ABC’s OF HEALTHY HEART
Dr Mary Jo Hull, MD
Specialists for Health Cardiology
INTRO
February is Heart Month for awareness of heart disease.
Cardiovascular disease #1 cause of DEATH in Americans with stroke ranked as #5.
“ABC’s” of a Healthy Heart and I have added letters “D, E and F”—How to lower risk of heart disease
THE SCOPE OF CARDIOVASCULAR DISEASE is HUGE.
Did you know….that in the US there are 1.7 Million heart attacks and strokes annually.
That over 600,000 people die every year?
Someone dies every 40 sec from cardiovascular disease.
Cardiovascular disease is costs $109 billion dollars per year.
47 million Americans, 1/3 of the US population is at risk for heart disease
CHALLENGE: Know your 10 year risk of cardiovascular disease are you high or low risk?
Use a cardiac risk calculators from the American Heart Association/ American College of Cardiology
It calculates your 10 yr risk of cardiac events (stroke or heart attack). It will also show how much lower
your risk could be if you improve your numbers or stop smoking. Higher your risk determines how
aggressive your evaluation or treatment should be.
Calculators can be found on line at
www.heart.org
www.cardiosmart.org
or app store for your phone
To use the calculator you need to know the following numbers:
-- your age
--your gender
--ethnicity
-- total cholesterol number (from lab results from your doctor)
--HDL good cholesterol number (from lab results from your doctor)
--blood pressure number and “yes or no” if you are on medications
--diabetes “yes or no”
--if you are smoking “yes or no”
Score results:
Low Risk is less than 5% risk over the next 10 yrs for cardiovascular disease
Intermediate Risk is > 7.5% risk over the next 10 yrs for cardiovascular disease.
SOME of the risk factors for heart disease are not modifiable:
---Age, sorry we cannot make you younger
---Gender, cardiovascular disease start in males in their 50s and women in their 60s
---Family history/genetics—know your family history as affects your risk
---Any first degree relative (parent, sibling or child) with a premature heart attack
---Premature is a family member male younger than age 55 yrs; female younger than 65 yrs
--- ETHNICITY cannot change, ie African Americans, Hispanics, native American Indians, or pacific
islanders.
MANY of the risk factors are Modifiable, Lifestyle Changes these are the ABCS+ DEF:
A=Aspirin
B=Blood pressure control
C=Cholesterol
S=Stop smoking
D=Diet
E=Exercise
F=Fat/Weight
A = Aspirin or Antiplatelet therapy
Aspirin reduces risk of cardiac events by approximately 20% and prevents cancer
1. Aspirin recommended for all patients that have already had a heart attack or stroke
2. Use in intermediate risk patients (risk greater than 7.5%)
a. Men > age 50
b. Women > age 60
c. If have one risk factor of smoking, hypertension, high cholesterol, diabetes, chronic
kidney disease, or premature family history (first degree male less than 55 yrs old or
female less than 65 yrs old)
3. Discuss with physician as small risk of bleeding 40 events/10,000 pts/10 yrs
B = Blood Pressure Control :
Silent Killer that increases risk of heart attacks, strokes kidney failure, heart failure
Did you know that one in three Americans have high blood pressure defined as a blood pressure higher
than 140/90, less than ½ have it under control
---Check frequently
---Goal blood pressure is less than 140/90, lower if diabetes or kidney disease
---Careful with over the counter medications
C=Cholesterol Management
---More than 1/3 of Americans have high cholesterol
---Every 1% decrease in cholesterol will reduce your cardiovascular risk by 3%
---Builds up and narrows blood vessels in the brain, heart, and legs, kidney
---Causes heart attacks, strokes, kidney disease, vascular disease-ulcers and amputations
---Goal of therapy is to lower your cholesterol levels 40%
---Physician should rule out treatable causes of high cholesterol
---Know your Numbers!
1. Total cholesterol goal is less than 200
2. HDL is good cholesterol, the higher this is it is protective and prevents events
a. Goal > 50 in women (naturally have higher number due to estrogen hormones)
b. Goal > 40 in men
c. Genes play a role
d. Difficult to increase with aerobic exercise, limited alcohol in moderation, 2 servings per day
in men, and 1 serving per day in women. Preferably less than 5 oz of wine (red), 12 oz beer,
or 1.5 oz of hard liquor.
e. Some medications, statins, niacin will increase this slightly
3. LDL is bad cholesterol, the higher it is increases cardiovascular risk
a. Goal is less than 130-160 in patients with no disease
b. Lower goals of < 100 in diabetics; < 70 in patients already with heart attack or stroke
c. Decrease 15-20% with diet and exercise
d. Lower with “statins”
4. Triglycerides are also associated with cardiovascular disease
a. goal is less than 160
b. higher than 600 may cause pancreatitis
c. Lower with diet; avoid alcohol; fish oil, and cholesterol medications, treat diabetes,
thyroid
---Who should be treated with medications for their cholesterol?
Everyone should work on lifestyle, diet, weight, and exercise to lower their numbers as much as
possible. Medications are in addition to lifestyle changes. Taking cholesterol medications does not
allow you to eat what you want.
1. All high risk patients, patient with prior heart attack or stroke should be on medical therapy.
2. All patients with LDL of > 190 should be on medication
3. LDL 70-189 with a cardiac risk of > 7.5% 10 yr risk of cardiovascular events
4. Those with high risk should be considered if LDL > 160, CAC (coronary artery calcium) score
greater than 300, family history of premature heart disease, high us CRP marker, peripheral
vascular disease (tested with Flocheck at your clinic)
---Goals of therapy is to reduce the cholesterol levels by 40%. This is best done with
1. Diet, exercise, and weight loss
2. Diabetes control
3. Statin therapy based on your 10 yr risk and risk factors.
S = Stop Smoking –STOP SMOKING!!! THIS IS THE MOST IMPORTANT CAUSE OF PREMATURE DEATH IN
THE UNITED STATES!!!!!!
---Smoking increases tendency to clot, accelerates vascular disease, lowers the good cholesterol the
HDL, increases blood pressure increasing risk of heart attack, stroke, and vascular disease, aneurysm.
---Second hand smoke is dangerous too, increases risk of cardiovascular disease 25-30%.
---38,000 people die from second hand smoke every year.
---When you stop smoking, you have IMMEDIATE cardiovascular benefit the day you stop smoking.
D= Diabetes
---Affects 6 million Americans
---Another 20 million Americans are at risk of diabetes.
---Majority do not know they have it for 5-10 years before it is finally diagnosed
--- Diabetes is caused by either your body does not make enough insulin or your body becomes insulin
resistant and does not use the insulin.
---Diabetes significantly increases risk of cardiovascular disease, heart attacks, strokes, eyes, kidneys,
nerves. Patients with diabetes are considered to have a heart disease equivalent already, high risk.
---Detected early with simple screening of blood sugar and a hemoglobin a1c blood test
---Goal blood sugar is less than 110 fasting and hemoglobin A1c < 6.0%
---Diabetes fasting is > 120 or Hemoglobin A1c >6.5%
---Prediabetes Blood sugar 110-120 and hemoglobin A1c of 6.0-6.4%
---Diabetes is a disease of lifestyle and can be reversed with small improvements in weight loss, dietary
changes, and exercise. Use your physician, health coaches, and nutritionists. Improved diabetic control
reduces long term complications of heart attacks, strokes, vascular disease, eye, nerves and kidney
health.
E= Exercise
---benefits weight control, reduces heart disease, improves functional status, blood pressure, vascular
disease, diabetes mood, sleep, and maintains an active lifestyle
---decreases risk of cardiovascular disease, hospitalizations, procedures.
---Goal of 30 min for more than 5 days a week, all at once on in increments ie 10 min three times a day
---Walk 2000 more steps a day, and try to walk total of 10,000 steps a day
F = Body Fat or weight—Try to maintain ideal body weight.
---Did you know that 1/3 of adults/children are obese? Increased risk of DM, HTN, heart disease and
stroke
---Determine your BMI (body mass index) calculated from your weight and height
---calculator at www.heart.org
---Maintain a healthy BMI
---BMI goal of less 18-25 is normal
---BMI of 25-29 is overweight
---BMI > 30 is obese, > 35 is morbidly obese
---BMI of < 18.5 is underweight
---Surrogate is waist circumference at narrowest point above belly button, bellow rib cage
---goal in women is less than 35
---goal in men is less than 40
SO WHAT IS A HEALTHY DIET
---Small weight loss of 5% can significantly improve your health, diabetes, cholesterol, hypertension and
cardiovascular risk.
---DASH or Mediterranean diet (low salt, fish, chicken, olive oil, fresh veg/fruit, grains and legumes)
---Calorie intake goal of 1200-1500 cal/day for women or 1500-1800 cal/day for men.
---Restrict foods high in sugar, simple carbohydrates, red meat, fatty meats, sugary sodas and fruit
---Restrict fat intake to less than 6% of calories (10-15 grams) .
---Avoid high fat foods with high in SATurated fat, TRANS-fat, cholesterol.
---Select mono- or poly- UNSATurated fats
---Decrease salt to less than 2300 mg of sodium intake daily. Become a label reader
---Some renal dysfunction or heart failure may require a lower goal of <1500 mg daily.
---Limit alcohol to TWO servings a day for men and ONE serving a day for women
---What is a serving? one serving = 12 oz beer, 5 oz wine, or 1.5 oz hard liquor.
In summary heart disease is a serious and common condition with high morbidity and mortality.
BUT heart disease is very modifiable with moderate effort at lifestyle changes. And it is reversible.
You can be healthier. Know your risk, know your numbers. Work with your doctor for screening,
monitoring and medical therapies. Work with your health coaches and nutritionist. Stop smoking!
Go have a heart healthy day!