HEARTINSIDE AND OUT IT IS ATO LIVE A HEALTHYLIFE ONE THAT IS 6WHAT IS 2DISEASE Coronary heart diseaseoften simply called heart diseaseoccurs when the arteries that supply blood to the heart musclethe ID: 885262
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1 THE HEART TRUTH MEANS TAKING HEARTÃINSI
THE HEART TRUTH MEANS TAKING HEARTÃINSIDE AND OUT. IT IS ATO LIVE A HEALTHYLIFE, ONE THAT IS à 6à WHAT IS DISEASE? Coronary heart diseaseÃoften simply called heart diseaseÃoccurs when the arteries that supply blood to the heart musclethe arteriesà inner walls. Plaque is the accumulation of fat,up in the arteries, blood flow to the heart is reduced.Heart disease can lead to a heart attack. A heart attackhappens when an artery becomes totally blocked with plaque,prevent
2 ing vital oxygen and nutrients from gett
ing vital oxygen and nutrients from getting to the heart.A heart attack can cause permanent damage to the heart muscle.Heart disease is one of several cardiovascular diseases, whichare diseases of the heart and blood vessel system. Otherand rheumatic heart disease.One reason some women arenÃt too concerned about heartdisease is that they think it can be Ãcuredà with surgery. This isa myth. Heart disease is a lifelong conditionÃonce you get it,youÃll always have it. True, pro
3 cedures such as bypass surgeryand angiop
cedures such as bypass surgeryand angioplasty can help blood and oxygen flow to the heartmore easily. But the arteries remain damaged, which means youare more likely to have a heart attack.WhatÃs more, the condition of your blood vessels will steadilywomen die of complications from heart disease or becomepermanently disabled. ThatÃs why it is so vital to take action to à 11à AT RISK that an existing disease will get worse. Important risk factors forheart disease that you can d
4 o something about are cigarettesmoking,
o something about are cigarettesmoking, high blood pressure, high blood cholesterol, overweight,physical inactivity, and diabetes. Research shows that more than95 percent of those who die from heart disease have at leastSome risk factors, such as age and family history of early heartdisease, canÃt be changed. For women, age becomes a riskfactor at 55. Women who have gone through early menopause,either naturally or because they have had a hysterectomy, aretwice as likely to develo
5 p heart disease as women of the samewome
p heart disease as women of the samewomen tend to develop other risk factors for heart disease.Family history of early heart disease is another risk factor thatcanÃt be changed. If your father or brother had a heart attack65, you are more likely to get heart disease yourself.While certain risk factors cannot be changed, it is important torisk of heart diseaseÃand it doesnÃt have to be complicated.Protecting your heart can be as simple as taking a brisk walk,whipping up a good veg
6 etable soup, or getting the support you
etable soup, or getting the support you à 12à Every Risk Factor Counts of all of their heart disease risk. For example, they may think that ifthey walk or swim regularly, they can still smoke and stay fairlyhealthy. Wrong! To protect your heart, it is vital to make changesthat address each risk factor you have. You can make the changesgradually, one at a time. But making them is very important.Other women may wonder, ÃIf I have just one risk factor for heartdiseaseÃsay, IÃm
7 overweight or I have high blood cholest
overweight or I have high blood cholesterolÃarenÃt I more or less ÃsafeÃ?à Absolutely not. Having just one riskfactor can double a womanÃs chance of developing heart disease.risk factors tend to Ãgang upà and worsen each otherÃs effects.Having two risk factors increases the chance of developing heartdisease fourfold. Having three or more risk factors increases theThe fact is, most women in midlife already have heart diseaserisk factors. Thirty-three percent of women age
8 s 40 to 60 haveone risk factor for heart
s 40 to 60 haveone risk factor for heart disease that they can change. AnotherWomen of color have higher rates of some risk factors. Moreoverweight or obese, while 52 percent have high bloodAmong Hispanic women in midlife, 78 percent are overweightThe message is clear: Every woman needs to take her heart à 13à DID you KNOW? heart disease. But the leading causes of death for American Heart Disease ______________________________________________________________________ 332,313Canc
9 er (all types) _________________________
er (all types) ________________________________________________________________ 265,022 Lung __________________________________________________________________________________ 67,838 Breast ________________________________________________________________________________ 40,539 Colorectal ________________________________________________________________________ 26,762 Pancreatic ________________________________________________________________________ 15,815 Ova
10 rian ___________________________________
rian ____________________________________________________________________________ 14,593 Uterine ________________________________________________________________________________ 6,906 Cervical ______________________________________________________________________________ 3,804 Others ______________________________________________________________________________ 88,765Stroke ______________________________________________________________________________________ Chronic O
11 bstructive Pulmonary Disease ___________
bstructive Pulmonary Disease ____________________________ AlzheimerÃs Disease ______________________________________________________________ 46,954Accidents ________________________________________________________________________________ 38,903Diabetes __________________________________________________________________________________ 37,771Pneumonia/Influenza ____________________________________________________________ 33,902 * Most recent year for which data are available. Ã 14Ã
12 ________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
13 ________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
14 ________________________________________
______________________________________________________________________________________________________________________________________________________________________________ DID you KNOW? Many women think that breast cancer is a bigger threat than heart disease. But the leading causes of death for American women in the year 2004* were: Heart Disease 332,313 Cancer (all types) 265,022 Lung 67,838 Breast 40,539 Colorectal 26,762 Pancreatic 15,815
15 Ovarian 14,593 Uterine 6,906
Ovarian 14,593 Uterine 6,906 Cervical 3,804 Others 88,765 Stroke 91,487 Chronic Obstructive Pulmonary Disease 64,409 AlzheimerÃs Disease 46,954 Accidents 38,903 Diabetes 37,771 Pneumonia/Influenza 33,902 * Most recent year for which data are available. Ã 14Ã FINDING OUT youRISK T he first step toward heart health is becoming aware of your own personal risk for heart disease. Some risks, such as smoking cigarettes, are obvious: Every woman knows wheth
16 er or not she smokes. But other risk fa
er or not she smokes. But other risk factors, such as high blood pressure or high blood cholesterol, generally donÃt have obvious signs or symptoms. So youÃll need to gather some information to create your personal Ãheart profile.Ã You and Your Doctor: A Heart Healthy Partnership A crucial step in determining your risk is to see your doctor for a thorough checkup. Your physician can be an important partner in helping you set and reach goals for heart health. But donÃt wai
17 t for your doctor to mention heart disea
t for your doctor to mention heart disease or its risk factors. Many doctors donÃt routinely bring up the subject with women patients. Research shows that women are less likely than men to receive heart healthy recommendations from their doctors. Here are some tips for establishing good, clear communication between you and your doctor: Speak up. Tell your doctor you want to keep your heart healthy and would like help in achieving that goal. Ask questions about your chances of devel
18 oping heart disease and how you can lowe
oping heart disease and how you can lower your risk. (See ÃQuestions To Ask Your Doctorà on page 17.) Also ask for tests that will determine your personal risk factors. (See ÃCheck It Outà on pages 18 and 19.) à 15à à Keep tabs on treatment. If you already are being treated for heart disease or heart disease risk factors, ask your doctor to review your treatment plan with you. Ask, ÃIs what IÃm doing in line with the latest recommendations? Are my treatments working? Are m
19 y risk factors under control?Ã If your
y risk factors under control?Ã If your doctor recommends a medical procedure, ask about its benefits and risks. Find out if you will need to be hospitalized and for how long, and what to expect during the recovery period. Be open. When your doctor asks you questions, answer as honestly and fully as you can. While certain topics may seem quite personal, discussing them openly can help your doctor find out your chances of developing heart disease. It can also help your doctor work wi
20 th you to reduce your risk. If you alrea
th you to reduce your risk. If you already have heart disease, briefly describe each of your symptoms. Include when each symptom started, how often it happens, and whether it has been getting worse. Keep it simple. If you donÃt understand something your doctor says, ask for an explanation in simple language. Be especially sure you understand how to take any medication you are given. If you are worried about understanding what the doctor says, or if you have trouble hearing, bring a
21 friend or relative with you to your appo
friend or relative with you to your appointment. You may want to ask that person to write down the doctorÃs instructions for you. Ã 16Ã QUESTIONS TO ASK YOUR docto Getting answers to these questions will give you vital information about your heart health and what you can do to improve it. You may want to take this list to your doctorÃs office: 1. What is my risk for heart disease? 2. What is my blood pressure? What does it mean for me, and what do I need to do about
22 it? 3. What are my cholesterol numbers
it? 3. What are my cholesterol numbers? (These include total cholesterol, LDL or Ãbadà cholesterol, HDL or Ãgoodà cholesterol, and triglycerides.) What do they mean for me, and what do I need to do about them? 4. What are my body mass index (BMI) and waist measurement? Do they indicate that I need to lose weight for my health? 5. What is my blood sugar level, and does it mean IÃm at risk for diabetes? 6. What other screening tests for heart disease do I need? How often s
23 hould I return for checkups for my heart
hould I return for checkups for my heart health? 7. What can you do to help me quit smoking? 8. How much physical activity do I need to help protect my heart? 9. What is a heart healthy eating plan for me? Should I see a registered dietitian or qualified nutritionist to learn more about healthy eating? 10. How can I tell if IÃm having a heart attack? Ã 17 Fasting Plasma Glucose fasted overnight, you will get a blood test the following morning.To find out if you have dia
24 betes or are likely to develop thefor di
betes or are likely to develop thefor diabetes and may have prediabetes. Diabetes is an importantrisk factor for heart disease and other medical disorders.At least every 3 years, beginning at age 45. If you have Body Mass Index (BMI) and Waist Circumference Waist circumference is a measure of the fat around your middle.To find out whether your body type raises your risk ofheart disease. A BMI of 25 or higher means you are overweight.A BMI of 30 or higher means you are obese. Both
25 overweightand obesity are risk factors
overweightand obesity are risk factors for heart disease. For women, a waistmeasurement of more than 35 inches increases the risk of heartEvery 2 years, or more often if your doctor recommends it. Other Tests There also are several tests that can determine whether you alreadyhave heart disease. Ask your doctor whether you need a stresstest. (See ÃScreening Testsà on page 105.) à 19à WHATÃS you RISK? Here is a quick quiz to find out your risk of a heart attack. DonÃ
26 t Yes No Is your blood pressure 140/90
t Yes No Is your blood pressure 140/90 mmHg or higher, OR level is 200 mg/dL or higher, OR that your HDL Has your father or brother had a heart attack before age 126 mg/dL or higher, OR do you need medicine to or more? (To find out, see page 41.) pains), OR have you had a heart attack? If you checked any of the Ãyesà boxes, youÃre at an increased risk of having a heart attack. If you checked ÃdonÃt knowà for any questions, ask your doctor for help in answering them. Read on
27 to learn what you can do to lower your r
to learn what you can do to lower your risk. Ã 20 Ã MAJOR RISK FACTORS FOR earDISEASE A s important as it is to work closely with your doctor, it is only the first step. To make a lasting difference in your heart health, youÃll also need to educate yourself about heart disease and about the kinds of habits and conditions that can raise your risk. ItÃs your heart, and youÃre in charge. What follows is a basic guide to the most important risk factors for heart disease a
28 nd how each of them affects a womanÃs h
nd how each of them affects a womanÃs health. Smoking Smoking is Ãthe leading cause of preventable death and disease in the United States,Ã according to the Centers for Disease Control and Prevention. Women who smoke are two to six times more likely to suffer a heart attack than nonsmoking women, and the risk increases with the number of cigarettes smoked each day. Smoking can also shorten a healthy life, because smokers are likely to suffer a heart attack or other major heart pro
29 blem at least 10 years sooner than nonsm
blem at least 10 years sooner than nonsmokers. Smoking also raises the risk of stroke. But heart disease and stroke are not the only health risks for women who smoke. Smoking greatly increases the chances that a woman will develop lung cancer. In fact, the lung cancer death rate for women is now higher than the death rate for breast cancer. Cigarette smoking also causes many other types of cancer, including cancers of the mouth, urinary tract, kidney, and cervix. Smoking also caus
30 es most cases of chronic obstructive lun
es most cases of chronic obstructive lung disease, which includes bronchitis and emphysema. If you smoke indoors, the Ãsecondhand smokeà from your cigarettes can cause heart disease, lung cancer, and other serious health problems in the nonsmokers around you. According to a recent report from the U.S. Surgeon General, exposure to smoke at home or work increases a nonsmokerÃs risk of developing heart à 21 à ROSARIO know it wonÃt be easy, but I know I have to do it.à Taking M
31 edication changes will help the medicine
edication changes will help the medicine work more effectively. In fact, ifTaking medicine to lower blood pressure can reduce your risk ofstroke, heart attack, congestive heart failure, and kidney disease.If you take a drug and notice any uncomfortable side effects, asknewer drugs to treat hypertension and to prevent some forms of heart disease. If youÃre starting treatment for high bloodpressure, try a diuretic first. If you need more than one drug,people, but if you need a diff
32 erent drug, others are veryeffective. T
erent drug, others are veryeffective. To make the best choice, talk with your doctor.Remember, it is important to take blood pressure medicationdoctorÃs office, be sure you understand the amount of medicine à 27à High Blood Cholesterol High blood cholesterol is another major risk factor for heartblood cholesterol level, the greater your risk for developing heartdisease or having a heart attack. To prevent these disorders, allwomen should make a serious effort to keep their chole
33 sterol atIf you already have heart disea
sterol atIf you already have heart disease, it is particularly important tofor a heart attack. Women with diabetes also are at especiallyhigh risk for a heart attack. If you have diabetes, you will needthan young men, between the ages of 45 and 55, womenÃslevels begin to rise higher than menÃs. After age 55, thisÃcholesterol gapà between women and men becomes still wider.Although womenÃs overall risk of heart disease at older ageswomanÃs blood cholesterol level, the greater
34 her chances ofdeveloping heart disease.C
her chances ofdeveloping heart disease.Cholesterol and Your Heart The body needs cholesterol to function normally. However, yourwalls of the arteries that supply blood to the heart. This buildup,called plaque, makes the arteries narrower and narrower. As aresult, less blood gets to the heart. Blood carries oxygen to theheart. If not enough oxygen-rich blood can reach your heart,you may suffer chest pain. If the blood supply to a portion of theheart is completely cut off, the re
35 sult is a heart attack. Ã 29Ã blockage
sult is a heart attack. Ã 29Ã blockage in the arteries.ThatÃs because HDL helps remove cholesterol from the body,preventing it from building up in the arteries.Getting Testedcholesterol level is too high, you may not be aware of it. ThatÃswhy itÃs important to get your cholesterol levels checkedregularly. Starting at age 20, all women should have theirTotal cholesterol is a measure of the cholesterol in all of yourÃoptimal,Ã or ideal. However, not every woman needs to aim f
36 or socategories of LDL level. The highe
or socategories of LDL level. The higher your LDL number, the higher yourrisk of heart disease. Knowing your LDL number is especially importantbecause it will determine the kind of treatment you may need.Your HDL number tells a different story. The lower your HDLlevel, the higher your heart disease risk.Your lipoprotein profile test will also measure levels of triglycerides,Triglycerides?Ã on page 33.)* Cholesterol levels are measured in milligrams (mg) of cholesterol per decilit
37 er à 30à WhatÃs Your Number? Blood Ch
er à 30à WhatÃs Your Number? Blood Cholesterol Levels and Heart Disease RiskTotal Cholesterol LevelCategoryLDL Cholesterol LevelCategoryLess than 100mg/dL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Optimal (ideal)100Ã129 mg/dL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Near optimal/above optimal130Ã159 mg/dL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Borderline high160Ã189 mg/dL _ _ _ _ _ _ _ _ _ _ _ _ _ _
38 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ High190 mg/dL and above _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Very highHDL Cholesterol Level40 mg/dL is a heart disease. An HDL level of à 31à ERIN ÃNo one, least of all me, was ever really concernedabout my heart health because I was a young, thinfemale, who did not smoke. After my heart attack, I had to face my own mortality. It was a life-alteringevent
39 for my entire family.Ã A Special Type
for my entire family.Ã A Special Type of Risksyndrome,Ã which is usually caused by overweight or obesityand by not getting enough physical activity. This cluster of riskfactors increases your risk of heart disease and diabetes,regardless of your LDL cholesterol level. Women have metabolicTriglycerides of 150 mg/dL or morescore and risk category as indicated in Steps 2 and 3 on theYou should make a particularly strong effort to reach and maintainyour LDL goal. You should emphasi
40 ze weight control and physical à 34à g
ze weight control and physical à 34à getting tested for it. You have diabetes if your fasting bloodglucose level is 126 mg/dL or higher.strongly linked with heart disease, managing diabetes must includekeeping certain factors under control (See ÃThe ABCs of Diabetesimportant ways to prevent heart disease if you have diabetes.normal but not yet in the diabetic range. But new research showschance of having a heart attack or stroke than those who havenormal blood glucose levels. I
41 f you are prediabetic, youÃll need high
f you are prediabetic, youÃll need high blood cholesterol, and other risk factors for heart disease. Ã 45Ã ÃAT THE TIME, IT NEVER OCCURRED TO ME THAT I COULD BE HAVING A HEART ATTACK. I THINK ABOUT HEART DISEASE EVERYDAY NOW.Ã Ã 46Ã Much remains to be learned about the connections among stress,depression, and heart disease, but a few things are clear:staying physically active, developing a wide circle of supportivepeople in your life, and sharing your feelings and concerns wi
42 ththem can help you to be happier and li
ththem can help you to be happier and live longer.develop heart disease than people who donÃt drink any alcoholprotect against heart disease by raising levels of HDL ÃgoodÃIf you are a nondrinker, this is not a recommendation to startthe risk of breast cancer. And, certainly, if you are pregnant,that could make alcohol use harmful, you should not drink.Otherwise, if youÃre already a moderate drinker, you may beless likely to have a heart attack.It is important, though, to weigh
43 benefits against risks. Talk withyour d
benefits against risks. Talk withyour doctor about your personal risks of breast cancer, heartdrinking alcohol. With the help of your doctor, decide whethermoderate drinking to lower heart attack risk outweighs thethe key. Heavy drinking causes many heart-related problems.Too much alcohol also can damage the heart muscle, leading toheart failure. Overall, people who drink heavily on a regularbasis have higher rates of heart disease than either moderate à 55à WHAT IS moderate DR
44 INKING? one drink per day, according to
INKING? one drink per day, according to the ÃDietary Guidelines for 12 ounces of beer (150 calories) 5 ounces of wine (100 calories) 11/2ounces of 80-proof distilled spirits (100 calories) Birth Control Pills Studies show that women who use high-dose birth control pills (oral contraceptives) are more likely to have a heart attack orstroke because blood clots are more likely to form in the bloodvessels. These risks are lessened once the birth control pill isblood cho
45 lesterol, and overweight.Much of this in
lesterol, and overweight.Much of this information comes from studies of birth control pillscontaining higher doses of hormones than those commonly usedtoday. Still, the risks of using low-dose pills are not fully known.Therefore, if you are now taking any kind of birth control pill orDonÃt mix smoking and Ãthe pill.Ã make a serious effort to quit. If you cannot quit, choose a differentform of birth control. Cigarette smoking boosts the risk of serioushealth problems from birth
46 control pill use, especially the risk of
control pill use, especially the risk ofblood clots. For women over the age of 35, the risk is particularlyhigh. Women who use birth control pills should not smoke. Ã 56Ã DIANE cardiologists and other doctors. I havenÃt had any more complications because of my heart disease.Ã Levels of glucose, or blood sugar,sometimes change dramatically in women who take birth controldiabetic should have regular blood sugar tests if she takes birthWatch your blood pressure. After startin
47 g to take birthpressure increases to 140
g to take birthpressure increases to 140/90 mmHg or higher, ask your doctorabout changing pills or switching to another form of birth control.Be sure to get your blood pressure checked at least once a year.Talk with your doctor. If you have heart disease or anotherheart problem, or if you have suffered a stroke, birth control pillsor other serious health conditions before prescribing birth control à 57à NEW RISK factors? We know that major risk factors such as high blood choleste
48 rol,high blood pressure, and smoking boo
rol,high blood pressure, and smoking boost heart disease risk.heart disease, including inflammation of the artery walls. Severalemerging risk factors have been identified. We donÃt know forsure yet whether they lead to heart disease or whether treatingC-reactive protein (CRP). inflammation in the artery walls. A simple blood test can measurea sign of metabolic syndrome. Treatment of the syndrome withoften lower CRP.increase risk for heart disease. For women, homocysteine level
49 sLp(a) protein. clots to form. Niacin,
sLp(a) protein. clots to form. Niacin, a cholesterol-lowering drug, may help to à 59à TAKING ow that you know the risks for heart disease, whatplenty. Research shows that women can lower their heart disease risk enormouslyÃby as much as 82 percentÃdozens of down-to-earth ideas for making heart healthy practicespart of your daily life.If you already have heart disease, this section also will tell you abouthealthier. You will also find out about the warning signs of a heartFor
50 all women, choosing a healthy lifestyle
all women, choosing a healthy lifestyle is extremely important.Remember, heart disease is a womanÃs greatest health threat.Adopting heart healthy habits can add years to your lifeÃvital, active years. Research from the Framingham Heart Study shows thatwomen who have no risk factors for heart disease live an average they donÃt take the time to keep themselves healthy and strong.the people and activities you love. And once you get started,keep it up. Ask your family and friends
51 to support you inmaintaining your new, h
to support you inmaintaining your new, heart healthy lifestyle. YouÃre worth it! their heart disease risk enormouslyÃby as à 60à A FAMILY PLAN FOR HEART hen it comes to heart health, whatÃs good for youngest members. We now know that two-thirds ofoverweight and Ãcouch potato-itisà to unhealthy blood pressuregreatly increases the risk of a later heart attack. By teachingimportance of eating well and getting regular physical activity,some ways to get started:Adults have a bi
52 g influence on childrenÃsmicrowave, and
g influence on childrenÃsmicrowave, and toaster safely. Show teens how to make simple,appreciate food more and are more likely to try new dishes.swimming, or bicycling. Walk, bike, or jog with them to placesclose by. Use your backyard or local park for basketball, à 61à AN ACTION PLAN FOR heart HEALTH H ereÃs The Heart Truthdiet, engage in regular physical activity,heart health. Currently, only 3 percent of U.S. adults practicethese ÃBig Fourà heart healthy habits. But itÃ
53 s never too late tostart. No matter wh
s never too late tostart. No matter what heart disease risk factors you haveÃorfour areas. If you already have heart disease, you can lessen itsTrue, you may need to take other steps to prevent or controlheart disease. For example, if you have diabetes, you also willfollowing a heart healthy eating plan, controlling your weight,this action plan can make an enormously positive difference inyour heart health. To find out how to get started, read on. Ã 62Ã The health of your hea
54 rt has a lot to do with the foods you ea
rt has a lot to do with the foods you eat.The ÃDietary Guidelines for Americansà give science-based Emphasize fruits, vegetables, whole grains, andfat-free or low-fat milk and milk products. Include lean meats, poultry, fish, Choose foods that are low intransfats,cholesterol, salt and sodium, Balance the calories you take in à 63à HOW TO READ A NUTRITIONAL FACTS LABEL Macaroni & Cheese Amount Per Serving Serving Size 1 cup (228g) Start Servings Per Container
55 2 Here Calories250Calories from Fat 110
2 Here Calories250Calories from Fat 110 Check Calories % Daily Value* Vitamin A 4%Vitamin C 2%Calcium20%Iron4% * Percent Daily Values are based on a 2,000 calorie diet. Your Daily values may be higher or lower depending on your calorie needs. Calories:2,0002,500Total FatLess Than65g80gLess Than20g25gCholosteralLess Than300mg300mgLess than2,400mg2,400mgTotal Carbohydrate300g375gDietary Fiber25g30g Total Fat 12gSaturatedFat 3g15%TransFat 3g30mg10%470mg20%Total Carbohydrate 31gDietaryF
56 iber 0gSugars5g Quick Guide to % Daily V
iber 0gSugars5g Quick Guide to % Daily Value Limit These Nutrients Â¥ 20% or More Get Enoughof These Footnote à 65à THE DASH EATING PLANThe DASH eating plan shown below is based on 2,000 calories a day. Thenumber of daily servings in a food group may vary from those listed, depending Food Group Daily Servings Serving Sizes (except as noted) Grains* 6Ã8 1 slice bread 1 oz dry cereal 1/2cupcooked rice, pasta, or cereal Vegetables 4Ã5 1 cup raw leafy vegetables 1/2cup cooked ve
57 getables 6 oz vegetable juice Fruits 4Ã
getables 6 oz vegetable juice Fruits 4Ã5 1 medium fruit 1/4cup dried fruit1/2cupfresh, frozen, or canned fruit1/2cup fruit juice Low-fat or fat-free 2Ã3 1 cup milk or yogurt milk and milk 11/2oz cheese products Lean meats, poultry, 6 or less 1 oz cooked meats, poultry, or fish and fish 1 eggà Nuts, seeds, 4Ã5 per week 1/3cup or 11/2oz nuts and legumes 2 tbsp peanut butter 2 tbsp or 1/2oz seeds 1/2cup cooked legumes (dry beans and peas) à 68à Food Group Daily Servings(exc
58 ept as noted) Serving Sizes Fats and oil
ept as noted) Serving Sizes Fats and oils¤ 2Ã3 1 tsp soft margarine1 tsp vegetable oil1 tbsp mayonnaise2 tbsp light salad dressing Sweets and added sugars 5 or less per week 1 tbsp sugar1 tbsp jelly or jam1/2cup sorbet or gelatin1 cup lemonade *Whole grains are recommended for most grain servings as a good source ofServing sizes vary between cups. Check the productÃsweek. Two egg whites have the same amount of protein as 1 ounce of meat.Fat content changes the serving amount for
59 fats and oils. For example, 1 tbspof r
fats and oils. For example, 1 tbspof regular salad dressing equals 1 serving; 1 tbsp of a low-fat dressing equalsone-half serving; 1 tbsp of a fat-free dressing equals zero servings. Ã 69Ã HOLD THE SALT: HOW TOSALT AND SODIUM IN YOUR DIET reduce You can help prevent and control high blood pressure by cuttingdown on salt and other forms of sodium. Try to consume nomore than 2,300 mg of sodium a dayÃor, if you can, no more Choose low-sodium, reduced-sodium, or no-salt-added
60 versionsof foods and condiments, when av
versionsof foods and condiments, when available. Choose fresh, frozen, or canned (low-sodium or no-salt-added) Use fresh poultry, fish, and lean meat, rather than canned, Choose ready-to-eat breakfast cereals that are lower in condiments sparingly, as you do table salt. Ã 70Ã A number of foods and other factors have been reported to affect affect blood pressure, but they are tasty, nutritious substitutes temporarily. Unless you are sensitive to caffeine, you do
61 not pressure. But the long-term effect
not pressure. But the long-term effects of stress are not clear.Furthermore, stress management techniques do not seem toprevent high blood pressure. However, stress management High Blood Cholesterol and the TLC Program and sterols to your diet as well as more soluble fiber. The TLCdeveloping heart disease, future heart attacks, and other heart à 72à eating THE TLC WAY and 33), you should start on the TLC eating plan right away.lower your chances of developing heart disease. If
62 you alreadyhave heart disease, it will
you alreadyhave heart disease, it will lessen your chances of a heart attackand other heart-related Less than 7 percent of the dayÃs total calories from saturated fat.Lowering saturated fat is the most important dietary change for Less than 200 mg of dietary cholesterol a day. No more than 25 to 35 percent of daily calories from total fat Just enough calories to reach or maintain a healthy weight. In addition, you should get at least 30 minutes of moderate-
63 along with the TLC Program. (See ÃTo
along with the TLC Program. (See ÃTo Learn Moreà on page 119.) à 73à PATTIE so I know itÃs important to take care of my health.Most women put everyone else but you canÃt put off taking care of your heart.à Recently, a large study reported what seemed to be startlingsignificantly reduce their risks for heart disease and other seriousdisorders. This widely publicized WomenÃs Health Initiative (WHI)study, which tracked more than 48,000 postmenopausal women,had about the same
64 risk of heart attack, stroke, breast ca
risk of heart attack, stroke, breast cancer, andprocessed foods, meats, and some dairy products. The type offat you eat affects your heart disease risk. Other studies havefound that reducing Ãbadà fats lowers risks for heart disease andfuture heart attacks, while consuming small amounts of ÃgoodÃsupports the heart benefits of reducing Ãbadà fats.to reduce their risk of heart disease. (For specifics, see ÃFiguring à 74à Getting Startedwell as fish, lean meat, poultry, or
65 dry beans. Choose foods thatare low in
dry beans. Choose foods thatare low in fat and added sugars. Choose sensible portion sizes.(See ÃPortion Distortionà on page 89.)Watch calories. To lose weight, most overweight people willDonÃt cut out milk products intrying to reduce calories and fat. Milk and milk products areproducts. Make the switch gradually. If youÃre used to drinkingPhysical activity is key to successful, long-termweight loss. It can help you burn calories, trim extra fat frommuscles and increase ae
66 robic fitness. To lose weight andpreven
robic fitness. To lose weight andprevent further weight gain, gradually build up to at least 60to get 60 to 90 minutes of daily physical activity. That may sound à 85à A recent study showed that moderate-intensity physical activity,more vigorous exercise. For more tips, see ÃLearn New MovesÃand grilled foods, and keep portion sizes small. Ask for saladserved on the sideÃor not at all.Forget the fads. carbohydrate diets, are not the answer. As tempting as theircalories per
67 day. Although fad diets can produce fas
day. Although fad diets can produce fast results,most of the weight loss is due to water loss. The weight returnsIf you are very overweight, or ifyou are overweight and have other weight-related risk factors oryou take off pounds. You should use a weight-loss drug onlyphysical activity, and other lifestyle changes for 6 months withoutbefore trying one of them. These drugs should be used alongwith a low-calorie eating plan and regular physical activity, not à 86à Get support. T
68 ell your family and friends about your w
ell your family and friends about your weight-lossprogram. The most effective groups provide support and advicefor permanently changing eating and physical activity (See ÃHow To Choose a Weight-Loss Programà on page 87.)weight, switch your efforts to keeping the weight off by60 to 90 minutes of moderate-intensity physical activity per day.Seven Secrets of Successful Weight ManagementIf you have ever tried to take off weight, you know that itÃs moremore. You also need to mentally
69 prepare yourself for newStart small. h
prepare yourself for newStart small. health by losing just 5 to 10 percent of your starting weight.Even though you may choose to lose more weight later, keep inSet smart goals. ItÃs important to set goals that are specific,achievable, and forgiving (allow yourself to be less than perfect).For example, Ãexercise moreà is a fine goal, but itÃs not veryspecific. ÃWalk for 60 minutes every dayà is specific andperhaps achievable. But what if you get a bad cold one day, and ther
70 eÃs a drenching rainstorm on another?
eÃs a drenching rainstorm on another? ÃWalk for 60 Ã 87Ã Likewise, with physical activity, first establish a small new habitÃit. Everyone can find time to walk 10 minutes each day. Whensomething you really want, donÃt put off giving it to yourself, andminutes daily for 3 weeks, IÃll take an afternoon off and treatmyself to a movie.Ã) Avoid food as a reward. It usually worksbetter to give yourself frequent, small rewards for reaching short-term goals than bigger rewards t
71 hat require long, difficult effort.Write
hat require long, difficult effort.Write it down. physical activity, as well as changes in your weight. (Try toprovider determine what behaviors you may want to improve.To lose weight successfully, you needyou may get a case of the munchies while watching TV, when à 88à friend who loves to eat. To Ãturn offà the trigger, youÃll need toThe fine art of feeling full. of noncaloric beverages can also make you feel fuller. Anothertrick is to use smaller plates so that moderate p
72 ortions donÃt seemskimpy. It also help
ortions donÃt seemskimpy. It also helps to set a regular eating schedule, especiallyHow To Choose a Weight-Loss ProgramSome people lose weight on their own, while others like the supportof a structured program. If you decide to participate in a weight- Does the program provide counseling to help youThe program should teach you how to permanently changeactivity, that have contributed to weight gain. Research shows Does the staff include qualified health professionals,successfully.
73 Before getting started, youÃll need t
Before getting started, youÃll need to be à 89à Does the program offer training on how to dealThe program should provide long-term strategies for preventingstrategies might include setting up a support system and a personal food likes and dislikes as well as your lifestyle. Avoid dietary supplements?Before you sign up, find out the total costs of participating in the How successful is the program?Few weight-loss programs gather reliable information on howwell they work. Still,
74 it is worthwhile to ask the following W
it is worthwhile to ask the following What percentage of people who start this program complete it? Â¥What percentage of people experience problems or sideeffects? What are they? Â¥What is the average weight loss among those who finish the à 90à portion DISTORTION How To Choose Sensible Servings ItÃs very easy to Ãeat with your eyesà and misjudge what equalsa servingÃand pile on unwanted pounds. This is especially truewhen you eat out, because restaurant portion sizes have b
75 eensteadily expanding. Twenty years ago
eensteadily expanding. Twenty years ago, the average pastaportion size was 2 cups, totaling 280 calories; today, it is 4portion sizes sensible: When eating out, choose small portion sizes, share an entree Check the Nutrition Facts label on product packages to learnhow much food is considered a serving as well as how much Be especially careful to limit portion sizes of high-calorie foods, Ã 91Ã regularly, begin with a 10- to 15-minute walk three times asessions unti
76 l youÃre doing something every day. Gr
l youÃre doing something every day. Gradually,60 minutes per day if youÃre also trying to manage your weight.(See ÃA Sample Walking Programà on page 98.)Making Opportunitiesadvantage of everyday opportunities to move around. For example: Use stairsÃboth up and downÃinstead of elevators. Start the way. If you take public transportation, get off a stop or Instead of eating that rich dessert or extra snack, take a brisk Do housework or yard work at a more vigorous pace. W
77 hen you travel, walk around the airport,
hen you travel, walk around the airport, train, bus, or Keep moving while you watch TV. Lift hand weights, do some Spend less time watching TV and using the computer. Take a movement break in the middle of the day. Get up and à 96à Some people should get medical advice before starting regularphysical activity. Check with your doctor if you: energetic activity. Currently have heart trouble or have had a heart attack. Have a parent or sibling who developed heart disease at diabet
78 es, osteoporosis, or obesity. Tend to ea
es, osteoporosis, or obesity. Tend to easily lose your balance or become dizzy. Feel extremely breathless after mild exertion. Are on any type of medication. Once you get started, keep these guidelines in mind:Go slow. warmup period, gradually increase your pace. Toward the endof your activity, take another 5 minutes to cool down with aslower, less energetic pace. Listen to your body. A certain amount of stiffness is normalat first. But if you hurt a joint or pull a muscle
79 , stop the activityfor several days to a
, stop the activityfor several days to avoid more serious injury. Rest and over-the-Check the weather report. humid days and for cold days. In all weather, drink lots of water before, during, and after physical activity. Ã 97Ã activity can strengthen your heart, some types of activity mayworsen existing heart problems. Warning signals include suddenyour upper body just after doing a physical activity. If younotice any of these signs, call your doctor right away. If youÃre
80 concerned about the safety of yourWalk,
concerned about the safety of yourWalk, bike, or jog during daylight hours.short-term goals for yourself. If you find yourself becomingbored, try doing an activity with a friend. Or switch to anotheractivity. The tremendous health benefits of regular, moderate-intensity physical activity are well worth the effort. We all have reasons to stay inactive. But with a little thoughtactivity. For example:ÃI donÃt have time to exercise.Ãweights while watching TV. Or, you can transf
81 orm some of youreveryday choresÃlike wa
orm some of youreveryday choresÃlike washing your car or walking the dogÃintoheart healthy activities by doing them more briskly than usual.ÃI donÃt like to exercise.ÃYou may have bad memories ofyourself through every sweating, panting moment. Now we à 98à health. Just do more of the activities you like. Try to get friendsor family members involved so that you can support each other. ÃI donÃt have the energy to be more active.Ãand watch your energy soar. Once you begi
82 n regular physicalactivity, you will alm
n regular physicalactivity, you will almost certainly feel stronger and morevigorous. As you progress, daily tasks will seem easier. ÃI keep forgetting to exercise.Ã _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
83 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
84 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
85 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
86 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
87 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
88 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
89 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
90 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ * For a healthy, 150-pound woman. A lighter person burns fewer calories; a heavier person burns more. Ã 99Ã A SAMPLE WALKING PROGRAM Warm Up Activity Cool Down TotalTime Week 1Walk slowly 5 min. Walk briskly 5 min. Walk slowly 5 min. 15 min. Week 2Walk slowly 5 min. Walk briskly 7 min. Walk slowly 5 min. 17 min. Week 3Walk slowly 5 min
91 . Walk briskly 9 min. Walk slowly 5 min.
. Walk briskly 9 min. Walk slowly 5 min. 19 min. Week 4Walk slowly 5 min. Walk briskly 11 min. Walk slowly 5 min. 21 min. Week 5Walk slowly 5 min. Walk briskly 13 min. Walk slowly 5 min. 23 min. Week 6Walk slowly 5 min. Walk briskly 15 min. Walk slowly 5 min. 25 min. Week 7Walk slowly 5 min. Walk briskly 18 min. Walk slowly 5 min. 28 min. Week 8Walk slowly 5 min. Walk briskly 20 min. Walk slowly 5 min. 30 min. Week 9Walk slowly 5 min. Walk briskly 23 min. Walk slowly 5 min. 33 mi
92 n. Week 10Walk slowly 5 min. Walk briskl
n. Week 10Walk slowly 5 min. Walk briskly 26 min. Walk slowly 5 min. 36 min. Week 11Walk slowly 5 min. Walk briskly 28 min. Walk slowly 5 min. 38 min. Week 12Walk slowly 5 min. Walk briskly 30 min. Walk slowly 5 min. 40 min. Ã 100Ã You of heart disease, cancer, and other serious disorders, with the benefitsincreasing over time. Just 1 year after you stop smoking, your heartdisease risk will drop by more than half. Within several years, it willapproach the heart disease risk of
93 someone who has never smoked.will lessen
someone who has never smoked.will lessen your chances of developing heart disease.If you already have heart disease, giving up cigarettes will lower yourrisk of a heart attack. Quitting also reduces the risk of a second heartabout giving up cigarettes. But with support and a plan of action,Getting Ready To Quit Take some time to think about all the benefits ofcigarettes? Write down all of the reasons you want to stop smoking. to stop smokingÃbut not too much! ItÃs best to cho
94 ose a dateabout 2 weeks away. aids inclu
ose a dateabout 2 weeks away. aids include a patch, gum, inhaler, nasal spray, and lozenges.Some of these medicines are available over the counter.Others require a prescription. All contain very small amountsof nicotine, which can help to lessen the urge to smoke. Twocraving for cigarettes, and varenicline tartrate (Chantixª), à 101à ÃI WAS 3 MONTHS PREGNANT WITH MYSECOND CHILD WHEN I STARTED HA A RACING HEARTBEAT. I ENDED UP BEINGDIAGNOSED WITH HYPERTROPHICCARDIOMYOPATHYÃTH
95 ICKER THAN NORMALHEART WALLS. THE CONDI
ICKER THAN NORMALHEART WALLS. THE CONDITION ISFAMILY WHO HAD IT. I GETREGULAR CHECKUPS AND TAKEHEALTH, AND I TEACH MY KIDSTO MAINTAIN A HEALTHYHAVE BEEN SCREENED FORHEART DISEASE.à à 102à five AIDS FOR QUITTING help you stay off cigarettes. Some of these medications contain veryVarenicline tartrate (Chantixª) the effects of nicotine if you slip and start smoking again. people to stop smoking, they are not safe for everyone. Talk with yourdoctor about whether you should try
96 any of these aids. A WEIGHTY concern
any of these aids. A WEIGHTY concern weight. But most exsmokers gain less than 10 pounds. Weight gainmay be partly due to changes in the way the body uses calories afterbecome comfortable as a nonsmoker. Meanwhile, concentrate onbecoming smoke freeÃyour heart health depends on it. Ã 106Ã HAVE HEART DISEASE f you have heart disease, it is extremely important activity, and maintaining a healthy weight willcarefully.You also may need certain tests, medications, or special proc
97 edures.your heart health.Screening Tests
edures.your heart health.Screening Testshave heart disease and how severe it is. If your doctor doesnÃttaking a careful medical history and doing a physical examination, ElectrocardiogramheartÃs electrical activity as it beats. This test can showabnormal heartbeats, heart muscle damage, blood flowproblems in the coronary arteries, and heart enlargement. heartÃs electrical activity during exercise, usually on a treadmillor exercise bike. The test can detect whether the heart i
98 s gettingto arthritis or another health
s gettingto arthritis or another health condition, a stress test can be doneincreases blood flow to the heart muscle and makes the heartbeat faster, mimicking the changes that occur when you exercise. Thissee whether there are any problems with the blood flow to the heart. Ã 107Ã shows the working of the heart muscle asblood flows through the heart. A small amount of radioactivematerial is injected into a vein, usually in the arm, and acamera records how much is taken up by the
99 heart muscle. show the heartÃs size, s
heart muscle. show the heartÃs size, shape, and movement. The soundthe heart when it contracts. diagnose and treat certain heart conditions. A long, thin,arm or upper thigh (groin) and threaded up into the heart.Through the catheter, the doctor can perform diagnostic tests andtreatments on the heart. The diagnostic tests include the following: Coronary angiography(or angiogram or arteriography)the coronary arteries. A dye is injected into the catheter,allowing the heart and b
100 lood vessels to be filmed as theheart pu
lood vessels to be filmed as theheart pumps. The picture is called an angiogram orarteriogram. Ventriculogram is sometimes a part of the x-ray dye testdescribed above. It is used to get a picture of the heartÃs mainpumping chamber, typically the left ventricle. Intracoronary ultrasoundcardiac catheterization to measure blood flow. It gives acoronary arteries that shows the thickness andother features of the artery wall. This lets the doctor see blood à 108à COULD YOU HAVE
101 hidden HEART DISEASE? Many women have u
hidden HEART DISEASE? Many women have undiagnosed heart diseaseÃeven after gettingUnited States have a hard-to-spot form of heart disease calledÃcoronary microvascular syndrome,Ã in which plaque spreads evenlythroughout the walls of very small arteries, rather than building up ina larger, main artery. Even though women with this condition haveinsufficient blood and oxygen flow to the heart muscle, a standardangiogram (which is designed to pick up blockages in large arteries)is l
102 ikely to show their arteries to be norma
ikely to show their arteries to be normal.This means that women with heart disease symptoms should beprepared to speak up to their doctors. If you receive a ÃnormalÃangiogram but still have chest pain or other heart symptoms, askof your small arteries. To find out, you may be asked to undergoeasily you can perform everyday tasks. This quiz, called the ÃDukeActivity Status Index,Ã can help to predict your heart attack risk. Ã 109Ã In addition, several new, highly sensitive sc
103 reening tests have Carotid doppler ultra
reening tests have Carotid doppler ultrasoundblockages and narrowing of the carotid artery in the neck.Both conditions can signal an increased risk for heart attack Electron-beam computed tomography coronary arteries. It may predict whether youÃll be at higher riskfor heart disease in the future. This test is promising, but notfoolproof, and requires careful evaluation by your doctor. heartÃs structure and functioning. It is often used to evaluatecongenital heart disease. Th
104 e test can also detect severeblockages i
e test can also detect severeblockages in coronary arteries in people who are havingunstable angina or a heart attack, thereby allowing immediatetreatment to restore blood flow to the heart. à 110à aspirin: TAKE WITH CAUTION This well-known Ãwonder drugà can help to lower the risk of a hearthelp to keep arteries open in those who have had a previous heartbypass or other artery-opening procedure, such as angioplasty. emergency department with a suspected heart attack or stroke.It
105 Ãs important to know that aspirin has n
Ãs important to know that aspirin has not been approved by theU.S. Food and Drug Administration for the prevention of heartattacks in those who have never had a heart attack or stroke.However, a recent large study has found that among healthywomen, taking low-dose aspirin every other day may help to preventevery other day may also prevent a first heart attack. If you arepowerful drug with many side effects. It can also mix dangerouslywith other drugs, including some over-the-count
106 er medicines anddietary supplements.If y
er medicines anddietary supplements.If youÃre thinking about using aspirin either to treat or prevent heartmedical history and current health condition can judge whether theyou, be sure to take the dose recommended by your doctor.practicing the ÃBig Fourà heart healthy habitsÃeating nutritiously,getting regular physical activity, maintaining a healthy weight, and à 111à To control or prevent heart disease, you may need to take medicine.Medications may be used to treat a risk fa
107 ctor, such as high bloodoften accompanie
ctor, such as high bloodoften accompanies heart disease. If you do take medicine, itÃsimportant to keep up your heart healthy lifestyle, because healthyMedications that are commonly prescribed for people with heart ACE (angiotensin converting enzyme) inhibitors are used to treat high blood pressure and damaged heart muscle.ACE inhibitors may reduce the risks of a future heart attack andheart failure. They also can prevent kidney damage in some therefore help to prevent clots from
108 forming in your arteries andblocking blo
forming in your arteries andblocking blood flow. (These medicines are sometimes calledAnticoagulants will not dissolve clots that have already formed, but are medications that stop blood particles calledplatelets from clumping together to form harmful clots. Thesemedications may be given to people who have had a heartmedicine. (See ÃAspirin: Take With Caution,Ã on page 109.) Ã 112Ã slow the heart and allow it to beat with less force.(abnormal heart rhythms) and to prevent a r
109 epeat heart attack. Calcium-channe
epeat heart attack. Calcium-channel blockers relax blood vessels. They are used totreat high blood pressure, angina, and some arrhythmias. makes the heart contract harder and is used when theheart canÃt pump strongly enough on its own. It also slows downsome fast heart rhythms. (water pills) decrease fluid in the body and are verythat diuretics also can help to prevent stroke, heart attack, andheart failure. For those who already have heart failure, diuretics different form
110 s can be used to relieve the pain of an
s can be used to relieve the pain of an angina attack,that occur by using the medicine regularly on a long-term basis. The risk of heart attack and stroke for women with heart disease. Butresearch now shows that women with heart disease should not takeit. Menopausal hormone therapy can involve the use of estrogenalone or estrogen plus progestin. For women with heart disease,estrogen alone will not prevent heart attacks, and estrogen plusprogestin increases the risk for heart atta
111 ck during the first few yearsclots, stro
ck during the first few yearsclots, stroke, and breast cancer. Ã 113Ã Special ProceduresAdvanced heart disease may require special procedures to openan artery and improve blood flow. These operations are usually Coronary angioplasty, or balloon angioplasty. an artery into the heartÃs narrowed blood vessel. The catheterdeflated to open and stretch the artery, improving blood flow.Often, a tiny tube called a stent is permanently inserted in theartery to keep it open. Stenting may
112 be particularly beneficial Coronary art
be particularly beneficial Coronary artery bypass graft, or Ãbypass surgery.ÃA piece of vein is taken from the leg or a section of an arteryheart artery both above and below the narrowed area,surgery, ask your doctor whether you are a candidate for onepumpà and Ãminimally invasiveà coronary bypass surgery. à 114à GETTING HELP FOR A heartF ATTACKor many people, the first symptom of heart disease is a heart attack. Therefore, everyof a heart attack and how to get immediate me
113 dical help.Ideally, treatment should sta
dical help.Ideally, treatment should start within 1 hour of the firstsymptoms. Recognizing the warning signs and getting help Know the Warning Signs Not all heart attacks begin with sudden, crushing pain, as is oftenshown on TV or in the movies. Many heart attacks start slowly asmild pain or discomfort. The most common warning signs for Chest discomfort. Most heart attacks involve discomfort in thefeel like uncomfortable pressure, squeezing, fullness, or pain.The discomfort
114 can be mild or severe, and it may come
can be mild or severe, and it may come and go. Discomfort in other areas of the upper body,one or both arms, the back, neck, jaw, or stomach. Shortness of breath. or without chest discomfort. Other signsinclude nausea, light-headedness, or breakingout in a cold sweat. Ã 115Ã Get Help Quickly If you think you, or someone else, may be having a heart attack,you must act quickly to prevent disability or death. Wait noIt is important to dial 9Ã1Ã1 because emergency m
115 edicalThey also have the equipment and t
edicalThey also have the equipment and training to start your heartEven if youÃre not sure youÃre having a heart attack, dial 9Ã1Ã1completely in less than 5 minutes, you should still call your doctor.You also must act at once because hospitals have clot-bustingmedicines and other artery-opening treatments and proceduresthat can stop a heart attack, if given quickly. These treatmentswork best when given within the first hour after a heart attack starts.Women tend to delay longer
116 than men in getting help for apossible h
than men in getting help for apossible heart attack. A large study of heart attack patientsbecause they donÃt want to bother or worry others, especially iftheir symptoms turn out to be a false alarm. But when youÃrefacing something as serious as a possible heart attack, it is muchbetter to be safe than sorry. If you have any symptoms of a possibleheart attack that last up to 5 minutes, call 9Ã1Ã1 right away.When you get to the hospital, donÃt be afraid to speak up forAsk for
117 tests that can determine if you are havi
tests that can determine if you are having a heart attack.ECG orEKG) and a cardiac enzyme blood test (to check for heart damage). à 116à At the hospital, donÃt let anyone tell you that your symptoms areÃjust indigestionà or that youÃre Ãoverreacting.à You have theright to be thoroughly examined for a possible heart attack. Ifyou are having a heart attack, you have the right to immediate Plan Ahead Nobody plans on having a heart attack. But just as manypeople have a plan in
118 case of fire, it is important to develo
case of fire, it is important to develop aplan to deal with a possible heart attack. Taking the followingsteps can preserve your healthÃand your life: Learn the heart attack warning signs by heart. Talk with family and friends about the warning signs and theneed to call 9Ã1Ã1 quickly. Talk with your health care provider about your risk factors forheart attack and how to reduce them. Write out a heart attack survival plan that has vital medicalinformation and
119 keep it handy. (Use the accompanying bo
keep it handy. (Use the accompanying box other dependents in an emergency. having a heart attack, you must act quicklyto prevent disability or death. Wait no more à 117à HEART ATTACK Fill out the form below and make several copies of it. Keep oneInformation To Share With Emergency Medical Medicines you are taking: Medicines you are allergic to: How To Contact Your Doctor call your doctor right away. Phone number during office hours: Person To Contact If You Go to the Ho
120 spital Name: Home phone number: Work pho
spital Name: Home phone number: Work phone number: Cell phone number: Ã 118Ã THE HEART OF THE matter etting serious about heart health may seem like a daily living habits, for many women it is a major effort.But it doesnÃt have to be an overwhelming one. Some And remember, nobodyÃs perfect. Nobody always eats the idealdiet or gets just the right amount of physical activity. Few smokersway. The important thing is to follow a sensible, realistic planthat will gradually lessen y
121 our chances of developing heartWomen are
our chances of developing heartWomen are taking a more active role in their own health care.We are asking more questions, and we are readier than ever tomake changes that will help us lead healthier lives. We areconcerned not only about treatment, but also about theTaking steps to prevent and control heart disease is part of thisreward of a healthy heartÃa better chance for a longer, morevigorous lifeÃis well worth the effort. Ã 119Ã HOW TO ESTIMATE YOUR riskU se these risk tab
122 les to find your chances of having a hea
les to find your chances of having a heart PointsPointsAge 20Ã34-7Age 55Ã598Age 35Ã39-3Age 60Ã6410Age 40Ã440Age 65Ã6912Age 45Ã493Age 70Ã7414Age 50Ã546Age 75Ã7916 00000160Ã19943211200Ã23986421240Ã279118532á 2801310742Age 20-39Age 40-49Age 50-59Age 60-69Age 70-79Total CholesterolPoints Age 20-39Age 40-49Age 50-59Age 60-69Age 70-79Nonsmoker 00000Smoker97421Points HDL (mg/dL)Points HDL (mg/dL)Points 60-1 40Ã491 50Ã590 02 Systolic BP (mmHg)Systolic BP (mmHg) If Untreated
123 If TreatedIf UntreatedIf Treated PointsP
If TreatedIf UntreatedIf Treated PointsPoints 00120Ã12913130Ã13924140Ã15935á 16046 Point Total 10-Year Risk % Point Total 10-Year Risk % Point Total 10-Year Risk % 14 2 20 11 9 1 15 3 21 14 10 1 16 4 22 17 11 1 17 5 23 22 12 1 18 6 24 27 13 2 19 8 25 30 (Framingham Heart Study Point Scores) Ã 120Ã o find out more about preventing and controlling heartdisease, contact the following information sources:P.O. Box 30105TTY: 240-629-3255 Provides information on the prevention and
124 treatment of heart disease and offerspu
treatment of heart disease and offerspublications on heart disease and heart health. Also, check out these NHLBI heart health Web sites and Web pages: NHLBI Web site: www.nhlbi.nih.gov www.nhlbi.nih.gov/health/dci/index.html The Heart Truth: A National Awareness Campaign for Women About Heart Disease:www.hearttruth.gov NHLBI ÃYour Guide To Better Healthà Series:http://hp2010.nhlbihin.net/yourguideÃYour Guide to a Healthy HeartÃÃYour Guide to Living Well With Heart DiseaseÃ
125 ÃYour Guide to Lowering Your Blood Pres
ÃYour Guide to Lowering Your Blood Pressure With DASHÃÃYour Guide to Lowering Your Cholesterol With TLCÃÃYour Guide to Physical Activity and Your HeartÃÃYour Guide to Healthy Sleepà ÃKeep the Beat: Heart Healthy Recipes from the NHLBIÃ:www.nhlbi.nih.gov/health/public/heart/other/ktb_recipebk/ Interactive Web Pages Your Guide to Lowering High Blood Pressure:www.nhlbi.nih.gov/hbp/index.html Live Healthier, Live Longer (on lowering elevated blood cholesterol):www.nhlbi.nih.go
126 v/chd High Blood Cholesterol: What You
v/chd High Blood Cholesterol: What You Need To Know:www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm à 121à Aim for a Healthy Weight:www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm Act in Time to Heart Attack Signs:www.nhlbi.nih.gov/actintime/index.htm We Can! (Ways to Enhance ChildrenÃs Activity and Nutrition): Stay in Circulation: Take Steps to Learn About P.A.D.: www.aboutpad.org Additional Resources National Diabetes Information Clearinghouse: www.canc
127 er.gov/cancertopics/factsheet/Tobacco Am
er.gov/cancertopics/factsheet/Tobacco American Heart Association: www.americanheart.org Heart Healthy Women: www.hearthealthywomen.org National WomenÃs Health Information Center, Office on WomenÃs Health, U.S.Department of Health and Human Services: www.womenshealth.gov WomenHeart: the National Coalition for Women with Heart Disease:www.womenheart.org For still more information on heart health, see MedlinePlus: Ã 122Ã THE HEALTHYHEART HANDBOOK FOR WOMEN National Heart, Lu