Heart Disease: How To Reduce The Risk

What Is Heart Disease?

Heart disease describes a variety of disorders and conditions that can affect the heart. The most common type of heart disease is coronary heart disease (CHD), also called coronary artery disease.

The word ‘coronary’ means crown, and it is the name given to the arteries that circle the heart like a crown. The coronary arteries supply the heart muscle with oxygen and nutrients.

The coronary arteries of the heart

Coronary heart disease develops when one or more of the coronary arteries that supply the blood to the heart become narrower than they used to be. This happens because of a buildup of cholesterol and other substances in the wall of the blood vessel, affecting the blood flow to the heart muscle.

  • Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a bump in the blood vessel wall known as plaque.
  • Plaque build-up narrows and hardens the blood vessel, a process called atherosclerosis, or hardening of the arteries.
  • Eventually these plaque deposits can build up to significantly reduce or block blood flow to the heart.

Cholesterol narrowing coronary artery

Many people experience chest pain or discomfort from inadequate blood flow to the heart, especially during exercise when the heart needs more oxygen. Without an adequate blood supply, heart muscle tissue can be damaged.

Although we typically think of atherosclerosis as a disease of old age, the process begins as early as childhood, making prevention of coronary heart disease a priority for everyone.

It’s not easy to tell if you have coronary heart disease, since the disease rarely causes symptoms in its early stages. That is why it’s important to see your physician regularly and evaluate your diet and lifestyle habits. Your physician can detect early warning signs of CHD, such as high blood pressure or high cholesterol levels.

Need To Know:

What happens as coronary heart disease gets worse?

As coronary heart disease develops, more damage to the heart occurs and the following conditions may develop:

  • Angina

    As CHD progresses, build-up of cholesterol and other fat-like materials significantly reduces blood flow to the heart. If the heart is not getting enough oxygen, a person may experience pain or discomfort in the chest known as angina, especially during exercise or increased activity.

    Symptoms of angina include:

    • A feeling of discomfort or pressure felt in the chest, ranging from a vague ache to a crushing sensation
    • Pain or pressure in the left arm, shoulder, or throat
    • Difficulty catching your breath

    CHD is the most common cause of angina. Angina is a sign that the heart muscle is not receiving enough oxygen and nutrients. If you are experiencing any of the symptoms of angina, you should be evaluated by a physician.

    For more detailed information on angina and its treatment, go to Angina.

  • Heart Failure

    Heart failure occurs when a weakened heart cannot pump efficiently, and fluid builds up in the ankles, legs, lungs, and other tissues. The combination of clogged blood vessels and high blood pressure often causes heart failure.

    For more detailed information on heart failure and its treatment, go to Heart Failure.

  • Heart Attack

    If blood flow to any part of the heart is completely blocked, the cells in that part of the heart begin to die, causing a heart attack. Heart attacks usually happen when a previously narrowed coronary artery is suddenly blocked or otherwise closed off.

    Symptoms of a heart attack vary widely for each person but can include:

    • Pain or pressure in the chest, shoulders or arms (most commonly on the left side), neck, or lower jaw.
    • Shortness of breath
    • Weakness
    • Rapid heart beat
    • Lightheadedness or faintness
    • Profuse sweating
    • Nausea or vomiting

For more detailed information on heart attack, go to Heart Attack.

Coronary artery disease; heart damage

Nice To Know:

The majority of people with heart problems suffer from coronary heart disease, but there also are other types of heart disease. These include:

  • Valve disease – disease of the heart’s valves, which keep blood flowing in the right direction
  • Congenital heart disease – a heart defect that is present at birth
  • Inadequate pumping – caused by failure of the muscular walls of the heart (cardiac failure) or failure of the left side of the heart to work properly (left ventricular failure)
  • Cardiomyopathy – a disease that makes the heart muscle weak and causes it to enlarge
  • Viral myocarditis – caused by a virus that affects the heart muscle
  • Heart rhythm disorders – such as arrhythmia or palpitations.

    For further information on palpitations, go to Palpitations.

Facts About Heart Disease

  • More than 12 million Americans suffer from CHD. It is the No. 1 killer of adult Americans, both men and women.
  • The death rate from coronary heart disease (CHD) has fallen by 40 percent over the past 20 years. This drop is partly because more people are eating right and exercising regularly, and partly because of advances in medical care for those who do have heart disease.
  • One in ten women aged 45 to 64 has some form of heart disease. The rate increases to one in five for women 65 years of age and older.
  • Close to one-half of Americans with high blood pressure – an important risk factor for heart disease – don’t even know they have it.
  • Heart disease is the leading cause of death in cigarette smokers.
  • Based on new weight-for-height guidelines, more than one-half of Americans are considered overweight or obese. Middle-aged men who are obese are three times more likely to have a heart attack than men of normal weight.
  • Deposits of cholesterol and other lipids, or fat-like substances, can begin to form on the artery wall as early as childhood. In studies of 22-year-old men killed during the Korean War, one-third had significant deposits in their arteries.
  • Only about one-quarter of American adults meet current recommendations for physical activity, which is a good way to help prevent heart disease.


Are You At Risk For Heart Disease?

Risk factors can be divided into two categories:

  • Risk factors you can’t do anything about
  • Risk factors you can do something about

Need To Know:

People who have more than one risk factor for coronary heart disease may be at much greater risk for CHD than people with no risk factors. For example, a person who has a high cholesterol level and smokes two packs of cigarettes a day may have as much as a 10 times greater chance of having a heart attack as a non-smoker with normal blood cholesterol.

Risk Factors You Can’t Do Anything About

Some risk factors for coronary heart disease (CHD) are beyond your control. Remember that having an uncontrollable risk factor for CHD does not mean that you are destined to develop CHD. It does mean, however, that you should do what you can to care for your heart’s health.

  • Age: The older you get, the more likely you are to develop CHD
  • Race: Black individuals are more likely than white individuals to develop CHD because they develop high blood pressure(hypertension) more often. High blood pressure increases risk for CHD.
  • Gender: Middle-aged men have a higher risk of CHD than middle-aged women do. The risk of CHD is similar in postmenopausal women and in men.
  • Heredity: The genetic make-up of some individuals increases their chances of developing CHD.

Risk Factors You Can Do Something About

  • High cholesterol levels: High levels of blood cholesterol (hypercholesterolemia) contribute to the build-up of plaques that can clog the blood vessels leading to the heart, narrowing them and potentially blocking blood flow to the heart.
  • High blood pressure (hypertension): High blood pressure strains the heart and increases wear and tear on the blood vessels, making blockage more likely.

    For further information on high blood pressure, go to High Blood Pressure.

  • Smoking: The Surgeon General of the United States has stated that cigarette smoking is the most important of the known modifiable risk factors for CHD. Nicotine in cigarettes speeds up the heart and also narrows the arteries, making it harder for enough blood to get through.
  • Being overweight: According to the American Heart Association guidelines, obesity is a major risk factor for CHD. Obesity increases blood pressure, blood cholesterol levels, and the risk of diabetes, and may directly contribute to CHD.
  • Inactivity: When you are inactive, your circulation is less efficient, increasing risk of blood vessel blockage.
  • Stress: Stress can increase blood pressure in some individuals.

Need To Know:

People who suffer from diabetes – either insulin-dependent or non-insulin-dependent – are also at a higher risk of developing CHD. Diabetes accelerates blockage of blood vessels. People with diabetes are also more likely to have high blood cholesterol levels and high blood pressure. Although diabetes cannot be cured, people with diabetes can significantly reduce their risk of CHD by controlling their diabetes.

For further information on diabetes, go to Diabetes In Adults.


How Can You Reduce Your Risk For Heart Disease?

In order to reduce your risk of coronary heart disease (CHD), you first must identify what may be putting you at risk. Determine if you’re at risk by reviewing your lifestyle and diet. Ask your physician to check your blood cholesterol level. If you have only one uncontrollable risk factor, smoking or being overweight could make it worse.

Even if you are at risk for coronary heart disease, you can eliminate many of the major risk factors for CHD by making simple changes in diet and lifestyle. These changes are healthy for the entire family and reduce your risk of other diseases as well. They include:

  • Control your cholesterol level
  • Control high blood pressure (hypertension)
  • Stop smoking
  • Lose weight if you need to
  • Get active
  • Manage stress

How-To Information:

Making changes

It is all too easy to hear some suggestions, tell yourself “that makes sense-I’ll do it,” and then forget all about it. A systematic approach to change can help you make gradual progress towards health, one step at a time:

  1. Find your starting point. Keep a diary for a few days to record your normal food intake or patterns of exercise. What needs to change?
  2. Once you have identified your problem, make a commitment to change.
  3. Develop a plan for change. How will you start to make a change? If many changes are required, which one will you make first?
  4. Check up on yourself to see how well you are carrying out and keeping up the changes. Keep a food and exercise diary or schedule weekly weight checks.
  5. Ask friends and family for support. Schedule a daily walk with a friend, or plan low-fat, high-fiber meals with your spouse.
  6. Reward yourself. When you reach a goal – say, a month without a cigarette, or losing 5 pounds – indulge in that book you’ve been wanting to buy, a new CD by your favorite musician, or new clothes.

Don’t expect to embark on four- or five-change campaigns at the same time. However, there is plenty of overlap. For example, a regular exercise program will help improve your health in many ways: exercise also helps lower your cholesterol, reduce blood pressure, and boosts your cardiovascular fitness.

When making changes, you need to pace yourself. Make adjustments to your way of living in whatever order is easiest and don’t rush. Gradual changes are more likely to be permanent than rapid and drastic ones.

If you need more help, check out local libraries, bookstores, and organizations such as the YMCA. Your local chapter of the American Heart Association can also offer a wealth of resources to help you make the changes you need.

Nice To Know:

Other Health Benefits

Changes such as low-fat eating, regular exercise, not smoking, and maintaining a healthy body weight will help you feel better, look better, and have more energy. Besides reducing your risk for coronary heart disease, you’ll also reduce your risk for:

  • Certain kinds of cancer
  • Diabetes
  • High blood pressure
  • Stroke
  • Osteoporosis (a condition in which the bones become weak and susceptible to fractures)

Even if your risk for coronary heart disease is high, you can reduce that risk immediately by changing your diet, exercise, and smoking habits. And since a low-fat diet rich in fruits, vegetables, and whole grains is appropriate for all people 2 years of age or older, your entire family can benefit.


What You Should Know About Cholesterol

Cholesterol is necessary for our bodies to function, and it is found in every cell in our body. About 80 percent of the cholesterol in our bodies is manufactured by the liver, while the other 20 percent comes from the foods that we eat.

However, a diet high in cholesterol can cause our bodies to make too much cholesterol, resulting in high levels of blood cholesterol. When blood cholesterol levels get too high, it can clog arteries and increase our risk for coronary heart disease.

  • What is cholesterol?
  • How does high cholesterol increase your risk of coronary heart disease?
  • The different types of cholesterol
  • What affects blood cholesterol levels?
  • Do all types of fats raise blood cholesterol levels?
  • Does cholesterol in foods raise blood cholesterol?

What Is Cholesterol?

Cholesterol is a waxy substance that is made in our bodies by the liver. Cholesterol forms part of every cell in the body. Our bodies need cholesterol to:

  • Maintain healthy cell membranes
  • Make hormones
  • Make vitamin D
  • Make bile acids, which aid in fat digestion

Sometimes, however, our bodies make too much cholesterol. When we eat too much saturated fat – the kind of fat found in hardened fat products like most margarines, vegetable shortening, and animal-based foods such as meat and dairy products – our bodies can make too much cholesterol.

We also get cholesterol from the foods we eat. Only animal-based foods such as meat, eggs, and dairy products contain cholesterol. Plant foods do not contain cholesterol.

How Does High Cholesterol Increase Your Risk For Heart Disease?

When we get too much cholesterol – either because our body makes too much or because we eat too many foods rich in saturated fat – the surplus cholesterol circulates in the bloodstream.

  • Deposits of cholesterol and other fat-like substances can build up in the inner lining of these blood vessels and become coated with scar tissue, forming a cholesterol-rich bump in the blood vessel wall known as plaque.
  • Plaque build-up narrows and hardens the blood vessel; a process called atherosclerosis, or hardening of the arteries.

Need To Know:

A high blood cholesterol level is especially dangerous for smokers and those with high blood pressure.

The Different Types Of Cholesterol

Cholesterol travels through the body in packages called lipoproteins, which consist of cholesterol and proteins. Some lipoproteins contain another type of fat, called triglycerides.

  • High-density lipoproteins (HDLs) contain mostly protein
  • Low-density lipoproteins (LDLs) contain mostly cholesterol
  • Very-low-density lipoproteins (VLDLs) contain mostly cholesterol and triglycerides.

Not all cholesterol is harmful. High-density lipoprotein (HDL) cholesterol is a good type of cholesterol that actually helps to remove cholesterol from the walls of arteries and transports it to the liver for elimination. HDL cholesterol helps the body get rid of low-density lipoprotein (LDL) cholesterol and very-low-density lipoprotein (VLDL) cholesterol, the bad types of cholesterol that are most likely to clog blood vessels.

LDL and VLDL are commonly known as “bad” cholesterol and HDL as “good” cholesterol.

Need To Know:

You should also have your blood level of another type of fat, triglycerides, measured at the same time you have your blood cholesterol levels checked. High blood triglyceride levels can also increase risk for coronary heart disease. Fortunately, these levels can be quickly lowered with weight control and more exercise.

What Affects Blood Cholesterol Levels?

Many things affect the cholesterol level in your blood:

  • What you eat: You can lower your cholesterol level by cutting down on animal fat and other fats and eating foods rich in starch and fiber, such as fresh fruits, vegetables, and whole grains.
  • Your hormones: Women get a natural boost in their HDL cholesterol from their hormones until they reach menopause. After menopause, taking estrogen can help maintain higher HDL cholesterol (“good” cholesterol) levels.
  • Medications: For most people, diet and exercise is the best way to control cholesterol levels. For some individuals, doctors may prescribe medication to reduce blood cholesterol levels, especially if high levels of cholesterol run in your family.
  • Other factors: Being overweight, inactive, and smoking all increase levels of the harmful type of cholesterol.

Do All Types Of Fats Raise Blood Cholesterol Levels?

There are three main types of fats in food:

  • Saturated fat: A type of fat found in animal foods like beef, pork, lamb, and dairy products; in tropical oils such as palm and coconut oil; and in vegetables oils that have been chemically changed to make them solid at room temperature (a process called hydrogenation).
  • Monounsaturated fat: A type of fat found in plant oils such as olive oil and canola oil.
  • Polyunsaturated fat: A type of fat found in plant oils such as safflower, sunflower, corn, or soybean oil.

Although all fats are concentrated sources of calories and can contribute to weight gain (and thus, high blood cholesterol levels), saturated fat is the most harmful. Saturated fat is the main cause of high blood cholesterol levels. When you eat it, your body may react by making more cholesterol than it needs, and the surplus ends up in your blood.

Nice To Know:

Fish, especially cold water fish, contain a special type of polyunsaturated fat called omega-3 fat that may help protect against coronary heart disease by slowing blood clotting.

Does Cholesterol In Foods Raise Blood Cholesterol?

Although a diet high in saturated fat is the main cause of high blood cholesterol levels, high cholesterol in the diet can also raise blood cholesterol levels.

Like people, animals also make cholesterol and carry cholesterol throughout their bodies. If we eat meat or dairy products, we cannot avoid cholesterol. If you eat modest amounts of lean meats and dairy products, your cholesterol intake will not be too high. However, you should limit foods such as egg yolks and liver, which contain high amounts of cholesterol.

Do I Have High Cholesterol?

The risk for coronary heart disease (CHD) increases with rising blood cholesterol levels. When blood cholesterol exceeds 220 ml/dl (milligrams per deciliter-the units blood cholesterol is measured in the United States), risk for CHD increases at a more rapid rate.

All adults should have their blood cholesterol level measured at least once every five years.

If your blood cholesterol level is:

  • Below 180-then your blood cholesterol level is ideal
  • 180-199-then your blood cholesterol level is acceptable
  • 200-219-then your blood cholesterol level is borderline high
  • 220 or higher-then your blood cholesterol level is too high

If your total blood cholesterol level is greater than 200 (and especially if it is over 220), you should have another test to see what type of cholesterol is high.

If your HDL cholesterol level is:

  • Under 35, then it is too low
  • 36-50, then it is acceptable
  • Over 50, then it is ideal

If your LDL cholesterol level is:

  • 130 or less, then it is ideal
  • 130 to 159, then it is borderline high
  • 160 or greater, it is too high

How much fat and cholesterol are you eating now?

How you can eat less saturated fat and cholesterol?

How you can easily cut your fat intake?

How you can eat more starches and fiber?

How Much Fat And Cholesterol Are You Eating Now?

Below is a quick self-assessment to help you find out how much saturated fat and cholesterol you eat now and what changes you might need to make. Answer the following questions:

How many eggs do you eat weekly?

more than 3

2 to 3

1 or less

How often do you eat red meat (beef, pork, or lamb) weekly?

5 or more

3 to 5

2 or less

What kind of milk do you drink?



1% or skim

How often each week do you eat cheese or ice cream that is not low fat?

5 or more

3 to 4

2 or less

How often each week do you eat baked goods like doughnuts, pastries, or cookies?

4 to 5

2 to 3

1 or less

Including breakfast, lunch, and dinner, how many meals do you eat weekly which do not contain any red meat, eggs, or cheese?

5 or less

6 to 13

14 or more

As you can guess, the ideal way of eating is shown in the right-hand column. This type of diet may even be low enough in fat and cholesterol to help reverse artery blockage, and it will certainly help prevent the build-up from starting.

The eating patterns of most Americans fall in the center or left-hand columns. For some people, the right-hand column may look almost out of reach, but anything you can do to work toward the goal will be helpful. Remember that gradual change is more likely to be permanent, so don’t feel you must make many drastic changes all at once.

How You Can Eat Less Saturated Fat And Cholesterol

To reduce your fat and cholesterol intake in your diet, start with changes that are relatively easy to make. For example, many people find it easy to switch from 2% milk to 1% or skim milk. Once you have adjusted to one change, pick another change to work on.

How-To Information:

Here are some simple changes that will help you greatly reduce saturated fat and cholesterol in your diet.

Egg yolks:

  • Eat no more than three eggs yolks weekly
  • Eat as many egg whites as you like-they contain no cholesterol


  • Buy lean meats such as fish, poultry, veal cutlet, pork tenderloin, or flank steak.
  • Trim as much fat off meat as possible.
  • Broil, barbecue or roast meat on a rack rather than fry it. This allows some of the fat to escape during cooking.
  • Limit the amount of hamburger you eat, and buy the leanest type available.
  • Replace high-fat prepared meats like sausage and luncheon meats with lower-fat meats like lean turkey or chicken.
  • Remove the skin from chicken or turkey before you cook or eat it.
  • Try to eat fish twice weekly. Fish contains a type of fat called omega-3 fat that may help prevent CHD.

Dairy products:

  • Use margarine instead of butter, choosing a margarine that has a liquid oil rather than a hydrogenated oil listed as the first ingredient.
  • Choose lower fat milk. If you use whole milk, switch to 2%. If you use 2%, switch to 1% or skim milk. All types of milks have the same amount of calcium and other vitamins and minerals.
  • Use non-fat or low-fat yogurt.
  • Use plain non-fat yogurt instead of sour cream.
  • Cut down on the amount of regular cheeses you eat. Look for lower fat cheese, which contain less than 3 grams of fat per ounce.
  • Sprinkle a little Parmesan cheese on food to give it a cheesy taste. Parmesan cheese is strong tasting, so a little goes a long way.

Tropical oils and processed oils:

  • Check food labels to see what the main type of fat in the food is. Limit foods that list contain palm oil, coconut oil, or hydrogenated oil as one of the first type of fats. (Food labels list ingredients in order from greatest to least by weight.
  • Be suspicious of commercial baked goods such as donuts, sweet rolls, brownies, and cookies, which are a major source of saturated fat.

Nice To Know:

About 60 percent of the saturated fat in the American diet comes from three food sources: hamburger, cheese, and whole milk. Cutting down on these foods, or cutting them out, can go a long way toward helping you cut down saturated fat and cholesterol.

How You Can Easily Cut Your Fat Intake

Ounce for ounce, fat contains more than twice the calories that protein or carbohydrate do. So although saturated fat is the type of fat most damaging for your heart, you should limit intake of all fats. Eating too much fat, no matter what kind, can make you put on excess weight. Eating too much fat can also increase your risk of certain types of cancer, such as breast or colon cancer.

How-To Information:

To limit your total fat intake:

  • Broil, bake, boil, or roast foods rather than fry.
  • Use non-stick pans or coat pans with a thin layer of non-stick spray.
  • Add less fat to food during both cooking and eating. Some examples include jam instead of margarine on toast, a non-fat or low-fat salad dressing instead of a high-fat dressing, lemon juice instead of butter on vegetables, or salsa instead of sour cream on baked potatoes.
  • Experiment with butter substitutes, spices, and other flavorings as alternative to fat.
  • Look for low-fat alternatives to foods, such as a bagel instead of a doughnut, pretzels instead of potato chips, or a round steak instead of a T-bone steak
  • Try new fat-free products like yogurt, cookies, or crackers.
  • Read labels, which offer excellent information to help you compare fat content of prepared foods.

How You Can Eat More Starches And Fiber

Including more starches and fiber in your diet can help you lower your cholesterol level as well as reduce your risk for obesity, cancer, high blood pressure, and other diseases.

Fresh fruits and vegetables and unprocessed grain products such as whole-grain breads and cereals are naturally low in fat, cholesterol-free, and rich in starches and dietary fiber.

For more information about fiber and your diet, go to Fiber: Its Importance In Your Diet.

A certain type of dietary fiber, called soluble fiber, may help lower cholesterol levels by sweeping cholesterol out of the body before it gets into the bloodstream. Foods rich in soluble fiber include oat bran, dried beans and peas, some fruits, and psyllium seeds (the main ingredient in the laxative Metamucil).

Fruits and vegetables also contain antioxidants, which are substances such as vitamin C (in citrus fruits), beta-carotene (in carrots), and vitamin E (in vegetable oils) that help protect body cells from damage. Antioxidants help prevent cholesterol from being moved out of the blood and into the lining of the blood vessels.

The U.S. Department of Agriculture’s Food Guide Pyramid recommends that you eat the following number of servings of these plant foods daily:

  • 6-11 servings of grains (1 serving equals 1 slice of bread, ½ of a bun, ½ cup of pasta or rice)
  • 3-5 servings of vegetables (1 serving equals 1 cup of raw leafy vegetables or ½ cup cooked vegetables)
  • 2-3 servings of fruits (1 serving equals 1 medium apple, peach or orange; ½ cup of berries; or 3/4 cup juice)

How-To Information:

To include more starches and fiber in your diet:

  • Keep a food diary showing the number of servings of fruits, vegetables, and grains you get daily. If you are low, gradually try to increase servings of the groups lacking by adding fruits, vegetables, or whole grains as side dishes or snacks.
  • Buy breads and cereals that list a whole grain as the first ingredient. Whole grains contain more fiber and vitamins and minerals
  • Whenever possible, choose raw fruits and vegetables rather than processed ones.
  • Steam vegetables until crisp-tender rather than boiling them to death.
  • Whenever possible, leave skin on fruits and vegetables.
  • Add lemon juice, butter flavoring, or other seasoning to vegetables rather than fat.
  • Include several meatless meals weekly. Start with breakfasts, and then gradually add two or three lunches or dinners weekly.

Need To Know:

Sometimes these efforts to lower your cholesterol may not be enough. Your doctor may need to add medication.

For more detailed information on how to lower your cholesterol, go to Lowering Your Cholesterol.


What You Should Know About Reducing Blood Pressure

High blood pressure is a major risk factor for coronary heart disease. One in four Americans has high blood pressure, and many of them are unaware of it. Although high blood pressure can usually be controlled with a combination of dietary and lifestyle changes and medication, most people with high blood pressure do not control it.

  • What is high blood pressure?
  • How does high blood pressure increase your risk for heart disease?
  • Is your blood pressure too high?
  • What factors increase your risk for high blood pressure?
  • How you can lower your blood pressure

What Is High Blood Pressure?

Blood that travels through your body is always under pressure, which is why it keeps circulating. But if blood pressure goes up and stays high, it is called high blood pressure, or hypertension. Usually, the term “hypertension” is used to mean increased pressure in the blood vessels that carry blood from the heart to the rest of the body. High blood pressure can be the result of narrowed arteries and/or excess fluid circulating in the bloodstream.

Think of your arteries as a garden hose. If you try to force more water through the hose or put a crimp in the hose, water pressure increases. Likewise, when your arteries are narrowed or more fluid is flowing through them, the blood exerts more pressure on the artery walls, causing high blood pressure.

For more information about high blood pressure and how you can control it, go to High Blood Pressure.

How Does High Blood Pressure Increase Your Risk For Heart Disease?

When your blood pressure is too high, your risk for CHD increases because:

  • Your heart has to work harder to force blood into the arteries that carry blood to every part of your body. Your heart may become enlarged and less efficient as a result.
  • The extra pressure on arterial walls can damage them.Cholesterol and other fat-like substances can catch on the rough surface of the damaged arterial walls, speeding up the process of atherosclerosis.

High blood pressure is especially dangerous for people who smoke or who have high blood cholesterol levels.

Is Your Blood Pressure Too High?

Everyone should have his or her blood pressure checked at least every two years, and more often if it is higher than it should be. Many people have high blood pressure without even knowing it, because high blood pressure usually causes no symptoms.

If you can’t have your blood pressure measured by a health professional, you can use a blood pressure machine found in many drug stores as an early alert system. Sit quietly for a few minutes before you start the machine and don’t talk while the machine is on. If the machine shows that your blood pressure is on the high side, have your blood pressure checked by a health professional.

Two numbers express blood pressure. The first and higher number,systolic blood pressure, measures the pressure when the heart is actually beating. The second and lower number,diastolic blood pressure, measures the pressure between beats of the heart. A typical normal blood pressure is 120/80, or “120 over 80.”

If your systolic blood pressure is:

  • Less than 120, your pressure is ideal
  • 121-140, your pressure is borderline
  • More than 140, your pressure is high

If your diastolic blood pressure is:

  • Less than 80, your pressure is ideal
  • 81-90, your pressure is borderline
  • More than 90, your pressure is high

If either type of blood pressure is too high, you need to work with your doctor to bring it down.

What Factors Increase Your Risk For High Blood Pressure?

Many factors affect your risk of developing high blood pressure. They include:

  • Heredity: To some extent, the tendency to develop high blood pressure is inherited. Black people are two to three times more likely than white people to develop high blood pressure.
  • Age: The older you are, the more likely you are to develop high blood pressure.
  • Body weight: High body weight and high blood pressure usually go hand in hand.
  • Activity level: The more inactive you are, the higher your blood pressure usually is.
  • Diet: For some people, high sodium intake from table salt and other sources can add fluid to the blood and raise blood pressure. Excessive alcohol intake can also raise blood pressure and make drug therapy less effective.
  • Stress: By itself, stress is not a primary cause of high blood pressure. If you already have high blood pressure, however, constant stress may help keep it high.
  • Other factors: Smoking, alcohol, and caffeine can all increase blood pressure

How You Can Lower Your Blood Pressure

If you have high blood pressure, you must work closely with your doctor to bring it down. If your blood pressure is not excessively high, your doctor may want you to try diet and lifestyle changes to control your blood pressure before prescribing antihypertensive medication. Your doctor may suggest that you:

  • Lose weight if you are overweight.
  • Increase your level of physical activity. Exercise helps reduce blood pressure in two ways: it helps you lose weight and it lowers blood pressure independent of weight loss.
  • Lower your sodium, or salt, intake. For most people, reducing sodium intake from salt and other sources also lowers blood pressure.
  • Eat plenty of fresh fruits and vegetables. A diet high in potassium (found in fresh fruits and vegetables) can help lower blood pressure. Some evidence shows that a vegetarian or near-vegetarian diet can significantly lower blood pressure.
  • Manage stress.

Need To Know:

If your blood pressure is very high, your doctor may prescribe antihypertensive medications to bring your blood pressure down right away.

Nice To Know:

For most people, losing weight will bring blood pressure down to a safe level. For every one pound you lose, you can expect about a one-point drop in your diastolic blood pressure.

How-To Information:

How you can reduce sodium in your diet

Table salt (sodium plus chloride) provides most of the sodium in the American diet. The average American gets 20 times more sodium than needed each day.

To reduce your sodium intake, you must retrain your taste buds. Taste for salt is learned gradually, so it can be unlearned gradually by slowly cutting down salt in your diet. After a few weeks, the high salt foods you used to like will taste too salty.

To eat less salt, make the following changes one at a time, starting with the easiest first:

  • Salt food only after you have tasted it.
  • Move the salt shaker off the table, so you have to get up to get it if you need it.
  • Cut down on the salt used in cooking by one-third, then one-half.
  • Experiment with different flavors as salt substitutes. Try garlic, pepper, lemon, onion, wine, herbs, and spices.
  • Cut down on highly salted prepared foods such as nuts, chips, and pickles.
  • Read labels carefully. In general, prepackaged or processed foods such as canned soups, tomato juice, frozen dinners, macaroni and cheese, processed meats, and other foods are higher in sodium than their home made counterparts.

For more information about high blood pressure and how you can contro it, go to High Blood Pressure.

Quit Smoking

Of all the known modifiable risk factors for coronary heart disease, cigarette smoking is the most significant. If current smoking patterns continue, more than 24 million people in the United States may die a premature death due to heart disease brought on by smoking, according to the American Heart Association.

Still, it’s never too late to quit smoking, even if you’ve smoked all your life. Your risk for heart disease drops dramatically the moment you put down your last cigarette. After a few years, your heart disease risk is the same as that of a nonsmoker, although your risk for developing cancer drops more slowly.

  • How does smoking increase your risk for heart disease?
  • How you can quit smoking
  • A program to help you quit smoking
  • Staying smoke-free

How Does Smoking Increase Your Risk For Heart Disease?

Smoking increases the risk of coronary heart disease by accelerating blockage of the arteries. Cigarette smoke contains more than 3,000 chemicals, many of which are poisonous. Two of the most dangerous chemicals in cigarette smoke are carbon monoxide, a gas also found in car exhaust, and nicotine, a powerful insecticide.

The body reacts to these toxins by producing an excess of unstable particles that bind with other molecules, called oxygen-free radicals. Inside the arteries, free radicals react with low-density lipoproteins (LDL), and a spongy cholesterol layer builds up on arterial walls. Eventually, this spongy cholesterol layer hardens into plaques.

Smoking also increases your risk for coronary heart disease over the short-term:

  • With each puff, the nicotine in cigarettes speeds up the heart and constricts (narrows) the arteries, increasing the strain on your heart.
  • The carbon monoxide in cigarettes robs the blood of up to 15 percent of its oxygen. This is especially serious considering the supply of oxygen may already be low because of partial blockages in the arteries.

Need To Know:

  • Smoking cigarettes is especially dangerous for individuals who also have high blood pressure or high blood cholesterol levels.
  • Women who smoke and take birth control pills are 10 times more likely to die of a heart attack than women who do neither.
  • Even if you don’t smoke, spending time in a smoky environment can increase your risk for heart disease and other smoking-related diseases.

Nice To Know:

Q: Do other forms of tobacco increase the risk for coronary heart disease?

A: Pipes and cigars are less likely than cigarettes to increase the risk of CHD, provided you don’t inhale. But ex-cigarette smokers almost always do inhale. Further, pipes and cigars still increase the risk of cancer, as does snuff or chewing tobacco. You’ll be better off if you give up tobacco completely.

How You Can Quit Smoking

Your own determination is the most important ingredient for kicking the smoking habit. Set a quit date and tell yourself that smoking after that date is not an option. Resolution may be enough for some people to quit, but others may be more seriously addicted to nicotine. Nicotine gum or patches can help to blunt withdrawal symptoms such as irritability, digestive upset, light-headedness, and sleep disturbances.

Need To Know:

The answers to two questions may indicate your level of addiction to cigarettes:

  • Do you smoke within 20 minutes of waking up?
  • Do you smoke even when you have a cold?

If you answered “yes” to either of these questions and have tried quitting before unsuccessfully, then consider asking your physician for the patches or gum-but use them strictly in accordance with the instructions. And don’t think of them as magic-they can supplement a quitting program, not replace it.

Nice To Know:

It’s easier to quit smoking today than it was 10 years ago for several reasons:

  • When you quit smoking, you’re joining the mainstream, since only about one-fourth of Americans adults now smoke.
  • Many more public places and work sites now prohibit smoking.
  • New evidence about the harmful effects of second-hand smoke on others, especially children, provides a powerful incentive to quit smoking.
  • Aids such as nicotine gum and skin patches can help certain people quit smoking when used in the context of a broader quitting program.

How-To Information:

A program to help you quit smoking

If you are not the kind of person who can simply quit smoking cold turkey, you may benefit from a more formal quitting program. Many people find it helpful to join classes such as those run by the American Cancer Society or the American Lung Association.

Other people prefer to quit smoking on their own. If you are one of these people, here is a sample program that can help you stop smoking:

First, set a date to quit smoking.

The week before you quit:

  • Make a firm commitment to yourself to stop smoking.
  • Write down the three main reasons that you want to quit smoking.
  • Make a note of the time and circumstances every time you smoke for a two-day period (for example, 8 am-driving to work, 8:45-with coffee). To help yourself remember to write the notes, wrap a piece of paper around your cigarette pack with rubber bands.
  • Prepare a first-aid package to help you through hard times when you first quit smoking. This should include things to keep your hands busy (a deck of cards, puzzles, paper clips, or knitting) and things to keep your mouth busy (toothpicks, chewing gum, hard candy, raw vegetable sticks, sunflower seeds, low-fat cookies, or bread sticks).

The day before you quit smoking:

  • Study your two-day record to see when you smoke most often. Then plan how you will cope with situations or times when you normally would have smoked. For example, if you normally smoke while driving to work, take the bus instead. If you normally smoke while having coffee at your desk, go for a short walk instead.
  • Clear the house of all cigarettes.

On the day you quit smoking, when you get the urge to smoke:

  • Reach for a stick of chewing gum, carrot and celery sticks, or small hard candies or mints.
  • Keep your hands occupied. Try knitting, crocheting, or woodworking.
  • Move to a different chair or room.
  • Breathe deeply.
  • Squirt the back of your throat with a breath freshener.
  • Take a one-minute walk.
  • Look at your watch and time the urge to smoke (it usually won’t last more than a minute or so).
  • Avoid alcohol, which can derail all your good intentions.
  • Avoid any cues that remind you of cigarettes.

Remember that the most important tool in your armory is your determination. You have quit smoking, and the long-term benefits will far outweigh the rough times you may have to put up with for the first week or so after quitting.

Staying Smoke-Free

After you have quit smoking, the urge to smoke gets progressively weaker, but you still need to stay on your guard. You might be taken by surprise with an urge to smoke you didn’t expect, especially during times of stress, when you are drinking alcohol, or when you are around other smokers.

When you believe you are no longer dependent on cigarettes, don’t be misled into thinking you can try a puff or two-you could easily fall back into the cigarette habit. Don’t ever try a cigarette again.

If you do find yourself smoking again:

  • Don’t let a minor slip sabotage your progress. Keep thinking of yourself as a non-smoker.
  • Re-start your quitting program. What works for you and what doesn’t? What situations pose a high risk for you?
  • Don’t be hard on yourself-we’re all human. Many people need to make two or three serious attempts before they are able to quit smoking for good.

Nice To Know:

Q: Will I gain weight if I quit smoking?

A: Not everyone gains weight when they quit smoking. Some people tend to put on a few extra pounds (the average is about six pounds). The weight gain may be because of a slight slow-down in how fast your body burns calories, or it may be because people tend to eat more simply because food tastes better. If you do put on a few pounds, don’t worry about the small weight gain. It’s healthier to gain a little weight than to continue smoking, and you can deal with the weight after you have the smoking conquered.


What You Should Know About Becoming More Active

The American Heart Association considers inactivity to be as much of a risk factor for coronary heart disease (CHD) as high blood cholesterol, high blood pressure, or cigarette smoking. Increased activity reduces the risk of CHD and can help to reduce other risk factors for CHD. Besides, it can be fun!

  • How does being more active lower your risk for heart disease?
  • Are you active enough?
  • Which types of activities are best?
  • Exercising safely

How Does Being More Active Lower Your Risk For Heart Disease?

When you become more active, you reduce your risk for CHD in several ways. Physical activity:

  • Increases the proportion of HDL cholesterol (the good kind of cholesterol) in your blood and reduces levels of triglycerides, another type of blood fat that can clog arteries and promote CHD
  • Boosts the body’s ability to clear away clots in the blood vessels
  • Improves circulation and makes the heart a stronger and more efficient pump
  • Can help prevent the development of diabetes
  • Promotes weight loss and weight control even more than dieting
  • Helps relieve stress
  • Provides an alternative to harmful addictions such as nicotine and alcohol use

Are You Active Enough?

Although deliberate forms of exercise such as walking, jogging, or swimming are great, smaller periods of less intense physical activity also help reduce your risk for heart disease. The more physically active you are, the better off you’ll be.

Experts now recommend that all adults accumulate at least 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. This doesn’t mean, however, that you need to jog or swim 30 minutes a day. You also benefit from several shorter periods of physical activity throughout the day.

For example, if you walk 10 minutes around the mall while your shopping for clothes, take a 10-minute walk during your coffee break, and take a 10-minute walk around the block after supper (if you live in a safe neighborhood), this counts as your 30 minutes of physical activity. Even activities like gardening or cleaning can add up if done vigorously enough.

The bottom line: be more active throughout the day in whatever way you can.

Which Types Of Activities Are Best?

The best activities for your heart are those that use the large muscles of your body, particularly those in your legs, making them demand more oxygen to do their work. Seek out activities that involve repetitive motion and raise your heart rate for an extended period of time. Examples of such activities include:

  • Walking
  • Running
  • Rowing
  • Bicycling
  • Swimming
  • Skating
  • Cross-country skiing

When your muscles demand more oxygen, you breathe faster to bring oxygen into your lungs, and your heart beats faster to deliver the oxygen to your muscles, giving your whole system a tune-up and making your heart a stronger and more efficient pump.

How-To Information:

Exercise does not always have to include a sweaty workout. You can benefit by simply including more activity throughout your day:

  • Park farther from work and walk the extra distance, or better yet, walk to work.
  • Walk more between stores when shopping.
  • Take walking breaks at work.
  • Take the stairs instead of the elevato.r
  • Clean your own house.
  • Mow the lawn yourself.
  • Choose leisure-time activities that get you moving. Golfing, skiing, bowling, dancing, or playing tennis or basketball can all add to your overall activity level.

Exercising Safely

Almost everyone can do some form of exercise, but to exercise safely you must start slowly and build up gradually. Start by finding out how much exercise you are getting now. Look back on the last three days and write down the approximate length of time that you spend being physically active. Then gradually increase the minutes you spend being physically active, adding a few minutes each week.

Need To Know:

You should check with your doctor before beginning any type of exercise program if you:

  • Are a man over 40 years of age
  • Are a woman over 50 years of age
  • Have risk factors for CHD such as high blood cholesterol levels, high blood pressure, diabetes, or cigarette smoking
  • Have symptoms of any heart disease (pain in the chest, neck or shoulder during exercise, shortness or breath, faintness, or dizziness) or known heart disease

If you experience any of these warning signs, stop exercising and check with your doctor:

  • Lightheadedness
  • Headache
  • Nausea
  • Shortness of breath
  • Cold sweat
  • Pain or pressure in the chest, neck, shoulder, or arms, especially on the left side

When you are exercising, check your heart rate periodically by counting your pulse at the neck or wrist. Count your heartbeats for 10 seconds, and then multiply by 6 to get the beats per minute.

In the early stages of your exercise routine, try to keep your heart rate within 65 to 70 percent of your maximum heart rate (approximately 220 minus your age). This is a safe range, in which your heart, lungs, and blood vessels benefit from the exercise but are not overtaxed. As you get in better shape you may be able to let your heart rate climb to 75 percent of your maximum heart rate.

For example, a 60-year-old man has a maximum heart rate of 160 beats per minute (220 minus 60). Sixty-five to 70 percent of this figure is 104-112 beats per minute. Thus, this man should count 17 to 18 beats during a 10-second pulse check.

Be sure to include a five-minute warm-up and cool-down period of light stretching before and after exercise to warm up your muscles and avoid injury and stiffness.

How-To Information:

Getting started

You might want to join your local health club or YMCA so experts can help you get started on an exercise program safely and enjoyably.

If you want to start your own program or do it with a friend, pick an activity you enjoy. Walking is an activity that almost anyone can do and only requires a pair of good shoes.

Although everyone must move at his or her own pace, you can use the following exercise schedule as a guide:

  • Week 1: Add at least five minutes of exercise to your daily routine
  • Week 2: Exercise every day for at least ten minutes
  • Week 3: Exercise a total of twenty minutes on at least three days of the week and at least 10 minutes on the other days
  • Weeks 4 and 5: Exercise twenty minutes on most or all days of the week
  • Week 6 and after: Exercise thirty minutes on most or all days of the week


What You Should Know About Losing Weight Safely

  • How does excess body weight increase your risk for heart disease?
  • Do you weigh more than you should?
  • Why do you need to exercise?
  • How you can cut calories

How Does Excess Body Weight Increase Your Risk For Heart Disease?

Excess body weight increases the risk for coronary heart disease because it:

  • Raises total blood cholesterol levels, especially levels of LDL cholesterol (the harmful kind of cholesterol that clogs blood vessels)
  • Decreases levels of HDL cholesterol (the good kind of cholesterol that helps clear blood vessels)
  • Raises blood triglyceride levels (a type of fat that also clogs blood vessels)
  • Increases blood pressure
  • Makes the heart work harder
  • Contributes to inactivity, since overweight individuals are often reluctant to join an exercise program for fear of ridicule or not being able to keep up

Do You Weigh More Than You Should?

Most of us can look in the mirror and tell if we are overweight. Generally, if you can pinch an inch at your waist, or if you weigh over 10 to 15 pounds more than you did when you were 20, you probably need to lose weight.

Experts now evaluate body weight using a formula called body mass index. Body mass index expresses body weight in relation to height. Body mass index actually equals body weight in kilograms divided by height in meters squared, but you can use the table below to help you figure your body mass index.

To calculate your body mass index:

  • Multiply your weight in pounds by 704.5
  • Multiply your height in inches by your height in inches
  • Divide the first result by the second

Or you can use the following table to determine your body mass index:

Weight in pounds equal to a BMI of:

























































































































Experts consider a person with a body mass index of 25 to 29 to be overweight, and a person with a body mass index of 30 or more to be obese.

Nice To Know:

Q: Is excess fat in the upper or lower body more harmful?

A: Some people carry excess weight in the hips and thighs (referred to as pear shaped, or lower body obesity), while others carry it in the abdominal area (referred to as apple-shaped, or upper body obesity). We now know that upper body obesity increases risk for coronary heart disease much more than lower body obesity.

Since the measurement around your waistline reflects your level of abdominal fat, a waist measurement can be a good clue to whether you have too much upper body fat. Generally speaking, you have too much abdominal fat if your waist measurement exceeds:

  • 40 inches for men
  • 35 inches for women

Need To Know:

Q: How can I Iose weight and keep it off?

A: Losing weight is hard, but keeping it off is even harder. The most successful way to lose weight and keep it off is to modestly reduce your calorie intake while maintaining a regular exercise program. In fact, people who are most likely to succeed in losing weight and keeping are people who exercise regularly.

Why Do You Need To Exercise?

For most people, reducing calorie intake alone is not enough to achieve permanent weight loss. When you cut calories, some of the weight you lose comes from muscle tissue. When you severely cut your calorie intake, your body reacts as though it were being starved, slowing down its metabolism and making it harder to lose weight.

Exercising regularly helps you lose weight in several ways:

  • Exercising while cutting calories helps you maintain muscle tissue and burn a higher percentage of body fat
  • Exercising re-sets the body’s metabolism, countering the effects of calorie restriction
  • Exercise burns calories
  • Exercise can keep you out of the kitchen and away from food

How-To Information:

How you can cut calories

Cutting your calories involves changing both the types of food you eat and the way you eat. Fortunately, the types of foods that lower blood cholesterol levels also reduce calories in the diet. Since fat is a very concentrated source of calories, eating more of the low-fat foods that help you lower your cholesterol levels-like fruits, vegetables, and whole grains-will also help you cut your calories.

If you tend to eat even when you are not really hungry, you may also need to change the way you eat. To help you cut calories:

  • Eat three main meals, including breakfast.
  • Plan for low-fat snacks in the morning and afternoon.
  • Keep a food diary to help you identify problem areas or situations that trigger overeating.
  • Always eat in the same place when you are home, which will help keep you from nibbling all the time.
  • Sit down while you eat.
  • Keep problem foods out of the house (or at least off the counter and less accessible).
  • Find substitutes for favorite foods that are high in calories-for example, angel food cake instead of richer types of cakes, pretzels instead of potato chips, bagels instead of doughnuts.

Need To Know:

Q: Are there any dangers with dieting?

A: Although excess weight increases the risk for coronary heart disease and other health problems, repeated cycles of weight loss and gain are even worse for health. Slow and steady weight loss that you can maintain over the long-term is much more healthful than crash dieting. Remember that the extra weight took a long time to creep on, so it will come off slowly too.

Try to focus on the positive lifetime changes you are making for your health rather than on what the scales say. If you exercise regularly and adopt healthy, low-fat foods as part of your usual diet, you may be surprised at how easily the weight will come off.


What You Should Know About Managing Stress Effectively

Life’s events are not in themselves stressful, but our reactions to those events can leave us feeling “stressed out.” Some people enjoy a fast-paced life with many challenges. For these people, slow, uneventful periods in their lives may be more stressful than challenging ones. Other people can become overwhelmed by a constant stream of pressure, demands, and lack of time. The key appears to be how we view and react to situations.

  • Does stress increase your risk for heart disease?
  • What are the symptoms of stress?
  • Is stress harmful for you?
  • How you can manage stress

Does Stress Increase The Risk For Heart Disease?

A growing collection of studies indicates that stress adversely affects heart health. It is not yet clear whether stress itself increases the risk of coronary heart disease, or if it simply exacerbates other risk factors. Some people may react to stress by overeating, smoking, or growing depressed and exercising less.

Studies show that stress may be especially harmful if it involves the following:

  • Frequent feelings of hostility, anger, and suspicion of the world around you
  • Being caught in situations where you have little control over the demands place on you
  • Having a low level of social support from family and friends
  • Experiencing major life events such as divorce, illness, or job loss

Stress can increase some people’s risk for heart disease because it:

  • Temporarily increases blood pressure or helps to keep blood pressure high
  • Interferes with the ability to make other healthful changes such as stopping smoking, exercising, or eating a healthier diet

What Are The Symptoms Of Stress?

Symptoms of stress can include the following:

  • Sweaty hands, tight muscles, or clenched jaw
  • Inability to sleep at night or wanting to sleep too much during the day
  • Increased or decreased appetite
  • Feeling short-tempered or easily upset
  • Feeling continually rushed
  • Decreased social interaction with friends and family

Need To Know:

Is stress harmful for you?

Some people may enjoy a life full of pressure and deadlines. Since stress is not always bad, how do you know if it is bad for you? To help you find out, answer the following questions:

  • Do you have physical symptoms of stress, such as clenched jaw, sweaty hands, or tight muscles? Do you eat, drink, or smoke to calm down?
  • Do you often feel that you are short of time?
  • Do you speak fast and tend to act as if you are in a hurry?
  • Do you hate losing?
  • Do you find it hard to forget work?

If you answered yes to any of the above questions, stress may be interfering with your ability to adopt a lifestyle that is healthful for your heart.

Now, answer the following three questions:

  • Do you feel angry when people are in your way, for example, in a traffic jam?
  • Do you feel that a lot of the people you deal with every day are incompetent?
  • Do you feel that most people act from selfish motives?

If you answered yes to any of the last three questions, you may have the type of cynical mistrust and hostility that experts think may increase risk for coronary heart disease.

How-To Information:

How you can manage stress

People who are able to manage stress do three things well:

  1. They change stressful situations when possible.
  2. They find new ways to look at stressful situations when it is not possible to change them.
  3. They find stress-relieving outlets.

Here are some suggestions to help you cope with stress in your life:

  • Keep a stress diary where you can note situations or relationships that make you feel unpleasantly stressed.
  • Plan to deflect your stress by avoiding a situation, altering it, or adapting to it. For example, if driving to work in busy traffic leaves you tense and angry, you could take a train to work, drive earlier when there is less traffic, or use the time to listen to tapes or music.
  • Relive stress through exercise. Take a walk, or go for a bicycle ride.
  • Practice deep muscle relaxation at least once daily. Sit in a comfortable chair in a quiet room and set an alarm for 15 minutes. Then tighten and relax each muscle group in the body in turn, starting with arms, legs, trunk, neck, etc. Close your eyes and imagine a soothing scene such as a beach or clouds as you relax your muscles.
  • Watch for physical symptoms of stress and make a conscious effort to calm yourself when they appear. For example, if you notice your knuckles turning white as you are gripping the steering wheel, tell yourself to relax.

If the above suggestions do not help relieve your stress, or if you frequently feel angry at the world, you may need to seek outside help in dealing with stress. Your physician can refer you to a mental health professional who specializes in dealing with stress-related anxiety, or look for courses in stress management.

For more information about managing stress, go to Stress And How-To Manage It.


Heart Disease: Frequently Asked Questions

Here are some frequently asked questions related to heart disease.

Q: Does a diet high in sugar increase the risk for coronary heart disease?

A: There is no evidence that high sugar intake by itself causes coronary heart disease. However, foods high in sugar-such as cakes, cookies, and ice cream are also often high in fat, which does increase risk for heart disease. Further, foods high in sugar displace other more nutritious foods, such as fresh fruits and vegetables, from your diet.

Q: Does alcohol decrease the risk of coronary heart disease?

A: A a glass or two of wine has been shown to increase HDL cholesterol levels (the good kind of cholesterol that helps clean out blood vessels). But more than two drinks a day can be harmful, raising blood pressure and throwing off cholesterol balance. Alcohol is also a fairly concentrated source of calories and can contribute to weight gain, which increases risk for CHD.

Q: Should I take antioxidant supplements to reduce my risk for coronary heart disease?

A: Antioxidants help prevent against CHD by slowing the depositing of cholesterol in the lining of the blood vessels. Foods rich in antioxidants such as vitamins C and E and beta-carotene include fresh fruits and vegetables, whole grains, nuts and seeds. Because these foods contain many different antioxidants, dietary fiber, and other vitamins and minerals, it is best to get your antioxidants from food rather than the health food store. These foods are also low in fat and should provide the foundation for your diet.

Q: Once cholesterol-rich deposits form in my arteries, do they ever go away?

A: The artery-clogging deposits of cholesterol and other fat-like substances that cause heart disease can begin as early as childhood and continue to form as we grow older. New research, however, has shown that a very low-fat diet combined with regular exercise and other healthy lifestyle changes can actually help shrink and clear out these deposits in the blood vessels, reversing CHD.

Heart Disease: Putting It All Together

Here is a summary of the important facts and information related to heart disease.

  • Heart-healthy changes in diet and lifestyle can significantly reduce your risk for coronary heart disease (CHD), and it is never too late to make these changes.
  • Major risk factors for coronary heart disease include high blood cholesterol levels, high blood pressure, cigarette smoking, inactivity, and diabetes. Being overweight or under stress can aggravate these risk factors.
  • Eating a diet that is low in fat (especially the saturated fat found in most animal foods) and cholesterol and rich in fruits, vegetables, and whole grains will help lower your cholesterol level.
  • Losing weight if needed, exercising regularly, and lowering your sodium (or salt) intake will significantly lower your blood pressure.
  • If you need to stop smoking, make a firm commitment to yourself and plan activities to keep your hands and mouth busy. When you stop smoking, your risk for coronary heart disease begins to fall immediately.
  • Exercise more by gradually increasing the minutes you spend being physically active. You should strive to accumulate at least 30 minutes of physical activity on most or all days of the week.
  • If you need to lose weight, cut back on your calorie intake modestly while increasing physical activity. Being active is one of the most important things you can do to lose weight.

Heart Disease: Glossary

Here are definitions of medical terms related to heart disease.

Angina pectoris: Pressure, tightness, or constricting pain in the chest that occurs due to inadequate blood flow to heart muscle; is usually associated with significant coronary artery disease.

Antioxidants: Substances in fruits, vegetables, whole grains, nuts, and seeds that can help prevent or slow build up of cholesterol and other fat-like substances in the arteries. Vitamins C and E and beta-carotene are all antioxidants that help protect against coronary heart disease.

Antihypertensive medication: A drug that is intended to reduce the blood pressure of individuals with high blood pressure (hypertension).

Atherosclerosis: A narrowing and hardening of blood vessels caused by a build-up of plaque.

Bile acids: Any of several types of acids found in bile (a yellow or greenish alkaline fluid secreted by the liver); it aids in the absorption of fats.

Blood pressure measurements: Measurements of blood pressure, usually expressed as the systolic blood pressure over the diastolic pressure.

Blood vessel: A tube conveying blood; an artery, capillary, or vein.

BMI or body mass index: A formula used to expresses body weight in relation to height. BMI equals weight in kilograms divided by height in meters squared.

Cardiovascular risk factors: Risk factors for cardiovascular disease including hypertension (high blood pressure), cigarette smoking, diabetes, dyslipidemia (abnormal blood lipid levels), older age, gender (men, postmenopausal women), and family history of cardiovascular disease.

Cell membrane (plasma membrane): An extremely thin layer surrounding each cell in the body that only allows certain molecules to pass through it. It consists of three layers, each one molecule in thickness. The inner and outer layers are made of protein, while the middle layer is made up of a double layer of fat molecules.

Cholesterol: A fat-like substance needed for the development body cells. Cholesterol is both produced by the body and found in animal foods. Although it is a necessary substance, if levels of cholesterol are too high it can be deposited on the artery wall, narrowing or blocking blood flow and leading to coronary heart disease.

Congestive heart failure (CHF): A condition in which the heart is weakened and cannot pump efficiently.

Coronary arteries: The arteries (blood vessels) that supply oxygenated blood to the heart.

Coronary heart disease (CHD): A disease develops when one or more of the coronary arteries that supply the blood to the heart become narrower than they used to be. This happens because of a build-up of cholesterol and other substances in the wall of the blood vessel, affecting the blood flow to the heart muscle. Without an adequate blood supply, heart muscle tissue can be damaged

Diabetes: A condition in which the body can’t use carbohydrates well. It is caused by a complete (type 1 diabetes) or relative (type 2 diabetes) deficiency of the hormone insulin, which acts as the “key” that allows sugar to enter cells. Without enough insulin, glucose (sugar) remains in the blood and can’t enter the cells to provide energy.

Diastolic blood pressure: The lowest level of pressure in the aorta that occurs when the heart is “in between” beats. It ranges between 70-80 mm Hg in healthy adults. Blood pressure is usually read as systolic/diastolic.

Estrogen: The general term for the female sex hormone responsible for developing and maintaining female secondary sex characteristics. Estrogen is a key component of women’s monthly menstrual cycles.

Heart attack (myocardial infarction): A sudden closure or blockage of one or more blood vessels to the heart, cutting off the oxygen supply and causing damage to part of the heart. The term specifically refers to death of heart muscle cells, which is usually due to the blockage of a coronary artery.

Heart rate (HR): The number of beats (contractions) of the heart per minute

High-density lipoprotein (HDL): A lipoprotein rich in phospholipids and cholesterol that transports cholesterol to the liver to be broken down. The empty protein “envelope” is then released by the liver into the bloodstream where it can pick up cholesterol from cells and pull away cholesterol from arterial walls.

High density lipoprotein (HDL) cholesterol: A good type of cholesterol that helps the body “scrub” bad types of cholesterol out of blood vessels. High levels of HDL cholesterol are thought to protect the heart because the transported cholesterol is destined for degradation (break-down).

High blood pressure (hypertension): When the pressure, or tension, that blood exerts on walls of the blood vessels as it travels around the body is higher than normal, straining blood vessel walls.

Hormones: Chemical substances formed in one part of the body that are carried in the blood to another part of the body before they act.

Hypercholesterolemia: Abnormally high levels of cholesterol in the blood, commonly referred to as high cholesterol. It is a major risk factor for cardiovascular disease.

Lipids: Substances extracted from animal or vegetable cells; includes fatty acids, glycerides, cholesterol, and “fat-soluble” vitamins A, D, and E, among others.

Low-density lipoprotein (LDL): A “package” that transports cholesterol in the blood to the rest of the body, where it is used in making cell membranes and hormones.

Low density lipoprotein (LDL) cholesterol: A “bad” type of cholesterol that tends to deposit in the artery wall and narrow or block the artery. High levels contribute to atherosclerosis, which clogs arteries and causes heart attacks and strokes.

Maximum heart rate: The fastest your heart can beat, estimated by subtracting your age in years from 220.

Metabolism: The chemical changes in living cells that provide energy for vital processes and activities. Through these chemical changes, new material is incorporated into those living cells.

Monounsaturated fats: Fats found in plant oils such as olive, canola, and peanut oil that are liquid at room temperature but harden in the refrigerator.

Nicotine: A toxic chemical found in cigarette smoke.

Plaques: When used in regard to atherosclerosis, this term describes the yellow and swollen areas of the inner layer of arteries that are thickened by the deposition of fatty substances (lipids and cholesterol) and fibrous tissue.

Polyunsaturated fats: Fats found in plant oils such as safflower, sunflower, corn, and soybean oil that remain liquid even at colder temperatures.

Postmenopausal: After menopause, or the permanent cessation of menstrual periods in women.

Saturated fats: A fatty acid found in animal foods, hydrogenated vegetable oils, and some dairy products.

Soluble Fiber: The type of fiber that can help reduce blood cholesterol levels. Foods such as oat bran, dried beans, and some fruits are high in soluble fiber.

Systolic blood pressure: The peak (highest) pressure that occurs in the aorta when the heart contracts. It averages about 120 mm Hg in healthy adults. Blood pressure is usually read as systolic/diastolic.

Triglycerides: Another type of blood fat that can also block blood vessels and lead to coronary heart disease.

Very low-density lipoproteins (VLDL): A “package” that transports cholesterol and triglycerides in the blood to the rest of the body.

Very low-density lipoprotein (VLDL) cholesterol: A “bad” type of cholesterol that tends to deposit in the artery wall and narrow or block the artery. VLDL also contains triglycerides. High levels contribute to atherosclerosis, which clogs arteries and causes heart attacks and strokes.

Heart Disease: Additional Sources Of Information

Here are some reliable sources that can provide more information on heart disease.

American Dietetic Association 
Phone: (800) 877-1600

American Heart Association 
Phone: (800) 242-8721

National Heart, Lung and Blood Institute 
Phone: (301) 251-1222

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