PREVENTIVE MEASURES  Reduce obesity Stop cigarette smoking Exercise regularly Good control of high blood pressure Good control of diabetes Cholesterol lowering- how low to go? Antioxidant therapy-Vitamin E  The Mediterranean Diet Fish oils is good for you An aspirin a day keeps heart attacks at bay Understanding fats American Heart Association New Advice on Diet to Prevent and Treat Hypertension

The KEY to preventing an acute heart attack would be to…. Identify the patient with plaque disease as early as possible so that effective preventive measures can be started to prevent plaque rupture and thrombosis. Studies have demonstrated that it  is possible to achieve plaque stabilization or even regression and consequently reduce the risk of heart attacks and death from fatal MI.  

EBCT Or Heartscan Is A Non-Invasive Tool For The Early Diagnosis Of Heart Disease which has a sensitivity of 95% and a specificity of 99% for presence of coronary atherosclerotic plaque. 

The treatment of coronary heart disease for the 21st century will not be treating heart attacks or its complications, but detecting and treating cholesterol plaque disease to prevent its development

Preventive Measure  Reduce Obesity

4% of Malaysians are obese while 16.6% of Malaysians are overweight  (Pre-obese Body Mass Index 25-29.9; Obese Body Mass IndexI >30.0) Obesity increases blood pressure and workload on the heart.  Obesity is related with increase in stroke (11x), Heart attack(15x), diabetes(30x)

5% reduction of body weight will lead to reduction in blood pressure while a10% reduction of body weight further lowers cholesterol

Preventive Measure   Stop cigarette smoking

In general, chronic exposure to nicotine may cause an acceleration of coronary artery disease, peptic ulcer disease, reproductive disturbances, esophageal reflux, hypertension, fetal illnesses and death, and delayed wound healing.Tobacco, the vehicle of nicotine delivery, contains tar (numerous chemicals that cause a thick, sticky substance when smoked) and about 2,000 chemicals total. Tobacco and its various components have been associated with an increased risk for cancer of various body organs.

Effects of Nicotine Nicotine has both stimulant and depressant effects upon the body. Bowel tone and activity increases along with saliva and bronchial secretions. Stimulation of the central nervous system may cause tremors in the inexperienced user, or even convulsions with high doses. Stimulation is followed with a phase that depresses the respiratory muscles. As a euphoric agent, nicotine causes arousal as well as relaxation from stressful situations.  On the average, tobacco use increases the heart rate 10 to 20 beats per minute, and it increases the blood pressure reading by 5 to 10 millimeters of mercury (because it constricts the blood vessels). Nicotine may also increase diaphoresis (sweating), nausea, and diarrhea because of its effects upon the central nervous system. Nicotine's effects upon hormonal activities of the body is also evident. It elevates the blood level of glucose and increases insulin production. Nicotine also tends to enhance platelet aggregation, which may lead to thrombotic (blood clot) events. The "positive" effects of nicotine upon the body may also be noted. It stimulates memory and alertness, enhancing cognitive skills that require speed, reaction time, vigilance and work performance. As a mood-altering agent, it tends to alleviate boredom and reduce stress and reduces aggressive responses to stressful events. It also tends to be an appetite suppressant, specifically decreasing the appetite for simple carbohydrates (sweets) and inhibiting the efficiency with which food is metabolized. Peoples who use tobacco products frequently depend upon it providing these side effects to help them accomplish certain tasks at specific levels of performance. The addictive effects of tobacco have been well documented. It is considered mood and behavior altering, psychoactive, and abusable. As a multisystem pharmacological agent that is voluntarily administered, tobacco is believed to have an addictive potential comparable to alcohol, cocaine, and morphine. For smokers, the specific health risks of tobacco use include: nicotine addiction, decreased senses of taste and smell increased fetal death and diseases, if mothers use lung disease--emphysema, chronic bronchitis, lung cancer coronary artery disease--angina, heart attacks atherosclerotic and peripheral vascular disease--aneurysms, hypertension, blood clots, strokes oral/tooth/gum diseases--including oral cancer For nonsmokers exposed regularly to second hand smoke, the specific health risks include: increased risk of lung cancer over those not exposed to smoke in infants and children, an increased frequency of respiratory infections (such as bronchitis and pneumonia), asthma, and decreases in lung function as the lungs mature may experience (upon exposure to smoke) acute, sudden, and occasionally severe, reactions including eye, nose, throat, and lower respiratory tract symptoms For smokeless tobacco users the specific health risks include: nicotine addiction, decreased senses of taste and smell increased infant death and diseases, if mothers use oral/tooth/gum diseases--including a 50 times greater risk for oral cancer with long term or regular use coronary artery disease--angina, heart attacks atherosclerotic and peripheral vascular disease--aneurysms, hypertension, blood clots, strokes STOP SMOKING A wide range of methods exist for quitting smoking. Family members, friends, and work associates may be supportive or encouraging but the desire and commitment to quit must be a personal decision. It may prove helpful to write up a specific list of the reasons why one wants to quit. A 1990 Gallup poll of smokers revealed that two-thirds of smokers state they would like to quit. Past attempts to quit tobacco use should be viewed as learning experiences, not failures. Information from people who have been able to successfully quit smoking shows that 70% had made 1 to 2 previously unsuccessful attempts; 20% had made 3 to 5 previously unsuccessful attempts; and 9% had made 6 or more previously unsuccessful attempts before actually quitting. Like other addictive behaviors, tobacco use is difficult to stop and maintain, particularly if acting totally alone. The best success in quitting has been noted with comprehensive programs that may combine various strategies, over time (usually 4 to 8 weeks with 1 or 2 hours of support per week) including education, peer support, behavior recognition, behavior modification methods, recognition of potential relapse situations, and strategies for confronting such situations. Medications that are nicotine substitutes, such as transdermal nicotine or nicotine gum, may be used temporarily in conjunction with such programs. These medications require a prescription, therefore seek the support and cooperation of the primary care provider for their use. Comprehensive programs for quitting smoking have a successful rate of about 20 to 40% of participants. In contrast, 2.5% of people who choose to quit smoking spontaneously, without help, achieve success. Once a person has chosen to quit using tobacco products, it may prove beneficial to elicit a broad range of collaborative methods and support persons to enhance optimal success. If success is not reached initially, simply look at what occurred or what didn't work, develop new strategies, and try again. Multiple attempts are frequently necessary to "beat the habit."

Benefit of quitting

	within 1 hour blood pressure and pulse rate drop to normal body temperature of extremities (hands/feet) increases to normal
	within 8 hours of quitting carbon monoxide level in blood drops to normal oxygen level in blood increases to normal
	within 24 hours of quitting risk of sudden heart attack decreases
	within 48 hours of quitting nerve endings begin to regenerate senses of smell and taste begin to return to normal
	within 2 weeks to 3 months of quitting circulation improves walking becomes easier lung function increases up to 30%
	within 1 to 9 months of quitting overall energy typically increases symptoms associated with chronic use decrease (such as coughing, nasal congestion, fatigue and shortness of breath) cilia (fine, hair-like projections lining lower respiratory tract) function begins to return to normal, which increases the body's ability to handle mucus, clean the respiratory tract, and reduce respiratory infections
	within 1 year of quitting excess risk of coronary heart disease is half that of a tobacco user
	within 5 years of quitting lung cancer death rate (for average 1 pack/day former smoker) decreases by nearly 50% risk of cancer of the mouth is half that of a tobacco user
	within 10 years of quitting lung-cancer death rate becomes similar to that of a nontobacco user precancerous cells are replaced with normal cell growth risk of stroke is typically lowered, possibly to that of a nontobacco user risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases
	within 15 years of quitting risk of coronary heart disease is that of a nonsmoker

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Preventive Measure    Exercise reduces risk in heart patients

An inactive lifestyle is a risk factor for coronary heart disease. It also contributes to other risk factors including obesity, high blood pressure and a low level of HDL ("good") cholesterol

Regular, moderate-to-vigorous exercise is important in preventing heart and blood vessel disease. Even moderate-intensity physical activities are beneficial if done regularly and long term. Even moderate-intensity physical activity such as brisk walking is beneficial when done regularly for a total of 30 minutes or longer on most days. More vigorous activities are associated with more benefits. Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people.

Why is exercise or physical activity important?

Regular aerobic physical activity increases a person's capacity for exercise. It also plays a role in both primary and secondary prevention of cardiovascular disease. Physical inactivity and cardiovascular mortality are linked.

Exercise can help control blood lipid abnormalities, diabetes and obesity. Aerobic exercise also has an independent, modest blood-pressure-lowering effect for certain groups of people with high blood pressure.

The results of pooled studies show that people who modify their behavior after heart attack to include regular exercise have better rates of survival. Healthy people - as well as many patients with cardiovascular disease - can improve their exercise performance with training.

How can physical activity or exercise help condition my body?

1. Some activities improve flexibility, some build muscular strength and some increase endurance.
2. Some forms of continuous activities involve using the large muscles in your arms or legs, called endurance or aerobic exercises. They benefit the heart because they make it work more efficiently during exercise and at rest.
3. Brisk walking, jumping rope, jogging, bicycling, cross-country skiing and dancing are examples of aerobic exercises that increase endurance.

How can I improve my physical fitness?

Programs designed to improve physical fitness take into account frequency (how often), intensity (how hard), and time (how long), and provide the best conditioning.

The FIT Formula:
F = frequency (days per week)
I = intensity (how hard, e.g., easy, moderate, vigorous) or percent of heart

Dr. J. Michael Gaziano of Brigham and Women's Hospital in Boston, reported 5-year follow-up findings of 5,290 physicians who had had a heart attack. He reported that those who exercised vigorously 2 to 4 times a week or more had a 40% reduction in risk of death overall and a 50% reduction in risk of cardiovascular death, specifically.

Gaziano, who also works at the Veteran's Affairs Medical Center in West Roxbury, Massachusetts, also noted that among the physicians in the study, those who exercised once a week had a risk reduction of 20% to 30% compared with those who exercised less than 3 times a month.

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Preventive Measure 

High blood pressure

High blood pressure, or hypertension , is defined in an adult as a systolic pressure of 140 mm Hg or higher and/or a diastolic pressure of 90 mm Hg or higher. Blood pressure is measured in millimeters of mercury (mm Hg).

Blood pressure (mm Hg)	Optimal	Normal	High normal	Hypertension
Systolic (top number)	less than 120	less than 130	130-139	140 or higher
Diastolic (bottom number)	less than 80	less than 85	85-89	90 or higher

 High blood pressure directly increases the risk of coronary heart disease (which leads to heart attack) and stroke, especially along with other risk factors.

High blood pressure can occur in children or adults, but it's particularly prevalent in African Americans, middle-aged and elderly people, obese people, heavy drinkers and women taking oral contraceptives. People with diabetes mellitus gout or kidney disease have a higher frequency of hypertension.

High blood pressure usually has no specific symptoms and no early warning signs. It's truly a "silent killer." But a simple, quick, painless test can detect it.

How does medicine help control high blood pressure?

Many medications, known as antihypertensives , are available to lower high blood pressure. Some, called diuretics , rid the body of excess fluids and salt (sodium). Others, called beta blockers, reduce the heart rate and the heart's output of blood.

Another class of antihypertensives is called sympathetic nerve inhibitors. Sympathetic nerves go from the brain to all parts of the body, including the arteries. They can cause the arteries to constrict, raising blood pressure. This class of drugs reduces blood pressure by inhibiting these nerves from constricting blood vessels.

Yet another group of drugs is the vasodilators . These can cause the muscle in the walls of the blood vessels (especially the arterioles) to relax, allowing the vessel to dilate (widen).

Other classes of drugs used to treat high blood pressure are the angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers and the calcium antagonists. The ACE inhibitors interfere with the body's production of angiotensin, a chemical that causes the arteries to constrict, and the angiotensin II receptor blockers block the effects of angiotensin. The calcium antagonists can reduce the heart rate and relax blood vessels.

In most cases these drugs lower blood pressure. Quite often, however, people respond very differently to these medications. That's why most patients must go through a trial period to find out which medications work best with the fewest side effects.

People with high blood pressure should remember these key points:

1. Follow your healthcare provider's instructions.
2. Stay on your medication.

What about diet and lifestyle changes?

Dietary and lifestyle changes also may help control high blood pressure. Before drugs are prescribed, these methods are often recommended for people with only mildly elevated blood pressure.

The American Heart Association Nutrition Committee has stated that to maximize the beneficial effects of diet on blood pressure,

1. Avoid high intakes of salt.
2. Make sure to eat enough fruits, vegetables, and fat-free and low-fat dairy products.

Such diets are rich in potassium, calcium, magnesium and protein, and low in total fat, saturated fat and cholesterol. Some people with mild hypertension can lower their blood pressure by reducing sodium (salt) in their diet. This means avoiding salty foods and cutting down on the amount of salt used in cooking and at the table.

Excessive alcohol intake (more than two ounces of pure alcohol or two drinks per day) raises blood pressure in some people and should be restricted. Alcoholic drinks are high in non-nutritious calories, so if you're trying to lose weight, avoid them.

Statistics show that many people who have high blood pressure are also overweight. If you're overweight or have gained weight over time, you'll be advised to cut down on calories and lose weight. Your doctor can prescribe a diet that's right for you. If you're given a diet, follow it closely, including any recommendations about reducing your consumption of alcohol. Often when people lose weight, their blood pressure drops, too.

Physical inactivity is a risk factor for heart disease. In addition, a sedentary or inactive lifestyle tends to contribute to obesity, a risk factor for both high blood pressure and heart disease. Regular exercise helps control weight and lower blood pressure. Don't be afraid to be active - exercise should definitely be part of your daily program. Besides helping to reduce your risk of heart attack, it can also help you lose weight or maintain a healthy weight.

For some people, weight loss, sodium reduction and other lifestyle changes won't lower high blood pressure as much as it needs to be lowered. If that's your situation, you'll probably need to take medication.

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Preventive Measure   Diabetes mellitus

What is diabetes mellitus?

Diabetes mellitus is the inability of the body to produce or respond properly to the hormone insulin. The body needs insulin to convert glucose ("blood sugar") to energy. Diabetes is defined as a fasting plasma glucose of 126 mg/dL or more measured on two occasions.

The two major forms of the disease are type 1 and type 2 diabetes. Type 2 diabetes, the most common form, usually appears in adults, often in middle age. Type 2 diabetes is often associated with obesity and may be delayed or controlled with diet and exercise. Obesity and physical inactivity are two risk factors for type 2 diabetes. In a mild form, it can go undetected for many years. Untreated diabetes can lead to a host of serious medical problems, including cardiovascular disease.

The other form of diabetes mellitus is type 1 or juvenile diabetes. It typically begins early in life. People with type 1 diabetes have a primary insulin deficiency and must take insulin to stay alive.

Diabetes is treatable, but even when glucose levels are under control, diabetes greatly increases the risk of heart disease and stroke. In fact, most people with diabetes die of some form of heart or blood vessel disease. Part of the reason for this is that diabetes affects cholesterol and triglyceride levels. Often people with diabetes also have high blood pressure, increasing their risk even more.

When diabetes is detected, a doctor may prescribe changes in eating habits, weight control and exercise programs, and even drugs to keep it in check. It's critically important for people with diabetes to have regular check-ups. Work closely with your healthcare provider to manage your diabetes and control any other risk factors. For example, blood pressure for people with diabetes should be lower than 130/85 mm Hg.

Diabetes is a major risk factor for stroke and is now recognized as a major risk factor for coronary heart disease, which leads to heart attack. People with diabetes may avoid or delay heart and blood vessel disease by controlling the other risk factors. It's especially important to control weight and blood cholesterol with a low-saturated-fat, low-cholesterol diet and regular exercise. It's also important to lower high blood pressure and avoid smoking.

Even when glucose levels are under control, diabetes greatly increases the risk of heart disease and stroke. About two-thirds of people with diabetes die of some form of heart or blood vessel disease.

If you have diabetes, it's critically important to work with your healthcare provider to manage your diabetes and control any other risk factors you can.

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Preventive Measure 

Cholesterol

Cholesterol is a soft, waxy substance found among the lipids (fats) in the bloodstream and in all your body's cells. It's an important part of a healthy body because it's used to form cell membranes, some hormones and other needed tissues. But a high level of cholesterol in the blood - hypercholesterolemia - is a major risk factor for coronary heart disease, which leads to heart attack.

Cholesterol and other fats can't dissolve in the blood. They have to be transported to and from the cells by special carriers called lipoproteins . There are several kinds, but the ones to be most concerned about are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

What is LDL cholesterol?

Low-density lipoprotein is the major cholesterol carrier in the blood. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis . A clot (thrombus) that forms in the region of this plaque can block the flow of blood to part of the heart muscle and cause a heart attack. If a clot blocks the flow of blood to part of the brain, the result is a stroke. A high level of LDL cholesterol (more than 130 mg/dL) reflects an increased risk of heart disease. That's why LDL cholesterol is often called "bad" cholesterol. Lower levels of LDL cholesterol reflect a lower risk of heart disease.

What is HDL cholesterol?

About one-third to one-fourth of blood cholesterol is carried by high-density lipoprotein or HDL. Medical experts think HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe HDL removes excess cholesterol from atherosclerotic plaques and thus slows their growth. HDL cholesterol is known as "good" cholesterol because a high level of HDL seems to protect against heart attack. The opposite is also true: a low HDL level (less than 35 mg/dL) indicates a greater risk.

What is Lp(a) cholesterol?

Lp(a) is a genetic variation of plasma LDL. A high level of Lp(a) is an important risk factor for developing atherosclerosis prematurely. The way an increased Lp(a) contributes to disease isn't understood. The lesions in artery walls contain substances that may interact with Lp(a), leading to the buildup of lipids in atherosclerotic plaques.

What about cholesterol and diet?

People get cholesterol in two ways. The body - mainly the liver - produces varying amounts, usually about 1,000 milligrams a day. Another 400 to 500 mg (or more) can come directly from foods. Foods from animals (especially egg yolks, meat, poultry, fish, seafood and whole-milk dairy products) contain it. Foods from plants (fruits, vegetables, grains, nuts and seeds) don't contain cholesterol. Typically the body makes all the cholesterol it needs, so people don't need to consume it.

Saturated fatty acids are the chief culprit in raising blood cholesterol, which increases your risk of heart disease. But dietary cholesterol also plays a part. The average American man consumes about 337 milligrams of cholesterol a day; the average woman, 217 milligrams.

Some of the excess dietary cholesterol is removed from the body through the liver. Still, the American Heart Association recommends that you limit your average daily cholesterol intake to less than 300 milligrams. If you have heart disease, limit your daily intake to less than 200 milligrams. Still, everyone should remember that by keeping their dietary intake of saturated fats low, they will also be able to significantly lower their dietary cholesterol intake. Foods high in saturated fat generally contain substantial amounts of dietary cholesterol.

People with severe hypercholesterolemia may need an even greater reduction. Since cholesterol is present in all foods from animal sources, care must be taken to eat no more than six ounces of lean meat, fish and poultry per day and to use skim (fat-free) and low-fat dairy products. High-quality proteins from vegetable sources such as beans are good substitutes for animal sources of protein.

How does exercise (physical activity) affect cholesterol?

For some people, exercise affects blood cholesterol level by increasing HDL ("good") cholesterol. A higher HDL cholesterol is linked with decreased risk of heart disease. Exercise can also help control weight, diabetes , and high blood pressure. Exercise that uses oxygen to provide energy to large muscles (aerobic exercise) raises your heart and breathing rates. Regular exercise such as brisk walking, jogging and swimming also condition your heart and lungs.

Physical inactivity has been established as a major risk factor for heart disease. Even moderate-intensity activities, if done daily, help reduce your risk. Examples are walking for pleasure, gardening, yard work, housework, dancing and prescribed home exercise.

How does cigarette / tobacco smoke affect cholesterol?

Cigarette and tobacco smoke is one of the six major risk factors of heart disease that you can change, treat or modify. Smoking has been shown to lower HDL ("good") cholesterol levels.

How does alcohol affect cholesterol?

In some studies, moderate use of alcohol is linked with higher HDL ("good") cholesterol levels. However, the benefit isn't great enough to recommend drinking alcohol if you don't do so already.

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Preventive Measure   ANTIOXIDANT VITAMINS

What are antioxidant vitamins?

Considerable research has recently focused on how antioxidant vitamins may reduce cardiovascular disease risk. Antioxidant vitamins - E, C and beta carotene (a form of vitamin A) - have potential health-promoting properties. Though the data are incomplete, up to 30 percent of the population is taking some form of antioxidant supplement.

The American Heart Association doesn't recommend using antioxidant vitamin supplements until more complete data are available. We continue to recommend that Americans eat a variety of foods daily from all of the basic food groups:

1. six or more servings of breads, cereals, pasta and starchy vegetables
2. five servings of fruits and vegetables
3. two to four servings of skim milk, low-fat dairy products
4. up to six cooked ounces of lean meat, fish, poultry

Eating a variety of foods low in saturated fat and cholesterol will provide a rich natural source of these vitamins, minerals and fiber.

Background

Oxidation of low-density lipoprotein (LDL or "bad") cholesterol plays an important role in the development of atherosclerosis , the disease process that leads to heart attacks and strokes. An increasing amount of evidence suggests that LDL cholesterol lipoprotein oxidation and its biological effects can be prevented by using antioxidants - both in the diet and in supplements. These data are from various sources: basic science, epidemiology , experiments in animals and clinical investigations, including limited clinical trials. The strongest evidence for using the naturally occurring antioxidants to protect against the development of cardiovascular disease is for vitamin E. It's weakest for vitamin C. Data on the role of beta carotene are limited.

High intakes of vitamin E have been associated with a decreased risk of coronary artery disease (CAD) incidence, according to epidemiological studies. Animal studies also suggest that vitamin E can slow the development of atherosclerosis. Furthermore, vitamin E inhibits LDL cholesterol oxidation in test tube experiments and in human studies. Some epidemiological studies suggest that vitamin C, which also inhibits lipoprotein oxidation, is associated with reduced rates of clinical CAD.

Although beta carotene does not appear to inhibit LDL cholesterol oxidation, early data suggest that it may reduce further clinical events in subjects with established CAD.

One should not recommend using dietary supplements of antioxidants to prevent cardiovascular disease until their effect is proved in clinical trials that directly test their impact on CVD end points. This caution is because the doses of these antioxidants that inhibited LDL cholesterol oxidation in some studies are much larger than can be achieved by diet alone. Beneficial effects must be demonstrated in randomized, placebo-controlled clinical trials before recommending widespread use to prevent cardiovascular disease.

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Preventive Measure    MEDITERRANEAN DIET

Does the "Mediterranean" diet follow AHA dietary guidelines?

There's no one, typical "Mediterranean" diet. Diets vary greatly, not only between Mediterranean countries, but also among different regions within a country.

In general, however, the diets of Mediterranean peoples contain a higher percentage of calories from fat than the American Heart Association recommends.

More than half of these fat calories come from monounsaturated fats (mainly from olive oil). Monounsaturated fat doesn't raise blood cholesterol levels the way saturated fat does.

In the average Mediterranean diet, the consumption of saturated fat is lower than the average in the American diet and well within the AHA's Dietary Guidelines.

The incidence of, and death rates from, heart disease in Mediterranean countries are lower than in the United States. This may not be entirely due to the diet, though. Lifestyle factors such as more physical activity, extended social support systems and drinking wine with meals may also play a part.

Before advising that people follow an optimal Mediterranean diet, we need to find out whether the diet itself or other lifestyle factors are responsible for the lower deaths from heart disease. The high fat content of the Mediterranean diet may increase the risk of obesity.

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Preventive Measure    Understanding FATS

There are three kinds of fats in the foods we eat: saturated, polyunsaturated and monounsaturated fatty acids. Most foods contain all three types of fat, but in varying amounts. Only saturated fats and dietary cholesterol raise blood cholesterol. A high level of cholesterol in the blood is a major risk factor for coronary heart disease, which leads to heart attack.

	The body can use all three types of fats, but the American Heart Association recommends that the average person limit total fat intake (saturated, monounsaturated, polyunsaturated) to no more than 30 percent of total calories.
	Saturated fat intake should be limited to 7-10 percent of total calories each day.
	Polyunsaturated fat calories should be up to 10 percent of total calories.
	Monounsaturated fat intake should be up to 15 percent of total calories.

What are recommended amounts of total fat and saturated fat in grams?

Calorie Level	Total Fat (grams)	Saturated Fat (grams)
1200	40	9-13
1500	50	12-17
1800	60	14-20
2000	67	16-22
2200	73	17-24
2500	83	19-28
3000	100	23-33

What are saturated fatty acids?

Saturated fatty acids have all the hydrogen the carbon atoms can hold. Saturated fats are usually solid at room temperature, and they're more stable - that is, they don't combine readily with oxygen. Saturated fat is the main dietary culprit in raising blood cholesterol. The main sources of saturated fat in the typical American diet are foods from animals and some plants.

Fats That Raise Cholesterol	Sources	Examples
Dietary cholesterol	Foods from animals	meats, egg yolks, dairy products, organ meats, fish and poultry
Saturated fats	Foods from animals	whole milk, cream, ice cream, whole-milk cheeses, butter, lard and meats
	Certain plant oils	palm, palm kernel and coconut oils, cocoa butter

What about hydrogenated fats?

During food processing, fats may undergo a chemical process known as hydrogenation . Hydrogenate means to add hydrogen, or, in the case of fatty acids, to saturate. The process changes a liquid oil, naturally high in unsaturated fatty acids, to a more solid and more saturated form. The greater the degree of hydrogenation, the more saturated the fat becomes. Many commercial products contain hydrogenated or partially hydrogenated vegetable oils.

Recent studies suggest that these fats may raise blood cholesterol. Hydrogenated fats in margarine and other fats are acceptable if the product contains liquid vegetable oil as the first ingredient and no more than 2 grams of saturated fat per tablespoon. The fatty acid content of most margarines and spreads is printed on the package or label.

What are polyunsaturated and monounsaturated fatty acids?

Polyunsaturated and monounsaturated fatty acids make up the total of unsaturated fatty acids. Unsaturated fats have at least one unsaturated bond - that is, at least one place that hydrogen can be added to the molecule. They're often found in liquid oils of vegetable origin.

	Polyunsaturated oils are liquid at room temperature and in the refrigerator. They easily combine with oxygen in the air to become rancid. Common sources of polyunsaturated fats are listed in the table below.
	Monounsaturated oils are liquid at room temperature but start to solidify at refrigerator temperatures. See the table below for sources.

Polyunsaturated fats tend to help the body get rid of newly formed cholesterol. Thus, they keep the blood cholesterol level down and reduce cholesterol deposits in artery walls. Recent research has shown that monounsaturated fats may also help reduce blood cholesterol as long as the diet is very low in saturated fat.

Both types of unsaturated fats may help lower your blood cholesterol level when used in place of saturated fats in your diet. But you should be moderate in your intake of all types of fat.

Poly- or monounsaturated oils - and margarines and spreads made from these oils - should be used in limited amounts in place of fats with a high saturated fat content, such as butter, lard or hydrogenated shortenings. Choose fats and oils that contain less than 2 grams of saturated fat per tablespoon.

Fats That Lower Cholesterol	Sources	Examples
Polyunsaturated fats	certain plant oils	safflower, sesame, soy, corn and sunflower-seed oils, nuts and seeds
Monounsaturated fats	certain plant oils	olive, canola and peanut oils, avocados

 

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Preventive Measure      Aspirin in secondary prevention

The American Heart Association recommends the use of aspirin in patients who have experienced a myocardial infarction (heart attack), unstable angina , ischemic stroke, or transient ischemic attacks (TIAs or "little strokes") if not contraindicated. This recommendation is based on sound clinical trial evidence showing that aspirin prevents the recurrence of clinical events such as heart attack, hospitalization for recurrent angina, second strokes, etc.

Taking aspirin after the onset of known heart or blood vessel disease is commonly referred to as "secondary prevention." Clinical trial evidence isn't available to demonstrate similar benefits in patients with other forms of diagnosed vascular disease, such as

1. peripheral vascular blockage
2. carotid artery narrowing
3. aortic atherosclerosis

However, the American Heart Association's secondary prevention panel believes that such benefits are likely, and that aspirin should be considered for use in all such patients.

Since aspirin is not without risk in certain people, the decision to use it should be made by the patient and physician. Together they should evaluate that patient's risk and likelihood of benefit. The main factors to consider are the presence of

1. liver or kidney disease
2. peptic ulcer
3. other gastrointestinal disease or bleeding
4. other bleeding problems
5. allergy to aspirin
6. use of alcohol

Aspirin in primary prevention

Using aspirin to prevent a first heart attack, stroke or other vascular event in healthy people is referred to as "primary prevention." In its 1997 scientific statement, entitled "Aspirin as a Therapeutic Agent in Cardiovascular Disease," the American Heart Association concluded that the clinical decision to use aspirin in primary prevention should be made on an individual basis by a physician. The American Heart Association cautions people not to start taking aspirin on a long-term basis without first consulting their doctors. When more data have been analyzed and published, these decisions may be made more objectively. Physicians will need to evaluate each patient individually. In particular they will have to weigh a person's risk of myocardial infarction and coronary heart disease and death against the potential for adverse reactions to prolonged aspirin therapy. Some of these possible side effects are now being explored.

Cautions

Overall, there are a number of cautions to exercise before one begins taking aspirin for life. These include risk of abnormal bleeding in the gastrointestinal tract.

AHA Recommendation

The American Heart Association makes these recommendations for using aspirin in primary prevention:

1. All other major risk factors for coronary heart disease and stroke should be determined and a concerted program begun to reduce or modify those risk factors, which include smoking, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes .
2. The decision to start taking aspirin regularly should be made only after each person consults with his or her physician. Among the contraindications to regular aspirin therapy are liver or kidney disease, peptic ulcer, gastrointestinal bleeding or other bleeding problems, and allergy to aspirin. These must be ruled out by the physician to protect the individual.
3. A person who chooses to start a regular aspirin regimen should be aware of its side effects . If they occur, they should be reported to his or her physician. If a person taking aspirin must undergo even a simple surgical procedure or dental extraction, the surgeon or dentist must be told of the aspirin dosage. That's because the tendency to bleed persists for up to 10 days after the drug is stopped.

What about aspirin and alcohol?

The U.S. Food and Drug Administration warns against drinking alcohol for people who regularly take aspirin. Patients who have heart disease should stop drinking and keep taking aspirin if their doctor prescribed aspirin as part of the treatment plan for their heart condition. Patients should not stop taking aspirin without talking to their doctor first.

What about taking aspirin during a heart attack or stroke?

If any heart attack warning signs occur, call for help immediately. After the call, the American Heart Association recommends taking an aspirin as soon as the warning signs of a heart attack occur, unless you have an allergy to aspirin or a condition that makes using it too risky. Research shows that taking an aspirin when symptoms start significantly improves chances of survival for people having a heart attack.

Taking aspirin isn't advised during a stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots, but some are caused by ruptures. Taking aspirin could actually make these bleeding strokes more severe.

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FISH OIL

Fish is a good source of protein without the high saturated fat in fatty meat products.

The benefits and risks of eating fish oil still need to be defined by further research. Until there's compelling evidence that fish oil supplements (capsules) benefit overall cardiovascular health, the American Heart Association does not recommend their general use.

Using fish oil capsules to lower high blood cholesterol levels is not recommended. Fish oil capsules are only recommended for a few patients with severely high triglycerides , who

1. haven't responded well to treatment and
2. are at increased risk of pancreatitis (inflammation of the pancreas).

Background

Public attention has recently focused on the value of fish and fish oils in the diet. Some studies have shown that people who regularly eat fish have lower rates of heart disease.

Current studies show that some benefits come from the fat content of fish. Fish are rich in omega-3 fatty acids. These are a form of polyunsaturated fat that's chemically different from the omega-6 fatty acids found in most vegetable oils.

What are the effects of omega-3 fatty acids?

On blood fats (lipoproteins)

Omega-3 fatty acids lower blood levels of triglyceride and very low-density lipoproteins (VLDL). Two blood fats are more closely linked with atherosclerotic heart disease:

	low-density lipoprotein cholesterol (LDL "bad" cholesterol)
	high-density lipoprotein cholesterol (HDL "good" cholesterol)

In studies where people who ate more fish oil also ate less saturated fat, their LDL levels went down. But in studies where saturated fat intake remained constant while fish oil increased, LDL levels either didn't change or increased.

On glucose tolerance (in people with and without diabetes)

Taking fish oil capsules doesn't seem to impair glucose tolerance in nondiabetic coronary bypass patients. The effect of fish oil on diabetics is harder to determine. Early studies showed a deterioration in glucose tolerance in people taking fish oil. Later studies have suggested that fish oil may have some benefits for people with diabetes. More research is needed before anything definitive can be said.

On blood pressure

Fish oil doesn't affect the blood pressure of people whose blood pressure is normal. It does appear to lower blood pressure in people who have high blood pressure and hypercholesterolemia . But the reduction isn't much, and the effect may not last.

On blood clots and bleeding

Fish oils interfere with the ability of blood to clot and to form protective barriers to hemorrhage (bleeding). While this effect can be useful in some cases, it may also be harmful. It's a potential risk when large amounts of fish oil are consumed.

On sudden cardiac death

Recent studies suggest that fish oil may help reduce risk for sudden cardiac death. More research on this topic is needed.

What are potential side effects of fish oil capsules?

1. Fishy odor, upset stomach or intestines.
2. Increased bleeding, nosebleeds, easy bruising.
3. Can increase cholesterol in people with combined hyperlipidemia .
4. Can increase calorie intake and weight gain.
5. Some preparations have added cholesterol.
6. Some lack vitamin E; concern for oxidation .
7. Vitamin A and D toxicity in some preparations; pesticide in some fish oils (not highly refined).
8. Expensive compared to eating fish in the diet.

Nutrition Committee Advisory - Fish and Fish Oil
November 1, 1996

Recommendation:

The American Heart Association encourages the consumption of fish as both an excellent source of omega-3 fatty acids and as a good protein source that is low in saturated fat. The basis of a heart-healthy diet, however, remains a diet low in saturated fat and cholesterol along with avoidance of extra calories to prevent obesity.

Fish oil capsules cannot be recommended at this time either to prevent disease of the coronary arteries, which carry blood to the heart tissue, or to prevent the re-closure of coronary arteries after they have been opened by balloon angioplasty. These capsules can be recommended only for patients who have high levels of triglyceride (fat) in the blood that cannot be lowered by drug treatment and who are at increased risk for pancreatitis. However, people should not start taking fish oil capsules without checking with their doctor.

The AHA recommends continued research to answer the many questions surrounding omega-3 fatty acids.

Background:

Few can deny the benefits of substituting fish for dietary sources of protein that are loaded with saturated fat. But, in addition, fish and other marine life are rich sources of a special class of polyunsaturated fatty acids known as the omega-3 fatty acids. Early attention to omega-3 fatty acids focused on the lower heart attack death rates of Greenland Eskimos as compared to the Danish people. The Eskimos' diet, which included seal, walrus and mackerel, was rich in these fatty acids.

Clinical studies showed that fish oils could affect blood levels of cholesterol and triglycerides as well as prolong the time required for blood to clot. Prolonged bleeding time might explain the Eskimos' higher risk of hemorrhagic stroke compared to the Danes.

At first, scientists paid the most attention to the effects of fish oil on blood cholesterol levels, but research results were inconsistent. Saturated fat is a key dietary factor affecting the blood levels of total cholesterol and the harmful low-density lipoprotein (LDL)-cholesterol. Cholesterol carried by LDL helps create the plaque that obstructs blood flow in the arteries. When saturated fat intake is held constant, LDL-cholesterol levels do not decrease in response to fish oil consumption. In fact, in certain people with milder elevations of triglycerides and associated high cholesterol, the LDL cholesterol levels may actually increase. However, fish oil was found to be particularly useful in lowering greatly elevated levels of triglyceride.

Several lines of evidence suggest that fish in the diet is "heart healthy." Although several large-scale epidemiologic studies suggested that people with a higher fish intake had lower rates of coronary heart disease, studies of populations with relatively high fish intake did not confirm these results.

A British clinical trial of heart attack survivors did show that men who ate more fish experienced a 29 percent reduction in deaths from all causes despite no significant lowering of cholesterol. These results showing beneficial effects with no cholesterol lowering may be due to omega-3 fatty acids' action on blood platelets; white blood cells, which are key to inflammation; and endothelial cells, which line the artery wall. Omega-3s make the platelets less likely to clump together to form a blood clot.

Early trials employing X-rays of the coronary arteries suggested that fish oil prevented artery closure (restenosis) after an angioplasty procedure. Yet in spite of this promising beginning, newer studies have failed to confirm these impressions.

A recent Seattle study suggests that people who experienced sudden cardiac death had a lower intake of fish than comparable people. The authors speculate that fish intake may protect against a fatal arrhythmia, or irregular heartbeat. Also research suggests that omega-3 fatty acids have potentially beneficial effects in some diabetics, as well as those with inflammatory and allergic disease.

Omega-3 fatty acids are so named because the first of the several double bonds between carbon atoms occurs three carbon atoms away from the end of the carbon chain. These fatty acids are also called "n-3 (n minus 3)" fatty acids where n stands for the number of carbon atoms in the chain.

The three omega-3 fatty acids are alpha linolenic acid (LNA), eicosapentenoic acid (EPA) and docosahexenoic acid (DHA). LNA is found in tofu, soybean and canola oils and nuts. EPA and DHA are found in seafood, especially cold-water seafood.

Omega-3 fatty acids affect the body differently from the polyunsaturated omega-6 fatty acids, which occur primarily in land plants and are the most common polyunsaturated fatty acids in the typical American diet.

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American Heart Association Issues New Advice on Dietary Approaches to Prevent and Treat Hypertension  February 2006

Weight loss. Approximately 65% of US adults are overweight or obese (body mass index [BMI] ≥ 25 kg/m2) and > 30% are clinically obese (BMI ≥ 30 kg/m2). Clinical trials show that weight loss lowers blood pressure even before desired body weight (BMI < 25 kg/m2) is reached. Greater weight loss leads to greater blood pressure reduction. Maintaining a high level of physical activity is a critical factor in sustaining weight loss. Reduced salt intake. Salt intake should be lowered as much as possible, ideally to about 65 mmol/day sodium (corresponding to 1.5 g/day sodium or 3.8 g/day of sodium chloride). Clinical studies have shown that reducing salt intake lowers blood pressure in people with and without hypertension. Reduced salt intake can blunt the rise in blood pressure that occurs with age and reduce the risk of atherosclerotic cardiovascular disease (CVD) events and congestive heart failure (CHF). The greatest effects of sodium reduction on blood pressure are in blacks, middle-aged and older people, and those already diagnosed with hypertension, diabetes, or chronic kidney disease. Because > 75% of consumed salt comes from processed foods, the writing group calls on food manufacturers to reduce salts in food by 50% over the coming 10 years. Increased potassium intake. Often forgotten, potassium intake should be increased to 120 mmol/day (4.7 g/day). This can be achieved by consuming foods such as fruits and vegetables that have a high potassium content. High potassium intake is associated with reduced blood pressure levels in people with or without high blood pressure, more in blacks than in whites. It should be noted, however, that the recommended potassium intake may be too high for people with impaired urinary potassium excretion such as those with diabetes, chronic renal insufficiency, end-stage renal disease, and heart failure, as well as people taking some antihypertensive drugs. Moderation of alcohol intake. For those who consume alcohol, consumption should be limited to ≤ 2 alcoholic drinks/day (men) or ≤ 1 alcoholic drink/day (women). One drink is defined as 12 oz of regular beer, 5 oz of wine (12% alcohol), or 1.5 oz of 80-proof distilled spirits. Clinical trials have shown a dose-dependent relationship between alcohol and blood pressure, especially in people consuming > 2 drinks/day. Although reduced alcohol consumption is associated with reduced blood pressure, evidence also suggests that a moderate alcohol intake is also effective in lowering blood pressure. DASH (Dietary Approaches to Stop Hypertension) dietary pattern. The DASH diet is rich in fruits and vegetables (8-10 servings/day), rich in low-fat dairy products (2-3 servings/day), and reduced in saturated fat and alcohol, and has been shown to help reduce blood pressure. The diet emphasizes fruits, vegetables, and low-fat dairy products; includes whole grains, poultry, fish and nuts; and is reduced in fats, red meat, sweets, and sugar-containing beverages. Other studies have shown that substituting some carbohydrates with protein, mostly from plant sources, or with monounsaturated fat, further lowers blood pressure. DASH-type diets that are relatively high in potassium, phosphorus, and protein are not recommended for people with chronic kidney disease.

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The information contained in this website is intended for general reference purposes only and is not a substitute for medical advice or treatment nor replaces consultation with your doctor and health care professional. The information above to the best of our knowledge are accurate, but some may be out of date as medical information changes rapidly.