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Reducing Heart Disease Risk
What Do We Know Now?

by Bonnie Bruce, DrPH, MPH, RD

Heart disease increases the risk of heart attacks and strokes and is still one of the major causes of death in the United States. Scientists have long known that damage to the heart and blood vessels can be caused by too much glucose in the blood. This makes heart disease an even greater concern for people with diabetes, who must take steps daily to manage their blood glucose levels. Having diabetes is a major risk factor for heart disease. People who have diabetes are two to four times more likely to suffer from its consequences.

However, the story of heart disease and diabetes is not all bleak. There are medication-free, lifestyle-related approaches that can help reduce the risk, slow its progression, and help avoid aftereffects. Indeed, modification of lifestyle habits is not only at the heart of public health approaches for reducing heart disease risk, but it can also help to reduce the impact of diabetes.

“Lifestyle factors” are things that are in your control and things that you have the power to do something about, like eating and exercising. This is in contrast to things you can’t control, such as who your grandparents are, your age and gender, and for women, menopause, all of which also have influences on heart disease risk.

However, relying solely on lifestyle-related strategies may not be enough, or feasible for everyone. Some people may additionally need to take medicines. This is a decision that they and their health-care professionals will have to make. Also, before you choose to make any changes in your current lifestyle, you should first check with your doctor or other health-care professional.

That being said, no matter what you decide, one of the most important things you can do is to start today. The clock for heart disease can start ticking in the teenage years, long before there is any hint of diabetes or other health problems. Alarmingly, recent studies have reported that young teenage boys and girls are showing beginning signs of unhealthy levels of blood fats related to heart disease. Further, autopsy studies have showed that young soldiers in their twenties had signs of heart disease at much younger ages than expected. Thus, the earlier you get started doing something, the more opportunities you will have to lower your risk, and the better off you will likely be.

Scientific knowledge about lifestyle factors for reducing heart disease risk has advanced considerably over the latter part of the 20th century, since the time when steaks and cigarettes were part of mainstream culture and associated with status and the good life. As evidence has mounted, the focal points of lifestyle approaches for reducing heart disease risk have become being tobacco free, being physically active, eating well, and aiming for a healthy weight.

Smoking
There is no doubt that the one lifestyle change with the greatest payoff is stopping smoking, if you smoke now. It is no secret that smoking is bad for your health, and it is considered by some to be the most hazardous and leading risk factor for heart disease. Not only are people with diabetes who smoke doubly at risk for heart disease, smoking reduces the beneficial effect of other risk factor changes, such as exercising or eating well.

Once you quit, your risk of heart disease dramatically drops within just one year. For some people, however, smoking can be one of the toughest habits to change. But there are numerous methods and resources available for help and support, such as the American Lung Association and American Cancer Society.

Keep in mind, too, that some folks may have to make dozens of attempts at quitting before they find a strategy that works or before things fall into place that open the doors to stopping smoking. This is not unusual, so don’t feel badly if it happens. Most important, don’t give up and don’t think any less of yourself if it takes many tries. Think of quitting smoking as a process and a positive, long-term challenge, while you continue to search for that particular approach that will work for you.

Exercise
Next, there is exercise. If you are inactive now, by exercising regularly, you can reduce your risk of a heart attack up to half. Regular physical activity helps your body all over. Not only does it help reduce blood pressure and make your heart work more efficiently and effectively, but it also helps with blood glucose control. Exercise also burns calories, so it helps with weight management, and when you exercise regularly, you can eat more calories without gaining weight. Best of all is that being physically active can make you feel better and have more energy.

Yet the very thought of getting out there and moving on a regular basis is unpleasant or insufficiently motivating to many people. This is evidenced by the fact that only a fraction of the US population is physically active.

Current guidelines recommend that most American adults get a total of at least 30 minutes of exercise most days of the week. You don’t need to do intense or heavy activity, which for many people may not be feasible. Activities like moderate walking and gardening, done regularly and over the long term, are just fine. You also don’t need to do all of the 30 minutes in one shot. Breaking up your 30 minutes of exercise over the day into, for example, three 10-minute bouts of activity, still gives you benefits. Simple ways to increase your activity level are to walk instead of drive when you can, park your car at the far end of the lot, take stairs instead of the elevator when you have only one or two floors to go up or down, use a printer in another room, or just walk around when you are talking on the phone.

Eating
Heart-healthy eating has long been promoted as one of the ways to help reduce risk of heart disease, and for good reason: It works.

The key to eating well and eating healthfully is not as restrictive as many people imagine. There is no such thing as a “bad” food or a “good” food, just good and bad ways of eating. There are a few major principles to heart-healthy eating, which can be summarized in one sentence: “Eat a moderate amount of a wide variety of colorful, minimally processed foods.”

In other words, make most of your diet come from foods that are as close to nature as possible. Fill half of your plate with varied and colorful fresh, frozen, or canned fruits and vegetables, and a fourth with grains (making at least half of them whole grains, such as brown rice or quinoa instead of refined white rice or regular pasta). Then finish off the rest of your plate with protein, such as lean, unprocessed meat, fish, or poultry. Don’t forget about tofu, cooked dried beans, lentils, and peas as alternatives to animal protein sources. Also consider including some nuts and seeds in your meals, which are great for heart health. For dressings and condiments, substitute olive or canola oil for butter, stick margarine, or shortening, and use soft margarines. By eating a moderate amount and a wide variety of these kinds of foods, you will get an abundance of essential vitamins, minerals, fiber, and especially plant chemicals (called phytochemicals) that will help promote health and reduce heart disease risk.

Following a heart-healthy eating plan will result in your eating less fried or breaded foods, deli and processed meats such as sausage, and foods and beverages with high amounts of added fats and sugars. All of these have been related to increasing the risk of a variety of chronic conditions, including heart disease, diabetes, and obesity. In addition, following this advice also means that you will not have to give up your favorite foods completely, just how often you eat them. You shouldn’t have to totally avoid any specific food, unless you have other special medical conditions or are on certain medicines. This way of eating leaves room for an occasional treat or special food.

If you would like to learn more about eating this way, check out the www.Choosemyplate.gov Web site, where you can practice designing your own meals. This way of eating is compatible with most diabetes meal plans, as long as attention is given to individually recommended amounts of calories, carbohydrate, and other nutrients.

Weight
How much a person weighs is also related to his risk of heart disease. Nearly two-thirds of people in the United States are overweight or obese, many to the point where it affects their health and increases their risk for heart disease and complications from diabetes. But if you are overweight, it takes losing as little as 7% of your current weight to improve your blood glucose and blood pressure levels, and reductions of both can help reduce your heart disease risk.

Losing weight can be very complicated and fraught with challenges. How much you eat, your physical activity level, and even how you think about food play roles. Taking a moderate approach is key to success. Think in terms of baby steps. Set a small weight-loss goal, such as 3–5 pounds, and begin by making small changes that are easy for you to put into action. Some examples might include leaving a few tablespoons of food on your plate at each meal, buying individually packaged portions of foods such as yogurt or oatmeal, measuring out your portions, using a smaller plate, taking a walk at lunchtimes, and learning about your thoughts around food. For example, ask yourself whether you are eating because you are hungry, or whether it’s because you are bored or unhappy.

Also, make sure to give yourself ample credit and let yourself feel good about what you achieve, especially on a daily basis. It is important for you to enjoy your successes as they happen. If you have an off day, remind yourself that you are still making progress; even if it means you took one step forward and two steps back. Remember, it doesn’t take a large weight loss to begin reaping health benefits. If you’re having trouble figuring out how to make healthful dietary changes on your own, see a registered dietitian (RD) for tailored advice. To read more about healthy weight loss, go to the Web site of the Academy of Nutrition and Dietetics, www.Eatright.org, and click on “Public.”

Setting priorities
Among lifestyle factors related to reducing heart disease risk, there is little doubt that not smoking is of paramount importance. But if you don’t smoke, what should you do first?

There is no scientific agreement as to whether being physically active, eating well, or being at a healthy weight is the most effective first step for reducing your heart disease risk. It is entirely possible that they work together in ways as yet unknown. Perhaps a potpourri approach, where you blend together some aspects of each, will help take care of this. Logically, the more action you take, the more likely you will benefit from that action.

In the end, one cannot forget that each person is unique. A one-size-fits-all approach to reducing heart disease risk is unlikely to work for everyone. Each person’s plan may be a bit different. Regardless of what you choose to do, however, it is never too early to start. The time to begin reducing your heart disease risk is now.

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Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

 

 

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