“Know Your Numbers”

You will find six health conditions known to increase the risk for CAD listed below. All of these conditions are modifiable, which means that they can be controlled. You can minimize your risk for CAD by identifying your personal risk factors and take action to control these risks. Your doctor will help you design a treatment plan tailored to meet your needs.

• High Blood Cholesterol
• High Blood Pressure
• Obesity or Overweight
• Physical Inactivity
• Diabetes
• Smoking

The American Heart Association recommends very specific treatment goals ... and that’s where the saying “know your numbers” comes into play. Because each of these risk factors can be measured by using blood tests or other methods, it will be easy for you to determine if your treatment plan is working. All you have to do is compare your “numbers,” or the results of these tests, to your goal “numbers”.

High Blood Cholesterol

What is cholesterol?
Cholesterol is a type of fat (lipid) and is an essential nutrient your body needs for many important functions, such as producing new cells. If you eat too many foods high in saturated fat and cholesterol or you have an inherited condition, the cholesterol levels in your blood may climb to unhealthy levels. This increases your risk for developing atherosclerosis (hardening of the arteries) in the arteries supplying blood to the heart, brain and legs, and can lead to lifethreatening illnesses, such as heart attack or stroke.

Are cholesterol and triglycerides the same thing?
Cholesterol travels through your blood attached to a protein. This cholesterol-protein package is called a lipoprotein. Depending on how much protein there is in relation to fat, lipoproteins are classified as:

• high density (HDL – good cholesterol, mostly protein with only a small amount of fat),
• low density (LDL – bad cholesterol, mostly fat with only a small amount of protein), or
• very low density (VLDL – similar to LDL cholesterol in that it contains mostly fat and not much protein).

Triglycerides are a type of fat carried in the blood by very low-density lipoproteins (VLDL). Only a small amount of triglycerides is normally found in the blood; most are stored in fat tissue. Women tend to have higher triglyceride levels than men. Cholesterol and triglyceride levels tend to rise with age and obesity. Many people with heart disease have high triglyceride levels in their blood, called hypertriglyceridemia. High triglycerides may not directly cause atherosclerosis but can be associated with health conditions that hasten the process. High triglyceride levels may result from other diseases such as untreated diabetes mellitus. People with high triglycerides often have high total cholesterol, high LDL cholesterol and low HDL cholesterol level.

I have high cholesterol but I don’t understand what the numbers mean.
When distinguishing cholesterol numbers, you want to know levels of the following: 1) total cholesterol, 2) LDL (low-density lipoproteins), 3) HDL (highdensity lipoproteins) and 4) triglycerides. When you state you have “high cholesterol”, you want to identify which one of these levels is high.

1) Total cholesterol is a measure of the total amount of cholesterol in the blood. Less than 200mg/dL is desirable.

2) LDL, the “bad” cholesterol, is the main source of cholesterol buildup and blockage in the arteries. Levels of 70-100 mg/dL are optimal, especially if you have a diagnosis of CAD or stroke.

3) HDL, the “good” cholesterol, helps keep cholesterol from building up in the arteries and protects against heart disease, so higher numbers are better. A level less than 40 mg/dL is considered a major risk factor for heart disease. Having an HDL level of 60 mg/dL or more helps to reduce heart disease risk and is the desired level.

4) Triglycerides are another type of fat and if elevated can also increase your heart disease risk.Triglyceride levels are considered borderline if between 150 and 199 mg/dL or high if greater than 200 mg/dL.The desired level is less than 150 mg/dL.

In summary, it is important to know your cholesterol numbers because lowering cholesterol reduces your chance of developing heart disease.

High Blood Pressure

What is blood pressure?
Blood pressure is the amount of force exerted by the blood against the walls of the arteries.This pressure is produced by the beating of the heart to maintain adequate blood flow to other parts of the body. When the arteries are narrowed or damaged, they make it harder for blood to flow and the blood pressure will rise. When high blood pressure continues untreated, the heart becomes strained and blood vessels can become damaged. High blood pressure is a major risk factor for stroke, heart attack or kidney failure.

My blood pressure reading is 130/80. What do these numbers mean?
Blood pressure is measured in two numbers – the top number is the systolic reading, which measures the pressure generated with each heartbeat. The bottom number is the diastolic reading, which measures the pressure when your heart is resting between beats. The blood pressure readings listed below will help you interpret your blood pressure results.

• Normal (ideal): Lower than 120/80
• Prehypertension: Between 120/80 and 139/89
• Hypertension Stage I: Between 140/90 and 160/100
• Hypertension Stage II: Above 160/100

Are women at higher risk of developing high blood pressure?
Women are particularly at risk of developing high blood pressure if they are using birth control pills (especially in combination with cigarette smoking), during pregnancy, if they are overweight, after menopause, if they are African American, or if they have a family history of high blood pressure. As women age, they have substantially increased risk for hypertension.

My blood pressure is 133/84 and I am a chain smoker. Am I more at risk of getting high blood pressure?
Nicotine, found in tobacco of any form, will temporarily increase the blood pressure and the heart rate with each use. It also causes constriction in the arteries of the arms and legs, which will increase an individual's blood pressure. In time, smoking combined with other risk factors significantly increases the chance of developing coronary artery disease.

I am 58 years old and always had blood pressure readings of 110/70. For the past two years, my automated blood pressure readings at the grocery store have been fluctuating – 150/73, 145/76, 135/76, the highest being 156/76. Do I have high blood pressure?
You will be diagnosed with hypertension if your blood pressure measurements are above 140/90 mm Hg on three or more separate occasions. They are usually measured one to two weeks apart. Except in very severe cases, the diagnosis is not based on a single measurement. High blood pressure screening tests and programs vary widely in reliability. Results from automated blood pressure testing, such as you might do at a grocery store or pharmacy, may not be accurate. Any high blood pressure measurement discovered during a blood pressure screening program needs to be confirmed by a health professional.

I do not have any symptoms from high blood pressure. Is it necessary to continue treatment?
High blood pressure can damage your arteries, heart and kidneys, and lead to atherosclerosis and stroke. Hypertension is called a “silent killer” because it does not cause symptoms unless it is severely high and, without your knowing it, causes major organ damage if not treated.

I am 58 years old and always had blood pressure readings of 110/70. For the past two years, my automated blood pressure readings at the grocery store have been fluctuating – 150/73, 145/76, 135/76, the highest being 156/76. Do I have high blood pressure?
You will be diagnosed with hypertension if your blood pressure measurements are above 140/90 mm Hg on three or more separate occasions. They are usually measured one to two weeks apart. Except in very severe cases, the diagnosis is not based on a single measurement. High blood pressure screening tests and programs vary widely in reliability. Results from automated blood pressure testing, such as you might do at a grocery store or pharmacy, may not be accurate. Any high blood pressure measurement discovered during a blood pressure screening program needs to be confirmed by a health professional.

I do not have any symptoms from high blood pressure. Is it necessary to continue treatment?
High blood pressure can damage your arteries, heart and kidneys, and lead to atherosclerosis and stroke. Hypertension is called a “silent killer” because it does not cause symptoms unless it is severely high and, without your knowing it, causes major organ damage if not treated.

Obesity or Overweight

I am 40 lbs overweight. My weight is mostly around my abdomen. What is my risk of developing CAD?
Women with excess body fat are at higher risk of heart disease, even if they don’t have other risk factors. The exact risk is still a matter of some debate, but it is known that increased weight increases your chances of developing high blood pressure, diabetes and high cholesterol, all major risk factors for CAD. Fat deposits, especially around the abdomen, are an important independent risk factor for developing coronary artery disease. The ideal waist circumference for women is 35 inches or less.

An additional method to determine if you are at your goal weight is to use the body mass index, or BMI. The BMI is a calculation that considers the relationship between a person’s height, weight and body fat. The desired BMI is 18.5- 25.

To determine your BMI, use calculator on this page.

Physical Inactivity

I am 63 years old and have high cholesterol and high blood pressure. My doctor said I should exercise but I’ve never done that in my life. Will it really help?
Lack of exercise is a risk factor for developing coronary artery disease (CAD). Lack of exercise can indirectly increase the risk of CAD because it also increases the risk of diabetes and high blood pressure. Regular exercise can help reduce your risk of CAD by helping you control cholesterol and blood pressure, regulate blood sugar (important for people with diabetes), and lose weight. Regular exercise is essential not only for preventing CAD but also for improving your overall cardiovascular health. Check with your doctor first before starting an exercise program if you have diagnosed CAD, have been sedentary for a long period of time, or have other heart, lung or metabolic diseases, such as diabetes.

Diabetes

Is heart disease directly related to diabetes? If so, in what way?
People with diabetes are more prone to heart disease and stroke. Long-term complications from diabetes develop because of persistent high blood sugar levels and progression of atherosclerosis in arteries throughout the body including arteries to the eyes, kidneys, heart, brain and legs. Diabetes damages the lining of blood vessels, causing them to become clogged with plaque, which is made up of cholesterol, white blood cells, calcium and other substances that collect under the inner lining of an artery. This damage narrows the vessels, decreasing the blood supply, which eventually causes injury to the affected area. It also increases the pressure in the blood vessels, resulting in high blood pressure. When blood vessels that supply the brain and heart are affected, a heart attack or stroke may occur.About three-quarters of people with diabetes die of some form of heart or blood vessel disease. A person with diabetes has the exact same risk for a heart attack as a person of the same age who has already had a heart attack. People with diabetes who experience a heart attack have an unusually high death rate immediately or in the long term.

How young is too young for people with diabetes to develop heart disease?
There is no specific timeframe for developing CAD if you have diabetes. In many circumstances, people who are newly diagnosed with Type 2 diabetes have had abnormally high blood sugars long before the diagnosis was made. Therefore, it is difficult to know exactly how long the heart has been exposed to the effects of diabetes. However, diabetes is frequently associated with other risk factors. Rather than focus on a person’s age at time of diagnosis, it is more important to keep the blood sugar under good control or modify other cardiac risk factors, such as quitting smoking, increasing activity, and working to get weight, blood pressure and cholesterol to goal levels.

Are women with diabetes at higher risk of heart disease?
Diabetes eliminates any survival advantage that a woman has over a man of the same age. A woman with diabetes has the same risk of dying from heart disease as a man her same age. Women with diabetes have 2-4 times higher risk of heart disease compared to women without diabetes. As women age, diabetes is more common and diabetes affects more women than men over the age of 60 years. If a woman has diabetes, she should aim to achieve near-normal fasting plasma glucose (blood sugar) of less than 100 mg/dL and near normal HbA1c of less than percent. (Hemoglobin A1c measures average blood sugar over the course of three months and a physician can order this test.)

Smoking

I have been smoking a pack of cigarettes daily for the last five years. Does smoking affect the heart?
Cigarette smoking is one of the most powerful risk factors for CAD in women. It is associated with 50% of all cardiovascular events in women. The incidence of a heart attack increases sixfold in women vs. threefold in men who smoke. When combined with other factors such as oral contraceptive use, it greatly increases the risk. In addition, smoking increases the blood pressure, decreases exercise tolerance, increases the tendency for the blood to clot, increases LDL cholesterol and decreases HDL cholesterol.

I recently quit smoking. How long will it take to reduce my risk of heart disease to that of a non-smoker?
The risk of CAD and stroke begins to drop immediately after quitting smoking. It becomes half after one year without smoking and continues to decline thereafter to a nonsmoker’s risk.

My husband is a smoker. Am I at increased risk of heart disease due to
secondhand smoking?
Constant exposure to other people’s tobacco smoke, called passive smoke, does increase your risk for CAD. After spending just 30 minutes in a smoky room, oxygen in the blood decreases, blood pressure rises and blood is more likely to clot.