HEART HEALTH
In 2004, the American Heart Association (AHA) released new guidelines for preventing heart disease and stroke in women, based on a woman's individual cardiovascular health. Those guidelines, still in effect today, adopted the idea that cardiovascular disease (CVD) develops over time and that women fall somewhere along a continuum, based on a variety of factors. This concept replaced the earlier idea that women either had or did not have CVD.
Guidelines for a better Heart for Women at a Glance:
- Prevention should be tailored to a woman's individual level of risk for cardiovascular events.
- Smoking cessation, regular physical activity, a heart-healthy diet, and weight maintenance are a strong priority.
- ACE inhibitors and beta-blockers are recommended for all high-risk women.
- High-risk women should be prescribed statin therapy even if their LDL cholesterol levels are below 100 mg/dL.
- Niacin and fibrate therapies are given a strong recommendation for high-risk women with specific cholesterol abnormalities.
- Aspirin is recommended for prevention in all high-risk women and is not recommended for low-risk women. For intermediate-risk women, aspirin can be considered as long as blood pressure is controlled and the benefit is likely to outweigh the risk of side effects.
- Blood pressure-lowering drugs are recommended when blood pressure is greater than or equal to 140/90. Diuretics should be part of the drug regimen for more patients unless contraindicated. Women with atrial fibrillation and intermediate or high risk for embolic stroke should take warfarin. If they cannot take warfarin, or if they are at low risk, they should be given aspirin.
- Women with diabetes must have their blood sugar carefully controlled, as defined by achieving near-normal glycosylated hemoglobin levels (less than 0.7 percent).
- Hormone therapy and antioxidant vitamin supplements are not recommended for CVD prevention.
- Women with cardiovascular disease should be evaluated for depression and treated or referred for treatment when indicated.
- In addition to a heart-healthy diet, supplementation with omega-3 fatty acids and folic acid may be considered in some high-risk women.
NOTE: Talk to your doctor about what steps you should take. (Sources: Medline Plus/ National Institutes of Health)
Heart Health – Children: Keeping Young Hearts Healthy
"Because they know the risk of heart disease can begin very early in life, health experts are beginning to focus on children earlier and earlier," says Richard P. Lewis, MD, MACC, professor of medicine, division of cardiology, at the Ohio State University Medical Center in Columbus. "By doing that, a lot of heart disease and stroke can be prevented as these children grow older." "Parents need to get children involved in a healthy lifestyle at an early age or it will never happen," says Dr. Graham. Encourage variety in their diet. Introduce them to foods that taste good without a lot of fat. Skip the sodas — according to the Food and Drug Administration, orange juice, grapefruit juice and skim milk are the only beverages that naturally contain the required amount of vitamins and nutrients to be labeled "healthy." But watch out for "juicy" product names such as cocktail, punch, drink, sparkler, blend and beverage. They signify "diluted juice" with added sweeteners. Look for the words "100% pure" on the label. Show your kids how to read nutrition labels on foods, too. And have the kids help prepare meals or snacks with you. By cooking together, and talking about good foods, kids develop habits that will last their whole lives. Instill a love of physical activity early, too. Make exercise a family affair: hiking, swimming or in-line skating together can make physical activity fun. Give your children household chores that are also good exercise, like mowing the lawn, raking leaves or shoveling snow. And limit the amount of time kids spend with TV, computers or videogames.
(Source: American College of Cardiology
Heart Health – Salt (Sodium) Restriction: Table salt is made up of the elements sodium and chlorine - the technical name for salt is sodium chloride. Your body needs some sodium to work properly. It helps with the function of nerves and muscles. It also helps to keep the right balance of fluids in your body. Your kidneys control how much sodium is in your body. If you have too much and your kidneys can't get rid it, sodium builds up in your blood. This can lead to high blood pressure. High blood pressure can lead to other health problems.
Most people in the U.S. get more sodium in their diets than they need. A key to healthy eating is choosing foods low in salt and sodium. Doctors recommend you eat less than 2.4 grams per day. That equals about 1 teaspoon of table salt a day. Reading food labels can help you see how much sodium is in prepared foods.
- A high-salt diet can reduce the effectiveness of high blood pressure medications in people with resistant high blood pressure.
- For patients with resistant hypertension, a low-salt diet decreased office, daytime, nighttime and 24-hour blood pressure compared to a high-salt diet.
- A majority of the salt in Western-style diets comes from processed foods.
Tips for Reducing Sodium (Salt) in Your Diet
- Buy fresh, plain frozen, or canned "with no salt added" vegetables.
- Use fresh poultry, fish, and lean meat, rather than canned or processed types.
- Use herbs, spices, and salt-free seasoning blends in cooking and at the table.
- Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.
- Choose "convenience" foods that are lower in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressings — these often have a lot of sodium.
- Rinse canned foods, such as tuna, to remove some sodium.
- When available, buy low- or reduced-sodium, or no-salt-added versions of foods.
- Choose ready-to-eat breakfast cereals that are lower in sodium.
(Source: National Heart, Lung, and Blood Institute)
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF)?
CHF is a disorder in which the heart loses its ability to pump blood efficiently, thereby failing to meet the demands of the body.
HEART HEALTH – CONGESTIVE HEART FAILURE - SYMPTOMS
Many symptoms of heart failure result from the congestion that develops as fluid backs up into the lungs and leaks into the tissues. Other symptoms result from inadequate delivery of oxygen-rich blood to the body's tissues. Since heart failure can progress rapidly, it is essential to consult a physician immediately if any of the following symptoms are detected.
- Weight gain (unintentional)
- Swelling of feet and ankles
- Swelling of the abdomen
- Pronounced neck veins
- Loss of appetite, indigestion
- Nausea and vomiting
- Shortness of breath, especially with activity
- Difficulty sleeping
- Shortness of breath which occurs after lying down for a while
- Fatigue, weakness, faintness
- Sensation of feeling the heart beat (palpitations)
- Pulse may feel irregular or rapid
- Decreased alertness or concentration
- Chronic Cough
- Decreased urine production (oliguria)
- Need to urinate at night (nocturia)
- Infants may sweat during feeding (or other exertion)
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) and Lifestyle changes
What are the lifestyle recommendations for congestive heart failure?
Answer: Adequate Home Support and Rehabilitation Programs
In one study, elderly people who had no emotional support at home had triple the risk of a heart attack after hospitalization for heart failure than those who did have such support. (In women, this risk was eightfold.) In another study, the greatest risk factor for death and readmission to the hospital after a first hospitalization for heart failure was being single, regardless of the health of the patient at discharge. In a number of studies, programs that offer intensive follow-up to ensure that the patient complies with lifestyle changes and medication regimens at home are reducing re-hospitalization and costs and improving survival. Patients without available rehabilitation programs should seek support from local and national heart associations and groups.
Between 30% to 47% of patients who require hospitalization for heart failure are back in the hospital again within six months. Many people return because of lifestyle factors, such as poor diet, failure to comply with medications, and social isolation.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) - Monitoring Weight Changes:
Heart failure patients should weigh themselves each morning and keep a record. Any weight changes are important:
- A sudden increase in weight of more than two or three pounds may indicate fluid accumulation and should prompt an immediate call to the physician.
- Rapid wasting weight loss over a few months is a very serious sign and may indicate the need for surgical intervention.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) - Dietary Factors:
Mediterranean Diet. There is some evidence suggesting that a diet such as the Mediterranean diet helps protect the heart and may even reduce the risk for heart failure after a first heart attack. Some researchers have suggested that this diet, which places an emphasis on whole grains, fish, olive oil, garlic, and moderate, daily intake of red wine, may have many benefits for the heart. Here are some of the characteristics of thediet
- The diet is high in fiber.
- It calls for a relatively high fat intake (about 35% to 45% of daily calories), but primarily composed of monounsaturated and polyunsaturated fats. Included in these fats are omega-3 fatty acids (docosahexaenoic and eicosapentaenoic acids). They are found in oily fish. Studies are indicating that they may have specific benefits for many medical conditions, including hypertension.
- It recommends the same protein intake as the American Heart Association diet, although fish is the primary source.
- Carbohydrate intake is reduced, and the emphasis is on fresh fruits and vegetables.
- Higher amounts of nuts, legumes, and beans are recommended than in standard American guidelines. Nuts are proving to be important for health.
- One study indicated that foods high in nutrients called flavonoids may have some benefit; such foods include tea, apples, onions, and red wine.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) – Salt Restriction:
All heart failure patients should limit their salt intake, and in severe cases, very stringent salt restriction may be necessary. Patients should not add salt to their cooking and their meals. They should also avoid foods high in sodium; these include ham, bacon, hot dogs, lunch meats, prepared snack foods, dry cereal, cheese, canned soups, soy sauce, and condiments. Some patients may need to reduce their water intake as well. People with high cholesterol levels or diabetes require additional dietary precautions.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) – and Exercise
Traditionally, heart failure patients were discouraged from exercising. Now, exercise is proving to be extremely important for many patients with stable conditions, when performed under medical supervision.
General Guidelines.
- Physicians should always be consulted before starting an exercise program.
- People not used to exercising should start with five to 15 minutes of easy exercise with frequent breaks.
- Although the goal would be to build to 30 to 45 minutes of walking, swimming, or low-impact aerobic exercises three to five times every week, any amount of time spent exercising is useful.
Exercising the legs, in fact, may help correct problems in heart muscles in these patients. Some studies report the following:
- Patients who exercise regularly, particularly using supervised treadmill and stationary-bicycle exercises, increase exercise capacity by 14% to 20%.
- Other studies have reported that patients with stable conditions who engage in moderate exercise (twice a week) for a year experience a better quality of life and lower mortality rates.
- One study found that performing daily hand-grip exercises improved blood flow through the arteries of patients with heart failure. This was backed up by another study that suggested that the loss of strength in small muscles, such as those in the hand, may produce as much exercise intolerance as heart failure itself.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) – and Bed Rest
Bed rest may be required in cases of severe congestive heart failure. To reduce congestion in the lungs, the patient's upper body should be elevated; for most patients, resting in an armchair is better than lying in bed. Relaxing and contracting leg muscles is important to prevent clots. As the patient improves, progressively more activity will be recommended.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) - Warm Baths and Saunas
Experts have traditionally recommended that people with heart failure avoid warm baths, which can increase the heart rate. Now, one study has reported that carefully controlled bathing for short periods may not be harmful and, in fact, may be beneficial, increasing cardiac output and ejection fraction. Warm water may behave like a vasodilating drug, opening up the vessels gently and improving circulation. The people in the study sat in water up to their chests at 106 degrees F or in a dry sauna at 140 degrees F. In both situations they sat for 10 minutes with their torsos tilted at 45 degrees. None of them experienced pain in the heart, shortness of breath, or irregular heart beats.
Warning Note: Prolonged periods in hot or even warm conditions can be dangerous, however. Any patient with heart failure should consult the physician first, not bathe unaccompanied, and be sure that the temperature does not go above those described in this report for either water bathing or dry saunas.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) – and Stress Reduction:
Stress reduction techniques may have direct physical benefits lowering stress hormones, including cortisol (which suppresses the immune system) and norepinephrine (also known as adrenaline), the chemical messenger associated with heart dysfunction. Many effective stress reduction techniques, including meditation and relaxation methods, are available.
HEART HEALTH – CONGESTIVE HEART FAILURE (CHF) - Alternative Medicine
- L-Arginine
- Coenzyme Q10
- Vitamin E
A small study reported that taking capsules L-arginine, found in health food stores, may have some benefit. This amino acid appears to reduce endothelin, a protein that causes blood vessel constriction and is found in high amounts in heart failure patients.
Some small studies suggest that coenzyme Q (CoQ10) may have some value for patients with heart failure, particularly in combination with vitamin E. CoQ10 is a vitamin-like substance found in organ meats and soybean oil. More recent studies, however, have found no effect on the heart or the quality of life with CoQ10 or vitamin E.
See Also:
Meditteranean Diet
