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HEART Insight:
doi: 10.1097/01.HEARTI.0000394434.47562.4a
Departments: Life's Simple 7(TM)

Modest Lifestyle And Behavioral Changes That Can Improve Your Health

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The Picture Of Ideal Health

Fewer than 25 percent of middle-aged and elderly Americans have four or more Life's Simple 7™ health factors at ideal levels, according to data from the Reasons for Geographic And Racial Differences in Stroke (REGARDS).

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After following 17,820 participants aged 45 to 84 years old when the study kicked off for roughly four years, researchers found that just two people — yes, two — had all seven health factors (see box below) at ideal levels. Here's what else they found during the course of the study:

▪ Those with five to seven factors at ideal levels tended to be younger than 65, female and white;

▪ Nearly 67 percent had fasting blood glucose levels that are within the AHA's recommended range, but just about no one (.043 percent) had an ideal healthy diet score;

▪ Death rates for those with five to seven factors at ideal levels were 55 percent lower than those who had no health factors at ideal levels; and

▪ For each additional health factor at the ideal level, study participants had a 14 percent lower chance of dying.

New findings from another study — the Multi-Ethnic Study of Atherosclerosis (MESA) — suggest that nonsmokers whose blood pressure, total cholesterol levels and blood sugar levels were within the AHA recommended range also were less likely to have elevated levels of coronary artery calcium and thickened carotid artery walls, both of which are risk factors for cardiovascular disease. Researchers measured coronary artery calcium and carotid artery thickness at the start of the study and after an average of three years, and found that carotid artery thickness steadily increased among those whose Life's Simple 7 health factors remained intermediate or poor.

Finally, a new analysis of data from the multigenerational Framingham Heart Study that looked at the original participants, their children and their grandchildren, finds that health behaviors and lifestyle factors appear to have a greater impact on cardiovascular well-being over time than genetic factors do. In other words, your heart health fate is largely in your hands.

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.

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.

Modest lifestyle or behavioral changes can move you in the right direction. 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.

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Your Cold, Cold Heart

For a variety of reasons, heart disease risk factors may be harder to control during the winter months. Blood pressure is often higher in cold weather, and going out into frigid air can trigger a condition known as cold-air angina, which is chest pain and discomfort caused by inhaling cold air. Cold temperatures may also trigger life-threatening cardiac events, such as heart attack — even if you live someplace where it's not especially bone-chilling.

Blood vessels tend to constrict when you exercise in the cold, which increases resistance to blood flow and raises blood pressure. In addition, certain high blood pressure and heart medications may also make it harder for your body to handle the cold, particularly diuretics, beta-blockers and vasodilators, which can alter heart rate, heightening the tendency of blood pressure to rise in the cold and interfere with the ability to maintain safe body temperatures during physical activity. Hypothermia can occur when your body can't produce enough energy to keep its internal temperature high enough, which may lead to deadly heart failure.

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So should you hibernate all winter? Not at all. If you have heart disease, it's important to stay fit and keep your heart pumping. Some winter sports, such as downhill skiing, ice-skating, hiking and indoor swimming or walking, offer ample opportunity to safely get in the 150 minutes per week of moderate-intensity, or 75 minutes per week of vigorous aerobic physical activity, or an equivalent combination of the two, recommended by the American Heart Association. But other sports, such as cross-country skiing or snowshoeing, may be more dangerous for your heart.

Like all aerobic workouts, downhill skiing, ice-skating and hiking keep the heart pumping at a high enough rate for long enough to boost “good” high-density lipoprotein cholesterol, and help keep high blood pressure in check. These activities also build endurance and help maintain normal weight or aid weight loss.

However, as altitude increases, the air becomes “thinner,” which means there is less oxygen in the atmosphere to draw into your lungs with each breath and the amount of oxygen in your blood declines. Both heart and breathing rate increase as the body tries to send more oxygen to its tissues. If you have heart disease, high-altitude activity can increase the heart rate to potentially dangerous levels. People with chronic conditions and symptoms should consult their healthcare provider about the types and amounts of physical activity appropriate for them.

In addition, cross-country skiing and snowshoeing may be dangerous for heart patients. Both sports rely on the hands, wrists, elbows, arms, shoulders and neck, which can increase blood pressure and put added pressure on the heart and could lead to a heart attack. For this reason, people with known or hidden heart disease can have a sudden, fatal heart attack after shoveling snow.

And people who have diabetes need to pay particular attention to their hands and feet. Diabetes commonly causes peripheral neuropathy — a condition that often interferes with nerve signals and makes it hard to sense coldness in the hands and feet — thereby making people with diabetes more susceptible to frostbite.

If you have heart disease risk factors or type 2 diabetes, and have not performed physical activity regularly, you should see your doctor and begin increasing daily physical activity over time, well before going on that long-planned ski vacation, or engaging in other vigorous activities.

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Can You Quit Smoking And Lose Weight?

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One reason people keep smoking even when they already have plenty of good reasons to quit — for instance, a persistent cough or shortness of breath — is the fear of gaining weight.

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While smoking is guaranteed to harm your health in a myriad of ways, it's not a foregone conclusion that you will pack on the pounds when you quit. Many people do not gain weight when they lose the smoking habit, and those who do average about 10 pounds of weight gain. This small weight gain — which can be temporary — is far less harmful to your health than smoking. If you smoke one pack of cigarettes per day, you'd have to gain something like 90 pounds after quitting to equal the negative impact on your health that smoking has.

If you plan ahead, you can prevent or reduce weight gain when you quit smoking — and even work to lose a few pounds, if your doctor has suggested that you do so.

When you pick the day you will quit smoking, make sure it's far enough into the future — say, 30 days — to allow you time to improve your eating habits and incorporate more physical activity into your day before The Big Day. Healthy eating helps prevent weight gain — for one thing, reducing sodium intake can help with water retention. Physical activity can help to control your appetite while revving up your metabolism It can also help to relieve the psychological effects of nicotine withdrawal, as well as promote a positive mindset that enhances your chance of success.

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Quitting smoking really involves three lifestyle changes — diet, exercise, and stubbing out your last cigarette.

Your doctor can prescribe a variety of aids to help you get through the worst of your nicotine withdrawal symptoms. You can do your part by drinking lots of water to flush smoking-related toxins from your body, and by cutting back on caffeinated beverages, which aggravate the jitteriness caused by nicotine withdrawal.

If you find yourself craving a cigarette, sip some water from a straw or suck on a sugar-free Popsicle to mimic the sensation of taking a drag. And distract yourself for a few minutes to allow the craving to pass. Wanna bet there's an app for that? Anything that takes your mind off smoking for about five minutes or so — a game, puzzle, doodling — will help you get over the craving.

If you find your hankering for a smoke replaced by a craving for a candy bar, reach for carrot or celery sticks, cucumber spears, fruit or sugarless gum, mints or hard candy instead. And avoid situations that will tempt you to grab a smoke, a snack or both, like coffee breaks and cocktail parties.

And if you end up gaining a few pounds, remember that you can shed them eventually if you continue to stay active and to eat a healthy diet.

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Checking Blood Glucose After Meals

If you have been diagnosed with type 2 diabetes, your doctor has recommended a target blood glucose range for you to stay within to reduce the risk of complications. In most cases, that range will be between 70 and 130 mg/dL before meals and less than 180 mg/dL one to two hours after meals. The only way to know whether you are within that range is to test your blood glucose with a blood sugar monitor.

How often you test your blood sugar level depends on your treatment plan — for instance, whether you are taking insulin or another medication to control your blood sugar — and how well your blood sugar is controlled.

If you're on insulin to manage type 2 diabetes, your doctor may recommend blood sugar testing after each dose. If you can keep your blood glucose levels at the recommended range using another medication, or with diet and physical activity, you may be able to test your blood sugar level just once a day — typically two hours after your main meal.

Each time you test, keep a record that includes the date, time, test results, medication and dosage. If your blood glucose level readings are consistently higher or lower than your target range, also make note of your diet and physical activity levels so you and your doctor can determine whether there is something in your daily routine causing your blood glucose levels to rollercoaster. Your doctor may also use this information to adjust the dosage of your medication or to try a new medication.

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Teens Need To Be Salt-Savvy

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What is the Number One source of salt in a teenager's diet? Pizza.

Teens eat more salt each day on average than any other age group, with processed or prepared foods providing roughly 80 percent of dietary sodium intake. The AHA recommends no more than 1,500 milligrams of sodium per day for most Americans.

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According to a new study, eating just 3 grams less salt per day during the teen years could reduce the incidence of high blood pressure between the ages of 35 and 50 by as much as 30 percent to 43 percent. Nationwide, as today's teenagers reach age 50, the health benefits would include:

▪ 7 percent to 12 percent reduction in coronary heart disease (120,000 to 210,000)

▪ 8 percent to14 percent reduction in heart attacks (36,000 to 64,000)

▪ 5 percent to 8 percent reduction in stroke (16,000 to 28,000)

▪ 5 percent to 9 percent reduction in death from any cause (69,000 to 120,000)

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Resources

Life's Simple 7™ Assessment

How many of your health factors are at optimal level? To understand the steps you may need to take to improve heart health and quality of life, visit http://mylifecheck.heart.org

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Diabetes Management

Learn about diabetes & share your experiences at www.Iknowdiabetes.org

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Smoking Cessation

For tips and tools check out www.heart.org/quitsmoking

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How to Avoid Weight Gain When Quitting Smoking

Find out how to combat cravings for cigarettes and sweets at www.heart.org/avoidgaining

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The No-Fad Diet

The secret to weight loss? Eat fewer calories than you expend through physical activity. Tips on how to eat smart, and to eat well — without hard-to-follow or unhealthy fad diets. For more information, visit www.heart.org/nofad

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Alliance for a Healthier Generation

http://www.HealthierGeneration.org

© 2011 American Heart Association, Inc.

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