Your Heart Health Everyone Should Know.docx

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Your Heart Health: 13 Numbers Everyone Should Know

By Sarah Baldauf, USNews.com

Thu, Feb 03, 2011

A long life free of heart disease does not come just from controlling the standard measures like blood pressure and cholesterol.

Sure, keeping tabs on these indicators is essential to gauging your heart's health, but a few other numberssome surprising

can be meaningful as well.

It's awareness worth having. The American Heart Association noted in its annual review for 2010 that while the death rate due

to cardiovascular disease in the United States fell between 1996 and 2006, the burden of the disease is still high. More than 1

in 3 deaths was related to heart disease in 2006.

U.S. Newsconsulted with cardiology experts to round up the target numbers you should strive for to keep your ticker in good

working condition over the long haul.

1. Alcohol intake

Those fond of tipple may be dismayed, but the science on alcohol as an agent to promote heart health is just not definitive. "If

you have heart disease, alcohol plays no role in your medicine cabinet; if [you do] not, alcohol is not the right way to reduce

your risk," says Jonathan Whiteson, director of the Cardiovascular Rehabilitation Program at New York University Langone

Medical Center. Some research has suggested that drinking red wine may increase one's HDL, or "good" cholesterol, but

Whiteson notes that the boost is minimal. "Exercise [offers] a better increase in HDL," he says.

While he's not against a drink in a social setting, it's certainly not something folksespecially those with heart diseaseshould

engage in with the idea that it will offer a heart benefit, says Whiteson. In fact, medications' effectiveness can be either

hampered or heightened by alcohol, sometimes to a dangerous extent. (Common herbal supplements can interact with heart

drugs, too). And drinking too much can lead to high blood pressure or increased blood levels of triglycerides, a type of fat.

Bottom line: The American Heart Association suggests that otherwise healthy individuals who drink should do so in moderation.

That is defined as one to two drinks per day for men and one drink per day for women. And be careful with that pour: The AHA

defines a drink as one 12-ounce beer, a 4 ounce glass of wine, 1.5 ounce of 80-proof spirits, or 1 ounce of 100-proof spirits.

2. Salt intake

Some experts say that the pervasive use of sodium in the America diet is wreaking havoc on our cardiovascular systems.

"Sodium causes retention of fluid within the circulation, and if you're sodium-sensitive, it expands your blood volume and can

contribute to high blood pressure, stroke, and other heart d isease," explains Clyde Yancy, medical director of the Baylor Heart

and Vascular Institute at Baylor University Medical Center in Dallas and spokesman for the American Heart Association.

A report in the New England Journal of Medicinesuggested that if Americans reduced daily salt intake by 3 grams, we could

significantly lower the annual number of new cases of coronary heart disease (by between 60,000 and 120,000), stroke (by

32,000 to 66,000), heart attack (by 54,000 to 99,000), and even the number of deaths from any cause (by 44,000 to 92,000).

The paper's authors noted previous research that showed the average American man consumes 10.4 grams of salt daily, while

the average American woman gets 7.3 grams.

Bottom line:The AHA recommends Americans limit salt intake to 1.5 grams daily. Be wary: Sodium creeps in via unexpected

sources, and it's not so much the salt shaker on our table that's to blame. Research suggests we get as much as 80 percent of

our daily salt intake from processed foods.

3. Sugar intake
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It's not just the savory flavors that'll get you; sweets, too, can ultimately become a cause for concern, says the American Heart

Association. Like salt, sugar creeps into the processed foods that make up much of the American diet, and sweetened

beveragessoda, juices, and sports drinksare especially loaded with the stuff. Here's some disturbing math for you: A 12-

ounce can of soda has about 8 teaspoons (or 33 grams) of added sugars, totaling about 130 calories. (A gram of sugar

translates into 4 calories.)

A can of Coke or Pepsi, then, basically takes you to the AHA's new upper limit on the recommended amount of added sugar

Americans should ingest on a daily basis. The association's primary concern is the number of excess calories that added

sugars sneak into our diets and pile onto our waistlines, which can contribute to metabolic changes that increase the chances

of developing a host of diseases.

Bottom line: According to the AHA, women should get no more than 100 calories per day of added sugars and men should stop

at 150 calories per day.

4. Resting heart rate

How hard does your heart have to workand how fast does it have to pumpto get oxygen-rich blood throughout your body?

A lower number suggests your cardiovascular system is more efficient at doing this. Thus, a highly trained athlete can have a

resting heart rate in the 40s, says Whiteson.

And while the research is still emerging on what one's resting heart rate predicts about heart disease risk, a picture is beginning

to take shape. "There is certain evidence to support [the idea that] a higher resting heart rate is associated with heart disease,"

especially ischemic heart disease, he says, which involves reduced blood flow (and oxygen) getting to heart arteries and the

heart muscle. This effect seems to be more pronounced in women than in men, but a study in the Journal of Epidemiology and

Community Healthsuggested that in women up to the age of 70, every 10-beats-per-minute increase in resting heart rate

boosted the risk of dying from ischemic heart disease by 18 percent. In men, the risk was increased by 10 percent for every

extra 10 beats per minute, and age didn't have an impact. The study also found that women who got high levels of physical

activity were able to reduce their risk of death considerably, compared with those who did little or no activity. The same effect

was not found in men, but the researchers suggest the results may have been skewed because men tend to overestimate how

much exercise they get.

Bottom line: A normal resting heart rate is between 60 and 100 beats per minute. Check yours by finding your wrist's pulse,

counting the beats in a 15-second period, then multiplying by four.

5. Hours of sleep per night

An overcaffeinated America seems to perpetually crave more shut-eye. And evidence is cropping up to suggest that a poor

night's sleep is not only felt the next day but could have implications for one's heart over the long term. It is well established that

sleep apnea, which results in numerous interruptions to breathing while asleep, is associated with stroke and coronary artery

disease.

The reason is not clear, says Whiteson, but it's been hypothesized that people with disrupted sleep breathing have higher blood

pressure overall because they don't get the restorative sleep that normally allows blood pressure to go down and gives the

cardiovascular system a break during slumber. And a study in the Journal of the American Medical Associationshowed that

middle-aged people who got five hours of shut-eye or less a night had a greater risk of developing coronary artery disease than

those who got eight hours. The clue was the beginnings of calcium buildup in their arteries, found by CT scanning long before

the disease process would normally be picked up.

Bottom line: Get eight hours of sleep per night. Making it happen isn't easy, we know.

6. Exercise

You've heard it a thousand times over, and the message stays the same: Regular, heart-thumping exercise offers a multitude of

health benefits, particularly for cardiovascular fitness. Perhaps clinicians (and health writers) keep bashing us over the head


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with that fact because of the eye-popping number of American adults who reported getting zero vigorous activity in a 2008

Centers of Disease Control and Prevention survey: 59 percent.

Bottom line: For a clean bill of health, the major health associations (including the AHA and the American College of Sports

Medicine) suggest a minimum of 150 minutes of moderate-intensity physical activity each weeksay, brisk walking that boosts

your heart rate. This translates into 30 minutes of exercise on five days of the week. Twice-weekly strength training of eight to10 exercises, up to 12 reps each, is also on their to-do list.

Whiteson at NYU Langone Medical Center suggests that those who don't have heart disease should bump that

recommendation up to 60 minutes a day, five days a week of vigorous activity, where you're breathing pretty heavily and

sweating. But he offers a concession: "You can break it up" into, say, three 20-minute sessions per day, since "the effect of

aerobic exercise is cumulative." He also thinks those without heart disease should do strength training thrice weekly. Individuals

with heart disease should always discuss a new exercise regimen with a doctor first, he says.

7. Cigarettes

A 2009 study of Norwegians found that heavy smokersthose who puff at least 20 cigarettes per daywere 2.5 times more

likely to die over a 30-year period than nonsmokers. But the cardiovascular risks associated with smoking aren't just seen in

chain smokers.

The more nuanced message that doesn't always get across is the risk that the occasional smoker is exposed to. Even 10

minutes of secondhand smoke exposure may affect cardiovascular function. Just because you might not smoke a pack a day

or even a week doesn't mean you're in the clear. "There is no safe level of exposure" to tobacco smoke, says Yancy.

Bottom line To protect against heart disease (not to mention cancer, stroke, and reproductive problems), the goal is to smoke

exactly zero cigarettes.

8. Blood sugar

Over time, high blood sugar levels associated with diabetes can damage nerves and blood vessels. This can spur the buildup

of fat on blood vessel walls, which can impede blood flow and promote atherosclerosis. Having diabetes increases one's risk of

cardiovascular disease considerably. Three quarters of those with diabetes die of heart or blood vessel disease.

Your body's ability to use glucose (blood sugar) properly can be tested by getting a fasting blood glucose test, which is a

snapshot of your blood sugar at the time, or by getting a hemoglobin A1C test, which measures overall blood glucose over the

previous three months. Both can be insightful. "There is data to suggest that there is a significant decrease in the risk of heart

and vascular disease with every 1 percent reduction in hemoglobin A1C," says Whiteson.

Bottom line: The more controlled, the better. The normal range for a fasting blood glucose test is typically less than 100

milligrams per deciliter; prediabetes is indicated by a level between 100 and 125 mg/dL and diabetes by a reading of 126 mg/dL

or above. A normal hemoglobin A1C level is below 6 percent, and those with diabetes should aim to keep it under 7 percent.

9. C-reactive protein

Inflammation is a process our body uses to fight off an assault, like a cold or injury, in order to heal. But over the long term,

chronic inflammation plays a detrimental role to health because the nasty byproductsinflammatory molecules like cytokines

are believed to be part of several disease processes, including atherosclerosis, obesity, and Alzheimer's disease. In the realm

of heart disease, much ado has been made of c-reactive protein, a marker for one's level of inflammation that can be picked up

through a blood test called hs-CRP, for high-sensitivity c-reactive protein.

Who should get the test, and what are doctors to do with the results? Those are matters of considerable debate. "We can't treat

high [c-reactive protein]," says Whiteson. It's an indicator of potential heart trouble, but medicine doesn't have the tools, via

medications or procedures, to bring an elevated c-reactive protein down to normal. It is possible, however, to directly treat other

critical risk factors like high blood pressure and high cholesterol. Doing so can bring down the risk of future cardiac events and


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death. A landmark study from late 2008 found that subjects who did not have heart disease and had normal cholesterol and

who took statins had a lower risk of heart attack and stroke and also had fewer angioplasties and bypass surgeries over the

course of the study, compared with the group who took a placebo. But too many questions remain about the study to make a

blanket statement that folks should be taking statins more liberally.

Bottom line: According to the American Heart Association, a hs-CRP measure of 1 mg/L means you are at low risk ofdeveloping cardiovascular disease, a measure between 1 and 3 mg/L means you are at average risk, and levels above 3 mg/L

means your risk is high. Getting the test may be helpful, says Yancy, if you are at intermediate risk for heart disease based on

other risk factors and your doctors would like another data point to determine treatment. But "there is no need to check CRP if a

person already has high risk or truly is in the healthy bracket," he says.

10. Waist circumference

While not a direct measure of heart disease, a high waist circumference tracks with increased risk for high blood pressure, high

cholesterol, and diabetesall of which have a direct impact on heart health. And the bigger the belly, the heavier one tends to

be. Obesity, of course, is a well-known risk factor for a range of diseases, including heart disease.

Importantly, a higher waist circumference indicates distribution of fat around the abdomen and packing fat around vital organs,

which research has indicated is more dangerous than carrying weight in the thighs or buttocks. Be sure you're measuring

properly. The correct waist circumference measurement is taken by wrapping a measuring tape around the natural waist at the

belly button, not around the hips.

Bottom line: Men should have a waist circumference of less than 40 inches. The figure for women is less than 35 inches.

11. Body mass index

Your weight matters, but it has to be considered in the context of how tall you are. Body mass index takes the two numbers into

account. Like waist circumference, BMI is an indirect measure of risk, but a higher measure correlates with greater risk. The

catch, however, is that it is not always entirely accurate. A person in excellent condition who has a lot of muscle mass may

have a high BMI.

Too much excess weight is associated with diabetes, heart disease and stroke, some cancers, sleep apnea, osteoarthritis, fatty

liver disease, and complications in pregnancy.

Bottom line: People with BMIs less than 18.5 are underweight. Target BMI range is between 18.5 and 24.9. Overweight is

considered between 25 and 30, and a BMI above 30 puts you in the obese category.

12. Blood pressure

This one is critical to heart health. According to the National Heart Lung and Blood Institute, 1 in 3 Americans have high blood

pressure. When a nurse wraps the cuff around your arm, she's taking a reading of the force on the walls of your arteries, which

is subject to fluctuating pressure as the heart beats to push blood through your body. The trouble is, high blood pressure

doesn't have any telltale symptoms, so a person might be living with hypertension unknowingly. Over the long haul, elevated

blood pressure can damage organs and fuel a cascade of problems.

Action to lower blood pressure can include medications, but diet and exercise can really beat those numbers back into

submission. The DASH diet (Dietary Approaches to Stop Hypertension)high in veggies, fruit, fish, and whole grains but low in

red meat fat and sugarhas been shown to lower blood pressure significantly. And research has suggested that the DASH diet

packs an especially powerful wallop when people simultaneously work to reduce salt intake, a known blood pressure booster.

Bottom line: "The only number that really matters is 120 over 80," which is the cutoff for a normal blood pressure reading, says

Yancy. The more one's blood pressure surpasses that level, the more damage to the vascular system, heart, and kidneys. The

top number is called systolic blood pressure and is the measure of pressure while the heart beats. The bottom number is called

diastolic and is the measure of pressure between heart beats. A reading above 120/80 but below 140/90 is considered


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prehypertension; anything above that is high blood pressure. Both require attention and steps to bring the blood pressure back

under control.

13. Cholesterol

Your cholesterol level is a measure of the fats circulating in your bloodstream. With out-of-whack cholesterol levels comes

greater risk for coronary artery disease and stroke. Reducing saturated fat, trans fat, cholesterol, and total fat can help bring

down your cholesterol level. And exercise, says Whiteson, "is one pill that treats all ills. It can touch all risk factors for heart

disease," including reducing weight, reducing stress, improving blood sugar profiles, bringing down high blood pressure, and

lowering total cholesterol, lowering LDL (the "bad" cholesterol), increasing HDL (the "good" cholesterol), and lowering

triglycerides, a type of fat in the blood.

Bottom line: You're aiming for total cholesterol below 200 mg/DL; above 240 mg/DL puts you at twice the risk of coronary artery

disease as a person within the normal range. HDL should be above 40 mg/DL for men and above 50 mg/DL for women

(women tend to have higher HDL before menopause); above 60 mg/DL is categorized as protective to your heart. LDL ideally

should be below 100 mg/DL, though up to 129 mg/DL is near optimal. High LDL is considered 160 mg/DL or above.

Triglycerides should be below 150 mg/DL; a measure above 200 mg/DL is considered high.

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Your Heart Health Everyone Should Know.docx