A Guide to Improving Your Heart Health. Understanding and Managing. Cholesterol

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1 A Guide to Improving Your Heart Health Understanding and Managing

2 Understanding and Managing Guiding Your Way Use the interactive features described here to add to your learning experience. Download PDF. Download or print activity sheets that help you manage your health. To use this tool, install the free Adobe Acrobat Reader ( Contents Why Matters...3 Types of and Fat....4 Symptoms of High...6 Risk Factors for High...7 Diagnosing High....8 Audio. Listen to the audio version of the pages you are viewing. Play. Play videos and animations by pressing the play button. Highlighted Text. Click on any highlighted text (in red) and you will see a definition of that word. Quizzes. Check what you have learned throughout this guide. Treating High....9 Questions to Ask Your Health Care Provider...18 Familial Hypercholesterolemia: A Bigger Problem...19 Symptoms of FH...20 Diagnosing FH Treating FH...21 Learn More. CardioSmart registered users can track key health indicators and their physical activity online. ( MEDICAL REVIEWERS: Martha Gulati, MD, MS, FACC, FAHA, FASPC, Editor-in-Chief of CardioSmart Susan D. Housholder-Hughes, RN, MSN, ANP-BC, FAHA, AACC Nkechinyere Ijioma, MD CardioSmart is sponsored in part by Pfizer. 2

3 CardioSmart.org/High Why Matters You have undoubtedly heard much about cholesterol by now as in, too much of some kinds can be a bad thing for your heart s health. But what exactly is cholesterol? How does too much of it threaten your heart? And what can you do about it? In this guide, you ll learn more about cholesterol and your cardiovascular health. We ll give you some of the tools you ll need to manage your cholesterol levels in a healthy way. Of course, working with your health care providers is even more important. is a fatty, waxy substance that is found in your bloodstream. You get cholesterol from two sources: Your body makes it (in fact, it makes all you need), and you get it from the foods you eat., in and of itself, is a good thing. Your body uses cholesterol to make the outer coating of your cells, and it even helps the body make vitamin D and some hormones. But too much of the wrong kinds of cholesterol can cause major health problems, even threatening the health of your heart (heart attack) and brain (stroke). In fact, the Centers for Disease Control and Prevention (CDC) reports that your risk of having heart disease is twice as great if you have high levels of total cholesterol. PLAY VIDEO 3

4 Understanding and Managing Types of and Fat There are three main types of fats in the bloodstream: LDL cholesterol is the bad type of cholesterol. LDL stands for low-density lipoprotein. It can build up in the bloodstream, forming plaques that attach to the walls of your arteries. These plaques can build up, narrow and harden your arteries, eventually choking off the flow of blood through the arteries. This process is called atherosclerosis. When that happens, your heart and PLAY VIDEO LDL other organs and tissues don t get the blood they need to function, and a heart attack or stroke can result. That s why a high level of LDL cholesterol is linked to a higher risk of heart disease or stroke. HDL cholesterol is the good type of cholesterol. HDL stands for high-density lipoprotein. HDL cholesterol actually helps your bloodstream get rid of LDL cholesterol and other bad fats. A high level of HDL is associated with a lower risk of getting heart disease or stroke. Triglycerides are a third type of fat in your blood that can also cause serious health problems. High levels of triglycerides are also linked to higher risk of heart disease and stroke. PLAY VIDEO Triglycerides 4

5 2016 American College of Cardiology and StayWell. All rights reserved. CardioSmart.org/High The CDC reports that 73.5 million Americans have LDL cholesterol levels that are too high. That s nearly onethird of the U.S. adult population. Also, fewer than 1 out of 3 American adults have the condition under control. That s probably because less than half of American adults with high LDL cholesterol are getting it treated. Understanding and Managing My Levels Each time you have your cholesterol checked, record the results below. Bring this chart to your next health care exam and discuss the results with your doctor. Date Total cholesterol HDL LDL Triglycerides For some people, their bodies make too much cholesterol, which drives their LDL cholesterol levels very high. This condition, called familial hypercholesterolemia (FH), is dangerous and must be treated as soon as it s detected. People with FH are at risk of heart disease even at very young ages. Buildup from a fat-like substance called cholesterol My Levels Download/print this PDF CardioSmart Registered users can track cholesterol levels online. Join to find out more. Too much cholesterol can clog your arteries and increase risk for heart attack or stroke. 5

6 Understanding and Managing Symptoms of High One of the problems with having high levels of the wrong kind of cholesterol in the bloodstream is that there usually are no symptoms of the condition until there is a significant blockage of the artery (often 70% or more). For many people who don t get their cholesterol tested, the first sign may be a heart attack or stroke. That s because the blockages caused by atherosclerosis can rupture or cause other major problems even when they are small and without causing any early symptoms. Signs of a Heart Attack Chest pain or discomfort (sometimes described as pressure or squeezing in the chest) Pain or discomfort in the arms, jaw, or back Nausea Sweating Shortness of breath For women, heart attacks can have additional, somewhat different symptoms. They may occur without the presence of chest pain or pressure and can include: Abdominal discomfort Extreme fatigue Feeling lightheaded or faint These are usually signs that the blood supply to the heart is being slowed or blocked. If you think you are having a heart attack, call 911 immediately. Know THE SIGNS of a Stroke Stroke symptoms appear quickly and suddenly, so it s important to know the signs and act fast. Use FAST to remember the warning signs: F FACE: A ARMS: S T Ask the person to smile. Does one side of the face droop? Ask the person to raise both arms. Does one arm drift downward? SPEECH: Ask the person to repeat a simple phrase. Is their speech slurred or strange? TIME: If you observe any of these signs, call 911 immediately. 6

7 CardioSmart.org/High Risk Factors for High The factors that may elevate your LDL cholesterol include: Poor eating habits: Eating too much food with unhealthy fats and carbohydrates Lack of daily physical activity Being overweight or obese High blood pressure Diabetes Age African-American race Family history of early heart disease Other health conditions, such as low thyroid levels (hypothyroidism) QUIZ 1 You re making great progress! Take a short quiz on what you ve learned so far. 7

8 Understanding and Managing Diagnosing High Fortunately, it s relatively easy for your health care provider to measure your cholesterol levels. This is most commonly done with a simple blood test called a fasting lipid panel. The fasting part means you go without food for a period of time before getting the blood test, usually 8 to 10 hours. (Your health care provider will tell you how long to go without food before the test.) When you get your results, you ll see four numbers measured in milligrams (mg) per deciliter (dl) of blood, or mg/dl. The four numbers are: Total cholesterol LDL bad cholesterol HDL good cholesterol Triglycerides The formula used to calculate total cholesterol is: LDL "Bad" HDL "Good TRIGLYCERIDES/5 TOTAL CHOLESTEROL If your total cholesterol level is Less than 200 mg/dl Between mg/dl Then you are Normal 240 mg/dl or above High Borderline-high If your results show high levels of total and LDL cholesterol, and/or triglycerides, your health care provider will talk with you about getting your levels into a healthy range. 8

9 2016 American College of Cardiology and StayWell. All rights reserved. CardioSmart.org/High Treating High Your health care provider will look at a variety of factors to see if your cholesterol levels need to be treated especially your overall risk of getting cardiovascular disease (heart disease and stroke). The first step to improve cholesterol levels is often making changes to your eating and exercise habits. Eating heart-healthy The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets are good places to start. The Mediterranean diet focuses on lean fish, whole grains, fruits and vegetables. The DASH diet is low in fat and sodium (salt) and is often recommended for people with high blood pressure (hypertension). Understanding and Managing How to Read a Food Label Nutrition Facts Serving Size 1 cup (240g) Servings Per Container 2 Amount Per Serving Calories 100 Calories from Fat 20 % Daily Value* Total Fat 2g 3% Saturated Fat 0g 0% Trans Fat 0g 0mg 0% Sodium 70mg 3% Total Carbohydrate 17g 6% Dietary Fiber 3g 12% Sugars 5g Protein 4g Vitamin A 70% Vitamin C 20% Calcium 15% Iron 8% *Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Serving size This tells you how much of the food makes up one serving. If you eat more than one serving, all the other values increase. Fat This is the total amount of fat in each serving. Limit saturated fats and avoid trans fats. Both are bad for your heart. This tells you how much cholesterol is in a serving. It s wise to limit your daily cholesterol intake. Sodium (salt) This is the total amount of sodium in each serving given in milligrams (mg). Try to eat less than 1,500 mg of sodium per day, but even consuming less than 2,300 mg per day has benefits. Total carbohydrate (starches) This tells you how many grams of carbohydrate are in one serving. Sugars By July 2018, nutrition labels will be updated to list added sugars, which should account for less than 10% of daily calories. How to Read a Food Label Download/print this PDF Talk with your health care provider about the diet plan that makes the most sense for you. In general, you want to: Limit the amount of saturated fats (fatty meats, full-fat dairy products) and carbohydrates you eat (and avoid trans fats completely, such as those found in many baked goods, fried foods and margarines). Avoid full-fat dairy products and processed foods, especially those with partially or fully hydrogenated oils. Hydrogenated oils are those that become solid at room temperature and are present in shortening, margarine, fried foods, baked goods and packaged snacks. Choose healthier (unsaturated) fats, such as olive oil, avocados and almonds, over butter or margarine. 9

10 2016 American College of Cardiology and StayWell. All rights reserved. Understanding and Managing Limit alcohol (no more than two drinks a day for males, or one drink a day for females a drink being one 12 oz. beer, one 5 oz. glass of wine, or 1.5 oz. of liquor). Keep in mind that alcohol contains sugars, which can raise triglyceride levels and provide empty calories that can make weight loss more difficult. Understanding and Managing My Food Diary Use this chart to keep track of the foods you eat. Meal Food Eaten Amount Notes Breakfast Snack Lunch Snack Dinner Snack My Fat and Goals: Making lifestyle changes can be challenging, so set small goals for yourself at first. It may help to talk with a dietitian about meal planning, and to keep a diary of the foods you eat. You can do that in the downloadable food diary on this page. Total Fat: g Saturated Fat: g Dietary : mg Food Diary Download/print this PDF Limit these Whole-fat dairy products, including cream, butter, whole milk, cheese and ice cream Egg yolks High-fat processed meats, such as hot dogs, salami, bologna and sausage Bakery goods that have been made with egg yolks, saturated fats and trans fats Organ meats (liver, kidney, brain, sweetbreads) Meat from ducks or geese that have been raised for market Eat more of these A variety of deeply colored fruits and vegetables several servings per day A variety of fiber-rich grain products, including whole-grain bread, cereal, pasta and brown rice 6 to 8 servings per day, with at least half of those servings being whole grain Fish, baked or grilled at least 2 servings per week Unsaturated vegetable oils, including canola oil, corn oil, olive oil or safflower oil; limit tub or liquid unsalted margarines and spreads made from them Lean meats and poultry without the skin, up to 5 to 6 total ounces per day (about the size of your fist) Nuts, seeds, and legumes (dried beans or peas), 4 to 5 servings per week 10

11 CardioSmart.org/High Heart-Healthy Diets Talk with your doctor & heart team about a diet that s right for you. MEDITERRANEAN This diet is LIGHT ON MEAT & SWEETS. DASH Dietary Approaches to Stop Hypertension (DASH) Diet focuses on LIMITING SALT TO LESS THAN 1,500 MG/DAY. FRUITS & VEGETABLES These diets: FRUITS, VEGETABLES & WHOLE GRAINS BEANS, LEGUMES & WHOLE GRAINS Help maintain a HEALTHY WEIGHT LOWER THE RISK of heart disease IMPROVE BLOOD PRESSURE LEAN MEATS & LOW-FAT DAIRY 2016, American College of Cardiology Z1627 FISH, NUTS & OLIVE OIL LEGUMES, GRAINS, SEEDS & NUTS FRUITS & VEGETABLES VEGETARIAN This dietary pattern CUTS OUT MEAT and, in some cases, SEAFOOD & DAIRY. 11

12 2016 American College of Cardiology and StayWell. All rights reserved. Understanding and Managing Daily Physical Activity For most people, getting 30 minutes of moderate-intensity activity at least five times a week is the goal. These activities can include walking, jogging, cycling or swimming or even gardening and heavy housework. The good news is that you don t have to get your half-hour in all at once. Breaking it up into 10-minute segments is just as effective in getting the benefits of physical activity as doing it all in one 30-minute block. Understanding and Managing My Activity Log Use this chart to keep track of the minutes of activity you do each day. Date What I Did Total Minutes of Activity My Activity Goals: minutes per day steps per day Total Steps per Day There are many little ways to add activity into your day, as well. Try parking farther away from your destination, taking the stairs instead of the elevator or escalator, dancing around the house, walking the dog, and getting off the bus or subway a stop or two before you arrive at your destination and walking the difference. My Activity Log Download/print this PDF Keeping your weight at a healthy level For many people, that means losing excess pounds. Losing just 5 to 10 pounds can lower your cholesterol levels. There s one reliable way to do this: Use more calories than you consume. Healthy weight loss typically means shedding no more than 2 pounds per week. Fad diets generally don t work for long, as people who go on them often gain the weight back once the novelty of the diet is gone. Quitting smoking If you don t smoke, don t start. If you do, talk with your health care provider about quitting. Smoking has terrible effects on your health, significantly raising your risk of cardiovascular disease, cancer and many other serious health conditions. Quitting can improve your HDL cholesterol level and improve your heart health. Be careful to avoid secondhand smoke, as well. There are several effective treatments available to help you quit. Call the Quit Line for help, too: QUIT-NOW. CardioSmart Registered users can track their activity and weight online. Join to find out more. 12

13 CardioSmart.org/High The Importance of Physical Activity Physical activity & stress reduction can help prevent or manage heart disease. WHY you should get moving... Supports a stronger heart Improves circulation Lifts mood & self-esteem Promotes sleep Lowers blood cholesterol, pressure & sugar Decreases the need for medications in some case Helps manage weight Reduces stress 2016, American College of Cardiology Z1544 MODERATE EXERCISE can be as simple as How you can REDUCE STRESS Dancing Brisk Walking Breathing Exercises Meditation Gardening Household chores such as vacuuming Progressive Muscle Relaxation Soothing Music Yoga 13

14 Understanding and Managing Medications For many people, even making lifestyle changes doesn t bring their cholesterol numbers into a healthy range. That s when medications often become the next step in treatment. This is especially true for people who have atherosclerotic cardiovascular disease or are at high risk for getting it. The first-line drug of choice is typically a statin. This class of drugs has been shown to be very effective in reducing the risk of cardiovascular events, such as heart attack and stroke. They lower cholesterol levels by blocking an enzyme needed to produce cholesterol. Each statin drug has varying degrees of additional benefits, which play a role in a health care provider s decision to prescribe one versus the other. As with any medication, statins have side effects, even though they are not common. If you have side effects from a statin you re prescribed, talk with your health care provider. Changing the dosing schedule, the type of statin prescribed, or the dosage can help reduce side effects. Sometimes, your health care provider will order an additional blood test to see if something else may be causing your symptoms. MEDICATION ADHERENCE MEANS : Make Sure You TAKE YOUR MEDICATION...in PROPER DOSES...at the RIGHT TIME 2X Daily AM/PM...the RIGHT WAY 14

15 2016 American College of Cardiology and StayWell. All rights reserved. CardioSmart.org/High There are other cholesterol medications, as well. These include: Understanding and Managing My Medication List Use this chart to keep track of all your medications. Any time your health care provider prescribes a medication, tells you to stop one or changes a dosage, record the change here. Share this list with any new health care provider you visit. Keep a copy in your wallet or purse. Generic Name Brand Name (if any) Strength (dose) Quantity per Dose How Often to Take Purpose Notes/Date Bile acid sequestrants: These medications help lower LDL cholesterol by causing excess cholesterol to be used to create more bile acids, which in turn help rid the bloodstream of cholesterol. They re often prescribed with statins. Ezetimibe: This medication is a cholesterol absorption inhibitor. It lowers LDL cholesterol by blocking the intestine from absorbing cholesterol. It is often used along with a statin. List all over-the-counter medications, vitamins, minerals, herbs and supplements you take: My Medication List Download/print this PDF CardioSmart Registered users can track their medications online. Join to find out more. Fibrates: These medications lower triglycerides and may help raise HDL cholesterol. They re sometimes prescribed with statins, as well. When they are used in combination with statins, they can increase the risk of muscle problems. Nicotinic acid: This medication lowers LDL cholesterol and triglycerides while raising HDL cholesterol. PCSK9 inhibitors: This new class of medication includes alirocumab and evolocumab, and is given by injection. It is used to further decrease levels of LDL cholesterol, in conjunction with other medications. PCSK9 inhibitors are also used to treat familial hypercholesterolemia (FH). 15

16 Understanding and Managing Regardless of which medications your health care provider prescribes, it s very important that you take your medications exactly as directed. That means taking your medications safely and as your health care provider instructs, and can include: Continuing to take your medications unless your health care provider tells you to stop. Setting a medication schedule, and sticking to it. It s helpful to take your medications at the same time every day so you re less likely to forget. Reading medication labels carefully. The labels usually contain vital information, such as whether to take the medication with food or drink, whether to avoid any types of food or drink while on the medication (for example, people who take statins should avoid grapefruit and grapefruit juice, which can interfere with how well the statin works), what the proper dosage is, and whether to avoid any activities while taking the medication. Taking medication PROPERLY can be challenging CardioSmart can help! 16

17 CardioSmart.org/High Sorting your medications into a pillbox. If you take medications as instructed at different times of the day, a pillbox with time-of-day compartments can be particularly helpful. Most drugstores carry pillboxes. Setting up a pill calendar or medication reminder. Many people find using an alarm on their watch or smartphone to be helpful, too. Ask your family or friends if they can help you remember. Download the FREE CardioSmart Med Reminder mobile app to help you take your medications as prescribed. CardioSmart Med Reminder App Download FREE App at CardioSmart.org/Tools/Med-Reminder Prescription Refill Alerts Secure Personal Medication Record Medication Reminders 17

18 Understanding and Managing Questions to Ask Your Health Care Provider It s extremely important that you understand what your cholesterol profile is, what it means for your heart health, and what you need to do to bring your cholesterol levels into a healthy range. Asking your health care provider the right questions can help. Here are some questions you may want to ask: 1. What are my cholesterol levels? 2. What is my risk for developing cardiovascular disease? 3. Do I need to be treated for anything other than cholesterol to help control my risk? 4. Can I lower my cholesterol levels enough by making changes to my diet and exercise habits? 5. How much exercise should I get when I start exercising more? 6. Are there any foods I should avoid or eat more of? 7. Do I need a medication? If so, which medication and why? 8. How long will it take to see improvement in my cholesterol levels? 9. What side effects should I be aware of? 10. Besides statins, what other medications are available for treating cholesterol levels? 11. How often should I get my cholesterol levels checked? 12. How can I raise my good cholesterol level? QUIZ 2 You re making great progress! Take a short quiz on what you ve learned so far. 18

19 CardioSmart.org/High Familial Hypercholesterolemia (FH): A Bigger Problem For more than 600,000 Americans, cholesterol is a major concern from early childhood onward. That s because they have a genetic (inherited from a parent) condition called familial hypercholesterolemia (FH). People with FH are at a high risk for getting cardiovascular disease, even when they re very young. There are two main types of FH. People who get the FH gene from one parent can have LDL cholesterol levels 2 to 3 times higher than normal. But people who inherit a faulty gene from both parents can have LDL cholesterol levels as high as 3 to 6 times higher than normal. This type of FH is harder to treat. FH must be treated properly. If it isn t, people with FH who have one faulty gene can have a cardiac event (such as a heart attack) as early as in their 40s or 50s. But those with two faulty genes can experience a cardiac event much younger as young as in their late teens or early 20s. 19

20 Understanding and Managing Symptoms of FH FH is different from the more common high LDL cholesterol levels because it can have distinct signs and symptoms. These can include: Untreated LDL cholesterol levels that range from 190 mg/dl to 400 mg/dl, or sometimes even higher. A family history of heart attacks at early ages, or high levels of total and LDL cholesterol. LDL cholesterol levels in one or both parents that are high and difficult to treat. Xanthomas (waxy deposits of cholesterol in the skin or tendons), xanthelasmas (yellowish cholesterol deposits in the eyelids), or corneal arcus (white, arcing cholesterol deposits around the cornea of the eye). Angina (chest pain), which can be a symptom of heart disease. FH is a Risk Factor for Heart Attacks Coronary Artery If you think you are having a heart attack, call 911 immediately! Heart attacks happen when the heart s blood supply is suddenly cut off. 20

21 CardioSmart.org/High Diagnosing FH Getting a diagnosis of high LDL cholesterol is important. Diagnosing FH as early as possible is absolutely critical. Health care providers diagnose FH with a complete family medical history and physical examination, as well as a fasting lipid panel. If LDL cholesterol levels are severely high, FH may be the reason why. Your health care provider may order additional tests, such as a genetic profile or procedures measuring heart function. Once the diagnosis is confirmed, treatment will begin promptly. The goal is to reduce the risk of cardiovascular disease, especially an event such as a heart attack or stroke. Treating FH A more aggressive approach to treatment is usually the case for people with FH. Changes to diet and exercise are nearly always part of the plan, and total fat intake is often limited to less than 30% of daily calorie intake. If body weight is an issue, weight loss is also often part of the plan. But these changes alone are rarely enough to bring cholesterol numbers into healthy ranges for people with FH. Medication therapy is almost always started as soon as FH is detected, even in young people. A combination of cholesterol-lowering medications is often the preferred approach, with statins, bile acid sequestrants, fibrates, PCSK9 inhibitors, and nicotinic acid (niacin) sometimes used together. But even medications, added to lifestyle changes, are sometimes not enough to help people with FH get their LDL cholesterol into a healthy range. For these people, a procedure called apheresis may be the next step. In apheresis, blood is extracted from the body and run through a machine that cleanses the excess LDL cholesterol through filtering and returns it to the patient. Whatever the treatment plan is, sticking to it is absolutely vital for a person with FH. Taking medication exactly as directed, keeping all health care appointments, and managing diet and exercise according to the plan are all important. QUIZ 3 You re making great progress! Take a short quiz on what you ve learned so far. 21

22 Understanding and Managing Get a Handle on Your Heart Health! Want to learn more about cholesterol and other factors affecting your heart health? Sign up now at CardioSmart.org! It s absolutely FREE and offers a wealth of in-depth information and tools on vital heart-health issues that matter to you, including: Personalized newsletters and alerts Trackers for key health indicators and physical activity Bookmarks for articles, fact sheets and questions to discuss with your doctor Quizzes to improve health and earn prizes Know Your Risk Calculator Heart Disease Risk Assessment Body Mass Index calculator CardioSmart Med Reminder App Download FREE App at CardioSmart.org/Tools/Med-Reminder 22

23 CardioSmart.org/High To learn more about cholesterol, visit CardioSmart.org/High. 23

24 Understanding and Managing My Levels Each time you have your cholesterol checked, record the results below. Bring this chart to your next health care exam and discuss the results with your doctor. Date Total cholesterol HDL LDL Triglycerides 2016 American College of Cardiology and StayWell. All rights reserved.

25 Understanding and Managing My Food Diary Use this chart to keep track of the foods you eat. Meal Food Eaten Amount Notes Breakfast Snack Lunch Snack Dinner Snack My Fat and Goals: Total Fat: g Saturated Fat: g Dietary : mg 2016 American College of Cardiology and StayWell. All rights reserved.

26 Understanding and Managing How to Read a Food Label Nutrition Facts Serving Size 1 cup (240g) Servings Per Container 2 Amount Per Serving Calories 100 Calories from Fat 20 % Daily Value* Total Fat 2g 3% Saturated Fat 0g 0% Trans Fat 0g 0mg 0% Sodium 70mg 3% Total Carbohydrate 17g 6% Dietary Fiber 3g 12% Sugars 5g Protein 4g Vitamin A 70% Vitamin C 20% Calcium 15% Iron 8% *Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Serving size This tells you how much of the food makes up one serving. If you eat more than one serving, all the other values increase. Fat This is the total amount of fat in each serving. Limit saturated fats and avoid trans fats. Both are bad for your heart. This tells you how much cholesterol is in a serving. It s wise to limit your daily cholesterol intake. Sodium (salt) This is the total amount of sodium in each serving given in milligrams (mg). Try to eat less than 1,500 mg of sodium per day, but even consuming less than 2,300 mg per day has benefits. Total carbohydrate (starches) This tells you how many grams of carbohydrate are in one serving. Sugars By July 2018, nutrition labels will be updated to list added sugars, which should account for less than 10% of daily calories American College of Cardiology and StayWell. All rights reserved.

27 Understanding and Managing Serving Sizes How much is an ounce? A cup? Ounces 2 to 3 ounces are about the size of your palm. 1 Cup 1 cup (or a medium-sized piece) is about the size of your fist. ½ Cup ½ cup is about the size of your cupped hand American College of Cardiology and StayWell. All rights reserved.

28 Understanding and Managing My Activity Log Use this chart to keep track of the minutes of activity you do each day. Date What I Did Total Minutes of Activity Total Steps per Day My Activity Goals: minutes per day steps per day 2016 American College of Cardiology and StayWell. All rights reserved.

29 Understanding and Managing My Medication List Use this chart to keep track of all your medications. Any time your health care provider prescribes a medication, tells you to stop one or changes a dosage, record the change here. Share this list with any new health care provider you visit. Keep a copy in your wallet or purse. Generic Name Brand Name (if any) Strength (dose) Quantity per Dose How Often to Take Purpose Notes/Date List all over-the-counter medications, vitamins, minerals, herbs and supplements you take: 2016 American College of Cardiology and StayWell. All rights reserved.

30 Your Comments and Suggestions are Needed! And now, please tell us what you think about this guide! We need your suggestions to make sure that this has everything you need to know about cholesterol. Go to our online survey and answer just a few questions. It will only take a few minutes of your time. Thank you for your help! For more information, visit CardioSmart.org/High Information provided for educational purposes only. Please consult your health care provider regarding your specific health needs American College of Cardiology

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