Wake Up Call for your heart (189A) 8 ways to reduce your risk for a heart attack

Product #189B

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This book is written to help you

understand heart disease risk factors.

It should not be used to replace any

of your doctor’s advice or treatment.

Your heart Your heart has 3 main arteries that supply the heart muscle with blood and oxygen. These branches can become damaged by inflammation or by the way we live.

Over the years, they can become narrowed due to:

• smoking • high blood pressure • diabetes

1

• being overweight

left coronary artery

• eating unhealthy fats • too little exercise • too much stress The result is poor blood flow and maybe a heart attack. But, you can reduce your risk for a heart attack with new health habits. This book will get you started.

2 right coronary artery

3 anterior descending artery 1

Know your risks for heart disease Check “yes” if you have: high cholesterol (over 200mg/dL) high blood pressure (130/80 or higher) diabetes had angioplasty or bypass surgery Also check “yes” if you: weigh too much exercise less than 150 minutes a week smoke (or are around smokers at work or home)

Wake

UP Call:

In the U.S., heart disease is still the leading cause of death among men and women. It kills more people than cancer, accidents, homicides, AIDS or other infectious diseases. Fifteen percent of these deaths from heart disease happen before age 65, and many who die will not have known they had heart disease.

often eat unhealthy fats, refined sugar or too much sodium have family members who had a stroke or heart attack before age 55 (if male) or 65 (if female) are a man over 45 are a woman past the change of life are often tense, stressed or pressed for time get angry quickly don’t know if you have high blood pressure or high cholesterol If you checked 3 or more of these, you may be at a much higher risk for heart disease. Make plans now to improve your health before serious heart damage occurs.

2

1 Kick the habit SMOKING RISK: less oxygen to the heart Tobacco (includes smoking, snuff, chew, nicotine in 'e' cigarettes and vaping): narrows blood vessels can cause artery spasms scars your lungs and reduces oxygen increases your heart rate lowers “good� cholesterol may injure the lining of your arteries

3

It may take more than one try to quit smoking.

So don’t give up. Each try improves your chance of quitting for good.

1. S et a quit date. Let others know

you are stopping. Clean your house, carpets, drapes and clothes. Get rid of ashtrays, lighters and all tobacco.

Clean out your car and car ashtrays.

Remember the smoking habits of others can affect you!

2. I f you are a heavy smoker or have

smoked for years, ask your doctor about nicotine patches, gum or other quit-smoking methods. These can help you withdraw, but one day you will still need to give up nicotine.

Drugs such as Zyban®, Wellbutrin® or Chantix® can help decrease the symptoms of withdrawal from any form of tobacco. This medicine is only available with a prescription.

Talk with your doctor to see if it would be OK for you.

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Wake

UP Call:

E-cigarettes are not regulated and they do deliver nicotine.

Nicotine in any form is harmful to the heart.

3. Nicotine acts like a “jump start� when you feel you need one.

Healthier jump starts are deep breathing, yoga, light exercise or meditation when you need more energy. These also help you when you need to slow down and take a break.

4. List the times you are most likely to smoke. Then, before you quit,

plan other things to do at these times. You might take a short walk; chew gum; eat a nonfat, low-calorie snack or sit quietly and breathe deeply until the smoking urge passes.

5. To help stop smoking, contact: American Lung Association,

American Heart Association, American Cancer Society (see page 24) or your doctor.

Wake UP Call: Smokers are more likely to have a heart attack than non-smokers. But, 1 year after quitting, your risk for coronary heart disease is cut in half.

5

Get the drop on the silent killer HIGH BLOOD PRESSURE RISK: damage to artery walls

High blood pressure is sneaky. You can have it and not know it. While it damages your artery walls, letting fat and cholesterol build up more easily, you may not feel a thing. It also makes the heart work harder. Over time, much damage can be done, causing strokes, heart attacks, or kidney failure. This doesn’t have to happen. High blood pressure can be controlled. You can bring it down with weight loss, exercise, medications, relaxation, not smoking and a low-salt diet. Salt can cause the body to hold fluid, which makes the heart work harder and blood pressure go up.

Beat the silent killer. Have your blood pressure checked several times a year. Everyone may not need to or be able to reach the same goals. It is

important to talk about your BP goals with your doctor. Many doctors suggest getting your own BP

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Wake UP Call: •5 0 million Americans have high blood pressure and 30% don’t even know it.

•P eople with poor health habits are more likely to have high blood pressure.

•A frican Americans tend to have high blood pressure more often than others.

•H igh blood pressure tends to run in families.

machine and keeping a record to show your doctor.

My blood pressure (BP) is: My BP goal is: I can lower my BP in these ways: My BP medicine is: I take this much each day at these times:

Copy this page and cut out this card.

Post it where you will see it each day.

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3

Eat healthy

FOOD RISK: too much fat and cholesterol Know your fats trans fat saturated polysaturated monosaturated

The trans fats and saturated fats are the worst for you, but all fats should be counted in your foods. This is because even healthy fats are high in calories. Your goal is to eat very little fat.

Know your cholesterol Your doctor may talk to you about HDLs and LDLs. These are parts of cholesterol that move through the blood. A high HDL level and low LDL level mean less fatty buildup in the arteries. Check with your doctor to learn what your cholesterol levels should be.

Know your sugar Sugar and a high carbohydrate diet can increase your risk of diabetes, obesity and high triglycerides.

All of these can increase your risk of heart disease.

Adult daily recommendations: Sugar – 35 grams Carbohydrates – 250 grams (in a 2000 calorie daily diet.)

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Foods high in trans fats, saturated fat, cholesterol and sugar have been linked to heart disease. Most often these are animal foods, like meat and dairy products. Saturated fats can also be found in vegetable oils, such as coconut and palm kernel oils. As a rule, plant foods (such as beans, grains, vegetables and fruits) have less fat than animal foods. And, plant foods have no cholesterol. Trans fats are usually found in stick margarine, some soft tub spreads and pre-packaged foods like cookies, chips and cakes.

Wake

UP Call:

•T he buildup of fat and cholesterol in the arteries is a leading cause of heart attacks.

•H ealthy eating habits can reduce the buildup in your arteries and bring your heart more blood and oxygen.

•N ot all fats and carbohydrates are bad. A well-balanced diet is best.

•A void “fad” diets and over-the-counter diet pills.

These can be harmful.

8

Your doctor may ask you to eat no more than 300 mg of cholesterol per day, and no more than 30% of your calories as fat. (Some doctors suggest 10 to 20%.) To know if you are getting too much fat or cholesterol, you will have to read food labels and get smart about foods.

If you pick foods with 3 g of fat or less per serving and eat less than 300 mg of cholesterol per day, you are off to a good start.

Your goal is to eat healthy foods in healthy portions.

You control how much fat, cholesterol and sugar you eat. Making good food choices can help lower your risk. Don’t overeat. And, control your portion sizes. Don’t “super size” your meals. This will lead to a “super sized” you!

Eat these OFTEN:

Eat these SOMETIMES:

fresh vegetables & fruits (without high-fat sauces)

lean meats (trimmed of all fat), fish, skinned chicken or turkey

whole wheat and grain pasta dishes with low-fat sauces

vegetable oils or sprays (Use very little. All oils have 14 g fat per tablespoon.)

whole grain or enriched white breads, plain bagels, pita breads

low-fat cheeses, yogurts, sour creams or 1% milk

skim or nonfat dairy foods (skim milk, nonfat cheeses, nonfat yogurts, nonfat sour creams, egg substitutes) nonfat snacks, like air popped popcorn or carrot sticks or a handful of almonds or walnuts dried or fresh herbs nonfat dressings or nonfat mayonnaise

olives, peanut butter (limit 2 teaspoons per day), seeds and nuts (limit 1 tablespoon per day)

Eat these RARELY: butter, stick or soft margarine, egg yolks, whole milk, 2% milk, cream, half ’n half, eggnog and most cheeses (unless they list 3 g fat or less per serving) red meats, sausage, bacon, fat back, goose, duck, dark meat poultry, organ meats prepared foods, fast or fried foods coffee creamers, regular salad dressings, regular mayonnaise, prepared sauces chips, fatty dips croissants, donuts, bakery cakes or cookies, Danish anything listed as “hydrogenated” – a man-made, trans fat

9

Do these to cut fat and cholesterol:

At home Season with herbs, peppers, fruits and vegetables.

Try low-fat vegetarian dishes to find some you like. Eat meatless meals more often.

If you need oil, use canola, sunflower, safflower or olive oil spray. Use as little as possible. All oils have fat.

Take the skin off poultry, and don’t eat the skin.

Cool soups or stews before serving. Lift off the solid fat layer, and throw it away.

Make gravy or sauces with potato flakes and nonfat broths.

Cook with low or nonfat dairy foods.

Wake

UP Call:

•L ow-fat doesn’t mean low calories. Check the labels for the amounts of calories per serving.

10

Eat less red meat, and when you do eat meat, choose leaner cuts of poultry or fish.

Broil, bake, grill or poach foods.

Don’t fry foods. Don’t cook with butter, lard or bacon fat.

Cook in nonstick pans.

Do these to cut fat and cholesterol:

When eating out Order low-fat sauces or dressings on the side. Dip your fork into the dressing then pick up some salad.

This way you don’t eat too much dressing.

Order less meat and cheese and more fish, vegetables and fruits. Veggie meals or sandwiches are good, if cooked without too much oil or high-fat cheese (like swiss, cheddar, american, feta, cream cheese, havarti, mozzarella, ricotta, monterey jack, provolone or romano). But it is okay to have a cheese serving with under 3g fat per serving.

Stay away from fried, greasy or breaded foods.

Wake UP Call: •L earn about portion sizes. With practice you can “eye” how much a portion should be.

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Try to skip margarine and butter.

Ask for mustard, fresh lemon, vinegar, pepper or hot sauce when you want more flavor.

Take home extra food for later. Ask for a “to-go box”, and cut big servings in half before you eat. That way you can eat everything on your plate and have a second meal for later.

=

=

Split a dessert with others at the table. Or order fruits, nonfat frozen yogurts or sherbets for dessert.

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4 Lose fat and that's that

Body Weight Risk: less oxygen to the heart Overweight people tend to have these heart risks: more cholesterol in the blood higher blood pressure shortness of breath diabetes more work for the heart A steady weight loss, done by controlling food portion sizes, eating low-fat foods and exercising is the best way to lose weight and keep it off. Eating this way, you can enjoy the same number of meals and still lose weight.

If you eat the low-fat or nonfat foods that are listed on pages 9-11 you will be cutting fat right away. The less fat you eat, the healthier you will be. To lose weight, it is smart to read labels, and count fat grams as well as calories.

Plan for weight loss to be: slow (a pound or two a week) done along with exercise and low-carb foods a lifetime change in the way you eat and exercise 12

Wake

UP Call:

• T he average person walks less than 6,000 steps per day. You can help your heart by walking 10,000 steps per day. A pedometer (machine that counts the number of steps you take) or a smart watch is a great way to keep track.

•T he way you “wear” your fat is important. If your fat is around your waist, you are more likely to have heart disease.

•W hen you weigh more than is normal for your height, you put yourself at risk for a stroke or heart attack. These risks go down when you lose the extra pounds and keep them off. Even a 10 lb weight loss can make a difference.

BMI chart The numbers don’t lie. Check your BMI.

5’ 0”

Your BMI score is:

19 20 21 22 23 24 25 26 27 28 29 30 31 32 Your Weight (pounds)

97 102 107 112 118 123 128 133 138 143 148 153 158 163

5’ 1” 100 106 111 116 122 127 132 137 143 148 153 158 164 169 5’ 2” 104 109 115 120 126 131 136 142 147 153 158 164 169 175 5’ 3” 107 113 118 124 130 135 141 146 152 158 163 169 175 180 5’ 4” 110 116 122 128 134 140 145 151 157 163 169 174 180 186

Your Height

5’ 5” 114 120 126 132 138 144 150 156 162 168 174 180 186 192 5’ 6” 118 124 130 136 142 148 155 161 167 173 179 186 192 198 5’ 7” 121 127 134 140 146 153 159 166 172 178 185 191 198 204 5’ 8” 125 131 138 144 151 158 164 171 177 184 190 197 203 210 NOTE:

5’ 9” 128 135 142 149 155 162 169 176 182 189 196 203 209 216 It may take 1 to

2 5’ 10” 132 139 146 153 160 167 174 181 188 195 202 209 216 222 hours to prepare and do all the tube 5’ 11” 136 143 150 157 165 172 179 186 193 200 208 215 222 229 placements before 6’ 0” 140 147 154 162 169 177 184 191 199 206 213 221 228 235 the surgery begins.

6’ 1” 144 151 159 166 174 182 189 197 204 212 219 227 235 242 6’ 2” 148 155 163 171 179 186 194 202 210 218 225 233 241 249 6’ 3” 152 160 168 176 184 192 200 208 216 224 232 240 248 256 6’ 4” 156 164 172 180 189 197 205 213 221 230 238 246 254 263

To be at a healthy weight, your BMI should be between 19 and 24. If your BMI is 25-29, you are overweight. If your BMI is 30 or higher, you are obese. If you need to lose weight, get professional help. Make it a healthy weight loss plan.

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5 It's time to

get moving

Wake

UP Call:

•L ess-fit people have a greater chance of high blood pressure, obesity and diabetes.

LACK OF EXERCISE RISK: a flabby heart

•C oronary heart disease is twice as likely in inactive people.

To pump well, the heart needs to be strong. You can improve your heart’s strength with at least 30 minutes of moderate exercise, 5 or more days a week.

Just get moving in some way and keep at it. Check with your doctor before starting any exercise program.

•A n easy way to get started is to walk briskly for 30 minutes most days of the week.

After only a few months: – t he heart can pump more blood and oxygen to the body – y ou likely will have more energy – y ou may sleep better and feel less stressed – y our blood pressure and blood sugar should go down – y our muscles will tone and you will lose body fat – y our good cholesterol level (HDL) should go up

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There are 3 kinds of exercise to do.

They are: stretching (staying loose) aerobic (for blood flow, weight loss and oxygen) strength (toning or building muscles) The most important exercise for your heart is aerobic exercise. Walking, jogging, running, swimming, dancing and cycling are aerobic. So are rowing, step machines, ski machines and cross country skiing.

With these exercises, you move your arms and your legs. Over time, exercise makes most heart muscles stronger.

To get moving, do this: First, see your doctor. Find out how much exercise is safe for you and how long you should exercise. Get his or her advice on your exercise choice.

Pick more than one kind of exercise, so that you don’t get bored. While on exercise machines, you can often watch TV, listen to music or read. This is a good way to keep from getting bored.

Join an exercise group, or get a friend to work out with you. This helps if working out alone is hard. If you have a high risk for or a history of heart disease, your doctor may suggest a medically supervised exercise program.

Add more daily exercise in these ways:

– Climb stairs rather than taking an elevator or escalator.

– Park at the far end of a parking lot so that you have to walk more.

– Do more yard work or housework.

– Go to a mall, a running track or a park, and walk.

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These are the exercises I like and when I plan to do them:

Your exercise could go like this:

Your exercise could look like this:

1. Get loose.

Spend 5-10 minutes warming the muscles before you work out. Take a walk, jog slowly or cycle with no tension.

2. Work out 30 minutes or more.

Wear comfortable clothes and shoes that match the sport.

Cool down the same way you warmed up.

3.

Spend 5-10 minutes walking slowly or cycling with no tension. Then stretch the muscles to keep them loose.

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6 Give yourself a break

STRESS RISK: high blood pressure and narrowed blood vessels All stress is not bad. Some gets you moving and helps you get things done. Stress is bad when it becomes “distressful” (upsetting) to you and can’t be “shifted down.” You can’t get rid of stress, but you can learn to deal with it. This will make you less angry, hostile and uptight.

Old, unhealthy stress relievers might be smoking, heavy drinking, picking a fight or keeping everything bottled up inside. New, healthy ways of dealing with stress might include: mindful breathing (breathing in and out deeply and slowly) to get relaxed a 10 minute rest or “power nap” a 30 minute brisk walk

Wake

UP Call:

•W ith stress, the body makes more adrenaline (a hormone that makes the heart pump faster and harder and makes blood vessels clamp down).

•W ith regular exercise and other ways of taking a break, the harmful effects of stress can be reduced right away.

a massage, meditation or yoga a soak in the tub or watching a funny video using imagery or visualization to calm down 17

Take a walk on the calm side:

Here’s a simple, visual trip to help you slow down:

1. Sit or lie quietly in a comfortable place.

It’s hard sometimes, but find a place where you won’t be disturbed.

2. Close

your eyes.

Take a few slow, deep breaths. As you breathe out, let your body go loose. Let all parts of your body relax, from your head to your toes.

3. T hink of a time or place that was a lot of fun for you.

Think of the smells, feelings, sounds or people that were part of that time. Tune out everything else.

4. Stay

relaxed and into this thought. feel rested and very calm.

Stay here until you

5. A s your private time comes to an end, open your eyes

slowly. Lie or sit quietly for a few minutes before getting up. Plan another quiet time for tomorrow.

I want to try these as a stress break:

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Look at your family tree

7

FAMILY RISK: high blood pressure, high cholesterol, strokes and heart attacks If family members have had strokes or heart attacks, you need to think about your risks.

The more members who had these and the younger they were (males under 55 or females under 65), the more changes you will want to make. Children are 4 times more likely to have high blood pressure if a parent has it and 6 times more likely to have it if both parents have it. Children in families with high blood cholesterol should be tested in childhood to avoid problems in their later years.

Wake

UP Call:

•F ind any weak limbs in your family tree, and work to make them stronger.

What you learn in this book will help.

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8 Keep your blood glucose down HIGH GLUCOSE RISK: narrowed arteries

There are 25 million people with diabetes in the US. If current trends continue, 1 in 3 people in the U.S. will have diabetes in 2050. Diabetes is a major risk factor for heart disease, stroke, kidney disease and eye problems. The only way to know if you have diabetes is to have your blood sugar checked by your doctor. This should be done regularly, especially if you have a family history of diabetes. A blood test called an A1C may be used to assess your risk. (Normal A1C is 5.7) If you have diabetes, do everything you can to control your blood sugar.

Self-blood testing is the best way to know your sugar level. Diabetes puts a person at very high risk for the buildup of fat and cholesterol in the arteries. With more buildup and reduced blood flow, a person with diabetes is likely to have many other health problems.

I can do these things to control my blood sugar:

Wake

UP Call:

•F atty buildup in the arteries is much more common in people with diabetes.

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Metabolic Syndrome The metabolic syndrome occurs when you have 3 or more of these risk factors for heart disease: waist measuring more than 35 inches (women) or 40 inches (men) triglycerides over 150 mg/dL HDL cholesterol less than 40 mg/dL (men) or 50 mg/dL (women) blood pressure higher than 130/85 fasting blood glucose over 100 mg/dL In many cases, people with the metabolic syndrome have a hard time using their body’s insulin. Being more active and losing weight will improve all of the above risk factors. But medicine may also be needed.

To help prevent or manage this syndrome, you can: Begin an exercise program to strengthen your muscles, including your heart.

Reduce the amount of fat, trans fat, cholesterol, salt and sugar you eat each day.

Add more fruits and fresh vegetables to your diet.

Don’t smoke or be around others who smoke.

Limit the amount of alcohol you drink.

Find healthy ways to manage stress.

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Know the warning signs Heart attack what to do

You can feel any of these when having a heart attack: discomfort or a band of pressure around the chest aching, burning, tightness or squeezing anywhere in the upper body, back, shoulder blades, chest, one or both arms, neck or jaw indigestion, fullness, heaviness, choking sweating (cold or hot) nausea or vomiting dizziness fast or irregular heartbeats severe weakness shortness of breath Get help if any of these go on for more than a few minutes. Don’t panic, but act at once. If you are alone, unlock your door and sit or lie down. Call 911. Chew a non-coated adult strength aspirin. Call someone to be with you while you wait for the ambulance. The longer you wait to get help, the more damage there can be.

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NOTE •W omen may not feel heart attacks the same way men do. They may have less intense chest pain, more nausea or more weakness.

People with diabetes or elderly people may also have less intense symptoms.

•H eart disease is the #1 killer of both men and women.

Tip sheet Doctor's Number:

These habits will keep your arteries open (Check the ones you need to work on): do not smoke (or be around people who are) keep your blood pressure at or near your goal eat little fat and cholesterol (take your medicines too, if prescribed) lose weight (if needed)

My ideal weight is:

To lose weight I will:

exercise each day learn to relax when stressed control blood sugar (to prevent or manage diabetes)

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Cholesterol goals to reach and keep: Bad cholesterol (LDL) = 100 mg/dL or less** Good cholesterol (HDL) = 40 mg/dL or more for men = 50 mg/dL or more for women Triglycerides = 150 mg/dL or less Total cholesterol = less than 200 mg/dL ** If you are at high risk for heart problems, your LDL cholesterol should be 70 mg/dL or less.

Blood Pressure Stages Blood pressure stages

Top number

Bottom number

Ideal for most

Below 120 and

Below 80

Elevated

120-129 or

less than 80

Stage 1 high blood pressure

130-139 or

80-89

Stage 2 high blood pressure

140 or higher

90 or higher

NOTE BP goals vary with age and other medical conditions. Ask your doctor what your BP goal should be. Lifestyle changes and medicine may be necessary to reach and keep your BP goal.

CAUTION Call your doctor right away for any BP more than 180 systolic or more than 120 diastolic.

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Resources American Lung Association lung.org 1-800-LUNG-USA (586-4872)

American Heart Association heart.org 1-800-AHA-USA-1 (242-8721)

American Cancer Society cancer.org 1-800-ACS-2345 (227)

National Cancer Institute cancer.gov 1-800-4-CANCER (422-6237)

Write down other information or questions you have here:

Medical Reviewer Suzanne Cambre, RN, BSHA Cardiology Nurse Atlanta, GA Barbara Johnston Fletcher, RN, MN, FAAN Brooks College of Health, School of Nursing Clinical Associate Professor University of North Florida Jacksonville, FL Julia Ann Purcell, RN, MN, FAAN Clinical Nurse Specialist, Cardiology 1968-1996 Emory University Hospital Atlanta, GA We would also like to thank the previous reviewers, Jennie S. Crays, RN, BSN and Erica Frank, MD, MPH

We believe that you have the right to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.

3440 OAKCLIFF ROAD, NE, SUITE 126 ATLANTA, GA 30340-3006 1-800-241-4925 • www.p-h.com