Am I At Risk? If you have any of these risk factors, you are at risk for heart disease. Controllable Risk Factors Uncontrollable Risk Factors High Cholesterol Increasing Age High Blood Pressure Heredity (family history) Physical Inactivity Race (members of some races, particularly African Americans, are at higher risks) Obesity and Overweight Type 2 Diabetes Smoking Several factors increase the risk of coronary heart disease and heart attack. The American Heart Association has identified several risk factors. Some can be modified, treated or controlled, and some can't. The more risk factors you have, the greater your chance of developing coronary heart disease. And, the greater the level of each risk factor, the greater the risk. Uncontrollable risk factors include: Increasing age Heredity or family history Race (members of some races, particularly African Americans, are at higher risk) Controllable risk factors include: High blood cholesterol High blood pressure Physical inactivity Obesity and overweight Diabetes Smoking We will spend some time learning more about these controllable risk factors and what you can do to lower your risks. (Source: http://www.americanheart.org/presenter.jhtml?identifier=500)

Your Risk: High Blood Cholesterol Total Cholesterol Level Desirable = Less than 200 Borderline high = 200 to 239 High = 240 and above About 50% of women have a total cholesterol of 200 mg/dL and above, which puts them at risk for heart disease. Cholesterol is a soft, fat-like substance found in the bloodstream and in all your body’s cells. Your body makes all the cholesterol it needs. The saturated fats, trans fats and cholesterol you eat may raise your blood cholesterol level. Having too much cholesterol in your blood increases your risk for heart disease and stroke. This happens because cholesterol and other fats can build up in the walls of arteries, narrowing the channel where the blood flows. If a narrowed artery gets blocked by a blood clot or other particle, the heart or brain loses its blood supply, resulting in a heart attack or stroke. About half of American adults have cholesterol levels that are too high (200 mg/dL or higher). About 17% of adults are at high-risk (240 mg/dL or higher). You should have your cholesterol levels checked regularly (at least once every five years starting at age 20). Your total blood cholesterol level is one measure of risk. We have highlighted the desirable, borderline and high levels you need to be aware of. Total Blood Cholesterol Levels Less than 200 mg/dL = Desirable (lower risk) 200 to 239 mg/dL = Borderline high (higher risk) 240 mg/dL and above = High blood cholesterol (more than twice the risk as desirable level) It’s also important to understand that we have two sources of cholesterol: 1. HDL or high-density lipoprotein. HDL is “good” cholesterol because it seems to lower your risk of heart attack and stroke. Unlike other cholesterol levels, the higher your HDL, the better. HDL Cholesterol Risk Levels Less than 40 mg/dL for men Less than 50 mg/dL for women 2. The second source, LDL, stands for low-density lipoprotein. This is the main carrier of harmful cholesterol in your blood. A high level of LDL cholesterol means there’s a higher risk of heart disease and stroke. LDL Cholesterol Risk Levels Less than 100 mg/dL = Optimal for people with heart disease or diabetes 100 to 129 mg/dL = Near or above optimal 130 to 159 mg/dL = Borderline high 160 to 189 mg/dL = High 190 mg/dL and above = Very High Triglycerides are the most common type of fat in your body. They’re also a major energy source. They come from food, and your body also makes them. As people get older, gain excess weight or both, their triglyceride levels tend to rise. Triglyceride Risk Levels Less than 150 mg/dL = Normal 150 to 199 mg/dL = Borderline High 200 to 499 mg/dL = High 500 mg/dL and above = Very High This image illustrates the sources of cholesterol in your body and how each form of cholesterol contributes to our total cholesterol level. [Source: GRFW Know Your Risk Fact Sheet, Cholesterol and Tri-glycerides, Content approved by AHA Science 9/07]

Your Risk: High Blood Pressure Normal Blood Pressure = Below 120/80 Pre-Hypertension = 120-139/80-89 Hypertension = Above 140/90 About 39 million women age 20 and older have high blood pressure. 28% of people with high blood pressure don’t know they have it. High Blood Pressure, or hypertension, is a condition in which blood pressure levels are above the normal range. Blood pressures of 120-139 mm Hg and/or 80-89 mm Hg are considered prehypertension. Blood pressure is considered high if it is 140 mm Hg and/or 90 mm Hg or higher. High blood pressure is called the “silent killer” because it increases the risk for heart attack, angina, stroke, kidney failure and peripheral artery disease (PAD). It may also increase the risk of developing fatty deposits in arteries (atherosclerosis). The risk of heart failure also increases due to the increased workload that high blood pressure places on the heart. About 73 million Americans (and 1 in 3 adults) have high blood pressure, but only 30% know their personal risk. No one knows exactly what causes most cases of high blood pressure. It usually can’t be cured, but it can be controlled. Not treating high blood pressure is dangerous. You can live a healthier life if you treat and control it! Some people are at higher risk of having high blood pressure. They include: • People with close blood relatives who have HBP • African Americans • People over age 35 • Overweight people • People who aren’t physically active • People who use too much salt • People who drink too much alcohol • People with diabetes, gout or kidney disease • Pregnant women • Women who take birth control pills and who are overweight, had HBP during pregnancy, have a family history of HBP or have mild kidney disease

Your Risk: Physical Inactivity Inactive women: White females – 38% Black females – 52% Hispanic females – 54% Asian females – 41% All healthy adults ages 18-65 should be getting at least 30 minutes of moderate intensity activity five days a week. Physical inactivity is a major risk factor for cardiovascular disease, and most Americans are not physically active enough to gain any health benefits. Swimming, cycling, jogging, skiing, aerobic dancing, walking and many other activities can help your heart. Whether it's included in a structured exercise program or part of your daily routine, all physical activity adds up to a healthier heart. Regular, moderate-intensity physical activity can lower your risk of • Heart disease and heart attack • High blood pressure • High cholesterol • Overweight or obesity • Diabetes • Stroke According to the latest joint American Heart Association/American College of Sports Medicine guidelines on physical activity, all healthy adults ages 18-65 should get at least 30 minutes of moderate-intensity activity five days a week. There are additional guidelines for those 65 and older, or for those  50-64 with chronic conditions or physical functional limitations (e.g., arthritis) that affect movement ability or physical fitness. [Source: http://www.americanheart.org/presenter.jhtml?identifier=1200013, Reviewed 10/7/07]

Your Risk: Obesity & Overweight Excess Weight: Strains your heart Raises blood pressure and cholesterol Can lead to diabetes About 69 million women are overweight and 36.7 million are obese, which greatly increases their risk for heart disease. Being overweight is another risk factor for heart disease. More than 142 million American adults are overweight. Of these, nearly 67 million are considered obese. People who are overweight or obese are more likely to develop heart disease and stroke, even if they have no other risk factors. Excess weight puts more strain on your heart. It can raise blood pressure and blood cholesterol and can lead to diabetes. Losing weight is one of the best ways to reduce your risk of heart problems and other diseases. Prepare yourself by setting goals and deciding how to deal with potential roadblocks. It’s never wise to follow fad diets, starve yourself or try to lose weight too fast. Remember, you didn’t become overweight overnight. It’s important to make changes over the long term and not get discouraged by setbacks. Start by changing your eating habits and working physical activity into your daily routine. Keeping extra weight off can be as challenging as losing it. Many things will tempt you to go back to your old habits. It takes commitment to stick to your new, healthy lifestyle. Yet when you do, you may notice that you have greater self-control with food, feel stronger, have better eating habits and fewer mood swings, and are in better overall shape! [Source: GRFW Know Your Risk Fact Sheet, Overweight and Obesity, Content approved by AHA Science 9/07]

Your Risk: Diabetes Complications of Diabetes Stroke, TIA Blindness Heart attack, angina Kidney disease High blood pressure Erectile dysfunction Loss of legs or feet Nerve disease Diabetes is also a major risk factor for stroke and heart disease. That means it can be as serious as smoking, high blood cholesterol, high blood pressure, physical inactivity or obesity. There are two forms of diabetes. Type 1, or juvenile diabetes, usually starts early in life. It results from the body’s failure to produce insulin. People with it must take insulin each day to regulate levels of blood glucose (sugar). Type 2 is the most common. About 95 percent of Americans diagnosed with diabetes have type 2 diabetes. It most often develops in middle-aged and older adults, and is often linked with obesity and physical inactivity. Type 2 diabetes develops when the body doesn’t make enough insulin and doesn’t efficiently use the insulin it makes. Who Gets Diabetes Diabetes is increasing. This is because more people are obese, don’t get enough physical activity and are getting older. However, many younger people are developing diabetes at an alarming rate. This is probably because obesity and lack of physical activity are increasing problems for this group, too. People in several ethnic groups seem to be more likely to develop type 2 diabetes: • Hispanics • African Americans • Native Americans • Asians (especially South Asians) If you have diabetes, it’s very important to have regular check-ups and work closely with your healthcare provider to manage your diabetes and reduce any other risk factors. Here are some steps you can take: • Control your weight and blood cholesterol with a low-saturated-fat, low-cholesterol diet. • If you take medicine, take it exactly as directed. Specific medicines may help you control your blood pressure, cholesterol and blood glucose. Your doctor will advise you if one is right for you. If you have questions about the dosage or side effects, ask your doctor or pharmacist. Additional Talking Points on Diabetes: Insulin and Diabetes Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. This happens because the hormone insulin converts sugar and other food into energy and helps glucose get into our bodies’ cells. When you have diabetes, your body doesn’t make enough insulin or can’t use its own insulin as well as it should, or both. This causes sugars to build up too high in your blood. [Source: GRFW Know Your Risk Fact Sheet, Diabetes, Content approved by AHA Science 9/07] People with diabetes are two to four times more likely to develop cardiovascular disease. 7.5 million women 20+ have been diagnosed with type 2 diabetes, 2.3 million go undiagnosed and 24.9 million are pre-diabetic.

Your Risk: Smoking Benefits of Quitting Within 1 to 2 years of quitting, your risk of coronary heart disease is substantially reduced. Your sense of smell and taste come back. A smoker’s cough will go away. You breathe much easier. It is easier to be physically active. You are free of “needing” cigarettes. 20.7 million women age 18 and older smoke, increasing their risk for heart disease. Smoking cigarettes is the most preventable major risk factor of our No. 1 killer — heart and blood vessel diseases. The long list of diseases and deaths due to smoking is frightening. Thousands of nonsmokers, including infants and children, are harmed by exposure to cigarette smoke. Even if you don’t smoke, you could become one of the more than 438,000 smoking-related deaths every year. It’s never too late to quit! No matter how much or how long you’ve smoked, when you quit smoking, your risk of heart disease and stroke starts to drop. In time your risk will be about the same as if you’d never smoked. Quitting smoking isn’t easy, but it’s worth it! Quitting will drastically reduce your risk of developing heart and blood vessel diseases. It will also lower your chance of having lung disease and cancer. Most of all, quitting can save your life and the lives of nonsmokers around you.

What Can I Do To Prevent Heart Disease? Choose to take ACTION and Lower Your Risk Eat a healthy diet low in saturated fat, trans fat, cholesterol and sodium. Keep your weight under control. Be physically active at least 30 minutes on most or all days of the week. Control your blood pressure and cholesterol levels. Manage your blood sugar if you have diabetes. Get regular medical check-ups. Talk to your doctor about a prevention plan and medicines that may be right for you. Don’t smoke, and avoid tobacco smoke. Reducing Your Heart Disease and Stroke Risk You can reduce your risk of heart disease and stroke. Here are some key steps you can take: • Eat a healthy diet low in saturated fat, trans fat, cholesterol and salt. • Keep your weight under control. • Be physically active at least 30 minutes on most or all days of the week. Don’t smoke, and avoid other people’s tobacco smoke. • Lower your blood pressure if you need to. Treat high blood pressure if you have it. • Control your blood sugar if you have diabetes. • Get regular medical check-ups. • Follow your doctor’s orders for taking medicine. [Source: GRFW Know Your Fact Sheet, Heart Disease and Stroke, AHA Science Review complete 9/07]