February is National Heart Month and Dental Month

 

“In 2010, an estimated 785,000 Americans had a new coronary attack and about 470,000 had a recurrent attack,” according to the Centers for Disease Control and Prevention. “About every 25 seconds, an American will have a coronary event, and about one every minute will die from one.”

Guidelines for preventing CVD in women

Smoking:  Women should not smoke and should avoid secondhand smoke.

Exercise: Women should have at least 150 minutes/week of moderate exercise or 75 minutes/week of vigorous activity. Additional cardiovascular benefits are provided by increasing moderate-intensity exercise to 300 minutes/week or 150 minutes/week of vigorous activity. Women should perform muscle-strengthening exercises that involve all major muscle groups at least 2 days/week. Women wanting to lose weight should accumulate a minimum of 60−90 minutes of at least moderate-intensity exercise on most or all days.

CVD risk-reduction: Women who recently have suffered acute coronary syndrome or coronary revascularization, new onset or chronic angina, or current/prior symptoms of heart failure who meet certain criteria, a recent cerebrovascular attack, or peripheral vascular disease should enroll in a comprehensive CVD risk-reduction regimen, such as rehabilitation or a community-based exercise program.

Diet: Women should eat plenty of fruits and vegetables, choose whole-grain and high-fiber foods, consume fatty fish at least twice a week, and limit intake of saturated fat, cholesterol, alcohol, sodium, sugar, and trans fatty acids. Specific diet guidelines include:

  • More than 4.5 cups of fruits and vegetables/day
  • 7 ounces (cooked) of fatty fish each week
  • 30 grams/day of fiber
  • Three servings/day of whole grains
  • Less than five servings/week of sugar and fewer than 450 calories/week from sugar-sweetened beverages
  • More than four servings of nuts, legumes, and seeds/week
  • Less than 7% of calories from saturated fat
  • Less than 150 milligrams (mg)/day of cholesterol
  • Less than one serving of alcohol/day
  • Less than 1500 mg of sodium/day
  • No trans fatty acids

Body mass index (BMI): Women should maintain or lose weight to achieve a BMI of less than 25, a waist size below 35″, and other targets.

Eicosapentaenoic acid (EPA): Women who already have hypercholesterolemia or hypertriglyceridemia are advised to take 1800 mg/day of EPA, an omega-3 fatty acid.

Blood pressure: An optimal blood pressure of <120/90 millimeters of mercury (mm Hg) is encouraged. If blood pressure is more than 140/90 mm Hg (or more than 130/80 mm Hg in women with chronic kidney disease and diabetes), most patients are prescribed thiazide diuretics. Beta-blockers and/or ACE inhibitors/angiotensin receptor blockers (ARBs) are the initial treatments for high-risk women with acute coronary syndrome or myocardial infarction (MI), with other medications, such as thiazide diuretics, added as necessary.

Lipids: The lipid goals are low-density lipoprotein (LDL) <100 mg/deciliter (dL), high-density lipoprotein (HDL) >50 mg/dL, triglycerides <150 mg/dL, and non-HDL cholesterol <130 mg/dL.

LDL: Women with coronary heart disease should use drug therapy, as well as lifestyle therapy, to decrease their LDL to <100 mg/dL. Medication also is indicated for women with other atherosclerotic CVD or diabetes or a 10-year absolute risk of >20%. Women who are very high risk should aim for an LDL of 70 mg/dL.

HDL: When HDL levels are low or when non-HDL cholesterol is high, niacin or fibrate therapy may prove useful.

A1c: Women with diabetes should achieve an A1c of <7% (if possible without hypoglycemia).

Antioxidants: Antioxidants such as vitamins E and C taken in supplemental doses are not useful for the prevention of heart disease. Neither are the B vitamins.

Low-dose aspirin: If you are younger than 65, you probably do not need to take low-dose aspirin. In older women, baby aspirin can help to reduce the risk of stroke. Talk to your doctor if you have questions about this.

Hormone therapy and selective estrogen-receptor modulators: Hormone therapy and selective estrogen-receptor modulators are not used for the primary or secondary prevention of cardiovascular disease.

Medications:

−  Warfarin is used for women with chronic or paroxysmal atrial fibrillation.

−  Dapigatran is an alternative to warfarin, used for the prevention of stroke and systemic thromboembolism.

−  Beta blockers are used in all women after MI or acute chest pain with normal ventricular function or with left ventricular failure. 

  ACE inhibitors are used for women after MI or for those who have heart failure, left ventricular ejection fraction (LVEF) <40%, or diabetes.

  Aldosterone blockade after MI is indicated in women without hypotension, renal dysfunction, or hyperkalemia if they are already on ACE inhibitors and beta blockers and have an LVEF of <40% and symptomatic heart failure.

Heart Health: What Are You Willing to Do?

I will avoid saturated fats.
Sources of saturated fat include:

  • Fatty meat           
  • Poultry skin
  • Whole milk
  • Lard
  • Coconut oil
  • Palm kernel oil
  • Palm oil
  • Butter
  • Cream
  • Cottonseed oil

I will read ingredient lists to make sure that the foods I choose do not contain partially hydrogenated oils.
These are trans fats.

I will choose healthier sources of fat.
Choose:

  • Olive oil
  • Canola oil
  • Walnut oil
  • Nuts
  • Seeds
  • Avocados

I will eat fatty fish at least two times each week.
The following are fatty fish:

  • Salmon
  • Tuna
  • Mackerel
  • Bluefish
  • Mullet
  • Anchovies
  • Herring
  • Lake trout
  • Sardines

If you do not like fish, take a fish oil supplement that contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Alpha-linolenic acid (ALA) is not as good. Your supplement should provide at least 1 gram (g)/day.

I will decrease the amount of sugar that I consume. 

I will eat several sources of soluble fiber each day.
Good sources include:

  • Citrus fruits
  • Apples
  • Pears
  • Prunes
  • Peaches
  • Plums
  • Barley
  • Oats
  • Legumes
  • Broccoli
  • Brussels sprouts
  • Carrots

I will increase my intake of foods that contain calcium and vitamin D.
If you do not think that you can get enough calcium and vitamin D from your diet, take a daily supplement.
Good sources of calcium include:

  • Milk
  • Milk products
  • Fortified orange juice
  • Fortified breads
  • Fortified cereals
  • Beans
  • Dried figs
  • Calcium-fortified tofu
  • Canned salmon with bones
  • Almonds
  • Carnation® Instant Breakfast
  • Ovaltine®
  • Dark-green leafy vegetables
  • Broccoli

I will eat plenty of potassium-rich foods.
These include:

  • Potatoes
  • Sweet potatoes
  • Bananas
  • Oranges
  • Halibut
  • Lima beans
  • Tuna
  • Swiss chard
  • Acorn squash
  • Tomatoes
  • Watermelon
  • Grapes
  • Raisins
  • Pistachios
  • Flounder
  • Parsnips
  • Pinto beans
  • Wheat germ
  • Brussels sprouts
  • Prunes
  • Spinach
  • Salmon
  • Cantaloupe
  • Lentils
  • Milk
  • Milk products

I will commit to consuming more plant stanols/sterols.
I will eat the recommended amount every day.

I will eat more fresh herbs.

I will eat several servings of nuts each week.
The best kinds of nuts are:

  • Walnuts
  • Almonds
  • Brazil nuts
  • Pecans
  • Pistachios

I will use garlic, onions, and leeks often when preparing food.

I will choose cereals that contain more than 5 g of fiber/serving.
Good choices include:

  • Raisin bran
  • Shredded wheat
  • Grape-Nuts
  • Fiber One®
  •  

    What did you commit to?

  1. I will avoid saturated fats.
  2. I will read ingredient lists to make sure that the foods I choose do not contain partially hydrogenated oils.
  3. I will choose healthier sources of fat.
  4. I will eat fatty fish at least two times each week.
  5. I will decrease the amount of sugar that I consume.
  6. I will eat several sources of soluble fiber each day.
  7. I will increase my intake of foods that contain calcium and vitamin D.
  8. I will eat plenty of potassium-rich foods.
  9. I will commit to consuming more plant stanols/sterols.
  10. I will eat more fresh herbs.
  11. I will eat several servings of nuts each week.
  12. I will use garlic, onions, and leeks often when preparing food.
  13. I will choose cereals that contain more than 5 g of fiber/serving.