The Healthy Heart Handbook for Women, HHS, NIH, NHLBI

The Healthy Heart Handbook for Women, HHS, NIH, NHLBI

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The Healthy Heart Handbook for Women

Major Risk Factors for Heart Disease

Diabetes
Diabetes is a major risk factor for heart disease and stroke. More than 65 percent of people who have diabetes die of some type of cardiovascular disease. Diabetic women are at especially high risk for dying of heart disease and stroke. Today, 7 million women in the United States have diabetes, including an estimated 3 million women who do not even know they have the disease.
The type of diabetes that most commonly develops in adulthood is type 2 diabetes. In type 2 diabetes, the pancreas makes insulin, but the body cannot use it properly and gradually loses the ability to produce it. Type 2 diabetes is a serious disease. In addition to increasing the risk for heart disease, it is the #1 cause of kidney failure, blindness, and lower limb amputation in adults. Diabetes can also lead to nerve damage and difficulties in fighting infection.
The risk of type 2 diabetes rises after the age of 45. You are much more likely to develop this disease if you are overweight, especially if you have extra weight around your waist. Other risk factors include physical inactivity and a family history of diabetes. Type 2 diabetes also is more common among American Indians, Hispanic Americans, African Americans, Asian Americans, and Pacific Islanders. Women who have had diabetes during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds are also more likely to develop type2 diabetes later in life.
Symptoms of diabetes may include fatigue, nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of sores. But type 2 diabetes develops gradually and sometimes has no symptoms. Even if you have no symptoms of diabetes, if you are overweight and have any of the risk factors for type 2 diabetes, ask your doctor about getting tested for it. You have diabetes if your fasting blood glucose level is 126 mg/dL or higher.
If you have diabetes, controlling your blood glucose (blood sugar) levels will help to prevent complications. Because diabetes is so strongly linked with heart disease, managing diabetes must include keeping certain factors under control (See "The ABCs of Diabetes Control"). Recommended levels of blood pressure and blood cholesterol control are lower for people with diabetes than for most others. Not smoking, being physically active, and taking aspirin daily (if your doctor recommends it) also are important ways to prevent heart disease if you have diabetes.
Some people do not yet have diabetes but are at high risk for developing the disease. They have a condition known as "prediabetes," in which blood glucose levels are higher than normal but not yet in the diabetic range. But new research shows that many people with pre diabetes can prevent or delay the development of diabetes by making modest changes in diet and level of physical activity (See "Preventing Diabetes").
People who are prediabetic also have a 50 percent greater chance of having a heart attack or stroke than those who haven normal blood glucose levels. If you are prediabetic, you'll need to pay close attention to preventing or controlling blood pressure, high blood cholesterol, and other risk factors for heart disease.

"AT THE TIME, IT NEVER OCCURRED TO ME THAT I COULD BE HAVING A HEART ATTACK. I THINK ABOUT HEART DISEASE EVERY DAY NOW." —  Sharon

THE ABCs OF DIABETES CONTROL

If you have diabetes, three key steps can help you lower your control risk of heart attack and stroke. Follow these ABCs:
A is for the A1C test, which is short for hemoglobin A1C. This test measures your average blood glucose (blood sugar) over the last 3 months. It lets you know if your blood glucose level is under control. Get this test at least twice a year. The number to aim for is below 7.
B is for blood pressure. The higher your blood pressure, the harder your heart has to work. Get your blood pressure measured at every doctor's visit. The numbers to aim for are below 130/80 mmHg.
C is for cholesterol. LDL, or "bad" cholesterol, builds up and clogs your arteries. Get your LDL cholesterol tested at least once a year. The number to aim for is below 100 mg/dL. Your doctor may advise you to aim for an even lower target number, for example, less than 70.
Be sure to ask your doctor these questions:

• What are my ABC numbers?
  
• What should my ABC target numbers be?
  
• What actions should I take to reach my ABC target numbers?
  

To lower your risk of heart attack and stroke, also take these steps:

• Be physically active every day.
  
• Follow your doctor's advice about the type of physical activity that's best for you.
  
• Eat less salt and sodium, saturated fat, trans fat, and cholesterol.
  
• Eat more fiber. Choose fiber-rich whole grains, fruits, vegetables, and beans.
  
• Stay at a healthy weight.
  
• If you smoke, stop.
  
• Take medicines as prescribed.
  
• Ask your doctor about taking aspirin.
  
• Ask others to help you manage your diabetes.
  

"I wasn't aware of my risk factors, such as being diabetic and having a family history of heart problems." —  Ann

Preventing Diabetes

If you have "prediabetes"—higher than normal glucose levels—you are more likely to develop type 2 diabetes. But you can take steps to improve your health and delay or possibly prevent diabetes. A recent study showed that many overweight, prediabetic people dramatically reduced the risk of developing diabetes by following a lower fat, lower calorie diet and getting 30 minutes of physical activity at least 5 days per week. The following are some encouraging results of the study:

• Overall, people who achieved a 5 to 7 percent weight loss(about 10 to 15 pounds) through diet and increased physical activity (usually brisk walking) reduced their risk of diabetes by 58 percent over the next 3 years.
  
• For people over age 60, these lifestyle changes reduced the risk of developing diabetes by 71 percent.
  
• Benefits were seen in all of the racial and ethnic groups who participated in the study—Caucasians, African Americans, Hispanics, American Indians, Asian Americans, and Pacific Islanders.
  
• People taking the diabetes drug metformin (Glucophage®) reduced their risk of developing the disease by 31 percent.
  

These findings suggest that you can act to prevent or delay diabetes, even if you are at high risk for the disease. For more information on how to choose and cook low-fat foods, get more physical activity, and achieve a healthy weight, see "Taking Control".

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