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HEART Insight:
doi: 10.1097/01.HEARTI.0000368503.71031.85
Features: An Ounce Of Prevention

Redefining Cardiovascular Health

MacReady, Norra

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Being “Healthy” And “Not Being Sick” Are Not The Same Thing

Congratulations, America. Between 2000 and 2010, deaths attributable to cardiovascular disease (CVD) plummeted nearly 40 percent, and stroke deaths also dropped 35 percent.

But we shouldn't pat ourselves on the back just yet. According to the Centers for Disease Control and Prevention, the number of people who smoke is only 16 percent lower, and the obese have slimmed their ranks only by 2.5 percent. And with the recent surge in childhood obesity, health experts worry that all of the gains we've made against cardiovascular disease will be wiped out by the time today's kids reach middle age. Making matters worse, the elderly — who have the highest risk of developing heart disease — are the fastest-growing segment of the American population.

To hold onto the heart-health gains we have made as a nation, and to keep the momentum going despite these demographic challenges, the American Heart Association is shifting its focus from managing individual conditions to improving the overall cardiovascular health of each American so that no one develops these conditions.

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Cardiovascular health encompasses two basic components: ideal health behaviors, and ideal health factors.

The behaviors include not smoking, maintaining a healthy weight, meeting or exceeding AHA recommendations for physical activity and eating a healthy diet (see sidebar on page 9).

The health factors include blood pressure, fasting blood glucose and total cholesterol levels that are within the AHA's recommended range — preferably without needing medication to keep them there.

Rather than a single, all-or-nothing target for each of these seven components that influence cardiovascular health, there is a sliding scale that defines “poor,” “intermediate,” or “optimal” health status (see chart on page 10) for adults aged 20 years and older, as well as for children up to 19 years old.

Even if your health status for one or more health factors is “poor” right now, modest lifestyle or behavioral changes can move you in the right direction — that is, to “intermediate.” And those who make behavioral changes before developing any serious health risks can look forward to a better quality of life and moving toward excellent heart health.

For example, a smoker who is at least 20 years old would have a “poor” health status for smoking. The same with a teenager who's tried smoking within the past 30 days. But if you're an adult who's quit smoking within the past 12 months, you have moved up to “intermediate” status in the smoking category (there is no intermediate status for children; for one thing, it is illegal to sell tobacco products to anyone in this age group). Adults who have never smoked, or who've quit more than 12 months ago, are in “optimal” health status for the smoking category, as are children who have never tried cigarettes or have never smoked a whole cigarette.

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Ideal cardiovascular health goes beyond talking about risk factors to offering a definition of ideal health, explains Clyde Yancy, M.D., AHA President and Medical Director of the Baylor Heart and Medical Institute in Dallas. “The beauty of this is that all of the components of cardiovascular health are modifiable with changes in behavior.”

In other words, “the more we focus on improving cardiovascular health, the less we'll have of cardiovascular disease and stroke,” notes Ralph Sacco, M.D., Professor and Chairman of Neurology at the University of Miami School of Medicine.

The emphasis on overall cardiovascular health puts prevention front and center, says Donald Lloyd-Jones, M.D., Associate Professor and Chair of Preventive Medicine Northwestern University in Chicago. Lloyd-Jones adds that the best way to attack cardiovascular disease is to make sure you don't get it in the first place.

Scientific evidence suggests that if you can make it to middle age having optimal cardiovascular health, you live longer, and can expect to enjoy a better quality of life and good health even in your 70s and 80s. Cardiovascular health may be the closest thing we have so far to a fountain of youth, Lloyd-Jones says. “It turns out that [factors that promote] cardiovascular health ... also reduce the cancer rate and prolong life.”

As an added bonus, prevention through lifestyle modifications such as diet, regular physical activity and avoiding smoking costs less than treatment of stroke, heart failure and other serious cardiovascular disease. Prevention bends the cost curve down (to borrow a well-worn phrase from the healthcare reform debates) for individual patients and the healthcare system overall.

A little bit goes a long way. The more heart health factors you can push from “poor” to “intermediate,” or from “intermediate” to “optimal,” the bigger the cardiovascular payoff. Whether you decide to tackle the goals one at a time, or all at once, it's up to you. But you're not in this alone. The AHA is here to help support you in becoming the best that you can be. HI

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If You Could Do Just One Thing To Improve Your Cardiovascular Health...

HEART INSIGHT asked Northwestern University's Donald Lloyd-Jones, M.D. “From where you are right now along the continuum of poor to optimal health, what's the one thing you and your family can do to move in the right direction for each of the health behaviors and factors that affect cardiovascular health?” Here's what he said:

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Adults: If you're smoking now, become a quitter. For the first 12 months you're getting huge benefits. But you'll get even more benefit if you throw [cigarettes] away forever.

Children: Don't start smoking.

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Body Mass Index*

Adults: The most important thing about weight is: Hold the line. At a minimum, stay where you are by balancing your caloric intake with your level of physical activity.

Children: Get up and moving, and make sure you don't take in more calories than you need.

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Physical Activity

Adults: The great news about physical activity is, the benefit starts with Minute One. If you're doing nothing, do something. Just adding five minutes of physical activity to your day is already beneficial, but if you can get in 20 minutes a day, your cardiovascular health will improve enormously.

Children: Limit the amount of time spent with anything that has a screen — the TV, computer, hand-held games — each day and instead engage in sports and other physical activity during your downtime.

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Healthy Diet**

Adults: Eat plenty of fruits and vegetables, and prepare them healthfully — avoid frying and adding salt, sugar and butter, for example.

Children: Parents should get kids started on good eating habits, and help them understand that whole foods, especially fruits and vegetables, taste pretty darn good.

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Total Cholesterol

Adults: Eat limited amounts of all fats, and make sure that the fats you do eat are as healthy as possible — olive oil, canola oil, foods that are good sources of omega-3 fatty acids.

Children: Children: Limit the amount of saturated fat in the diet — for instance, switching from whole milk to 1 percent or fat-free milk.

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Blood Pressure

Adults: Everyone should limit intake of fast foods and processed foods, which are high in sodium. If you already have elevated blood pressure, you can help keep it in check by losing some weight if you are overweight.

Children: Stay at a healthy weight. Good dietary habits, like limiting salt intake, should start early.

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Fasting Glucose

Adults: If you are pre-diabetic (fasting glucose levels between 100 and 125 mg/dL), limit dietary starches and sugars. If you have type 2 diabetes, lose weight and increase physical activity to the levels the AHA recommends.

Children: Avoid sugar-sweetened beverages.

The AHA's My Life Check empowers Americans to take a big step towards a better life. In just a few minutes, you can get your personal heart score and a custom plan with the seven simple steps you need to start living your best life. Visit to start your new life resolution.

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Table. How Cardiovas...
Table. How Cardiovas...
Image Tools

* Weight (kilograms) divided by the square of height (meters). This online tool can help you calculate your BMI: Cited Here...

** A diet with a high health score follows these guidelines:

▪ Fruits and vegetables: At least 4.5 cups per day;

▪ Fish: At least two 3.5-oz servings per week (preferably, oily fish);

▪ Fiber-rich whole grains (providing at least 1.1 grams fiber per 10 grams carbohydrate): At least three 1-oz servings per day;

▪ Sodium: Less than 1,500 mg per day; and

▪ Sugar-sweetened beverages: No more than 450 calories (36 oz) a week.

Cited Here...

© 2010 American Heart Association, Inc.