1. Dr. K’s 10 RULES to Lower Your Heart Disease Risk Peter Klementowicz MD FACC Director, Cholesterol Management Center Catholic Medical Center

2. # 1: Smoking Keeps Me in Business No smoking Minimize exposure to second hand smoke

3. # 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.

4. # 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

5. # 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/compen dium.htm

6. # 3: Exercise is a Medicine ActivityMETSDuration (min) Days/ wk MET min Walk 3.0mph 3.3302198 Jog 5.0mph 8.0202320 518

7. # 3: Exercise is a Medicine TIME 70% 90% (Maximum Predicted Heart Rate=220-Age) MPHR Aerobic Interval Training

8. # 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.

9. # 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/m 2. –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.

10. # 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

11. # 4: Have a Nutritional Plan If you need to lose weight, strongly consider adopting a Low Glycemic Index Diet.

12. # 5: Eat a Fish Consume fish, especially oily fish, at least twice a week Avoid frying the fish or using cream sauces.

13. # 5: Eat a Fish FishEPADHAEPA+DHA Salmon0.5871.2381.825 Herring1.0560.7511.807 Mackerel0.5551.0161.571 Sablefish0.7370.7821.519 White fish0.3451.0251.37 Halibut0.5730.4281.00 Trout0.2840.6970.981 Bluefish0.1980.5650.84 Tuna0.1980.5350.733 Grams of fatty acid per 3 oz of fish, cooked

14. # 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.

15. # 6: Drink Alcohol Responsibly TOTAL MORTALITY RELATIVE RISK 0 1 2 3 4 5 6 DRINKS/DAY 1

16. # 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

17. # 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

18. # 8: Measure Blood Pressure at Home Use a fully automated device with an upper arm cuff that has been validated by the Association for the Advancement of Medical Instrumentation

19. # 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)

20. # 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)

21. # 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

22. # 9: Use NSAIDs Wisely Cardiovascular Risk Gastrointestinal Risk Naproxen Ibuprofen Diclofenac Celecoxib Rofecoxib

23. # 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.

24. # 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