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HEART Insight:
doi: 10.1097/01.HEARTI.0000398189.20313.36
Departments: Life's Simple 7(TM)

Modest Lifestyle And Behavioral Changes That Can Improve Your Health

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Smokers With Type 2 Diabetes Are Playing With Fire

Cigarette smoking causes a host of health problems from head to toe, including heart and artery disease, respiratory ailments, gum disease, a variety of cancers, erectile dysfunction and low bone density that can lead to osteoporosis. So what could be worse than being a cigarette smoker? Being a cigarette smoker who has type 2 diabetes, because in addition to these other risks, you are:

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▪ Three times more likely than nonsmokers to die of cardiovascular disease;

▪ At increased risk of nerve and kidney disease compared with others who have diabetes; and

▪ More likely to have elevated blood sugar levels — even if you watch your diet and take your medication — which can lead to serious complications. Diabetes interferes with your body's ability to use insulin, and smoking one cigarette decreases insulin's effectiveness another 15 percent.

Why is smoking more dangerous if you have diabetes? For one thing, your heart, pancreas and other organs aren't getting all the oxygen needed to function properly. If you have diabetes and your pancreas is already struggling to pump out the amount of insulin needed to control your blood sugar, imagine how much harder it has to work dealing with lack of enough oxygen.

Smoking can accelerate the process that leads to hardening of the arteries (arteriosclerosis) if you have diabetes. Here's how: The cells lining the inner walls of your blood vessels produce nitric oxide, which causes the vessels to widen and allow a greater amount of blood flow. Diabetes impairs nitric oxide production by these cells, contributing to blood vessel stiffness and constriction and, ultimately, leading to arteriosclerosis.

So if you're a smoker who is among the 81.5 million who are prediabetic (fasting glucose levels between 100 and 125 mg/dL), or the approximately 23 to 24.5 million who already have type 2 diabetes (fasting glucose levels above 125 mg/dL), it's a good time to talk to your doctor about the support and treatment you need to stub out that last cigarette.

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Life's Simple 7 In A Nutshell

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 — that is, from “poor” to “intermediate,” or from “intermediate ” to “ideal.” 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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Born This Way

Maybe you've inherited your father's eyes or your mother's laugh or your aunt's freckles. If your family members have high cholesterol, you may have inherited a tendency to have high cholesterol, too.

There are four conditions causing elevated cholesterol levels — 240 mg/dl or higher — that run in the family (that is, are “familial”). If you have inherited one of these genetic conditions your cholesterol levels are persistently high, despite eating a healthier diet, losing weight and becoming more active.

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Scientists believe that in these inherited conditions, one or more genes that enable your body to remove LDL (low-density lipoprotein) cholesterol from the bloodstream are not working properly. As a result, the “bad” cholesterol gets deposited on the walls of your blood vessels — particularly in the arteries that supply blood to the heart — and restricts the flow of blood. When not enough blood flows to the heart, a heart attack can occur. When the same thing happens to the brain, a stroke can occur.

Don't assume you're doomed if you have a genetic tendency to have elevated cholesterol levels. Your doctor will likely prescribe a cholesterol-lowering statin, combined with a sensible diet and regular physical activity.

Foods that are high in saturated and trans fats, such as butter, fried foods and whole-fat dairy products, tend to raise LDL levels, thus reducing the effectiveness of the statin. Also, high-fat foods can pack on the pounds, which will also make cholesterol management more difficult. To help the medication help you, include heart-healthy foods in your diet: vegetables, fruits, whole grains, high-fiber foods, lean meats and poultry, fish at least twice a week and fat-free or 1% dairy products. And five days out of the week, take at least 30 minutes to do some type of moderate-intensity physical activity, whether it's taking a brisk walk, a bike ride, a water aerobics class or dance lessons.

With a cholesterol management program that combines medication and lifestyle changes, you should be able to lower your total cholesterol, LDL and triglyceride levels — while also boosting your HDL (high-density lipoprotein, or “good” cholesterol) levels — enough to reduce risk of heart attack and stroke. Here's what you're aiming for:

The AHA recommends that all adults age 20 or older have a fasting lipoprotein profile (the blood test is done after nine or 12 hours without food, liquid or medications) to check levels of total cholesterol, LDL, HDL and triglycerides. If you have a genetic tendency toward high cholesterol, your doctor will probably want to test you more frequently to determine the proper dosage of statin drugs and to monitor your progress.

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Need To Lose Weight? Should You Eat Less Or Work Out More?

Nearly 34 percent of adults in the U.S. are obese — having a body mass index (BMI) of 30 or higher — according to the Centers for Disease Control and Prevention, and only five percent of American adults engage in vigorous physical activity on any given day.

What do these stats have to do with each other? Plenty.

Even if you take in the same number of calories day in, day out, year in, year out — and really, who among us can honestly say this is the case — you may find your weight creeping up because of age-related changes in body composition that slow metabolism (over time, the body loses muscle tissue and gains fat tissue). So what's your best bet to get rid of that muffin top, eating fewer muffins or working out to replace fat with muscle?

While it's true you can lose weight by following diets that ban certain foods (bread and pasta, for instance) or emphasize others (eggs, steak and other high-protein foods), but they tend to be unenjoyable — and eventually unsustainable over the long haul. Eventually — and inevitably — you will crave the forbidden fruit (literally, in the case of some fad diets) or get bored with the limited food choices the diet plan allows.

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OK then, what about eating anything you want, and burning it off at the gym? A meta-analysis of several studies of the effectiveness of losing weight by increasing physical activity levels concludes that this approach doesn't pare pounds but can reduce “visceral fat” — sometimes called “hidden fat” because unlike subcutaneous fat that lies just beneath the skin and is noticeable, visceral fat lies beneath the stomach muscles and surrounds the vital organs in the abdominal cavity. Visceral fat is associated with type 2 diabetes and heart disease. The best approach is to eat a well-balanced, nutritious diet every day and reduce the amount of calories you eat while increasing your daily physical activity level.

If pounding out the miles on a treadmill or working up a sweat in a kick boxing class doesn't get the numbers on the scale going in the right direction, many people get discouraged and give up. So what's the answer? Numerous studies show that routine physical activity — at least 30 minutes of moderate-intensity physical activity on five days of the week — can help you keep your weight at a healthy level and can boost your efforts to lose weight if you're dieting.

For instance, one recent study also found that those who diet and exercise lose more weight — and lose more belly fat, too. Researchers at the University of Pittsburgh School of Medicine divided 130 severely obese people into one group that ate a calorie- and portion-controlled diet and began a walking regimen and one group that followed the same diet. The first group, which eventually worked up to 60 minutes of walking five days a week, had lost an average of 24 pounds after six months. Those who didn't exercise had lost an average of 18 pounds at the six-month mark, at which point the non-exercisers also began the walking regimen. After a year those who had exercised throughout the study had lost 27 pounds on average, and the delayed-exercise group had lost 22 pounds. Most of the study participants had lost 30 to 40 pounds, but some had lost nearly 100 pounds. The researchers conclude that a sensible diet-and-exercise program can help even very obese people lose weight.

The bottom line: Losing weight and keeping it off is not an either/or choice between eating less and increasing physical activity. To be successful, you need to do both.

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High Blood Pressure In Pregnancy

Preeclampsia (also known as “toxemia”) is a serious complication of pregnancy that causes a woman's blood pressure to skyrocket. One in 20 women in the U.S. will develop preeclampsia — typically after the 20th week of pregnancy — but the risk doubles for a woman whose blood pressure is not well-controlled before she becomes pregnant.

Other risk factors for developing preeclampsia include obesity, family history, carrying more than one baby and having type 2 diabetes.

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Left untreated, preeclampsia can cause life-threatening problems for mother and baby alike, such as premature separation of the placenta from the uterus — which can lead to premature birth, low birth weight or stillbirth. Preeclampsia can also cause stroke, liver and kidney failure or progress to eclampsia, which is characterized by dangerous seizures (convulsions) and/or coma, and is the second leading cause of maternal death in the U.S.

In addition to elevated blood pressure and protein in the urine, symptoms include:

▪ Dull, throbbing headache;

▪ Dramatic weight gain (more than two pounds a week);

▪ Nausea or vomiting;

▪ Swelling of the hands and face;

▪ Vision changes (temporary vision loss, auras, light sensitivity, blurriness); and

▪ Decreased urine output.

If a woman develops preeclampsia, the doctor may prescribe a low-sodium diet and medications to treat high blood pressure that are safe to use during pregnancy. In more serious cases, the doctor will order bed rest or may induce labor if a woman is close to term.

In most cases, elevated blood pressure levels will drop back to normal within six weeks of delivery. But some women do go on to develop high blood pressure or heart disease later in life, and researchers are trying to figure out why and how to prevent this outcome.

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Buying Trouble At School Vending Machines

Schools around the country are revamping their cafeteria menus, aiming to offer healthier options, but are shooting themselves in the foot by allowing vending machines on campus.

A survey published in the Journal of Adolescent Health of 152 schools found that 83 percent had vending machines that sold chips, soda, candy and other foods with little nutritional value. Not surprisingly, the students at these schools ate more sweets. In contrast, students ate more produce in schools that had vending machines that sold fruits and vegetables.

A recent analysis of data from four federal diet surveys between 1977 and 2006 involving more than 31,000 children aged 2 to 18 found that the average kid eats nearly three snacks a day, and gets as much as 27 percent of his or her calories from snack foods – roughly 586 calories per day. The study also showed that kids are eating less fruit and milk and more salty snacks such as potato chips, as well as more candy, juice and soft drinks. It's no coincidence that during this period, childhood obesity has risen from 14.8 percent in 2003 to 16.4 percent in 2007 among children 10 to 17 – as have rates of high blood pressure, high cholesterol and type 2 diabetes in this age group.

Until recently, food in a school's lunch and breakfast programs had to meet federal nutritional standards to qualify for government reimbursement, but not food sold in vending machines. But the Healthy, Hunger-Free Kids Act, the 2010 version of legislation that reauthorizes the Child Nutrition Act for a five-year period, promises to change that. As part of the law, the Institute of Medicine will draft nutritional standards for food sold in vending machines.

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Resources

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Life's Simple Seven Assessment

To understand the steps you may need to take to improve heart health and quality of life, visit www.mylifecheck.heart.org

Diabetes Management

www.diabetes.org/diabetes-basics/prevention/

Smoking Cessation

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

Tips For Exercise Success

www.heart.org/physicalactivitysuccess

Cholesterol Management

www.heart.org/dietaryrecommendations

Alliance for a Healthier Generation

www.HealthierGeneration.org

Body Mass Index Calculator

www.heart.org/BMI

© 2011 American Heart Association, Inc.

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