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Leah Kaiser.
Will You be My Valentine?
Taking Care of Your Heart
The Center for
Wellness and Prevention
Heart Healthy Nutrition
Angela Blackstone, RD, LD
Staff Dietitian
The OSU Center for Wellness and
Prevention
The American Heart
Association states that:
“a healthy diet and
lifestyle are your best
weapons in the fight
against heart disease.”
www.heart.org
What Can You Do?
 Eat more fiber-rich foods.
 Eat at least 4.5 cups of fruits
and vegetables per day.
 Eat two 3.5oz servings of oily
fish (salmon, trout,
herring)per week.
 Eat four 1.5oz servings of
nuts per week.
www.heart.org
What Can You Do?
 Limit sodium to <1500mg per
day.
 Limit sugary beverages to < 36oz
(450 calories) per week.
 Limit total fat to < 35% of total
calories.
 Saturated fat < 7% of total calories
 Trans fat < 1% of total calories
 Cholesterol < 200mgwww.heart.org
Keys to Making Changes
 Focus on gradual changes.
 Track what you eat and drink.
 Keep moving forward.
 Reward yourself.
 Seek out support.
www.heart.org
Activity and Exercise for
Heart Health
Ellen S Aberegg, MA, LD, RD
Exercise and Heart Health
We all know we should exercise
First we need to know why.
Then, how do we start?
What regular exercise “buys” us
•
•
•
•
•
•
•
•
Lower blood pressure.
Lower blood sugar levels.
Calories burned, which helps reduce weight.
Improved blood fat profile.
Improved circulation in leg arteries
Increased energy. It gets easier when you exercise regularly!
Lower stress levels.
Lower the risk of having another
cardiovascular event if have already had
one.
Starting an Exercise Program
• Guidelines for healthy adults under age
65 with no apparent chronic disease or
condition
• If you could answer
– yes to any of these questions on the
next slide or
– are older than 65 or
– if have a chronic disease or condition,
check in with your physician FIRST
Answer these questions:
•
Yes
•
Yes
•
Yes
•
Yes
•
Yes
•
Yes
•
Yes
No Has your health care provider ever said that you have a
heart condition and that you should only do
physical activity recommended by a health care provider?
No Do you feel pain in your chest when you do
physical activity?
No In the past month, have you had chest pain when
you were not doing physical activity?
No Do you lose your balance because of dizziness
or do you ever lose consciousness?
No Do you have a bone or joint problem
(for example, back, knee or hip) that could be made worse
by a change in your physical activity?
No Is your health care provider currently prescribing drugs
(for example, water pills) for your blood pressure
or heart condition?
No Do you know of any other reason why you should not
do physical activity?
Starting an Exercise Program
• STEP 1 - Set aside time each day to exercise.
• STEP 2 - Choose cardiovascular activities you enjoy
• STEP 3 - Start with 10 to 15 min of cardiovascular
exercise daily.
Each week, add five minutes
• STEP 4 - Incorporate strength training
Resources for exercise information
https://patienteducation.osumc.edu/Pages/search.aspx?k=exercise
Patient Education
Search Patient Education Health Information
Learn more about your health care
The Do's and Don'ts of Exercise
Diabetes and Exercise
Exercise Log - Oncology Rehabilitation
Using Exercise to Fight Cancer-Related Fatigue
Diabetes Class Series - Benefits of Exercise to Manage
Diabetes
My Exercise Plan (Pulmonary Rehab)
Exercise Induced Asthma
Exercise for People with Lung Disease
and many more!!!
Resources for exercise information
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Your Prescription for Health Series
Information and recommendations for exercising safely with a variety of health conditions.
Click here to download the full Your Prescription for Health flier series, or choose a flier below.
Exercising
Exercising
Exercising
Exercising
Exercising
Exercising
Exercising
Exercising
Exercising
Exercising
Exercising
•
and Alzheimer's
with Amyotrophic Lateral Sclerosis
with Anemia
with an Aneurysm
with Angina
with Anxiety and Depression
with Arthritis
with Asthma
with Atrial Fibrillation
Following a Brain Injury
with Cancer
And many more!!!!!
Stress Management for
Heart Health
Katharine Feister, ABD, PC
Health Coach
OSUMC Center for Wellness and
Prevention
What Can You Do?
Develop healthy habits that will
help you prevent and manage
stress.
“Healthy habits can protect you from
the harmful effects of stress.”
-American Heart Association
Habits to Fight Stress
• Talk with family and friends
• Engage in daily physical activity
• Accept the things you cannot
change
• Remember to laugh
• Give up the bad habits
American Heart Association at http://www.heart.org/
Habits to Fight Stress
•
•
•
•
•
Slow down
Get enough sleep
Get organized
Practice giving back
Try not to worry
American Heart Association at http://www.heart.org/
Quick Stress Relievers
• Take a walk and change your
environment
• Take a few deep breaths
• Listen to music
• Journal
• Say no—even if it is difficult
• Use humor
• Prayer or meditation
Quick Stress Relievers
• Ask for help
• Say “thank you” and/or “I’m sorry”
• Look at pictures of loved ones and
places with positive memories
• Take a mini-vacation through guided
imagery (examples available on
Youtube or other sites such as:
osuhealthplan.com/online/guidedimagery/)
Quick Stress Relievers
• Progressive Muscle Relaxation
– Cycle of tensing and relaxing muscles
– Tense muscles for 10 to 15 seconds,
then notice the contrast of relaxation
– Start at forehead and move all the way
to your toes
– If any muscles still feel tight, go back
and repeat
For More Information, Contact:
• The OSU Center for Wellness and
Prevention at:
http://medicalcenter.osu.edu/patientc
are/healthcare_services/center_for_we
llness_prevention/Pages/index.aspx
• OSU Wellness Services and Health
Coaching at:
www.osuhealthplan.com/wellness
Medical Approaches for
Heart Health
Martha Gulati MD, MS, FACC, FAHA
Associate Professor of Medicine (Cardiology)
Sarah Ross Soter Chair in Women’s Cardiovascular Health
Section Director for Women’s Cardiovascular Health and
Preventive Cardiology
Cardiovascular Disease Mortality Trends for
Males and Females in the United States
1979-2007
2011 Heart and Stroke Statistical Update. Roger V et al. Circ 2011
Myth : fat deposits at old age!
It starts from 2 years of age
Foam
Cells
Fatty
Streak
From First
Decade
Intermediate
Lesion
Atheroma
From Third
Decade
Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).
Fibrous
Plaque
Complicated
Lesion/ Rupture
From Fourth
Decade
Heart Disease is Preventable!
…NOT an inevitable part of life
We have effective means to reduce heart
disease
90% of heart disease is preventable
We don’t use them enough or effectively –
especially in women and minorities
What Increases Risk for Heart Disease
Non-Modifiable Risk Factors (Things You Can’t Change):
Age
Gender
Family History
Race
Modifiable Risk Factors (Things You Can Change!):
Abnormal cholesterol levels
Obesity
Cigarette smoking
Hypertension
Diabetes/Metabolic Syndrome
Physical Inactivity
Alcohol
Grundy SM, et al, Circulation, 1998; Grundy SM, Circulation, 1999;
Braunwald E, N Engl J Med, 1997; Grundy SM, et al, J Am Coll Cardiol, 1999
Where Are We Now: Estimates for USA
for Ideal Heart Health based on AHA
2020 Goals: NHANES 2005-06
Roger VL et al. Published online in Circulation Dec. 15, 2010
Start By Knowing Your
Numbers
BMI
<25 kg/m2
Waist circumference
<35 inches
BP
<120/80
Total cholesterol
<200
Triglycerides
<150
LDL
<100
HDL
>50 women/>40 men
Fasting Glucose
<100
Hypertension
BP > 180/110 evaluate and treat immediately or within one
week depending on the clinical situation
mm Hg
BP > 160/100 evaluate and treat or refer within one month
mm Hg
BP ≥ 140/90
mm Hg
recheck within 2 months, if confirmed,
evaluate and treat or refer
BP ≥ 120/80
mm Hg
counsel regarding lifestyle factors, recheck
within one year and monitor
Initial evaluation of the hypertensive patient
should include 12-lead EKG, urinalysis,
hematocrit, serum glucose, creatinine, calcium,
and potassium measurement and a lipid profile
Source: Seventh Report of the Joint National Committee on Prevention, Evaluation, and Treatment of
High Blood Pressure 2004.
Hypertension
Treatment:
• Encourage an optimal blood pressure of <
120/80 mm Hg through lifestyle approaches
• Pharmacologic therapy is necessary when blood
pressure is ≥ 140/90 mm Hg or an even lower
blood pressure in the setting of diabetes (≥
130/80 mm Hg)
• Thiazide diuretics should be part of the drug
regimen for most patients unless
contraindicated, or unless compelling
indications exist for other agents
Lifestyle Approaches to Reduce
Hypertension
• Maintain ideal body weight
- Weight loss of as little as 10 lbs. reduces blood
pressure
• DASH (Dietary Approaches to Stop
Hypertension) eating plan (low sodium)
- Even without weight loss, a low fat diet that is rich
in fruits, vegetables, and low fat dairy products
can reduce blood pressure
• Sodium restriction to 1500 mg per day
• Increase physical activity
• Limit Alcohol: <1 drink/day for women, <2
drinks/day for men
- Alcohol raises blood pressure
- One drink = 12 oz. beer, 5 oz. wine, or 1.5 oz.
liquor
Source: Seventh Report of the Joint National Committee on Prevention, Evaluation, and Treatment of High Blood Pressure
2004, Sacks 2001, Mosca 2011
Dietary Approaches to Stop
Hypertension (DASH) Plan
• 7–8 servings of grains, grain products daily
• 4–5 servings of vegetables daily
• 4–5 servings of fruits daily
• 2–3 servings of low-fat or nonfat dairy foods
daily
• ≤ 2 servings of meats, poultry, fish daily
• 4–5 servings of nuts, seeds, legumes weekly
• Limited intake of fats, sweets
Source: National Heart, Lung, and Blood Institute 1998, Sacks 2001.
DASH Study
•
•
•
•
48% women ( BP 133/85)
60% African Americans
> 60% obese
BP Results:
• 6.4/2.9 mmHg overall
• Greater drop in African
Americans and higher
baseline BP
Svetkey, Archives Int Med, 1999
DASH + Sodium + Wt. Loss
• Na+ restriction (<1.5 gm/d) additive
to DASH (↓~4mmHg)
• More effective: women, age > 45,
AA’s, hypertensives
• Magnitude = single drug Rx
(11/6mmHg)
• Add exercise & wt. loss
– = ↓16/10 mmHg
Sacks, NEJM 2001; Bray, AJC 2004; Blumenthal, Arch Int med, 2010
Effects of Lifestyle on Blood
Pressure
Modification
Recommendation
Avg SBP Reduction
Weight
reduction
Normal body wt
(BMI 18-5-24.9 kg/m2)
5-20 mm Hg/10 kg
DASH eating
plan
 fruits, vegetables, and
low-fat diary
8-14 mm Hg
 saturated and total fat
Dietary
sodium
reduction
 Na+ sodium intake to
100 mmol per day
(2.4 g Na+ or 6 g NaCI)
2-8 mm Hg
Aerobic
physical
activity
Regular aerobic physical
activity (eg, brisk walking)
at least 30 min/d, most
days of the week
4-9 mm Hg
Moderate
alcohol
consumption
Men: Limit to 2 drinks/day
Women and lighter weight
persons: Limit to 1 drink/day
2-4 mm Hg
JNC VII
21-55 mm Hg
Good vs. BAD Cholesterol
• LDL cholesterol is known as bad
cholesterol. It has a tendency to
increase risk of heart disease
• LDL cholesterol is a major component of
the plaque that clogs arteries
• HDL cholesterol is known as the good
cholesterol. Higher in women, increases
with exercise and when quit smoking
• HDL cholesterol helps carry some of the
bad cholesterol out of arteries.
Know your Numbers!
Desirable numbers
• Total cholesterol < 200;
• LDL < 100
• HDL > 40 (men) >50 (women)
• Triglycerides < 150
• Get the levels tested routinely and keep
them under control
• The only thing worse than finding out
that you have one of these conditions
is…….NOT finding out that you have
it!!
Cholesterol/Lipids
• Key is to Know your numbers
• Optimal levels of cholesterol (lipids) are as
follows:
– LDL-C < 100 mg/dL
– HDL-C > 50 mg/dL for women, >40 in
men
– Triglycerides < 150 mg/dL
– Non-HDL-C < 130 mg/dL
(Non-HDL-C equals total cholesterol minus HDL-C)
Approximate and Cumulative LDL
Cholesterol Reduction Achievable By
Diet and Weight Loss Modifications
Dietary Component
Dietary Change
Major
Saturated fat
Dietary cholesterol*
Weight reduction
< 7% of calories
< 200 mg/day
Lose 10 lbs.
Approximate
LDL Reduction
8-10%
3-5%
5-8%
Other LDL-lowering options
Viscous fiber
5-10 g/day
Plant/sterol
2 g/day
stanol esters
3-5%
6-15%
Cumulative estimate
20-30%
*NOTE: New cholesterol guideline recommends <150mg/day
Source: Adapted from National Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) 2002.
Treatment for
Cholesterol/Lipids
• Drugs to lower LDL is recommended
simultaneously with lifestyle therapy in
those with heart disease to achieve an LDL-C
< 100 mg/dL and is also indicated in those
with atherosclerotic CVD or diabetes
mellitus or 10-year absolute CHD risk > 20%
• A reduction to < 70 mg/dL is reasonable in
very-high-risk
Obesity and Weight
• People who are overweight (1030% more than their normal
body weight)
• Obese have 2 to 6 times the
risk of developing heart
disease
• Waist measurement
>35 inches for women;
>40 inches for men
• Pears or apples?
Waist
Waist?
“More Americans Die
By the Fork than any
Other Weapon.”
Obesity Trends* Among U.S. Adults
BRFSS,
1990,
1999,
2010
(*BMI  30, or about 30 lbs. overweight for 5’4” person)
1999
1990
2010
No Data
Source: CDC
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%