With Every Heartbeat is Life - Picture Cards for Community Health Workers

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Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 08-5843). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

With Every Heartbeat Is Life

Picture Cards for Community Health Workers

Dear Community Health Worker:

Among African Americans, heart disease is the #1 killer, and stroke is the third leading cause of death. Risk factors such as overweight and obesity, physical inactivity, high blood pressure, and high blood cholesterol increase risk for heart disease. The good news is that people can lower their risk by making some lifestyle changes, and community health workers like you can help. The picture cards are part of With Every Heartbeat Is Life, a heart health project created especially for African American communities by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH). The project helps people build skills to make practical, lasting changes to improve their health and fight heart disease. These picture cards can help you present many of the ideas in the program. Each picture shows a different aspect of heart health, from controlling high blood pressure to being physically active and aiming for a healthy weight. On the back of each picture card are messages that will help you to explain the illustration and related information. You can use these picture cards along with the “With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans.” The manual consists of 12 sessions that feature step-by-step instructions on how to teach 11 fun and educational sessions, 1 session on project evaluation, and an appendix with teaching tips. The picture cards correspond with the sessions in the manual. The picture card stamp image (to the right) will appear in the manual to tell you when to show a picture card. The “With Every Heartbeat Is Life” manual and picture cards can be used with the following materials to enhance your project:

• “Heart Healthy Home Cooking: African American Style” booklet features recipes of your favorite African American dishes that you can prepare in ways that protect you and your family from heart disease and stroke.

With Every Heartbeat Is Life

Picture Cards for Community Health Workers

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

NIH Publication No. 08-5843 November 2007

Picture Card 1.1

The Harris family members will appear throughout this manual to show how they are adopting healthy lifestyles.

Darnell

Jill

Tamika KeShawn

The Harris Family

Pam James Faye Tina

Imani Elijah

Diane Devon Jamar Miles and Shondra

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The heart is a hollow, muscular, cone-shaped organ, about the size of a fist.

Hold up your fist for the group members to see.

Point to each part of the heart on the picture card. The heart has two upper chambers and two lower chambers. The upper chambers (right atrium and left atrium) receive blood. The lower chambers (right ventricle and left ventricle) pump blood.

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

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The heart is located in the middle of the chest. Did you place your felt or paper heart in the correct spot? The heart is one of three main components of the circulatory system. The others are blood vessels and the blood. The circulatory system is very important for sustaining life. It is made of all the vessels that carry the blood throughout the body. Blood vessels are long, hollow tubes of tissue, much like drinking straws. There are various kinds of blood vessels. The main ones are called arteries (shown in red), veins (shown in blue), and capillaries (not shown). The circulatory system delivers oxygen and nutrients to cells in your body and removes carbon dioxide and other waste products.

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Point to each vein and artery.

Describe the two steps while pointing to pictures 1 and 2.

1. Blood (with little oxygen) enters the right top chamber of the heart through the largest veins in your body. These veins are called the superior and inferior vena cava.
2. Blood then flows down to the right lower chamber, so it can be pumped out to the lungs through the pulmonary arteries. In the lungs, waste (carbon dioxide) is removed from the blood. The blood then gathers more oxygen.

1 2

1 2

Picture Card 1.5

Point to each vein and artery.

Describe the two steps while pointing to pictures 3 and 4.

1. The blood, rich with oxygen, returns to the heart and enters the upper left chamber through the pulmonary veins.
2. The blood then flows down to the lower left chamber and is pumped out of the aorta to the rest of your body. Your left and right coronary arteries carry oxygen-rich blood to all parts of your heart.

3 4

3 4

Picture Card 1.6

Heart disease is a serious health problem for African Americans. It is the #1 cause of death among African Americans in the United States. About one out of four deaths among African Americans is due to heart disease. The rate of death from heart disease is 31 percent higher among African Americans than among whites.

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You will hear about something called risk factors. Risk factors are traits or habits that make a person more likely to get heart disease. Some risk factors—such as age, family history, and gender—are things you cannot change. But the good news is that you can do something about some risk factors, such as: High blood pressure High blood cholesterol Cigarette smoking Diabetes Overweight Physical inactivity

Risk Factors for Heart Disease

1. High blood pressure
2. High blood cholesterol
3. Cigarette smoking
4. Diabetes
5. Overweight
6. Physical inactivity

Risk Factors for Heart Disease

1. High blood pressure
2. High blood cholesterol
3. Cigarette smoking
4. Diabetes
5. Overweight
6. Physical inactivity

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

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A normal artery allows blood to flow freely. A heart attack occurs when the blood supply going to a portion of the heart through one of the coronary arteries is blocked.

Here’s how this happens: Heart disease, which can lead to a heart attack, develops over time. Fatty deposits build up on the inside of the coronary arteries. When this happens, the arteries become narrow, and not enough blood, oxygen, and nutrients get through to meet the needs of the heart. The coronary arteries can become blocked, usually by a clot. When this happens, the blood flow is closed off, and a heart attack happens. If the blockage continues, part of the heart muscle will start to die. When a heart attack occurs, medical treatment can restore the blood flow to the heart. This keeps the heart muscle from dying, if there is medical treatment right away. Treatments work best if given as soon as possible, within 1 hour after warning signs of a heart attack begin. When a part of the heart muscle dies, nothing can be done to restore it.

1. Normal Artery
2. Clogged Artery

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There is a treatment called angioplasty. A balloon is placed in the coronary artery and inflated to open the artery. This restores the blood flow. Sometimes with angioplasty, doctors will insert a stent. A stent is a wire mesh tube. The stent stays in the artery and keeps it open to improve blood flow to the heart.

Coronary Artery

Balloon Angioplasty

Stent

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These are the warning signs most commonly reported by women and men who have had heart attacks: Discomfort in the center of the chest that lasts more than a few minutes. It can feel like uncomfortable pressure, squeezing, fullness, or pain. Discomfort in one or both arms or the back, neck, jaw, or stomach Shortness of breath, with or without chest discomfort Cold sweat Feeling light-headed Nausea or feeling sick to their stomach

Chest pain or discomfort

Trouble breathing

Arm, back, or stomach discomfort Feeling light-headed or breaking into a cold sweat

Neck or jaw discomfort Feeling sick to your stomach

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You now know the warning signs of a heart attack. Talk to your family and friends about these signs and the importance of calling 9–1–1 right away.

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You and other adults in your family should talk to your doctor about your risk of having a heart attack and how to lower it.

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You and your family should have a plan of action in case of emergency. This plan includes an emergency card that gives health care providers the information they need to know about you in case of an emergency. Let’s look at your emergency card.

This emergency card should include the following information: Name, relationship, and phone number of emergency contacts who should be called if you have to go to the hospital Emergency numbers in your area Name and phone number of your doctor or clinic Your health conditions Current medicines Known allergies Any other important information

Make copies for all adults in your family and encourage them to fill it out.

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Ask:

How do you think physical activity can help you?

Physical activity can help you: Strengthen your heart and lungs. Build and maintain healthy bones, muscles, and joints. Control your weight. Have more energy. Feel better about yourself. Lower your stress. Reduce feelings of depression and anxiety. Improve sleep.

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Physical activity also can help you: Lower your blood pressure. Control your blood cholesterol. Lower your risk of getting heart disease, diabetes, and cancer.

If you have any of these risk factors, it is important to talk to a doctor before starting a physical activity program.

Cholesterol Numbers

240 + High

200–239 Alert

Less than

Cholesterol Numbers

240 + High

200–239 Alert

Less than

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People feel better when they are active. Physical activity may help you lose weight.

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You may want to start with moderate (medium-level) activities. Moderate activities should require you to make some physical effort, but you should be able to have a conversation comfortably while doing them.

Examples of moderate activities include: Walking at a brisk pace Gardening (mowing, raking) Dancing (African dancing, hand dancing, line dancing, or stepping) Making home repairs (painting) Washing and waxing a car Scrubbing floors and washing windows Actively playing with children (walking, running, or climbing) Weightlifting Taking the stairs instead of the elevator Doing floor exercises (pushups, situps) Doing chair exercises (for seniors or persons with disabilities)

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After a while, you will be able to do more vigorous (high-level) activities. Vigorous activities require lots of physical effort and make your heart rate and breathing much faster. You usually can’t carry on a conversation comfortably while you are doing vigorous activities.

Vigorous activities that you might enjoy include: Playing basketball, baseball, or football Swimming laps Running or jogging Bicycling fast or uphill Doing aerobic dance or step aerobics Jumping rope, such as double dutch Skating Using a stair climber machine or stationary bike at a fast pace

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If you can’t set aside 30 or 60 minutes at one time to be active, you can break your activity into shorter periods of 10 minutes or longer. It’s the total time of physical activity that is important. Just make sure that the total time adds up to 30 or 60 minutes on most days.

For example, if you can only do 30 minutes of physical activity a day: Ride your stationary bike for 10 minutes before you go to work. 10 Take a 10-minute walk with your kids after work. +10 Dance for 10 minutes later in the day. +10

30 minutes

10 Minutes + 10 Minutes

+ 10 Minutes

= 30 Minutes

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If you have more time, you can build up to 60 minutes a day with activities like these: Take an early morning jog for 10 minutes. 10 Use your stationary bike for 10 minutes before you go to work. +10 Take a 15-minute walk with coworkers during your lunch break. +15 Play basketball with your children for 15 minutes after dinner. +15 Dance for 10 minutes later in the day. +10

60 minutes

10 Minutes + 10 Minutes + 15 Minutes

+ 10 Minutes

+ 15 Minutes

= 60 Minutes

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Blood pressure is the force of blood against the walls of your arteries. Blood pressure is needed to move the blood through your body.

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Blood pressure is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats).

The measurement is written one number above the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mmHg (millimeters of mercury) is expressed verbally as “120 over 80.”

It is important to keep track of your blood pressure numbers. Write down your numbers every time you have your blood pressure checked.

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If you have high blood pressure—hypertension—it means your heart has to pump harder than it should to get blood to all parts of your body. High blood pressure raises your chances for having a heart attack, a stroke, or kidney problems, or becoming blind.

High blood pressure is also known as the “silent killer,” because it often has no symptoms. Most people who have it don’t feel sick until they have a stroke, heart attack, or some other problem caused by high blood pressure.

High blood pressure is a major risk factor for stroke. Other risk factors that increase your chances of having a stroke include heart disease, smoking, diabetes, and high blood cholesterol.

Ask:

Do you know anyone who has had a stroke?

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A stroke is also called a brain attack. A stroke happens when blood suddenly stops going to the brain, and brain cells die. A stroke is very serious and can lead to disability and death.

The warning signs of a stroke happen suddenly. A person may have one or more warning signs.

The warning signs of a stroke include: Numbness of the face, arm, or leg (especially on one side of the body) Confusion, trouble talking, and difficulty understanding others Trouble seeing in one or both eyes Trouble walking, dizziness, and loss of balance or coordination Severe headache

Brain Eyes

Face

Arm

Leg

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Measuring blood pressure is easy and does not hurt. The best way to find out if you have high blood pressure is to have it checked at least once a year. Check it more often if you already have high blood pressure.

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Let’s talk about what foods are high in sodium. Most of the sodium that we eat comes from packaged foods, restaurants, and fast food.

Examples of packaged foods are: Regular canned soups and vegetables Frozen dinners Macaroni and cheese Canned fish and meats, such as salmon, tuna, sardines, and vienna sausages Salty chips Regular lunch meats, such as bologna Meats high in sodium, such as hotdogs and bacon

When you eat out, most of the food will be high in sodium. If you have high blood pressure, you should eat out less often.

Sodium also comes from salt added during cooking or at the table. POTATO

MACARONI CHIPS

& CHEESE

POTATO MACARONI CHIPS

& CHEESE

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The food label found on packaged foods is one of the best tools we have for choosing foods for a healthy diet.

In this picture, the Percent Daily Value for sodium in packaged noodle soup is circled on the food label.

The sodium content of the same food can vary, depending on how it is packaged or what brand it is. Compare food labels to choose foods that are lower in sodium.

%DV*

Nutrition Facts Amount/Serving %DV* Amount/Serving 26g 9%

Serving Size 1/2 block Total Fat 8g 12% Total Carbohydrate 4% Servings Per Container 2 Saturated Fat 4g 20% Dietary Fiber 1g Amount Per Serving Trans Fat 0g Sugars 1g Calories 190 Cholesterol 0mg 0% Protein 5g

Calories from Fat 70 Sodium 820mg 34%

• Percent Daily Values (DV) arebased on a 2,000-calorie diet. Your Vitamin A 2% • Vitamin C 2%Iron 6% Daily Values may be higher or lowerdepending on your calorie needs. Calcium 2% •

Nutrition Facts

Serving Size 1/2 block Servings Per Container 2

Amount Per Serving Calories 190 Calories from Fat 70

• Percent Daily Values (DV) are. Your based on a 2,000-calorie diet Daily Values may be higher or lower depending on your calorie needs.

%DV* Amount/Serving %DV* Amount/Serving

26g 9% 12% Total Carbohydrate Total Fat 8g 4% 20% Dietary Fiber 1g Saturated Fat 4g Sugars 1g

Trans Fat 0g

5g 0% Protein Cholesterol 0mg

34% Sodium 820mg

• Vitamin C 2% Vitamin A 2% Iron 6% Calcium 2%

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Cholesterol comes from two sources:

1. Your liver makes all the cholesterol your body needs to keep you healthy. When cholesterol is produced, it goes into the bloodstream. The cholesterol that travels in your bloodstream is called blood cholesterol.
2. Cholesterol also comes from the food you eat. Foods that come from animals have cholesterol. The cholesterol from foods you eat is called dietary cholesterol. Other types of fat in foods that raise cholesterol are saturated fat and trans fat.

When too much cholesterol is in the blood, it leads to increased risk of a heart attack, stroke, and other health problems.

Liver Food

Blood Vessel

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Cholesterol travels through the bloodstream in the form of packages called “lipoproteins.” These packages are made of fat and protein.

Low-density lipoproteins, or LDL, carry the cholesterol to your blood vessels, clogging them like rust in a pipe. This is why LDL cholesterol is often called the “bad” cholesterol.

Cholesterol also travels in the blood in high-density lipoproteins, or HDL. HDL helps to remove cholesterol from your body. This is why HDL cholesterol is often called the “good” cholesterol. Picture it this way: The LDL person in the car (“bad” blood cholesterol) throws fat and cholesterol into the street (your blood vessels). The HDL person (“good” blood cholesterol) cleans up fat and cholesterol deposited by the LDL and puts it in the trash (liver). Just remember the “L” in LDL for Lousy, and the Lower it is, the better. Remember the “H” in HDL for Healthy, and the Higher it is, the better.

Cholesterol and Fat

Cholesterol and Fat

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Ask:

How do you find out if you have high blood cholesterol levels or too much fat in your blood?

Your blood cholesterol levels are measured with a blood test. The test can be done at a doctor’s office or at a cholesterol screening (for example, at a health fair). A lipid profile is the blood test done at the doctor’s office. It is a complete test to measure the levels of each type of fat in the blood. It measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. (We will talk about triglycerides later.) You have to fast for 12 hours before this test. This test is recommended for adults age 20 or older. Screening sites may do only total cholesterol and sometimes HDL cholesterol. If you are age 20 or older, you may need to go to the doctor for a complete lipid profile.

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

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Cholesterol is measured in milligrams per deciliter (mg/dL).

Here are what the total cholesterol numbers mean:

Less than 200 mg/dL is desirable.

Good for you! Keep up the good work.

200–239 mg/dL is borderline high.

Depending on your other risk factors, you may be at a higher risk for heart disease. It is time to change your eating habits, increase your physical activity, and lose weight if you are overweight.

240 mg/dL or more is high.

You are at a higher risk for clogged arteries and a heart attack. Ask your doctor what your risk is for heart disease.

or more

200 to

Less Than

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The five factors that make up metabolic syndrome are:

1. A high waist measurement:

• Greater than 35 inches for women
• Greater than 40 inches for men

1. A triglyceride level of 150 mg/dL or more
2. A low HDL (“good”) cholesterol level:

• Less than 50 mg/dL for women
• Less than 40 mg/dL for men

1. A blood pressure of 130/85 mmHg or more (either number that is high counts as a risk)
2. Higher than normal fasting blood glucose (blood sugar) levels (100 mg/dL or more)

Three out of Five = Metabolic Syndrome

More than 150 mg/dL

Men: Less than 40 mg/dL Women: Less than 50 mg/dL

Three out of Five = Metabolic Syndrome

1. High waist measurement
2. High triglyceride level
3. Low HDL cholesterol level
4. Blood pressure 130/85 mmHg or more
5. Fasting blood glucose higher than 100 mg/dL

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Blood flows freely to all cells of the body when arteries are normal and healthy.

When your LDL cholesterol is too high, cholesterol may become trapped in the walls of the arteries, causing them to harden. The opening of the arteries can become clogged and narrowed.

1. Normal Artery
2. Clogged Artery

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high in saturated fat: Whole milk and products made from whole milk (regular cheeses, sour cream, evaporated whole milk) Ice cream and whipped cream Fatty cuts of meat, such as chuck steak, regular ground beef, ribs, pork chops, bacon, pork sausage, beef oxtail, Polish sausage (kielbasa), and liverwurst Skin of chicken, turkey, and pig Smothered meat and poultry dishes, such as smothered chicken or pork chops, made with animal fat or grease gravies Chitterlings, which are also called chitlins (pork intestines), pickled pig’s feet, and hog maws (hog stomach) Beef or pork hotdogs Foods fried in grease or lard (such as chicken, fish, shrimp, and french fries) Butter Shortening Lard Oils such as coconut, palm, and palm kernel Doughnuts, pastries, cakes, and cookies Cornbread, hushpuppies, spoonbread, biscuits, and other breads made with lard, butter, or shortening

WHOLE MILK

WHOLE MILK

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Here are foods that are lower in saturated fat: Lean meats such as loin, round, and extra lean ground beef Fish and seafood Turkey bacon Poultry without the skin Rice Beans Tub margarine Fat-free and low-fat milk, cheese, yogurt, and evaporated milk (or lactose-free products for people who have trouble digesting lactose found in milk products) Vegetable oil Breads (made without butter or lard) Fruits and vegetables

FAT- FREE MILK

FAT- FREE MILK

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Foods high in cholesterol also can raise your blood cholesterol and increase your risk of heart disease. Dietary cholesterol is found only in foods that come from animals.

Foods that are highest in cholesterol are: Egg yolks Organ meats, such as liver, gizzards, and chitterlings (chitlins) Pig’s feet Whole milk products, including butter, cream, ice cream, and cheese Shrimp

WHOLE MILK

WHOLE MILK

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Foods that come from plants do not contain cholesterol. Foods that do not contain cholesterol include: Fruits, such as bananas, pineapple, mangos, and apples Vegetables, such as tomatoes, green peppers, lettuce, and corn Beans of all varieties Rice, such as brown rice Grains, such as those in corn tortillas and whole-grain bread Cereals, such as oatmeal

Plant foods that are prepared with an animal product (for example, greens cooked with fatback or bacon grease) have cholesterol.

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Soluble fiber is found in foods such as oats, barley, fruits, vegetables, and cooked dry beans and peas. So this gives you one more reason to eat a variety of fruits and vegetables in addition to some whole-grain cereals, such as oatmeal and oat bran. Fruits and vegetables that are a good source of soluble fiber are citrus fruits (oranges and grapefruit), pears, apples, peaches, bananas, brussels sprouts, green beans, broccoli, cauliflower, peas, baked or sweet potatoes (with skin), corn, okra, cabbage, spinach, collard and mustard greens, and carrots. For great sources of soluble fiber, try to include a variety of cooked dry beans. Avoid canned beans that contain high amounts of salt and sodium. Prepare beans at home, flavoring them with celery, garlic, and spices instead of salt.

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For a healthy heart, use the Nutrition Facts labels to choose foods with a lower Percent Daily Value for saturated fat and cholesterol. If you have high cholesterol, you may need to aim for a lower amount of saturated fat and cholesterol. Try to keep trans fat as low as possible. A doctor or registered dietitian can help you with this.

Note: Point out where to find the Percent Daily Value for saturated fat, trans fat, and cholesterol on the food label for whole milk.

Nutrition Facts

Serving Size 8 fl oz (236 ml)

Servings Per Container 8

Amount Per Serving

Calories 150 Calories from Fat 70

% Daily Value*

Total Carbohydrate 12mg 4%

MILK Sugars 11gDietary Fiber 0g 0%

Protein 8g

Nutrition Facts

Serving Size 8 fl oz (236 ml)

Servings Per Container 8

Amount Per Serving

Calories 150 Calories from Fat 70

% Daily Value*

Total Fat 8g 12%

Saturated Fat 5g 25%

Trans Fat 0g

WHOLE

Cholesterol 35mg 12%

Sodium 125mg 5%

Total Carbohydrate 12mg 4%

Dietary Fiber 0g 0%

MILK

Sugars 11g

Protein 8g

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We’re going to work together to find out if James and Tina have healthy weights, using the Body Mass Index (BMI) chart. The BMI chart lets you measure the weight of a person in relation to his or her height.

James weighs 180 pounds, and he is 6 feet tall. First, look for James’ height on the left side of the chart and circle it. Then, put your finger on the circled number and move your finger to the right until you find the number that corresponds to his weight. The shade of your square will show you if James’ weight is healthy, overweight, or obese.

James’ BMI is 24, so he is at a healthy weight.

Now we will find Tina’s BMI, following the same steps. Tina weighs 170 pounds, and she is 5 feet, 5 inches tall. Tina’s BMI is 28, which means she is overweight.

Now we’re going to find out if you have a healthy weight.

Body Mass Index (BMI) Chart

Healthy Weight Overwe gi ht Obese

BMI Height 4’10” 4 1’ 1” 5’0” 5’1” 5’2” 5’3” 5’4” 5’5” 5’6” 5’7” 5’8” 5’9” 5’10” 5 1’ 1” 6’0” 6’1” 6’2” 6’3” 6’4”

19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Weight (in pounds) 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 256 144 151 159 166 174 182 189 197 294 212 219 227 235 242 250 257 265 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287

PICTURE CARD 6.1

Healthy Weight

BMI 19 20 21

Body Mass Index (BMI) Chart

Overweight Obese

22 23 24 25 26 27 28 29 30 31 32 33 34 35

Weight (in pounds)

105 110 115 119 124 129 134 138 143 148 153 158 162 167

109 114 119 124 128 133 138 143 148 153 158 163 168 173

112 118 123 128 133 138 143 148 153 158 163 168 174 179

116 122 127 132 137 143 148 153 158 164 169 174 180 185

120 126 131 136 142 147 153 158 164 169 175 180 186 191

124 130 135 141 146 152 158 163 169 175 180 186 191 197

128 134 140 145 151 157 163 169 174 180 186 192 197 204

132 138 144 150 156 162 168 174 180 186 192 198 204 210

136 142 148 155 161 167 173 179 186 192 198 204 210 216

140 146 153 159 166 172 178 185 191 198 204 211 217 223

144 151 158 164 171 177 184 190 197 203 210 216 223 230

149 155 162 169 176 182 189 196 203 209 216 223 230 236

153 160 167 174 181 188 195 202 209 216 222 229 236 243

157 165 172 179 186 193 200 208 215 222 229 236 243 250

162 169 177 184 191 199 206 213 221 228 235 242 250 256

166 174 182 189 197 294 212 219 227 235 242 250 257 265

171 179 186 194 202 210 218 225 233 241 249 256 264 272

176 184 192 200 208 216 224 232 240 248 256 264 272 279

180 189 197 205 213 221 230 238 246 254 263 271 279 287

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A waist measurement greater than 35 inches for women is high. A waist measurement greater than 40 inches for men is high. A high waist measurement increases your risk for heart disease.

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Like Tina, you can lose weight in a healthy way if you: Eat smaller portions. Eat a variety of foods lower in fat and calories. Increase your activity level.

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Losing weight has become a moneymaking business. You hear about miracle diets that claim to help you lose weight quickly and easily. These products make only one thing lighter—and that’s your wallet.

Be careful about ads that promote diets and exercise products using personal testimonies.

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You can look on the food label to find the number of calories in one serving. This food label shows the number of calories in a can of regular soda.

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In the healthy body, the food we eat goes to the stomach where it is digested. The food is broken down into glucose. Blood glucose is also called blood sugar.

The blood takes the glucose to the cells of your body, where it is turned into the energy needed for daily life. However, glucose cannot enter the cells alone. Insulin, a hormone made in the pancreas, helps glucose enter the cells.

Insulin

The pancreas makes the insulin.

Glucose

The stomach digests the food.

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Diabetes happens when the body does not produce enough insulin, or when the cells cannot use the insulin well. This means that glucose cannot enter the cells and builds up in the blood. People who have high levels of glucose in their blood have diabetes.

Insulin

Glucose

Cell

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When a person does not have diabetes, the pancreas produces a healthy amount of insulin, which the body can use.

There are two main types of diabetes. Type 1 diabetes: Happens when the pancreas no longer produces insulin. Requires an insulin pump or shots every day. Is usually found in children, adolescents, or young adults. Affects about 5 to 10 percent of those with diabetes.

Type 2 diabetes: Happens when some insulin is produced, but the body cannot use it well. Happens more often in people who are overweight and physically inactive. Is usually treated with pills or, sometimes, insulin shots. Can occur at any age, but it is more common after age 40. Is common among African Americans. Is rising among children, especially if they are overweight and African American. Affects 90 to 95 percent of people with diabetes.

No diabetes

PANCREAS

Type 1 diabetes

PANCREAS

Type 2 diabetes

PANCREAS

Healthy insulin

No insulin

Very little insulin Insulin does not or function well

or

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Your risk of getting diabetes increases if you: Are overweight—especially if you have extra weight around the waist. Nearly 8 out of 10 African American women are overweight or obese. Are physically active fewer than three times a week. Have a parent, brother, or sister with diabetes. Are African American, Latino, American Indian, Asian American, or Pacific Islander. Have had gestational diabetes or have given birth to a baby weighing more than 9 pounds. African American women are more likely to have had gestational diabetes than are white women. Have blood pressure that is 140/90 mmHg or higher or have been diagnosed with high blood pressure. Have cholesterol levels that are not normal:

• HDL (high-density lipoprotein) cholesterol (“good” cholesterol) is 35 mg/ dL or lower.
• Triglyceride level is 250 mg/dL or higher.

Risk Factors for Diabetes

1. Overweight, especially if you have extra weight around the waist
2. Physically inactive
3. Family members with diabetes
4. Have had diabetes during pregnancy (gestational diabetes)
5. High blood pressure

Left Atrium

Right Atrium

Left Ventricle

Right Ventricle

1. Cholesterol levels that are not normal

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Now let’s review the symptoms of diabetes: Feeling tired Increased thirst Frequent urination Increased hunger Unexplained weight loss Sores that don’t heal Very dry skin “Pins and needles” feeling in feet Blurry vision Feeling irritable

Often, people with type 2 diabetes have no symptoms. If you have one or more symptoms, see your doctor right away.

Feeling tired

Increased thirst

Frequent urination

Increased hunger

Diabetes Symptoms

Sores that don’t heal

Very dry skin

“Pins and needles” feeling in the feet

Blurry vision

Unexplained weight loss

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To find out if you have diabetes, you can take a fasting blood glucose test at the doctor’s office or at a lab. A fasting blood glucose level below 100 mg/dL is normal. Good news! A fasting blood glucose level of 100 to 125 mg/dL is prediabetes. This is a warning that you are at risk for developing type 2 diabetes. It is time to lose weight and be physically active at least 5 days a week. A fasting blood glucose level of 126 mg/dL or higher means that you have diabetes. If you have diabetes, you should work with your doctor and other health care providers to learn to control it.

Less than 100 mg/dL

Fasting Blood Glucose

Diabetes

126 mg/dL or higher

Prediabetes

100 mg/dL to 125 mg/dL

Normal

Less than 100 mg/dL

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A heart healthy eating plan is useful. It shows both the types and amounts of foods that we can choose for better health.

FAT- FREE MILK

SUNFLOWER VEGETABLEOIL OLIVEOIL SEEDS

Grains

Fruits

Lean meats, poultry, and fish

Nuts, seeds, and legumes

SUNFLOWER SEEDS

Vegetables

Fat-free and low-fat milk products

FAT- FREE MILK

Fats and oils

VEGETABLE

OIL OLIVE OIL

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People often find that they are too tired to prepare the kinds of meals they would like their families to eat. Today, we will learn some ways to save time and make meal preparation easier. Some tips include: Plan weekly meals based on your family’s schedule. Save money and time by making only one trip to the store. Make and use a shopping list. Teach your family how to shop for groceries.

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There are some things families can do to enjoy heart healthy meals when time is limited. Some tips include: Prepare some foods in advance, such as spaghetti sauce. Use these foods for quick meals. For example, you can add chicken or turkey to the sauce and serve it over spaghetti or rice with vegetables. Prepare part of a meal the night before. For example, marinate chicken in the refrigerator overnight. Pack your lunch the night before. Cook two or three dishes on your day off, then freeze them.

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Many fast foods can be higher in saturated fat, sodium, and calories, but you can choose healthier foods from the menu.

Some tips include: Order small, plain hamburgers instead of deluxe sandwiches. Choose grilled chicken sandwiches instead of breaded chicken sandwiches. Share a small order of french fries instead of eating a large order by yourself. Order a green vegetable or salad instead of two or more starches, such as potatoes, rice, pasta, and cornbread. Choose water instead of a soft drink or milkshake.

FAT- FREE MILK

FAT- FREE MILK

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Today, we are going to talk about what can happen when you smoke. Smoking can cause a heart attack, stroke, and cancer. It can also cause asthma attacks and chronic obstructive pulmonary disease (COPD), such as emphysema and chronic bronchitis. Other unpleasant effects include yellow stains on teeth and fingers, bad breath, gum disease, early wrinkling of the skin, and decreased sense of smell and taste.

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Ask:

Do you think that pregnant women should smoke?

Note: Allow a moment for group members to respond.

Pregnant women should not smoke, because it will affect their babies’ health and well-being. They also should stay away from others who smoke because of the harm that secondhand smoke causes.

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These are reasons why many people begin to smoke as teenagers. Teens want to be like their friends. Young people smoke to try to look older. Some teens want to be like celebrities who smoke in movies or on television. Some teens are influenced by advertisements that make smoking look “cool” or glamorous. Some teens want to be like their parents or other family members who smoke. Some teens will smoke just to do something their parents don’t want them to do. Young people downplay the harm smoking can do, or they think they will not be harmed. Teens may like the jackets, hats, and other prizes tobacco companies offer.

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Thank you for taking the time to attend and actively participate in the sessions. Now you are equipped with the knowledge and skills to live a heart healthy lifestyle. I hope you will use the information to help improve the heart health of yourself and your family.

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For More Information

The National Heart, Lung, and Blood Institute (NHLBI) Health Information Center (HIC) is a service of the NHLBI of the National Institutes of Health. The NHLBI HIC provides information to health professionals, patients, and the public about the treatment, diagnosis, and prevention of heart, lung, and blood diseases and sleep disorders. For more information, contact:

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 and 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.

NIH Publication No. 08-5843 November 2007