Healthy Heart

February brings us Valentines Day and American Heart Month

Did you know that heart disease is the leading cause of death in the U.S.?

Did you know that if you are a man over age 45 or a woman over age 55 you are at greater risk of heart disease?


Isn't it good to know that prevention and wellness based medicine is now the growing trend!

Do you believe that what you eat today, impacts your health tomorrow?

Do you think that you can have some control over your own strength and longevity?

Most diseases are preventable! 

Where do we start? What do we do first? Second?

My husbands story:





Looking at the research, what is being advocated is more Patient and Public Education. That you can have an impact on your health by modifying a lifestyle that is high in risk factors, to a lifestyle that is low in Risk Factors.

High Risk factors include:
(from Science Talk with Dr. Jamie McMannus, MD and Les Wong)

1. Family history

2. Age (as you age your risk factor increases)

3. Smoking (almost ¼ of the American population still smokes)

4. Obesity

5. Diabetes – often related to life style choices.

a. Lifestyle – sedentary lifestyle  - risk factor

b. Elevated lipids and  elevated blood pressure

c. Inflammation another risk factors – including increased levels of C reactive protein.

 You can impact your health in a positive way!



Audio:
Shaklee Hotline News, February 2011 (coming soon)

Heart Health Webinare
Link to a very well done Webinaire On Heart Health. Jennifer Glacken explains in a way that easy to understand, and you move the webinaire at your own pace.



Links to Resources:




The following Guidelines are from Circulation: Journal of the American Heart Association

Table 4. Guidelines for the Prevention of CVD in Women
Lifestyle Interventions
Cigarette smoking
Women should be advised not to smoke and to avoid environmental tobacco smoke. Provide counseling at each encounter, nicotine replacement, and other
pharmacotherapy as indicated in conjunction with a behavioral program or formal smoking cessation program (Class I; Level of Evidence B).

Physical activity
Women should be advised to accumulate at least 150 min/wk of moderate exercise, 75 min/wk of vigorous exercise, or an equivalent combination of
moderate- and vigorous-intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 min, preferably spread throughout
the week (Class I; Level of Evidence B).
Women should also be advised that additional cardiovascular benefits are provided by increasing moderate-intensity aerobic physical activity to 5 h (300
min)/wk, 2 1/2 h/wk of vigorous-intensity physical activity, or an equivalent combination of both (Class I; Level of Evidence B).
Women should be advised to engage in muscle-strengthening activities that involve all major muscle groups performed on 2 d/wk (Class I; Level of
Evidence B).
Women who need to lose weight or sustain weight loss should be advised to accumulate a minimum of 60 to 90 min of at least moderate-intensity physical
activity (eg, brisk walking) on most, and preferably all, days of the week (Class I; Level of Evidence B).

Cardiac rehabilitation
A comprehensive CVD risk-reduction regimen such as cardiovascular or stroke rehabilitation or a physician-guided home- or community-based exercise
training program should be recommended to women with a recent acute coronary syndrome or coronary revascularization, new-onset or chronic angina,
recent cerebrovascular event, peripheral arterial disease (Class I; Level of Evidence A) or current/prior symptoms of heart failure and an LVEF 35% (Class I;
Level of Evidence B).

Dietary intake
Women should be advised to consume a diet rich in fruits and vegetables; to choose whole-grain, high-fiber foods; to consume fish, especially oily fish, at least twice
a week; to limit intake of saturated fat, cholesterol, alcohol, sodium, and sugar; and avoid trans-fatty acids. See Appendix (Class I; Level of Evidence B).
Note: Pregnant women should be counseled to avoid eating fish with the potential for the highest level of mercury contamination (eg, shark, swordfish, king
mackerel, or tile fish).

Weight maintenance/reduction
Women should maintain or lose weight through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated to
maintain or achieve an appropriate body weight (eg, BMI 25 kg/m 2
in US women), waist size (eg, 35 in), or other target metric of obesity. (Class I; Level
of Evidence B).

Omega-3 fatty acids
Consumption of omega-3 fatty acids in the form of fish or in capsule form (eg, EPA 1800 mg/d) may be considered in women with hypercholesterolemia
and/or hypertriglyceridemia for primary and secondary prevention (Class IIb; Level of Evidence B).
Note: Fish oil dietary supplements may have widely variable amounts of EPA and DHA (likely the only active ingredients).

Major risk factor interventions
Blood pressure: optimal level and lifestyle
An optimal blood pressure of 120/80 mm Hg should be encouraged through lifestyle approaches such as weight control, increased physical activity, alcohol
moderation, sodium restriction, and increased consumption of fruits, vegetables, and low-fat dairy products (Class I; Level of Evidence B).

Blood pressure: pharmacotherapy
Pharmacotherapy is indicated when blood pressure is 140/90 mm Hg (130/80 mm Hg in the setting of chronic kidney disease and diabetes mellitus).
Thiazide diuretics should be part of the drug regimen for most patients unless contraindicated or if there are compelling indications for other agents in
specific vascular diseases. Initial treatment of high-risk women with acute coronary syndrome or MI should be with -blockers and/or ACE inhibitors/ARBs,
with addition of other drugs such as thiazides as needed to achieve goal blood pressure (Class I; Level of Evidence A).
Note: ACE inhibitors are contraindicated in pregnancy and ought to be used with caution in women who may become pregnant.

Lipid and lipoprotein levels: optimal levels and lifestyle
The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL-C 100 mg/dL, HDL-C 50 mg/dL,
triglycerides 150 mg/dL, and non–HDL-C (total cholesterol minus HDL) 130 mg/dL (Class I; Level of Evidence B).

Lipids: pharmacotherapy for LDL-C lowering, high-risk women
LDL-C–lowering drug therapy is recommended simultaneously with lifestyle therapy in women with CHD to achieve an LDL-C 100 mg/dL (Class I; Level of
Evidence A) and is also indicated in women with other atherosclerotic CVD or diabetes mellitus or 10-year absolute risk 20% (Class I; Level of Evidence B).
A reduction to 70 mg/dL is reasonable in very-high-risk women (eg, those with recent ACS or multiple poorly controlled cardiovascular risk factors) with
CHD and may require an LDL-lowering drug combination (Class IIa; Level of Evidence B).
Lipids: pharmacotherapy for LDL-C lowering, other at-risk women
LDL-C–lowering with lifestyle therapy is useful if LDL-C level is 130 mg/dL, there are multiple risk factors, and the 10-y absolute CHD risk is 10% to 20%
(Class I; Level of Evidence B).
LDL-C lowering is useful with lifestyle therapy if LDL-C level is 160 mg/dL and multiple risk factors even if 10-y absolute CHD risk is 10% (Class I; Level
of Evidence B).
LDL-C lowering with lifestyle therapy is useful if LDL 190 mg/dL regardless of the presence or absence of other risk factors or CVD (Class I; Level of
Evidence B).
In women 60 y of age and with an estimated CHD risk 10%, statins could be considered if hsCRP is 2 mg/dL after lifestyle modification and no acute
inflammatory process is present (Class IIb; Level of Evidence B).
Lipids: pharmacotherapy for low HDL-C or elevated non–HDL-C
Niacin or fibrate therapy can be useful when HDL-C is low (50 mg/dL) or non–HDL-C is elevated (130 mg/dL) in high-risk women after LDL-C goal is
reached (Class IIb; Level of Evidence B).

Diabetes mellitus
Lifestyle and pharmacotherapy can be useful in women with diabetes mellitus to achieve an HbA1C 7% if this can be accomplished without significant
hypoglycemia (Class IIa; Level of Evidence B).

Preventive drug interventions
Aspirin: high-risk women
Aspirin therapy (75–325 mg/d) should be used in women with CHD unless contraindicated (Class I; Level of Evidence A).
Aspirin therapy (75–325 mg/d) is reasonable in women with diabetes mellitus unless contraindicated (Class IIa; Level of Evidence B).
If a high-risk woman has an indication but is intolerant of aspirin therapy, clopidogrel should be substituted (Class I; Level of Evidence B).

Aspirin: other at-risk or healthy women
Aspirin therapy can be useful in women 65 y of age (81 mg daily or 100 mg every other day) if blood pressure is controlled and benefit for ischemic stroke
and MI prevention is likely to outweigh risk of gastrointestinal bleeding and hemorrhagic stroke (Class IIa; Level of Evidence B) and may be reasonable for
women 65 y of age for ischemic stroke prevention (Class IIb; Level of Evidence B).

Aspirin: atrial fibrillation
Aspirin 75–325 mg should be used in women with chronic or paroxysmal atrial fibrillation with a contraindication to warfarin or at low risk of stroke (1%/y
or CHADS2 score of 2) (Class I; Level of Evidence A).
Warfarin: atrial fibrillation
For women with chronic or paroxysmal atrial fibrillation, warfarin should be used to maintain the INR at 2.0 to 3.0 unless they are considered to be at low
risk for stroke (1%/y or high risk of bleeding) (Class I; Level of Evidence A).

Dabigatran: atrial fibrillation
Dabigatran is useful as an alternative to warfarin for the prevention of stroke and systemic thromboembolism in patients with paroxysmal to permanent AF
and risk factors for stroke or systemic embolization who do not have a prosthetic heart valve or hemodynamically significant valve disease, severe renal
failure (creatinine clearance 15 mL/min), or advanced liver disease (impaired baseline clotting function) (Class I; Level of Evidence B).

b-Blockers
-Blockers should be used for up to 12 mo (Class I; Level of Evidence A) or up to 3 y (Class I; Level of Evidence B) in all women after MI or ACS with
normal left ventricular function unless contraindicated.
Long-term -blocker therapy should be used indefinitely for women with left ventricular failure unless contraindications are present (Class I; Level of Evidence A).
Long-term -blocker therapy may be considered in other women with coronary or vascular disease and normal left ventricular function (Class IIb; Level of
Evidence C).

ACE inhibitors/ARBs
ACE inhibitors should be used (unless contraindicated) in women after MI and in those with clinical evidence of heart failure, LVEF 40%, or diabetes
mellitus (Class I; Level of Evidence A).
In women after MI and in those with clinical evidence of heart failure, an LVEF 40%, or diabetes mellitus who are intolerant of ACE inhibitors, ARBs should
be used instead (Class I; Level of Evidence B).
Note: ACE inhibitors are contraindicated in pregnancy and ought to be used with caution in women who may become pregnant.

Aldosterone blockade
Use of aldosterone blockade (eg, spirololactone) after MI is indicated in women who do not have significant hypotension, renal dysfunction, or hyperkalemia
who are already receiving therapeutic doses of an ACE inhibitor and -blocker and have LVEF 40% with symptomatic heart failure (Class I; Level of Evidence B).





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