Blood pressure is rising in America after a 30 year
decline. The latest survey found that 29% of the adult population now
has high blood pressure (140/90 or higher). This is up from 25% in
1988. In people 60 years of age or older the rate of high blood
pressure is 60%.
Of those with known high blood pressure, only 31%
have their blood pressure
under good control (blood pressure less than 140/90). This trend is of major concern
because high blood pressure increases the risk for heart attacks,
heart failure, stroke, kidney disease, and blindness. To help combat
this rising problem, the National High Blood Pressure Education
Program, sponsored by NIH, has recently announced 5 key steps people
can take to combat high blood pressure (in addition to taking
medications if prescribed):
NIH has also set new standards for blood pressure. Normal blood
pressure is now defined as less than 120/80. Pressures of 120/80 to
139-89 are called "prehypertension". High blood pressure is still
defined as 140/90 or higher.
Research shows that starting at a blood pressure of 115/75, the
risk for cardiovascular disease doubles with each increase of 20
points systolic (top BP number) or 10 points diastolic (bottom BP
number) pressure. Thus, people with pressures of 120/80 to 139/89 are
at increased risk. If your present blood pressure is in this
prehypertension range, take steps now to prevent it from climbing
higher with age. You will be cutting your risk of both heart attack
and stroke.
People with high levels of c-reactive protein (CRP),
a marker for inflammation, appear to have a harder time lowering their
blood cholesterol levels by diet. In a recent study published in
Circulation (July 2003) 100 people went on the DASH diet to lower
their blood cholesterol levels. The DASH diet emphasizes fruits and
vegetables, low fat dairy, and a low saturated fat diet (less than 6%
of calories from saturated fat). Half of the people were randomly
selected to eat a control diet, a typical American diet with 16
percent of the calories from saturated fat. Weight was held constant.
Those on the DASH diet had a significant drop in
their cholesterol levels. In those with low CRP levels (less than average)
LDL cholesterol dropped by 12%, but in those with high CRP levels (above
average) LDL cholesterol dropped only 3 percent. The triglyceride levels were also affected. In those with above average CRP
levels at the start of the study, triglycerides increased on the DASH
diet by 20%, but in those with low CRP levels there was no significant change
in their triglyceride levels.
These results need confirmation by other studies but
it appears that CRP levels affect how the body responds to dietary
changes to prevent heart disease. Weight loss and physical activity
both decrease inflammation
levels. If you are having a hard time
lowering your blood cholesterol level, you may need to add weight loss and physical activity to
your program to get better results. This approach can help lower both
CRP and cholesterol levels.
Prostate Cancer Risk and Smoking
Smoking is associated with increased risk for
many cancers, including cancer of the bladder, cervix, kidney,
esophagus, and lung. Now a new study links smoking to prostate cancer.
Prostate cancer is the second leading cause of death
from cancer in American men (lung is first) so learning ways to
prevent it is very important. This new study found that people who
smoked a pack of cigarettes a day for 40 years had a 60% increased
risk of prostate cancer. They were also twice as likely to develop an
aggressive form of prostate cancer that is more lethal. Those who had
smoked for less than 40 years still had a 40% increased risk of
prostate cancer.
One good way to prevent prostate cancer is not to
smoke, or if you smoke, stop! By not smoking you may cut your risk of
prostate cancer in half or more!
Source: Cancer Epidemiology, Biomarkers, and
Prevention, July 2003
More info ...
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Help in Quitting Smoking
Washington State is offering phone support to help
its residents stop smoking. If you have a friend who wants to stop,
have them checkout their web site
http://quitline.com.
They provide phone counseling, a "Quit Kit",
support, and information to help make quitting smoking easier and more
successful. Their toll free number is 877-270-7867.
Philip Morris, as part of their tobacco suit
settlement, has an excellent web site on the dangers of smoking.
They provide
information for parents on preventing youth from starting smoking and
information on quitting if you smoke. It's an excellent resource on
smoking.
http://philipmorrisusa.com
The
Excess Cost of Being Overweight
We often hear about the high cost of health care
caused by smoking. A recent estimate is about $76 billion annually. A
new study by the
U.S. Centers for Disease Control and Prevention now has estimated the
cost of being overweight -- how much excess body weight contributes to health care expenses each
year in America. Would you believe $93 billion dollars annually? This
represents nearly 10% of all health care costs in the U.S. This cost
estimate includes direct medical costs due to being overweight, but
does not include indirect costs such as increased work loss time which
adds many billion more annually.
Overall, annual medical expenses for an obese person
(BMI 30+) is about 38% (or $732) higher each year than the medical
expenses
of people who are not overweight. Obese Medicare recipients cost $1,486 more
per year than normal weight individuals, and the cost is $864 more per year for an
obese Medicaid recipient. These high costs add up quickly when you
realize that nearly 65% of the population is now overweight!
This study is a wakeup call to the government,
businesses, and individuals who will be picking up the tab for these
excess or preventable expenses. Want to save money as well as live
longer? Maintain a healthy weight!
Source: U.S.
Centers for Disease Control and
Prevention
Help in losing weight...
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Maintaining a Healthy Brain
Dementia and Alzheimer's are words we don't like to
think about, especially as we grow older. Is there anything we can do
to prevent these tragic health problems? There are three recent studies
that give insights for maintaining healthy,
active brains.
The first study1 included 469 older
individuals, all in good physical and mental health. They followed this
group for several years to see who would develop dementia or
Alzheimer's. They found that those who kept their minds active by
reading, playing "thinking" board games (such as checkers, chess,
cards, etc.), playing musical instruments, and dancing were all
associated with a decreased risk of dementia. They found mental/social
activity more important than physical activity in preserving brain
function.
Several studies now show that rich social networks
and participation in leisure activities that keep the brain active
help keep the thinking mind in good condition.
A second study2 looked at excess body
weight and the likelihood of developing Alzheimer's. This study
included 392 elderly Swedish people who were followed for 18 years. They found
that people who were overweight developed Alzheimer's at a higher rate
than those who were not overweight. For every one-point increase in
body mass index (BMI) above a BMI of 25 (upper limit for healthy
weight) the risk of Alzheimer's increased by 36%. This means that
obese individuals (BMI of 30+) have and increased risk of at least 2.4 times
that of people in a healthy weight range.
The women in the study who developed dementia had an
average BMI of 29. The average BMI of those who didn't develop
dementia was 25.
A third study3 found that women who take
combination hormone therapy had twice the rate of dementia and
Alzheimer's disease compared to women not taking the medication. This
data is from the large Women's Health Initiative Study including 4,500
women, followed for 5 years. At one time it was thought that hormone
therapy would reduce the risk of Alzheimer's. This clinical trial
demonstrated just the opposite effect. This adds to the growing
research of the increased risks due to taking female hormones after
menopause.
These studies detail practical strategies for
preventing dementia:
1. Maintaining a healthy weight.
2. Participate in social and effortful mental activities.
3. Don't take hormone therapy after menopause.
4. Other studies suggest physical activity to help maintain good
circulation and good mental health and maintaining a healthy blood
pressure (less than 120/80) to prevent strokes, a common cause of
dementia.
Sources:
1. New England Journal of Medicine, June 19,
2003
2. Archives of Internal Medicine,
July 14, 2003
3. JAMA May 28, 2003, and NIH News Release May 27, 2003
Top
n-3
Fatty Acids and Sudden Death
Sudden death causes about half of all deaths from
heart disease, about 250,000 deaths per year. Sudden death occurs when a person
with a heart
problem (often unknown) develops a fatal rhythm disturbance in the
heart beat resulting in cardiac arrest and death. This usually occurs within
minutes of the onset of any symptoms.
In the Physician's Health Study. the level of n-3 fatty acids in the blood and the
likelihood of sudden death was investigated. This was a large population study with 17 years of follow-up. Men with
the highest levels of n-3 fatty acids in the blood (top 50% of men)
had a 70-80% decrease in risk of sudden death! After adjusting for
age, BMI, alcohol intake, exercise, blood pressure, cholesterol, and
other dietary fats in the diet, the men in the top quartile (top 25%)
with the highest n-3 fatty acid levels, reduced their risk by 90%.
This study confirms previous studies that n-3 fatty
acids are very protective to the heart and can potentially prevent
sudden death by an amazing 80 to 90%. A major source of n-3 fatty
acids is fish (especially Northern fatty fish like salmon). Non
animal sources include walnuts, flax meal, soy foods, and Canola oil.
Eat one or more servings of these foods daily to increase your blood
levels and heart tissue levels of n-3 fatty acids. They can protect your
heart from developing fatal arrhythmias.
Source: New England Journal of Medicine Apr 11,
2003
Top
Changes in Physical Activity and Mortality Outcomes
People who exercise regularly have lower mortality
rates and live longer lives. But what if you are getting older and
have been sedentary for many years. Is it too late to start? Will
it do any good? Data from a large study (7553 women age 65+) says that
even if you've been sedentary but start to exercise, you will
experience significant benefits.
Women who had been sedentary but took up regular
activity after the age of 65, reduced their risk of dying from any
cause by 48% compared to those older women who remained sedentary!
It's never to late to start. They also saw a significant reduction in heart
attacks and stroke, and a reduction in deaths from cancer
(51% lower than the sedentary women). The older women who had the lowest
mortality rates walked on the average of about 1 mile per day (8+
miles per week).
If active women became inactive, their mortality
rate approached those who had always been inactive. The
benefits from exercise occur only as long as you keep it up it. Stop
exercising and you lose it's protective power. Past fitness levels are of
little benefit. For best results, try to be active 30+ minutes every
day.
Source: JAMA 289:2379-86, May 14, 2003
More info on getting fit (8 page booklet, PDF)
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Depression and Quality
of Life
Depression needs to be recognized as a devastating
illness for many people. It is the primary risk factor for suicide and
seriously erodes quality of life. The National Institutes of Health
(NIH) estimate that 20 million Americans suffer from depression, and most
do not get treatment. Anyone can become depressed, but women, older
people, and those who have recently experienced a traumatic event
(divorce, job loss, or sudden death of a loved one) are most
susceptible.
NIH recently completed a 6 month depression
treatment study1 with low-income minority women (a high
risk group). After screening to identify women with depression, they
were randomly assigned to one of three treatments: medication,
psychotherapy, and referral to a community mental health provider.
Those women on medication and psychotherapy made the most improvement.
Those referred to community mental health centers (standard treatment)
made the least improvement, primarily because they often didn't follow
through on treatment.
Women assigned to psychotherapy were treated in 8
weekly cognitive behavioral therapy sessions. They were taught
techniques to manage mood, disprove thinking that may keep them
depressed, engage in pleasant activities, reverse self-defeating
beliefs, and get social support from others.
The bottom line is that those who got help
and completed their therapy made significant improvement (reduced
depressive symptoms, improved home and work life, and engaged more in
social activities) compared to those who didn't get treatment.
Another study looked at the quality of life of
persons with coronary artery disease2. They looked primarily
at two issues; impairment of cardiac function and presence of
depressive symptoms to see which affected quality of life the most.
They found depression to be highly related to quality of life issues
such as: symptom burden, physical limitations, diminished quality of
life, and worse overall health status. Depressed persons where
generally twice as likely to have poor quality of life compared to
non depressed persons.
Interestingly, two primary measures of cardiac
function -- ejection fraction (the percent of blood in the heart
chamber that is pumped per beat) and ischemia (lack of oxygen to the
heart muscle due to partially blocked vessels) were not related to
quality of life issues. The researchers concluded that to improve the
quality of life of heart patients it is just as important (if not more
important) to screen for depression and treat it when found. Among the
1024 patients studied, 20% (201) were found to be depressed. A very
high rate.
A third study looked at nutrition and depression in
pregnant women and young mothers3. They found that in women
who had a high intake of n-3 fatty acids, depression occurred only
half as often as those with low intakes. n-3 fatty acids are required
by growing infants for normal brain development. During
pregnancy, mothers may have a higher need for n-3 fatty acids for
their infants and their own bodies.
Although fish is a primary source of n-3 fatty acids, the FDA has recently recommended that pregnant women avoid
eating certain fish high in mercury which is toxic to the fetus
(swordfish, shark, king mackerel, and tilefish). If you eat fish,
choose those that are lower in mercury and high in n-3 fatty acids such
as farm-raised salmon, lake trout, common mackerel, and sardines. Non
fish sources of n-3 fatty acids include walnuts, flax meal, Canola
oil, soy foods, and soy oil.
The researchers suggested that eating an additional
1 gram of n-3 fatty acids daily may help prevent depression. Other
studies need to be made to collaborate these findings but in the mean
time, eating more n-3 fatty acids is a good health principle for
building heart health. It appears that n-3 fatty acids help keep both
the heart and brain in good health.
Sources:
1. NIH, National Institute of Mental Health, News Release, July 1,
2003
2. JAMA 290:215-221, July 9, 2003
3. Presented at the American Psychiatric Meetings in San Francisco,
May, 2003
Top
Downloadable Power Point Slides
The following slides are taken from studies reviewed
in this newsletter and are available to view and
download for your use in presenting health information in your local
health promotion programs. Do not copy slides to distribute to other people.
New
blood pressure norms, prevalence data, and reduction guidelines.
Changes in
physical
activity levels and mortality in older women.
n-3 fatty acids and sudden death.
Depression and quality of
life in people with heart disease.
Featured Health Links
Nutrition Analysis. Would you like to analyze a recipe, find out how
your are eating for a meal or day? A very easy to use
Nutrition Analyzer
is available for your free use online. It gives you the nutritional
composition of foods (including many fast foods), makes a nutrition
label, and gives detailed nutrition information to help you evaluate
foods, meals, or your own diet. This is a valuable resource to anyone
interested in improving nutrition. Try it out.
Diabetes Dictionary. Medical terms can be
confusing. For example, what does "HbA1c" mean? This online
diabetes dictionary explains this and many other terms you may
hear but not understand, especially if you just found out you have
diabetes. This site is a great resource for diabetics.
Healthy Recipes
Looking for something new and good to eat? Here are
a few ideas for you to try that are tasty and good for you!
-
Fruit smoothies
- A great way to get your family to eat more fresh fruit and it's a cool
treat for a hot summer day.
-
Savory
Soybeans - Soybeans are an excellent source of protein,
n-3 fatty acids, and dietary fiber and they have a very low glycemic
index. The trick in making soybeans taste good is to season them
properly. Try this recipe. It makes soybeans come alive!
