Heart disease remains the number one killer in the United States for both men and women. February is a great month to encourage your clients to renew their commitment to heart-healthy habits.
February’s focus on heart health is near and dear to me. My dear father had heart disease from the time I was 3 years old and died 10 years later at age 56. I was only 13 at the time, and it changed my life. A cherished uncle followed, and then another uncle (both my dad’s brothers). Years later, my mom had a heart attack, which was the beginning of her health decline at age 80. Then, a few years ago, I was challenged with a heart arrhythmia—I was the same age my dad was when he died. I never thought I’d see the day when I was the heart patient. But I was fortunate to have great care at the Cleveland Clinic, where an ablation procedure cured my symptoms. However, I’m careful to follow lifestyle habits to avoid future issues. My story isn’t unique; more than one in three adults have at least one type of CVD.1
Anyone who knows me knows that I’ve focused my career on improving nutrition care for older adults. Well, I’m celebrating a milestone birthday this month—and getting closer to being an “older adult” myself. So my health is at the center of my thoughts. Just because I’m an RDN, this doesn’t mean that I’m immune to health issues—or bad habits, for that matter. Heart month is a time to renew one’s commitment to heart-healthy lifestyle habits. I hope this information will help you coach your clients and patients to make changes to improve both the quality and quantity of their lives so that their children can enjoy them for many years to come.
Bit of Background
About one in every three deaths in the United States is a result of heart disease, stroke, or other CVD. There are some risk factors that can’t be controlled: age over 45 for men and over 55 for women, heredity (including race), or previous stroke or heart attack. But there are many risk factors that can be controlled, such as hypertension, tobacco smoking, hypercholesterolemia, physical inactivity, overweight/obesity, and diabetes.2 Almost one-half (47%) of Americans have high blood pressure, high cholesterol, or are smokers, risk factors that can be addressed through lifestyle changes.3,4
Urge Clients to Know Their Numbers
Heart disease risk is based on many factors. Each person will have goals for blood sugar, blood pressure, blood lipids (total cholesterol, LDL cholesterol, HDL cholesterol), and BMI based on their family history and medical condition, so encourage your clients to talk to their health care providers about setting goals. Typical targets are the following:
- Blood lipids: Goal levels vary for each individual depending on other heart disease risks, and treatment is recommended accordingly.5
- Blood pressure: Less than 120/80 mm Hg is considered normal. A blood pressure of 130/80 mm Hg is now used for a diagnosis of stage 1 hypertension.6
- Fasting blood sugar: Less than 100 mg/dL is considered normal; greater than or equal to 126 mg/dL is used to diagnose diabetes.7
- A1c: 4% to 5.6% is considered normal; greater than or equal to 6.5% is used to diagnose diabetes. For those with diabetes, a higher A1c may be acceptable.7
- BMI: 5 to 24.9 kg/m2 is considered a normal or healthy weight.8
Essential Steps for Heart Health
The American Heart Association (AHA) encourages people to follow “Life’s Simple 7”: manage blood pressure, control cholesterol, reduce blood sugar, get active, eat better, lose weight, and stop smoking.4 The detailed information below provides more specific guidance and goals your clients can aim for.
1. Manage Blood Pressure
Almost one in three American adults have high blood pressure, which is a major risk factor for first heart attack, stroke, chronic heart failure, and kidney disease.9,10 Smoking, eating high-sodium and low-potassium foods, physical inactivity, obesity, and heavy alcohol drinking are risk factors for hypertension.11
About 90% of Americans over age 2 consume too much sodium.12 The Dietary Approaches to Stop Hypertension (DASH) eating plan is well known as an effective intervention for lowering blood pressure. There’s an abundance of information about the DASH eating plan available from the National Heart, Lung, and Blood Institute.
It’s also helpful to reduce stress. Encourage your clients to take time out each day to relax, renew, and reenergize: go for a walk, do some deep breathing, or enjoy their favorite music, yoga, meditation, a hot bath, or talking to a friend. Even 10 to 15 minutes a day can be helpful.
2. Control Cholesterol
Educate clients on the benefits of choosing healthful polyunsaturated fats found in liquid vegetable oils such as sunflower and soybean oils, fish, flaxseeds, and walnuts, and monounsaturated fats found in nuts, nut butters, olives, olive and canola oils, and avocados.
The AHA recommends 5% to 10% of daily calories come from omega-3 and -6 fatty acids. Omega-3 fatty acids can help lower triglyceride levels and can be found in fatty fish, walnuts, flaxseeds, and eggs. Vegetable oils are major sources of omega-6s. Substitute these for solid fats and tropical oils such as coconut, palm, and palm kernel oils.13
Encourage reduced portions of foods high in saturated fats, which have been linked to heart disease. Cut visible fat from meat, remove skin from poultry, prepare foods using low-fat cooking methods (eg, baking, broiling, roasting), choose low-fat or no-fat dairy products, and read labels to identify more healthful foods.
3. Reduce Blood Sugar
This is especially important for people with diabetes, but important for others as well. Researchers recently have made the connection between high levels of sugar intake and heart disease. One study found a 38% higher risk of CVD mortality for people who consumed 17% to 21% of their calories from added sugars compared with those who consumed 8% of calories from added sugars. This was largely consistent regardless of age group, gender, Healthy Eating Index score, BMI, and physical activity level.14 The average sugar consumption of adults in the United States is 22 tsp sugars each day, which is more than three times the recommended level. Major sources of added sugars in the US diet can be found here.
Suggest clients eliminate sugary beverages and foods for at least 30 days to break the habit and instead drink unsweetened beverages such as water, sparkling water, infused water (eg, with lemons, limes, cucumbers, or fruit), or hot or iced tea. Start with limiting or eliminating obvious sources of sugar and switch to naturally sweet foods such as fruits. Remind them that raw sugar, honey, and agave syrup are all simple sugars. Encourage label reading and selection of choices that are lower in sugar. One more caution: Some studies suggest that even artificially sweetened foods and beverages may create cravings for sweets.15
4. Get Active
More than 80% of adults don’t meet the 2008 Physical Activity Guidelines for Americans for both aerobic and muscle-strengthening activities.16 Encourage clients to include physical activity on most days of the week. (People with health issues should get their doctor’s approval before starting an exercise program.) Exercising lowers blood pressure, strengthens the heart, helps maintain lean body mass, burns calories, and produces endorphins, the “feel-good” hormone.16 Experts recommend at least 150 minutes of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity aerobic physical activity, along with muscle strengthening exercises on two or more days per week for adults aged 18–64.17
People aged 65 and older are encouraged to follow the same guideline unless they’re physically unable. In that case, they should be as physically active as they’re able. They also should do exercises to improve balance and reduce risk of falls. For beginners, even 10 minutes at a time can be positive, and they can work up to the minimum of 60 minutes on most days to meet the recommendations.17
Fitness trackers or pedometers can motivate clients and keep you informed of their progress. I love the Fitbit feature that reminds you to do a minimum of so many steps every hour. It’s especially nice for people who work in sedentary jobs.
5. Eat Better
Sadly, US adults only consume vegetables about 1.6 times per day and fruit about 1.1 times per day.18 Most Americans don’t follow a healthful eating pattern, and, as a result, about 36% of US adults are obese.19 Start with encouraging individuals to follow a healthful eating pattern such as the USDA-recommended eating patterns including DASH-style diets, Mediterranean-style diets, and the Healthy Vegetarian Eating Pattern, as outlined in the 2015–2020 Dietary Guidelines for Americans.
6. Lose Weight
There are many benefits to losing weight and maintaining a healthy weight, including better control of hypertension, blood sugar, and hypercholesterolemia.20 Even a 10-lb weight loss can lower heart disease risk. There’s an abundance of good information on this subject available, so I won’t go into detail here. Controlling portion sizes of all foods is one simple way for your clients to control their calorie intake.
7. Stop Smoking
Unfortunately, 15% of US adults still smoke.21 Encourage your clients to stop smoking and refer them to a good smoking cessation program.
One more note: People sometimes alter doses or stop taking heart medications altogether, which can cause negative health outcomes. Suggest clients take medications as prescribed and talk to their doctor if they have concerns.
It takes time to develop new healthful habits. Encourage clients to take one step they believe they can be successful with and move forward from there. The most important key is that they believe they can make changes that become lifelong habits for better health and quality of life.
— Becky Dorner, RDN, LD, FAND, is widely known as one of the nation’s leading experts on nutrition, aging, and long-term health care. Her company, Becky Dorner & Associates, Inc., is a trusted source of valuable continuing education and resources dedicated to improving quality of life for older adults. Visit www.beckydorner.com and sign up for the free membership.
- American Heart Association My Life Check
- American Heart Association Cholesterol: Check. Change. Control.
- Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics — 2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e1-e458.
- Heart disease and stroke. Healthy People 2020 website. https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke. Accessed February 12, 2018.
- Heart disease risk factors. Centers for Disease Control and Prevention website. https://www.cdc.gov/heartdisease/risk_factors.htm. Updated August 10, 2015. Accessed February 12, 2108.
- My Life Check — Life’s Simple 7. American Heart Association website. http://www.heart.org/HEARTORG/Conditions/My-Life-Check—Lifes-Simple-7_UCM_471453_Article.jsp#.WoGHWkxFxPa. Accessed February 12, 2018.
- Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S1-S45.
- New ACC/AHA high blood pressure guidelines lower definition of hypertension. American College of Cardiology web site. http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017. Published November 13, 2017. Accessed February 12, 2018.
- Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes — 2018. Diabetes Care. 2018;41(Suppl 1):S13-S27.
- About adult BMI. Centers for Disease Control and Prevention website. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Updated August 29, 2017. Accessed February 12, 2018.
- Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B. CDC Grand Rounds: a public health approach to detect and control hypertension. MMWR Morb Mortal Wkly Rep. 2016;65(45):1261-1264.
- Mozzafarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics — 2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29-e322.
- High blood pressure fact sheet. Centers for Disease Control and Prevention website. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm. Updated June 16, 2016. Accessed February 12, 2018.
- Jackson SL, King SM, Zhao L, Cogswell ME. Prevalence of excess sodium intake in the United States — NHANES, 2009-2012. MMWR Morb Mortal Wkly Rep. 2016;64(52):1393-1397.
- Good fat versus bad fat. American Heart Association Go Red for Women website. https://www.goredforwomen.org/live-healthy/good-fat-versus-bad-fat/. Accessed February 9. 2018.
- Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;174(4):516-524.
- Artificial sweeteners. Harvard T.H. Chan School of Public Health website. https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/artificial-sweeteners/. Accessed February 12, 2018.