16
Be aware, too, that a high systolic blood pressure level (first number)
is dangerous. If your systolic blood pressure is 140 or higher (or
130 or higher if you have diabetes), you are more likely to develop
heart disease complications and other problems even if your
diastolic blood pressure (second number) is in the normal range.
High systolic blood pressure is high blood pressure. If you have this
condition, you will need to take steps to control it. High blood
pressure can be controlled in two ways: by changing your lifestyle
and by taking medication.
Changing your lifestyle. If your blood pressure is not too high, you may be able to control it entirely by losing weight if you are overweight, getting regular physical activity, limiting the salt in your
food, cutting down on alcohol, and changing your eating habits.
A special eating plan called DASH can help to lower blood pressure.
DASH stands for Dietary Approaches to Stop Hypertension. The
DASH eating plan emphasizes fruits, vegetables, whole-grain foods,
and low-fat dairy products. It is rich in magnesium, potassium, cal-
cium, protein, and fiber, but low in saturated fat, trans fat, total fat, and cholesterol. ( Trans fat is a harmful type of dietary fat that
forms when vegetable oil is hardened.) The diet also limits red meat,
sweets, and sugar-containing beverages.
If you follow the DASH eating
plan and also consume less
sodium, you are likely to
reduce your blood pre s s u re
even more . Sodium is a sub-
stance that aff e c t s blood pres-
sure. It is the main ingredient
in salt and is found in many
processed foods,
such as soups,
convenience
meals, some
breads and cere-
als, and salted
snacks. For
more on the
DASH eating
17
Sudden Symptoms:
L e a rn the Wa rning Signs
of a S t r o k e
A stroke is a loss of blood flow to the brain that causes brain
tissue to die. Stroke is a medical emergency. If you or someone
you know has a stroke, it is important to recognize the symptoms
so that you can get to a hospital quickly. Getting treatment within
60 minutes can prevent disability. The chief warning signs of a
stroke are:
● Sudden numbness or weakness of the face, arm, or leg
(especially on one side of the body).
● Sudden confusion, trouble speaking, or understanding speech.
● Sudden trouble seeing in one or both eyes.
● Sudden trouble walking, dizziness, or loss of balance or
coordination.
● A sudden, severe headache with no known cause.
If you think someone might be having a stroke, call 9–1–1
immediately. Also, be sure that family members and others close
to you know the warning signs of stroke. Give them a copy of
this list.
Ask them to call 9–1–1 right away if you or someone else shows
any signs of a stroke.
Signs of a
S t ro k e
18
plan and other changes you can make to lower and prevent high
blood pressure, see the National Heart, Lung, and Blood Institute’s
(NHLBI’s) Web page, Your Guide to Lowering High Blood Pressure,
which is listed in the “To Learn More” section of this guidebook.
Taking medication. If your blood pressure remains high even
after you make lifestyle changes, your doctor will probably prescribe
medicine. Depending on your health needs, your doctor may pre-
scribe medication from the start, along with changes in your living
habits. One recent study found that diuretics (water pills) work bet-
ter than newer drugs to treat high blood pressure in many people.
Other research shows that using a diuretic can reduce the risk of
death from heart and blood vessel diseases, especially among people
with diabetes. Talk with your doctor about making one of your
high blood pressure medications a diuretic.
Keep in mind that lifestyle changes will help the medicine work
more effectively. In fact, if you are successful with the changes you
make in your daily habits, you may be able to gradually reduce the
amount of medication you take.
Taking medicine to lower blood pressure can reduce your risk of
heart attack, stroke, congestive heart failure, and kidney disease.
Be sure to take your blood pressure medicine exactly as your
doctor has prescribed it. Before you leave your physician’s office,
make sure you understand the amount of medicine you are sup-
posed to take each day, and the specific times of day you should be
taking it. If you take a drug and notice any uncomfortable side
effects, ask your doctor about changing the dosage or switching to
another type of medicine.
High Blood Cholesterol
The higher your blood cholesterol level, the greater your risk of hav-
ing a heart attack. Because you have heart disease, your heart attack
risk is already high, which means it is especially important to lower
your cholesterol level. If you have diabetes as well as heart disease,
your heart attack risk rises still higher. If you have both diseases, it
is extremely important to take steps to keep both your cholesterol
and your diabetes under control. Studies have proven that lowering
cholesterol in people with heart disease reduces the risks for heart
attack and death from heart disease and can actually prolong life.
19
How Cholesterol Causes Heart Problems
The body needs cholesterol to function normally. However, your
body makes all the cholesterol it needs. Over time, extra cholesterol
and fat circulating in the blood build up in the walls of the arteries
that supply blood to the heart. This buildup, called plaque, makes
the arteries narrower and narrower. If enough oxygen-rich blood
cannot reach your heart, you may suffer chest pain, or angina. If
the blood supply to a portion of the heart is completely cut off, the
result is a heart attack. This usually happens when a cholesterol-
rich plaque bursts, releasing the cholesterol into the bloodstream
and causing a blood clot to form over the plaque.
Types of Cholesterol
Cholesterol travels in the blood in packages of fat (lipid) and protein
called lipoproteins. Cholesterol packaged in low-density lipoprotein
(LDL) is often called “bad” cholesterol, because too high a level of
LDL in your blood can lead to blockages in your arteries. Another
type of cholesterol is high-density lipoprotein (HDL) known as
“good” cholesterol. That’s because HDL helps to remove choles-
terol from the body, preventing it from building up in your arteries.
Getting Tested
High blood cholesterol itself does not cause symptoms, so if your
cholesterol level is too high, you may not be aware of it. So it is
important to get your cholesterol levels checked regularly, especially
if you have heart disease. A blood test called a “lipoprotein profile”
measures the levels of all types of lipids, or fats, in your blood.
Total cholesterol is a measure of the cholesterol in all of your
lipoproteins, including the bad cholesterol in LDL and the good
cholesterol in HDL. Let’s start with LDL levels. The higher your
LDL number, the higher your risk of heart disease and heart attack.
Knowing your LDL number is very important because it will deter-
mine the kind of treatment you may need. The bottom line: If you
have heart disease, reducing LDL cholesterol will reduce your risk
of heart attack and can actually lengthen your life.
Your HDL number tells a different story. The lower your HDL
number, the higher your risk of heart disease and heart attack.
Your lipoprotein profile test will also measure levels of triglycerides,
which are another fatty substance in the blood.
20
HDL Cholesterol Level
An HDL cholesterol level of less than 40 mg/dL is a major risk
factor for heart disease and heart attack. An HDL level of 60 mg/dL
or higher is somewhat protective.
Your LDL Goal
The main goal of cholesterol-lowering treatment is to lower your
LDL level enough to reduce your risk of heart attack. Reaching
this goal is critically important if you have heart disease. The higher
your risk category, the lower your LDL goal will be. For most
people with heart disease or diabetes who are at high risk for heart
attack, the goal of cholesterol-lowering treatment is an LDL level
below 100 mg/dL.
If You Are in This Risk Category
Your LDL Goal
High risk
Is less than 100 mg/dL*
Very high risk
May be less than 70 mg/dL*
* Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.
Even Lower May Be Better
Because recent studies show a direct relationship between lower LDL
cholesterol and reduced risk for heart attack, doctors now may
prescribe more intensive cholesterol-lowering treatment for people
at very high risk for a heart attack. For example, those with heart
disease as well as diabetes, or those who have just had a heart
attack, may have their LDL goal level lowered by their doctors to
less than 70 mg/dL.
A Special Type of Risk
Nearly one-quarter of Americans have a group of risk factors known
as metabolic syndrome. This condition is usually caused by over-
weight or obesity, and by not getting enough physical activity. If you
have heart disease, this cluster of risk factors greatly increases your
risk of heart attack regardless of your LDL cholesterol level. You
have metabolic syndrome if you have three or more of the following
conditions:
■ A waist measurement of 35 inches or more for a woman, and
40 inches or more for a man
21
W h a t ’s Your Number?
Blood Cholesterol Levels f o r
P re v e n t i n g H e a rt Disease
Total Cholesterol Level
Category
Less than 200*
Desirable
200–239
Bord