Heart Disease
79
Don’t Go Breaking My Heart: Understanding Heart Disease in Women
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Transcript of Heart Disease
Do
n’t
Go
Bre
ak
ing
My
Hea
rt:
Un
der
stan
din
g H
eart
Dis
ease
in
Wo
men
“T
ell
a F
rien
d” C
am
paig
n
•R
ais
e A
ware
nes
sh
eart
dis
ease
isth
ele
ad
ing
cau
se–
hea
rt d
isea
se i
s th
e le
ad
ing
cau
seo
f d
eath
in
wo
men
.–
of
the
sym
pto
ms
of
hea
rt d
isea
se,
an
d
yp
ho
w t
hey
may
dif
fer
in w
om
en.
–o
f th
e im
po
rtan
ce o
f “k
no
win
g y
ou
r n
um
ber
s”n
um
ber
s•
cho
lest
ero
l •
blo
od
pre
ssu
re
•b
od
ym
ass
ind
ex•
bo
dy
mass
in
dex
•
blo
od
su
gar.
•E
nco
ura
ge
wo
men
to
talk
to
th
eir
ih
lth
idb
tp
rim
ary
hea
lth
care
pro
vid
ers
ab
ou
t h
eart
hea
lth
.
Over
vie
w
•S
cop
e o
f th
e P
rob
lem
•G
end
er d
isp
ari
ties
in
care
?
•C
hall
eng
es i
n p
ub
lic
aw
are
nes
sg
p
•C
hall
eng
es i
n a
ware
nes
s am
on
g c
lin
icia
ns
•G
end
erd
iffe
ren
ces
inp
rese
nta
tio
n?
Gen
der
dif
fere
nce
s in
pre
sen
tati
on
?
•R
edu
cin
g C
VD
ris
k i
n w
om
en
•R
ole
of
po
stm
eno
pau
sal
HT
?•
Ro
le o
f p
ost
men
op
au
sal
HT
?
Hea
rt D
isea
se:
Th
e L
ead
ing
Cau
se o
f D
eath
for
Am
eric
an
Wo
men
Card
iova
scu
lar
Dis
ease
Mo
rtali
ty T
ren
ds
Card
iova
scu
lar
Dis
ease
Mo
rtali
ty T
ren
ds
Un
ited
Sta
tes:
197
9U
nit
ed S
tate
s: 1
979--
2001
2001
Source:CDC/NCHS.
Dea
th R
ate
s fr
om
Hea
rt D
isea
se p
er
100,0
00
Wom
en,2002
(CD
C)
100,0
00
Wo
men
,2002
(CD
C)
Are
Wo
men
Aw
are
?
Per
cen
tag
e o
f w
om
en w
ho
kn
ow
th
at
hea
rt
di
ih
ld
if
dh
id
isea
se i
s th
e le
ad
ing
cau
se o
f d
eath
in
wo
men
:
Ci
li
2004
109
573
579
46
%35
40
45
50
Cir
cula
tion
2004:1
09:5
73-5
79
30
%
34
%
46
%
10
15
20
25
30 05
10
19
97
20
00
20
03
Fa
ct o
r F
icti
on
?
Rec
ent
stu
die
s sh
ow
th
at w
om
en p
erce
ive
hea
rt
dis
ease
to
th
e b
igg
est
thre
at t
o t
hei
r h
ealt
h?
Gre
ate
st H
ealt
h P
rob
lem
Mo
sca,
Cir
cula
tio
n 2
004
40 3035 152025%
1997
5101520
00
2003
05
Bre
ast
Can
cer
Hea
rt
Can
cer
Gen
eral
Dis
ease
Fla
wed
Co
nce
pt
of
Wo
men
’s H
ealt
h?
“…
Th
e co
mm
un
ity
has
view
ed w
om
en’s
h
ealt
halm
ost
wit
ha
‘bik
ini’
ap
pro
ach
hea
lth
alm
ost
wit
h a
b
ikin
i a
pp
roach
, lo
ok
ing
ess
enti
all
y at
the
bre
ast
an
d
rep
rod
uct
ive
syst
em,
an
d a
lmo
st i
gn
ori
ng
th
e f
hf
’re
st o
f th
e w
om
an
as
part
of
wo
men
’s
hea
lth
.”
Nan
ette
Wen
ger
, M
DChief of Car
dio
logy, G
rady H
osp
ital
Pro
fess
or of M
edicin
e, E
mory
Univer
sity
Atl
tG
iAtlan
ta, G
eorg
ia
Per
cep
tio
n o
f H
eart
Dis
ease
Ris
k F
act
ors
Mo
sca,
Cir
cula
tio
n 2
004
40
45
30
35
40
Sm
ok
ing
Hig
h C
hole
sterol
Fa
mil
y H
isto
ry
15
20
25
%H
TN
Dia
bete
s
Hig
h T
g
05
10
Overw
eig
ht
Lack
of
ex
ercis
e
0
Wh
y T
he
Gen
der
Gap
?•
Wo
men
pre
sen
t to
em
erg
ency
ro
om
s o
r ch
est
pain
cen
ters
1-
2 h
ou
rsla
ter
than
men
ho
urs
late
r th
an
men
.
•T
he
mu
ltip
le r
ole
s a w
om
an
p
tak
es o
n m
ay
del
ay
care
bec
au
se
of
her
res
po
nsi
bil
itie
s to
oth
ers?
•W
om
en d
elay
care
bec
au
se t
hey
p
erce
ive
that
hea
rt d
isea
se i
s so
met
hin
gth
at
hap
pen
sto
on
e’s
som
eth
ing
th
at
hap
pen
s to
on
es
fath
er,
bro
ther
, o
r sp
ou
se?
Wh
y T
he
Gen
der
Gap
?
Wh
y T
he
Gen
der
Gap
?
Wh
y T
he
Gen
der
Gap
?
“V
inta
ge”
AH
A t
each
ing
mate
rials
!
yp
gg
Gap
May
Ex
ten
d t
o H
ealt
hca
re P
rofe
ssio
nals
•20
03 s
urv
ey i
nd
icate
s o
nly
38%
of
wo
men
h
ave
dis
cuss
ed h
eart
hea
lth
wit
h t
hei
r h
ealt
hca
rep
rovi
der
hea
lth
care
pro
vid
er.
•O
ne
year
dea
th r
ate
fo
r m
en f
oll
ow
ing
a h
eart
att
ack
is25
%fo
rw
om
en38
%*
att
ack
is
25%
, fo
r w
om
en 3
8%–
on
ly p
art
of
this
gap
can
be
exp
lain
ed b
y ag
e
•R
eco
mm
end
ed t
reatm
ents
fo
r h
eart
dis
ease
are
les
s li
kel
y to
be
use
d i
n w
om
en.
–A
spir
inA
spir
in–
Ref
erra
ls t
o c
ard
iac
reh
ab
pro
gra
ms
–R
evasc
ula
riza
tio
nC
ho
lest
ero
llo
wer
ing
med
icin
es–
Ch
ole
ster
ol-
low
erin
g m
edic
ines
*Hea
rt D
isea
se &
Stroke
Statistics 20
04 U
pdate (A
mer
ican
Hea
rt A
ssociat
ion)
Fact
or
Fic
tion
?
Th
esu
rviv
alra
tefo
rw
om
enaf
ter
ah
eart
atta
ckT
he
surv
ival
rate
for
wo
men
afte
ra
hea
rtat
tack
is t
he
sam
e as
fo
r m
en?
Mo
rta
lity
for
Wom
en a
nd
Men
Post
-AM
I*
an
d A
fter
Ad
just
men
t b
y R
isk
Sco
re †
jy
† Wo
me
n
50
40
Wo
me
n
Me
n3
0
20
10
(%)
500
Po
st-
AM
I
12
24
36
48
50
40
30
20
(%)
*p<
0.0
01
;†p
<0
.00
2.
20
10 0
12
24
36
48
p;p
Aft
er
ad
jus
tme
nt
by
ris
k s
co
re
CH
D M
ort
ali
ty i
n Y
ou
ng
er W
om
enW
d65
ffh
hi
hl
iW
om
en u
nd
er65
su
ffer
th
e h
igh
est
rela
tive
sex
-sp
ecif
ic C
HD
mo
rtali
ty
Wh
at
can
yo
u d
o…
..
•S
eek
med
ical
ad
vice
fo
r w
arn
ing
sig
ns
y
gg
•A
ct p
rom
ptl
y w
ith
acu
te
sym
pto
ms
sym
pto
ms
•S
eek
in
form
ati
on
rel
ate
d t
o
you
r o
wn
ris
k l
evel
•M
ak
eap
pro
pri
ate
Mak
e ap
pro
pri
ate
m
od
ific
ati
on
s in
lif
esty
le t
o
red
uce
th
eir
risk
SY
MP
TO
MS
OF
HE
AR
T
DIS
EA
SE
IN
WO
ME
N
Sym
pto
ms
Of
A H
eart
Att
ack
•R
equ
ire
imm
edia
te a
ctio
n!
–u
nco
mfo
rtab
le p
ress
ure
, f
llb
ifu
lln
ess,
bu
rnin
g o
r sq
uee
zin
g s
ensa
tio
n i
n t
he
ches
t–
sho
rtn
ess
of
bre
ath
–n
au
sea,
vom
itin
g,
diz
zin
ess,
sw
eati
ng
swea
tin
g•
Sym
pto
ms
can
vary
gre
atl
y an
d
may
be
dif
fere
nt
in w
om
en
ththan
men
•Y
ou
kn
ow
yo
ur
bo
dy-
tru
st y
ou
r in
stin
cts
y
Dif
fere
nce
s in
Hea
rt A
ttack
Sym
pto
ms
Men
•S
ub
-ste
rnal
ches
t p
ain
or
pre
ssu
re
Wo
men
•P
ain
in
ch
est,
up
per
back
, p
ress
ure
•P
ain
at
rest
•P
ain
do
wn
left
arm
an
d
,p
p,
jaw
or
nec
k
•S
ho
rtn
ess
of
bre
ath
Fl
lik
Pain
do
wn
lef
t arm
an
d
sho
uld
er
•W
eak
nes
s
•F
lu-l
ike
sym
pto
ms:
n
au
sea o
r vo
mit
ing
, co
ld
swea
ts
•F
ati
gu
e o
r w
eak
nes
s
•F
eeli
ng
s o
f an
xie
ty,
loss
of
ap
pet
ite,
mala
ise
pp
,
Gen
der
Dif
fere
nce
s in
ED
Pre
sen
tati
on
fo
r
CA
D W
ith
ou
t C
hes
t P
ain
48
41
33
35
32
40
50
nts
Wo
men
(n
= 9
0)
Men
(n=
127)
30
26
22
19
14
22
32
19
11
20
30
Percent of patie
Men
(n127)
8
0
10
spne
a
miti
ng
estio
n
intin
g
atig
ue
eatin
g
rpai
n
P
Dys
p
Nau
sea/
vom
Indi
ges
Diz
zine
ss/fa
in
Fatig
Sw
ea
Arm
/sho
ulde
rp
Wo
men
’s E
arl
y W
arn
ing
Sym
pto
ms
of
Hea
rtA
ttack
Sym
pto
ms
of
Hea
rt A
ttack
•P
ub
lish
edo
nli
ne
bef
ore
pri
nt
No
v3
2003
Pu
bli
shed
on
lin
e b
efo
re p
rin
t N
ov
3, 2
003
•51
5 w
om
en w
ith
AM
I fr
om
5 s
ites
Pd
l1
hb
fA
MI
•P
rod
rom
al
sym
pto
ms
1 m
on
th b
efo
re A
MI
–u
nu
sual
fati
gu
e (7
0.7%
)
–sl
eep
dis
turb
an
ce (
47.8
%)
–sh
ort
nes
s o
f b
reath
(42
.1%
)
–ch
est
dis
com
fort
(29
.7%
)
KN
OW
YO
UR
RIS
KK
NO
WY
OU
RR
ISK
FA
CT
OR
S F
OR
HE
AR
T
DIS
EA
SE
DIS
EA
SE
Ris
k F
act
ors
fo
r H
eart
Dis
ease
Mo
dif
iab
leM
od
ifia
ble
•A
ge
No
n-m
od
ifia
ble
•P
hys
ical
Inact
ivit
yA
ge
•F
am
ily
his
tor y
•P
sych
oso
cial
Fact
ors
Hi
hB
ld
Py
•G
end
er•
Hig
h B
loo
d P
ress
ure
•O
bes
ity
•D
iab
etes
•H
igh
Ch
ole
ster
ol
an
dH
igh
Ch
ole
ster
ol
an
d
Tri
gly
ceri
des
, L
ow
HD
L
•C
igare
tte
Sm
ok
ing
Cig
are
tte
Sm
ok
ing
•H
igh
fat
die
t
Fa
ct o
r F
icti
on
?
Th
ere
is n
oth
ing
th
at c
an b
e d
on
e to
red
uce
the
risk
of
hea
rt d
isea
se i
n i
nd
ivid
ual
s w
ith
stro
ng
fam
ily
his
tory
of
CH
D.
“G
enet
ics
load
s th
e g
un
, b
ut
envi
ron
men
tp
ull
sth
etr
igg
er”
envi
ron
men
t p
ull
s th
e tr
igg
er…
Jud
ith
Ste
rn
Pro
fess
or
of
Nu
trit
ion
an
d
Inte
rnal
Med
icin
e
Un
iver
sity
of
Cali
forn
ia a
t D
avi
s
Det
erm
inin
g Y
ou
r R
isk
for
HD
•T
he
Fra
min
gham
Hea
rt S
tudy e
stab
lish
ed m
ajor
pre
dis
po
sin
g r
isk
fac
tors
fo
r H
D-a
ge,
DB
, H
TN
, S
mo
kin
g,
Dysl
ipid
emia
•Im
po
rtan
t st
ep i
n p
rim
ary
pre
ven
tio
np
pp
yp
•E
stim
ates
10 y
r pro
bab
ilit
y f
or
CH
D
Ste
p1
:A
ge
Po
ints
Fra
min
gh
am
Ris
k S
core
: W
om
enF
ram
ing
ha
m R
isk
Sco
re:
Wo
men
Ste
p4
:S
BP
Po
ints
Ste
p5
:S
mo
kin
gS
tatu
sP
oin
ts
Yea
rsP
oin
ts
20
-34
-7
35
-39
-3
40
-44
0
Ste
p1
:A
ge
Po
ints
SB
P
(mm
Hg)
Iftr
eate
dIf
un
trea
ted
<1
20
00
12
0-1
29
13
130
139
24
Ste
p4
:S
BP
Po
ints
Age
20
-39
Age
40
-49
Age
50
-59
Age
60
-69
Age
70
-79
No
nsm
ok
er0
00
00
Sm
ok
er9
74
21
Ste
p5
:S
mo
kin
gS
tatu
sP
oin
ts
45
-49
3
50
-54
6
55
-59
8
60
-64
10
65
-69
12
130-1
39
24
14
0-1
59
35
>160
46
Age
Tota
l C
ho
lest
ero
l
HD
L-C
St
liB
ld
P
Ste
p 6
: S
um
of
Po
ints
70
-74
14
75
-79
16
TC
Age
Age
Age
Age
Age
Ste
p 2
: To
tal C
ho
les
tero
l P
oin
ts
Syst
oli
cB
lood
Pre
ssu
re
Sm
ok
ing
Sta
tus
Po
int
Tota
l
Ste
p 7
: 1
0-y
ea
r C
HD
Ris
kT
C(m
g/d
l)A
ge
20
-39
Age
40
-49
Age
50
-59
Age
60
-69
Age
70
-79
<160
00
00
0
16
0-1
99
43
21
1
20
0-2
39
86
42
1
240
279
11
85
32
Po
int
To
tal
10
-yea
r R
isk
Po
int
To
tal
10
-yea
r R
isk
Po
int
To
tal
10
-yea
r R
isk
<9
<1
%1
53
%2
21
7%
91
%1
64
%2
32
2%
240-2
79
11
85
32
>280
13
10
74
2
HD
L-C
(m
g/d
l)P
oin
ts
Ste
p 3
: H
DL
-C P
oin
ts
10
1%
17
5%
24
27
%
11
1%
18
6%
>2
5>
30
%
12
1%
19
8%
13
2%
20
11
%
14
2%
21
14
%
>6
0-1
50
-59
0
40
-49
1
<4
02
Gu
ide
to P
reve
nti
ve C
ard
iolo
gy
in W
om
en
•W
om
en h
ave
a l
ow
, in
term
edia
te,
or
hig
h r
isk
fo
r h
eart
att
ack
dep
end
ing
on
thei
r“ri
skfa
cto
rs”
hea
rt a
ttack
dep
end
ing
on
th
eir
risk
fact
ors
•D
epen
din
g o
n l
evel
of
risk
, m
ore
ag
gre
ssiv
e p
g,
gg
card
iova
scu
lar
risk
red
uct
ion
str
ate
gie
s are
re
com
men
ded
in
clu
din
g l
ifes
tyle
an
d
med
icati
on
sm
edic
ati
on
s
WH
AT
CA
N Y
OU
DO
TO
RE
DU
CE
YO
UR
RIS
K O
F
HE
AR
TD
ISE
AS
E?
HE
AR
TD
ISE
AS
E?
Mo
dif
iab
le R
isk
Fa
cto
rs
•C
igare
tte
Sm
ok
ing
•D
iab
etes
•A
bn
orm
al
lip
id l
evel
sp
•H
igh
Blo
od
Pre
ssu
re
Ob
i•
Ob
esit
y
•P
sych
oso
cial
fact
ors
•H
igh
fat
die
t
•P
hys
ical
Inact
ivit
y•
Ph
ysic
al
Inact
ivit
y
Imp
act
of
Mu
ltip
le R
isk
Fact
ors
in
Wo
men
•N
En
glJ
Med
. S
tam
pfe
r, M
J. 2
00
0:3
43
:16
-22
N E
ngl
J M
ed. S
tam
pfe
r, M
J. 2000:3
43:1
6-2
2
TO
BA
CC
O #
1 P
RE
VE
NT
AB
LE
RIS
K
•Fem
ale sm
oke
rs h
ave
2-6
tim
es t
he risk
of su
dden
ca
rdiac dea
th than
non sm
oke
rs. T
he risk
is h
igher
for
hea
vysm
oke
rshea
vy sm
oke
rs.
•Sec
ond-h
and sm
oke
incr
ease
s ca
rdiac risk
.
•The hea
lth b
enef
its of quitting sm
oking beg
in
imm
ediate
ly.y
Fa
ct o
r F
icti
on
?
The fa
stes
t gr
owin
g gr
oup o
f new
sm
oke
rs are
ad
olesc
ent m
ales
Sm
ok
ing
Ces
sati
on
Fiv
e K
ey
s f
or
Qu
itti
ng
:
1G
td
1.
Get re
ady.
2.
Get support
.
3Learn
new
skill
sand
behavio
rs3.
Learn
new
skill
sand
behavio
rs.
4.
Get m
edic
ation a
nd u
se it corr
ectly.
5B
epre
pare
dfo
rre
lapse
or
difficult
situations
5.
Be
pre
pare
dfo
rre
lapse
or
difficult
situations.
ww
w.s
mo
kef
ree.
go
v
Nat
ion
al Q
uit
lin
e: 1
-80
0-Q
UIT
NO
W
Dia
bet
es P
revale
nce
per
100 A
du
lts:
1996
Dia
bet
es P
revale
nce
per
100 A
du
lts:
2004
Wo
men
an
d D
iab
etes
•T
ype
2 d
iab
etes
has
incr
ease
d 5
0% i
n t
he
last
10
years
.
•2
of
3 p
erso
ns
wit
h d
iab
etes
die
of
card
iova
scu
lar
dis
ease
.
•D
iab
etes
in
crea
ses
a w
om
an
’s r
isk
of
hea
rt d
isea
se 3
-7X
(2-3
X i
n m
en).
•P
eop
le w
ith
dia
bet
es s
ho
uld
be
trea
ted
as
ag
gre
ssiv
ely
as
tho
se w
ith
kn
ow
n h
eart
d
isea
sed
isea
se.
•D
iab
etes
mark
edly
red
uce
s th
e su
cces
s ra
te w
hen
a w
om
an
un
der
go
es b
ypass
g
ypsu
rger
y o
r b
all
oo
n a
ng
iop
last
y p
roce
du
res.
Fa
ct o
r F
icti
on
?
An
op
tim
al f
asti
ng
blo
od
glu
cose
lev
el i
s
bet
wee
n 1
00
-12
5
Am
eric
an
Dia
bet
es A
sso
ciati
on
(A
DA
) G
uid
elin
es
•O
pti
mal
fast
ing
blo
od
su
gar
100
mg
/d
Lp
gg
g/
•C
rite
ria f
or
dia
bet
es–
Fast
ing
glu
cose
126
mg
/d
L o
r h
igh
erg
gg
g–
Ran
do
m g
luco
se 2
00 m
g/
dL
or
hig
her
•Im
pair
ed f
ast
ing
glu
cose
100
-12
5 m
g/
dL
Lif
esty
le a
nd
Dia
bet
es
•R
esea
rch
sh
ow
s th
at
dia
bet
es c
an
be
pre
ven
ted
by
imp
rovi
ng
die
t an
d p
hys
ical
py
pg
py
act
ivit
y le
vels
.
li
kf
di
bh
fll
di
•P
eop
le a
t ri
sk f
or
dia
bet
es w
ho
fo
llo
w a
die
t an
d e
xer
cise
pla
n (
wit
h o
nly
a m
od
est
wei
gh
t lo
ss)
can
dec
rease
thei
rri
sko
fd
evel
op
ing
loss
) ca
n d
ecre
ase
th
eir
risk
of
dev
elo
pin
g
dia
bet
es b
y alm
ost
50%
.
Th
e L
ipid
Pro
file
: K
no
w Y
ou
r N
um
ber
s!
To
tal
Ch
ole
ster
ol
<2
00
mg
/dL
Ch
ole
ster
ol
LD
L<
10
0m
g/d
L
Lo
w-D
ensi
ty L
ipo
pro
tein
g
Ti
lid
<1
50
/dL
Tri
gly
ceri
des
<1
50
mg
/dL
HD
L>
40
/dL
fH
DL
Hig
h-D
ensi
ty L
ipo
pro
tein
>4
0 m
g/d
Lfo
r m
en
>5
0 m
g/d
L f
or
wo
men
Fa
ct o
r F
icti
on
?
Th
e n
um
ber
1 d
ieta
ry c
on
trib
uto
r to
ele
vat
ed
LD
L c
ho
lest
ero
l is
eat
ing
fo
od
s h
igh
in
g
g
satu
rate
d f
ats.
Th
erap
euti
c L
ifes
tyle
Ch
an
ges
Die
t–
Min
imiz
e d
ieta
ry i
nta
ke
of
satu
rate
d f
ats
an
d t
ran
s f
idfa
tty
aci
ds
–A
dd
pla
nt
stan
ol/
ster
ols
an
d s
olu
ble
fib
er t
o t
he
die
t
Wei
gh
tg
–M
ain
tain
a d
esir
ab
le b
od
y w
eig
ht
an
d p
reve
nt
wei
gh
t g
ain
Ex
erci
se–
En
gag
e in
ph
ysic
al
act
ivit
y to
in
clu
de
eno
ug
h
mo
der
ate
ex
erci
se t
o e
xp
end
at
least
200
k
ilo
calo
ries
/d
ay
•D
epen
din
g o
n l
evel
of
risk
, m
edic
ati
on
may
be
init
iate
d
alo
ng
wit
hd
iet
alo
ng
wit
h d
iet.
PC
NA
’s W
hat’
s M
issi
ng
in
Ch
ole
ster
AL
L
Cam
paig
n
“What’s M
issing in
Cholester
ALL?”
invite
s wom
en to b
ecom
e det
ective
s in
inve
stigatin
g all t
he pote
ntial clu
es to a
hea
lthy ch
olester
ol p
rofile.
PCN
A’s b
roch
ure
, web
site
and toll-
free
num
ber
mak
es it
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and
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restin
gfo
rwom
ento
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ecu
lprits
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rtan
d in
tere
stin
g fo
r wom
en to sea
rch o
ut th
e cu
lprits o
f hea
rt
disea
se.
To
rece
iveafree
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chure
:To rec
eive
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e bro
chure
:
Call: 87
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htt
//
tVisit: h
ttp:/
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cna.net
http:/
/www.raise
yourc
holester
ol.c
om
Rec
og
niz
ing
Hig
h B
loo
d P
ress
ure
•M
ore
men
th
an
wo
men
have
h
yper
ten
sio
n u
nti
l ag
e 55
.yp
g
•H
igh
blo
od
pre
ssu
reis
mo
reH
igh
blo
od
pre
ssu
re i
s m
ore
co
mm
on
in
old
er w
om
en
than
old
er m
en.
•A
per
son
wh
o h
as
a n
orm
al
pb
loo
d p
ress
ure
at
ag
e 55
has
a 9
0% l
ifet
ime
chan
ce o
f d
evel
op
ing
hyp
erte
nsi
on
dev
elo
pin
g h
yper
ten
sio
n.
Blo
od
Pre
ssu
re:
Kn
ow
yo
u n
um
ber
s!
Ca
teg
ory
Sy
sto
lic
BP
(H
)
Dia
stoli
c B
P
(H
)(m
mH
g)
(mm
Hg)
No
rmal
< 1
20
< 8
0
Pre
hy
per
ten
sio
n1
20
-13
98
0-8
9
Sta
ge
1
Hyper
tensi
on
14
0-1
59
90
-99
Sta
ge
2
Hy
per
tensi
on
> 1
60
>1
00
yp
Nat
iona
l H
eart
Lun
g an
d B
lood
Ins
titu
te –
Join
t N
atio
nal C
omm
itte
e -7
Fa
ct o
r F
icti
on
?
On
e in
fiv
e ad
ult
Am
eric
ans
has
hig
h b
loo
d
pre
ssure
.p
Ben
efit
s o
f L
ow
erin
g B
loo
d P
ress
ure
•R
edu
ces
the
chan
ceo
f:•
Red
uce
s th
e ch
an
ce o
f:H
eart
Att
ack
: 20
-25
%S
tro
ke:
35-4
0%
Str
ok
e: 3
540
%H
eart
Fail
ure
: 50
%
Am
erican
Hea
rt A
ssoc
iation
web
site
:
ww
w.a
mer
ican
hear
t.or
g
Lif
esty
le C
han
ge:
Wh
at
Dif
fere
nce
Do
es i
t M
ak
e ?
•W
eig
ht
loss
–(d
ecre
ase
s S
BP
1.6
mm
Hg
fo
r ea
ch k
g l
ost
)
•D
ieta
ry A
pp
roach
es t
o S
top
Hyp
erte
nsi
on
: D
AS
H
die
t: (dec
rease
sS
BP
814
mm
Hg
)–
(dec
rease
s S
BP
8-1
4 m
mH
g)
•R
edu
cin
g s
alt
in
th
e d
iet
(dec
rease
sS
BP
2-8
mm
Hg
)–
(dec
rease
s S
BP
2-8
mm
Hg
)
•30
-45
min
ute
s d
ail
y aer
ob
ic e
xer
cise
–(d
ecre
ase
s S
BP
4-9
mm
Hg
) (
g)
•L
imit
alc
oh
ol
–(d
ecre
ase
s S
BP
2-
4 m
m H
g)
•A
void
an
ce o
f to
bacc
o p
rod
uct
s
Ob
esit
y
•G
row
ing
ep
idem
ic i
n U
.S.
•In
crea
ses
risk
of
:•
Incr
ease
s ri
sk o
f :
•h
igh
blo
od
pre
ssu
re•
lip
id a
bn
orm
ali
ties
p•
dia
bet
es•
Cu
rren
t fo
cus
is o
n t
ak
ing
sm
all
step
s:sm
all
ste
ps:
•sm
all
ch
an
ges
in
die
tary
p
att
ern
s•
incr
easi
ng
“in
cid
enta
l”
exer
cise
CH
EE
SE
BU
RG
ER
20
Yea
rs
Ag
oT
od
ay
33
3 c
alo
rie
sH
ow
ma
ny
ca
lorie
s are
in t
od
ay
’s c
heese
bu
rg
er?
CH
EE
SE
BU
RG
ER
CH
EE
SE
BU
RG
ER
20
Yea
rs
Ag
oT
od
ay
59
0 c
alo
rie
s3
33
ca
lorie
s
Ca
lorie
Dif
feren
ce:
25
7 c
alo
rie
s
BM
I: K
no
w y
ou
r n
um
ber
s!
Cla
ssif
ica
tio
no
fO
verw
eig
ht
an
dO
besi
tyb
yB
MI
Ob
esi
ty C
lass
BM
I k
g/m
2
Un
derw
eig
ht
<1
85
Cla
ssif
ica
tio
no
fO
verw
eig
ht
an
dO
besi
tyb
yB
MI
Un
derw
eig
ht
<1
8.5
No
rm
al
18
.5–
24
.9
Ov
erw
eig
ht
25
–2
9.9
Ob
esi
tyI
30
.0–
34
.9
II3
5.0
–3
9.9
EO
bi
III
Ex
trem
e O
besi
tyII
I!
40
.0
Wai
st C
ircu
mfe
rence
Hig
hR
isk
Hig
hR
isk
Men
> 4
0 i
nch
es
Wo
men
> 3
5 i
nch
es
Hea
lth
Ben
efit
s of
Wei
gh
t L
oss
g
•D
ecre
ased
car
dio
vas
cula
r ri
sk
•D
ecre
ased
glu
cose
and insu
lin lev
els
•D
ecre
ased
blo
od p
ress
ure
•D
ecre
ased
LD
L a
nd tri
gly
ceri
des
, in
crea
sed H
DL
•D
ecre
ased
sev
erit
y of
slee
p a
pnea
yp
p
•R
educe
d s
ym
pto
ms
of
deg
ener
ativ
e jo
int dis
ease
•Im
pro
ved
gynec
olo
gic
alco
ndit
ions
Impro
ved
gynec
olo
gic
alco
ndit
ions
Nati
on
al
Str
ate
gy
to A
dd
ress
Ob
esit
y E
pid
emic
yp
•U
.S.
Dep
art
men
t o
f H
ealt
h a
nd
H
um
an
Ser
vice
sIn
itia
tive
Hu
man
Ser
vice
s In
itia
tive
•S
mall
Ste
ps:
w
ww
.sm
all
step
.go
v
•E
xam
ple
s:•
cho
ose
fat
free
ove
rw
ho
lem
ilk
cho
ose
fat
free
ove
r w
ho
le m
ilk
•p
ark
fu
rth
er f
rom
th
e st
ore
an
d
walk
•sh
are
an
entr
éesh
are
an
en
trée
•w
alk
to
a c
o-w
ork
er’s
des
k
inst
ead
of
e-m
ail
ing
Th
e M
etab
oli
c S
ynd
rom
e
•C
erta
in “
risk
fact
ors
” f
or
hea
rt d
isea
se
ten
d t
o c
lust
er t
og
eth
er a
nd
mark
edly
in
crea
seyo
ur
risk
:in
crea
se y
ou
r ri
sk:
–o
verw
eig
ht,
esp
ecia
lly
wh
en c
arr
ied
aro
un
d t
he
wais
t–
hig
h b
loo
d p
ress
ure
–ch
ole
ster
ol
ab
no
rmali
ties
(lo
w H
DL
an
dh
igh
trig
lyce
rid
es)
an
d h
igh
tri
gly
ceri
des
) –
elev
ate
d b
loo
d g
luco
se
•P
eop
le w
ith
th
ese
risk
fact
ors
nee
d t
o b
e tr
eate
d v
ery
ag
gre
ssiv
ely
for
hea
rt
dis
ease
pre
ven
tio
n:
life
styl
e ch
an
ges
are
k
!k
ey!
Psy
cho
soci
al
Fa
cto
rs
Str
ess
Dep
ress
ion
Po
stm
eno
pau
sal
Ho
rmo
ne
Th
erap
y
•P
ost
men
op
au
sal
HT
is
no
lon
ger
reco
mm
end
edn
o l
on
ger
rec
om
men
ded
as
a s
trate
gy
to p
reve
nt
hea
rt d
isea
se.
•S
ho
rt t
erm
ho
rmo
ne
ther
ap
ma
stil
lb
ese
dth
erap
y, m
ay
stil
l b
e u
sed
to
tre
at
sym
pto
ms
of
men
op
au
se -
this
is
a
pd
ecis
ion
bet
wee
n a
w
om
an
an
d h
er
hea
lth
care
pro
vid
er.
hea
lth
care
pro
vid
er.
Hea
rt H
ealt
hy D
iet
•E
at a
var
iety
of
fru
its,
veg
etab
les
gra
ins
veg
etab
les,
gra
ins
•L
imit
fo
od
s h
igh
in
satu
rate
dfa
ttr
ans
fatt
ysa
tura
ted
fat,
tran
sfa
tty
acid
an
d c
ho
lest
ero
l
•S
ub
stit
ute
wit
hS
ubst
itu
tew
ith
un
satu
rate
d f
at f
rom
ve g
etab
les,
fis
h, le
gum
es,
g,
,g
,
and
nu
ts
•L
imit
sal
t in
tak
e
Ph
ysi
cal
Act
ivit
y
•Wh
at i
s th
e m
ost
co
mm
on
ex
cuse
fo
r n
ot
exer
cisi
ng
?ex
erci
sin
g?
Nh
iN
ot
eno
ug
h t
ime
•W
hat
ex
erci
se h
as t
he
low
est
dro
po
ut
rate
of
any
ph
ysi
cal
acti
vit
y?
Walk
ing
FIT
T:
Th
e E
xer
cise
Pre
scri
pti
on
Fre
quen
cy:
3-5
tim
es p
er w
eek
Inte
nsityy
Moder
ate in
tensity
Tim
eTim
e
30-4
5 m
inute
s
TTyp
e
Low-im
pac
t ac
tivities
Su
mm
ary
•K
no
w t
he
sym
pto
ms
of
hea
rt d
isea
se.
•K
no
w y
ou
r ri
sk f
act
ors
fo
r h
eart
dis
ease
.
Vi
ith
lth
id•
Vis
it y
ou
r h
ealt
hca
re p
rovi
der
:–
Dis
cuss
yo
ur
risk
fact
ors
–
Ask
qu
esti
on
s ab
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Pri
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HEART TALK: Nourishing Healthy Hearts
Presented by Preventive Cardiovascular Nurses’ Association and Promise Spread
Resources
AUGUST 2005
HEART TALK: Nourishing Healthy Hearts Resources 1
Resources
Websites for Patient Education
Copyright 2005, developed by Jo Ann Carson. Used with permission Therapeutic Lifestyle Changes - http://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi Live Healthier, Live Longer - http://www.nhlbi.nih.gov/chd Health Heart Handbook for Women - http://www.nhlbi.nih.gov/health/public/heart/other/hhw/hdbk_wmn.pdf NHLBI general prevention of heart disease and care for patients - http://www.nhlbi.nih.gov/chd/index.htm Live Healthier, Live Longer Portion Distortion - http://hin.nhlbi.nih.gov/portion/ Be Heart Smart (eat foods lower in saturated fat and cholesterol---part of a series for African-Americans) - http://www.nhlbi.nih.gov/health/public/heart/other/chdblack/smart.pdf Heart Healthy Recipes from NHLBI
Keep the Beat - http://www.nhlbi.nih.gov/health/public/heart/other/ktb_recipebk/ktb_recipebk.pdf “Stay Young at Heart, The Heart Healthy Cooking Way” http://www.nhlbi.nih.gov/health/public/heart/other/syah/index.htm “Heart Healthy Home Cooking, African-American Style:” - http://www.nhlbi.nih.gov/health/public/heart/other/chdblack/cooking.pdf “Latino Heart Healthy Recipes,” - http://www.nhlbi.nih.gov/health/public/heart/other/sp_recip.pdf
American Heart Association, http://www.americanheart.org and http://www.deliciousdecisions.org National Restaurant Association - http://www.restaurant.org/dineout/nutrition.cfm Guidance on How to Understand and Use the Nutrition Facts Panel on Food Labels, US Food and Drug Administration http://www.cfsan.fda.gov/~dms/foodlab.html
HEART TALK: Nourishing Healthy Hearts Resources 2
“Healthy Eating and Physical Activity across Your Lifespan,” provides a four-part series, including “Better Health for You” (for adults) and “Young at Heart” (older adults) from the Weight Control Information Network - http://www.niddk.nih.gov/health/nutrit/nutrit.htm Aim for a Healthy Weight - http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/ DASH - http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf DASH Recipes - http://hin.nhlbi.nih.gov/nhbpep_kit/recipes.htm Reduce Salt and Sodium in Your Diet - http://www.nhlbi.nih.gov/hbp/prevent/sodium/sodium.htm Maintaining a Healthy Weight - http://www.nhlbi.nih.gov/hbp/prevent/h_weight/h_weight.htm
HEART TALK: Nourishing Healthy Hearts Resources 3
Registered Dietitian as a Resource
As described in Section III, evidence supports the benefits of referral to the registered dietitian for lowering serum lipids. The Institute of Medicine describes the registered dietitian as the nutrition professional uniquely prepared with academic preparation, clinical training, national examination and continuing education.
Description of MNT provided by the RD
In general, patients with risk factors for heart disease can benefit from one or more sessions with the dietitian to address improving lifestyle. but referral to the registered dietitian (RD) is more important for some patients. Examples of such patients include:
!" Patients with diabetes who need counseling or have never been to the RD
!" Patients with genetically elevated triglycerides above 500 mg/dL
!" Patients with hypertriglyceridemia who need to increase fat and lower carbohydrate.
!" Patients who wish to defer use of indicated lipid-lowering medications.
!" Patients who have difficulty adopting TLC parameters due to dining out, travel, economic or other restraints.
!" Patients with lots of alternative medicine/dietary supplement questions
Tips for Reimbursement for Medical Nutrition Therapy
!"The provider should provide written referral to a registered dietitian !"Some registered dietitians are listed by geographic area and area of
expertise at www.eatright.org !"The provider’s order for referral to the dietitian should request Medical
Nutrition Therapy !"Accurate diagnoses should be included
o As of 2005, Medicare specifically covers MNT for diabetes and pre-dialysis renal disease
o Metabolic syndrome has now been assigned an International Classification of Disease code (ICD9).
Insurance coverage for MNT varies, but is enhanced when the above listed steps are included.
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