5’1” 111 116 122 127 132 137 143 148 153 158 164
5’3” 118 124 130 135 141 146 152 158 163 169 175
5’5” 126 132 138 144 150 156 162 168 174 180 186
5’7” 134 140 146 153 159 166 172 178 185 191 198
5’9” 142 149 155 162 169 176 182 189 196 203 209
5’11” 150 157 165 172 179 186 193 200 208 215 222
6’1” 159 166 174 182 189 197 204 212 219 227 235
6’3” 168 176 184 192 200 208 216 224 232 240 248
* Weight is measured with underwear but not shoes.
What Does Your BMI Mean?
BMI
Categories:
Normal weight: BMI = 18.5–24.9. Good for you! Try not to gain weight.
Overweight: BMI = 25–29.9. Do not gain any weight, especially if your waist measurement is high. You need to lose weight if you have two or more risk factors for heart disease and are overweight, or have a high waist measurement.
Obese: BMI = 30 or greater. You need to lose weight. Lose weight slowly—about 1/2 to 2 pounds a week. See your doctor or nutritionist if you need help.
Major Risk Factors
Source: Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report; National Heart, Lung, and Blood Institute, in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; NIH Publication 98-4083; June 1998.
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Keeping Tabs on Your Progress
You can reduce your risk of heart disease. Set goals for blood pressure, cholesterol, and weight with your doctor. If you have diabetes, also set goals for blood glucose (or blood sugar) levels. Fill out the important information below each time you get your cholesterol or blood pressure measured, or get other measurements.
Blood Pressure
Date Blood
Pressure
/
/
My Goal Blood Pressure:
Cholesterol
Date Total
LDL HDL
My Goal LDL:
Triglyceride levels can also raise heart disease risk. Levels that are borderline high (150–199 mg/dL) or high (200 mg/dL or more) may need treatment in some people.
Blood Glucose
Date
Blood Glucose Level
My Goal Blood Glucose Level:
Weight
Date
Weight
Body Mass Index (BMI)
My Goal Weight:
My Goal BMI:
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Your Progress Blood Pressure
Normal:
less than 120/80 mmHg
Prehypertension: 120/80 to 139/89 mmHg
Hypertension:
140/90 or higher mmHg
Cholesterol
Total Cholesterol
Desirable:
less than 200 mg/dL
Borderline high:
200–239 mg/dL
High:
240 mg/dL and above
LDL Cholesterol
Optimal
less than 100 mg/dL
Near optimal
100–129 mg/dL
Borderline high
130–159 mg/dL
High
160–189 mg/dL
Very high
190 mg/dL and above
HDL Cholesterol
An HDL cholesterol of less than 40 mg/dL is a major risk
factor for heart disease.
Blood Glucose
Normal:
under 99 mg/dL
Prediabetes:
100–125 mg/dL
Diabetes:
126 mg/dL and above
BMI
Normal weight:
BMI = 18.5–24.9
Overweight:
BMI = 25–29.9
Obese:
BMI = 30 or greater
Major Risk Factors
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being age 45 or older is also a heart disease risk factor. For a woman, being age 55 or older or having gone through menopause increases the risk. If you have a condition known as metabolic syndrome, your risk of heart disease is increased. (See “A Special Type of Risk” on page 21.) If you aren’t sure whether you have some of these risk factors, ask your doctor.
Once you’ve taken these three steps, you can use the information to decide if you need to take off pounds. While you should talk with your doctor about whether you should lose weight, keep these guidelines in mind:
■ If you are overweight AND have two or more other risk
factors, or if you are obese, you should lose weight.
■ If you are overweight, have a high waist measurement (over 35 inches for a woman; over 40 inches for a man), AND have two or more other risk factors, you should lose weight.
■ If you are overweight, but do not have a high waist measurement and have fewer than two other risk factors, you should avoid further weight gain.
Lose a Little, Win a Lot
If you need to lose weight, here’s some good news: A small weight loss—just 5 to 10 percent of your current weight—will help to lower your risk for heart disease and other serious medical disorders. The best way to take off pounds is to do so gradually by getting regular physical activity and eating a balanced diet that is lower in calories and saturated fat. For some people at very high risk, medication also may be necessary. To develop a weight-loss or weight-maintenance program that works well for you, consult with your doctor, registered dietitian, or qualified nutritionist. For ideas on how to lose weight safely and keep it off, see “Aim for a Healthy Weight”
on page 61.
Physical Inactivity
“I’d love to take a walk—tomorrow.”
“I can’t wait to start yoga—if I can find a good class.”
“I’m going to start lifting weights—as soon as I get the time.”
Many of us put off getting regular physical activity, and hope that our bodies will understand. But our bodies don’t understand, our Guide to a Healthy Heart
and sooner or later, they rebel. Even if a person has no other risk Y
31
factors, being physically inactive greatly boosts the chances of developing heart-related problems. It also increases the likelihood of developing other heart disease risk factors, such as high blood pressure, diabetes, and overweight. Lack of physical activity also leads to more visits to the doctor, more hospitalizations, and more use of medicines for a variety of illnesses.
Despite these risks, most Americans aren’t getting enough physical activity. According to the CDC, nearly 40 percent of Americans are not active at all during their free time. Overall, women tend to be less physically active than men, and older people are less likely to be active than younger individuals. But young people need to get moving, too. Forty percent of high school-aged girls and 27 percent of high school-aged
boys don’t get enough physical activity to
protect their health.
Fortunately, research shows that as
little as 30 minutes of moderate-
intensity physical activity on most,
and preferably all, days of the week
helps to protect heart health. This
level of activity can reduce your risk
of heart disease as well as lower your
chances of having a stroke, colon
cancer, high blood pressure, diabetes,
and other medical problems.
Examples of moderate activity are
taking a brisk walk, light weight-
lifting, dancing, raking leaves,
washing a car, house cleaning, or
gardening. If you prefer, you can
divide your 30-minute activity into
shorter periods of at least 10 minutes
each. To find out about easy, enjoyable
ways to boost your activity level, see
Major Risk Factors
“Get Moving!” on page 72.
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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, about 14 million people in the United States have diagnosed diabetes. In addition, nearly 6 million people have this serious disease but don’t know it.
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 with fighting infection.
While the risk of type 2
diabetes increases after age
45, the disease is on the
rise among both children
and adults. A major risk
factor for type 2 diabetes
is overweight, espe-
cially having extra
weight around
the waist.
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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 type 2 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. More than 14 million Americans have a condition known as “prediabetes,” in which blood glucose levels are higher than normal but not yet in the diabetic range. Prediabetes is defined as a fasting blood glucose level of 100–125 mg/dL. New research shows that many people with prediabetes 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 with normal blood Major Risk Factors
glucose levels. If you are prediabetic, you’ll need to pay close attention to preventing or controlling high blood pressure, high blood cholesterol, and other risk factors for heart disease.
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AB
The ABCs C
of
Diabetes Control
If you have diabetes, three key steps can help you lower your risk of heart attack and stroke. Follow these ABCs:
is for A1C test, which is short for hemoglobin A1C. This A test measures your average blood glucose 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. Number to aim for: below 7.
is for blood pressure. The higher your blood pressure, B the harder your heart has to work. Get your blood pressure measured at every doctor’s visit. Numbers to aim for: below 130/80 mmHg.
is for cholesterol. LDL, or “bad” cholesterol, builds up C and clogs your arteries. Get your LDL cholesterol tested at least once a year. Number to aim for: below 100 mg/dL. If you have both diabetes and heart disease, your doctor may advise you to aim for a lower target number, for example, less than 70.
Be sure to ask your doctor:
1. What are my ABC numbers?
2. What should my ABC target numbers be?
3. 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 getting physical activity every day.
● 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.
our Guide to a Healthy HeartY
● Ask others to help you manage your diabetes.
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PreventingDiabetes
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 their 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 that participated in the study—White, African American, Hispanic, American Indian, Asian American, 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 Charge:
Major Risk Factors
An Action Plan for Heart
Health,” on page 45.
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What Else Affects Heart
Disease?
A number of other factors affect heart disease, including certain health conditions, medicines, and other substances. Here is what you need to know:
Stress
Stress is linked to heart disease in a number of ways. Research shows that the most commonly reported “trigger” for a heart attack is an emotionally upsetting event, particularly one involving anger.
In addition, some common ways of coping with stress, such as overeating, heavy drinking, and smoking, are clearly bad for your heart. The good news is that sensible health habits can have a protective effect. Regular physical activity not only relieves stress, but also can directly lower your risk of heart disease. Stress management programs can also help you develop new ways of handling everyday life challenges. Good relationships count, too. Developing strong personal ties reduces the chances of developing heart disease.
Much remains to be learned about the connections between stress and heart disease, but a few things are clear. Staying physically active, developing a wide circle of supportive people in your life, and sharing your feelings and concerns with them can help you be happier and live longer.
Alcohol
Recent research suggests that moderate drinkers are less likely to develop heart disease than people who don’t drink any alcohol or who drink too much. Small amounts of alcohol may help protect against heart disease by raising levels of HDL “good” cholesterol.
If you are a nondrinker, this is not a recommendation to start using alcohol. If you are a pregnant woman, if you’re planning to become pregnant, or if you have another health condition that could make alcohol use harmful, you should not drink. Otherwise, if you’re our Guide to a Healthy Heart
already a moderate drinker, you may be less likely to have a heart attack.
Y
37
L I L L Y K R A M E R
I think exercise is extremely important. Whenever
“I feel stressed,I go to the gym and workout.I
come out of there feeling much better.”
What Else Af
fects Heart Disease?
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What IsModerate Drinking?
Moderate drinking is defined as no more than one drink per day for women, and no more than two drinks per day for men, according to the “U.S. Dietary Guidelines for Americans.” Count as one drink:
● 12 ounces of beer
● 5 ounces of wine
● 11/2 ounces of 80-proof hard liquor
Moderate Drinking
It is important, though, to weigh benefits against risks. Talk with your doctor about your personal risks of heart disease and other health conditions that may be affected by drinking alcohol. With the help of your doctor, decide whether moderate drinking to lower heart attack risk outweighs the possible increased risk of other medical problems.
If you do decide to use alcohol, remember that moderation is the key. Heavy drinking causes many heart-related problems. More than three drinks per day can raise blood pressure and triglyceride levels, while binge drinking can contribute to stroke. Too much alcohol also can damage the heart muscle, leading to heart failure.
Overall, people who drink heavily on a regular basis have higher our Guide to a Healthy Heart
rates of heart disease than either moderate drinkers or nondrinkers.
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Sleep Apnea
Sleep apnea is a serious disorder in which a person briefly and repeatedly stops breathing during sleep. People with untreated sleep apnea are more likely to develop high blood pressure, heart attack, congestive heart failure, and stroke.
Sleep apnea tends to develop in middle age, and men are twice as likely as women to have the condition. Other factors that increase risk are overweight and obesity, smoking, using alcohol or sleeping pills, and a family history of sleep apnea. Symptoms include heavy snoring and gasping or choking during sleep, along with extreme daytime sleepiness.
If you think you might have sleep apnea, ask your doctor for a test called a polysomnography, which is usually performed overnight in a sleep center. If you are overweight, even a small weight loss—10 percent of your current weight—can relieve mild cases of sleep apnea. Other self-help treatments include quitting smoking and avoiding alcohol and
sleeping pills. Sleeping on your side
rather than on your back also may
help. Some people benefit from a
mechanical device that helps
maintain a regular breathing
pattern by increasing air
pressure through the nasal
passages via a face mask.
For very serious cases,
surgery may be needed.
Menopausal Hormone
Therapy
Until recently, it was
thought that
What Else Af
menopausal hormone
therapy
could ward off
fects Heart Disease?
heart disease, osteo-
porosis, and cancer,
as well as improve
40
a woman’s quality of life. But several important studies, conduct-ed as part of the Women’s Health Initiative, show that long-term use of hormone therapy poses serious health risks, including increased risks of heart attack, stroke, and a condition called venous thrombosis (a blood clot that usually occurs in one of the deep veins of the leg).
In one study, 16,608 postmenopausal women with a uterus took either estrogen-plus-progestin therapy or a placebo—a pill that looks like the real drug but has no biological effect. The results were surprising: The estrogen-plus-progestin therapy actually increased women’s risk for heart attacks, stroke, blood clots, and breast cancer. A related study showed that the hormone combination doubled the risk of dementia and failed to protect women from memory loss. However, the estrogen-plus-progestin medication did reduce the risks of both colorectal cancer and bone fractures. It also relieved menopausal symptoms such as hot flashes and night sweats.
The second study involved 10,739 women who had had a
hysterectomy and took either estrogen alone or a placebo. The results: Estrogen-alone therapy increased the risks for both stroke and venous thrombosis. The treatment had no effect on heart disease and colorectal cancer, and an uncertain effect on breast cancer. Estrogen alone offered no pro-
tection against memory loss.
Estrogen alone, however, did
reduce the risk for bone frac-
tures.
The research also showed
that both estrogen alone and
estrogen combined with pro-
gestin increase the risk of
developing urinary inconti-
nence, which is the inability to
“hold in” urine. For
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women who already have the condition, these medications can worsen symptoms.
If you are a woman who is taking menopausal hormone therapy, or if you’ve used it in the past, these findings can’t help but concern you. It’s important to understand, however, that the results apply to a very large group of women. For an individual woman, the increased risk for disease is quite small. For example, in the estrogen-plus-progestin study, each woman had an increased risk of breast cancer of less than one-tenth of 1 percent per year.
While questions remain, these findings provide a basis for advice about using hormone therapy:
■ Estrogen alone, or estrogen-plus-progestin, should not be used to prevent heart disease. Talk with your doctor about other ways of preventing heart attack and stroke, including lifestyle changes and medicines such as cholesterol-lowering statins and blood pressure drugs.
■ If you are considering using menopausal hormone therapy to prevent the bone-thinning disease osteoporosis, talk with your doctor about the possible benefits weighed against your personal risks for heart attack, stroke, blood clots, and breast cancer.
Ask your doctor about alternative treatments that are safe and effective in preventing osteoporosis and bone fractures.
■ Do not take menopausal hormone therapy to prevent dementia or memory loss.
■ If you are considering menopausal hormone therapy to provide relief from menopausal symptoms such as hot flashes, talk with your doctor about whether this treatment is right for you. The studies did not test the short-term risks and benefits of using hormone therapy for menopausal symptoms. The U.S. Food
and Drug Administration recommends that menopausal
hormone therapy be used at the lowest dose for the shortest What Else Af
period of time to reach treatment goals.
Remember, your risks for heart disease, stroke, osteoporosis, and fects Heart Disease?
other conditions may change as you age, so review your health needs regularly with your doctor. New treatments that are safe and effective may become available. Stay informed.
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New Risk Factors?
We know that major risk factors such as high blood cholesterol, high blood pressure, and smoking boost heart disease risk.
Researchers are studying other factors that might contribute to heart disease, including inflammation of the artery walls. Several emerging risk factors have been identified. We don’t know for sure yet whether they lead to heart disease or whether treating them will reduce risk. While these possible risk factors are not recommended for routine testing, ask your doctor whether you should be tested for any of them.
C-reactive protein (CRP). High levels of CRP may indicate inflammation in the artery walls. A simple blood test can measure the levels of CRP in the blood. In many cases, a high CRP level is a sign of metabolic syndrome. Treatment of the syndrome with lifestyle changes—weight loss and regular physical activity—can often lower CRP.
Homocysteine. High blood levels of this amino acid may increase risk for heart disease. It may be possible to lower elevated levels of homocysteine by getting plenty of folic acid and vitamins B6 and B12 in your diet.
Lp(a) protein. This lipoprotein
may make it easier for blood
clots to form. Niacin, a
cholesterol-lowering drug,
may help to lower Lp(a)
protein levels.
Risk Factors
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