nitroglycerin • wait 5 minutes If your angina is still not relieved: • take a third dose of nitroglycerin • wait 5 minutes
If after taking 1 tablet or spray your angina is not relieved or is increasing in intensity, call your local emergency number.
If your angina has not gone away or is increasing in intensity after taking 1 tablet or spray, call 911 or your local emergency number or have someone take you to the nearest emergency room. Do not drive on your own. Go right away—do not wait. Storing your nitroglycerin
Store your NTG at room temperature. Keep your NTG away from heat, moisture, and sunlight. Do not put your NTG in the refrigerator or in a plastic container. Remove the cotton from your bottle of NTG tablets. (Cotton can cause the tablets to lose strength). Get a new supply of NTG every 6 months even if you have some left. It will work better if you replace it often. Check with your doctor before using nitroglycerin if you are taking medicines for erectile dysfunction. 8
H E A R T AT TA C K H E A R T AT TA C K S Y M P T O M S
A heart attack occurs when there is a severe blockage in an artery that carries oxygen-rich blood to the heart muscle. The sudden lack of blood flow to the heart muscle deprives the heart of the oxygen and nutrients it needs. A heart attack can cause permanent damage or death to a part of the heart. Sometimes an artery can be opened up before the damage is done. Causes of a heart attack may be:
• plaque buildup inside the artery (atherosclerosis)
The symptoms of a heart attack do not go away with rest and nitroglycerin. The discomfort may last 20 minutes or more and may range from mild to severe. Warning signs of a heart attack:
• a blood clot - blood cells
■ heavy pressure or burning in the chest, back, neck, jaw, or shoulders
clump together and stick to the plaque inside an artery
• a spasm - a coronary artery
Even if you have already had a heart attack, it’s important to review the early warning signs. You may never have another one, but if you do, you and your family will know what to do.
temporarily contracts (the cause is often unknown)
Although a heart attack may be the result of any of these problems, the trigger for a heart attack is often a blood clot that has lodged in an artery that is already narrowed with plaque. In most cases, the cause of the blood clot is linked to atherosclerosis.
■ indigestion or a feeling of fullness ■ shortness of breath ■ sweating (may be a cold, clammy sweat) ■ weakness or unusual fatigue ■ dizziness or fainting ■ rapid or irregular heartbeat ■ pale or grey looking skin
When your heart muscle does not get enough blood and oxygen, it begins to change within minutes. Damage to the heart muscle can happen quickly so it is important to get help as soon as you have any of the warning signs of a heart attack. Medications may reduce the amount of damage to the heart, but they work best if they are given soon after the symptoms appear.
Women tend to have different symptoms than men. Although they may experience shortness of breath, cold sweats, weakness or unusual fatigue, they may not experience chest pain. Instead, they may feel pain high in the abdomen or chest, or in the back, neck, or jaw. They also may experience dizziness.
If you have any of the symptoms of a heart attack and they are not relieved within a few minutes with rest and nitroglycerin, call 911 or have someone take you to the emergency room right away.
Women have reported symptoms of unusual fatigue, shortness of breath, anxiety, insomnia, and indigestion in the weeks leading up to a heart attack.
E A R LY T R E A T M E N T After a heart attack, medications called thrombolytics may be given to restore blood flow. These medications dissolve blood clots that may have formed in an artery. They must be given within a few hours of a heart attack.
THE HEALING OF YOUR HEART Soon after a heart attack, scar tissue begins to form over the damaged area. New, smaller blood vessels begin to grow from the original artery. These new blood vessels supply blood to the area around the damaged heart muscle. As the new, smaller blood vessels grow in size, more blood is brought to the damaged area. Healing takes place over several weeks. Sometimes a procedure, such as angioplasty or stenting, is needed to restore blood flow to the heart. Depending upon the severity of the heart attack, the scarring of the heart muscle, and how rapidly a person gets medical care, a heart attack can lead to:
• Full recovery. Many patients recover fully. • Heart failure. Heart failure is a condition in which the heart has weakened and cannot pump well enough to meet the body’s needs.
• Heart rhythm problems. The heart’s electrical system produces signals that cause the heart to pump blood. When a part of the heart has been damaged, the electrical system can be affected. Because different coronary arteries supply blood to different areas of the heart, the severity of the damage will depend upon which artery was blocked, how much it was blocked, and how much of the heart muscle depended on that blocked artery.
New smaller blood vessels
Damaged heart muscle
T E S T S Y O U M AY H A V E These tests help identify heart damage and other heart problems. Electrocardiogram (ECG) shows the electrical activity that causes the heart to beat. The written record that comes out of the ECG machine shows heart damage or changes in the heart rhythm. Chest X-ray shows an outline of the heart and lungs on X-ray film. From this film, your doctor can see the size and shape of your heart and the condition of your lungs. Blood tests measure enzymes, substances which are stored in cells within the heart. When a heart attack occurs, damaged cells send enzymes into the blood. This test helps determine whether the heart has been damaged. Echocardiogram and transesophageal echocardiogram use sound waves to create a picture of the heart, the heart chambers, and the valves. These tests show whether the heart is pumping normally and the valves are working properly. A stress echocardiogram shows how well the heart pumps when more demands are placed on it. Nuclear scans show areas of the heart that are not getting enough blood. A safe radioactive substance is injected into the body. A special device scans areas of the heart. Stress tests show areas of the heart that may not be getting enough blood. A stress test may involve walking on a treadmill or riding a stationary bike while your heart rate and blood pressure are checked. A chemical stress test involves using a special drug to raise your heart rate so that your doctor can see how well your heart functions under stress. Different types of medications may be used during a chemical stress test. Heart catheterization shows heart damage and blocked coronary arteries. In this test, a catheter is inserted through a blood vessel in the arm, wrist, or groin and guided into the heart. Angiogram is the part of the test that involves injecting a special dye through the catheter. The dye causes the arteries to show up on X-rays so blockages or other problems can be seen. Cardiovascular 64 slice CT scan is a test that scans for coronary artery plaque. Calcification on the plaque can be measured and scored. This test can detect significant coronary artery blockage. During this test, the cylinder part of the CT scanner is placed over the chest. The scanner directs a series of X-rays through the body that are analyzed by a computer to produce a picture of a â€œsliceâ€? of the heart. This text helps identify people at risk for heart disease. Due to the amount of exposure to X-rays and the cost of the test, your doctor may suggest other tests for diagnosing coronary artery disease.
P R O C E D U R E S Y O U M AY N E E D Your doctor may suggest a percutaneous coronary intervention or PCI. Such a procedure will improve blood flow to your heart. Some of the most common procedures are listed here. Studies and trials on new procedures continue to be done. Based on your test results your doctor may recommend one of the procedures listed here or a new type of procedure. Angioplasty. Catheter with a balloon at the tip presses plaque against artery walls leaving a wider opening for blood flow. Many times, angioplasty also involves the insertion of a stent. Stents. A stent is a small mesh device that is placed in an artery to keep it open so more blood can get to the heart muscle. Restenosis An artery clearing procedure, such as angioplasty or stents, can cause tiny cracks in the artery lining. New tissue then forms to repair the tiny cracks. This new tissue growth can cause re-narrowing in the artery. It is possible for the area where a stent has been placed to become blocked again by tissue growth. This is called restenosis. In some cases, a medicine-coated stent is used to prevent restenosis. A medicine-coated stent releases medicine that reduces the amount of scar tissue that forms in the artery. This type of stent also may be used to help keep the artery open. Bypass surgery In bypass surgery, a blood vessel from another part of the body is used to bypass a blocked artery. The transplanted vein or artery, known as a graft, carries blood to the Graft using the heart muscle beyond the blocked saphenous area. A vein from the leg, an vein artery from the forearm, or an artery from the chest, may be used as a graft. 12
Graft using the internal mammary artery
Graft using the saphenous vein
H O M E R E C O V E RY A F T E R A H E A R T AT TA C K Recovery time depends on the severity of your heart attack. The time it takes to recover may range from 2 to more than 6 weeks. During the first few weeks, try not to do too much too soon. As you recover, you can slowly return to your activities. At first, you will probably be able to: • read, watch TV, play cards, do light meal preparation • knit, sew, do handwork or crafts • ride as a passenger in a car, climb stairs (slowly) As you get stronger, you will probably be able to: • do laundry, do light housework, do yard work • attend social events, do regular physical activities • do more strenuous recreational activities Concentration and visual changes You may have trouble concentrating. Slight visual changes may make it hard for you to read for long periods. In time these symptoms will go away. Driving & travel As you get stronger, you
Do not drive a car, motorcycle, tractor, or can do more strenuous recreational activities. any other motor vehicle for at least 1 to 2 weeks after you go home. While you are recovering, your reaction time may be slower than usual. Talk to your doctor before you take a trip. Discuss how you can get medical care if you need it. Put your medication in the luggage you carry with you. Hot & cold Hot and cold temperatures make your heart work harder. Try to stay inside on very cold days. If you go out, wait until the warmest time of the day. When you are out in the cold, cover your mouth and nose with a scarf or mask. When it is very hot, go out early in the day or later in the evening. Avoid strenuous outdoor activities when it is very hot or very cold. Lifting Do not lift anything heavier than 5 to 10 pounds for at least 2 weeks (or for as long as your doctor tells you to avoid lifting).
Rest Get up and move around as much as you can without becoming overtired. Plan rest periods for napping, reading, or relaxing. Get plenty of sleep each night. Do not stay up late one night and try to catch up the next. Rest for 20 to 30 minutes after eating a full meal. Sexual activity The amount of stress on your heart during sex is about the same as climbing 2 flights of stairs. If you can do this, you should have no problems having sex. It is best to wait 1 to 3 hours after eating a full meal before having sex. Do not drink alcohol for at least 3 hours before having sex. Use positions that won’t strain your upper body. If you have shortness of breath or chest discomfort while having sex, stop. Rest for a few minutes. Take nitroglycerin. Your doctor may suggest taking NTG 15 minutes before having sex to prevent symptoms. If Viagra is taken with certain heart medications, it is possible for a drug reaction to occur. Talk to your doctor before taking Viagra . ®
Cardiac rehabilitation Getting involved in cardiac rehabilitation may be an essential part of your treatment plan. You may be referred to a program in your community or in a community near your home. A cardiac rehab program provides guidelines for exercise and lifestyle changes that can reduce your risk for another heart attack. Specially trained staff will teach you how to start an exercise program. You also will learn how to stop smoking (if you are a smoker), eat healthfully, control your weight, and manage stress. Participating in a cardiac rehab program is one of the best things you can do to reduce your risk of another heart attack and improve your overall health. Work Many people can go back to work in a few weeks. When you return to work depends on your condition and the type of job you have. Ask your doctor when you can go back to work. 14
M E D I C AT I O N S You may be placed on certain types of medications that will help treat your coronary artery disease. The medications listed here may reduce the risk of death for people who have heart disease and for people who have had a heart attack. ACE inhibitors improve blood flow to and from the heart and also may be used for blood pressure treatment. Over-the-counter anti-inflammatory medications, such as ibuprofen or Aleve® (naproxen), can interfere with the effect of ACE inhibitors. Check with your doctor before taking over-the-counter medications. Beta blockers decrease the heart rate and stabilize heart rhythm. When you begin to take a beta blocker you may feel light headed when you get out of bed or get up from a chair, or you may notice a slow heartbeat. If these symptoms trouble you, discuss them with your doctor. Antiplatelet medications help prevent the formation of blood clots in the blood vessels going to and from the heart. Plavix® is an antiplatelet medication that may be prescribed to a person who has had a stent placed in a coronary artery. This medication should not be stopped without your doctor’s approval. Since antiplatelet medications may cause or contribute to bleeding, it is important to report any unusual bleeding to your doctor. Lipid-lowering medications help lower cholesterol levels and stabilize the blood vessels going to and from the heart. Various medications can help lower blood cholesterol levels. They may be prescribed individually or in combinations. Side effects from most lipid-lowering medications are mild and generally go away as your body adjusts to to them. Although it is rare, these medications can affect your liver. Your doctor may order tests from time to time to check your liver function. Entresto is a medication that may be prescribed for certain people with chronic heart failure. Heart failure can occur after a heart attack and is included here because it has been shown to reduce the risk of death for a person with heart failure. This medication helps lower the risk for complications and frequent hospitalizations due to worsening symptoms. It contains a combination of two medications: Sacubitril and Valsartan. Sacubitril is a blood pressure medication which increases levels of certain proteins in the body that can dilate (widen) blood vessels. Valsartan is a blood pressure medication which keeps blood vessels from narrowing, thereby lowering blood pressure and improving blood flow.
COMMON MEDICAT IONS
ACE INHIBITORS Generic name Quinapril Perindopril Ramipril Captopril Benazepril Trandolapril Lisinopril Fosinopril Enalapril BETA BLOCKERS Generic name Sotalol Nebivolol Carvedilol Nadolol Propranolol
Brand name Accupril® Aceon® Altace® Capoten® Lotensin® Mavik® Prinivil® & Zestril@ Monopril® Vasotec®
Brand name Betapace® & Betapace AF® Bystolic® Coreg® & Coreg CR® Corgard® Inderal® & Inderal XL®
Betaxolol (generic only) Metoprolol Lopressor® & Toprol XL® Acebutolol (generic only) Atenolol Tenormin® Labetalol (generic only) Bisoprolol (generic only) ANTIPLATELET MEDICATIONS Generic name Brand name Aspirin (generic only) Clopidogrel Plavix® Prasugrel Effient® Ticagrelor Brilinta® LIPID-LOWERING MEDICATIONS Generic name Brand name Lovastatin & Niacin Advicor® Lovastatin Altoprev® Rosuvastatin Crestor® Fluvastatin Lescol XL® Pitavastatin Lovalo® Atorvastatin Lipitor® Pravastatin Pravachol® Simvastatin & Ezetimibe Vytorin®
YOUR EMOTIONS Having a heart attack can be a frightening experience. Under the circumstances, you may have some lingering concerns about your health. Some people also are bothered by depression. After having a heart attack you need to take care of yourself mentally as well as physically. By doing so, you’ll give yourself the best chance of having a full recovery. • Tell your family members and friends how you feel. Sharing your feelings with others can be a great source of comfort. Strong supportive relationships are especially important at this time. • Get back to your routines as soon as you can. Return to the hobbies and activities that you enjoy. Doing this will improve your outlook and bring some order to your life. • Exercise regularly, as directed by your doctor. In addition to improving your heart health, exercise also helps relieve anxiety, depression, and other difficult feelings. • Join a cardiac rehab program. These programs can help with depression. Rehab addresses issues such as reducing stress and managing anger. Such a program allows people to share feelings with others who have had similar experiences. This may give you a chance to hear how others are making healthy changes. • Ask for help if you need it. It is not unusual to have some degree of depression after having a heart attack, but if you are still depressed after 6 to 8 weeks, talk to your doctor. Participating in counseling and/or taking medications can reduce the symptoms of depression and improve the quality of your life. Family support • Encourage your loved one to talk. He or she may feel a little down or irritable. Talking about these feelings will help everybody feel better. • Work together. Lifestyle changes will be easier if you work together. Perhaps you can help your loved one choose healthy foods or stop smoking. You may want to start an exercise program together. Ask how you can help. Family members live together, eat together, and can influence one another’s attitudes toward exercise, diet, portion sizes, and other factors that have an impact on heart health. Be a good example by making healthy changes in your own life and encouraging your loved one to do the same. • Be understanding. We all cope in different ways. Accepting these differences and making communication a priority will strengthen your relationship in the weeks ahead. 16
R IS K FA CTO R S Risk factors are habits or characteristics that increase a person’s chance of developing blockage in the coronary arteries. There are some risks, such as age, that you can’t do much about. But if you reduce the risks you can control, you may be able to prevent future heart and blood vessel problems.
RI SK FAC TO R S Y O U C A NN O T C H AN G E There is good reason to be aware of the risk factors you cannot change. Knowing all your risk factors can make you more determined to reduce those risk factors that you can change. Age. When men reach age 45, the risk for cardiovascular disease increases. For women, the risk increases at age 55. As we age, fatty deposits build up inside arteries at a more rapid rate. Women often see an increase in total cholesterol, LDL cholesterol and weight after menopause occurs. Gender. Men are more likely than women to develop cardiovascular disease at an early age (before the age of 55). But women are at equal risk after menopause or surgical removal of the ovaries, especially if they have other risk factors. Family history of cardiovascular disease. You can inherit your parents’ risk of disease just as you can inherit their height or hair color. Based on genetics you can inherit a risk of high cholesterol and heart disease. For instance, if your mother or sister had heart disease, especially before the age of 65 –– or if your father or brother had heart disease, especially before age 55 –– your risk is higher.
Women and heart disease Many women think that heart disease is a man’s disease, and they may not do what they can to protect themselves. However, starting at about age 55, cardiovascular disease kills more women than breast cancer. And yet, cardiovascular disease is not for older women only. Every year thousands of women under the age of 45 have a heart attack. The risk rises for women who smoke, are overweight, have diabetes, have high cholesterol, have high blood pressure and lead inactive lives. Please share this information with your female friends and family members. Encourage them to do what they can to reduce their risks of developing cardiovascular disease. No matter what your age, you can improve your health by knowing the risks and doing what you can to reduce them.
R IS K FA CTO R S YO U CA N CH A N G E Here are the risk factors you can change: • use of any type of tobacco • high blood pressure • abnormal blood lipids (such as cholesterol and triglycerides) • being overweight • lack of regular exercise • diabetes or high blood sugar • poor management of stress There is no easy, effort-free solution that’s going to decrease your risk of cardiovascular disease, but your behavior does make a difference. You can have an impact on your cardiovascular risks by not smoking, maintaining a healthy weight, following a heart-healthy diet, being physically active and learning to manage stress. Getting started Know your family history. Find out which risk factors you have. It’s important to know if you have high blood pressure or abnormal blood lipids. Ask your healthcare provider which need your attention first. Then plan how you will make the necessary lifestyle changes. Lifestyle changes are easier to make when you have the support of others. Your family and friends want to be supportive, but they may not know how. Let them know what they can do to help. Give them specific examples, such as: • helping you shop for healthy foods and avoiding buying and eating junk food at home • asking them to exercise with you • asking them to help you quit smoking by not smoking around you, providing encouragement or helping you keep busy when you feel the urge to smoke
R I S K FA C T O R - U S E O F T O B A C C O SMOKING TRIGGERS
Tobacco tightens blood vessels, raises blood pressure and makes the heart work harder. The chemicals in tobacco products can damage the protective lining inside the arteries. All forms of tobacco, such as cigarettes, e-cigarettes, cigars, pipes and smokeless tobacco, affect the heart and blood vessels. Electronic nicotine delivery systems Electronic nicotine delivery systems are sometimes called vapes, vape pens, e-cigarettes and e-hookahs. These devices mimic the experience of smoking a cigarette. They usually contain a combination of nicotine and solvent carriers, such as glycerol, propylene and/or ethylene glycol, as well as a number of other chemicals. They work by heating the liquid inside to a high enough temperature to create an aerosol or “vapor” that is inhaled and exhaled. You may be tempted to switch to electronic cigarettes as a way to transition to not smoking or you may believe these devices are safe when compared to other forms of tobacco. Scientists are still studying the effects of using electronic nicotine delivery systems, but evidence suggests that people who use these devices increase their odds of suffering a stroke or a heart attack or developing heart disease or lung disease. While research has found that there may be fewer chemicals in an e-cigarette than a regular cigarette, remember that electronic nicotine delivery systems still contain nicotine and other chemicals which can damage the heart and blood vessels. These devices expose your body to all kinds of chemicals. We don’t yet know how these chemicals will affect your body in the long term. Electronic nicotine delivery systems are not considered a safe alternative to smoking or a safe and effective way to stop smoking. These devices are just as addictive as other regular tobacco products. If you have coronary artery disease and keep using tobacco in any form or an elecctronic nicotine delivery system, you increase your risk of having future heart problems. If you use these products, make the decision to quit –– for yourself and those who love you. Some people taper off by reducing the number of cigarettes they smoke until they are no longer smoking. Other people quite all at once. There are also many types of nicotine replacement products that may help you quit, but you should talk to your healthcare provider before you try them. Since the nicotine in these products can affect your heart, your healthcare provider may not want you to use them.
A trigger can be an emotion, place, or time that makes you want to smoke. Some common triggers are: - being around smokers - drinking alcohol - feeling hungry - feeling tense or stressed - drinking coffee - taking a break at work - talking on the telephone - driving in the car - watching television List your triggers. Plan ahead for how you will cope with them. How can you cope? ■ ask friends or family members not to smoke around you ■ avoid drinking alcohol while you are trying to quit ■ have healthy foods and snacks around when you feel hungry ■ practice some of the relaxation techniques on page 42 or exercise to release tension ■ switch to fruit juice or water instead of coffee if coffee triggers your urge to smoke ■ keep your hands busy doing something else when you are on the phone ■ listen to your favorite music or an audio book while you are in the car and keep your ashtray full of sugar-free candy or gum ■ don’t sit in a spot where you used to smoke - choose a different room or a different chair and keep healthy snacks nearby
STOP-SMOKING TIPS BEFORE YOU QUIT
■ get rid of all the tobacco in your home, car, and at work ■ throw away all the ashtrays and cigarette lighters ■ don’t allow smoking in your home ■ dry-clean your favorite clothes ■ have your teeth cleaned ■ clean your home and carpets ■ clean your car and fill the ashtray with sugar-free candy, gum, or toothpicks Get the support you need Surround yourself with people who will be supportive. Talk with other people who have quit smoking. Have one or two people you can call if you need a word of encouragement. Ask your friends and family members not to smoke around you. Let them know how they can help you quit. You and only you Experts can offer advice. Supportive friends can be a blessing. But no expert or friend can do it for you. The responsibility for quitting is yours. Plan ahead and choose a time that’s right for you. What do you have to gain? Improved health. Energy. Confidence. Self-respect. Freedom!
If you’ve tried to stop smoking in the past and failed, don’t give up. Most people try to stop several times before being successful. Research shows that the odds for quitting are greater if you get the support you need and/or take medication that lessens the urge to smoke. If you need additional support, join a stop-smoking program or call your state’s telephone Quit Line, which you can access by calling 800-784-8669. You also may want to ask your doctor for help. A non-nicotine therapy, which includes prescription medication that lessens the urge to smoke and decreases withdrawal symptoms, may be recommended. Treatment with these medications often begins a few days or weeks before your quit date, so if you would like to try medication, you will need to plan ahead. Withdrawal symptoms can be the most difficult part of quitting. Symptoms may include fatigue, irritability, insomnia, coughing, constipation and an increased appetite or cravings for sweets. • When you feel irritable, moody, or tense take a long walk or do something relaxing, such as listening to music or working in your garden. • If you feel fatigued, exercise to boost your energy level. Cut back on caffeine, and get plenty of sleep each night. Take a nap if you need one. • When you have trouble sleeping, avoid caffeine in the afternoon or evening. Exercise earlier in the day. Go to bed at the same time each night. Practice the relaxation exercises on page 46. • To ease coughing, drink plenty of water, juice, or warm tea. • If you are bothered by constipation, drink 6 to 8 glasses of water each day. Eat high-fiber foods, such as apples, prunes, citrus fruits, whole grain breads, and high-fiber cereals. • To combat an increased appetite, drink plenty of water and eat several small meals during the day (eat every 2 1/2 to 3 hours).
R I S K FA C T O R – H I G H B L O O D P R E S S U R E Blood pressure is the force of blood pushing against artery walls as your heart contracts and relaxes. When blood pressure is too high, it puts strain on your heart and damages your arteries. It’s possible to have high blood pressure and not know it because there may not be any symptoms. Uncontrolled high blood pressure increases your risk of a heart attack and stroke. Fortunately, high blood pressure can be easily detected. Once you know you have it, you can work with your healthcare provider to control it. To control your blood pressure: • Give up tobacco. The chemicals in tobacco narrow arteries and contribute to high blood pressure. • Lose weight if you are overweight. When you are overweight, your body needs more blood in order to supply your tissues and organs with the blood and oxygen they need. As the amount of blood moving through your blood vessels increases, so does your blood pressure. Even a 10 to 15 pound weight loss can help lower high blood pressure. The best way to lose weight and keep it off is to commit to long-term lifestyle changes. • Exercise regularly. Most experts recommend at least 30 minutes of aerobic exercise on most days. • Limit the amount of alcohol you drink. Drinking too much alcohol can damage your heart. Having more than 2 or 3 drinks in a sitting also can temporarily raise your blood pressure. Ask your healthcare provider for advice on drinking alcohol • Learn healthy ways to manage stress. High levels of stress can lead to increases in blood pressure. If you try to cope with stress by using tobacco or drinking alcohol, you may have even more problems with high blood pressure. See page 42 for information on coping with stress.
Eat less sodium to control your blood pressure: Eating too much sodium causes your body to retain fluid, which increases blood pressure. The U.S. Dietary Guidelines set the daily sodium limit for adults at 2,300 mg. However, the recommendation is lower for certain people. You should consume no more than 1,500 mg. per day IF: • you are 51 years of age or older • you have heart disease • you have high blood pressure
• you have diabetes or pre-diabetes • you have chronic kidney disease • you are African American
Sodium is found in nearly every processed food — in frozen and canned vegetables; in boxed or frozen convenience meals; in cheese; in processed meats; in soups; in pickles and other condiments; in seasonings and cooking ingredients; in chips, nuts, and other snack foods. Cutting back on these foods will decrease your sodium intake, which can help you control your blood pressure. • Limit or avoid packaged or convenience foods, such as prepared dinners, deli foods, frozen entrees, or canned soups. Also avoid salty snack foods. • Limit high-sodium bottled sauces and condiments, such as chili sauce, soy sauce, steak sauce, teriyaki sauce, and any product that contains MSG (monosodium glutamate). Go easy on salad dressing. Even the low-fat versions may be high in sodium. If you use bottled dressing, try dipping the salad bites instead of pouring dressing over the salad. • Buy fresh meats, such as chicken, fish, pork, and beef. Avoid cured or smoked meat, and meat that has been marinated. • Buy fresh or plain frozen vegetables instead of vegetables with sauces or canned vegetables. If you use canned vegetables, use the unsalted version or rinse before eating. • Season your foods with fresh herbs, such as chives, basil, dill, garlic, and thyme, or fresh lemon juice. Use no-salt seasonings instead of high-sodium condiments. An eating plan that many heart patients are encouraged to follow is called the DASH Eating Plan. It is designed to help patients decrease sodium, saturated fat, and trans fat AND increase nutrients, such as potassium, calcium, magnesium, protein and fiber. Ask your healthcare provider for information on the DASH Eating Plan. For a copy of the plan go to: www.nhlbi.nih.gov.
If your blood pressure isn’t lowered enough by diet, exercise, and other measures, one or more medications may be prescribed to help lower your blood pressure. There are many types of medications, so it may take some time to find the medication that works best for you. If you have trouble with your medication, tell your doctor. Your medication or the dose may need to be adjusted. Blood pressure medications should not take the place of lifestyle changes. 22
HIGH BLOOD PRESSURE As health care professionals and researchers learn more, medical guidelines often are updated. The American Heart Association released new blood pressure guidelines. Here are the latest blood pressure guidelines: American Heart Associationâ€™s 2018 Blood Pressure Guidelines: Category
Systolic (Upper #)
Diastolic (Lower #)
Less than 120
Less than 80
120 to 129
Less than 80
High blood pressure
130 to 139
80 to 89
140 or higher
90 or higher
Higher than 180
and / or
higher than 120
(Hypertension) Stage 1
High blood pressure (Hypertension) Stage 2
Contact your doctor immediately if you have a hypertensive crisis.
Since blood pressure recommendations may vary, ask your healthcare provider for advice regarding blood pressure levels that are right for you. Taking your own blood pressure If you have high blood pressure, your healthcare provider may want you to buy a blood pressure kit so that you can take your blood pressure at home. When taking your blood pressure, sit with your back straight and your feet flat on the floor. It is a good idea to sit in a chair with a straight back. Do not cross your legs. Make sure the bottom of the cuff is placed directly above the bend of the elbow. Follow the instructions that come with your monitor. Take your blood pressure at the same time every day. To be sure your reading is accurate, take two or three readings one minute apart. Keep a record of your readings and take it with you when you see your healthcare provider. Check with your healthcare provider if you have any questions about your blood pressure readings. 23
R I S K FA C T O R – A B N O R M A L B L O O D L I P I D S A blood test will measure blood lipids. A lipid panel will provide your doctor with several different values, including total cholesterol, LDLs, HDLs, and triglycerides. Cholesterol is a waxy fat that circulates through your body in your blood. Most cholesterol is made by your body. The rest of it comes from the foods you eat. A certain amount is needed for good health. But if there is too much cholesterol in your blood, the extra amount builds up inside your arteries in the form of plaque. Cholesterol is carried through your bloodstream in packages made of fat and protein called lipoproteins. There are many lipoproteins. The most common are LDLs and HDLs. Low density lipoproteins - LDLs travel through the bloodstream and are used by the cells. LDLs that are not used stay in the bloodstream where they collect in the arteries. LDLs are called “bad” cholesterol because they tend to block the arteries. High density lipoproteins - HDLs - mop up the leftover LDLs and send them back to the liver, where they are reprocessed or removed from the body. HDLs are called “good” cholesterol since they clear the arteries of harmful LDL cholesterol. Low levels of HDLs increase your risk for heart disease.
LDLs block arteries
HDLs mop up LDLs
Triglycerides are another type of fat found in the blood. Your body uses triglycerides for energy. A high level of triglycerides relates to higher levels of LDL (bad) cholesterol. A diet that is rich in sugar, certain carbohydrates, alcohol, and fat may increase triglyceride levels in the blood. Blood glucose levels If your HDLs are low and your triglycerides are high, your doctor may want you to have a blood glucose test, which will check your blood glucose (sugar) levels. When blood glucose levels are too high, your arteries can be damaged. High blood glucose may increase your risk of a heart attack or stroke. 24
THE HDL / LDL BALANCE The higher the level of LDL cholesterol, the more likely you are to have blockage in your arteries. Your total cholesterol may be only slightly high, but if your LDL (bad) cholesterol is high and your HDL (good) cholesterol is low, your risk for coronary artery disease increases. A blood test called a lipid profile will provide information on your total cholesterol, LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. How often should your cholesterol be tested? The answer depends on your age and your risk factors for coronary artery disease. Discuss testing with your healthcare provider. Lifestyle changes â€“ including losing excess weight, increasing your physical activity, and following a healthy diet â€“ are very important in the fight against high cholesterol. Losing even 5 to 10 pounds of excess weight can help lower total cholesterol levels. Regular exercise can help you maintain a healthy weight, lower triglyceride levels, and boost HDL (good) cholesterol. Cholesterol-lowering medications If lifestyle changes do not lower your cholesterol enough, medications may be prescribed to help lower your total cholesterol and your LDL (bad) cholesterol levels. If cholesterol-lowering medication has been prescribed for you, take it exactly the way your doctor tells you to. Remember, medications work best when combined with healthy lifestyle changes.
Heart healthy guidelines Your total cholesterol should be:
less than 200
If you have coronary artery disease, your doctor may want you to keep your cholesterol: below 150-160
Your LDL (bad) cholesterol should be:
Your LDL cholesterol goal is dependent on many factors including your age, your overall health and changing guidelines. Ask your doctor what your LDL CHOLESTEROL goal should be.
Your triglycerides should be:
less than 150
Your fasting blood glucose should be:
less than 100
Your HDL (good) cholesterol should be:
more than 40
Women may be advised to keep their HDL cholesterol at:
more than 50
Total cholesterol: _____________ LDL cholesterol: _____________ Triglycerides: _____________ Blood glucose: _____________ HDL cholesterol: _____________ 25
LOWERING YOUR CHOLESTEROL Some people have high cholesterol because their bodies make too much or do not use it up. But for many of us, high cholesterol is caused by eating too much saturated fat and trans fat. To keep your LDL (bad) cholesterol and your risk of heart disease low, reduce your intake of total fat and saturated fat and avoid trans fats altogether. • Eat less total fat. Fat may be saturated, polyunsaturated, monounsaturated or a mixture of these fats. Research shows that reducing the amount of saturated fat you eat and cutting trans fats from your diet are even more important than the amount of total fat you eat. • Eat less saturated fat. Saturated fat raises LDL (bad) cholesterol. It is found in animal foods such as fatty cuts of meat, butter and full-fat dairy products. A few vegetable fats, such as coconut and palm oil, also contain saturated fat. • Avoid trans fats. There are two sources trans fats: natural (found in small amounts in foods such as milk, meat and cheese) and artificial (found in processed foods). Most of the trans fats in our diet come from the artificial kind. Artificial trans fats are dangerous because they raise LDL (bad) cholesterol levels and can contribute to coronary artery disease. Trans fats are produced in a process called hydrogenation, which hardens unsaturated oils. Butter, stick margarine and shortening, which are often used in making such products as cookies, crackers and snack chips, contain trans fats. Trans fats have to be listed on the food label unless the product contains less than 0.5 grams per serving. Some products are labeled “zero trans fats” but they may still contain small amounts. Small amounts of trans fats per serving may pose a health risk if you eat several servings of the food. The Food and Drug Administration plans to remove trans fats from food products in the future. For now, read labels carefully. Check the ingredients lists for partially hydrogenated vegetable oil or shortening. Avoid trans fats altogether. Cholesterol Cholesterol is found in animal foods, such as lamb, organ meats, shellfish and egg yolks. New research suggests that eating foods which are high in cholesterol may not have much of an effect on the levels of cholesterol in your blood. The cholesterol made by your body and dietary fats, such as saturated fat, may be more likely to determine whether you have high LDL (bad) cholesterol. More research may be needed before we know how dietary cholesterol can affect blood cholesterol. For now, experts suggest asking a registered dietitian for advice on cholesterol. 26
U N S AT U R AT E D FA T S Unsaturated fats are better for your heart than saturated fats. There are two kinds of unsaturated fats: polyunsaturated and monounsaturated. Polyunsaturated fats Polyunsaturated fats are found mostly in plant-based foods and oils. Studies show that eating a diet rich in polyunsaturated fats may improve cholesterol levels. Research also sugests that polyunsaturated fats may help control blood sugar levels. Examples of polyunsaturated fats are: • corn oil • flaxseed oil • sesame oil
• soybean oiil • sunflower oil • sunflower seeds
Monounsaturated fats Monounsaturated fats are found in a variety of foods and oils. Studies show that eating foods that are rich in monounsaturated fats may improve cholesterol levels. Research suggests that monounsaturated fats may help control blood sugar levels. Examples of monounsaturated fats are: • canola oil • olive oil • peanut oil
• most nuts • avocados • safflower oil
Since unsaturated fats are still high in total fat and contain as many calories as saturated fat, you should limit the amount you use. Talk to your dietitian about the use of unsaturated fats in your diet. It is a good idea to discuss any dietary questions you may have with a registered dietitian. Your healthcare provider may be able to help you get in touch with a registered dietitian in your area.
Cut back on saturated fat: butter lard bacon fat cream ice cream sour cream fatty cuts of red meat poultry skin many fast foods deep fried foods many processed foods cocoa butter coconut oil palm oil whole-milk full-fat dairy products fried foods pastries solid shortening vegetable shortening Cut back on cholesterol: egg yolks shellfish (like shrimp and lobster) organ meats (like liver) Use unsaturated fats in place of saturated fats. Unsaturated fats include: corn oil canola oil flaxseed oil olive oil sesame oil peanut oil safflower oil most nuts soybean oil avocados sunflower oil sunflower seeds
Avoid trans fat: butter stick margarine shortening ready-made frosting some microwave popcorn many fast foods many processed foods high-fat baked goods - most cakes, cookies, pie crusts snacks chips - potato, corn & tortilla chips fried food - deep fried foods, such as french fries, doughnuts & fried chicken can contain trans fats from the oil used to prepare them refrigerator dough - canned biscuits, cinnamon rolls & frozen pizza crusts can contain trans fats
Products that list partially hydrogenated or hydrogenated vegetable oils in their ingredients contain trans fats. Read labels carefully to determine if the food contains trans fat.
LIMITING ADDED SUGAR The American Heart Association recommends that: • women should get no more than 100 calories a day from added sugar (that amounts to about 6 teaspoons of sugar a day or 24 grams) • men should get no more than 150 calories a day from added sugar (that amounts to about 9 teaspoons of sugar a day or 36 grams) This recommendation refers to added sugars and syrups, such as white, brown or raw sugar, honey and high-fructose corn syrup, that are added to foods or beverages when they are processed. Added sugars do not include naturally occurring sugars such as those found in fruits. Major sources of added sugars are:
A 12 oz. can of regular soda has 39 grams of added sugar, which equals about 8.75 teaspoons of sugar or 140 calories.
• soft drinks, fruit drinks and fruitades • sweetened coffee, tea and energy drinks • alcoholic beverages • snacks & sweets which include grain-based desserts (such as cakes, pies, cookies, doughuts, sweet rolls & pastries) • dairy desserts & milk products (such as ice cream and sweetened yogurt & milk) • other grain based foods such as cinnamon toast and waffles Don’t be fooled! Some high-sugar ingredients include: • brown sugar & raw sugar • corn sweetener • corn syrup & malt syrup • dextrose & lactose • fructose & high fructose • fruit juice concentrates Why should you be careful of added sugar?
• glucose • honey & invert sugar • maltose • molasses • sucrose • turbinado sugar
Sugary junk food should list sugar first in ingredients list if the product is high in sugar, but this is not always the case. Because of the many forms of sugar, such as the ones listed here, that are often in the food, you may not realize that the food is high in sugar. These many forms of sugar can add up and cause the food to be very high in sugar.
Scientists have long known that eating too much sugar can lead to obesity and high cholesterol. Studies also indicate that eating too much sugar could greatly increase your risk of developing or dying from cardiovascular disease. How excess sugar may harm the heart is not yet clear. Scientists believe that a high-sugar diet may cause the liver to release more harmful fats into the bloodstream. In addition, eating too much sugar can lead to inflammation in the body, which may be a contributing factor in the development cardiovascular disease. Choosing unsweetened beverages and unprocessed foods can make a big difference in your sugar intake. 29
L O W E R I N G Y O U R T R I G LY C E R I D E S Like cholesterol, triglycerides are a lipid (fat) that circulates in your blood. You need some triglycerides for good health, but if your triglycerides are too high, they can increase your risk of heart disease. High triglycerides also may be a sign of a condition called metabolic syndrome, a group of medical problems that increase your risk for heart attack and stroke. (See page 47 for information.) High triglycerides are associated with high levels of LDL (bad) cholesterol and low HDL (good) cholesterol levels. It is important for your HDL cholesterol to stay high, since it clears the arteries of harmful LDL cholesterol. To lower your triglycerides, the American Heart Association suggests these guidelines: • Lose weight if you are overweight. Losing just 10 to 15 pounds can help lower your triglycerides. • Limit or avoid sugary foods and drinks. Triglycerides go up when you eat a lot of sweets such as cakes, candy, pastries, fruit juices, sugary soft drinks, sugary cereals and many prepared foods. • Limit refined carbohydrate-containing foods. White rice and bread and pasta made from white flour can contribute to high triglycerides in sensitive people. Instead, choose small amounts of whole grains such as whole grained breads, whole wheat pasta, brown rice and other grains whenever possible. • Cut back on cholesterol and saturated fat. Foods high in cholesterol and saturated fat can contribute to high triglycerides. Trade saturated fats for unsaturated fats found in plant-based foods. Avoid foods which contain trans fats. • Include fish in your diet. Eating fish twice a week, especially fish high in Omega-3 fatty acids such as salmon and tuna, may help lower triglycerides. • Choose high-fiber foods. Eating foods that are high in soluable fiber can help you lower your triglycerides and LDL (bad) cholesterol. Some high fiber foods include beans, whole grains, ground flax seed and high fiber cereal. Be sure to drink more water when you increase your fiber intake. It is also wise to increase your fiber slowly. • Watch your alcohol intake. Alcohol is high in calories and sugar and has a strong effect on triglycerides. For people who are sensitive, even a small amount of alcohol can raise triglyceride levels. The type of alcohol doesn’t seem to matter, beer, wine or mixed drinks can contribute to high triglyceride levels. Ask your doctor if you can have alcohol. Follow your doctor’s guidelines on alcohol use. Sometimes medication also is needed to help lower triglycerides. Talk to your doctor about keeping your triglyceride levels within a healthy range. 30
H E A R T- H E A LT H Y E AT I N G Heart-healthy eating is not just about cutting back. Many foods contain substances that may help protect you from coronary artery disease. You may be advised to add or eat more of certain foods, such as soluble fiber, omega-3 fatty acids, and plant sterols and stanols. Soluble fiber Foods that are high in soluble fiber may help lower your cholesterol. These high-fiber foods may even help regulate your blood sugar (glucose), and they help you feel full sooner, so you feel like eating less.Some of the foods which are high in soluble fiber include: • apples, prunes, & citrus fruits • high-fiber cereals (with oat bran or oatmeal) • dried beans (like pinto, kidney, navy beans & chick peas) • whole-grain breads & barley Omega-3 fatty acids Omega-3 fatty acids seem to positively influence a number of factors related to protection from coronary artery disease. You will find omega 3s in these foods: • fish - fresh tuna & fatty, cold-water types (such as salmon, mackerel, herring, lake trout & white fish) • fish oil capsules • ground flax seed • vegetable oils (such as canola, flaxseed, & walnut oil) • soybeans • some nuts (such as walnuts & almonds) Note: While some types of nuts are high in omega-3s, they also may be high in calories and carbohydrates. Ask your dietitian which nuts are the best choices. Limit the amount you eat to no more than 1 ounce. 31
P L A N T S T E R O L S A N D S TA N O L S Plant sterols and stanols are natural substances which are found in the cell membranes of all plants. These plant substances block the absorption of cholesterol in your body. Research has shown that eating foods which contain plant sterols and stanols may lower total cholesterol up to 10 percent and LDL (bad) cholesterol up to 14 percent. This reduction is in addition to the other healthy lifestyle changes a person may make to help lower cholesterol. The National Cholesterol Education Program recommends that people with high cholesterol include 2 grams of plant sterols and stanols each day. A few foods which contain plant sterols and stanols are wheat germ, wheat bran, peanuts, vegetable oils, almonds and Brussels sprouts. It is difficult to get enough of these substances from foods alone so some food manufacturers are adding them to their food products. Here are some commercial products with added plant sterols and stanols: Benecol® spread (a margarine-like spread) Promise Activ® (a margarine-like spread) Smart Balance® Heart Right Buttery Spread (a margarine-like spread) Minute Maid® Premium HeartWise orange juice Health Valley® Heart Wise cereal Nature Valley® Heart Healthy granola bars Oroweat® whole grain and oat breads VitaTops® Muffin tops Yogurt and dairy products fortified with plant sterols and stanols Plant sterols and stanols have been studied for many years and researchers tell us that they are safe and effective for lowering cholesterol levels. However, they caution us to avoid large doses of plant sterols and stanols because in large amounts these substances can cause nausea, indigestion and diarrhea. Plant sterols and stanols also can interfere with the absorption of fat-soluble vitamins. Women who are pregnant or breastfeeding should check with their healthcare providers before eating foods that have been fortified with plant sterols and stanols. There are over-the-counter dietary supplements available which contain plant sterols and stanols, however, it is a good idea to discuss them with a registered dietitian before you decide to take this type of supplement.
Remember, eating foods which contain plant sterols and stanols are safe and healthy in small amounts, but they are not a substitute for taking cholesterol-lowering medication and making other healthy lifestyle changes. Plant sterols and stanols work well along with cholesterol medication. If you have questions about these substances, talk to a registered dietitian.
FOOD GUIDE This guide is for people who have been advised to cut down on sodium, fat, calories and cholesterol. The amount of sodium, fat, and cholesterol a food contains varies based on the brand. Read food labels to determine whether the food is a good choice for you.
Breads, cereals, pasta, rice, dried peas and beans (6 to 11 servings a day) Always check the serving size.
Choose Whole grains such as breads, English muffins, bagels, and buns made with whole wheat, whole rye, or whole corn. Whole grain crackers Reduced-fat cookies, muffins, cornbreads and quickbreads made with whole grains. Whole-grain hot cereals or cold cereals, such as oatmeal
Go easy on
Limit or avoid
Packaged and store-bought mixes like pancakes, waffles, biscuits, muffins, and cornbread that are made with refined grains
Croissants, butter rolls, sweet rolls, Danish pastry, doughnuts
Starchy vegetables (1/2 c. = 1 serving)
Instant cooked cereals
Canned beans (rinse the beans to lower the sodium content)
Whole spelt or whole-wheat pasta
White bread Most snack crackers, like cheese crackers, butter crackers, and those made with saturated fats or fully or partially hydrogenated oil Cereals with coconut
Granola-type cereals made with saturated fats
Dried peas and beans, like split peas, black-eyed peas, chickpeas; kidney, navy, pinto beans, lentils, soybeans
Pasta and rice made with cream, butter or cheese sauce Egg noodles
One serving equals: 1 slice of bread (or 1 oz.) 1/2 bagel, bun, English muffin 1/2 to 1 cup of cold, dry cereal (or 1 oz.) 1/2 c. cooked pasta or rice
Limit breads, pasta, crackers and other starchy foods if you need to lose weight. Fruits (2 to 4 servings a day) Always check the serving size.
Choose Fresh or frozen fruit Try to choose fresh fruit instead of fruit juices.
One serving equals: 1 med. size piece of fresh fruit 1/2 c. cooked / canned fruit 3/4 c. fruit juice
Go easy on
Limit or avoid
Canned fruit / juices
Limit sweetened fruit juices to 4 oz. a day Sweetened Fruit drinks
Vegetables (3 to 5 servings a day) Always check the serving size.
Go easy on
Limit or avoid
Fresh, frozen or canned vegetables with no salt
Lower-salt and lower-fat spaghetti sauce
Vegetables made with butter, cheese, cream, bacon, salt pork
Unsalted tomato juice or sauce
Canned vegetables (rinse the vegetables to lower the sodium content)
Vegetables in brine, like pickles, sauerkraut, olives
One serving equals: 1/2 c. cooked / raw vegetables 1 c. raw, leafy vegetables 3/4 c. vegetable juice
Fried vegetables, like french fries, fried onion rings or fried mushrooms
Since vegetables are low in calories and carbohydrates, your dietitian may suggest eating more than 5 servings a day to help you control your weight. Meat, poultry, fish and shellfish (No more than 6 oz. of cooked lean meat, poultry or fish a day) If your doctor or dietitian approves more of these foods, choose the leanest meats, poultry, fish, and shellfish.
Choose Poultry without the skin Lean ground turkey or chicken
Go easy on Luncheon meats (with 2 grams of fat per ounce and less than 300 mg of sodium per serving
Fish—baked, broiled, poached or grilled without fat
Shellfish like shrimp or lobster
No salt canned tuna in water
Fresh lean cuts of red meat with fat trimmed, like: Beef— lean cuts such as round, sirloin, tenderloin and flank
One serving equals: 3 oz. white chicken/turkey 3 oz. extra lean hamburger 2 oz. extra lean luncheon meat 3 oz. fish 3 oz. lean pork tenderloin, sirloin, or chop
Limit or avoid Fatty cuts of meat, like: Beef--corned beef brisket, regular ground beef, short-ribs, rib-eye steak or spare ribs, chuck or blade roasts, “prime” grade-prime rib, rump (ground beef from these cuts) Pork--spareribs, blade roll, ham, tenderloin, legs (fresh) sirloin, loin roast or chop Goose, domestic duck Organ meats, like liver
Lamb—lean cuts such as leg, arm, loin, rib
Sausage, bacon, salami, minced ham, canned meats
Veal—all trimmed cuts except ground
Your dietitian may suggest limiting red meat to 2 or 3 times a week. Talk to your dietitian about including red meat in your diet.
Regular luncheon meats, such as bologna Hot dogs, corn dogs Frozen breaded fish or entrèe Fried meats and fish, like fried chicken and fried shrimp
Three oz. of cooked meat, poultry or fish is about the size and thickness of a deck of cards.
Dairy products (2 to 3 servings a day)
Go easy on
Skim milk, 1% milk, fat-free or low-fat buttermilk, low-fat evaporated or nonfat dry milk or fortified skim milk Fat-free yogurt & sour cream Fat-free cheeses, like Alpine Lace , Kraft Healthy Favorites , Healthy Choice , and Lifetime ®
One serving equals: 1/2 c. 1% cottage cheese 1 c. nonfat yogurt 1 to 2 oz. fat-free cheese 1 c. skim or 1% milk
Part-skim ricotta Part-skim or imitation hard cheeses, like part-skim mozzarella “Light” cream cheese
Whole milk, like regular, evaporated or condensed Cream, half-and-half, most non-dairy creamers, real or non-dairy whipped cream Buttermilk
“Light” sour cream
Cream cheese, cream cheese frosting
Frozen nonfat yogurt
Sour cream and sour cream in salad dressings, gravy, sauces
Cheeses labeled no more than 3 grams of fat per oz. & less than 140 mg sodium per oz. 1% fat cottage cheese
Limit or avoid
Cheese labeled no more than 4 to 5 grams of fat per ounce, like farmer’s cheese or Kraft Light Naturals (substitute cheese for a meat serving) ®
Custard-style yogurt High-fat and high-sodium cheeses, like brie, colby, Swiss, American, cheddar Regular, 2% or 4% cottage cheese
Sweets and snacks Choose 1 or 2 snacks a day depending on your calorie needs. High fat, high sugar snacks should be limited. If you have high triglycerides, focus on whole grain snacks. Make sweetened foods occasional choices or choose sugar-free foods.
Choose Low-fat snacks, like plain popcorn, low-salt pretzels Unsweetened and non-fat beverages, like tea, coffee, carbonated drinks
One serving equals: 1 - 2 oz. jelly beans 1 - 2 oz. hard candy 1 - 2 oz. air-popped popcorn or microwave light popcorn 1 - 2 oz. baked snack chips 1 - 2 oz. low-fat cake like angelfood cake 1/2 c. low-fat or fat-free frozen yogurt
Go easy on
Limit or avoid
Low-fat frozen desserts, like sherbet, sorbet, frozen yogurt
High-fat frozen desserts, like ice cream and frozen tofu Store-bought cakes, pies and cookies Most candy, like chocolate Potato and corn chips made with saturated fat and salt Buttered and salted popcorn High-fat beverages, like frappes, milkshakes, floats and eggnog Sweetened Carbonated drinks Frozen desserts “Lite” ice cream Homemade cakes, cookies and pies made with unsaturated oils Fruit crisps and cobblers Chocolate (choose 70% cocoa products)
Low-fat desserts, like gelatin, pudding or custards made with skim milk, cakes made from a “light” cake mix or angelfood cake Low-fat cookies or cakes with less than 2 grams of fat per serving, like fig bars and gingersnaps Low-fat hard candy
Eggs Check with your doctor or dietitian regarding your individual dietary recommendations.
Limit or avoid
Choose Egg whites Cholesterol-free egg substitutes Omega eggs
Ask your dietitian for advice on including egg yolks in your diet.
Fats and oils (5 grams of fat = 1 tsp. of fat or oil)
Choose Monounsaturated oils: (canola, olive, sesame, peanut) Unsalted nuts - 1 oz. Avocados & olives Cooking sprays “Ultra” or “Extra” or “Light” margarines and spreads Margarines with plant stanols and sterols, such as Benecol Fat-free salad dressings (if bottled or from a mix, limit to 1 to 2 Tablespoons a day) Fat-free sour cream or cream cheese ®
Eat only 2 to 8 tsp.from this list: Polyunsaturated oils: (corn, safflower, sunflower, soybean) Regular margarine with allowable oils Reduced-fat salad dressing Reduced-fat mayonnaise 2 tsp. light margarine (with 50 to 60 calories per Tbs.) 1 Tbs. extra-light margarine 1/4 to 1/2 oz. sunflower seeds
Limit or avoid Lard and bacon fat Butter, cocoa butter Coconut Coconut oil, palm oil Salt pork Chocolate Cream Hydrogenated or partially hydrogenated oil or shortening Regular mayonnaise Regular salad dressing Salted nuts and seeds
Seasonings Go easy on
Limit or avoid
Herbs like: basil, bay leaves, chives, dill, oregano, rosemary, sage, tarragon, thyme
Seasonings with 150 mg of sodium per serving - Eat only 1 serving a day
Chili powder, curry powder
Corn flake crumbs - 2 T.
Onion powder, garlic powder
Ketchup - 1 T.
Lemon or lime juice
Worcestershire sauce 1/2 T.
Steak sauce 1/2 T.
Salt, garlic salt, onion salt, seasoned salt, MSG Regular beef or chicken bouillon and powdered broth Packaged seasonings, sauces and soup mixes Canned soups Anchovies Regular or “Lite” soy sauce Steak sauce, teriyaki sauce Meat tenderizers with salt Salt and “Lite” salt (unless approved by your dietitian) Instant puddings Seasonings where salt is listed as one of the first ingredients
Vegit , Mrs. Dash
BBQ and Chili sauce - 2 tsp.
Mustard - 2 tsp.
Parmesan cheese - 1 T.
Horseradish - 2 T.
Molly McButter - 1/2 tsp.
Vinegar, plain or flavored
Regular baking powder/soda
Unsalted meat tenderizer
Chicken or beef broth made from lean meats (de-fatted)
Whole grain bread crumbs
READING LABELS A new Nutrition Facts label has been designed that makes it easier for you to make healthy choices. All manufacturers need to use the new label by January 1, 2020. For a while you are likely to see some products with the old label and some with the new label. The new label is shown here. Whether the product uses the old or the new label, you should check:
Nutrition Facts 8 servings per container Serving size 2/3 cup (55g) Amount per serving
SERVING SIZE / SERVINGS PER CONTAINER Serving sizes have been updated on the new label to show what people actually eat and drink today. Pay close attention to the serving size to determine how much you can eat based on your meal plan. CALORIES Calories on the food label are figured per serving. In the nutrition facts label shown here, if you ate both servings, you would count this food as 460 calories. TOTAL FAT The American Heart Association recommends eating between 25 and 35 percent of your total daily calories as fats from foods such as fish, nuts and vegetable oils. Ask your healthcare provider for advice on how much total fat your daily diet should include. Choose foods with low amounts of total fat per serving. SATURATED FAT If you have heart disease or if you are trying to lower your cholesterol, the American Heart Association recommends reducing your saturated fat to no more than 5 to 6 percent of your total daily calories. For someone who is eating 2,000 calories a day, thatâ€™s about 11 to 13 grams of saturated fat per day. Saturated fat raises cholesterol levels, which can lead to plaque buildup in the arteries. Look for foods with no saturated fat or only very small amounts of saturated fat.
Calories Total Fat 8g Saturated Fat 1g Trans Fat 0g
230 % Daily Value* 10% 5%
Sodium 160mg Total Carbohydrate 37g Dietary Fiber 4g Total Sugars 12g Includes 10g Added Sugars
7% 13% 14% 20%
Protein 3g Vitamin D 2mcg Calcium 260mg Iron 8mg Potassium 235mg
10% 20% 45% 6%
* The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.
TRANS FAT Trans fat is more harmful for your heart and blood vessels than saturated fat. Avoid foods which contain trans fat.
SODIUM Most people should eat less than 2,300 mgs of sodium a day. People who are 51 years of age or older, African-Americans and people who have high blood pressure, heart disease or heart failure should reduce their sodium to less than 1,500 mg of sodium a day (or the amount your healthcare provider recommends).
CHOLESTEROL If you have heart disease, the American Heart Association recommends that you limit your cholesterol intake to 200 mgs or less per day. Check with your healthcare provider to determine how much cholesterol you should have each day.
FIBER A common recommendation for fiber is 25 to 30 grams a day. Check with your healthcare provider to determine how much fiber you should include in your diet.
LEARN ABOUT LABEL CLAIMS WHAT IT SAYS
WHAT IT MEANS
less than 0.5 g saturated fat per serving and no ingredient that is fat
No trans fat
less than 0.5 g trans fat per serving
3 g or less saturated fat per serving and not more than 30% of calories from fat for meals and main dishes
at least 25% less fat per serving than the regular version
Low Saturated Fat
1 g or less saturated fat per serving and 15% less of the calories coming from saturated fat (10% or less for meals and side dishes)
less than 10 g fat, 4 1/2 g or less saturated fat and 95 mg cholesterol
less than 5 g fat, 2 g saturated fat and 95 mg cholesterol
less than 2 mg cholesterol and no ingredient that contains cholesterol
20 mg or less cholesterol
at least 25% less cholesterol than the regular version
less than 5 mg sodium and no ingredient that contains sodium chloride or contains sodium
140 mg or less sodium per serving
25% less sodium than the regular version
Very Low Sodium
35 mg or less sodium per serving
50% less sodium than is normally added to the food
Unsalted / no salt added no salt added during processing Calorie Free
less than 5 calories per serving
40 calories or less per serving
25% fewer calories per serving than the regular version
less than 0.5 g sugar per serving and no ingredient that is a sugar
25% less sugar per serving than the regular version
No sugar added
no sugar or sugar-containing ingredient added during the processing of the food
CONFUSING CLAIMS Fat free. Often fat-free foods contain as many calories as the full fat versions and the foods may be high in sugar and sodium. The claim that the product is “Fat free” does not mean the food is a healthy choice. All natural. All natural means the food does not contain added colors, artificial flavors or synthetic substances. A food may be labeled “natural” but may still contain high fructose corn syrup, and the food may be high in fat and sodium. Lightly sweetened. The Food and Drug Administration has definitions for “reduced sugar,” “no sugar,” and “sugar free,” but food manufacturers sometimes come up with advertising lingo that is meaningless. “Lightly sweetened” is one of those meaningless terms. Multigrain. When shopping, look for the words whole grain or 100% whole grain. Whole grains, such as brown rice, have more fiber and other nutrients than those that have been refined, a process that strips away the healthiest portions of the grain. Zero trans fat. Products that say no trans fat can actually contain less than 0.5 grams per serving. If you were to have 2 or 3 servings, you would add a good amount of trans fat added to your diet.
C O O K I N G W I T H L E S S FAT E AT I N G O U T
• Remove the skin and trim the leftover fat from ■ Meats - Order baked, grilled or roasted (without fat), poached, or steamed meats. - Choose sandwiches made with lean unbreaded chicken, turkey, or roast beef. - Avoid high-fat sauces, gravy, cheese, and mayonnaise. ■ Salads - Avoid using high-fat dressings, eggs, cheese, or real bacon bits on your salad. Instead, choose fresh fruit and vegetables. - Use low-fat or fat-free dressings. Ask for the dressing to be served on the side. - Ask for a taco salad without the tortilla bowl or sour cream. - Order chicken salad made with grilled chicken. - Avoid salads made with mayonnaise or sour cream, like tuna, chicken, potato, or pasta salad. ■ Side dishes - Avoid french fries, onion rings, and fried or breaded vegetables. - Ask for fresh, raw or steamed vegetables without butter or sauce. Order a baked potato without butter or sour cream, or steamed rice without butter or fat. ■ As a general rule: - Stay away from fried, basted, au gratin, crispy, escalloped, pan-fried, sautéed, stewed, or stuffed foods that are high in fat.
chicken or turkey before you cook it.
• Use low-fat cooking methods, like baking, steaming, grilling (without fat), broiling, poaching, or roasting.
• Choose leaner meats like chicken, turkey, fish, round or loin cuts of beef, extra-lean ground beef, loin or leg cuts of pork, lean ham, Canadian bacon, and loin or leg cuts of lamb.
• Limit or avoid the fattiest meats, such as sausage, bacon, hot dogs, salami, liver, duck, and goose.
• Cook with unsaturated vegetable oil, like olive, canola, corn, or soybean oil. Use no more than one tablespoon of oil for sautéing or use a nonstick cooking spray.
• Use low-fat products such as sour cream, cottage cheese, or yogurt for dips or toppings.
• Use garlic, onion, lemon, herbs, or vinegar to flavor food instead of fat.
• Use 1 percent or skim milk or canned evaporated skim milk instead of whole milk in recipes. Use low-fat or fat-free cheese in place of regular cheese. Use egg substitutes or egg whites instead of whole eggs.
• Use fat-free, lower-fat liquid or soft tub margarine made with unsaturated fat and water, or margarines that contain plant sterols or stanols, like Benecol.®
ALCOHOL Alcohol is high in calories and sugar, can raise triglycerides and blood sugar levels and it can contribute to sleeping problems. Ask your doctor if you can have alcohol. Your doctor’s recommendation is based on the medications you take, your HDL and LDL cholesterol levels, your triglycerides and your overall health. If your doctor approves alcohol, the recommendation for men is 1 to 2 servings a day. The recommendation for women is 1 serving a day. One serving of alcohol may be: • 1 - 4 ounce glass of dry (red or white) wine • 12 ounces of a lite type of beer • 1 1/2 ounce of hard liquor
SLEEP APNEA Research shows that untreated sleep apnea can lead to the progression of cardiovascular disease and may contribute to high blood pressure, irregular heart rhythms and heart failure. The most common form of sleep apnea is called obstructive sleep apnea, which occurs when an upper airway collapses or becomes blocked and prevents a person from breathing normally during sleep. Although anyone can develop obstructive sleep apnea, it is more likely to occur in men than women. People who are overweight are especially prone to developing sleep apnea. Signs of sleep apnea • your partner or spouse notices that you are snoring and having periods where you stop breathing or wake up • daytime sleepiness • difficulty staying asleep all night • morning headaches • moodiness or difficulty concentrating If you think you have sleep apnea, DON’T IGNORE YOUR SYMPTOMS. Talk to your healthcare provider. A sleep study may be needed to diagnose your condition. If you are diagnosed with sleep apnea, it can be treated with a device known as a continuous positive airway pressure device or CPAP which keeps your airways open. Prompt treatment of sleep apnea can help prevent the progression of cardiovascular disease and the development of other cardiovascular problems.
R I S K FA C T O R – B E I N G O V E R W E I G H T Being overweight makes your heart work harder. What’s more, people who are overweight are also more likely to have high blood pressure and abnormal blood lipids as well as other health problems. When it comes to losing weight, it’s hard to resist the lure of quick and easy diet promotions. But the truth is, these diets probably aren’t the solution to a weight problem. You may lose weight on one of these diets, but the lost weight often comes back when old habits are resumed. And you may not be eating the best foods for your health. For healthy weight loss, experts recommend eating nutritious, low-fat foods, reducing total calories, eating smaller portions, and increasing your physical activity.
• Reduce your total calories. A pound of body fat equals 3,500 calories. To lose 1 pound of fat in a week, you must create a 3,500 calorie deficit, or 500 calories a day. It’s tough to create that deficit through exercise alone. Your best bet is to reduce your total daily calories.
• Eat smaller portions. Learn what serving sizes really are. You can’t use restaurant servings as a guide because so many of them are super-sized. In reality, a serving is small by comparison. Use measuring cups and spoons until you can identify a serving size.
• Cut back on fat. Fat has twice as many calories as an equal amount of protein or carbohydrate. Eating less fat will help you cut back on calories, but only if you don’t increase portion sizes or number of servings. Some reduced-fat or fat-free foods have as many calories per serving as the higher-fat versions, so read the labels.
• Eat a balanced diet. Eat foods from all of the food groups. Choose higher fiber carbohydrates such as fresh fruits and vegetables, and whole grains, rather than refined carbohydrates, such as white potatoes, white rice and foods which contain white flour and white sugar.
• Cut back on sugar. Sugary foods stimulate appetite and fill you up with empty calories.
• Increase your physical activity. Cutting 250 calories from your daily diet can help you lose 1/2 pound a week. But add a 30 minute brisk walk 4 days a week and you can almost double your rate of weight loss. Exercise also burns fat. Aerobic exercises, such as walking, are helpful for losing weight. 41
R I S K FA C T O R – L A C K O F R E G U L A R E X E R C I S E A lack of regular exercise may contribute to the development of coronary artery disease. Regular exercise:
• helps your heart pump better • helps control your weight & your blood pressure • helps people with diabetes control their blood sugar • helps you handle stress better • helps manage lipid levels To get stronger your heart needs the right kind and amount of exercise. The best exercises for your heart, lungs, and blood vessels are aerobic exercises. These exercises work large muscles non-stop for 20 to 30 minutes. Examples of aerobic exercises are: walking, jogging, swimming, biking, aerobics class, and rowing. Every exercise period should begin with 5 to 10 minutes of a warm-up activity and end with 5 to 10 minutes of a cool-down activity. Warming up and cooling down prevents injuries to muscles and joints. Walking slowly or doing slow, gentle stretching exercises before and after every exercise session will help you warm up and cool down. When you get home, exercise for 5 minutes (or the number of minutes the staff tells you to). Try to exercise 3 to 5 times each day. Slowly increase the amount of time you exercise by adding 1 minute every other day as long as you have no symptoms. When you reach 10 minutes, decrease the number of times you exercise to 3 to 4 times a day. You will be given an exercise goal. A reasonable goal for many people is 30 minutes once a day, 4 to 6 days a week. This sample will show you how you can work up to that goal. SAMPLE EXERCISE PROGRAM
Aerobic exercise time
How often to exercise
3 times a day
2 times a day
1 time a day
TA K I N G YO U R P U L S E To get the most from your exercise, your heart should beat at a set rate during the aerobic part of your workout. This is your target heart rate. The hospital staff will help you find your target heart rate range. Taking your pulse will tell you if you are staying within your target heart rate range. Take your pulse before, during, and after your workout. Take it in the same position (sitting or standing). To take your pulse, place the flat surface of your middle two or three fingers onto the opposite wrist at the base of your thumb.
• Use light but firm pressure. • Count the beats for 10 seconds. • Multiply the number of beats by 6. The number you get is your heart rate for one minute.
Exertion scale 6 7 very, very light 8 9 very light 10 11 Do not go past 13 12 or somewhat hard 13 14 15 hard 16 17 very hard 18 19 very, very hard 20
R P E : R AT I N G O F P E R C E I V E D E X E R T I O N RPE or Rating of Perceived Exertion means the total amount of physical effort you put forth when you exercise. The scale takes into account all feelings of physical exertion, such as muscle fatigue and shortness of breath. When you use this scale, focus on your total inner feeling of exertion. A rating of 6 means you are working at a minimum level. A rating of 20 means you are working at a maximum level. You may use this scale for walking, biking, or other types of exercises.
Are you overdoing it? If your pulse (heart rate) is too high according to the limits set by your doctor or the hospital staff, you are exercising too hard.
ARE YOU OVERDOING IT? You can tell when you are overdoing it by paying attention to your body. If you have any of these symptoms while you are exercising or doing any type of physical activity, stop and rest:
• chest discomfort • unusual shortness of breath • weakness or fainting
• rapid heart rate • irregular or slow heart beat • leg pain or cramping 43
ANGINA WHEN EXERCISING I F YO U H AV E D I A B E T E S
■ Check your blood sugar before and after you exercise. If you plan to exercise for more than an hour, also check your blood sugar during exercise. ■ Do not exercise if you are ill or if there are ketones in your urine. ■ Do not inject insulin into an area of your body that you will use during exercise. For instance, do not inject insulin into your legs if you will be riding a bike. ■ Watch for signs of low blood sugar. If you do not usually have symptoms, check your blood sugar during exercise as well as before and after. Low blood sugar can occur right after you exercise or it may be delayed. It can occur anytime up to 24 hours after you have exercised.
If you have angina, sit down and rest for a few minutes. Take nitroglycerin. If you feel dizzy, sit down. Wait until your symptoms go away before going back to your activity. Go at a slower pace. If the symptoms don’t go away in a few minutes, get help. Before returning to the activity in the future, call your doctor. Some changes may need to be made in your exercise program or your medications. You also may need to cut down on the intensity of your exercise or exercise more slowly for a while. Exercise guidelines
• Exercise before you eat or wait at least 1 1/2 hours after eating. If your stomach is full, your heart has to work harder to digest food.
• Exercise inside when it is very hot or very cold. • Do not exercise harder or more often than your doctor or the hospital staff tell you to.
To prevent low sugar: ■ Take along a source of carbohydrate, such as 3 glucose tablets, 2 pieces of hard candy, or 8 Lifesavers®. ■ Don’t exercise when your insulin is working its hardest. ■ Eat a light carbohydrate snack about 30 minutes before you exercise if your blood sugar is below 100 mg/dL and you will be exercising at a moderate to high intensity. After you exercise, check your feet for sores or blisters.
• Take nitroglycerin with you in case you need it. • Drink plenty of water after you exercise. • Do not use tobacco before or after you exercise. Use of tobacco is dangerous, especially 2 hours before you exercise.
• To stay motivated, exercise with a friend or join a gym and arrange to exercise with a group.
• Get back on track. If you miss a few exercise sessions, get back to it as soon as you can. You can prevent a lapse from becoming a relapse by overlooking the exercise sessions you have missed and getting back on track right away.
R I S K FA C T O R – D I A B E T E S Hardening and narrowing in the arteries is more common when diabetes is present. If you have diabetes or pre-diabetes, you can lower your risk of heart and blood vessel disease by controlling your blood sugar. The term pre-diabetes identifies people who have blood sugar levels that are higher than normal but not high enough to be diagnosed with diabetes. People with pre-diabetes are at risk of developing Type 2 diabetes as well as cardiovascular disease. Blood test Fasting plasma glucose test (FPGT)
Normal range less than 100 mg/dL
126 mg/dL or greater on two separate occasions
is taken after an 8-hour fast
If your doctor has told you that you have pre-diabetes, it is important to make healthy lifestyle changes. This includes losing weight (if you are overweight), making healthy food choices, and exercising regularly. Prediabetes may be reversible if you make these healthy lifestyle changes. Your doctor may want you to be tested for Type 2 diabetes every 1 to 2 years. If you have diabetes:
• Work with your dietitian and certified diabetes educator to develop a meal plan to fit your lifestyle. A meal plan is a guide to how much food and what kind of food can be eaten at a meal or snack time to help control your blood sugar.
• Balance the carbohydrates in your meals and snacks. Read labels and keep records to help you learn the carbohydrate contents in your food.
• Check your blood sugar as often as your doctor tells you to. Keep your blood sugar within the recommended range. Call your doctor if your blood sugar is consistently over or under your target range.
• Exercise regularly. Try to exercise at about the same time each day. Check your blood sugar before and after you exercise.
• Maintain a healthy weight. • Take your medication exactly the way your doctor or diabetes nurse tells you to take it.
• Report problems or symptoms to your doctor as soon as they appear. 45
R I S K FA C T O R – S T R E S S TO RELIEVE STRESS
■ Tell your friends how you are feeling. Talking it out helps release pent-up anger and frustration.
When you are under stress, your body produces chemicals which make your heart pump harder and faster. Too much stress for a long time can raise blood pressure and increase your risk of a heart attack. Learning how to relax can relieve your stress.
■ Exercise. Exercise burns stress chemicals, relaxes tense muscles, and gets your mind off your problems.
Relaxation involves learning skills that help relax your mind and your body. Practice these relaxation exercises whenever you feel stressed.
■ Decide what you don’t want in your life. This includes doing things because you said you would or feel you should. It includes doing too many things, even if some of them are things you want to do. Simplify your life by cutting back on your activities. ■ Practice positive thinking. Your thoughts affect your feelings. If your thoughts are negative, you can end up feeling stressed. Replacing negative thoughts with positive thoughts will help reduce your stress. ■ Learn how to relax. When you relax, your blood pressure, breathing, and other body functions return to normal. There are many healthy ways to relax. Get a massage. Take a walk. Do what works for you. For as many causes as exist for stress, there are almost as many techniques for dealing with it. Understanding what works for you may require that you try a number of stress reduction methods. If you have trouble managing stress on your own, consider taking a stress management class.
• Sit or lie down. Pay attention to the depth and rhythm of your breathing. Breathe normally for a couple of minutes.
• Put one hand on your abdomen and the other on your chest. Breathe more with your abdomen and less with your chest. Feel how your abdomen goes up and down, but your chest does not.
• Take a deep breath through your nose. Let your abdomen fully expand. Hold your breath for 2 to 3 seconds.
• With your lips puckered, exhale slowly through your mouth. Breathe out as completely as you can. Do deep breathing for a few minutes whenever you feel stressed.
Progressive muscle relaxation In this exercise, you tighten different muscles and then let them go to see how a relaxed muscle feels.
• Sit or lie down. Focus on your right hand. Make a fist and tighten it as hard as you can. Keep it tense for 5 or 6 seconds. Let go; open your fist. See how your hand relaxes. Keep it relaxed for 20 to 30 seconds. Repeat the exercise.
• Compare your right hand, which is relaxed, with your left hand. Do you feel a difference? Practice tightening and letting go of all of your muscles from head to toe. This will help you contract and relax all muscle groups. In time, you will be able to relax your muscles by making mental contact with them.
O T H E R R I S K FA C T O R S Scientists have been studying other factors that may contribute to coronary artery disease. They have found that people with metabolic syndrome have double the risk for a heart attack or stroke when compared to people without the syndrome. The risk for developing diabetes is also greater for people with metabolic syndrome. Metabolic syndrome is not a disease. Instead, it is a group of symptoms including: • elevated fasting blood glucose (sugar) levels • abdominal obesity (accumulation of fat around the abdomen) • low HDL (good) cholesterol levels • high triglycerides • high blood pressure You do not have metabolic syndrome unless you have at least 3 of these symptoms. If you have metabolic syndrome, your treatment goal is to prevent a heart attack, stroke, and diabetes. Prevention involves making the lifestyle changes outlined in this book. Scientists are continually researching these and other potential risk factors. For more information on other risk factors, talk to your healthcare provider.
STICK WITH THE PROGRAM • Set some goals you know you can reach without too much trouble. Be realistic. For example, you may want to lose 20 pounds right away, but 3 or 4 pounds a month for several months is a more reasonable goal. • Get the support you need, even if it means asking for it. Let your friends, family, and co-workers know that you are trying to cut down on fat and get in shape. If they know it’s important to you, they’ll give you the encouragement and praise you need to keep it up. • Reward yourself. If you’ve given up smoking, you deserve a standing ovation. Buy yourself something special with all the money you are saving. If you’ve cut out high-fat snacks, talk to your doctor about some special treat that would be right for you, or try a new experience, like going to a play or a special event. • Don’t punish yourself if you slip up. You can prevent a lapse from becoming a relapse by overlooking a moment of weakness and getting back on track right away. Remember, you are making progress toward the long-term management of your health. 47
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This comprehensive guide is a valuable tool for patients who have been hospitalized with a heart attack, and also for patients who have not...