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Heart Health

Introduction

The heart

Atherosclerosis

Coronary heart disease

Cholesterol

Blood pressure

Smoking

Resources


Introduction

The Heart Health Manager is an educational guide to causes and prevention of heart disease. It lists the risk factors for heart disease and provides information about areas where you may intervene, taking control and lowering your relative risk of heart disease.There are sections containing information about cholesterol, blood pressure and smoking.

The Heart Health Manager helps you lower blood cholesterol and blood pressure in sections entitled "Guidelines for lowering blood cholesterol," "Helpful hints to reduce your cholesterol level" and "Lowering Blood Pressure."

Cardiovascular disease is the leading cause of death in the United States. By reducing your risk factors where you are able, you may lessen your risk of getting this disease and enjoy a healthier heart.


The heart

The heart is a pump. The heart beats continually during your entire life at roughly one beat per second. The exact rate is determined by a number of factors including your level of physical fitness. The heart weighs approximately five pounds. It is made up of muscle tissue. The heart pumps blood throughout the body, thereby delivering oxygen and nutrients to all the tissues.

Together with the arteries and veins, the heart forms the circulatory system. The heart itself consists of four chambers. They are the left and right atria and ventricles. Blood follows a specific cycle through the heart. Blood returns to the heart from the body by way of the venous system. This blood, which has supplied oxygen to the body and is now full of carbon dioxide (the waste product of metabolism) enters the heart by way of the superior vena cava into the right atrium. The blood then enters the right ventricle through the tricuspid valve. The right ventricle pumps the oxygen-poor blood into the lungs where the carbon dioxide is exchanged for oxygen. From the lungs the blood moves into the left atria, through the mitral valve and into the left ventricle. The left ventricle moves the blood through the aorta and to the rest of the body. Systole occurs when the heart contracts and blood is forced out of the ventricles. Diastole occurs when the heart muscle relaxes and blood enters the ventricles.

Related Topics:

Coronary circulation


Coronary circulation

Like any muscle, the heart needs its own blood supply to function normally. Although the heart is continually pumping blood through the atria and ventricles, it cannot obtain the oxygen it needs to function from this blood flow. Therefore, the heart has its own circulatory system that supplies the muscle with the oxygen it needs. This circulation is called the coronary circulation. The heart receives its blood from two coronary arteries which arise from the aorta. These two arteries then branch and supply the heart muscle with fresh oxygenated blood. Deoxygenated blood is removed from the heart muscle via the coronary veins. Just like any arteries in the body the coronary arteries can be damaged by high blood pressure, high cholesterol, smoking, and obesity. The end result is coronary artery disease, or a narrowing of the coronary arteries.


Atherosclerosis

Over time, high cholesterol, high blood pressure, obesity, and smoking take their toll on your arteries. All of these cause progressive narrowing of the arteries which leads to reduced blood flow. Fat and cholesterol gradually build up in the artery wall, slowly narrowing the artery, until the artery is completely blocked. Research has shown that if cholesterol is lowered, high blood pressure is controlled, weight is lost, and smoking is stopped, some of the process of build up can be reversed. It is, therefore, never too late to change your lifestyle.


Coronary heart disease

The leading cause of death in the United States is coronary heart disease (CHD). According to the United States Department of Health and Human Services more than six million Americans have symptoms of coronary heart disease. Each year more than one million Americans suffer a heart attack, and over 500,000 die of coronary heart disease. High cholesterol is one of the three controllable risk factors for coronary heart disease.

When arteries that carry blood to your heart muscle get clogged with deposits of cholesterol and fat (atherosclerosis) your heart does not get the food and oxygen that it needs. This is coronary heart disease. A heart attack occurs when these arteries are so clogged that blood stops flowing to a portion of the heart.

Related Topics:

Heart attack

Risk factors for coronary heart disease


Heart attack

A heart attack is also known as a myocardial infarction. An infarction is an area of tissue that has died due to lack of blood supply and oxygen. When it occurs in the heart it is termed myocardial ("myo" for muscle and "cardia" for heart).  The most common cause is from clot formation in one of the arteries supplying the heart as the artery becomes thickened and damaged by atherosclerosis.

Symptoms: Symptoms of a heart attack are pain in the chest and or left shoulder, arm, and upper abdomen. The pain may radiate to the jaw. It may be accompanied by nausea, shortness of breath, sweating and fainting. THESE SYMPTOMS REPRESENT A MEDICAL EMERGENCY AND MEDICAL ATTENTION MUST BE SOUGHT AT ONCE. DELAYING FOR ANY LENGTH OF TIME MAY LOSE THE FEW MINUTES THAT CAN MEAN THE DIFFERENCE BETWEEN LIFE AND DEATH. IF YOU THINK YOU ARE HAVING A HEART ATTACK CALL AN AMBULANCE. IF ONE IS NOT AVAILABLE, GO TO THE NEAREST EMERGENCY ROOM AND CLEARLY STATE YOU BELIEVE YOU ARE HAVING A HEART ATTACK. AS YOU MAY LOSE CONSCIOUSNESS, DO NOT DRIVE A CAR YOURSELF.

Diagnosis: Diagnosis is by electrocardiogram. An electrocardiogram is an indirect representation of the electrical conduction system of the heart which causes the heart to contract. During and after myocardial infarction the electrocardiogram is changed, thus this test is useful in making the diagnosis of a heart attack.

Treatment: Oxygen is given along with medications that stabilize the heart's rhythm. Select cases may be given medicines that act to dissolve clot formation, reestablishing blood flow.


Risk factors for coronary heart disease

High total cholesterol, high blood pressure, smoking and obesity are risk factors for coronary heart disease that you can control. Consult your physician for an evaluation of your risk factors. Obesity is discussed in the Weight Manager. Risk factors for coronary heart disease include the following:

•	High total cholesterol

•	High blood pressure

•	Smoking

•	Obesity

•	Diabetes

•	Hormonal factors. Early in life, men are more likely to suffer heart attacks than women.

•	Family history of heart disease before age 55. If a family member has suffered a Heart attack  before age 55 then you are at higher risk.

•	African-American ancestry

•	Sedentary lifestyle. Lack of exercise contributes to obesity, low HDLs, and high cholesterol and triglycerides.

•	Excessive alcohol intake. Excessive alcohol intake has been shown to increase blood pressure and triglycerides.

•	High triglycerides. Although elevated triglycerides are not a direct cause of heart disease, they may accompany other abnormalities such as high blood cholesterol.

•	Kidney disease

•	Birth control pills. Oral contraceptives can cause an increase in blood pressure, abnormalities in blood lipids, namely an increase in LDLs and a decrease in HDLs, a mild diabetic state, blood clots in the arteries and veins, and damage to the arterial walls.

Each risk factor can increase your chance of developing heart disease. Obviously the more risk factors you have the greater chances of developing coronary heart disease. Luckily, you can take an active role in controlling some of the risk factors. Three of these are cholesterol levels, high blood pressure, and smoking.


Cholesterol

Cholesterol is a fat-like, odorless, white, waxy substance that is a key component of cell membranes and certain hormones. You cannot taste or see cholesterol in the foods you eat. Cholesterol is found only in animal products, including red meat, poultry, dairy products, and egg yolks. Your body needs some cholesterol to function, but it makes all the cholesterol that it needs. Therefore, dietary cholesterol only raises your total blood cholesterol. High blood cholesterol levels can be harmful to your health.

Cholesterol is carried in your blood in packages called lipoproteins which are composed of cholesterol, fat and protein. There are two main types of lipoproteins that you should be aware of and which will be important to you in managing your cholesterol level, diet, and overall health: low density lipoproteins (LDLs) and high density lipoproteins (High density lipoproteins (HDLs)). In addition to these two types of lipoproteins there is also a third type called very low density lipoprotein (VLDLs).

Related Topics:

Total blood cholesterol levels

Dietary cholesterol

Low density lipoproteins (LDLs)

High density lipoproteins (HDLs)

Very low density lipoproteins (VLDLs)

Triglycerides

Controlling blood cholesterol levels

Measuring cholesterol

Desirable frequency of cholesterol tests

Guidelines for lowering blood cholesterol

Calculations

Helpful hints to reduce your cholesterol level


Total blood cholesterol levels

The following chart shows desirable, borderline and high total blood cholesterol levels.

Blood cholesterol level	Interpretation
Less than 200 milligrams of cholesterol per deciliter of blood    (< 200 mg/dl)	Desirable
200 to 239 milligrams of cholesterol per deciliter of blood (200-239 mg/dl)	Borderline
Greater than or equal to 240 milligrams of cholesterol per deciliter of blood (>= 240 mg/dl)	High
According to the United States Department of Health and Human Services more than half of all adult Americans have total blood cholesterol levels of 200 mg/dl or greater which puts them above the desirable level. In addition, approximately 25% of the adult population 20 years old or older has a total cholesterol level of 240 mg/dl or greater, which is considered high. The average American adult has a level of 210 to 215 mg/dl.

Studies have shown that women's total blood cholesterol levels before menopause are, on average, lower than those of men of the same age. After menopause the total cholesterol levels of women usually increase to a level higher than that of men. Oral contraceptives and pregnancy can also increase a woman's total cholesterol levels. Total cholesterol levels usually return to normal 20 weeks after childbirth. In men, total cholesterol levels usually plateau or decline slightly after age 50.


Dietary cholesterol

The average American consumes between 400 to 500 milligrams (mg) of cholesterol a day. Your body makes approximately 1000 mg of cholesterol per day, mostly in the liver, from the fats, protein and carbohydrates that you eat. A diet rich in cholesterol and saturated fats can increase your blood cholesterol level. Decreasing your intake of cholesterol and saturated fats will help you lower your blood cholesterol level. The higher your cholesterol level the greater your chance of getting Heart attack . Your blood cholesterol level is one of the controllable risk factors for coronary heart disease.(Smoking and High blood pressure, discussed below, are others). Dietary fat, particularly saturated fat, is much more important to control than dietary cholesterol since studies have shown that fat, namely, saturated fat, has the greatest affect on serum blood cholesterol levels. Regardless, you should try to lower your dietary intake of cholesterol and fat.


Low density lipoproteins (LDLs)

Cholesterol is carried in your blood in packages called lipoproteins which are composed of cholesterol, fat and protein. LDL are a type of lipoprotein which carry cholesterol and deposit it in the arteries of the body.

High LDL levels may indicate cholesterol buildup in your arteries.

Low density lipoproteins (LDLs) carry between 60% to 70% of the total cholesterol in the blood. If LDL cholesterol is elevated, cholesterol and fat can build up in your arteries. This leads to a narrowing of the blood vessels, a process called atherosclerosis.

LDL level	Interpretation
Less than 130 milligrams of LDLs per deciliter of blood (< 130 mg/dl)	Desirable LDL
130 to 159 milligrams of LDLs per deciliter of blood (130-159 mg/dl)	Borderline LDL
Greater than or equal to 160 milligrams of LDLs per deciliter of blood (>=160 mg/dl)	High LDL
A level of less than 160 mg/dl is considered acceptable if you do not have definitive coronary heart disease and do not have two risk factors for coronary heart disease. If you have evidence of coronary heart disease, or have two risk factors for coronary heart disease, then your goal should be an LDL cholesterol level of <130 mg/dl.

Risk Factors Include:

•	Being male, or post-menopausal female

•	Family history of Heart attack

•	Low HDL cholesterol (<35 mg/dl)

•	Smoking

•	High blood pressure

•	Diabetes

•	Obesity

•	History of cerebrovascular disease or occlusive peripheral vascular disease

Because most of the cholesterol in the blood is carried in the LDL, the concentration of total cholesterol is closely related to the concentration of LDL cholesterol. The goal of diet or medical therapy is to lower the LDL cholesterol level. LDL cholesterol level is calculated by the following formula:

LDL cholesterol = total cholesterol - HDL cholesterol - (triglyceride/5)


High density lipoproteins (HDLs)

HDLs remove cholesterol from the blood

High density lipoproteins (HDLs) contain approximately 20% to 30% of total cholesterol. Their levels are inversely correlated with risk for coronary heart disease. HDLs are thought to carry cholesterol back to the liver from the blood and body organs for processing and removal, thus removing cholesterol from the blood and preventing the build up of cholesterol in the wall of the arteries. HDL is often called the "good cholesterol." The recommended level of HDLs is greater than or equal to 35 milligrams per deciliter of blood (>=35 mg/dl). According to the Helsinki Heart Study, every 1% increase in HDL cholesterol is linked to a 3% reduction in heart disease in patients with low HDL cholesterol and high LDL cholesterol.

(M. H. Frick, O. Elo, K. Haapa, et al, Helsiniki Heart Study: Primary-Prevention Trial with Gemfibrozil in Middle-aged Men with Dyslipidemia: Safety of Treatment, Changes in Risk Factors, and Incidence of Coronary Heart Disease, New England Journal of Medicine (1987),pages 317 & 1237-1245.)

Total cholesterol, LDL and HDL, and the risk of coronary heart disease

Average risk implies a 20% to 25% chance of developing coronary heart disease by age 60.

All measurements are described in milligrams per deciliter of blood.

Men:

Risk	HDL	LDL / HDL	total / HDL
½ average	> 65	1.0	3.43
average	45-54	3.5	5
2 times average	25-44	6.3	9.6
3 times average	< 25	8.0	13.4
Women:

Risk	HDL	LDL / HDL	total / HDL
½ average	> 75	1.5	3.3
average	55-64	3.2	4.4
2 times average	40-54	5.0	7.1
3 times average	< 40	6.1	11.0
From the National Heart, Lung and Blood Institute (NHLBI), for adults over the age of 20.


Very low density lipoproteins (VLDLs)

Very low density lipoproteins (VLDLs) are the largest of the three lipoproteins. They are composed mostly of Triglycerides. VLDLs contain 10% to 15% of the total blood cholesterol. As the VLDLs circulate through the blood stream they deliver triglycerides to the muscle and fat cells to be used for energy or to be stored for later use. Once a VLDL drops off its triglyceride it becomes a low density lipoprotein (LDL). The level of VLDL is greatly influenced by what has been eaten recently. As a result, the levels of VLDL cholesterol fluctuate greatly.


Triglycerides

Triglycerides are the form in which fat is carried through blood to the tissues. The bulk of your body's fat tissue is in the form of triglycerides. At this time it is not clear whether high triglycerides alone increase your risk of heart disease, but because elevated triglyceride levels often accompany other abnormalities of blood chemistry, such as elevated blood cholesterol, low HDLs and high LDLs, triglycerides should be watched. High levels of triglycerides should be considered a warning sign for smokers and people with a positive family history of heart disease. Elevated triglyceride levels and obesity are closely related. The desirable triglyceride level is less than 250 milligrams of triglycerides per deciliter of blood (< 250 mg/dl).


Controlling blood cholesterol levels

You can take an active role in controlling your cholesterol. HealthDesk can help you achieve this goal. The food you eat has the greatest effect on your blood cholesterol level. Most people can lower their cholesterol levels by changing the way they eat. To lower your cholesterol you do not need to give up all the foods that you love. See the section Guidelines for lowering blood cholesterol from the National Cholesterol Education Program or see Helpful hints to reduce your cholesterol level  for suggestions. Lowering your elevated cholesterol will slow fatty buildup in the arteries, and in some cases may even reverse the process. It will also help you reduce your risk of Heart attack .

If you have a desirable blood cholesterol level you can still benefit from the suggestions in HealthDesk. Even if your total blood cholesterol level is < 200mg/dl it should be rechecked within five years.


Measuring cholesterol

A blood sample is required for cholesterol measurement. The blood sample can be obtained by a simple finger prick, or can be drawn from your vein when blood for other tests is required. The cholesterol measurement test can be performed at any time and does not require fasting. If the first measurement is 200mg/dl or greater of total blood cholesterol it should be repeated with a second blood sample. If your two total cholesterol measurements are high (>240 mg/dl), then the National Cholesterol Education Program Expert Panel recommends that you have a complete lipoprotein analysis which will measure your LDL, HDL, and triglycerides. If your total blood cholesterol level is borderline high (200-239 mg/dl) and you either have coronary heart disease or two risk factors for coronary heart disease, then your doctor will probably recommend that you have a complete lipoprotein analysis. In both cases you should follow the recommendations presented in HealthDesk to lower your cholesterol. Unlike the routine cholesterol measurements, the lipoprotein analysis will require that you fast--that is, eat or drink nothing but water for twelve hours before the test.


Desirable frequency of cholesterol tests

The National Cholesterol Education Program recommends that all adults aged 20 and over have their total blood cholesterol measured at least every five years. If your cholesterol measurement is above the normal range, that is, 200 milligrams or more per deciliter of blood (200 mg/dl), your doctor will probably recommend a cholesterol-lowering diet.

Generally, you should begin to see a drop in your total cholesterol and LDL levels two to three weeks after beginning your diet. With a proper diet it is possible to reduce your total blood cholesterol by as much as 15% or roughly 30 to 55 mg/dl. Your physician will probably repeat your test four to six weeks after you begin your diet, and again after three months.

If your levels are acceptable after three months, your cholesterol measurement will probably be repeated every six months to a year as long as you remain on your diet. If you have not met your desired cholesterol goal, then your doctor will assess your diet and determine what steps need to be taken.


Guidelines for lowering blood cholesterol

The following guidelines are provided by the Adult Treatment Panel of the National Cholesterol Education Program.

Treatment of high cholesterol begins with dietary therapy. The goals of the therapy are to lower total cholesterol and LDL cholesterol levels, while still maintaining a nutritionally adequate eating pattern. Total fat in the American diet averages roughly 35% to 40% of calories. Many Americans consume as much as 15% to 20% of their calories from saturated fat. In addition many Americans with high cholesterol average intakes of dietary cholesterol of about 350 to 450 milligrams per day.

The guidelines presented will help you lower your cholesterol by lowering your percentage of total fat, saturated fat and cholesterol. Because LDL cholesterol levels correlate with total cholesterol levels, most people can be managed on the basis of their total cholesterol levels. Blood cholesterol levels of 240 mg/dl and 200 mg/dl correspond roughly to LDL cholesterol levels of 160 and 130 mg/dl respectively. Assessing total cholesterol has the advantage of lower cost. It also has the advantage of ease of testing because the total cholesterol test does not require fasting.

Keep your total calories from fat to less than 30%. Some specialists even recommend that you lower your calories from fat to 20%. You can lower your fat calories by choosing lean meats, poultry without skin, fish, and low-fat dairy products. Also remember to watch for the hidden fats that are present in prepared foods such as salad dressing, cookies, and soups. Avoid food fried in fats.

Replace part of your saturated fat with unsaturated fat. Calories from saturated fats should be less than 10% of total calories in the first stage of a cholesterol-lowering diet. If cholesterol remains high, then saturated fats should be reduced further so that they are less than 7% of total calories. Up to 10% of total calories should consist of polyunsaturated fats and up to 10% to 15% of total calories should consist of monounsaturated fats. Although polyunsaturated and monounsaturated fats are better than saturated fats and oils, they are high in total calories. Consequently, their intake should be limited. It is generally recommended to restrict intake of these fats and oils to six to eight teaspoons a day.

Polyunsaturated fats are those fats in which many of the carbon atoms remain joined by a double or triple bond. There are two main categories of polyunsaturated fats--those which contain the omega-6 fatty acids found in several vegetable oils and those which contain the omega-3 fatty acids found in certain fish oils. Oils high in polyunsaturates include safflower, sunflower, corn, cottonseed, soybean, and sesame seed oil. Fish high in polyunsaturates (more than 1 gram per 100 grams of fish) include rainbow trout, Pacific mackerel, Atlantic herring, Atlantic halibut, Atlantic salmon, lake trout, anchovy, coho salmon, bluefin tuna, king salmon, albacore tuna, and pink salmon. Fish with medium content of polyunsaturates (between 0.6 to 1 gram) include channel catfish, red snapper, yellowfin tuna, turbot, striped bass, and swordfish. sole, haddock, striped mullet, brook trout, and Atlantic and Pacific cod have some of the lowest values (0.5 grams and under). (Based on data from the United States Department of Agriculture.)

Sources of monounsaturated fats include olive, canola, and peanut oil.

Saturated fats are fully hydrogenated. This property makes them solid at room temperature. Saturated fats come from animal sources and from palm, palm-kernel, and coconut oil. Butter, lard and beef fat are high in both saturated fats and cholesterol.

Always check food labels. Even though a product says "Prepared with 100% Vegetable Oil" it may be full of saturated fat in the form of coconut, palm, or palm-kernel oils.

Consume 50% to 60% of your total calories in the form of carbohydrates. You can reach this goal by eating five or six portions of vegetables and fruits a day. Use carbohydrates to replace dietary fat. Choose foods high in complex carbohydrates. Eat between 25 mg and 35 mg of soluble fiber per day as recommended by The National Cancer Institute.

Although complex carbohydrates are long chains of glucose, they are better for you than simple carbohydrates (sugar), whose calories are devoid of other nutritional value. The complex carbohydrates also bring with them protein, vitamins, and minerals.

Consume 10% to 20% of your total calories in the form of protein. Remember that, although meat is an excellent source of protein, it is also high in fat. It is better to get your protein from low fat sources such as beans.

Eat less than 300 milligrams of dietary cholesterol per day. If this does not lower your cholesterol, then dietary cholesterol should be lowered to less than 200 milligrams per day.


Calculations

To calculate the grams of saturated fat you are allowed to eat, add up the total number of calories that you consume in a day and divide by ten, then divide by nine.

(Total calories ÷10) ÷ 9

Dividing the total number of calories you consume in a day by 10 will give you the number of calories of saturated fat that you can have in a given day according to the recommendations of the National Cholesterol Education Program. To calculate the number of grams of saturated fat that you are allowed, divide the calories by 9, as there are 9 calories per gram of fat. Compare this number with the numbers on the labels of foods you eat. Use a fat gram counter to calculate the grams of saturated fat in foods without labels.


Helpful hints to reduce your cholesterol level

•	Trim fat from meat.

•	Remove skin from poultry before cooking.

•	Select grades of meat which are lower in fat. In order of preference from low-fat to high-fat are "select", "choice", and "prime" grades.

•	Avoid nuts and seeds. Nuts are full of both calories and fat. If you must have them, eat the dry roasted variety since they are not cooked in oil. An even better alternative is to eat defatted peanuts which have about 60% of the fat removed from them.

•	Stop smoking. Smoking lowers HDLs and may increase total cholesterol.

•	Maintain the proper weight. In addition to raising blood cholesterol and LDLs, excess weight is an independent risk factor for heart disease.

•	Increase your exercise level. An aerobic exercise program of at least 30 minutes in duration and performed at least three times per week may help lower cholesterol and raise HDL levels.

•	Moderate alcohol consumption.

•	Bake, broil, roast, poach, or braise. Avoid frying.

•	Choose liquid vegetable oils high in unsaturated fat such as canola, safflower, corn, olive, sesame, and soybean oils. Avoid palm, palm-kernel, and coconut oils which contain high amounts of saturated fat.

•	Avoid processed meats such as bacon, bologna, salami, hot dogs, and sausage. These are high in fats.

•	Always check food labels for cholesterol and fat content.

A word about butter and margerine. In butter, 100% of the calories come from fat, mostly from saturated fat. In margarine 100% of the calories also come from fat, but mostly from polyunsaturated fat. Butter contains cholesterol. Most margarines have no cholesterol because they are made from vegetable oils. The amount of polyunsaturated or saturated fat in margarine depends on which vegetable oil it contains and how it was made. Remember that even though certain oils are high in polyunsaturated fats, they all also contain some saturated fats as well. The polyunsaturated oils with the lowest saturated fat content are safflower, sunflower, and corn oil, in that order. Avoid margarines that list hydrogenated or partially hydrogenated oils first. Hydrogenation is the process used to make polyunsaturated fats more solid at room temperature. Unfortunately, hydrogenation changes the good polyunsaturated fats to a more saturated form. A good rule of thumb is that the softer or more fluid the margarine the less saturated fat it is likely to contain.

Related Topics:

Eating low cholesterol & low fat foods


Eating low cholesterol & low fat foods

Food	Recommended Substitute
Cheese	Low fat cheese
Milk	Skim milk or 1% milk
Eggs	Two egg whites or egg substitute. (One egg yolk has 275 milligrams of cholesterol.)
Cream sauces	Herbs and infused vinegars
Red meat	Poultry or fish
Goose or duck	Turkey or chicken
Butter	Margarine
Sour cream	Low-fat cottage cheese, low-fat yogurt, nonfat yogurt
Prepared salad dressings	Homemade dressings using vinegar, lemon juice, and herbs
Ice cream	Nonfat frozen yogurt, sorbet, ice milk
Prepared baked goods	Bake your own with less fats, sugar, and oils
Potato chips	Unsalted and unbuttered popcorn or unsalted pretzels
Snack foods	Vegetables and fruits
Lobster and shrimp	Low-cholesterol, low-fat fish
Mayonnaise	Imitation mayonnaise or plain low-fat yogurt flavored with mustard
Butter or oil for cooking	Non-stick cookware or spray oils
Bacon	Canadian bacon or boiled ham
Tuna packed in oil	Tuna packed in water
Self-basting turkey	Regular turkey, basted
Dessert sauces	Puréed fresh or frozen fruits
Lard, shortening, saturated oils	Olive, canola, peanut, safflower, sunflower, corn, and soybean oils


Blood pressure

The circulatory system can be seen as a complex plumbing system with pumps (the heart and skeletal muscles), valves (heart valves and veins) and partial dams or floodgates (kidneys and capillaries) allowing inflow or outflow from the main system. The main force that keeps blood moving through the body is the pumping action of the heart. However, there is a complex interplay among nerve impulses, hormones, and other elements that have an effect on the flow of blood by changing the size of the blood vessels. Blood pressure will thus depend on the force of the heart's contraction, the rate of the contractions and the size and elasticity of the arterial walls.

Related Topics:

High blood pressure

Measuring blood pressure

Risk factors for high blood pressure.

The body's control of blood pressure

Types of high blood pressure

Effects of high blood pressure

Lowering blood pressure

Medical treatments for high blood pressure


High blood pressure

Approximately 60 million Americans have high blood pressure, also called hypertension. Yearly 31,000 deaths are attributed to the disease. African- Americans have a significantly higher risk of developing hypertension, often with increased severity. The prevalence of high blood pressure increases with age.

In adults, blood pressure is elevated when either the systolic measurement is 140 millimeters of mercury (mm/Hg) and/or the diastolic measurement is 90 millimeters of mercury or higher. The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure uses the following classification to further define high blood pressure. You will notice that high blood pressure can be defined as either diastolic or systolic high blood pressure.

Diastolic Reading	Interpretation
less than ( < ) 85 mm/Hg	Normal Blood Pressure
85-89 mm/Hg	High Normal Blood Pressure
90-104 mm/Hg	Mild High Blood Pressure
105-114 mm/Hg	Moderate High Blood Pressure
greater than or equal to  (>=) 115 mm/Hg	Severe High Blood Pressure
When Diastolic Blood Pressure is less than 90 mm/Hg:

Systolic Reading	Interpretation
less than ( < ) 140 mm/Hg	Normal Blood Pressure
140-159 mm/Hg	Borderline Isolated Systolic High Blood Pressure
greater than or equal to (>=) 160 mm/Hg	Isolated Systolic High Blood Pressure
One isolated abnormal reading does not mean you have high blood pressure. Rather the diagnosis requires that the initial elevated reading be confirmed on at least two subsequent visits with your physician.


Measuring blood pressure

Blood pressure measurement is performed with an instrument called a sphygmomanometer. A rubber air bladder covered by cloth is wrapped around a person's arm and the cuff (bladder) is inflated. When the cuff is inflated it causes the large artery in the arm to be compressed, momentarily stopping the flow of blood. The air in the cuff is then released and the person measuring the pressure listens for a sound of the blood as it restarts to flow through the artery. This sound is recorded as the systolic pressure, or the point of greatest pressure. As the air continues out of the cuff, the sound will disappear. This is recorded as the diastolic pressure, or the point of lowest pressure. Both the systolic and diastolic are important, but physicians have traditionally focused on the diastolic pressure when diagnosing and treating high blood pressure.


Risk factors for high blood pressure.

The major risk factors for high blood pressure are as follows:

•	Gender. Men are more likely to develop high blood pressure than women.

•	Obesity

•	Heredity. High blood pressure has a tendency to run in families.

•	Race. African-Americans are more apt to be affected and often more severely. In addition, they tend to be affected earlier in life.

•	Age. The risk of developing high blood pressure increases with age.

•	Sedentary lifestyle. Lack of exercise contributes to obesity and poor cardiac performance.

•	Oral Contraceptives. Women on birth control pills can develop high blood pressure.

•	Alcohol. Excessive drinking can lead to high blood pressure.

•	Excessive sodium intake. Lowering sodium intake has been shown to lower blood pressure. The Recommended Dietary Allowance (RDA) from the United States Government for adults is 1100 milligrams (mg) to 3300 mg of sodium. This number allows for those times when more sodium may be needed, such as during strenuous exercise. The body only needs about 220 mg per day, so you can see that added sodium is not needed. Sodium-free salt substitutes are available.

•	Pregnancy. During pregnancy some women develop high blood pressure.


The body's control of blood pressure

Over the long term, blood pressure is mainly controlled by the kidneys. When blood pressure falls, the kidneys retain water and salt until the volume of blood rises, raising pressure to normal levels. Over the short term, blood pressure is mainly controlled by a series of sensors in arterial walls. These sensors (through the nervous system) control the force and rate of the heartbeat as well as the contraction of some of the blood vessels.

It is easy to see that in a system so complex, there are many ways that blood pressure control can go awry, as well as many ways the body can bring blood pressure back under control.


Types of high blood pressure

The most common type of high blood pressure is essential hypertension--that is, hypertension of unknown origin. This represents about 90% of all cases. The remaining 10% of cases are caused by kidney disease, diabetes or another underlying disorder.


Effects of high blood pressure

Elevated blood pressure causes excess wear and tear on the plumbing itself (arteries) and associated controls (heart and kidneys). High blood pressure is known as the "silent killer" because it rarely produces any noticeable symptoms until considerable damage has been done. Often people will think that dizziness, headaches, and the feeling of excess stress are symptoms of high blood pressure. This rarely the case. Left untreated, high blood pressure increases the likelihood of strokes, causes damage to the arteries (atherosclerosis), and makes the heart work harder, thus making it less efficient in the long run. Fortunately, high blood pressure is treatable.


Lowering blood pressure

The following are methods for lowering high blood pressure:

•	Lose weight. Obesity and blood pressure are closely related.

•	Exercise. Regular aerobic exercise helps in weight control and may be helpful in reducing blood pressure. Remember, before beginning an exercise program, consult your physician.

•	Cut down on salt intake.

•	Stop smoking

•	Lower stress. (See the Stress Manager.)

•	Decrease alcohol consumption to one ounce of alcohol per day.


Medical treatments for high blood pressure

Most high blood pressure medications are aimed at either ridding the body of excess fluid, opening narrowed vessels, or preventing constriction of vessels.

Four types of high blood pressure medications are used. They are as follows:

a) Diuretics (rid the body of fluid, reducing blood volume).

b) Adrenergic inhibitors (reduce constriction of vessels and/or impulses to the heart).

c) Vasodilators (open vessels, thereby creating less resistance to blood flow and thus lowering blood pressure).

d) Enzyme inhibitors (prevent hormones from elevating blood pressure).


Smoking

Of all the risk factors for hypertension, heart disease, and cancer, none has been as widely studied and publicized as smoking. Given all the evidence, there is simply no sane reason to smoke. Cigarettes have three components, all of which damage your health--nicotine, carbon monoxide, and tar. One of the benefits of quitting smoking is that even after decades of smoking your body will repair some of the damage you have inflicted on it over the years. Your respiratory function will begin to improve almost immediately. Within two years without cigarettes your risk of heart disease from smoking will begin to disappear. Your risk of lung cancer will drop over the years.

It is hard to quit smoking because there is both a psychological and physiological addiction. Nicotine is a psychoactive, addictive drug. After inhalation, the nicotine goes almost immediately to the brain, rapidly producing a sense of euphoria and calm. Nicotine stimulates those centers responsible for producing a potent sense of reward and pleasure. In addition, nicotine stimulates the centers in the brain responsible for complex reasoning where it heightens awareness and improves cognitive performance. The psychological effects, such as the pleasure a smoker associates with smoking, make smoking hard to quit.

In order to stop smoking you must address both the psychological as well as the physiological addiction to smoking. Recently there has been a great deal of interest in nicotine skin patches. While these patches are effective in dealing with the body's craving for nicotine, they do not deal with the smoker's psychological dependence on cigarettes.

The best way to stop smoking is to combine a variety of different methods dealing with both psychological and physical addictions. No two smokers are alike. Therefore, a single combination of methods will not work for everyone.

Often people are reluctant to quit smoking for fear of gaining weight. While some weight gain is often associated with quitting, you can lessen the chance by increasing your exercise level once you decide to quit. In addition, during the initial period when you might crave food as a substitute for cigarettes, try to eat foods that are not fattening such as raw vegetables and fruits.

Suggestions for quitting smoking:

•	Pick an easy starting date to stop. A weekend often works best because there is less stress. Try to keep busy so that you do not have time to think about smoking. Avoid places and people that you associate with smoking.

•	Join a smoking cessation program. These programs usually include counseling, relaxation training, hypnosis, or some other form of behavior modification therapy.

•	Consider the use of a nicotine substitute such as gum or skin patches. Both of these require a prescription from your doctor.

•	Find substitutes for smoking. Try to get pleasure out of exercise, reading or helping others. If you like the feel of the cigarette in your hand, try holding another object.

It will be normal for you to experience withdrawal symptoms. These include irritability, impaired concentration, mood swings, drowsiness, depression, and the urge to eat more. Remember that these symptoms are temporary and will decrease with time.

Once you have quit, develop a plan that will keep you from resuming smoking. If you feel the urge to smoke again, immediately get involved in something else.


Resources

Action on Smoking and Health

American Heart Association

American Lung Association

Citizens for Public Action on Blood Pressure and Cholesterol

Coronary Club, Inc., The

Mended Hearts, Inc., The

National Heart, Lung, and Blood Institute Education Programs Information Center

National Institute of Hypertension Studies

Office on Smoking and Health


Action on Smoking and Health

2013 H Street, NW

Washington DC  20006

(202) 659-4310

9:00am - 5:00pm, EST, Monday - Friday

Action on Smoking and Health (ASH) is a national nonprofit scientific and educational organization fighting for the rights of nonsmokers against the many problems of smoking. Using the tremendous power of legal action to represent nonsmokers in courts and legislative bodies and before regulatory agencies, ASH has been tremendously successful during the past quarter century. Although its income is tiny compared with the big national health organizations also active in this field, ASH has been a major factor in the war against smoking. For this reason, and because of its location in the nation's media center, ASH has also emerged as a major spokesperson for nonsmokers on radio and television and in the print media. Unlike the major national health organizations, ASH is concerned only with the problems of smoking. Unlike the many smaller state, local and specialty antismoking organizations with which it cooperates closely, ASH is active with regard to all aspects of the problems of smoking and smoker's rights, and has a truly national focus.


American Heart Association

7272 Greenville Avenue

Dallas, Texas 75231-4596

1-800-242-8721

(214) 373-6300

FAX (214) 706-1341

8:30am - 5:00pm, all time zones, Monday - Friday

The American Heart Association (AHA) was established in 1924 by six prominent cardiologists concerned about the lack of information about heart disease. In 1948 the AHA changed from being a primarily a medical association to a voluntary health organization involving people from many professions. Today the AHA is one of the world's premier health organizations with about 3.5 million volunteers. They are either involved nationally or with the association's nearly 2,000 state and metropolitan affiliates, divisions, and branches. The areas where the AHA concentrates both its volunteer and its physical resources are cardiovascular research, cardiovascular education, and revenue generation. The AHA provides money to support scientists and their projects. Results of research funded by the AHA and others are presented to the public and to health professionals through a wide range of educational and community programs conducted by the association. The money to support research and educational and community programs is derived primarily from contributions by individuals and from other sources such as corporations and foundations.


American Lung Association

1740 Broadway

New York, New York  10019-4374

(212) 315-8700

9:00am - 5:00pm, EST, Monday - Friday

The American Lung Association (ALA) is dedicated to fighting lung disease, the third leading cause of death in the U.S., and seeks the eradication and control of tuberculosis and chronic obstructive pulmonary diseases, including chronic bronchitis, asthma, and emphysema. It develops materials and programs for professional publication, research, and advocacy in four major areas: (1) occupational health, (2) clean air conservation, (3) smoking and health, and (4) pulmonary disease. Printed materials, films and resource materials on emphysema, chronic bronchitis, asthma, air pollution, smoking and health, tuberculosis, and other lung disease are available free to lay and medical persons. Several pamphlets are available in Spanish. Local and constituent lung associations maintain local directories of facilities and direct care providers, and act as lung information and referral centers. For information, contact the ALA national headquarters at the above address or a local lung association listed in the telephone book.


Citizens for Public Action on Blood Pressure and Cholesterol

7200 Wisconsin Avenue, Suite 1002

Bethesda, Maryland  20814

(301) 907-7790

FAX: (301) 907-7792

9:00am - 5:00pm, EST, Monday - Friday; answering machine available when out of office or after hours

Citizens for Public Action on Blood Pressure and Cholesterol is a nonprofit public advocacy group for public policy and resources to prevent heart disease. As an advocate for research, education and prevention programs, Citizens moniters public policy to enhance effective screening, education and treatment services. Citizens is a charter member of the National Heart, Lung and Blood Institute's advisory panels overseeing the National High Blood Pressure and Cholesterol Education Programs.


Coronary Club, Inc., The

9500 Euclid Avenue, Mail Code E4-59

Cleveland, Ohio  44195

(216) 444-3690

8:00am - 3:00pm, EST, Monday Friday; voice mail for leaving messages is on 24 hours a day, every day

The Coronary Club, Inc. is a nonprofit organization dedicated to improving the lives of cardiac patients through education and understanding. They publish Heartline, a monthly publication written by doctors, surgeons, nutritionists, and cardiac rehabilitaion experts at the Cleveland Clinic Foundation.


Mended Hearts, Inc., The

7320 Greenville Avenue

Dallas, Texas  75231

(214) 706-1442

8:00am - 4:00pm, CST, Monday - Friday

The Mended Hearts is a nonprofit educational organization that serves as an extended support group for heart patients. It is composed of heart patients, spouses, health professionals and other interested persons who are particularly interested in helping people deal with the emotional recovery from heart disease. There are currently over 200 Mended Hearts chapters throughout the United States. Most chapters meet on a regular basis, usually monthly, and many feature presentations by health providers. Members are thus able to keep up with changing treatments and technologies in the heart field. Meetings are also devoted to members discussions, social interaction and mutual support. Most chapters send newsletters to members as an added way to stay in touch. Mended Hearts also has a visiting program. Members carefully trained as visitors strive to give emotional support to heart patients and families.


National Heart, Lung, and Blood Institute Education Programs Information Center

P.O. Box 30105

Bethesda, Maryland  20824-0105

(301) 951-3260

FAX: (301) 951-3269

The National Heart, Lung, and Blood Institute Education Programs Information Center was established in 1986 as a source of information and materials on cholesterol and smoking, two major risk factors for cardiovascular health. In 1987, it merged with the National High Blood Pressure Education Program. Two new programs, the National Blood Resource Education Program and the National Asthma Education Program, have also been added. Services include dissemination of public education materials, programmatic and scientific information for health professionals, materials on worksite health, and response to information requests. The center is a service of the National Institutes of Health.

A cholesterol, high blood pressure, and smoking education database and a blood resource database are subfiles on the Combined Health Information Database (CHID), which is available on BRS (Bibliographic Retrieval System).

Consumer materials are available on cholesterol, high blood pressure, smoking, asthma, chronic cough, heart disease, exercise, stroke, and blood resources. Serial publications: Infomemo provides program updates about cholesterol, high blood pressure, asthma, and smoking, and Infoline describes the activities of the National Blood Resource Education Program.


National Institute of Hypertension Studies

295 Mt. Vernon

Detroit, Michigan  48202

(313) 931-3427

(313) 872-0505

9:00am - 5:00pm, EST, Monday - Friday

The National Institute of Hypertension Studies provides information about hypertension as well as individual hypertension symptom profiles.


Office on Smoking and Health

MS K-50

1600 Clifton Road, NE

Atlanta, Georgia  30333

(404) 488-5701

FAX: (404) 488-5767

The Office on Smoking and Health (OSH) offers bibliographic and reference services through its Technical Information Center (TIC). TIC publishes and distributes a number of titles and comprehensive bibliographies in the field of smoking and health. The Epidemiology Branch collects and analyzes data sets on tobacco use. This section also designs and conducts national surveys on smoking behavior, attitudes, knowledge, and beliefs among adult and teenagers on a periodic basis, and works with other individuals and organizations that are interested in incorporating smoking behavior as part of their survey research activities.

The Smoking and Health Database contains almost 50,000 citations and abstracts. Sources indexed include journal articles, conference reports, and newsletters. Reference services are also provided by telephone. Copies of reference items are provided only in single copies, and only in cases where material cannot be obtained from other sources.

OSH offers consumer publications on smoking and teenagers, smoking and pregnancy, and smoking cessation. Materials for professionals cover cancer, heart disease, and lung disease associated with smoking. Serial publications: Smoking and Health Bulletin (quarterly) - abstracts of current literature, Bibliography of Smoking and Health (annual), and Health Consequences of Smoking (the annual report of the Surgeon General).


Glossary of Terms

Atherosclerosis

Blood lipids

Carbohydrates

Cerebrovascular disease

Cholesterol

Complex carbohydrates

Coronary heart disease

Diastolic pressure

Fat

Heart disease

High blood pressure

High density lipoproteins

Infused

Low density lipoproteins

mg/dl

mm/Hg

Monounsaturated fat

Obesity

Occlusive peripheral vascular disease

Polyunsaturated fats

Protein

Saturated fat

Simple carbohydrates

Soluble fiber

Sphygmomanometer

Systolic pressure

Triglycerides

Very low density lipoproteins


Atherosclerosis

Thickening of the walls of the arteries due to build up of cholesterol.


Blood lipids

Fats and fat-like substances found in the blood.


Carbohydrates

A food group containing starches, fiber or sugars. Starches are found mostly in breads, cereals, vegetables, and fruits.


Cerebrovascular disease

An injury to the blood vessels of the brain.


Cholesterol

A fat-like substance found in animal products..


Complex carbohydrates

Starches and fiber.


Coronary heart disease

Heart damage caused by insufficient blood supply due to blocked coronary arteries.


Diastolic pressure

The point of least blood pressure.


Fat

A white or yellowish greasy substance that is a source of energy for the body.


Heart disease

A collection of diseases that affect the heart, the most common one is coronary heart disease. Other types of heart disease include congenital heart disease, congestive heart disease, and valve abnormalities.


High blood pressure

Blood pressure depends on the force of the heart's contraction, the rate of the contractions and the size and elasticity of the arterial walls. High blood pressure is a term used to described a condition in which a person's blood pressure is higher than is normal.


High density lipoproteins

High density lipoproteins (HDLs) contain approximately 20% to 30% of total cholesterol. HDL is known as the "good" cholesterol.


Infused

Vinegars that are made with herbs.


Low density lipoproteins

Low density lipoproteins (LDLs) carry between 60% to 70%  of the total cholesterol in the blood. LDL is known as the "bad" cholesterol.


mg/dl

mg/dl stands for milligrams per deciliter, which is a standardized form for measuring blood chemistry.


mm/Hg

mm/Hg stands for millimeters of mercury, which is a standardized form for measuring blood pressure.


Monounsaturated fat

A type of unsaturated fat. Unsaturated fatty acids do not have all the hydrogen atoms they can carry. A saturated fat is completely full of hydrogen atoms.


Obesity

There is no strict definition for obesity.  Generally, it is considered an excessive accumulation of body fat.  A figure of 20 percent more weight than that listed in standard height-weight tables is often used as the definition.


Occlusive peripheral vascular disease

The disease process whereby the small blood vessels become blocked by atherosclerotic deposits. Blood flow is slowed and pain in the affected limb develops.


Polyunsaturated fats

Those fats in which many of the carbon atoms remain joined by a double or triple bond. There are two main categories of polyunsaturated fats--those which contain the omega-6 fatty acids found in several vegetable oils and those which contain the omega-3 fatty acids found in certain fish oils.


Protein

One of three nutrients that supply the body with energy, along with fats and carbohydrates. Protein is an essential part of muscle, bone, skin, and blood.


Saturated fat

Fully hydrogenated fat. This property makes saturated fat solid at room temperature.


Simple carbohydrates

Sugars, which include glucose and fructose.


Soluble fiber

A nondigestible type of complex carbohydrate. Foods high in soluble fiber include fruits and beans.


Sphygmomanometer

An instrument for measuring arterial blood pressure.


Systolic pressure

Maximum blood pressure which occurs during the contraction of the ventricle.


Triglycerides

The form in which fat is carried in the blood to the tissues.


Very low density lipoproteins

Very low density lipoproteins (VLDLs) contain 10% to 15% of the total blood cholesterol.