12 HEART INSIGHT AUGUST 2010

Triple Threat: Diabetes, Elevated Cholesterol And High Blood Pressure

People with diabetes are at significantly high-er risk of developing cardiovascular disease (CVD) than people without this metabolic dis-

order. At least 65 percent of people the U.S. who have diabetes die from CVD, and research sug-gests that cholesterol and blood pressure levels should be monitored and treated as carefully as insulin levels.

Elevated blood pressure and high cho-lesterol are the common and potentially le-thal links between diabetes and CVD. Two in five people with diabetes have poor cho-lesterol control, one in three has poor blood pressure control and one in five have poor glucose control.

If diabetes is caught early on, a combi-nation of medication and lifestyle changes can greatly improve longevity and quality of life.

The first step is to understand that op-timal blood pressure and cholesterol levels for people with diabetes are higher than for people without diabetes. The American Heart Association (AHA) recommends that

someone who has diabetes keep his or her systolic blood pressure under 130 mmHg and diastolic blood pressure under 80 mmHg. And anyone over age 40 who has diabetes plus one or more major CVD risk factors, such as overweight or high blood pressure, needs to keep LDL (bad) cholesterol level below 100 mg/dL.

Luckily, one set of lifestyle recommendations con-trol all three conditions: Maintain a healthy weight: Body mass index be-

tween 18.5-24.9; Get regular physical activity: 150 or more minutes

a week of moderate activity, or 75 or more minutes a week of vigorous activity or a combination; and

Don’t smoke.While making these changes may be difficult, you

will quickly see benefits. For example, losing just five pounds can significantly reduce your risk for heart disease. And just a few days after quitting smoking — once the nicotine and carbon monoxide are cleared from your body — your blood pressure probably will go down, and levels of oxygen and carbon monoxide in your blood should return to normal.

L i fe ’s Simple 7

Life’s Simple Seven In A NutshellCardiovascular health encompasses two basic components: ideal health behaviors, and ideal health factors.

The behaviors include not smoking, maintaining a healthy weight, meeting or exceeding AHA recommendations for physical activity and eating a healthy diet.

The health factors include blood pressure, fasting blood glucose and total cholesterol levels that are within the AHA’s recommended range — preferably without needing medication to keep them there.

Modest lifestyle or behavioral changes can improve your health and move you in the right direction. And those who make behavioral changes before developing any serious health risks can look for-ward to a better quality of life and moving toward excellent heart health.

Lose Weight Get Active Control Cholesterol Manage Blood Pressure Reduce Blood Sugar Quit Smoking Eat Better

HEART INSIGHT AUGUST 2010 13

Smoking Is As Bad For Your Arteries As For Your Lungs

On average, nonsmokers live several years lon-ger than smokers, and not just because their lungs are healthier.

Smoking’s effects inside your body aren’t pretty. Smoking increases your risk of heart attack and stroke by making your blood stickier and more likely to clot; cutting your high-density lipoprotein (HDL) cholesterol (the good cholesterol); and increasing carbon monox-ide (yes, the same gas that comes out of your car’s tail-pipe!) in your blood, robbing your body of vital oxygen. In addition, the nicotine in cigarettes raises your blood pressure while it’s in your system.

Smoking also damages the insides of your arteries and blood vessels, which stiffens them over the years and makes fatty buildup more likely. This damage not only increases heart attack and stroke risk but may cause pain, cramping or aching in your legs when you walk (peripheral artery disease).

People who have diabetes are in even greater dan-ger of adverse cardiovascular effects. Smoking can make the blood vessel damage of diabetes worse, leading to leg and foot infections, even disability. According to recent research, smoking also makes controlling blood sugar more difficult, as well as blunting the benefits of inhaled insulin. Diabetics die of heart disease more than any other cause.

QUITTING TIMEStopping smoking abruptly with no outside help — cold turkey — is cheap, and you can do it at home. But studies show that it has only about a five percent success rate.

Fortunately, there are oth-er options to help you become an ex-smoker; Counseling increases your chances of quit-

ting from 20 percent (telephone) to 30 percent (group) to 70 percent (face-to-face). Support groups can be great motivators, as well as pools of advice; one-on-one counseling can be tailored to your needs - you don’t have to listen to some-one talk about something that doesn’t apply to you; and if you’d rather not go to meetings or ses-sions, telephone quit lines may help.

Nicotine replacement can boost your chances of quitting by 50 percent (gum) to 180 percent (inhaler). Though safer than smoking, nicotine replacement therapy may not be for you — es-

pecially if you’ve had a heart attack, irregular or rapid heartbeat, or chest pain — so get your doctor’s OK first. And though nicotine replace-ment therapy products are considered safe for adolescents, no studies on the long-term safety in this age group have been published.

Nicotine replacement products minimize withdrawal symptoms (among them, depressed

mood, disrupted sleep, irritability, frustration and anger) while spar-ing you many other harmful sub-stances in smoke as you taper the dose and break the habit. In

addition to nicotine gum and inhal-er, nicotine replacement can be got-

ten in a lozenge, patch and nasal spray. The inhaler and spray is available by pre-

scription; the other products are over-the-counter. Antidepressants bupropion or varenicline block

nicotine’s effects in the brain, and either drug can increase your chances of success when other methods don’t do the trick. Talk with your healthcare provider to determine if this is an option for you.

Combining counseling with nicotine replacement or antidepressant therapy may give you your best chance of success.

14 HEART INSIGHT AUGUST 2010

L i fe ’s Simple 7

Shaking Salt From Your Diet

For years, health experts have been telling us to lower the sodium in our diets. You may think the advice doesn’t apply to you, because you don’t

have high blood pressure. Or that all you need to do to eat less sodium is to put away the saltshaker. Well, read on ‘cause you’re in for a surprise!

Salt contains sodium, and high sodium intake causes the body to retain water, which puts an extra burden on the heart and blood vessels that increases your risk of developing high blood pressure — a major risk factor for heart disease and stroke.

The average American eats 2,900 milligrams (mg) to 4,300 mg of sodium a day — significantly more than American Heart Association (AHA) recommendation of less than 1,500 mg per day for most people.

Even if your blood pressure is normal – below 120/80 mmHg (mil-limeters of mercury) without medication — since nine out of 10 Americans will develop high blood pressure in their lifetimes, preventing or delaying onset is beneficial.

HIDDEN SOURCES OF SODIUM Believe it or not, most of the sodium you eat does not come out of the saltshaker. It’s already in the prepack-aged and processed foods that you eat! For example, did you know that one-third of the salt in your diet comes from baked goods?

Read food labels carefully — the sodium content of foods may be listed as “soda” or “sodium”. Plus, you might find sodium where you least expect it — for in-stance, powdered hot cocoa mix. And keep in mind that even low-salt versions of your favorite foods may still take a big bite out of your sodium budget.

Choose items that provide less than 200 mg of so-dium per serving. Any food with more than 400 mg per serving is a red flag. Canned and powdered soups are notoriously high in salt, but many lower sodium ver-sions are available, with no real sacrifice in flavor.

A low-salt diet needn’t be bland or boring. These tips will help you salt your life with a few more healthy years: Substitute other seasonings and flavors, such as

herbs, spices, lemon, wine and fruit juice. Unless you’re on an extremely salt-restricted diet,

removing as many processed and prepackaged foods from your diet as possible will cut your overall sodium intake substantially and help you meet recommendations and improve your heart health.

Frozen fruits and vegetables are convenient to have on hand, and contain very little added so-dium, as long as they are plain and not in a sauce.

When eating out, you can avoid unwanted sodium by ordering grilled chicken or fish, steamed veg-etables and salads — just steer clear of dressings,

gravies and sauces, which tend to be loaded with sodium

Limiting sodium intake isn’t the only thing you should do to lower your risk of high blood pressure. It’s also important to keep your weight within a healthy range and to eat lots of fresh fruit, vegetables and fat-free and low-fat dairy products — they’re good sources of potas-

sium, which helps blunt the effects of sodium and helps keep blood pressure

levels normal. As an added bonus, these foods are naturally low in

sodium so if you fill up on them, you’ll have less room in your tummy for the salty stuff.

HEART INSIGHT AUGUST 2010 15

Kids And Teens At Risk For Heart Disease, Too

Being sedentary and overweight in childhood raises risk of heart disease and related ailments in adulthood:

Children who are overweight – above the 85th per-centile of body mass compared to others in their age group — from 7 to 13 years old are at increased risk of developing heart disease beginning at age 25.

Children 6 to 11 years old who are obese — above the 95th percentile of body mass — are twice as likely to have diabetes as those who are normal weight.

Children (average age 12) who watch two-to-four hours of TV daily have 2.5 times the risk of high blood pressure, as compared with those who watch less TV. Limit screen time to 2 hours or less per day.

Low levels of aerobic fitness in childhood are associated with metabolic syndrome in adolescence.

You Do The Walk Of Life

Walking is the Number One physical activity in America. And for good reason: It’s convenient, affordable and pro-

vides social interaction.Walking can increase energy, reduce stress, strengthen

bones and muscles, improve stamina and fitness-even lower the risk of heart disease and type 2 diabetes. And it’s a more challenging workout than you might think.

Walking can run the gamut from a slow saunter to speed walking, but generally speaking, a 15 minute-per-mile walk is a fitness walk. For most people, reaching that pace will require some hard work. A good way to judge your progress is the ‘talk test.’ If you can carry on a monologue, you’re not walking fast enough-and if you can’t carry on a conversation, then you’re working too hard.

Proper form helps walkers increase heart rate and burn calories: Align the body properly. Keep ears over your shoulders

and hips and knees over your ankles. Keep the torso tall and look straight ahead.

Bend your arms at a 90-degree angle, with your forearms parallel to the ground. Keep your fingers in a loose fist, with fingertips lightly touching your palms and thumbs resting gently on your index fingers.

Your arms should swing back and forth, but never higher than the chest bone.

Step heel to toe, with a roller motion, but don’t over-stride. When less of your heel touches the ground and your foot plant becomes flat, you’re over-striding.

ResourcesLife’s Simple Seven Assessment To understand the steps you may need to take to improve heart health and quality of life, visit http://mylifecheck.heart.org

Diabetes Management Learn about diabetes & share your experiences at www.Iknowdiabetes.org

Smoking Cessation For tips and tools check out www.americanheart.org/quitsmoking

Start! Walking For a Healthier LifestyleMotivate yourself to Start! Walking, and connect with “Sole-Mates” — friends, colleagues and walkers nation-wide who share your goals http://startwalkingnow.org

Alliance for a Healthier Generation http://www.HealthierGeneration.org

Body Mass Index Calculator www.americanheart.org/BMI