Topics of Interest INTERVENTION STRATEGIES FOR HEART DISEASE EVERYONE SHOULD OBSERVE There are Risk Reduction Strategies ("Interventions") that can be undertaken to reduce the chance of developing cardiovascular disease. These intervention strategies fall into three categories: Dietary. Lifestyle. Risk Factor Assessment. DIETARY STRATEGIES To reduce the risk of heart disease in patients without demonstrated disease, and who have a normal cholesterol, the American Heart Association recommends what they refer to as the Step I Diet. THE STEP I DIET CONSISTS OF THE FOLLOWING: RECOMMENDATIONS: TOTAL FAT INTAKE: It is recommended that the calories obtained from fat should be no more than 30% of total calories. SATURATED FAT: Calories from saturated fat (sat fat) should be limited to 8-10% of total calories. POLYUNSATURATED FAT: Calories from Polyunsaturated fat can account for up to 10% of total calories. MONOUNSATURATED FAT: Calories from monounsaturated fat can be up to 15% of total calories. CARBOHYDRATES: Calories from carbohydrates should be 55% or more of total calories. PROTEIN: Calories from protein should be approximately 15% of total calories. CHOLESTEROL: Cholesterol intake should be limited to 300 mg per day. TOTAL CALORIES: Total calories should be the number of calories that would allow you to achieve and maintain a desired weight. The following chart will allow you to estimate fat intake at selected levels of total calorie intake according to the Step I Diet: TOTAL CALORIES TOTAL FAT (grams) SATURATED FAT (gm) 1200 40 or less 11-13 1500 50 or less 13-17 1800 60 or less 16-20 2000 67 or less 18-22 2200 73 or less 20-24 2500 83 or less 22-28 3000 100 or less 27-33 For patients with a history of heart disease, or who have an elevated cholesterol, the Step II Diet is recommended. LIFESTYLE ISSUES Appropriate lifestyle modification should occur, and should address the following areas: SMOKING: The goal should be complete cessation of smoking. A smoking cessation program should be discussed, to include cessation strategies and pharmacological therapy where appropriate. EXERCISE: A goal should be set for physical activity to include 30 minutes of vigorous exercise 3 to 4 times per week. Daily activities should be modified so as to increase the amount of walking, such as parking farther from the store or office, taking stairs instead of elevators, etc. ALCOHOL INTAKE: Alcohol should be consumed in moderation, as excessive alcohol consumption has been linked to an increased risk of heart disease. Moderation is defined as no more than 2 alcohol containing beverages per day. Red Wine consumption, at no more than 2 glasses per day, has been shown to be associated with a reduced risk of cardiovascular disease. This is thought to be due to its content of tannins and isoflavones, which function as anti-oxidants. STRESS MANAGEMENT: Stress, and how we deal with it, is known to contribute to the development of cardiovascular disease. Life stressors should be examined, and an appropriate strategy to better deal with stress should be undertaken, to include the use of behavioral therapists or other treatment modalities, such as biofeedback, Yoga, meditation, and acupuncture. PERIODIC RISK FACTOR ASSESSMENT: Risk factors for cardiac disease should be assessed periodically by your primary care physician. These should include: Lipid Screening: to include measuring total cholesterol, LDL, and triglycerides. Blood Pressure Screening. Monitoring Weight. Assessment of estrogen status. When assessment of these risk factors shows the need, intervention strategies should be implemented as appropriate.

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