Dr. K’s 10 RULES to Lower Your Heart Disease Risk

Peter Klementowicz MD FACCDirector, Cholesterol Management

CenterCatholic Medical Center

# 1: Smoking Keeps Me in Business

• No smoking

• Minimize exposure to second hand smoke

# 2: Do Not Ignore Your Family

• If your brother or father had a heart attack, required a stent, underwent bypass surgery or had a stroke before the age of 55, then you are at risk.

• If your sister or mother had a heart attack, required a stent, underwent bypass surgery or had a stroke before the age of 65, then you are at risk.

# 3: Exercise is a Medicine

• 30 minutes of moderate intensity aerobic physical activity five days a week– Walking at 3.0 mph is 3.3 METS– Walking at a brisk pace (4mph) is 5.0 METS

• Vigorous intensity aerobic activity for a minimum of 20 minutes three days a week. – Jogging at 5mph is 8.0 METS

# 3: Exercise is a Medicine

• Your minimum goal is 450 MET min/wk to 750 MET min/wk.

• Comprehensive listing of MET values: http://prevention.sph.sc.edu/tools/compendium.htm

# 3: Exercise is a Medicine

Activity METS Duration(min)

Days/wk

MET min

Walk 3.0mph

3.3 30 2 198

Jog 5.0mph

8.0 20 2 320

518

# 3: Exercise is a Medicine

TIME

70%

90%

(Maximum Predicted Heart Rate=220-Age)

MPHR

Aerobic Interval Training

# 3: Exercise is a Medicine

• If you are older than 50 years old and plan to run a marathon, you should consider having a coronary artery calcium score performed.

# 4: Have a Nutritional Plan

• Balance caloric intake and physical activity to achieve or maintain a healthy body weight. A healthy body weight is currently defined as a body mass index of 18.5 to 24.9 kg/m2.– The lowest risk related to BMI, a BMI of 25.3

for men and a BMI of 24.3 for women

• Avoid fast food restaurants.• No sugary drinks.

# 4: Have a Nutritional Plan

• Consume a diet rich in vegetables and fruits.

• Choose whole grain, high fiber foods.

• Limit your intake of saturated fat to <7% of energy; eliminate trans fats– Choose lean meats and vegetables– Select fat-free, 1% fat and low fat diary

products

# 4: Have a Nutritional Plan

• If you need to lose weight, strongly consider adopting a Low Glycemic Index Diet.

# 5: Eat a Fish

• Consume fish, especially oily fish, at least twice a week

• Avoid frying the fish or using cream sauces.

# 5: Eat a FishFish EPA DHA EPA+DHA

Salmon 0.587 1.238 1.825

Herring 1.056 0.751 1.807

Mackerel 0.555 1.016 1.571

Sablefish 0.737 0.782 1.519

White fish 0.345 1.025 1.37

Halibut 0.573 0.428 1.00

Trout 0.284 0.697 0.981

Bluefish 0.198 0.565 0.84

Tuna 0.198 0.535 0.733

Grams of fatty acid per 3 oz of fish, cooked

# 5: Eat a Fish

• If you do not like to eat fish, take fish oil capsules instead. You should consume between 500 mg and 900mg of EPA+DHA.

• When buying fish oil capsules, ignore the dose listed on the front label.

# 6: Drink Alcohol Responsibly

TOTAL MORTALITYRELATIVE

RISK

0 1 2 3 4 5 6DRINKS/DAY

1

# 7: Do Not Develop Diabetes

• Normal Blood Glucose: < 100 mg/dl

• Impaired Fasting Glucose: 100-125 mg/dl

• Diabetes Mellitus: ≥126 mg/dl

• Determine your risk of developing Diabetes Mellitus

# 7: Do Not Develop Diabetes

• If you are at risk of developing diabetes Mellitus, you should:– Lose 7% of your weight over a 6 month period

of time– Exercise at least 150 minutes/week

# 8: Measure Blood Pressureat Home

• Use a fully automated device with an upper arm cuff that has been validated by the Association for the Advancement of Medical Instrumentation

# 8: Measure Blood Pressure at Home

• Measure BP– No tobacco or caffeine for 30 minutes

preceding measurement– After 5 minutes of rest– With arm at heart level, back supported and

feet flat on the floor– On non-dominant arm (or arm with the highest

BP)

# 8: Measure Blood Pressure at Home

• Base decisions on a 7-day measurement period with 2-3 measurements each morning and 2 to 3 measurements in evening at pre-stipulated times (an average of 12 morning and evening measurements)

# 8: Measure Blood Pressure at Home

• Target BP goals– Normal blood pressure <125/75 mmHg– 130/80 mmHg if you have diabetes, coronary

heart disease or chronic kidney disease– 135/85mmHg

# 9: Use NSAIDs WiselyCardiovascular

Risk

GastrointestinalRisk

Naproxen

Ibuprofen

Diclofenac

Celecoxib

Rofecoxib

# 9: Use NSAIDs Wisely

• If you take immediate release low dose Aspirin( 81mg) and Ibuprofen 400mg, take the Ibuprofen at least 30 minutes after the Aspirin or at least 8 hours before taking the Aspirin.

# 10: You Do Not Need Most Vitamin Supplements

• These do not prevent heart disease:– Beta carotene– Folate– Selenium– Vit B6– Vit B12– Vit C– Vit E