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CORP-98001-AA JUL2012
HEART DISEASE AND YOUBlack Americans
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2
WHAT IS HEART DISEASE?
2
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What is Heart Disease?Heart disease is a broad term used to describe a range of diseases that affect your heart
Coronary Artery Disease(heart attack & stroke)
Arrhythmias
Conditions & Infections
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Coronary Artery Disease(heart attack & stroke)
Coronary Artery Disease• Your heart is a pump that
circulates blood, oxygen and nutrients throughout your body
• Coronary artery disease isa disease of the heart, andcan lead to:– Chest pain– Shortness of breath– Heart failure– Heart attack– Stroke
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Heart Arrhythmias
• Electrical impulses cause your heart to beat
• When your heart beats too fast, too slow or irregularly, you have an arrhythmia
• Most are harmless. However, some heart arrhythmias may cause bothersome — sometimes even life-threatening — signs and symptoms
Arrhythmias
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The Heart of the MatterHeart disease is the leading cause of death for women and men, regardless of race and ethnicity
African American Males 44.8%
African American Females2 47.3%
White Males 37.4%
White Females3 33.8%
Hispanic/Latino Males 30.7%
30.9%Hispanic/Latino Females4
82.6 Million American Adults Have Heart Disease1
1. American Heart Association. Heart Disease and Stroke Statistics-2012 Update2. American Heart Association. African Americans and CVD – 2012 Statistical Fact Sheet3. American Heart Association. Whites and CVD – 2012 Statistical Fact Sheet4. American Heart Association. Hispanics/Latinos and CVD – 2012 Statistical Fact Sheet
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%
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The Heart of the Matter: Major Causes of Death
African American men and women are 30% more likely to die from heart disease
than non-Hispanic white males2
1. American Heart Association. African Americans and CVD – 2012 Statistical Fact Sheet2. The Office of Minority Health. Heart Disease and African Americans. Accessed http://minorityhealth.hhs.gov/templates/content.aspx?
lvl=3&lvlID=6&ID=3018
Heart Disease (31.8)
Cancer (22.4)
Accidents (5.7)
Homocide (4.9)
Diabetes (3.7)
Kidney Disease (2.7)
Heart Disease (35.1)
Cancer (21.8)
Accidents (2.8)
Homocide (.8)
Diabetes (4.7)
Kidney Disease (3.3)
Black Men Black Women
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The Heart of the Matter • Heart disease, high blood
pressure and diabetes are prevalent among Black Americans
• Some people have simply accepted this is a way of life
• This doesn’t have to be true for you
• Heart disease and most risk factors can be prevented or treated
Take responsibility for your heart’s health
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WHAT YOU NEED TO KNOW ABOUT HEALTH CARE DISPARITIES
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Disparities in Health Care
Women
Ethnic Groups
RacialGroups
Over 65
Non-English
Smedley BD, Stith AY, Nelson AR. Institute of Medicine. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Policy, Institute of Medicine. Washington, DC: National Academy Press; 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Accessed: http://www.nap.edu/openbook.php?record_id=12875&page=R1
Racial or ethnic differences in the quality of health care that are not due to access-related factors, clinical needs, preferences,
or appropriateness of intervention
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Reasons Are Complex
Henry J. Kaiser Family Foundation. Why the Difference Power Point Presentation, slide # 26. Unequal Treatment Confronting Racial and Ethnic Disparities in Healthcare: March 2000.
Health System
Geography
Language
Time
Insurance
Provider
Culture
Bias
Uncertainty
Stereotypes
Patient
Refusal
Preference
Behavior
Language
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WHAT CAN I DO?
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Know Your Risk Factors
Take Charge of Your Heart
Health
Talk to Your Doctor
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Know Your Risk Factors
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Risk Factors Lead to Heart DiseaseRisk Factors You Can NOT Control• Increasing Age• Family History
Risk Factors You CAN Control• Diabetes• High Blood Pressure• High Cholesterol• Physical Inactivity• Overweight/Obesity• Smoking• Stress• Alcohol
National Heart Lung and Blood Institute. “Your Guide to a Healthy Heart.” 2005. NIH Publication No. 06-5269
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Age and Family History
Increasing Age• For men, are you over 45?• For women, are you over
55?
Family History• Does anyone in your
immediate family have a history of heart diseaseor diabetes?
National Heart Lung and Blood Institute. “Your Guide to a Healthy Heart.” 2005. NIH Publication No. 06-5269
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Diabetes What is it?• A lifelong disease in which there are high
levels of sugar (glucose) in the blood
Why a major risk factor?• Heart disease and stroke account for about
65% of deaths in people with diabetes1
How many Black Americans affected2?• Nearly 15% of men and women have
diagnosed diabetes• Almost 5% of men and women have
undiagnosed diabetes• Nearly 32% of men and 27% of women
have pre-diabetes
Good diabetes management can help
reduce your risk
Many people are not even aware that they
have diabetes
1. American Heart Association. Cardiovascular Disease and Diabetes. Accessed: http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp
2. American Heart Association. African Americans and CVD – 2012 Statistical Fact Sheet
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High Blood Pressure (Hypertension)What is it?• Blood pressure (the force of blood against the
walls of arteries) that stays high and damages the heart over time
Why a major risk factor?• About 69% of people who have a first heart
attack, 77% who have a first stroke, and 74%who have congestive heart failure have highblood pressure, i.e. higher than 140/90 mm Hg.1
How many Black Americans affected?• More women (45.7%) than men (43%) have
the condition1
1. American Heart Association. High Blood Pressure– 2012 Statistical Fact Sheet
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High Blood CholesterolWhat is it?• The body needs cholesterol — a waxy, fat-like
substance in your blood — but too much bad (LDL) cholesterol can lead to plaque build up in arteries and veins
• Your LDL cholesterol level is a better gauge of risk than total blood cholesterol 1
Why a major risk factor?• When levels of bad (LDL) cholesterol are 130 mg/dl
or higher there is a higher risk of developing coronary heart disease 1
How many Black Americans affected? 2
• 28% of women have high bad cholesterol • 34% of men have high bad cholesterol
1. American Heart Association. What Your Cholesterol Levels Mean. Accessed: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-Mean_UCM_305562_Article.jsp
2. American Heart Association. High Blood Cholesterol– 2012 Statistical Fact Sheet
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Physical InactivityWhat is it?• Lack of regular moderate physical activity
Why a major risk factor?• Exercise helps to prevent or reduce high
blood pressure, diabetes and being overweight or obese
How many Black Americans affected?• Over 40% of men and women are inactive1
Moderate exercise for 30 minutes/day• Improves physical wellness• Decreases risk of developing heart disease• Boosts mental wellness• Relieves tension, anxiety, depression• Improves mental alertness
Key Guidelines Snapshot3
Adults (aged 18–64)Moderate-intensity aerobic exercise; 2 hours and30 minutes /week; Muscle-strengthening; 2+days per week
Older Adults (aged 65+)Follow adult guidelines(as abilities allow)Inactivity should be avoided
1. American Heart Association. Physical Inactivity– 2012 Statistical Fact Sheet2. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans.
http://www.health.gov/paguidelines/factsheetprof.aspx
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Overweight & ObesityWhat is it?• When your weight exceeds what is
generally considered healthy for your height
• A waist measurement greater than 40 inches for men and 35 inches for women
Why a major risk factor?• Leads to many diseases and conditions,
including high blood pressure and Type 2 diabetes which can cause heart disease
How many Black Americans affected 1
• 71% of men are overweight or obese• 78% of women are overweight or obese
1. American Heart Association. Overweight & Obesity– 2012 Statistical Fact Sheet
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Cigarette and Tobacco Smoke
What is it?• Inhalation of the smoke of burning tobacco
encased in cigarettes, pipes, and cigars
Why a major risk factor?• Cigarette smoking and secondhand smoke
further raises risk of heart disease when combined with high cholesterol, high blood pressure, and being overweight or obese
How many Black Americans affected? 1
• 24% of men smoke• 17% of women smoke
1. American Heart Association. African Americans & CVD– 2012 Statistical Fact Sheet
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Stress and Heart DiseaseWhat is it?• Stress affects each of us in different ways — you
may have physical signs, emotional signs or both
Why a major risk factor?• Stress sets off a chain of events
– Stressful situation – Breathing and heart rate speed up; blood pressure rises– Body experiences “fight or flight” response– When it lasts days/weeks = chronic stress– Chronic stress increases heart rate and blood pressure
How many Americans affected?• 22% of Americans reported extreme stress in 2011• Top reasons: money, work, economy, relationships,
family responsibilities
American Psychological Association. Stress in America report. http://www.apa.org/news/press/releases/2012/01/chronic-disease.aspx
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Alcohol Beverages and Heart DiseaseWhat is it?1
• The relation between alcohol and heart disease is complex
• Some say no alcohol at all, but
• Moderate-alcohol use has been shown to reduce coronary heart disease
• Excessive or binge drinking can lead to high blood pressure, heart failure and a higher calorie intake
How many Black Americans affected? 2
• In 2010, rates of alcohol use among Black persons 12 and older was 43%
• Rates of excessive/binge alcohol use among Black persons was 20%
4 oz.
1. American Heart Association. Alcoholic Beverages and Heart Disease. Accessed http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Alcoholic-Beverages-and-Cardiovascular-Disease_UCM_305864_Article.jsp
2. Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.
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The Multiplier EffectRisk Factors Don’t Add Their Potential Danger
Like 1 + 1 = 2 They Multiply It1
= 10 more likely to
develop heart disease
Woman over 55Overweight
+ High Blood Cholesterol
3
1. National Heart Lung and Blood Institute “The Heart Truth” speaker’s guide. 2010. Publication No. 10-520B, p. 172. National Heart, Lung, and Blood Institute (2006), HEART DISEASE RISK FACTOR "MULTIPLIER EFFECT“ IN MIDLIFE
WOMEN infographic
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Talk to Your Doctor
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Talk to Your Doctor
• Being honest will get you the most realistic assessment– Help your doctor develop a
plan to lower your overall risk
• Visit your doctor regularly and bring 2–3 questions
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Talk to Your Doctor• Do I have heart disease? What tests
should I have?
• What do my test results mean?
• Are my blood pressure numbers within a normal range? Cholesterol numbers?
• Can you help me plan a safe weight loss and exercise program?
• What are the possible side effects of the medications I’ve been prescribed?
Your doctor is your partner — working
together you can live a longer, healthier and
happier life
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Take Charge of Your Heart
Health
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Enjoy Regular Physical ActivityRecommendation• Pick a physical activity that you like
(brisk walking, dancing, swimming)• Make the time!• Do it for 30+ minutes 5X per week
Why?– 70% of Americans do not get the
physical activity they need1
– Daily physical activity will guarantee you a healthier and more satisfying life while lowering your risks for heart disease, stroke and diabetes1
– Studies show that for every hour of walking, life expectancy may increase by 2 hours2
1. American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=8&CultureCode=en-US2. American Heart Association: Get Moving. Where Do I Start
http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/StartWalking/Get-moving-Where-do-I-start_UCM_307978_Article.jsp
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Eat a Heart-Healthy DietRecommendation:• Stock up on healthy foods• Eat a lot of vegetables and fruits• Eat unrefined fiber-rich whole-grain foods• Eat fish at least twice a week• Choose skinless lean meats and poultry• Select fat-free, 1% fat, and low-fat
dairy products• Cut back on saturated/trans fats,
cholesterol, salt and added sugars• Remember candy, cakes, cookies, ice
cream, etc. are occasional special treats!
Why? One of your best weapons for fighting heart diseaseOver 90% of us fail to eat a heart-healthy dietPoor eating can lead to heart disease, stroke, diabetes and obesity
American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=10&CultureCode=en-US
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Maintain a Healthy Weight
Recommendation• Know your Body Mass Index or
BMI• Understand your caloric needs• Track your calories• Only eat at restaurants/fast food
1-2 times per week
Why?• When you shed extra fat and
unnecessary pounds, you reduce the burden on your heart, lungs, blood vessels and skeleton
American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=11&CultureCode=en-US
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Body Mass Index (BMI) Chart
Weight-control Information Network: an information service of the National Institute of Diabetes and Digestive and Kidney Diseases: Web page, “Understanding Adult Obesity.” Accessed http://win.niddk.nih.gov/publications/understanding.htm#bodymass
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Stop Smoking (please!)Recommendation• Do whatever it takes to quit! • Talk with your health-care provider
or look for a quit-smoking program
Why?• Cigarette smokers have a higher risk of
developing cardiovascular disease 1
• Smoking is one of our nation’s top causes of early death1
• Smoking will only add to your stress by taking away your good health and shortening your life1
• On average, smokers die 13–14 years earlier than nonsmokers 2
1. American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=14&CultureCode=en-US 2. Centers for Disease Control and Prevention. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/.
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Reduce Your Blood SugarRecommendation• Reduce consumption of simple
sugars that are found in soda, candy and sugary desserts
• Get regular physical activity! • Take medications or insulin, if
prescribed for you
Why?• High levels of blood sugar can
damage your heart, kidneys, eyes and nerves
• When you reduce excessive sugars you help protect your vital organs
American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=13&CultureCode=en-US
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Control Your Cholesterol
Recommendation• Eat healthy foods low in cholesterol,
trans fats and saturated fats and lots of fiber
• Schedule a cholesterol screening• Get active • Maintain a healthy weight• Take your prescribed medication
Why?• When you control your cholesterol, you
are giving your arteries their best chance to remain clear of blockages that can lead to heart disease and stroke
American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=9&CultureCode=en-US
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Manage Your Blood PressureRecommendation:• Eat a heart-healthy diet with less sodium• Enjoy regular physical activity• Maintain a healthy weight• Take your prescribed medication• Managing stress• Limit alcohol• Avoid tobacco smoke
Why?• High blood pressure is the single most
significant risk factor for heart disease• Managing it is common sense for
good health
American Heart Association. My Life Check. http://mylifecheck.heart.org/Multitab.aspx?NavID=12&CultureCode=en-US
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Stress and Heart DiseaseRecommendation for Stress• Exercise• Maintain a positive attitude• Do not smoke or drink too
much coffee• Enjoy a healthy diet • Maintain a healthy weight• Talk to your doctor or other
healthcare professionals
Why?• Managing stress is good for your
overall health• After a heart attack or stroke,
people can feel depressed, anxious or overwhelmed by stress
American Heart Association/American Stroke Association: webpage, “Stress and Heart Health” Accessed http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Stress-and-Heart-Health_UCM_437370_Article.jsp
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Alcohol Beverages and Heart DiseaseRecommendation• Talk to your doctor about benefits and
risks based on your own family history and health
• If you drink alcohol, do so in moderation – 1 to 2 drinks per day for men– 1 drink per day for women
Why?• Alcohol use may be harmful for anyone
with:– Personal/family history of alcoholism– Hypertriglyceridemia– Certain blood disorders– Heart failure– Uncontrolled hypertension – Taking certain medications
4% 804 oz.
Standard Drink Equivalents
American Heart Association. Alcohol Beverages and Cardiovascular Disease. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Alcoholic-Beverages-and-Cardiovascular-Disease_UCM_305864_Article.jsp
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DISCUSSION
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How Heart Healthy Are You?Raise your hand if you….
• Have immediate family members who have heart disease/diabetes
• Smoke or live with someone who does
• Have been tested for type 2 diabetes in the last 2 years
• Had your blood pressure checked in the last year
• Know your cholesterol numbers, i.e., total, LDL and HDL
• Exercise for 30 minutes a day at least 4 days a week
• Know how many calories you should eat in a day
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Know Your NumbersRisk Factor Goal
Total cholesterol less than 200 mg/dL
LDL “Bad” less than 160 mg/dL; < 130; <100, <70
HDL “Good” women > 50 mg/dL; men > 40 mg/dL
Triglycerides less than 150 mg/dL
Blood Pressure less than 120/80 mmHg
Fasting Glucose less than 100 mg/dL
Body Mass Index (BMI) less than 25
Waist Circumference women < 35 inches; men < 40 inches
Exercise30 minutes ≥ 5 X week of moderate-intensity aerobic AND muscle strengthening ≥ 2 X week
Diet and Nutritionwith your doctor, determine how many calories you need each day and eat healthy, low sodium/sugar and high fiber foods
Tobacco and AlcoholStop smoking and exposure to secondhand smoke; women: one drink or less per day; men: 2 drinks or less per day
American Heart Association; webpage, “Numbers That Count for a Healthy Heart.” Accessed http://www.heart.org/HEARTORG/Conditions/Numbers-That-Count_UCM_305427_Article.jsp
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QUESTIONS?
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Thank You!
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Heart Attack Signs in Women• Uncomfortable pressure, squeezing, fullness or pain in center of
chest
• Pain or discomfort in one or both arms, the back, neck, jaw or stomach
• Shortness of breath with or without chest discomfort
• Breaking out in a cold sweat, nausea or lightheadedness
• Most common heart attack symptom is chest pain or discomfort
• Shortness of breath, nausea/vomiting and back or jaw pain are likely
American Heart Association. Heart Attack Symptoms in Women. Accessed http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp
If you have any of these signs, don’t wait more than five minutes
before calling 9-1-1 and get to a hospital right away
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Stroke Warning Signs
• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause
American Stroke Association: home page. Accessed: http://www.strokeassociation.org/STROKEORG/WarningSigns/Warning-Signs_UCM_308528_SubHomePage.jsp
If one or more of these signs is present, don’t delay — call 9-1-1
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CVD Risk and Black American Women
• Heart disease is more prevalent among Black women than White women1
• As are some of the risk factors, high blood pressure (46%), obesity (51%), and diagnosed/undiagnosed diabetes (19%) 2
• Women can lower their heart disease risk by as much as 82% just by leading a healthy lifestyle1
• However, in a 2006 study of women3:– Only 57% knew heart disease is leading cause of death
among women– Awareness was lower among Black (31%) and Latina
women (29%) compared with White women (68%)– Majority (≥ 50%) reported confusion related to heart
disease prevention• More outreach and education clearly is warranted
1. National Heart, Lung and Blood Institute’s “The Heart Truth for African American Women: An Action Plan.” NIH Pub. No. 07-50662. American Heart Association. African Americans & CVD– 2012 Statistical Fact Sheet3. Christian, A. et al. Nine-Year Trends and Racial and Ethnic Disparities in Women’s Awareness of Heart Disease and Stroke: An
American Heart Association Study. Journal of Women’s Health. Volume 16, Number 1. 2007. Abstract accessed: http://online.liebertpub.com/doi/abs/10.1089/jwh.2006.M072?journalCode=jwh
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Diabetes, Heart Disease and Stroke
High blood glucose levels can lead to increased deposits of fatty materials inside blood vessels, affecting blood flow and increasing the chanceof clogging and hardening of blood vessels
If you have diabetes: • You are 2X more likely to have heart disease or a
stroke than someone who does not• And are a woman, you have an even greater risk of
heart disease• And have already had one heart attack, you run an
even greater risk of having a second one• Your heart attack may be more serious and more
likely to result in death than someone without diabetes
National Diabetes Information Clearinghouse. Diabetes, Heart Disease and Stroke. Accessed: http://diabetes.niddk.nih.gov/dm/pubs/stroke/#connection
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