A presentation for women or men on how to live a heart-healthy life. By cardiologist Shawn Patrick, M.D., Portland, Oregon.

2. Heart Disease
 Number one killer of women.
 Kills 1 in 2 women (1 in 3 men).
 Often undiagnosed and undertreated.
 A very dangerous, but very preventable problem.
 "Women are like teabags; you never know how strong they are
until they're put in hot water."
— Eleanor Roosevelt

3. Top Ten List

4. Women’s Heart Smarts:
Top Ten List for a
Heart-Healthy Life
Shawn Patrick, MD
April 29, 2011

5. 10. Get a Good Night’s Sleep
 Risk of high blood pressure increases when you sleep less than 7
hours per night.
 The risk doubles when you get less than 5 hours per night.
 If you have high blood pressure and sleep less than 7 hours per night,
your risk for heart attack is increased.
 REM sleep is responsible for reducing stress.
 Muscle tissue repair increases during sleep.
 Have good sleep habits.
 If you have sleep apnea, TREAT IT!

6. Sleep Apnea

7. Sleep Apnea Associated with…
 Coronary artery disease
 Atrial fibrillation
 Pulmonary hypertension
 Hypoxic brain injury

8. Sleep Apnea
 An estimated 20 to 30 percent of Americans have some degree of
sleep apnea.
 If you have sleep apnea, wear your CPAP.
 Weight loss is often curative.
 Sleep apnea affects men and women.

9. Sleep Apnea

10. Get plenty of sleep

11. 9. Know and Manage Your Blood Pressure
 The risk for stroke is decreased 30% by lowering the systolic
blood pressure from greater than 140 mmHg to 130 mmHg.
 Only 30% of patients being treated for high blood pressure in the
United States actually have control.
 The ideal is less than 120/80.
 Blood pressure higher than 130/80 should be treated.

12. Prevalence of High Blood Pressure in
Americans Age 20 and Older by Age and Sex
NHANES IV: 1999-
2000
p18
Source: Health, United States, 2003, CDC/NCHS.
Note: NA = data not available. Prevalence estimates for women ages
20-34 are considered unreliable.

13. Hypertension
 Prior to 1990 the incidence of hypertension was declining.
 Data from 1999-2002 showed that the incidence had risen to
28.6% of the US population.
 As of 2006, only one-third of Americans with hypertension had
control of their blood pressure.

14. Treating Hypertension
 Weight loss
 Medications
 Diet changes
 Exercise

15. 8. Eat a Smart, Healthy Diet
 Always eat breakfast, it can save you from a heart attack.
 Avoid processed foods, especially foods with High Fructose Corn
Syrup (HFCS).
 When in season, shop at a farmer’s market at least twice per
month or join a Community Sponsored Agriculture.
 Avoid fast food.
 Avoid saturated and trans-fats.

16. Fast Food
 Fast food is designed to be fast, not nutritious.
 Fast food is often cooked in oil and the amount of sugar, salt, and fat is
maximized to increase flavor.
 Fast food is usually eaten by hand and is quickly consumed allowing
customers to eat greater quantities (supersize) before they realize they
are full.

17. Processed Food
 Many foods are now processed to contain corn products such as HFCS,
which increase caloric load.
 Processing often introduces chemicals designed to trigger parts of the
brain to crave that particular food.
 Many foods are predigested with enzymes or are tumbled to make them
easier to eat.

18. 7. Know and Manage Your Cholesterol
 Weight loss
 Medications
 Diet changes
 Exercise
 Know your numbers
> Total
> Triglycerides <150
> HDL >40 men, >50 women
> LDL <70 with DM CAD, <100
> Total/HDL <5.0

19. Cholesterol
 LDL particles cause atherosclerosis.
 LDL concentration (gm/dl) is measured.
 LDL particles may be large or small, so the concentration does not
tell the number of particles present.
 If LDL is mostly small particles, more particles are present, greater
risk for atherosclerosis.

20. 6. Make Three Little Choices Every Day
 Conscious decisions to do something good for your health.
 Simple choices: walking, taking the stairs, turning off the TV
earlier, fruit for dessert, extra 30 minutes of exercise.
 These little choices add up to have a huge impact.
 They also confirm your dedication to good health.

21. 5. Maintain a Healthy Weight

22. Age-Adjusted Prevalence of Obesity in
Americans Ages 20-74 by Sex and Survey
NHES, NHANES I, NHANES II, NHANES III, NHANES
IV: 1960-62, 1971-74, 1976-80, 1988-94 and 1999-2000
Note: Obesity is defined as a BMI of 30.0 or higher.
p33
Source: CDC/NCHS.

23. Prevalence of Overweight Among Students
in Grades 9-12 by Sex and
Race/Ethnicity United States: 2001
p33
Note: Overweight is defined as BMI 95th
percentile or higher by age and
sex of the CDC growth chart.
Source: YRBS, MMWR, Vol. 51, No. SS-4, June 28, 2002, CDC/NCHS.

24. Weight
 For thousands of years, weight had been stable with no significant
change.
 In 1960, the average weight of the American woman aged 20-29
was 128 lbs.
 By 2000, the average weight was 157 lbs.
 As of 2007, 74.1% of Americans were overweight or obese.
 WHY???

26. WHY???
 Fast food
 Processed food
 Lack of exercise

27. 4. Quit Smoking

28. Prevalence of High School Students Using
any Tobacco Product Within the Last 30
Days by Race/Ethnicity and Sex
United States: 2001
p27
Source: YRBS, MMWR, Vol. 51, No. SS-4, June 28, 2002, CDC/NCHS.

29. A Smoking Problem
 Approximately 25% of Americans smoke (27% men, 22.6%
women).
 1 in 2 chance of smoking-related death.
 Average life years lost from smoking: 12
 Cancers: lung, mouth, larynx, throat, oral, esophagus, urinary
tract, kidney, pancreas, and cervix.
 Most smokers die of heart disease first.

30. Smoking
 Quit
 Use whatever means is necessary
 Replace the activity
 If not for you, for those around you

31. 3. Avoid or Cure Diabetes

32. Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1990
No Data Less than 4% 4% to 6% Above 6%

33. Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1991-92
Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
No Data Less than 4% 4% to 6% Above 6%

34. Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1993-94
Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
No Data Less than 4% 4% to 6% Above 6%

35. Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1995-96
No Data Less than 4% 4% to 6% Above 6%

36. Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1995
Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
No Data Less than 4% 4% to 6% Above 6%

37. Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1997-98
Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
No Data Less than 4% 4% to 6% Above 6%

38. Source: Mokdad et al., Diabetes Care 2001;24:412.
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1999
No Data Less than 4% 4% to 6% Above 6%

39. Source: Mokdad et al., J Am Med Assoc 2001;286(10).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2000
No Data Less than 4% 4% to 6% Above 6%

40. Source: Mokdad et al., J Am Med Assoc 2001;286(10).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2002
No Data Less than 4% 4% to 6% Above 6%

41. Diabetes Now and in the Future
 2010 National Incidence: 14%
 Projected Incidence 2050: 33%

42. Normal Type 2 Diabetes
Courtesy of Wilfred Y. Fujimoto, MD.
Visceral Fat Distribution
Normal vs Type 2 Diabetes

43. Diabetes
 Do you have diabetes?
 Are you sure?

44. Metabolic Syndrome: “Pre-Diabetes”
3 of These 5 Risk Factors
Risk Factor Defining Level
Abdominal obesity
Men
Women
Waist Circumference
>102 cm (>40 in)
>88cm (>35 in)
Triglycerides >150 mg/dl
HDL-C
Men
Women
<40 mg/dl
<50 mg/dl
Blood Pressure >130/>85 mmHg
Fasting Glucose >110 mg/dl

45. Diabetes
 If you have metabolic syndrome, high probability of developing
diabetes within 5 years.
 Metabolic syndrome and diabetes have the same cardiovascular
risk as established coronary artery disease.
 Are you still sure?

46. Treating (and Curing!) Diabetes
 Weight loss
 Medications
 Diet changes
 Exercise

47. 2. Drink Plenty of Water
 Americans far under-consume water.
 Water is essential for every system in the body to function
normally.
 Consuming alcohol or sweetened soft drinks often defeats the
purpose of drinking and adds empty calories.
 Water helps us maintain normal body weight.
 Rule of thumb: eight 8oz glasses per day, more with exercise,
warm weather, altitude, or thirst.

48. 1. Exercise
 5 to 7 days per week.
 Minimum of 30 minutes, more is better.
 Exercise: Aerobic activity and strength.

49. Leisure-time Physical Activity (PA)
Patterns Among Overweight Adults by
Race/Ethnicity and Sex
BRFSS: 1998
p31
Source: MMWR, Vol. 49, No. 15, April 21, 2000, CDC/NCHS.

50. Walking the dog

51. Exercise
 Lowers blood pressure.
 Improves cholesterol, lowers LDL and raises HDL.
 Can help treat/cure diabetes.
 Can help weight control.
 Improves endothelial function and reduces risk of heart attack and
stroke.
 Improves lean muscle mass and bone density.

52. Design an Exercise Program
 Pick activities you enjoy
 Start slow, build as you go
 Do it more days than you don’t
 Sequester your exercise time
 Get a partner, if you need one
 Follow your progress
 If it helps, think of exercise as medicine

53. Check Your Progress
 Compare objective data
> Weight, BP, cholesterol, glucose control
> Speed, strength, endurance
 Compare subjective data
> How do you feel?

55. Conclusion
 10. Get plenty of sleep.
 9. Know and manage your blood pressure.
 8. Eat a smart, healthy diet.
 7. Know and manage your cholesterol.
 6. Make 3 little choices every day.

56. Conclusion
 5. Maintain a healthy weight.
 4. Quit smoking.
 3. Avoid or cure diabetes.
 2. Drink plenty of water.
 1. Exercise

57. "I am what I am today because of the choices I
made yesterday"
— Eleanor Roosevelt

58. For more tips and information
 www.theactiveheart.blogspot.com
 Coming in May 2011
www.theactiveheart.com