YOUR GUIDE TO

A Healthy Heart

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute
YOUR GUIDE TO

A Healthy Heart

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 06-5269

December 2005
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

Written by: Marian Sandmaier
Heart Disease: Why Should You Care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

What You Need To Know About Heart Disease . . . . . . . . . . . . . . . . . . . . . . 3

What Is Heart Disease?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Who Is at Risk? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

How Risk Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

What’s Your Risk? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

How To Talk With Your Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Major Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

High Blood Pressure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

What Is Blood Pressure?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Understanding Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Changing Your Lifestyle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Taking Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

High Blood Cholesterol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Cholesterol and Your Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Getting Tested . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

What’s Your Number?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

HDL Cholesterol Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Heart Disease Risk and Your LDL Goal . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

A Special Type of Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Your LDL Goal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

How To Lower Your LDL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Overweight and Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Should You Choose To Lose? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Lose a Little, Win a Lot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Physical Inactivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

What Else Affects Heart Disease?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Sleep Apnea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Menopausal Hormone Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Birth Control Pills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Contents

Contents
iv

Taking Charge: An Action Plan for Heart Health . . . . . . . . . . . . . . . . . . . 45

Choose Healthy Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Getting Extra Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Blood Pressure and the Dash Eating Plan . . . . . . . . . . . . . . . . . . . . . . . . . 48

What Else Affects Blood Pressure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

High Blood Cholesterol and the TLC Program . . . . . . . . . . . . . . . . . . . . . . . . 53

Now You’re Cooking: Limiting Saturated Fat, Trans Fat, and Cholesterol . . . . . . 53

Meat, Poultry, and Fish . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Milk Products and Eggs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Grains and Grain Products. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Sauces, Soups, and Casseroles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

When You Can’t Face Cooking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Dining Out for Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Make Healthy Choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

How To Tame a Snack Attack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Aim for a Healthy Weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Seven Secrets of Weight Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

How To Choose a Weight-Loss Program . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Get Moving! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

A Little Activity Goes a Long Way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

No Sweat!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Safe Moves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

What’s Your Excuse? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Move It and Lose It . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

You Can Stop Smoking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Prepare To Succeed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Breaking the Habit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

If You “Slip” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Heart Health Is a Family Affair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

A Change of Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

How To Estimate Your Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

To Learn More . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Your Guide to a Healthy Heart
If you’re like many people, you may think of heart disease as a

problem that happens to other folks. “I feel fine,” you may think,

“so I have nothing to worry about.” If you’re a woman, you may

also believe that being female protects you from heart disease.

If you’re a man, you may think you’re not old enough to have a

serious heart condition.

Wrong on all counts. In the United States, heart disease is the #1

killer of both women and men. It affects many people at midlife, 

as well as in old age. It also can happen to those who “feel fine.”

Consider these facts: 

■ Each year, 500,000 Americans die of heart disease, and approximately half of them are women.

■ As early as age 45, a man’s risk of heart disease begins to rise 

significantly. For a woman, risk starts to increase at age 55.

■ Fifty percent of men and 64 percent of women who die suddenly

of heart disease have no previous symptoms of the disease.

1Heart Disease: Why Should You Care?

Heart Disease:

Why Should You Care?
2

These facts may seem frightening, but they need not be. The good

news is that you have a lot of power to protect and improve your

heart health. This guidebook will help you find out your own risk

of heart disease and take steps to prevent it.

“But,” you may still be thinking, “I take pretty good care of myself.

I’m unlikely to get heart disease.” Yet a recent national survey shows

that only 3 percent of U.S. adults practice all of the “Big Four”

habits that help to prevent heart disease: eating a healthy diet, 

getting regular physical activity, maintaining a healthy weight, and

avoiding smoking. Many young people are also vulnerable. A

recent study showed that about two-thirds of teenagers already have

at least one risk factor for heart disease.

Every risk factor counts. Research shows that each individual risk

factor greatly increases the chances of developing heart disease.

Moreover, the worse a particular risk factor is, the more likely you

are to develop heart disease. For example, if you have high blood

pressure, the higher it is, the greater your chances of developing

heart disease, including its many serious consequences. A damaged

heart can damage your life by interfering with enjoyable activities,

preventing you from holding a job, and even keeping you from

doing simple things, such as taking a walk or climbing steps.

What can you do to reduce your personal risk of heart disease?

First, you can learn about your own risk factors. Second, you can

begin to make healthful changes in your diet, physical activity, and

other daily habits. Whatever your age or current state of health, it’s

never too late to take steps to protect your heart. It’s also never too

early. The sooner you act, the better. So use this guidebook to find

out more about the state of your heart, and to learn about heart

healthy living. Talk with your doctor to get more information.

Start taking action to improve your heart health today.

Your Guide to a Healthy Heart
What Is Heart Disease? 

Coronary heart disease—often simply called heart disease—occurs

when the arteries that supply blood to the heart muscle become

hardened and narrowed due to a buildup of plaque on the arteries’

inner walls. Plaque is the accumulation of fat, cholesterol, and other

substances. As plaque continues to build up in the arteries, blood

flow to the heart is reduced.

Heart disease can lead to a heart attack. A heart attack happens

when an artery becomes totally blocked with plaque, preventing

vital oxygen and nutrients from getting to the heart. A heart attack

can cause permanent damage to the heart muscle.

Heart disease is one of several cardiovascular diseases, which are

disorders of the heart and blood vessel system. Other cardiovascular

diseases include stroke, high blood pressure, and rheumatic heart

disease.

Some people aren’t too concerned about heart disease because they

think it can be “cured” with surgery. This is a myth.

Heart disease is a lifelong condition: Once you get it,

you’ll always have it. It’s true that procedures such as

angioplasty and bypass surgery can help blood and

oxygen flow more easily to the heart. But the arteries remain damaged, which means you are still more

likely to have a heart attack. What’s more, the

condition of your blood vessels will steadily

worsen unless you make changes in your

daily habits and control your risk factors.

Many people die of complications

from heart disease, or become 

permanently disabled. That’s

why it is so vital to take action to 

prevent this disease.

3What You Need To Know About Heart Disease

What You Need To Know

About Heart Disease
4

Who Is at Risk?

Risk factors are conditions or habits that make a person more likely

to develop a disease. They can also increase the chances that an

existing disease will get worse. Important risk factors for heart disease that you can do something about are cigarette smoking, high

blood pressure, high blood cholesterol, overweight, physical 

inactivity, and diabetes. Recent research shows that more than 

95 percent of those who die from heart disease have at least one 

of these major risk factors.

Certain risk factors, such as getting older, can’t be changed. After

menopause, women are more likely to develop heart disease. For

both women and men, middle age is a time of increasing risk

because people are more likely to develop heart disease risk factors

during this stage of life.

Family history of early heart disease is another risk factor that can’t

be changed. If your father or brother had a heart attack before age

55, or if your mother or sister had one before age 65, you are more

likely to get heart disease.

While certain risk factors cannot be changed, it is important to 

realize that you do have control over many others. Regardless of

your age or family history, you can take important steps to lower

your risk of heart disease.

How Risk Works

It may be tempting to believe that doing just one healthy thing will

take care of your heart disease risk. For example, you may hope

that if you walk or swim regularly, you can still eat a lot of fatty

foods and stay fairly healthy. Not true. To protect your heart, it is

vital to make changes that address each and every risk factor you

have. You can make the changes gradually, one at a time. But making them is very important.

While each risk factor increases your risk of heart disease, having

more than one risk factor is especially serious. That’s because risk

factors tend to “gang up” and worsen each other’s effects. For

example, if you have high blood cholesterol and you smoke, your

heart disease risk increases enormously. The message is clear: You

need to take heart disease risk seriously, and the best time to reduce

that risk is now.

Your Guide to a Healthy Heart
The first step toward heart health is becoming aware of your 

own personal risk for heart disease. Some risks, such as smoking

cigarettes or being overweight, are obvious: All of us know whether

we smoke or whether we need to lose a few pounds. But other risk

factors, such as high blood pressure or high blood cholesterol, have

few visible signs or symptoms. So you’ll need to gather some 

information to create your own personal “heart profile.”

How To Talk With Your Doctor

The first step in finding out your risk is to make an appointment

with your doctor for a thorough checkup. Your physician can be 

an important partner in helping you set and reach goals for heart

health. But don’t wait for your doctor to mention heart disease or

its risk factors. Many physicians don’t routinely bring up the topic,

especially with their female patients. New research shows that

women are less likely than men to receive heart healthy recommendations from their doctors. Here’s how to speak up and establish

good, clear communication between you and your doctor.

Ask for what you need. Tell your doctor that you want to keep your

heart healthy and would like help in achieving that

goal. Ask questions about your chances of

developing heart disease and ways to lower

your risk. (See “Questions To Ask Your

Doctor” on the next page.) Also ask for

tests that will determine your personal

risk factors. (See “What’s Your Number?”

on page 8.) 

Be open. When your doctor asks you

questions, answer them as 

honestly and fully as you

can. While certain topics

may seem quite personal,

5

What’s Your Risk?

What’s Your Risk?
6

discussing them openly can help your doctor find out your chances of

developing heart disease. It can also help your doctor work more effectively with you to reduce your risk.

Keep it simple. If you don’t understand something your doctor says,

ask for an explanation in plain language. Be especially sure you

understand why and how to take any medication you’re given. If

you are worried about understanding what the doctor says, or if you

have trouble hearing, bring a friend or relative with you to your

appointment. You may want to ask that person to write down the

doctor’s instructions for you.

Your Guide to a Healthy Heart

Questions To

Ask Your Doctor

Getting answers to these questions will give you important information about your heart health and what you can do to improve

it. You may want to bring this list to your doctor’s office. 

1. What is my risk for heart disease?

2. What is my blood pressure? What does it mean for me, and 

what do I need to do about it?

3. What are my cholesterol numbers? (These include total 

cholesterol, low-density lipoprotein (LDL) “bad” cholesterol, 

high-density lipoprotein (HDL) “good” cholesterol, and 

triglycerides.) What do they mean for me, and what do 

I need to do about them?

4. What are my body mass index (BMI) and waist measurement? 

Do they indicate that I need to lose weight for my health?

5. What is my blood sugar level? Does it mean I’m at risk for

diabetes?

6. What other screening tests for heart disease do I need? How 

often should I return for checkups for my heart health?

7. For smokers: What can you do to help me quit smoking?

8. How much physical activity do I need to help protect my 

heart? What kinds of activities are helpful? 

9. What is a heart healthy eating plan for me? Should I see a 

registered dietitian or qualified nutritionist to learn more about

healthy eating?

10. How can I tell if I’m having a heart attack?
7

I just didn’t think I could be having a 

heart attack. I didn’t expect it to happen 

to me. I was overweight and had high 

cholesterol but thought I was in good 

health. I’d had diabetes about 4 years, but 

I had no idea that it was a risk factor for 

heart disease. Most women don’t know 

they’re at risk for heart disease. I have 

several friends who have a lot of the 

same risk factors that I do, but they’re 

just not tuned in to them. They need to 

know that, and they need to take better 

care of themselves.

ANN STIEGLER

“

What’s Your Risk?

”
8Your Guide to a Healthy Heart

What’s Your Number?

Tests That Can Help 

Protect Your Health

Ask your doctor to give you these tests. Each one will give you

valuable information about your heart disease risk. 

Lipoprotein Profile

What: A blood test that measures total cholesterol, LDL “bad”

cholesterol, HDL “good” cholesterol, and triglycerides (another form

of fat in the blood). The test is given after a 9- to 12-hour fast.

Why: To find out if you have any of the following: high blood

cholesterol (high total and LDL cholesterol), low HDL cholesterol,

or high triglyceride levels. All affect your risk for heart disease. 

When: All healthy adults should have a lipoprotein profile done

at least once every 5 years. Depending on the results, your 

doctor may want to repeat the test more frequently. 

Blood Pressure

What: A simple, painless test using an inflatable arm cuff.

Why: To find out if you have high blood pressure (also called hypertension) or prehypertension. Both are risk factors for heart disease.

When: At least every 2 years, or more often if you have high

blood pressure or prehypertension. 

Fasting Plasma Glucose

What: The preferred test for diagnosing diabetes. After you have 

fasted overnight, you will be given a blood test the following morning.
9What’s Your Risk?

What’s Your Number?

Why: To find out if you have diabetes or are likely to develop the

disease. Fasting plasma glucose levels of 126 mg/dL or higher in

two tests on different days mean that you have diabetes. Levels

between 100 and 125 mg/dL mean that you have an increased

risk of developing diabetes and may have prediabetes. Diabetes

is an important risk factor for heart disease and other medical

disorders.

When: At least every 3 years, beginning at age 45. If you have

risk factors for diabetes, you should be tested at a younger age

and more often. 

Body Mass Index (BMI) and Waist Circumference

What: BMI is a measure of your weight in relation to your height.

Waist circumference is a measure of the fat around your middle. 

Why: To find out if your body type raises your risk of heart disease. A BMI of 25 or higher means you are overweight. A BMI of

30 or higher means you are obese. Both overweight and 

obesity are risk factors for heart disease. For women, a waist

measurement of more than 35 inches increases the risk of heart

disease and other serious health conditions. For men, a waist

measurement of more than 40 inches increases risk. 

When: Every 2 years, or more often if your doctor recommends it.

There are also several tests that can determine whether you

already have heart disease. Ask your doctor whether you need a

stress test, an electrocardiogram (ECG or EKG), or another 

diagnostic test. 
10Your Guide to a Healthy Heart

Rating 

Your Risk

Here is a quick quiz to find out if you have an increased risk for a

heart attack. If you don’t know some of the answers, ask your

health care provider.

● Do you smoke?

● Is your blood pressure 140/90 mmHg or higher; OR, have you 

been told by your doctor that your blood pressure is too high?

● Has your doctor told you that your LDL “bad” cholesterol is 

too high; that your total cholesterol level is 200 mg/dL or higher;

OR, that your HDL “good” cholesterol is less than 40 mg/dL?

● Has your father or brother had a heart attack before age 55; 

OR, has your mother or sister had one before age 65?

● Do you have diabetes OR a fasting blood sugar of 126 mg/dL 

or higher; OR, do you need medicine to control your blood sugar?

● For women: Are you over 55 years old?

● For men: Are you over 45 years old? 

● Do you have a Body Mass Index score of 25 or more? (To find

out, see page 27.)

● Do you get less than a total of 30 minutes of physical activity 

on most days?

● Has a doctor told you that you have angina (chest pains); 

OR, have you had a heart attack?

If you answered “yes” to any of these

questions, you have a higher risk of

having a heart attack. Read on to

learn what you can do to lower

your risk. 

Rating Your

Risk
A strong partnership with your doctor is a vital first step in protecting your heart health. But to make a lasting difference, you’ll also

need to learn more about heart disease and the kinds of habits and

conditions that can increase your risk. It’s your heart, and you’re in

charge. What follows is a guide to the most important risk factors

for heart disease and how each of them affects your health.

Smoking

Smoking is “the leading cause of preventable death and disease 

in the United States,” according to the Centers for Disease Control

and Prevention (CDC). People who smoke are up to six times more

likely to suffer a heart attack than nonsmokers, and the risk increases with the number of cigarettes smoked each day. Smoking can 

also shorten a healthy life, because smokers are likely to suffer a

heart attack or other major heart problem at least 10 years sooner

than nonsmokers.

But heart disease is far from the only health risk faced by smokers.

Smoking also raises the risk of stroke and greatly increases the

chances of developing lung cancer. Smoking is also linked with

many other types of cancer, including cancers of the mouth, urinary

tract, kidney, and cervix. Smoking also causes most cases of chronic

obstructive lung disease, which includes bronchitis and emphysema.

If you live or work with others, your secondhand smoke can cause

numerous health problems in those individuals. A recent study

shows a 60-percent increased risk of heart disease for nonsmokers

who are regularly exposed to secondhand smoke.

Currently, 25 percent of American men and 20 percent of American

women are smokers. Even more disturbing, 26 percent of high

school seniors smoke. In young people, smoking can interfere with

lung growth and cause more frequent and severe respiratory illnesses,

in addition to heart disease and cancer risks. The younger people

11Major Risk Factors

Major Risk Factors
12

start smoking cigarettes, the more likely they are to become strongly

addicted to nicotine.

There is simply no safe way to smoke. Low-tar and low-nicotine 

cigarettes do not lessen the risks of heart disease or other smokingrelated diseases. The only safe and healthful course is not to smoke at

all. (For tips on quitting, see “You Can Stop Smoking” on page 76.) 

High Blood Pressure 

High blood pressure, also known as hypertension, is another major

risk factor for heart disease, as well as for kidney disease and congestive heart failure. High blood pressure is also the most important

risk factor for stroke. Even slightly high blood pressure levels

increase your risk for these conditions.

New research shows that at least 65 million adults in the United

States have high blood pressure—a 30-percent increase over the last

several years. Equally worrisome, blood pressure levels have

increased substantially for American children and teens, which

increases their risk of developing hypertension in adulthood.

Major contributors to high blood pressure are a family history of

the disease, overweight, and dietary salt. Older individuals are at

higher risk than younger people. Among older individuals, women

are more likely than men to develop high blood pressure. African

Americans are more likely to develop high blood pressure, and at

earlier ages, than Whites. But nearly all of us are at risk, especially

as we grow older. Middle-aged Americans who don’t currently 

have high blood pressure have a 90-percent chance of eventually

developing the disease.

High blood pressure is often called the silent killer because it 

usually doesn’t cause symptoms. As a result, many people pay little

attention to their blood pressure until they become seriously ill.

According to a national survey, two-thirds of people with high 

blood pressure do not have it under control. The good news is that

you can take action to control or prevent high blood pressure, and

thereby avoid many life-threatening disorders. A new blood pressure category, called prehypertension, has been created to alert people to their increased risk of developing high blood pressure so that

they can take steps to prevent the disease.

Your Guide to a Healthy Heart
What Is Blood Pressure?

Blood pressure is the amount of force exerted by the blood against

the walls of the arteries. Everyone has to have some blood pressure,

so that blood can get to all of the body’s organs. Usually, blood

pressure is expressed as two numbers, such as 120/80, and is 

measured in millimeters of mercury (mmHg). The first number 

is the systolic blood pressure, the amount of force used when the 

heart beats. The second number, or diastolic blood pressure, is the

pressure that exists in the arteries between heartbeats.

Because blood pressure changes often, your health care provider

should check it on several different days before deciding whether it is

too high. Blood pressure is considered “high” when it stays above

prehypertensive levels over a period of time. (See accompanying box.)

13Major Risk Factors

Your Blood Pressure:

Crunching the Numbers

Your blood pressure category is determined by the higher 

number of either your systolic or your diastolic measurement.

For example, if your systolic number is 115 but your diastolic

number is 85, your category is prehypertension. 

Systolic Diastolic

Normal blood pressure Less than and Less than

120 mmHg 80 mmHg

Prehypertension 120–139 or 80–89 mmHg

mmHg

High blood pressure 140 mmHg or 90 mmHg

or higher or higher

Blood Pressure
14

Understanding Risk

It’s important to understand what each of these categories means.

High blood pressure, of course, increases heart disease risk more

than any other category. But many people don’t realize that the 

second category—prehypertension—also increases your risk of heart

attack, stroke, and heart failure. To the extent possible, everyone

should aim for normal blood pressure levels.

Be aware, too, that a high systolic blood pressure level (first number)

is dangerous. If your systolic blood pressure is 140 mmHg or higher, you are more likely to develop cardiovascular and kidney diseases

even if your diastolic blood pressure (second number) is in the 

normal range. After age 50, people are more likely to develop high

systolic blood pressure. High systolic blood pressure is high blood

pressure. If you have this condition, you will need to take steps to

control it. High blood pressure can be controlled in two ways: by

changing your lifestyle and by taking medication.

Changing Your Lifestyle

If your blood pressure is not too high, you may be able to control 

it entirely by losing weight if you are overweight, getting regular

physical activity, cutting down on alcohol, and changing your eating

habits. A special eating plan called DASH can help you lower your

blood pressure. DASH stands for “Dietary Approaches to Stop

Hypertension.” The DASH eating plan emphasizes fruits, vegetables, whole-grain foods, and low-fat or fat-free milk and milk products.

It is rich in magnesium, potassium, and calcium, as well as protein

and fiber. It is low in saturated and total fat and cholesterol, and

limits red meat, sweets, and beverages with added sugars.

If you follow the DASH eating plan and also consume less sodium,

you are likely to reduce your blood pressure even more. Sodium is a

substance that affects blood pressure. It is the main ingredient in

salt and is found in many processed foods, such as soups, convenience meals, some breads and cereals, and salted snacks.

For more on the DASH eating plan and other changes you can make

to lower and prevent high blood pressure, see the “Taking Charge”

section of this guidebook (pages 45–82.)

Your Guide to a Healthy Heart
Major Risk Factors

15

The doctor sent me to a dietitian. She is the one

who taught me the things that I had to do in

order to eat right. It was hard at the beginning

because once you have bad habits, they are

hard to break. But, once I realized it was for my

own good and no one was going to take care of

me except me, I decided to start eating better.

JOSE HENRIQUEZ 

“

”
16

Taking Medication

If your blood pressure remains high even after you make lifestyle

changes, your doctor will probably prescribe medicine. Lifestyle

changes will help the medicine work more effectively. In fact, if you

are successful with the changes you make in your daily habits, you

may be able to gradually reduce how much medication you take.

Taking medicine to lower blood pressure can reduce your risk of

stroke, heart attack, congestive heart failure, and kidney disease. If you

take a drug and notice any uncomfortable side effects, ask your doctor

about changing the dosage or switching to another type of medicine.

A recent study found that diuretics (water pills) work better than

newer drugs to treat hypertension and prevent some forms of heart

disease. If you’re starting treatment for high blood pressure, try 

a diuretic first. If you need more than one drug, ask your doctor

about making one of them a diuretic. If you’re already taking 

Your Guide to a Healthy Heart

Preventing 

Congestive Heart Failure

High blood pressure is the #1 risk factor for congestive heart 

failure. Heart failure is a life-threatening condition in which the

heart cannot pump enough blood to supply the body’s needs.

Congestive heart failure occurs when excess fluid starts to leak

into the lungs, causing tiredness, weakness, and breathing 

difficulties. 

To prevent congestive heart failure and stroke as well, you must

control your high blood pressure to below 140/90 mmHg. If your

blood pressure is higher than that, talk with your doctor about 

starting or adjusting medication, as well as making lifestyle

changes. 

To avoid congestive heart failure, controlling your weight is also

very important. Being even moderately overweight increases

your risk of developing heart failure. 

Congestive Heart Failure
medicine for high blood pressure, ask about switching to or adding

a diuretic. Diuretics work for most people, but if you need a different drug, others are very effective. To make the best choice, talk

with your doctor.

A reminder: It is important to take blood pressure medication 

exactly as your doctor has prescribed it. Before you leave your 

doctor’s office, make sure you understand the amount of medicine

you are supposed to take each day, and the specific times of day 

you should take it.

High Blood Cholesterol

High blood cholesterol is another major risk factor for heart disease

that you can do something about. The higher your blood cholesterol level, the greater your risk for developing heart disease or 

having a heart attack. To prevent these disorders, you should make

a serious effort to keep your cholesterol at healthy levels. Cholesterol

lowering is important for everyone—women and men; younger, 

middle-aged, and older adults; and people with and without heart

disease.

Cholesterol and Your Heart

The body needs cholesterol to function normally. However, your

body makes all the cholesterol it needs. Over a period of years,

extra cholesterol and fat circulating in the blood build up in the

walls of the arteries that supply blood to the heart. This buildup,

called plaque, makes the arteries narrower and narrower. As a

result, less blood gets to the heart. Blood carries oxygen to the

heart; if enough oxygen-rich blood cannot reach your heart, you

may suffer chest pain. If the blood supply to a portion of the heart

is completely cut off, the result is a heart attack.

Cholesterol travels in the blood in packages called lipoproteins.

LDL carries most of the cholesterol in the blood. Cholesterol packaged in LDL is often called bad cholesterol, because too high a level

of LDL in your blood can lead to cholesterol buildup and blockage

in your arteries.

Another type of cholesterol is HDL, also called good cholesterol.

That’s because HDL helps remove cholesterol from the body, 

preventing it from building up in your arteries.

17Major Risk Factors
18Your Guide to a Healthy Heart

JULIE RODRIQUEZ 

“

I’ve always considered myself to be a very

healthy person. I exercise regularly; I don’t

smoke; and I’m not overweight. So when I found

out that I have high cholesterol, it came as a

surprise. After my doctor’s appointment, I 

wanted to learn as much as I could about high

cholesterol. I learned that it puts me at risk for

heart disease, so I’ve started making 

changes. Now I avoid 

foods with lots of 

saturated fat and 

cholesterol, and 

I eat less red meat

and more fish.

”
19Major Risk Factors

Getting Tested

High blood cholesterol itself does not cause symptoms, so if your cholesterol level is too high, you may not be aware of it. That’s why it is

important to get your cholesterol levels checked regularly. Starting at

age 20, everyone should have their cholesterol levels checked by

means of a blood test called a lipoprotein profile. Be sure to ask for

the test results, so you will know whether you need to lower your

cholesterol. Ask your doctor how soon you should be retested.

Total cholesterol is a measure of the cholesterol in all of your

lipoproteins, including the “bad” cholesterol in LDL and the “good”

cholesterol in HDL. An LDL level below 100 mg/dL is considered

“optimal” or ideal. As you can see in the accompanying table, there

are four other categories of LDL levels. The higher your LDL number, the higher your risk of heart disease. Knowing your LDL number is especially important because it will determine the kind of

treatment you may need.

Your HDL number tells a different story. The lower your HDL

number, the higher your heart disease risk.

Your lipoprotein profile test will also measure levels of triglycerides,

which are another fatty substance in the blood. (See “Tame Your

Triglycerides.”) 

What’s Your Number?

Blood Cholesterol Levels and Heart Disease Risk

Total Cholesterol Level Category

Less than 200 mg/dL* Desirable

200–239 mg/dL Borderline high

240 mg/dL and above High

LDL Cholesterol Level Category

Less than 100 mg/dL Optimal (ideal)

100–129 mg/dL Nearly optimal

130–159 mg/dL Borderline high

160–189 mg/dL High

190 mg/dL and above Very high

* Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.
20Your Guide to a Healthy Heart

HDL Cholesterol Level

An HDL cholesterol level of less than 40 mg/dL is a major risk factor for heart disease. An HDL level of 60 mg/dL or higher is somewhat protective.

Heart Disease Risk and Your LDL Goal

In general, the higher your LDL cholesterol level and the more other

risk factors you have, the greater your chances of developing heart

disease or having a heart attack. The higher your overall risk, the

lower your LDL goal level will be. Here is how to determine your

LDL goal:

Step 1: Count your risk factors. Below are risk factors for heart

disease that will affect your LDL goal. Check to see how many of

the following risk factors1 you have:

■ Cigarette smoking

■ High blood pressure (140/90 mmHg or higher, or if you are on 

blood pressure medication)

Tame Your

Triglycerides

Triglycerides are another type of fat found in blood and in food.

Triglycerides are produced in the liver. When you drink alcohol or

take in more calories than your body needs, your liver produces

more triglycerides. Triglyceride levels that are borderline high

(150–199 mg/dL) or high (200–499 mg/dL) are signals of an

increased risk for heart disease. To reduce blood triglyceride 

levels, it is important to control your weight, get more physical

activity, and avoid smoking and drinking alcohol. You should

also eat a diet that is low in saturated fat, trans fat, and cholesterol and that avoids high amounts of carbohydrates.

Sometimes, medication is needed. 

Triglycerides

1 Diabetes is not on the list because a person with diabetes is considered to already be at

high risk for a heart attack—at the same level of risk as someone who has heart disease.

Also, even though overweight and physical inactivity are not on this list of risk factors,

they are conditions that raise your risk for heart disease and need to be corrected.
21Major Risk Factors

■ Low HDL cholesterol (less than 40 mg/dL)2

■ Family history of early heart disease (your father or brother 

before age 55, or your mother or sister before age 65)

■ Age (55 or older if you’re a woman; 45 or older if you’re a man) 

Step 2: Find out your risk score. If you have two or more risk 

factors on the above list, you will need to figure out your “risk

score.” This score will show your chances of having a heart attack

within the next 10 years. To find out your risk score, see “How To

Estimate Your Risk” on pages 86–87. Note that there are separate

risk “scorecards” for men and women.

Step 3: Find out your risk category. Use your number of risk 

factors, risk score, and medical history to find out your category of

risk for heart disease or heart attack. Use the table below.

If You Have Your Category Is

Heart disease, diabetes, or High risk 

a risk score of more than 

20 percent*

Two or more risk factors Next highest risk

and a risk score of 

10–20 percent

Two or more risk factors Moderate risk 

and a risk score of less 

than 10 percent

Zero or one risk factor Low-to-moderate risk

* Means that more than 20 of 100 people in this category will have a heart attack within

10 years.

A Special Type of Risk

Nearly 25 percent of Americans have a group of risk factors known

as metabolic syndrome, which is usually caused by overweight or

obesity and by not getting enough physical activity. This cluster 

of risk factors increases your risk of developing heart disease and

2 If your HDL cholesterol is 60 mg/dL or higher, subtract 1 from your total.
22Your Guide to a Healthy Heart

diabetes, regardless of your LDL cholesterol level. You have 

metabolic syndrome if you have three or more of the following 

conditions:

■ A waist measurement of 35 inches or more for a woman or 

40 inches or more for a man

■ Triglycerides of 150 mg/dL or more

■ An HDL cholesterol level of less than 50 mg/dL for a woman 

and less than 40 mg/dL for a man

■ Blood pressure of 130/85 mmHg or more (either number 

counts) 

■ Blood sugar of 100 mg/dL or more

If you have metabolic syndrome, you should calculate your risk

score and risk category as indicated in Steps 2 and 3 above. You

should make a particularly strong effort to reach and maintain your

LDL goal. You should also emphasize weight control and physical

activity to correct the risk factors of the metabolic syndrome.

Your LDL Goal

The main goal of cholesterol-lowering treatment is to lower your

LDL level enough to reduce your risk of heart disease or heart

attack. The higher your risk category, the lower your LDL goal will

be. To find your personal LDL goal, see the table below:

If You Are in This Risk Category Your LDL Goal Is

High Risk Less than 100 mg/dL

Next highest risk or moderate risk Less than 130 mg/dL

Low-to-moderate risk Less than 160 mg/dL

How to Lower Your LDL

There are two main ways to lower your LDL cholesterol—through

lifestyle changes alone, or through lifestyle changes combined with

medication. Depending on your risk category, the use of these treatments will differ.

For information on the best treatment plan for your risk category,

see the factsheet, “High Blood Cholesterol: What You Need To

Know,” available from NHLBI’s Web site or Health Information

Center. (See “To Learn More” on page 88.) 
23Major Risk Factors

CholesterolLowering Medicine

As part of your cholesterol-lowering treatment plan, your doctor

may recommend medication. You may be prescribed just one

cholesterol-lowering drug, or two in combination. Following are

the most commonly used medicines:

Statins. These are the most commonly prescribed drugs for

people who need a cholesterol-lowering medicine. Of all available medications, statins lower LDL cholesterol the most, usually

by 20 to 60 percent. Side effects are usually mild, although liver

and muscle problems occur rarely. If you experience muscle

aches or weakness, contact your doctor promptly. 

Bile acid sequestrants. These medications lower LDL cholesterol

by about 10 to 20 percent. Bile acid sequestrants are often 

prescribed along with a statin to further decrease LDL cholesterol 

levels. Side effects may include constipation, bloating, nausea, and

gas. However, long-term use of these medicines is considered safe. 

Niacin. Niacin, or nicotinic acid, lowers total cholesterol, LDL

cholesterol, and triglyceride levels, while also raising HDL 

cholesterol. Niacin is available without a prescription, but it is

important to use it only under a doctor’s care because of possible serious side effects. In some people, it may worsen peptic

ulcers or cause liver problems, gout, or high blood sugar. 

Fibrates. These drugs can reduce triglycerides levels by 20 to

50 percent, while increasing HDL cholesterol by 10 to 15 percent.

Fibrates are not very effective for lowering LDL cholesterol. The

drugs can increase the chances of developing gallstones and

heighten the effects of blood-thinning drugs. 

Ezetimibe. This is the first in a new class of cholesterollowering drugs that interfere with the absorption of cholesterol 

in the intestine. It can be used alone or in combination with a

statin. Side effects may include back and joint pain. 
Lifestyle changes. One important treatment approach is called TLC,

which stands for “Therapeutic Lifestyle Changes.” This 

treatment includes a low saturated fat and low-cholesterol diet, 

regular moderate-intensity physical activity, and weight management. Everyone who needs to lower their LDL cholesterol should

use this TLC program. (For more information, see “Give Your

Heart a Little TLC” on page 55.) Maintaining a healthy weight and

getting regular physical activity are especially important for those

who have metabolic syndrome.

Medication. If your LDL level stays too high even after making

lifestyle changes, you may need to take medicine. If you need medication, be sure to use it along with the TLC approach. This will

keep the dose of medicine as low as possible, and will lower your

risk in other ways as well. You will also need to control all of your

other heart disease risk factors, including high blood pressure, 

diabetes, and smoking.

Overweight and Obesity

A healthy weight is important for a long, vigorous life. Yet overweight and obesity (extreme overweight) have reached epidemic 

levels in the United States. Today, nearly two-thirds of American

adults are overweight or obese. Groups at highest risk for obesity

include African American women, Mexican Americans, and

American Indians, but millions of people from all backgrounds

weigh more than is healthy for them. Since 1991, the proportion 

of Americans who are obese has soared by 75 percent.

Overweight among children is also swiftly increasing. Among young

people ages 6–19, more than 16 percent are overweight, compared

to just 4 percent a few decades ago. This is a disturbing trend

because overweight adolescents have a greatly increased risk of

dying from heart disease in adulthood. Even our youngest citizens

are at risk. About 10 percent of preschoolers weigh more than is

healthy for them.

Our national waistline is expanding for two simple reasons—we are

eating more and moving less. Americans consume about 200–300

more calories per day than they did in the 1970s. Moreover, as we

spend more time in front of computers, video games, TV, and other

electronic pastimes, we have fewer hours available for physical activity.

24Your Guide to a Healthy Heart
25Major Risk Factors

BALERMA BURGESS 

“

I know that if I don't change things in my life,

I might not live to see my grandchildren. Every

day, I talk myself into doing things for my

health, like taking the stairs instead of the 

elevator and eating more fruits and vegetables.

These things haven't become habits for me yet,

but I'm working on it.

”
26

There is growing evidence of a link between “couch potato” 

behavior and increased risk of obesity and many chronic diseases.

It is hard to overstate the dangers of an unhealthy weight. If you are

overweight, you are more likely to develop heart disease even if you

have no other risk factors. The more overweight a person is, the

more likely he or she is to develop heart disease. Overweight and

obesity also increase the risks for diabetes, high blood pressure, high

cholesterol, stroke, congestive heart failure, gallbladder disease,

arthritis, breathing problems, and gout, as well as cancers of the

breast and colon. Each year, an estimated 300,000 U.S. adults 

die of diseases related to obesity. The bottom line: Maintaining a

healthy weight is a vital part of preventing heart disease and 

protecting overall health.

Should You Choose To Lose? 

Do you need to lose weight to reduce your risk of heart disease?

You can find out by taking three simple steps.

Step 1: Get your number. Take a look at the box on the next page.

You’ll see that your weight in relation to your height gives you a

number called a Body Mass Index (BMI). A BMI from 18.5 to 24.9

indicates a normal weight. A person with a BMI from 25 to 29.9 is

overweight, while someone with a BMI of 30 or higher is obese.

Those in the overweight and obese categories have a higher risk of

heart disease—and the higher the BMI, the greater the risk.

Step 2: Take out a tape measure. The second step is to take your

waist measurement. For women, a waist measurement of over 35

inches increases the risk of heart disease as well as the risks of high

blood pressure, diabetes, and other serious health conditions. For

men, a waist measurement of more than 40 inches increases these

risks. To measure your waist correctly, stand and place a tape measure around your middle, just above your hipbones. Measure your

waist just after you breathe out.

Step 3: Review your risk. The final step in determining your need to

lose weight is to find out your other risk factors for heart disease.

It is important to know whether you have any of the following:

high blood pressure, high LDL cholesterol, low HDL cholesterol,

high triglycerides, high blood glucose (blood sugar), a family history

of heart disease, physical inactivity, or smoking. If you’re a man,

Your Guide to a Healthy Heart
27Major Risk Factors

Here is a chart for men and women that gives the BMI for various

heights and weights*

BODY MASS INDEX

What Does Your BMI Mean?

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.

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.

Are You at a Healthy Weight?

4’10” 100 105 110 115 119 124 129 134 138 143 148

5’0” 107 112 118 123 128 133 138 143 148 153 158

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.

BMI

21 22 23 24 25 26 27 28 29 30 31
28Your Guide to a Healthy Heart

Keeping Tabs on Your Progress 

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:

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.
29Major Risk Factors

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 
30

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, 

and sooner or later, they rebel. Even if a person has no other risk

Your Guide to a Healthy Heart
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 schoolaged 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 moderateintensity 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 weightlifting, 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

“Get Moving!” on page 72.

31Major Risk Factors
32

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, especially having extra

weight around 

the waist.

Your Guide to a Healthy Heart
33Major Risk Factors

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 

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.
34Your Guide to a Healthy Heart

ABC

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

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,

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

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.

● Ask others to help you manage your diabetes.

The ABCs of 

Diabetes Control

A

B

C
35Major Risk Factors

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:

An Action Plan for Heart

Health,” on page 45.
36

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

already a moderate drinker, you may be less likely to have a heart attack.

Your Guide to a Healthy Heart

What Else Affects Heart

Disease?
37What Else Affects Heart Disease?

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.

LILLY KRAMER 

“

”
38

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

rates of heart disease than either moderate drinkers or nondrinkers.

Your Guide to a Healthy Heart

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
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

menopausal hormone

therapy 

could ward off 

heart disease, osteoporosis, and cancer, 

as well as improve 

39What Else Affects Heart Disease?
40

a woman’s quality of life. But several important studies, conducted 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 protection against memory loss.

Estrogen alone, however, did

reduce the risk for bone fractures.

The research also showed

that both estrogen alone and

estrogen combined with progestin increase the risk of

developing urinary incontinence, which is the inability to

“hold in” urine. For

Your Guide to a Healthy Heart
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 

period of time to reach treatment goals.

Remember, your risks for heart disease, stroke, osteoporosis, and

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.

41What Else Affects Heart Disease?
42Your Guide to a Healthy Heart

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
Birth Control Pills

Studies show that women who use high-dose birth control pills 

(oral contraceptives) are more likely to have a heart attack or stroke

because blood clots are more likely to form in the blood vessels.

These risks are lessened once the birth control pill is stopped. Using

the pill also may worsen the effects of other risk factors, such as

smoking, high blood pressure, diabetes, high blood cholesterol, and

overweight.

Much of this information comes from studies of birth control pills

containing higher doses of hormones than those commonly used

today. Still, the risks of using low-dose pills are not fully known.

Therefore, if you are now taking any kind of birth control pill or 

are considering using one, keep these guidelines in mind:

Don’t mix smoking and the “pill.” If you smoke cigarettes, stop

smoking or choose a different form of birth control. Cigarette

smoking raises the risk of serious health problems from birth 

control pill use, especially the risk of blood clots. For women over

35, the risk is particularly high. Women who use birth control pills

should not smoke.

Pay attention to diabetes. Levels of glucose, or blood sugar, sometimes change dramatically in women who take birth control pills.

If you are diabetic or have a close relative who is, be sure to have

regular blood sugar tests if you take birth control pills.

Watch your blood pressure. After starting to take birth control pills,

your blood pressure may go up. If your blood pressure increases to

140/90 mmHg or higher, ask your doctor about changing pills or

switching to another form of birth control. Be sure to get your

blood pressure checked at least once a year.

Talk with your doctor. If you have heart disease or another heart

problem, or if you have suffered a stroke, birth control pills may not

be a safe choice. Be sure your doctor knows about these and any

other serious health conditions before prescribing birth control pills

for you.

43What Else Affects Heart Disease?
44Your Guide to a Healthy Heart

In my family, we exercise, we drink water, we

don’t give our children much juice, and we

rarely keep sugary snacks in the house.

I’m also very aware of 

portion sizes and 

how many 

calories are in 

the portions we 

eat.

JEANETTE GUYTON-KRISHNAN 

AND FAMILY

“

”

”
You have just learned a great deal about risk factors for heart 

disease. Now you’re ready for action. The good news: Research

shows that people can lower their heart disease risk enormously—

by as much as 82 percent—simply by adopting sensible health

habits. It’s never too late to start protecting your heart health.

A recent study shows that among people ages 70 to 90, leading a

healthy lifestyle reduces the chances of dying from heart disease by

nearly two-thirds.

What does it mean to “lead a healthy lifestyle”? Here are the basics:

If you eat a nutritious diet, get regular physical activity, maintain a

healthy weight, and stop smoking, you will help to keep your heart

healthy. But doing just one or two of these “Big Four” habits isn’t

enough to protect your heart. To keep your heart strong and

healthy, it is vital to adopt and practice all four lifestyle habits.

Some people may need to take additional steps to prevent heart 

disease. For example, if you have diabetes, you also will need to

keep your blood sugar levels under control. Eating a nutritious diet,

controlling your weight, and getting more physical activity will help

you to keep your blood sugar at healthy levels. These steps will 

also help reduce your chances of developing high blood pressure or

high blood cholesterol. Whatever your current health condition or

habits, the action plan that follows will make a positive difference in

your heart health.

Ready to get started? Read on.

Choose Healthy Foods

A healthy heart needs a healthy diet. The “Dietary Guidelines for

Americans” offers two examples of eating plans to choose from, and

also includes advice for overall health and food safety. These guidelines encourage you to:

45Taking Charge: An Action Plan for Heart Health

Taking Charge: An Action

Plan for Heart Health
46

■ Choose a variety of grains daily; half of your daily grains 

should come from whole grains.

■ Choose a variety of fruits and vegetables daily.

■ Choose a diet that is low in saturated fat, trans fat, and cholesterol.

■ Choose foods and beverages that are low in added sugar.

■ Choose and prepare foods with little salt.

■ If you drink alcoholic beverages, do so in moderation.

■ Aim for a healthy weight.

■ Be physically active most days.

■ Balance the calories you take in with the calories you expend 

through physical activity.

■ Keep foods safe to eat.

For detailed tips on getting regular physical activity and maintaining

a healthy weight, see later sections of this guidebook.

Getting Extra Support

While the “Dietary Guidelines for Americans” offer an excellent

“basic menu” for heart health, you may need to make some additional changes in your diet if you have high blood pressure or high

Your Guide to a Healthy Heart

What Are

Trans Fats?

Trans fats, or trans fatty acids, are another type of dietary fat 

that raises LDL cholesterol. They are formed when vegetable oil

is hardened to become margarine or shortening in a process

called hydrogenation. The harder the margarine or shortening,

the more likely it is to contain more trans fat. To reduce trans 

fats in your diet, read food labels and buy fewer products that

list “hydrogenated oil” or “partially hydrogenated oil” as an 

ingredient. When possible, choose margarines that list “liquid

vegetable oil” as the first ingredient. The main sources of trans

fat are foods made with hydrogenated oils such as some 

margarines, shortenings, cookies, crackers, cakes, pies, snack

foods, and fried foods. 

Trans Fats
47Taking Charge: An Action Plan for Heart Health

How To Use the

Nutrition Facts Label 

on the Food Package

Nutrition Facts Label

Start

here

Check

calories

Limit these

nutrients

Get enough

of these

nutrients

Quick Guide

to % DV:

5% or less 

is low

20% or more 

is high
48

blood cholesterol. You may want to work with a registered dietitian

to help you make these changes. A dietitian can teach you about the

eating plan that is best for you, determine a reasonable calorie level,

and help you choose foods and plan menus. A dietitian can also help

you keep track of your progress and encourage you to stay on your

eating plan. Talk with your doctor about whether you should get a

referral to a registered dietitian. In the meantime, if you have high

blood pressure or high blood cholesterol, here are some guidelines: 

Blood Pressure and the DASH Eating Plan

If you have high blood pressure or prehypertension, you may want

to follow an eating plan called DASH. DASH stands for “Dietary

Approaches to Stop Hypertension,” and the eating plan emphasizes

fruits, vegetables, whole-grain foods, and low-fat milk products.

It is rich in magnesium, potassium, calcium, protein, and fiber, but

low in saturated fat, trans fat, total fat, and cholesterol. It limits 

red meat, sweets, and beverages with added sugars. In many ways,

DASH is similar to the TLC eating plan described on pages 53–55.

However, the DASH plan also encourages you to eat specific foods

rich in the nutrients noted above.

A major study found that people who followed this eating plan

reduced their blood pressure more than those who ate more “typical”

American diets, which have fewer fruits and vegetables. A second

study found that people who followed the DASH eating plan and cut

down on sodium had the biggest reductions in blood pressure. (Salt,

or sodium chloride, and other forms of sodium are found in many

processed foods. Often, more salt is added to food during cooking

and at the table.) So, for a truly winning combination, follow the

DASH eating plan and lower your sodium intake as much as possible.

The study found that the less sodium people consumed, the more

their blood pressure dropped. (See ”The DASH Eating Plan” on

pages 51–52 and “Please Don’t Pass the Salt” on page 52.) 

While the DASH eating plan is geared especially toward people with

high blood pressure or prehypertension, it is a healthy plan for

everyone. So share it with your family. When people with normal

blood pressure follow the DASH eating plan, especially when they

also consume less sodium, they lessen their chances of developing

high blood pressure. Remember, 90 percent of middle-aged

Americans go on to develop high blood pressure. Use the DASH

plan to help beat the odds! 

Your Guide to a Healthy Heart
49Taking Charge: An Action Plan for Heart Health

My doctor noticed my blood pressure was a 

little high. At that time I was not thinking about 

exercising every day like I do now. Since then,

I’ve lost weight, and my body is in good shape

now. I really watch what I eat, and I work out 5

to 7 days a week.

RICARDO ELEY

“

”
50Your Guide to a Healthy Heart

The DASH Eating Plan

The DASH eating plan shown in the following table is based on

2,000 calories per day. The number of daily servings in a food

group may vary from those listed, depending on how many daily

calories you need. If you need to lose weight, you can follow the

DASH eating plan and simply decrease calories by choosing fewer

servings or smaller serving sizes of the foods shown on the list. 

Food Group Serving Sizes Examples

Grain and grain 1 slice whole- Whole-wheat 

products grain bread bread, English 

7–8 daily servings 1 cup ready-to- muffin, pita bread,

eat cereal*, 1/2 cup bagel, cereals,

cooked rice, grits, oatmeal, 

pasta, or cereal crackers, unsalted 

pretzels, popcorn 

Vegetables 1 cup raw, dark Tomatoes, pota4–5 daily servings green, leafy toes, carrots,

vegetable, 1/2 cup green peas, 

cooked vegetables, squash, broccoli,

6 ounces vegetable turnip greens,

juice collards, kale,

spinach, artichokes,

green beans, lima

beans, sweet 

potatoes

Fruits 1 medium-sized fruit Apricots, bananas,

4–5 daily servings 1/4 cup dried fruit, dates, grapes,

1/2 cup fresh, frozen, oranges, orange

or canned fruit, juice, grapefruit, 

6 ounces fruit juice grapefruit juice,

mangoes, melons,

peaches, pineapples, prunes,

raisins, strawberries, tangerines
51Taking Charge: An Action Plan for Heart Health

Low-fat or fat-free 8 ounces milk, Low-fat or fat-free

milk products 1 cup yogurt, milk, low-fat or

2–3 daily servings 11/2 ounces cheese fat-free buttermilk,

low-fat or fat-free

regular or frozen 

yogurt, low-fat 

or fat-free cheese

Lean meats, poultry, 3 ounces cooked Select only lean; 

and fish lean meat, skinless trim away visible

2 or fewer daily poultry, or fish fats; broil, roast, or

boil, instead of 

frying; remove 

skin from poultry

Nuts, seeds, and 1/2 cup or 11/2 ounces Almonds, filberts,

dry beans nuts, 1 tablespoon mixed nuts, 

4–5 servings per week or 1/2 ounce seeds, peanuts, walnuts, 

1/2 cup cooked dry sunflower seeds,

beans kidney beans, 

lentils

Fats and oils† 1 teaspoon soft Soft margarine,

2–3 daily servings margarine, low-fat mayon1 tablespoon low-fat naise, light salad

mayonnaise, dressing, veg2 tablespoons light etable oil, such as 

salad dressing, olive, corn, canola,

1 teaspoon or safflower

vegetable oil

Sweets 1 tablespoon sugar, Maple syrup, sugar,

5 servings per week 1 tablespoon jelly or jelly, jam, fruitjam, 1/2 ounce jelly flavored gelatin,

beans, 8 ounces jelly beans, hard 

lemonade candy, fruit punch,

sorbet, ices

* Serving sizes vary between 1/2 –11/4 cups. Check the Nutrition Facts label on the 

product’s package. 

† Fat content changes serving counts for fats and oils. For example, 1 tablespoon 

of regular salad dressing equals 1 serving; 1 tablespoon of a low-fat dressing 

equals 1/2 serving; 1 tablespoon of a fat-free dressing equals 0 servings. 
52Your Guide to a Healthy Heart

Please Don’t Pass the Salt:

How To Reduce Salt and Sodium 

in Your Diet

You can help prevent and control high blood pressure by cutting

down on salt and other forms of sodium. Try to consume no more

than 2,300 mg of sodium (approximately 1 teaspoon of salt) per

day from all the foods you eat. If you can, cut your sodium intake

even more—to no more than 1,500 mg per day, which equals

about two-thirds of a teaspoon of salt. Here are some tips on limiting your intake of salt and other forms of sodium:

● Use reduced-sodium or no-salt-added products. Examples are 

no-salt-added canned vegetables or ready-to-eat cereals that 

have no added salt or the lowest amount of sodium listed on the

Nutrition Facts panel on the food label. 

● When you cook, be “spicy” instead of “salty.” Flavor foods with

herbs, spices, wine, lemon, lime, or vinegar. Be creative!

● Don’t bring the salt shaker to the table. Try an herb substitute 

instead, such as powdered garlic, onion, or thyme. 

● Use fresh poultry, fish, and lean meat, rather than canned, 

smoked, or processed types.

● Cut down on cured foods (such as bacon and ham), foods 

packed in brine (such as pickles and olives), and condiments 

(such as mustard, ketchup, barbeque sauce, and monosodium

glutamate). You should even limit lower sodium versions of 

soy sauce and teriyaki sauce. 

● Read the Nutrition Facts label on the food package and choose

convenience foods that are lower in sodium. These foods 

include frozen dinners, pizza, breads, packaged mixes, canned 

soups and broths, and salad dressings.

● Rinse canned foods, such as tuna and canned beans, to 

remove some of the sodium.

While salt substitutes containing potassium chloride may be useful

for some individuals, they can be harmful to people with certain

medical conditions. Ask your doctor before trying salt substitutes.

Don’t Pass the Salt
What Else Affects Blood Pressure?

A number of foods and other factors have been reported to affect

blood pressure. Here are the latest research findings: 

Garlic and onions. These foods have not been found to affect blood

pressure. But they are tasty, nutritious substitutes for salty seasonings and can be used often.

Caffeine. This may cause blood pressure to rise, but only temporarily.

Unless you are sensitive to caffeine, you do not have to limit how

much you consume in order to prevent or control high blood pressure.

Stress. Stress, too, can make blood pressure go up for a while, and 

is popularly thought to contribute to high blood pressure. But the

long-term effects of stress are not clear. Furthermore, stress management techniques alone do not seem to prevent high blood pressure.

However, stress management approaches may help you control

other unhealthy habits, such as overeating or smoking.

High Blood Cholesterol and the TLC Program

TLC is a treatment program that stands for “Therapeutic Lifestyle

Changes.” This program helps reduce LDL cholesterol via a low-saturated fat, low-trans fat, low-cholesterol eating plan. The program

also emphasizes regular physical activity and weight control. Adopt

the TLC approach and you’ll lower your chances of developing

heart disease, future heart attacks, and other heart disease complications. (The main difference between the TLC and the DASH eating

plans is that the TLC plan puts more emphasis on decreasing saturated fat and trans fat to lower blood cholesterol levels.) 

Now You’re Cooking: Limiting Saturated Fat, Trans Fat, and Cholesterol

Planning and preparing nutritious meals may take a little extra

effort, but the health benefits are huge. Here are some tips for cutting down on saturated fat, trans fat, and dietary cholesterol, which

will help lower your LDL cholesterol and reduce your heart disease

risk. It will improve heart health for everyone, and may be particularly helpful to those following the TLC eating plan.

Meat, Poultry, and Fish

■ Choose fish, poultry, and lean cuts of meat. Trim the fat from 

meats; remove the skin and fat from chicken. Keep portion 

sizes moderate.

53Taking Charge: An Action Plan for Heart Health
54Your Guide to a Healthy Heart

Mineral Medicine:

Another Way To Control Blood

Pressure

Certain mineral-rich foods can help keep blood pressure levels

healthy. For example, a diet rich in potassium can help to both

prevent and control high blood pressure. A potassium-rich diet

not only blunts the effects of salt on blood pressure, but may

also reduce the risk of developing kidney stones, and possibly

decrease bone loss with age. But be sure to get your potassium

from food sources, not from supplements. Many fruits and vegetables, some dairy foods, and fish are rich sources of potassium. 

Calcium and magnesium are two other minerals that may help to

prevent high blood pressure, as well as improve health in other

ways. Low-fat or fat-free milk and milk products are rich sources

of calcium, while magnesium is found in many whole-grain 

products; dark green, leafy vegetables; fish; and dry beans.

Mineral Medicine

■ Broil, bake, roast, or poach instead of frying. When you do fry, 

use a nonstick pan and a nonstick cooking spray or a very small 

amount of oil or margarine.

■ Cut down on sausage, bacon, and processed, high-fat cold cuts 

(which are also high in sodium).

Milk Products and Eggs

■ Instead of whole milk or cream, use fat-free or 1-percent milk.

■ Use fat-free or low-fat cheeses and yogurt.

■ Replace ice cream with sorbet, sherbet, and fat-free or low-fat 

frozen yogurt. Keep portion sizes moderate.

■ Limit the number of egg yolks you eat. Egg whites contain no 

fat or cholesterol, so you can eat them often. In most recipes, 

you can substitute two egg whites for one whole egg.

■ Use soft margarines (liquid or tub types) that contain little or 

no trans fat. Some brands of soft margarines are high in plant 

sterols or stanols, which lower LDL cholesterol.
Grains and Grain Products

■ Eat foods with lots of fiber and nutrients and make sure that 

half of your grain products are whole grain. These include 

whole-grain breads, pasta, and cereals, as well as brown rice.

When you check package labels, look for the word “whole” in 

the ingredients. Make sure that whole grains appear among the 

first items listed.

Sauces, Soups, and Casseroles

■ After making sauces or soups, cool them in the refrigerator and 

skim the fat from the top. Do the same with canned soups.

55Taking Charge: An Action Plan for Heart Health

Give Your Heart a Little TLC

If your LDL cholesterol is above your goal level (see page 22),

you should start on the TLC eating plan right away. Consuming

foods that are high in saturated fat, trans fat, and cholesterol

contributes to high levels of LDL cholesterol. On the TLC eating

plan, you should consume:

● Less than 7 percent of the day’s total calories from saturated fat.

Lowering saturated fat is the most important dietary change for 

reducing blood cholesterol. 

● Less than 200 milligrams of dietary cholesterol per day.

● Just enough calories to achieve or maintain a healthy weight.

If your blood cholesterol is not lowered enough on the TLC 

eating plan, your doctor or registered dietitian may advise you 

to increase the amount of soluble fiber and/or add cholesterollowering food products to your diet. These products include

margarines that contain “plant sterols” or “plant stanol esters,”

which are ingredients that lower LDL cholesterol. If your LDL

level is still not lowered enough, your doctor may prescribe a

cholesterol-lowering drug along with the TLC eating plan. For

more information, see NHLBI’s Web page, “Live Healthier, Live

Longer.” (See “To Learn More” on page 88.) 

TLC
56

■ Thicken a low-fat sauce with cornstarch or flour.

■ Make main dishes with whole-grain pasta, brown rice, or dry 

peas and beans. If you add meat, use small pieces for flavoring 

rather than as the main ingredient.

When You Can’t Face Cooking

Check the Nutrition Facts label on food packages to choose frozen

dinners and pizzas that are lowest in saturated fat, trans fat, and

cholesterol. Also watch the calories and sodium content. Make sure

the dinners include vegetables, fruits, and whole grains—or add

them on the side.

Choose store-bought baked goods that are lowest in saturated fat,

cholesterol, trans fats, and hydrogenated (hardened) fats. Also,

remember that even “no cholesterol” and fat-free baked goods still

may be high in calories.

Dining Out for Health

With a little planning and a willingness to speak up you can eat

healthfully when you dine out. Here are some tips.

Ask for what you want. Most restaurants will honor your requests.

You have nothing to lose by asking!

Order small. To reduce portion size, try ordering appetizers or 

children’s portions as your main meal. Or, take half of your entrée

home with you for lunch the next day.

Ask questions. Don’t hesitate to ask your server how foods are 

prepared and whether the restaurant will make substitutions.

Ask if they will: 

■ Serve low-fat or fat-free milk rather than whole milk or cream.

■ Tell you the type of cooking oil used. (Preferred types that are 

lower in saturated fat are canola, safflower, sunflower, corn, 

and olive oils.)

■ Trim the fat off poultry or meat.

■ Leave all butter, gravy, and sauces off an entrée or side dish.

■ Add no salt during cooking.

■ Serve salad dressing on the side.

■ Meet special requests if you make them in advance.

Your Guide to a Healthy Heart
Select foods cooked by low-fat methods. Look for terms such as

broiled, baked, roasted, poached, or lightly sautéed.

Limit foods high in calories and fats, especially saturated fat and

trans fat. Watch out for terms such as fried, crispy, creamed, escalloped, hollandaise, bernaise, casserole, and pastry crust.

Make Healthy Choices

■ Breakfast: Fresh fruit, small glass of citrus juice, low-fat or fatfree milk and yogurt, whole-grain bread products and cereals, 

omelet made with egg whites or egg substitute.

■ Beverages: Water with lemon, flavored sparkling water, juice 

spritzer (half fruit juice and half sparkling water), iced tea, 

reduced-sodium tomato juice.

■ Breads: Most yeast breads are low in calories and fat—as long 

as you limit the butter, margarine, or olive oil. Choose wholegrain breads, which are packed with important nutrients and 

are full of fiber to make you feel fuller faster. Also, watch the 

sodium content.

■ Appetizers: Steamed seafood, fresh fruit, bean soups, salad 

with reduced-fat dressing.

■ Entrées: Skinless poultry, fish, shellfish, vegetable dishes, or 

pasta with red sauce or vegetables. Limit your use of butter, 

margarine, and salt at the table.

■ Salads: Fresh lettuce, spinach, and other

greens; other fresh vegetables, chickpeas,

and kidney beans. Skip high-fat and

high-calorie nonvegetable choices 

such as deli meats, bacon, egg, 

cheese, and croutons. Choose 

lower-calorie, reduced-fat, or 

fat-free dressings, lemon 

juice, or vinegar.

■ Side Dishes: Vegetables and grain 

products, including whole-grain

rice or noodles. Ask for

salsa or low-fat yogurt 

instead of sour cream

or butter.

57Taking Charge: An Action Plan for Heart Health
58

■ Dessert: Fresh fruit; fat-free frozen yogurt, sherbet, or fruit 

sorbet (usually fat free, but ask for the calorie content). Try 

sharing a dessert. If you drink coffee or tea with dessert, ask 

for low-fat or fat-free milk instead of cream or half-and-half.

Know your foods. Following are some additional tips on shopping,

cooking, and eating for heart health: 

■ To choose foods wisely, see “How To Use the Nutrition Facts 

Label on the Food Package” on page 47 and “The Lowdown 

on Labels.” 

■ To prepare and eat heart healthy meals, see “Figuring Out Fat” 

on page 60.

■ For other tips on making good food choices, see “How To Tame a 

Snack Attack” below and “Vitamins for Heart Health” on page 62.

How To Tame a Snack Attack

Many snacks, including many types of cookies, crackers, and chips,

are high in saturated fat, trans fat, cholesterol, sodium, and calories.

But that doesn’t mean you have to cut out all between-meal treats.

Keep the foods listed below on hand for snack attacks. But, keep in

mind that while these foods may be low in fat, many are not low in

calories. So watch how much you eat, especially if you are trying to

control your weight.

Here are some healthier, low-fat snacks:

■ 100-percent fruit juices

■ Low-fat or fat-free milk

■ Fat-free frozen yogurt, 

sherbet, and sorbet

■ Low-fat cookies such as 

animal crackers, graham 

crackers, ginger snaps, and 

fig bars

■ Low-fat crackers such 

as melba toast, or rice, 

rye, and soda crackers; 

look for unsalted or 

low-sodium types

Your Guide to a Healthy Heart
59Taking Charge: An Action Plan for Heart Health

The Lowdown on Labels

Lowdown on Labels

Food labels can help you choose items that are lower in sodium,

saturated and total fat, trans fat, cholesterol, and calories. When

you grocery shop, look for these claims on cans and other packaging—and use this guide to find out what each claim really means. 

Sodium Claims What They Mean

Sodium free or salt free Less than 5 mg of sodium per 

serving

Very low sodium 35 mg or less per serving

Low sodium 140 mg or less per serving

Low sodium meal 140 mg or less per 31/2 ounces

Reduced or less sodium At least 25 percent less per serving than the regular version

Unsalted or no salt added No salt added during processing

Fat Claims What They Mean

Fat free Less than 1/2 gram of fat per 

serving

Low saturated fat 1 gram or less of saturated fat 

per serving

Reduced fat At least 25 percent less fat per 

serving than the regular version

Light 50 percent less fat than the 

regular version

Calorie Claims What They Mean

Calorie free Less than 5 calories per serving

Low calorie 40 calories or less per serving

Reduced or less calories At least 25 percent fewer calories

per serving than the regular version

Light or “lite” Half the fat or one-third of the

calories per serving of the

regular version
60Your Guide to a Healthy Heart

Figuring Out

Fat

Figuring Out Fat

Your personal fat allowance depends on how many calories you

consume each day. If you do not have high blood cholesterol or

heart disease, the saturated fat in your diet should be less than

10 percent of your daily calories, and total fat should be 20–35

percent of calories. Most fats should come from foods that are

high in polyunsaturated fats and monosaturated fats, such as

fish, nuts, and vegetable oils.

The table below shows the maximum amount of saturated fat

you should eat, depending on how many calories you take in

each day. If you have high blood cholesterol or heart disease,

the amount of saturated fat will be different. (See “Give Your

Heart a Little TLC,” on page 55.) Check the Nutrition Facts 

label on food packages to find out the number of fat grams—

both saturated and total—in each serving. 

Total Calorie Intake Limit on Saturated Fat Intake

1,600 18 g or less

2,000* 20 g or less

2,200 24 g or less

2,500* 25 g or less

2,800 31 g or less

* Percent daily values on the Nutrition Facts label on

the food package are based on a 2,000-calorie diet.

Values for 2,000 and 2,500 calories are rounded to the

nearest 5 grams to be consistent with the Nutrition Facts

label.
■ Fresh or dried fruit, or fruits canned in their own juice 

■ Vegetable sticks; try a dab of reduced-fat peanut butter on 

celery sticks

■ Air-popped popcorn with no salt or butter; fat-free, lowsodium pretzels 

Aim for a Healthy Weight 

If you are overweight or obese, taking pounds off can reduce your

chances of developing heart disease in several ways. First, losing

weight will directly lower your risk. Second, weight loss can help 

to reduce a number of other risk factors for heart disease, as well 

as lower your risk for other serious conditions. Weight loss can help

control diabetes, as well as reduce high blood pressure and high

blood cholesterol. Reaching a healthy weight can also help you to

sleep more soundly, experience less pain from arthritis, and have

more energy to take part in activities you enjoy.

Remember, if you need to lose weight, even a small weight loss will

help lower your risk for heart disease and other serious health conditions. At the very least, you should not gain any additional weight.

A recent study found that young adults who maintain their weight

over time, even if they are overweight, have lower risk factors for

heart disease in middle age than those whose weight increases.

When it comes to weight loss, there are no quick fixes. Successful,

lasting weight loss requires a change of lifestyle, not a brief effort 

to drop pounds quickly. Otherwise, you will probably regain the

weight. Aim to lose between 1/2 pound to 2 pounds per week—

no more. If you have a lot of weight to lose, ask your doctor, a 

registered dietitian, or a qualified nutritionist to help you develop 

a sensible plan for gradual weight loss.

To take off pounds and keep them off, you will need to make

changes in both your eating and physical activity habits. Weight

control is a question of balance. You take in calories from the 

foods you eat. You burn off calories during physical activity.

Cutting down on calories, especially calories from fat, is key to 

losing weight. Combining this change in diet with a regular physical

activity program, such as walking or swimming, will help you both

shed pounds and stay trim for the long term.

61Taking Charge: An Action Plan for Heart Health
62Your Guide to a Healthy Heart

Vitamins for Heart Health:

Choose Foods,

Not Supplements

Until recently, it was believed that antioxidant vitamins, particularly vitamin E and beta carotene, might protect against heart

disease and stroke, as well as cancer. But new research shows

that taking these vitamins in supplement form can be harmful—

even deadly.

In the case of vitamin E supplements, a review of 19 studies

showed that daily doses of 400 IUs or more may significantly

increase the risk of death from all causes. Meanwhile, two major

studies showed that supplementation with beta carotene (a substance that is converted to vitamin A in the liver) increases the risks

of lung cancer and death in smokers. Other recent studies have

shown that there are no benefits to taking either vitamin E or beta

carotene supplements to prevent cardiovascular diseases or cancer. 

But studies suggest that antioxidants in foods do protect heart

health. So keep eating plenty of foods that are packed with these

vitamins. Foods rich in vitamin E include vegetable oils (especially

safflower and sunflower oils), wheat germ, leafy green vegetables,

and nuts (almonds and mixed nuts).

Foods rich in beta carotene are 

carrots, yams, peaches, pumpkin,

apricots, spinach, and broccoli. 

Note: If you are taking vitamin E 

supplements for protection against

medical conditions other than

cardiovascular diseases or 

cancer, talk with your doctor

about the risks and benefits 

of higher dose vitamin E 

supplements.
Getting Started

Anyone who has ever tried to lose weight—and keep it off—knows

that it can be quite a challenge. Here are some tips to help you succeed:

Eat for health. Choose a wide variety of low-calorie, nutritious foods

in moderate amounts. Include vegetables, fruits, whole grains, and

low-fat or fat-free milk, as well as fish, lean meat, poultry, or dry

beans. Choose foods that are low in fat and added sugars. Choose

sensible portion sizes. (See “Portion Distortion” on page 68.) 

Watch calories. To lose weight, most overweight people will need to

cut 500 to 1,000 calories per day from their current diet.

For tips on choosing low-fat, low-calorie foods, see “The Substitution

Solution” on pages 66–67.

Keep milk on the menu. Don’t cut out milk products as you try to

reduce calories and fat. Milk and milk products are rich in calcium, 

a nutrient that helps prevent the bone-thinning disease osteoporosis.

Instead, choose low-fat or fat-free milk and milk products, which

have the same amount of calcium as whole-milk products. Make the

switch gradually. If you are used to drinking whole milk, first cut

back to 2 percent, then move to 1 percent, and finally to fat-free milk.

Keep moving. Physical activity is key to successful, long-term

weight loss. It can help you burn calories, trim extra fat from your

waist, and control your appetite. It can also tone your muscles and

increase aerobic fitness. To lose weight and to prevent further

weight gain, gradually build up to at least 60 minutes of moderateintensity physical activity on most, and preferably all, days of the

week. If you’ve lost weight, in order to keep it off, you’ll need to 

do even more physical activity—from 60–90 minutes of daily moderate-intensity physical activity. But you don’t need to run yourself

ragged. A recent study showed that moderate physical activity, such

as brisk walking, helps people lose weight as effectively as more 

vigorous exercise. For more tips, see “Get Moving!” on page 72.

Steer clear of fast food. A single meal from a fast food restaurant

may contain as many calories as you need for a whole day! A recent

study showed that young adults who eat frequently at fast food

restaurants gain more weight and are at higher risk for diabetes in

middle age than those who avoid the fast food habit. If you do eat

63Taking Charge: An Action Plan for Heart Health
64

at a fast food restaurant, choose salads and grilled foods, and keep

portion sizes small. Ask for salad dressings, mayonnaise, and other

high-fat condiments to be served on the side—or not at all.

Know about medicines. If you are very overweight, or if you are

overweight and have other weight-related risk factors or diseases,

your doctor may advise you to take a medicine to help you take off

pounds. You should use a weight-loss drug only after you have tried

a low-calorie diet, more moderate-intensity physical activity, and

other lifestyle changes for 6 months without successfully losing

weight. Because weight-loss medicines have side effects, you should

consider all of the risks and benefits before trying one of them.

These drugs should be used along with a low-calorie eating plan and

regular physical activity, not as a substitute for these lifestyle changes.

Get support. Tell your family and friends about your weight-loss

plans and let them know how they can be most helpful to you.

Some people also find it useful to join a structured weight-loss program. The most effective groups provide support and advice for permanently changing eating and physical activity habits. (See “How

To Choose a Weight-Loss Program” on page 70.)

Lock in your losses. After reaching your weight-loss goal, switch

your efforts to keeping the weight off by continuing to eat a nutritious, lower calorie diet and getting regular physical activity. To

maintain your weight, you’ll need to become even more active than

before: Aim for 60 to 90 minutes of physical activity per day.

While this may seem like a tall order, remember that you can count

the activities that you’re already doing. Common daily activities

such as climbing stairs, pushing a stroller, unloading groceries, gardening, and brisk walking all count as physical activity. Just be sure

you do enough of them!

Seven Secrets of Weight Management

If you have ever tried to take off weight, you know that it’s more than

a matter of promising yourself that you’ll eat less and move more.

You also need to mentally prepare yourself for new behaviors. Here

are some tips for getting and staying in a healthy weight mindset.

Start small. Many people set unrealistic goals for the amount of

weight they want to lose. But you can greatly improve your health

by losing just 5 to 10 percent of your starting weight. While you

Your Guide to a Healthy Heart
may choose to lose more weight later, keep in mind that this initial

goal is both realistic and valuable.

Set smart goals. It’s important to set goals that are specific, achievable, and “forgiving” (allow you to be less than perfect). For 

example, “exercise more” is a fine goal, but it’s not very specific.

“Walk for 60 minutes every day” is specific and perhaps achievable.

But what if you have a bad cold one day, and you awake to a

drenching rainstorm on another? “Walk 60 minutes, 5 days each

week” is specific, achievable, and forgiving. A great goal! 

Build on success. Rather than focusing on one big goal, choose a

series of smaller goals that will bring you closer and closer to your

larger goal. For example, if one of your big goals is to reduce your

daily calories from 2,000 to 1,200, first reduce your calories to

1,700, then move to 1,400, and finally to 1,200. Likewise, with

65Taking Charge: An Action Plan for Heart Health

Thin Quickies:

Are High-Fat, Low-Carb

Diets the Way to Go?

The currently popular high-fat, low-carbohydrate diets promise

quick, dramatic weight loss. But they’re not the route to healthy,

long-term weight management. A diet high in fat, especially if it

is high in saturated fat, is not good for your heart. These diets

are also high in protein and can cause kidney problems and

increased bone loss. High-fat, low-carb diets are also low in

many essential vitamins, minerals, and fiber. 

While some people following this type of a diet lose weight in the

short term, much of the weight loss is due to water loss. As with

most quick-fix diets, the weight tends to quickly return once you

stop dieting. The best course is to steer clear of all fad diets.

The healthiest, most effective route to long-term weight loss is a

lower fat, lower calorie, well-balanced diet. 
66Your Guide to a Healthy Heart

The Substitution Solution:

Making the Switch to 

Low-Calorie Foods

Here are some tasty, low-calorie alternatives to old favorites.

Read labels to find out how many calories are in the specific

products you buy. 

Instead of Replace With

Milk Products

Whole milk Low-fat or fat-free milk

Ice cream Sorbet, sherbet, fat-free frozen yogurt, 

or reduced-fat ice cream

Whipping cream Imitation whipped cream (made with 

fat-free milk) or low-fat vanilla yogurt

Sour cream Plain, low-fat yogurt or fat-free sour 

cream

Cream cheese Neufchatel cheese, “light” or fat-free 

cream cheese

Cheese (sandwich types) Reduced-calorie, low-calorie, or fatfree cheeses

Cereals and Pastas

Ramen noodles Brown rice or whole-grain pasta

Pasta with cheese sauce Whole-grain pasta with red sauce or 

vegetables

Granola Bran flakes, crispy rice cereals, cooked

grits or oatmeal, reduced-fat granola

Meat, Fish, Poultry

Cold cuts, hot dogs Low-fat cold cuts and hot dogs (watch 

sodium content)

Bacon or sausage Canadian bacon or lean ham

Regular ground beef Extra-lean ground beef or ground turkey

Chicken or turkey White-meat chicken or turkey without 

with skin skin
67Taking Charge: An Action Plan for Heart Health

Low-Calorie Foods

Instead of Replace With

Oil-packed tuna Water-packed tuna

Beef (chuck, rib, brisket) Beef (round, loin) with fat trimmed off; if

possible, choose select grades

Pork (spareribs, Pork tenderloin (trimmed), lean smoked

untrimmed loin) ham

Whole eggs Egg whites

Baked Goods

Croissants, brioches, etc. Hard French rolls or “brown ‘n serve” 

rolls

Donuts, sweet rolls, English muffins, bagels, reduced-fat or 

muffins fat-free muffins

Cake (pound, layer) Cake (angel food, gingerbread)

Cookies Reduced-fat, low-calorie, or fat-free 

cookies (graham crackers, ginger 

snaps, fig bars)

Fats, Oils, Salad Dressings

Regular margarine or Light-spread, reduced-calorie, or diet 

butter margarines; look for “trans fat-free” 

soft margarines

Regular mayonnaise Light or diet mayonnaise

Regular salad dressing Reduced-calorie or fat-free dressings, 

lemon juice, vinegars

Butter or margarine on Jelly, jam, or honey on toast

toast

Oils, shortening, or lard Nonstick cooking spray instead of 

greasing pans for sautéing
68

physical activity, first establish a “small” new habit—such as walking 10 minutes a day—and then gradually increase it. Everyone can

find time to exercise 10 minutes each day. When you experience

success at reaching a small goal, it will motivate you to keep moving

toward your larger goals.

Reward yourself! Rewards that you control will encourage you to

achieve your goals. For a reward to work well, choose something

you really want, don’t put off giving it to yourself, and make it

dependent on meeting a specific goal. The reward you choose may

be something you buy for yourself or an act of self-kindness, such as

an afternoon off from your usual responsibilities or an evening spent

with a friend. Avoid food as a reward. It usually works better to

give yourself frequent, small rewards for reaching short-term goals

than bigger rewards that require a long, difficult effort.

Your Guide to a Healthy Heart

Portion Distortion:

How To Choose Sensible

Servings

It’s very easy to “eat with your eyes” and misjudge what equals a

serving—and pile on unwanted pounds. This is especially true

when you eat out, because restaurant portion sizes have been

steadily expanding. Twenty years ago, the average pasta portion

size was 2 cups totaling 280 calories. Today, it’s 4 cups totaling

560 calories! To keep your portion sizes sensible:

● When eating out, choose small portion sizes, share an entrée

with a friend, or take some of the food home (if you can chill it 

right away).

● Check the Nutrition Facts label on product packages to learn 

how much food is considered a serving, as well as how many 

calories and how much fat are in the food.

● Be especially careful to limit portion sizes of high-calorie foods 

such as cookies, cakes, other sweets, sodas, french fries, oils, 

and spreads. 
69Taking Charge: An Action Plan for Heart Health

I realize I’m not as young as I used to be. I began

working out doing both weights, and cardio work.

Over time the more I exercised, the more I built up,

and increased the weights, the more I began to see

the benefits. It’s a stress reliever. I’m the father of

two young boys and they are very active in sports,

and now I have the ability to do more of that with

them.

BILL KIRWAN 

“

”
70

Write it down. Regularly record what you do on your weight-loss

program, such as your daily calorie intake and amount of physical

activity, as well as changes in your weight. (Try to weigh yourself at

the same time of day once or twice a week.) Keeping track this way

can help you and your health care provider determine what behaviors you may want to improve. Keeping tabs on your progress can

also help you stay motivated.

Know your triggers. To lose weight successfully, you’ll need to be

aware of your personal eating “triggers.” These are the situations that

usually bring on the urge to overeat. For instance, you may get a case

of the munchies while watching TV, when you see treats next to the

office coffeepot, or when you’re with a friend who loves to snack. To

“turn off” the trigger, you’ll need to make a change in the tempting

situation. Example: If the pile of doughnuts near the coffeepot is hard

to resist, leave the scene as soon as you pour yourself a cup of coffee.

The fine art of feeling full. Changing the way you eat can help you

eat less without feeling deprived. Eating slowly can help you feel

satisfied sooner, and therefore you will avoid second helpings.

Eating lots of vegetables and fruits and drinking plenty of noncaloric

beverages can also make you feel fuller. Another trick is to use

smaller plates and taller, narrower glasses so that moderate portions

don’t seem skimpy. It can also help to set a regular eating schedule,

especially if you tend to skip or delay meals.

How To Choose a Weight-Loss Program

Some people lose weight on their own, while others like the support

of a structured program. If you decide to participate in a weightloss program, here are some questions to ask before you join:

Does the program provide counseling to help you change your eating and activity habits?

The program should teach you how to permanently change eating

and lifestyle habits, such as lack of physical activity, that have contributed to weight gain. Research shows that people who successfully keep weight off are those who make changes in their overall

lifestyles, rather than simply join an exercise program.

Does the staff include qualified health professionals, such as nutritionists, registered dietitians, doctors, nurses, psychologists, and

exercise physiologists? 

Your Guide to a Healthy Heart
Qualified professionals can help you lose weight safely and successfully. Before getting started, you’ll need to be examined by a doctor

if you have any health problems, are currently taking or plan to take

any medicine, or plan to lose more than 15 to 20 pounds.

Does the program offer training on how to deal with times when

you may feel stressed and slip back into old habits?

The program should provide long-term strategies for preventing and

coping with possible weight problems in the future. These strategies

might include setting up a support system and a regular physical

activity routine.

Do you help make decisions about food choices and weight-loss goals?

In setting weight-loss goals, the program staff should consider your

personal food likes and dislikes, as well as your lifestyle. Avoid a 

“one strategy fits all” program.

Are there fees and costs for additional items, such as dietary 

supplements?

Before you sign up, find out the total costs of participating in the

program. If possible, get the costs in writing.

How successful is your program?

Few weight-loss programs gather reliable information on how well they

work. But it’s still worthwhile to

ask: 

■ What percentage of people 

who start this program complete 

it?

■ What percentage of people 

experience problems or side

effects? What are they?

■ What is the average 

weight loss among 

those who finish the 

program?

71Taking Charge: An Action Plan for Heart Health
72

Get Moving!

Regular physical activity is a powerful way to reduce your risk of

heart disease. Physical activity directly helps prevent heart problems.

Staying active also helps prevent and control high blood pressure,

keep cholesterol levels healthy, and prevent and control diabetes.

Plus, regular physical activity is a great way to help take off extra

pounds—and keep them off.

Regular physical activity has a host of other health benefits. It may

help prevent cancers of the breast, uterus, and colon. Staying active

also strengthens the lungs, tones the muscles, keeps the joints in good

condition, improves balance, and may slow bone loss. It also helps

many people sleep better, feel less depressed, cope

better with stress and anxiety, and generally feel

more relaxed and energetic.

You can benefit from physical activity at any 

age. In fact, staying active can help prevent,

delay, or improve many age-related health

problems. As you grow older, weightbearing activities can be particularly 

helpful for strengthening bones and 

muscles, improving balance, and lowering

the risk for serious falls. Good weightbearing activities include carrying groceries,

walking, jogging, and lifting weights. (Start

with 1- to 3-pound hand weights and gradually

progress to heavier weights.) 

Activities that promote balance and flexibility

are also important. Practices such as T’ai Chi

and yoga can improve both balance and 

flexibility and can be done alternately with heart

healthy physical activities. Check with your health

insurance plan, local recreation center, YWCA 

or YMCA, or adult education program for lowcost classes in your area.

A Little Activity Goes a Long Way

The good news is that to reap benefits from

physical activity, you don’t have to run a

marathon—or anything close to it. To reduce the risk

Your Guide to a Healthy Heart
of disease, you only need to do about 30 minutes of moderateintensity physical activity on most, and preferably all, days of the

week. If you’re trying to manage your weight and prevent gradual,

unhealthy weight gain, try to boost that level to approximately 60

minutes of moderate- to vigorous-intensity physical activity on most

days of the week.

Brisk walking (3 to 4 miles per hour) is an easy way to help keep

your heart healthy. One study, for example, showed that regular,

brisk walking reduced the risk of heart attack by the same amount

as more vigorous exercise, such as jogging. To make physical activity a pleasure rather than a chore, choose activities you enjoy. Ride 

a bike. Go hiking. Dance. Play ball. Swim. Keep doing physical

tasks around the house and yard. Rake leaves. Climb stairs. Mulch

your garden. Paint a room.

You can do an activity for 30 minutes at one time, or choose shorter

periods of at least 10 minutes each. For example, you could spend

10 minutes walking on your lunch break, another 10 minutes raking

leaves in the backyard, and another 10 minutes lifting weights. The

important thing is to total about 30 minutes of activity each day.

(To avoid weight gain, try to total about 60 minutes per day.)

No Sweat!

Getting regular physical activity can be easy—especially if you take

advantage of everyday opportunities to move around. For example:

■ Use stairs—both up and down—instead of elevators. Start with 

one flight of stairs and gradually build up to more.

■ Park a few blocks from the office or store and walk the rest of 

the way. If you take public transportation, get off a stop or two 

early and walk a few blocks.

■ Instead of eating that rich dessert or extra snack, take a brisk 

stroll around the neighborhood.

■ Do housework or yard work at a more vigorous pace.

■ When you travel, walk around the train station, bus station, or 

airport rather than sitting and waiting.

■ Keep moving while you watch TV. Lift hand weights, do some 

gentle yoga stretches, or pedal an exercise bike.

■ Spend less time watching TV and using the computer.

73Taking Charge: An Action Plan for Heart Health
74

Safe Moves

Some people should get medical advice before starting regular physical activity. Check with your doctor if you:

■ Are over 50 years old and not used to moderately energetic 

activity 

■ Currently have heart trouble or have had a heart attack

■ Have a parent or sibling who developed heart disease at an 

early age

■ Have a chronic health problem, such as high blood pressure, 

diabetes, osteoporosis, or obesity 

Once you get started, keep these guidelines in mind: 

Go slow. Before each activity session, allow a 5-minute period of

slow-to-moderate movement to give your body a chance to limber up

and get ready for more exercise. At the end of the warmup period,

gradually increase your pace. Toward the end of your activity, take

another 5 minutes to cool down with a slower, less energetic pace.

It’s best to wait until after your activity to do stretching exercises.

Listen to your body. A certain amount of stiffness is normal at first.

But if you hurt a joint or pull a muscle, stop the activity for several

days to avoid more serious injury. Rest and over-the-counter

painkillers can heal most minor muscle and joint problems.

Check the weather report. Dress appropriately for hot, humid days

and for cold days. In all weather, drink lots of water before, during,

and after physical activity.

Pay attention to warning signals. While physical activity can

strengthen your heart, some types of activity may worsen existing

heart problems. Warning signals include sudden dizziness, cold

sweat, paleness, fainting, or pain or pressure in your upper body just

after doing a physical activity. If you notice any of these signs, call

your doctor right away.

Use caution. If you’re concerned about the safety of your surroundings, pair up with a buddy for outdoor activities. Walk, bike, or jog

during daylight hours.

Your Guide to a Healthy Heart
Stay the course. Unless you have to stop your activity for a health

reason, stick with it. If you feel like giving up because you think

you’re not going as fast or as far as you should, set smaller, shortterm goals for yourself. If you find yourself becoming bored, try

doing an activity with a friend. Or switch to another activity. The

tremendous health benefits of regular, moderate-intensity physical

activity are well worth the effort.

What’s Your Excuse? 

We all have reasons to stay inactive. But with a

little thought and planning, you can overcome

most obstacles to physical activity. For example:

“I don’t have time to exercise.” While

physical activity does take time, remember

that you can reduce your heart disease

risk by getting just 30 minutes of

moderate-intensity physical activity

on most days of the week. Plus,

you can save time by doubling up

on some activities. For example, you can ride an exercise bike or use hand

weights while watching

TV. Or, you can transform some of your

everyday chores—like

washing your car or

walking the dog—into

heart healthy activities

by doing them more

briskly than usual.

“I don’t like to exercise.” You may have bad

memories of doing situps or running around the

track in high school, forcing yourself through every sweating, 

panting moment. Now we know that you can get plenty of gain

without pain. Activities you already do, such as gardening or 

walking, can improve your health. So just do more of the activities

you like. If possible, get your friends or family members involved 

so that you can support each other.

75Taking Charge: An Action Plan for Heart Health
76Your Guide to a Healthy Heart

“I don’t have the energy to be more active.” Get active first—with

brief periods of moderate-intensity physical activity—and watch

your energy start to soar. Once you begin regular physical activity,

you will almost certainly feel stronger and more vigorous. As you

progress, daily tasks will seem easier.

“I want to exercise, but I keep forgetting!” Leave your sneakers near

the door to remind yourself to walk, or bring a change of clothes to

work and head straight for the gym, yoga class, or walking trail on

the way home. Put a note on your calendar to remind yourself to

exercise. While you’re at it, get in the habit of adding more activity

to your daily routine.

Move It and Lose It

Activity Calories Burned Per Hour*

Walking, 2 mph 240

Walking, 3 mph 320

Walking, 4.5 mph 440

Bicycling, 6 mph 240

Bicycling, 12 mph 410

Tennis, singles 400

Swimming, 25 yards per minute 275

Swimming, 50 yards per minute 500

Hiking 408

Cross-country skiing 700

Jumping rope 750

Jogging, 5.5 mph 740

Jogging, 7 mph 920

* For a healthy, 150-pound person. A lighter person burns fewer calories; a heavier person burns more. 

You Can Stop Smoking

The good news is that quitting smoking immediately reduces your

risk of heart disease and other serious disorders, with the benefit

increasing over time. Just 1 year after you stop smoking, your heart

disease risk will drop by more than half. Within several years, it will

approach the heart disease risk of someone who has never smoked.

No matter how long you’ve been smoking, or how much, quitting

will lessen your chances of developing heart disease.
77Taking Charge: An Action Plan for Heart Health

Walk Into Health:

A 12-Week Program

Walk Into Health

Do on most days each week. Your heart will thank you! 

Warmup Activity Cool Down Total Time

Week 1

Walk slowly 5 min. Walk briskly 5 min. Walk slowly 5 min. 15 min.

Week 2

Walk slowly 5 min. Walk briskly 7 min. Walk slowly 5 min. 17 min.

Week 3

Walk slowly 5 min. Walk briskly 9 min. Walk slowly 5 min. 19 min.

Week 4

Walk slowly 5 min. Walk briskly 11 min. Walk slowly 5 min. 21 min.

Week 5

Walk slowly 5 min. Walk briskly 13 min. Walk slowly 5 min. 23 min.

Week 6

Walk slowly 5 min. Walk briskly 15 min. Walk slowly 5 min. 25 min.

Week 7

Walk slowly 5 min. Walk briskly 18 min. Walk slowly 5 min. 28 min.

Week 8

Walk slowly 5 min. Walk briskly 20 min. Walk slowly 5 min. 30 min.

Week 9

Walk slowly 5 min. Walk briskly 23 min. Walk slowly 5 min. 33 min.

Week 10

Walk slowly 5 min. Walk briskly 26 min. Walk slowly 5 min. 36 min.

Week 11

Walk slowly 5 min. Walk briskly 28 min. Walk slowly 5 min. 38 min.

Week 12

Walk slowly 5 min. Walk briskly 30 min. Walk slowly 5 min. 40 min.
78Your Guide to a Healthy Heart

Prepare to Succeed

■ Get motivated. Take some time to think about all the benefits 

of being “smoke free.” Besides the health benefits of quitting, 

what else do you have to gain? Money saved from not buying 

cigarettes? Loved ones no longer exposed to secondhand 

smoke? A better appearance? No more standing outside in the 

cold or rain for a smoke? Write down all of the reasons you 

want to stop smoking.

■ Sign on the dotted line. Write a brief contract that states your 

intention to stop smoking, your quitting date, and some ways 

you plan to reward yourself for becoming an exsmoker. Have 

someone sign it with you.

■ Lineup support. Ask the person who cosigns your contract—or

another friend or relative—to give you special support in your 

efforts to quit. Plan to get in touch with your support person 

regularly to share your progress and to get encouragement. If 

possible, quit with a friend or family member.

Breaking the Habit

■ Know yourself. To quit successfully, you need to know your 

personal smoking “triggers.” These are the situations and 

feelings that typically bring on the urge to light up. Some 

common triggers are drinking coffee, having an alcoholic drink, 

talking on the phone, watching someone else smoke, and 

experiencing stress. Make a list of your own personal triggers.

Especially during the first weeks after quitting, try to avoid as 

many triggers as you can.

■ Find new habits. Replace your “triggers” with new activities 

that you don’t associate with smoking. For example, if you’ve 

always had a cigarette with a cup of coffee, switch to tea for a 

while. If stress is a trigger for you, try a relaxation exercise 

such as deep breathing to calm yourself. (Take a slow, deep 

breath, count to five, and release it. Repeat 10 times.) 

■ Keep busy. Get involved in activities that require you to use your

hands, such as needlework, art projects, jigsaw puzzles, or fix-up

projects around your house or apartment. When you feel the 

urge to put something in your mouth, try some vegetable sticks, 

apple slices, or sugarless gum. Some people find it helpful to 

inhale on a straw or chew on a toothpick until the urge passes.

■ Keep moving. Walk, garden, bike, or do some yoga stretches.

Physical activity will make you feel better and will help prevent 

weight gain.
79Taking Charge: An Action Plan for Heart Health

My father died of heart problems.

I’m on medication for my high 

blood pressure. I’m trying to 

learn from my family history by

focusing on maintaining my

quality of life. I don’t want 

to get old. I want to be 

able to do all the things I

have been doing all my 

life. I am a little kid at

heart.

ALAN LETOW “ ”
80Your Guide to a Healthy Heart

■ Know what to expect. During the first few weeks after quitting,

you may experience temporary withdrawal symptoms such as 

headaches, irritability, tiredness, and trouble concentrating.

While these feelings are not pleasant, it may help to know that 

they are signs that your body is recovering from smoking. Most

symptoms end within 2 to 4 weeks.

■ Ask for help. A number of free or low-cost programs are available to help people stop smoking. They include programs 

offered by local chapters of the American Lung Association and

the American Cancer Society. Other low-cost programs can be 

found through hospitals, health maintenance organizations, 

workplaces, and community groups.

■ Give yourself a break. Get plenty of rest, drink lots of water, 

and eat three healthy meals each day. If you are not as productive

or cheerful as usual during the first weeks after quitting, be 

gentle with yourself. Give yourself a chance to adjust to your 

new smoke-free lifestyle. Congratulate yourself for making a 

major, positive change in your life.

More Help for Quitting

As you prepare to quit smoking, consider using a medicine that

can help you stay off cigarettes. Some of these medications

contain very small amounts of nicotine, which can help lessen

the urge to smoke. They include nicotine gum (available over-the

counter), the nicotine patch (available over the counter and by

prescription), a nicotine inhaler (by prescription only), and a nicotine nasal spray (by prescription only). Another quitting aid is

Bupropion SR, a medicine that contains no nicotine but reduces

the craving for cigarettes. It is available only by prescription.

While all of these medications can help people stop smoking,

they are not safe for everyone. Talk with your doctor about

whether you should try any of these aids. 

Help for Quitting
81Taking Charge: An Action Plan for Heart Health

A Weighty Concern

Many people fear that if they stop smoking, they will gain

unwanted weight. But most exsmokers gain less than 10

pounds. Weight gain may be partly due to changes in the way

the body uses calories after smoking stops. Some people also

may gain weight because they substitute high-calorie foods for

cigarettes. Choosing more low-calorie foods and getting more

physical activity can reduce the amount of weight you gain.

If you do put on some weight, you can work on losing it after you

have become comfortable as a nonsmoker. When you consider

the serious health risks of smoking, the possibility of gaining a

few pounds is no reason to continue.

A Weighty Concern

If You “Slip”

A slip means that you’ve had a small setback and smoked a cigarette

after your quit date. Most smokers slip three to five times before

they quit for good. To get right back on the nonsmoking track:

■ Don’t be discouraged. Having a cigarette doesn’t mean you 

can’t quit smoking. A slip happens to many people who 

successfully quit. Keep thinking of yourself as a nonsmoker.

(You are one.)

■ Learn from experience. What was the “trigger” that made you 

light up? Were you driving home from work, enjoying a glass of 

wine at a party, feeling angry with your boss? Think back on 

the day’s events until you remember what the trigger was.

■ Take charge. Write a list of things you will do the next time 

you face that particular trigger situation—and other tempting 

situations as well. Sign a new contract with your support 

person to show yourself how determined you are to kick the 

habit. You’re on your way.
82Your Guide to a Healthy Heart

Aspirin:Take With Caution

This well-known “wonder drug” is an antiplatelet

medicine that can help to lower the risk of a heart

attack or stroke for those who have already had

one. Aspirin also can help to keep arteries open

in those who have had a heart bypass or other

artery-opening procedure, such as angioplasty. In

addition, aspirin is given to people who arrive at the hospital

with a suspected heart attack or stroke.

It’s important to know that aspirin has not been approved by the

U.S. Food and Drug Administration for the prevention of heart

attacks in those who have never had a heart attack or stroke. 

However, a recent, large study has found that among healthy

women, taking low-dose aspirin every other day may help to

prevent a first stroke, and among women over the age of 65,

may also help prevent a first heart attack. If you are considering taking aspirin for this purpose, keep in mind that it is a

powerful drug with many side effects, and can mix dangerously with other drugs. Take daily aspirin to prevent heart attack

only with your doctor’s specific advice and guidance. If aspirin

is a good choice for you, be sure to take the dose 

recommended by your doctor. 

If you’re thinking about using aspirin to either prevent or treat

a heart problem, talk with your doctor first. Only a doctor who

knows your medical history and current health condition can

judge whether the benefits would outweigh the risks. If aspirin

is a good choice for you, be sure to take the dose recommended by your doctor. 

If your doctor does advise you to take aspirin, be sure to 

continue practicing the “Big Four” heart healthy habits—eating

nutritiously, getting regular physical activity, maintaining a

healthy weight, and avoiding smoking. While aspirin can be 

a useful treatment for some people, it is not a substitute for a

healthy lifestyle.
83Heart Health Is a Family Affair

When it comes to heart health, what’s good for you is good for your

whole family—including its youngest members. We now know that

two-thirds of teenagers have at least one risk factor for heart disease, from overweight and “couch potato-itis” to unhealthy blood

pressure and cholesterol levels. Even more disturbing, about one

million U.S. teenagers have metabolic syndrome, which is a cluster

of risk factors that greatly increases the risk of a later heart attack.

We owe it to our children and grandchildren to help them develop

heart healthy habits—and the earlier the better. Here are some ways

to begin:

Set a good example. Adults have a big influence on children’s and

teens’ behavior—even though kids may not want to admit it. If you

follow a healthy lifestyle, the younger members of your family will be

more likely to do the same. Let them see you eating nutritious snacks and enjoying outdoor

activities, and invite them to join in. If you

smoke, stop—and tell your kids and grandkids why you’re quitting.

What’s cookin’? Fully 80 percent of

children eat fewer than five servings of fruits and vegetables per

day. What to do? Practice

“stealth cooking”—creating

healthy meals for kids that will

still make their mouths water. You

can chop veggies into small pieces

and add them to favorite recipes,

such as pizza or spaghetti sauce.

If your kids love tacos, try replacing

taco shells with crunchy lettuce

leaves, and pile on some extra

chopped tomato. Use whole-wheat

Heart Health Is a Family Affair
84

or bran breads to add fiber to sandwiches. For dessert, skip the ice

cream and offer fresh fruit, fig bars, ginger snaps, graham crackers,

or frozen fat-free dairy desserts.

Raise “kitchen kids.” Most children enjoy cooking when it’s presented as an easy, fun activity. Show young kids how to clean fruits

and veggies and combine them into colorful salads. Let them make

“fruit-salad faces” out of sliced apples, bananas, and raisins. When

they’re old enough, teach children to use the stove, oven, microwave,

and toaster safely. Show teens how to make simple, healthy dishes,

such as whole-grain pasta with vegetables and broiled chicken or

fish. Encourage them to be creative with herbs and spices. Children

who have basic kitchen skills appreciate food more and are more

likely to try new dishes.

Get them moving. The latest “Dietary Guidelines for Americans”

recommend that children and teenagers be physically active for at

least 60 minutes per day. Yet, in a world chock full of video games,

TV shows, and computer offerings, few young people are as active

as they should be. To encourage children to get off the couch, find

out what kinds of physical activities they do enjoy and make it easy

for them to participate. If the kids in your family like to ride bikes,

plan a Sunday outing on your local trail. Walk, cycle, or jog with

them to places close by. Use your backyard or local park to toss a

Frisbee around or to play a game of basketball, badminton, or volleyball. Make an effort to gear activities to children’s ages. Younger

kids, up to age 10, tend to have quick bursts of energy sandwiched

between longer periods of rest, while older children usually have

more endurance. Play down

the competition, play up

the fun, and pretty soon,

your kids may start

asking you to

shoot some

hoops. Better

get in shape! 

Your Guide to a Healthy Heart
85A Change of Heart

Taking care of your heart is one of the most important things you

can do for your health and well-being. But, because heart health

involves changing daily habits, it can require some real effort. To

make the process easier, try tackling only one habit at a time. For

example, if you smoke cigarettes and also eat a diet high in saturated fats, work first on kicking the smoking habit. Then, once you’ve

become comfortable as a nonsmoker, begin to skim the fat from

your diet.

Remember, nobody’s perfect. Nobody always eats the ideal diet or

gets just the right amount of physical activity. The important thing

is to follow a sensible, realistic

plan that will gradually lessen

your chances of developing

heart disease.

So keep at it. Work

with your doctor. Ask

family members and

friends for support. If you

slip, try again. Be good to

your heart, and it will

reward you many times

over—with a better

chance for a longer, more

vigorous life.

A Change of Heart
86Your Guide to a Healthy Heart

How To Estimate Your Risk

Estimate of 10-Year Risk for Men 

Point Total 10-Year Risk %

<0 <1 

0 1 

1 1 

2 1 

3 1 

4 1 

5 2 

6 2 

7 3 

8 4 

9 5 

10 6 

11 8 

12 10 

13 12

14 16 

15 20 

16 25 

≥17 ≥30 

<160 0 0 0 0 0

160–199 4 3 2 1 0

200–239 7 5 3 1 0

240–279 9 6 4 2 1

≥280 11 8 5 3 1

Total

Cholesterol Age 20–39 Age 40–49 Age 50–59 Age 60–69 Age 70–79

Age 20–39 Age 40–49 Age 50–59 Age 60–69 Age 70–79

Points 

Nonsmoker 00 000

Smoker 85 311

Points

HDL (mg/dL) Points

≥60 -1

50–59 0

40–49 1

<40 2

Systolic BP (mmHg) If Untreated If Treated

<120 0 0

120–129 0 1

130–139 1 2

140–159 1 2

≥160 2 3

Age Points

20–34 -9

35–39 -4

40–44 0

45–49 3

50–54 6

55–59 8

60–64 10

65–69 11

70–74 12

75–79 13

10-Year risk_____%
87A Change of Heart

How To Estimate Your Risk

Estimate of 10-Year Risk for Women 

Point Total 10-Year Risk %

<9 <1 

9 1 

10 1 

11 1 

12 1 

13 2 

14 2 

15 3 

16 4 

17 5 

18 6 

19 8 

20 11 

21 14 

22 17 

23 22 

24 27 

≥25 ≥30 

<160 0 0 0 0 0

160–199 4 3 2 1 1

200–239 8 6 4 2 1

240–279 11 8 5 3 2

≥280 13 10 7 4 2

Total

Cholesterol Age 20–39 Age 40–49 Age 50–59 Age 60–69 Age 70–79

Age 20–39 Age 40–49 Age 50–59 Age 60–69 Age 70–79

Points

Nonsmoker 00 000

Smoker 97 421

Points 

HDL (mg/dL) Points

≥60 -1

50–59 0

40–49 1

<40 2

Systolic BP (mmHg) If Untreated If Treated

<120 0 0

120–129 1 3

130–139 2 4

140–159 3 5

≥160 4 6

Age Points

20–34 -7

35–39 -3

40–44 0

45–49 3

50–54 6

55–59 8

60–64 10

65–69 12

70–74 14

75–79 16

10-Year risk_____%
88Your Guide to a Healthy Heart

To Learn More

The National Heart, Lung, and Blood Institute provides information

on the prevention and treatment of heart disease and offers publications on heart health and heart disease.

NHLBI Health Information Center NHLBI Heart Health

P.O. Box 30105 Information Line

Bethesda, MD 20824-0105 1–800–575–WELL

Phone: 301–592–8573 Provides toll-free recorded

TTY: 240–629–3255 messages.

Fax: 301–592–8563

Also, check out these heart health Web sites and Web pages:

NHLBI Web site: www.nhlbi.nih.gov

Diseases and Conditions A–Z Index:

http://www.nhlbi.nih.gov/health/dci/index.html 

The Heart Truth: A National Awareness Campaign for Women 

About Heart Disease: www.hearttruth.gov

Your Guide to Lowering High Blood Pressure: www.nhlbi.nih.gov/hbp/index.html

Live Healthier, Live Longer (on lowering elevated blood cholesterol):

www.nhlbi.nih.gov/chd

High Blood Cholesterol: What You Need To Know:

www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm

Aim for a Healthy Weight:

www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm

Act in Time to Heart Attack Signs: www.nhlbi.nih.gov/actintime/index.htm

Heart Healthy Recipes:

www.nhlbi.nih.gov/health/public/heart/other/syah/index.htm

http://www.nhlbi.nih.gov/health/public/heart/other/ktb_recipebk/

Smoking Cessation: For information from the National Cancer Institute on

quitting smoking, call 1–800–QUITNOW 

(1–800–784–8669) or go to http://www.smokefree.gov/

For still more information on heart health, see Medline Plus:

http://medlineplus.gov/
Discrimination Prohibited: Under provisions of

applicable public laws enacted by Congress

since 1964, no person in the United States shall,

on the grounds of race, color, national origin,

handicap, or age, be excluded from participation

in, be denied the benefits of, or be subjected to

discrimination under any program or activity (or,

on the basis of sex, with respect to any education program or activity) receiving Federal financial assistance. In addition, Executive Order

11141 prohibits discrimination on the basis of

age by contractors and subcontractors in the

performance of Federal contracts, and Executive

Order 11246 states that no federally funded contractor may discriminate against any employee or

applicant for employment because of race, color,

religion, sex, or national origin. Therefore, the

National Heart, Lung, and Blood Institute must be

operated in compliance with these laws and

Executive Orders.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Heart, Lung, and Blood Institute

NIH Publication No. 06–5269

November 2005

ISBN 1-933236-03-5