Thursday October 30th 2014

Optimizing heart health

Know the facts, have a plan, make a difference for you and your patients

What do we know about RNs, their risk for cardiovascular disease (CVD) and prevention in America?

CVD remains the No. 1 cause of death, and it kills more women than men. According to the INTERHEART Study, the factors attributable for 90 percent of heart-related events worldwide are lipids, hypertension, diabetes, lack of fruits and vegetables, lack of exercise, tobacco use, abdominal obesity, alcohol and stress/depression/anxiety/hostility. The cornerstone of CVD prevention is the promotion of a healthy lifestyle and the identification and reduction of CV risk factors.

We know that RNs are at risk. The Nurses Health Study showed that 60 percent of those enrolled were overweight or obese, greater than 50 percent exercised less than two hours per week (goal is 150 min/week) and ate fewer fruits and vegetables than the minimum daily standards (the goal for fruits/vegetables is >5/day). It might be expected that cardiovascular nurses, who know the risk factors, would engage in a heart-healthier lifestyle, but in a survey conducted of Preventive Cardiovascular Nurses Association members in 2008, 47 percent were overweight or obese, 43.4 percent exercised no more than twice a week and 50 percent ate fewer than five servings of fruits and vegetables daily. The smoking rate for nurses is 18 percent and for cardiovascular nurses 3.3 percent.

We also know lifestyle changes make an impact. Although coronary bypass, stents and angioplasties are common treatments for CVD, lifestyle and medical therapy are considered to be the foundation of preventing and treating CVD.  According to the Nurses Health Study, the healthy lifestyle factors associated with the greatest risk reduction are absence of current smoking; 30 minutes or more of moderate or vigorous physical activity daily; BMI less than 25; adherence to a diet low in saturated fats, lower glycemic load, higher fiber, higher marine omega-3 fatty acids, higher folate and higher polyunsaturated to saturated fat ratio; and drinking a half glass or more of wine per day. (But if you do not currently drink alcohol, it is not recommended that you start.) When three, four or five of these healthy lifestyle factors were present, risk for coronary heart disease over a 14-year period was reduced by 57 percent, 66 percent and 83 percent, respectively.

Know your risk; make a plan. Your heart is counting on you.

We will focus on several of the CV risk factors that are a particular threat to the heart health of American nurses.

Hypertension: Women who reach the age of 55 without hypertension, however, still have a 90 percent residual lifetime risk of developing hypertension, increasing not only the risk of heart failure and heart attack, but also stroke, blindness and kidney disease.

Take Heart! Your goal: <120/80.

Consider the DASH (Dietary Approaches to Stop Hypertension). This is a scientifically proven pattern of eating to lower blood pressure by 8-14 mm Hg. For a comprehensive approach to reducing blood pressure, see the table below.

Obesity: From aching joints to obstructive sleep apnea to diabetes and heart attack, obesity is more than a vanity issue for our growing population. The obesity epidemic could lead to more than six million cases of type 2 diabetes mellitus and five million cases of heart disease and stroke in the next two decades. Central adiposity is riskiest for heart disease and diabetes.

Take Heart! Your goal: A BMI of 18.5-24.9 is the goal, with a waist circumference <35 in for women and <40 in for men.

Calculate your BMI to assess the level of risk your weight confers at www.nhlbi.nih.gov.  Small changes make large metabolic changes. Target 5-10 percent body weight loss! Think, “Fewer calories in and more calories out,” smaller portions, healthy choices and daily exercise. Make water your beverage of choice. Eat breakfast every day. Try fruit for a snack rather than a baked good. Tracking your intake and output is an effective strategy, either through writing it down or using mobile apps on your smartphone (such as “Lose it” or “My Fitness Pal”) to track lifestyle changes.

Exercise is the most powerful risk reduction strategy. William C. Roberts, MD, describes exercise as “an agent with lipid-lowering, antihypertensive, positive inotropic, negative chronotropic, vasodilating, diuretic, weight-reducing, cathartic, hypoglycemic, tranquilizing, hypnotic and antidepressive qualities.”

Take Heart! Your goal: Get moving! Exercise moderately or vigorously for 30 minutes on most days, preferably every day. Incorporate resistive exercises 2-3 times/week.

If time is a challenge, break it up into 10-15-minute increments. Walk at lunch before you sit down to eat, or walk 15 minutes in the halls on your way out the door. Take the stairs whenever possible. Find a buddy to walk with, and hold each other accountable. Reduce your television and computer time and replace it with physical activity. Try a pedometer, and listen to music or an audio book while walking.

Diabetes: A diagnosis of diabetes increases the risk of heart disease and stroke two- to fourfold. In the landmark Diabetes Prevention Program trial, the risk of developing diabetes in high-risk individuals was reduced by 58 percent by lifestyle alone.

Take Heart! Your goal: Fasting blood glucose <100

Increase your insulin sensitivity with 30 minutes of aerobic exercise, choosing low-fat food options, and working toward a 5-10 percent weight loss. Other strategies to reduce insulin resistance are stress reduction and adequate sleep. Decrease high glycemic load from sugary sodas, juices and sweets.

Smoking: Increases the risk of CVD and stroke three- to sixfold. Be a smoke-free role model. Your confidence translates to confidence for your patient.

Take Heart! Your goal: Smoking cessation, avoidance of secondhand smoke

Set a quit date, and create an environment to help you be successful. Engage support from family and friends; remove smoking paraphernalia; identify the high-urge times when you are most apt to smoke and develop behavioral strategies to get through those high-urge times. Pharmacological support can help with the physical withdrawal and cravings.

You can optimize your heart health by assessing your own risk for heart disease and stroke, and stepping into action to reduce your risk. Visualize your SMART goal. Make it specific, measurable, action-oriented, realistic and time-bound. Create a personal affirmation and say it to yourself 10 times. Practice self-talk: Remember that what you are saying to yourself absolutely affects how you feel. Check out the Heart Healthy Tool Box on the PCNA website at www.pcna.net.

— Donna Louie, BSN, CDE, FPCNA, and Robin Wedell, BSN, FPCNA,
are Northern California Chapter Leaders of the Preventive
Cardiovascular Nurses Association.

Resources

Visit ANAHealthyNurse.org for resources, including the ANA Health Risk Appraisal and web wellness portal.


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