CARDIOVASCULAR HEALTH

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1 SPECIAL ADVERTISING FEATURE CARDIOVASCULAR HEALTH Cardiovascular disease (CVD) is our nation s leading killer for both men and women, and among all racial and ethnic groups. More than 960,000 Americans die of CVD, principally heart disease and stroke, each year, accounting for more than 40% of all deaths. The death toll alone does not tell the full story about cardiovascular disease. About 58 million Americans almost one-fourth of the nation s population live with some form of CVD. One of every two males and one of every three females aged 40 years and under will develop heart disease sometime in their lives. Congestive heart failure, one form of cardiovascular disease, is the single most frequent cause of hospitalization for people aged 65 years or older. CVD is also the leading cause of premature, permanent disability CVD: What It Is, What It Costs U.S. Surgeon General Dr. David Satcher among working adults. Stroke accounts for disability among more than one million people nationwide, while almost six million hospitalizations each year are due to cardiovascular disease. CVD costs the nation $274 billion each year in health expenditures and lost productivity. Racial disparities exist in this area. For example, African-American men die from heart disease at nearly twice the rate of white men, and African-American women are 40% more likely to die from cardiovascular disease than white women. The following articles take a closer look at the causes of CVD as well as the various ways you can help prevent it. I hope you'll read them carefully, and use the information to protect your health and the health of those close to you. Many are learning how to rise above the grip of heart disease and live healthier lives. ILLUSTRATIONS BY PAUL ZWOLAK Conceived and produced by EXPERT REPORTS / FUTURE PERFECT! Contact us at PerfectFuture@ .com or at 7 Teresa Lane, Cortlandt Manor, NY Special thanks to Israel Berkowitz, MD, Attending Cardiologist, Lenox Hill Hospital in New York City; Ellen Grabowitz, MD, of Cortlandt Manor, NY; and Damon Thompson, Director of Public Affairs, U.S. Government Office of Public Health and Science for their valuable editorial assistance. EXPERT REPORTS / FUTURE PERFECT! creates advertising supplements that contribute to greater understanding of important social issues.

2 SPECIAL ADVERTISING FEATURE KNOW THE SYMPTOMS OF A HEART ATTACK THEY COULD SAVE YOUR LIFE The American Heart Association says the body will likely have one or more of these symptoms: Most Common or Classic Warning Signals of a Heart Attack: Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back Pain that spreads to the shoulders, neck or arms Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath Less Common Warning Signs of Heart Attack: Atypical chest pain, stomach or abdominal pain Nausea or dizziness (without chest pain) Shortness of breath and difficulty breathing (without chest pain) Unexplained anxiety, weakness or fatigue Palpitations, cold sweat or paleness Not all these signs occur in every attack. Sometimes they go away and return. If some occur, get help fast If you notice one or more of these symptoms in yourself or another person, don t wait. Call your emergency medical services immediately. Every minute counts. Treatment can be more effective if given quickly. CVD Risk Factors and Lifestyle Changes U.S. Surgeon General Dr. David Satcher Heart disease and stroke share several risk factors, including high blood pressure, cigarette smoking, high blood cholesterol and overweight. Physical inactivity and diabetes are additional risk factors for heart disease. They have not declined in recent years and, in some cases, they have even worsened: Only about one-quarter of Americans with high blood pressure have their condition under control. More than 50 million American adults have blood cholesterol levels that require medical advice and treatment, while more than 90 million adults have cholesterol levels that are higher than desirable. Nearly 450,000 people a year die from smoking in the U.S., while 3,000 teenagers a day become new smokers, one-third of whom will become addicted before they are old enough to legally buy cigarettes. Overweight and obesity are growing public health problems, affecting adults, adolescents and children. Some 97 million adults are obese or overweight and thus are at increased risk of illness from high blood pressure, high blood cholesterol and other lipid disorders, type 2 diabetes, heart disease, stroke, and other diseases. TV, video games and computers increasingly contribute to sedentary lifestyles among children, while only one state in the Union still requires physical education in grades K through 12. At the same time, diabetes in overweight children is on the rise. Efforts to promote heart-healthy behaviors beginning in childhood are needed to help reverse these trends. Lifestyle changes can have a dramatic effect on these risk factors. We could reduce deaths from CVD in America by 50% if everyone would incorporate moderate physical activity (walking, gardening, swimming, washing the car, jogging, riding a bicycle) into their daily schedules. People who quit smoking before age 50 have half the risk of dying within the next 15 years as do continuing smokers. I have developed a Surgeon General s Prescription that addresses lifestyle changes. You won t see any medications prescribed on it, but rather the following: 1) at least 30 minutes a day of moderate physical activity for at least five days a week; 2) eat at least five servings of fruits and vegetables a day; 3) avoid toxins such as tobacco, illicit drugs and the abuse of alcohol; and 4) responsible sexual behavior, including abstinence where appropriate. With particular regard to cardiovascular disease, I would also suggest that all adults aged 20 years and older should have their cholesterol levels checked at least once every five years to help them take action to prevent or lower their risk. Healthy lifestyles are not merely individual responsibilities; often, they are also community responsibilities. If we glamorize smoking and sell cigarettes to our children, if we don't require physical education in our schools, if adults don't organize children s sports activities, if our cafeterias at school and work do not support good nutrition and if there are no places where citizens feel they can safely engage in physical activity, those are community problems that require a community-wide response. What is Heart Disease? Rose Marie Robertson, MD President, American Heart Association Coronary heart disease is caused by narrowing of the coronary arteries the large vessels that bring blood to the heart muscle and it affects more than 12 million Americans. This narrowing occurs through a process called atherosclerosis. Atherosclerosis involves the buildup of plaque fatty substances, cholesterol, cellular waste products and other substances in the inner lining of an artery. In addition, there is an actual growth of cells in the artery wall that contributes to the narrowing. Atherosclerosis affects the body s larger arteries. These include the coronary arteries, which deliver blood to the heart; the aorta, which delivers blood from the heart to the rest of the body; and two branches of the aorta, called the carotid arteries, which deliver blood to the brain. As the passageways of the coronary arteries narrow, blood flow to the heart is reduced and the heart s oxygen supply may be limited. This lack of oxygen can produce chest pain known as angina pectoris, a heart attack or both, and it may permanently damage the heart muscle itself. If the blood supply to the brain is cut off, a stroke can occur. A heart attack occurs when the blood supply to part of the heart muscle is severely reduced or stopped, such as when one of the coronary arteries is affected by the buildup of plaque. The plaque can eventually tear or rupture, triggering a blood clot to form that blocks the artery and leads to a heart attack. Atherosclerosis is a slow, progressive disease and we now know that it sometimes starts in childhood! Many scientists think atherosclerosis begins because the innermost layer of the artery, called the endothelium, becomes damaged. Some factors that increase the risk of damage to the arterial wall are smoking, high levels of cholesterol and triglycerides in the blood, high blood

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4 SPECIAL ADVERTISING FEATURE KNOW THE SYMPTOMS OF STROKE THEY COULD SAVE YOUR LIFE The National Stroke Association says the body will likely have one or more of these symptoms: Sudden numbness or weakness of 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 If you notice one or more of these symptoms in yourself or another person, don t wait. Call 911 or your emergency medical services immediately. Symptoms that come and go quickly could mean a TIA transient ischemic attack or mini-stroke a serious warning of a stroke waiting to happen. Every minute counts. Treatment can be more effective if given quickly. pressure and diseases such as diabetes. Angina can occur when blood flow to the heart is enough for normal needs but not enough when the heart s needs increase. Chest pain may happen during physical exertion, such as running to catch a bus, strong emotions or extreme temperatures. But, some people may even have angina when they re resting. Angina is a sign that someone is at increased risk for heart attack. It s important to realize that some people, especially women, will have atypical symptoms, such as unusual shortness of breath, nausea or weakness, rather than chest pain. Unfortunately, heart disease can lead to congestive heart failure a condition in which the heart can t pump enough blood to meet the needs of the body s other organs. The failing heart keeps working but doesn t work as efficiently as it should. People with heart failure can t exert themselves because they become short of breath and tired. Heart failure often causes swelling in the legs and ankles, but possibly in the lungs as well. This interferes with breathing, causing shortness of breath, especially when a person is lying down. Symptoms of angina or heart failure should trigger you to see your doctor. Symptoms of a heart attack (see sidebar previous page) require immediate care. Rose Marie Robertson, MD, president of the American Heart Association, is Vice-Chair, Department of Medicine, Vanderbilt University Medical Center, and Medical Director-Vanderbilt Women s Heart Institute. Stroke is a Brain Attack! Patti Shwayder Stroke affects the most delicate and vital organ of the body, the brain. A stroke or brain attack occurs when blood flow to the brain is interrupted either by a clogged artery or a blood vessel rupture. When a stroke occurs, it kills brain cells in the immediate area. Brain cells are no longer able to receive the oxygen and nutrients they need to function. As cells die, the body loses control of the abilities that the affected area of the brain once controlled. Often this includes speech, movement and/or vision. Every minute counts. Treatments to restore function and lessen disability are available if administered quickly. Medications can dissolve blood clots quickly, allowing blood and oxygen to flow to the brain. The sooner a person can begin treatment, the greater the chances for a positive outcome and recovery. Implementing rehabilitation programs immediately also improves functionality and lessens the effects of stroke. Stroke touches the lives of four out of every five American families. It strikes 750,000 people each year, 160,000 of whom will die, making it the third leading cause of death in this country. Stroke is also a leading cause of adult disability, leaving a majority of those High blood pressure affects 50 million people in the United States, and while it causes no symptoms directly, if untreated it can lead to strokes, heart attacks and other health problems. Thus, having a regular blood pressure check should be a routine part of health care. High blood pressure is also called hypertension, referring to increased tension or pressure in the arteries. Blood pressure is continually varying, increasing during exercise and decreasing during inactivity and sleep. In conjunction with other risk factors such as smoking, diabetes and high cholesterol, hypertension accelerates the process of atherosclerosis (the formation of plaques which can block arteries). Thus, one s risks associated with hypertension depend on the presence or absence of these other factors. Blood pressure tends to increase with age, parwho survive with moderate to severe disabilities. The statistics are staggering, but fortunately, many strokes can be prevented by maintaining a healthy weight and diet, monitoring your blood pressure and cholesterol, and, if you smoke, stopping. Patti Shwayder is Executive Director and CEO of the National Stroke Association. Understanding Hypertension Thomas Pickering, MD

5 SPECIAL ADVERTISING FEATURE ticularly in westernized societies and both genetic and environmental factors influence how fast this happens. If both your parents had hypertension, your chances of getting it are substantially increased. Hypertension can also occur during pregnancy and can have serious health consequences for both mother and baby. But your lifestyle is equally important: if you put on weight your pressure will go up faster, and the typical American diet, high in salt and fat, and low in minerals such as potassium, calcium and magnesium, tends to raise blood pressure. Stress also contributes to hypertension. In the United States, hypertension is much more common in blacks than in whites, for reasons which are unclear. However, in Africa and elsewhere, blood pressure tends to be low in traditional village societies and increase when people move to big cities, suggesting that the stress and lifestyle of modern city life is responsible for higher blood pressure. Understanding Your Blood Pressure Numbers Blood pressure is expressed as two numbers, such as 120/80 or 120 over 80. The reason for this is that the pressure in the arteries is continuously going up and down with each heart beat. When your heart pumps blood into the arteries, the pressure inside the arteries goes up and the peak level is called the systolic pressure. Then the heart relaxes and the pressure in the arteries starts to fall and reaches a minimum level just before the next heart beat, which is the diastolic pressure. So the number 120 is a measure of the systolic pressure and 80 is a measure of the diastolic pressure. Of the two numbers, it is the systolic that is more important and in older people the systolic pressure may be high with a normal diastolic pressure (systolic hypertension). In some people the blood pressure may be high in a doctor's office but normal at other times (white coat hypertension). Because blood pressure is so variable, self-monitoring of blood pressure at home is increasingly recommended. Reducing Your Pressure The good news about high blood pressure is that it can be reduced lowering the risks of strokes by about 50% and heart attacks by 25%. Various medications, taken alone or in combination, can lower blood pressure. Non-drug methods of lowering blood pressure are also important and may be sufficient for some people with high blood pressure. For people who are overweight the best treatment is weight loss. Restricting your intake of salt and alcohol will also help. Importantly, a regular program of aerobic exercise can help you reduce both weight and blood pressure. Whichever type of treatment is used, the goal is to get the average blood pressure below 140/90, or 130/85 if there is also diabetes or kidney damage. Thomas Pickering, MD, is Director of the Integrative and Behavioral Cardiology Program at Mount Sinai Hospital, and founder of both the Hypertension Network and bloodpressure.com. Many of the strains on your heart and blood vessels can go undetected for years before causing any harm.

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9 SPECIAL ADVERTISING FEATURE Understanding Your Blood Chemistry By Antonio Gotto, MD Cholesterol, a fatty substance or lipid, is a normal component of the body, where it is used to make cell membranes and certain hormones. The body produces enough cholesterol to meet its needs, but high levels in the blood increase the risk for build-up in the arteries that may cause heart attacks. Cholesterol is carried through the blood by particles called lipoproteins. The cholesterol in low density lipoprotein (LDL) is called the bad cholesterol and increases the risk for a heart attack, while that in the high density lipoprotein (HDL) is called the good cholesterol and decreases the risk for heart attack. Another lipid is called triglyceride, a substance that your body uses to store energy made by the body or obtained from food. High levels of triglycerides may be associated with increased heart attack risk, especially for women or those with diabetes. Triglyceride is generally less recognized as a risk factor than cholesterol and is sometimes called the forgotten fat. Total cholesterol, HDL, LDL and triglyceride values are measured in milligrams per deciliter of blood. Today, physicians generally recommend a total cholesterol reading of 200 or less as favorable. However, societies where the cholesterol is lower have a lower risk for heart attack, so a value of 160 to 180 is probably a healthier range. A total cholesterol value greater than 240 is definitely considered high. For LDL, the goal should be a value less than 130, or if you already have heart disease or have diabetes, less than 100. In general the higher the HDL, the better. In fact it is better if your value is over 50, although the current guideline for defining a low HDL is less than 35. When measured after several hours of fasting, a desirable level of triglyceride is 200 or lower. A high level of triglyceride would be about 400 or greater. Other chemicals in the blood may also increase the risk for heart attack. One of these is homocysteine, an amino acid formed from the breakdown of other amino acids and not present in proteins. Values higher than 15 are thought to increase the risk for heart attack. Taking the vitamin folic acid or folate, found in vegetables or over-the-counter supplements, will reduce homocysteine. Cholesterol: Drugs and Diet LDL, or bad cholesterol, is removed mainly in the liver, where structures on the surface of liver cells called LDL receptors recognize and remove it from the blood. Diets high in saturated fat and cholesterol decrease these receptors and increase the bad cholesterol. This is why high fat diets are associated with increased risk for heart attack. Limiting the consumption of red meat and dairy products from whole milk and increasing consumption of vegetables, fruits and carbohydrates will lower the bad cholesterol. It is more difficult to raise the HDL, or good cholesterol, but aerobic exercise to the equivalent of running 12 to 15 miles a week will do so in most people. When diet and exercise alone are insufficient, adding drug therapy may help. The most effective and widely tested are called statins, which increase the receptors that clean the bad cholesterol from the blood. Another class of drugs called fibrates may help increase good cholesterol and decrease triglyceride, but have variable effects on bad cholesterol. Antonio M. Gotto, Jr., MD, D.Phil., is Dean of Weill Medical College of Cornell University where he is also a Professor of Medicine. It won t hurt to look under the hood and find out your cholesterol level.

10 SPECIAL ADVERTISING FEATURE WARNING SIGNS OF DIABETES Type 1 Diabetes Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue Irritability Type 2 Diabetes* Any of the type 1 symptoms Frequent infections Blurred vision Cuts/bruises slow to heal Tingling/numbness in the hands or feet Recurring skin, gum or bladder infections *Often people with type 2 diabetes have no symptoms If you are having any of these warning signs, contact your health care professional and get tested for diabetes. Diabetes, Heart Disease and Stroke: What You Need to Know Robert Sherwin, MD President, American Diabetes Association When it comes to diabetes, heart disease and stroke, the facts are deadly. Heart disease strikes people with diabetes more than twice as often as it strikes people without diabetes. It hits them earlier in life and it hits them harder. Adults with diabetes are two to four times more likely to die from cardiovascular disease than the general population. In fact, heart disease accounts for 80% of all deaths for people with diabetes, and more than half of all deaths for older people with diabetes. People with diabetes are also five times more likely to suffer strokes and once having had a stroke, are two to four times as likely to have a recurrence. They are less likely to have high levels of good cholesterol and are more likely to have high blood pressure, which can also lead to heart disease and stroke. With these odds, it s easy to get discouraged. But don t lose heart. There s a lot a person with diabetes can do to help prevent heart disease and stroke. Most of the cardiovascular complications related to diabetes have to do with the way the heart pumps blood through the body. Diabetes can change the chemical makeup of some of the substances found in the blood and this can cause blood vessels to narrow or to clog up completely. This is called atherosclerosis, or hardening of the arteries, and diabetes seems to speed it up. But in recent years scientists have learned a lot about keeping arteries free from blockages. If you have diabetes, here are some steps you can take to lower your risk of heart disease and stroke: Keep your blood glucose levels as close to normal as possible Stop smoking Eat a high-fiber, low-fat diet Keep your blood pressure numbers, and your total and bad (LDL) cholesterol numbers, as close to normal as possible Exercise Take an aspirin a day All of these actions will help keep your large blood vessels wide open, allowing the blood to flow to your heart, your brain and all of your vital organs. This will help to prevent both heart disease and stroke. So if you have diabetes, talk to your health care professional about lowering your risk for heart disease and stroke. The statistics may tell a grim story. But you can play a part in how this story ends. A good diet and active lifestyle may keep you from going under with the effects of diabetes.

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13 SPECIAL ADVERTISING FEATURE Obesity and Heart Disease: The Last Great Risk Factor James M. Rippe, MD and Kyle J. McInnis, ScD Americans are just too darn fat and it is killing us. Anyone who has tried to lose weight knows that the battle of the bulge is not an easy one. But, the stakes couldn t be higher. While impressive gains have been made in controlling other CVD risk factors, during the last decade, the prevalence of obesity in the United States has skyrocketed. Between 25-35% of the adult population in the United States is obese. Over half of the adult population is at least somewhat overweight. Even more alarming, the prevalence of obesity grew a shocking 40% in the last decade! By the time an individual is more than 20% over normal body weight, the chances are he or she is obese. A more precise estimate can be obtained by determining your Body Mass Index (BMI). To calculate your BMI you can visit the National Heart, Lung, and Blood Institute s website at By the time an individual is 30% overweight, the risk of heart disease has doubled. The more overweight you are, the higher your risk of heart disease. In addition, obesity is strongly related to other major risk factors for heart disease. It is estimated that over 50% of all blood lipid problems, 40-70% of all high blood pressure and over 85% of all cases of adult onset diabetes are obesity related. Certain types of body fat distribution carry additional cardiac risk. Individuals who accumulate excess body fat around their abdomen (so-called apple shaped) are at higher risk for developing heart disease than individuals who tend to accumulate excess fat in their hips and thighs (so-called pear shaped). Adult weight gain also increases cardiac risk. Even gains of only 15 to 20 pounds substantially increase risk. Fortunately, there is also some good news in the battle of the bulge. First, weight loss of as little as 5-10% of initial body weight will significantly lower cardiac risk. Second, you can lose weight simply following good nutritional guidelines and increasing physical activity. And for some, effective medical treatments are now available. Physical activity is critically important both for short-term weight loss and maintenance of weight loss. The best advice is to accumulate minutes of moderate physical activity on most, if not all, days. In some instances, your doctor may recommend medications to enhance weight loss and maintenance of proper body weight. Xenical diminishes the quantity of fat absorbed by the body and has the independent benefit of lowering cholesterol while Meridia affects brain chemistry to decrease appetite. To learn more about the relationship between weight and health, join the Registry of Weight and Related Disorders. For information visit its website: or call REWARD. James Rippe, MD, is Associate Professor of Medicine (Cardiology) at Tufts University School of Medicine. He is Director of the Rippe Lifestyle Institute in Shrewsbury, Massachusetts and the Rippe Health Assessment at Florida Hospital, Celebration Health in Orlando. Dr. Kyle McInnis is the Director of Research and Preventive Cardiology Programs at the Rippe Lifestyle Institute and Assoc. Professor of Exercise Physiology at the University of Massachusetts in Boston. FOR MORE INFORMATION Office of the Surgeon General U.S. Department of Health and Human Services 200 Independence Ave., SW Washington, DC American Heart Association 7272 Greenville Ave. Dallas, TX AHA-USA1 National Stroke Association 9707 East Easter Lane Englewood, CO STROKES American Diabetes Association 1701 North Beauregard St. Alexandria, VA DIABETES Successful weight loss can help prevent heart disease and add years to your life. Combating Obesity: What You Can Do Individuals who lose weight and keep it off invariably pay attention to what they eat. For many, simple lifestyle measures will result in short-term weight loss and long-term maintenance of healthy body weight. By far the most effective strategy is portion control following good basic nutritional guidelines and cutting down on your portions. Simply paying attention to decreasing the amount of fat in the diet will result in weight loss for some people. However, calories still do count. Substituting high caloric products in pursuit of a low fat diet will not work.

14 Reprinted from TIME magazine, December 11, 2000 issue Time Inc.