Your Choice for Change - Honoring the Gift of Heart Health for American Indians

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Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 08-6340). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

Your Choice for Change!

Honoring the Gift of Heart Health for American Indians

Your Choice for Change!

Honoring the Gift of Heart Health for American Indians

NIH Publication No. 08-6340 July 2008

Table of Contents

Introduction

Section 1

Knowledge Is Power: Know Your Risk for Heart Disease

Section 2

Act in Time to Heart Attack Signs!

Section 3

Help Your Heart! Control Your High Blood Pressure

Section 4

Be Heart Healthy! Learn Ways To Lower Your Blood Cholesterol

Section 5

Maintain a Healthy Weight! Stay Active and Feel Better

Section 6

Protect Your Heart: Take Good Care of Your Diabetes for Life

Section 7

Enjoy Living Smoke Free Take the Path to Heart Healthy Living

Introduction

American Indians and Heart Disease

Heart disease is a serious health problem for all Americans, including American Indians and Alaska Natives (AI/AN) Although it is the #1 killer of Americans, including AI/AN, most people are not aware that they are at risk for heart disease Most people believe that a heart attack or stroke happens suddenly because of a scary experience, getting bad news, or having strong feelings like anger A heart attack or stroke may seem sudden, but the truth is that these conditions develop over many years It often starts at a very young age

Risk Factors

High blood pressure, high blood cholesterol, obesity, smoking, physical inactivity, and diabetes can increase the risk for heart disease

You can reduce your risk by making lifestyle changes All you need is a little information, a few skills, and a bit of motivation

Honoring the Gift of Heart Health for American Indians 1

Easy-To-Read Booklet

This easy-to-read booklet is filled with practical information that can help you reduce your risk for heart disease You will be introduced to the Wisdom family, who will share what they did to prevent and control their risk factors Join them and take steps to prevent heart disease in your family

Hope for a Healthy Future

Taking steps to prevent heart disease at any age is important Caring for your heart is one of the most important things you can do for your health and the health of your family When you choose an apple instead of pie, or take a walk instead of watching TV, you are being a role model for others Here is more good news! There are many healthy things you can do to become healthier Being healthier means lessening your chances of having heart problems Future generations are counting on you

2 Your Choice for Change!

Section 1: Knowledge Is Power: Know Your Risk for Heart Disease

You Have the Power To Protect and Improve Your Heart Health!

The Amazing Heart Your heart is one of your strongest muscles It pumps blood through miles of blood vessels to all parts of your body The heart is so important, you want to keep it healthy When the heart stops, life stops

Heart Disease Is a Growing Problem Among American Indians and Alaska Natives.

Grandma Mary of the Wisdom family will show you how she and her family take care of their hearts

Mary Wisdom: “A long time ago, our ancestors were very active—walking, running, hunting, picking berries, hauling wood and water. They took care of their animals and had to do other things just to survive. Our ancestors did not smoke commercial cigarettes. Today, we have more demands and are less active. This change in lifestyle has caused our people to have an increased chance of getting heart disease.”

4 Your Choice for Change!

What You Need To Know About Heart Disease

What Is Heart Disease? Normal Artery

Heart disease develops over many years It happens when the blood vessels going to the heart become narrow and clogged Clogged Clogged Artery arteries increase the risk of developing heart disease

What Are Risk Factors?

Risk factors are traits and habits that make you more likely to develop heart disease There are some risk factors that you can do something about and others you cannot change The more risk factors you have, the greater your chance of developing heart disease

Will: “My doctor told me that I was overweight. I also have diabetes and high blood pressure. He said that being overweight, diabetic, and having high blood pressure increase my risk for heart disease. Also, my father died of a stroke because of high blood pressure. Now that I know my risk factors, I take steps to lower my risk.”

Honoring the Gift of Heart Health for American Indians 5

Are You at Risk for Heart Disease?

Look at the list of risk factors below Check all the risk factors you have

Risk factors that you can do something about:

Overweight

High blood cholesterol

High blood pressure

Diabetes

Not sure

Not sure

Not sure

Not sure Lack of physical activity Cigarette smoking

Risk factors you cannot change:

Family History:

• Father or brother with heart disease before age 55
• Mother or sister with heart disease before age 65

Age (45 years or older for men, 55 years or older for women)

The more risk factors you have, the greater your chances of developing heart disease.

6 Your Choice for Change!

Lower Your Risk for Heart Disease.

Mary: “The good news is that there are many things my family and I can do to lower our risk for heart disease. We have agreed to take the path of heart health. Working together as a family strengthens our chances of staying healthy. I am changing my habits because I want to be at my grandchildren’s graduations and weddings.”

Mary’s Family Takes the Path to Heart Health

• Lose weight. “We eat smaller portions If we are still hungry, we have salad ”
• Get 30 to 60 minutes of moderate physical activity a day. “We walk together after dinner every night ”
• Eat less saturated fat and sodium. “I bake chicken instead of frying I use herbs instead of salt to season our food ”
• Eat more fruits and vegetables. “We enjoy them with meals, as a snack, or for dessert ”

Honoring the Gift of Heart Health for American Indians 7

• Limit beverages and foods with sugar. “We limit sweets, such as doughnuts, cookies, and soda ”
• Quit smoking. “Our home We are a is smoke free ” smoke-free family.
• Have regular checkups. “We use our heart health cards to track our weight, waist measurement, blood pressure, blood cholesterol, and blood sugar (to check for diabetes)”

You can lower your risk, too When you change your lifestyle behaviors by doing some of these things, you will live longer

Sally: “Changing old habits is no easy chore, but as a family, we will help each other. We are more active and eat healthier meals now.”

8 Your Choice for Change!

Section 2: Act in Time to Heart Attack Signs!

Act in Time to Heart Attack Signs!

Did you know that healthy choices can reduce your risk factors for heart disease and protect your heart? Sometimes, even if we try our best, heart disease can result in a heart attack That is why it is important to know the warning signs of a heart attack and what to do if you experience them Quick action can help save your life or the life of someone else

Heart Attack Warning Signs

The most common heart attack warning sign for men and women is chest pain or discomfort Sometimes, the pain or discomfort is mild, and the warning signs may come and go Most people have more than one warning sign Some signs can occur at the same time Anyone with heart attack signs needs to get medical care as soon as possible Even if you’re not sure it’s a heart attack, have it checked out If you feel any of the signs on the next page, call Will: “Since I have several

risk factors for heart disease,

9–1–1* right away Every

it is important for me to

minute counts!

know the heart attack signs and symptoms. I will be

Be prepared Keep a heart

ready to act quickly if the

attack survival plan and

symptoms occur. My doctor

emergency card handy told me that it is best to call

9–1–1* immediately if I have

• If you do not have a 9–1–1 system, use your any of the symptoms.” local emergency number

10 Your Choice for Change!

Call 9–1–1 if You Feel Any of These Symptoms of a Heart Attack.

One or both arms,

Your chest hurts or feels squeezed You feel like you can’t breathe

your back, or stomach may hurt You may feel lightheaded or break out

You may feel pain in the neck or jaw You may feel sick to your in a cold sweat stomach

Honoring the Gift of Heart Health for American Indians 11

My Heart Attack Survival Plan

Follow the steps below to be prepared for a possible heart attack:

Learn the heart attack warning signs

Think about what to do in case of a heart attack

Talk with family and friends about the heart attack warning signs and the importance of calling 9–1–1 (or other local emergency number)

Talk to the doctor about my risk for a heart attack

Talk to the doctor about what to do if I experience any of the heart attack warning signs

Fill out the “My Emergency Card” and share it with my family

Do it for yourself; do it for your family.

12 Your Choice for Change!

My Emergency Card

OtherDiabetesHigh Blood CholesterolHigh Blood PressurePrevious heart attackHeart diseaseDo you have any of the following conditions?

______________

_______________________

___________________ Phone ________ ______________ ______

Relationship

YesYesYesYesYes

My Emergency Card

_____________ Home Phone: No No No No No _______________________

(FOLD 1)

Name Name:Date of Birth:Emergency Contacts:

(FOLD 2)

________________________________________________________________________________________________________Other information:Known allergies:Current medications:other information.List current medications, known allergies, and any

___________________ _____________________________________ ___________________________________

______________

________________

___________________________________

___________________________________________

Emergency NumbersFamily Doctor: _____________________________________Phone:Local Clinic/Hospital:Phone:Fire Department:Local Police Department: Cut along dotted lines. Fold card in half and paste with a glue stick (Fold 1). Fold in half again to make your own personal wallet card (Fold 2).

" " Front Back

Honoring the Gift of Heart Health for American Indians 13

Section 3: Help Your Heart! Control Your High Blood Pressure

Help Your Heart! Control Your High Blood Pressure

Did you know that controlling your blood pressure can lower your chances of a heart attack or stroke? This section will show you how to prevent or control high blood pressure

Will Learns Important Facts About Blood Pressure.

Will: “When I was diagnosed with high blood pressure, the doctor told me that I had to change my habits now if I wanted to be around to enjoy my family. By making small changes, I will start to feel better.”

What Is Blood Pressure?

Blood pressure is the force of blood against the walls of your arteries Blood pressure is needed to move the blood through your body so that blood can get to all parts of the body’s organs

16 Your Choice for Change!

Why Is High Blood Pressure Dangerous?

High blood pressure—also called hypertension—puts you at risk for heart disease When your blood pressure is high, your heart has to work harder High blood pressure is known as the “silent killer” because it has no symptoms

If not treated, high blood pressure increases your chances of:

• Stroke
• Heart attack
• Kidney problems
• Eye problems
• Death

Blood Pressure Numbers

Blood pressure is given as two numbers The systolic number (as the heart beats) is on top The diastolic number (as the heart relaxes between beats) is on the bottom For example, 120/80 is expressed verbally as “120 over 80 ”

Will: “Getting my blood pressure checked was easy and didn’t hurt. The numbers were my only warning that I had high blood pressure. My heart health card helps me to keep track of my numbers.”

Honoring the Gift of Heart Health for American Indians 17

Know Your Blood Pressure Numbers.

• Have your blood pressure checked by a health care provider at least once a year It is quick, easy, and painless
• If you have high blood pressure, it should be checked more often at your doctor’s office, neighborhood clinic, or at a health fair
• Keep track of your numbers using the “My Heart Health Card” on page 73

The chart below shows normal, prehypertension, and high blood pressure numbers Look at the chart below to see where you fit in

Level Blood Results Pressure Numbers

Normal Below 120/80 Good for you!

Check your blood pressure once a year.

Prehypertension 120/80 to 139/89 You are more likely to end up with high blood pressure.

Take action to prevent it.

High 140/90 and above Ask your doctor how to lower it.

Check your blood pressure often.

18 Your Choice for Change!

The Wisdom Family Takes Five Steps To Prevent or Control Blood Pressure.

This family plan can help you prevent high blood pressure If you already have high blood pressure, it can help you lower it

Will: “High blood pressure runs in my family. My mother has high blood pressure; she takes medication to lower it. My wife Sally has prehypertension and is now taking steps to prevent high blood pressure. My whole family follows a heart healthy eating plan and has a more active lifestyle to keep our blood pressures normal. I want to be a good role model for my children.”

1. Cut down on sodium.

• Buy fruits and vegetables for snacks instead of salty chips and crackers
• Buy fresh, frozen, or no-saltadded canned vegetables
• Choose fewer canned and processed foods like bacon, hotdogs, sausage, meat jerky, bologna, pepperoni, salami, ham, canned or potted meat, dried and packaged soups and noodles, pickles, and olives

Honoring the Gift of Heart Health for American Indians 19

• Read the Nutrition Facts labels to compare the amount of sodium in food

Tips on using the Nutrition Facts label to compare sodium in foods:

• Choose foods that have 5 percent or less of the Daily Value for sodium.
• Limit foods with 20 percent or more of the Daily Value for sodium.
• Limit your sodium intake to 2,300 milligrams (mg) or less per day.

Compare these Nutrition Facts labels on regular soup and reduced-sodium soup Which one is the better choice?

Reduced-Sodium Soup Regular Soup

The regular soup has almost four times more sodium than the reduced-sodium soup

20 Your Choice for Change!

Mary Has Learned Ways To Eat Less Sodium.

Mary: “To make food taste good without salt, I use cilantro, cumin, fresh garlic, parsley, onion, green pepper, oregano, and even a dash of chili powder when I cook. Everyone in my family has gotten used to the taste of food with less salt.”

Mary’s Seasoning Recipe

Fill the saltshaker with this combination of herbs and spices, and use it, instead of salt, to flavor foods:

½ cup paprika 1 teaspoon garlic powder ■

2 tablespoons oregano 1 teaspoon black pepper

2 teaspoons dried chili peppers ½ teaspoon red pepper ■

• Cut back a little each day on the amount of salt
• Use reduced-sodium bouillon cubes, soy sauce, and ketchup
• Take the saltshaker off the table
• Use a mixture of herbs, spices, and chili powder instead of salt

Honoring the Gift of Heart Health for American Indians 21

1. Eat heart healthy foods.

• Cook with more fruits, vegetables, and whole grains
• Choose low-fat or fat-free milk products
• Cook with lean meats, wild game, chicken without the skin, and fish *
• Choose unsalted nuts, seeds, and cooked dry beans
• Cook with small amounts of fats and oils

1. Limit alcohol.

• Men who drink should have no more than two drinks a day
• Women who drink should have no more than one drink a day
• Pregnant and breastfeeding women should not drink any alcohol

1. Watch your weight.

• Take steps to lose weight if you are overweight
• Eat smaller portions and do not go back for a second serving
• Pregnant and breastfeeding mothers: Talk to your health care provider to find out what types of fish are lower in mercury Mercury may be harmful for your baby

22 Your Choice for Change!

• Be active for at least 30 minutes a day, and slowly increase to 60 minutes

1. Take your medicines.

• If you have high blood pressure, take your medicine(s) the way your doctor tells you
• Do not share medicines with friends or family
• If you cannot afford your medicine, let your doctor know There may be programs to help you buy your medicine
• Use notes and other reminders to take your medicine Ask your family to help you with reminder phone calls
• When you go to the doctor, take all of your medicine bottles with you

Honoring the Gift of Heart Health for American Indians 23

My Plan To Prevent or Control High Blood Pressure

Check two or three things you will do Add more things over time

1. Add Spice—Not Salt—to Your Life

Season foods with herbs and spices like garlic, cilantro, pepper, oregano, and onion instead of salt

Eat more fruits and vegetables instead of salty snacks

1. Take Heart. Try to:

Lose weight if you are overweight

Eat smaller portions—do not go back for a second serving

Get 30 to 60 minutes of moderate physical activity on most days

Limit alcohol

1. If You Have High Blood Pressure:

Have your blood pressure checked often

Take your medicines the way your doctor tells you

Your health and your family’s health are priceless.

Make an investment in it!

24 Your Choice for Change!

Questions to ask the doctor about high blood pressure medicine:

Name of medicine(s):

Amount of medicine to take:

When to take it:

What to eat or drink with it:

If you can take other medicines safely at the same time: yes no

If problems occur, call this number immediately:

Honoring the Gift of Heart Health for American Indians 25

Session 4: Be Heart Healthy! Learn Ways To Lower Your Blood Cholesterol

Be Heart Healthy! Learn Ways To Lower Your Blood Cholesterol.

Knowing your cholesterol numbers may help you lower your risk of getting heart disease. This section will help you learn how to lower or maintain your blood cholesterol levels

Mary Learns About Blood Cholesterol.

Mary: “My LDL cholesterol level was 130! I needed to bring it down to less than 100. The doctor told me I need to adopt a heart healthy way of life that includes eating healthy, losing weight, and being physically active.”

What Is Cholesterol?

Cholesterol is a waxy, fat-like substance found in your body

Why Is High Blood Cholesterol Bad for Your Heart?

Your body makes all the cholesterol you need to keep you healthy When you eat foods high in saturated fat, trans fat, and cholesterol, your body can make too much cholesterol

Over time, this extra cholesterol can clog your arteries The higher your blood cholesterol, the greater your chances of having a heart attack or stroke

28 Your Choice for Change!

What Is Good and Bad Cholesterol?

HDL is “good cholesterol ” It helps clean fat and cholesterol from your blood vessels Remember the H in HDL is for Healthy, and the Higher it is, the better

• 
  )%

LDL is “bad cholesterol ”

• %-

It carries cholesterol to

)%-

your blood vessels, clogging them like rust in a pipe Remember the L in LDL is for Lousy, and the Lower it is, the better

Have Your Blood Cholesterol Checked.

The blood test to measure the cholesterol levels is called a lipid profile You can have this test done at your doctor’s office If you are 20 years of age or older, check your cholesterol at least every 5 years Your doctor may test you more often if your cholesterol levels are high

Honoring the Gift of Heart Health for American Indians 29

Learn What Your Cholesterol Levels Mean.

Total cholesterol:

• Less than 200—Ideal Good for you!
• 200 to 239—Borderline Be alert!
• 240 or more—High Danger!

LDL (Bad) Cholesterol:

• Keep it low!
• Less than 100 mg/dL is ideal

HDL (Good) Cholesterol:

• The higher, the better!
• Keep it 40 mg/dL or higher

You can make changes in what you eat. This may help you lower your blood cholesterol level.

30 Your Choice for Change!

The Wisdom Family Takes Four Steps To Keep Their Cholesterol in Check.

Will: “Sally and I have lost weight, and our cholesterol levels are approaching normal. We feel good! The kids are eating healthy, too. We are healthy lifestyle role models for our children.”

1. Cut back on foods high in saturated fat, trans fat, and cholesterol.

Be Heart Smart: Watch for These Fats

Saturated fat and trans fat are fats that raise blood cholesterol levels the most.

Saturated fat is found in foods such as high-fat meat, cheese, milk, and butter.

Trans fat is found in foods such as vegetable shortening, stick margarine, fried foods, and baked products (cookies, crackers, pies, and pastries).

Stay away from these fats. Know where they hide. Read the Nutrition Facts labels.

Honoring the Gift of Heart Health for American Indians 31

Start making healthy changes a few at a time. Eat more of these foods:

• Fat-free milk, cheese, ■ and yogurt
• Fruits, vegetables, and whole grains
• Corn (instead of flour) tortillas

Cut back on these foods:

• Whole milk, regular ■ cheese, and ice cream
• Fatty cuts of meat and refried beans
• Bacon, sausage, hotdogs, bologna, and canned meat
• Liver, kidney, and other organ meats
• Egg yolks (no more than four per week)

Fish*

Turkey and chicken without skin

Lean cuts of meat

Beans and lentils

Lard and shortening

Butter and stick margarine

Fried foods, such as fried chicken and french fries

Fry bread

Doughnuts and pastries

• Pregnant and breastfeeding mothers: Talk to your health care provider to find out what types of fish are lower in mercury for your baby

Mercury may be harmful

Your Choice for Change!

1. Read the Nutrition Facts label to choose foods lower in saturated fat, trans fat, and cholesterol.

Compare the Nutrition Facts labels for an English muffin and a doughnut

• Choose foods that have 5 percent or less of the Daily Value for saturated fat and cholesterol
• Limit foods with 20 percent or more of the Daily Value for saturated fat and sodium
• Limit trans fat intake

Which would you choose?

English Muffin Doughnut

Answer: The English muffin is the better choice The doughnut is higher in saturated fat, trans fat, and cholesterol

Honoring the Gift of Heart Health for American Indians 33

1. Be physically active for 30 to 60 minutes on most days.
2. Aim for a healthy weight. Lose weight if you are overweight.

What Are Triglycerides?

Triglycerides are another type of fat in the blood When your triglycerides are high, it can raise your risk of heart disease

A healthy triglyceride level is less than 150 mg/dL.

Will: “The doctor told me my triglyceride level is 300 mg/dL. This is twice as high as the normal value. I cut back on sweets and soda. I drink less alcohol.”

These steps can help you control your triglyceride level:

• Quit smoking
• Limit foods and beverages that are high in sugar
• Limit alcohol
• Aim for a healthy weight and lose weight if overweight
• Be physically active

34 Your Choice for Change!

What Is the Metabolic Syndrome?

The metabolic syndrome is a group of factors that increase your chances of developing heart disease or stroke The metabolic syndrome also increases your risk for diabetes

Will: “I have the metabolic syndrome. Five risk factors make up this syndrome and can cause trouble for your heart. My doctor said you only need three of the five risk factors to have the metabolic syndrome. I am working with my doctor to decrease these factors.”

Honoring the Gift of Heart Health for American Indians 35

Do You Have the Metabolic Syndrome?

Having three or more of these risk factors means you have the metabolic syndrome

Take Action Against the Metabolic Syndrome.

Check the risk factors you have:

• High waist measurement

Greater than 35 inches for women

Greater than 40 inches for men

• High triglyceride level of 150 mg/dL or more
• Low HDL (good) cholesterol level

Less than 50 mg/dL for women

Less than 40 mg/dL for men

• Blood pressure of 130/85 mmHg or more 105
• High fasting blood sugar of 100 mg/dL or more

If you have three or more of these risk factors, talk to your doctor about the metabolic syndrome.

Follow the Wisdom family’s four-step plan on pages 31–34 if you have the metabolic syndrome.

36 Your Choice for Change!

My Family Plan To Lower Blood Cholesterol Levels

Check the steps you plan to take to lower your blood cholesterol and keep it low Start with a few changes and add more over time

Get my cholesterol level checked

Talk to my doctor about what my cholesterol numbers mean

Read the Nutrition Facts labels to choose healthier foods

Bake, boil, or broil foods instead of frying

Eat more fruits, vegetables, and whole grains

Choose water or sugar-free beverages instead of soda and juice

Aim for a healthy weight Lose weight if overweight

Do 30 to 60 minutes of moderate physical activity on most days

Healthy arteries allow the blood to flow like a river. Take steps to control your blood cholesterol levels.

Honoring the Gift of Heart Health for American Indians 37

Section 5: Maintain a Healthy Weight! Stay Active and Feel Better!

Maintain a Healthy Weight! Stay Active and Feel Better!

Did you know that losing even a small amount of weight can lessen health problems that result from being overweight? This section will discuss healthy ways to lose weight or maintain a healthy weight

Mary’s problem: Mary and her family like to have snacks while they watch television. Recently, she has noticed that her family has gained a little too much weight.

Mary says she and her family gained weight because:

• “Our family sits in front of the TV for hours We snack even after having a large dinner”
• “The kids no longer play outside like they used to They watch TV, play video games, and use the computer”
• “I don’t have time or energy to go for a walk ”
• “We eat at places where the food is cheaper We order large hamburgers, french fries, and sodas”

Mary: “The doctor told me that being overweight affects my heart and my health. My family and I have started walking to lose the extra pounds.”

Does Mary’s family situation sound like yours? If so, it is time to make some healthy changes!

40 Your Choice for Change!

Do You Know if You Need To Lose Weight?

Your body mass index (BMI) and waist measurement can Follow the steps below to find your BMI and waist measurement

1. Find out if your weight is healthy. In the BMI chart below, mark the square where your height The color of the square will show you if you are a healthy weight, overweight, or obese

Body Mass Index (BMI) Chart

Healthy Weight Overweight Obese

BMI Height 4’10” 4’11” 5’0” 5’1” 5’2” 5’3” 5’4” 5’5” 5’6” 5’7” 5’8” 5’9” 5’10” 5’11” 6’0” 6’1” 6’2” 6’3” 6’4”

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

33 34 35 36 37 38

158 162 167 172 177 181

163 168 173 178 183 188

168 174 179 184 189 194

174 180 185 190 195 201

180 186 191 196 202 207

186 191 197 203 208 214

192 197 204 209 215 221

198 204 210 216 222 228

204 210 216 223 229 235

211 217 223 230 236 242

216 223 230 236 243 249

223 230 236 243 250 257

229 236 243 250 257 264

236 243 250 257 265 272

242 250 256 265 272 279

250 257 265 272 280 288

256 264 272 280 287 295

264 272 279 287 295 303

271 279 287 295 304 312

PICTURE CARD 6.1

Honoring the Gift of Heart Health for American Indians

Guide to a Healthy Weight

Your BMI can be used to indicate if you are overweight or obese. Height and weight are used to find your BMI on this chart.

• You have a healthy weight if your BMI is 18.5 to 24.9.
• You are overweight if your BMI is 25 or higher.
• You are obese if your BMI is 30 or higher.

My weight is:

Healthy: I will keep this weight.

Overweight: I will take steps to lose weight.

Obese: I will ask my doctor or a registered dietitian for help losing weight.

1. Measure Your Waist.

Measure your waist by placing a measuring tape snugly around your waist

Write down your waist measurement: _____________

Your waist measurement is high if:

• Your waist measurement is greater than 35 inches, for women
• Your waist measurement is greater than 40 inches, for men

My waist measurement is: o Healthy o High

A high waist measurement increases your risk of heart disease If your waist measurement is high, take steps to lose weight.

42 Your Choice for Change!

How To Start Your Family Plan To Lose Weight

Remember:

• If you are overweight or obese, losing a small amount of weight can help you lower your risk of heart disease.
• Lose weight slowly, about 1 to 2 pounds a week.
• Pick a day to begin.
• Change one thing at a time, and stick to each one.
• Be physically active. Walk or dance for 30 to 60 minutes on most days.

Try These Steps To Lose Weight.

1. Choose heart healthy foods.

• Choose fat-free or low-fat (1%) milk and cheese
• Eat fruit and vegetables with your meals
• Drink water or other calorie-free drinks instead of regular soda
• Eat lean cuts of meat and fish *
• Pregnant and breastfeeding mothers: Talk to your health care provider to find out what types of fish are lower in mercury Mercury may be harmful for your baby

Mary: “We took steps to lose weight slowly. We are now at a healthy weight. My cousin followed a diet that offered a fast and easy way to lose weight. She lost weight initially, but she gained it all back.”

Honoring the Gift of Heart Health for American Indians 43

1. Prepare foods the heart healthy way.

• Bake, boil, or broil foods instead of frying
• Cook beans and rice without lard or bacon
• Use fat-free or low-fat dressing on your salad

1. Read the nutrition facts on the food labels to choose foods lower in calories and sugar.

Compare the nutrition facts for water and regular soda Which one is the better choice?

Water Regular Soda

Nutrition Facts

Serving Size 1 bottle (12 fl oz) Servings Per Container 1

Amount Per Serving Calories 0 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g

Sugars 0g

Protein 0g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 0%

Answer: The water is the better choice Regular soda has 140 calories and 39 grams of sugar The water has no calories or sugar

44 Your Choice for Change!

1. Limit your portion size.

• Eat small meals and healthy snacks throughout the day instead of one big meal
• When eating out:
• Split a main dish with a friend
• Order two small side orders, such as a half sandwich and salad, instead of a large entree
• Divide your main dish in half as soon as you get it Ask the server to wrap the other half “to go”

Honoring the Gift of Heart Health for American Indians 45

Say “Yes” to Physical Activity.

Make physical activity your answer to feeling tired, bored, and out of shape Physical activity helps you improve your heart health, reduce stress, and feel better Follow the steps below to get started:

1 Set your goal Start slowly, and work your way up

2 Do your favorite moderate physical activity for 30 to 60 minutes on most days

If you are short on time, divide it up For example, walk for 20 minutes three times a day

3 Write down the activities you plan to do

46 Your Choice for Change!

Mary: “I do not wait until the end of the day. I am active throughout the day. I take the stairs and walk everywhere I can. Now I am up to walking 40 minutes a day with my neighbor. It helps to like what you do and to enjoy it with someone. We are so busy talking, we walk even longer.”

Examples of moderate and vigorous activities

Moderate Activities ■ Brisk walking

You may breathe harder, or your heart ■ Dancing may beat faster. You should still be able to talk with a friend. ■ Playing traditional games

• Lifting weights
• Riding a stationary bike

Vigorous Activities ■ Running

You may breathe harder, or your heart ■ Aerobics may beat very fast. It will be hard to talk with a friend at the same time. ■ Swimming

• Chopping wood
• Jumping rope
• Playing basketball or other sports

Honoring the Gift of Heart Health for American Indians 47

Are You Ready To Begin?

• You can start physical activity slowly if you do not have a health problem.
• If you have a health problem, check with your doctor before starting physical activity

Celebrate in a Healthy Way With Your Family.

Try Mary’s Family Tips for Family Gatherings:

• We encourage each other to eat the right amount of food and not eat too much
• Don’t go to the family gathering hungry Eat a heart healthy snack before you leave home
• Bring a heart healthy dish to share Prepare a dish with lots of vegetables
• Cut down on calories and high-fat foods Eat more vegetables and fruits instead of fried food
• Watch your portions Go for small portions, and eat slowly
• Take the focus off food Dance, take walks, or play sports such as basketball or other ball games Plan activities for the kids Encourage the family to get involved

48 Your Choice for Change!

Mary: “I have a big family, and we get together often. Now, I prepare healthier food to bring to the gatherings. I encourage everyone to share their ideas for being active together, and we celebrate our successes. We older folks like walking or gardening. The young people like basketball and dancing. I want my family to follow a healthy path.”

Check Three Things You Will Do To Help You Lose Weight:

Get up 15 minutes earlier to eat breakfast at home Include fruit, whole-grain bread, and fat-free or low-fat (1%) milk

Prepare a heart healthy lunch the night before Include fruits, vegetables, and small portions of leftovers

Take a piece of fruit for a snack at work

Eat smaller portions at dinner Eat vegetables every night, or have a salad with low-calorie dressing

Drink water instead of soda or other drinks high in calories and sugar

Get active at work, at home, and in your spare time Walk with your family or a friend

Honoring the Gift of Heart Health for American Indians 49

Find Help.

• Ask for help from the doctor and dietitian if you need to lose weight
• Find out if your community has heart health classes taught by community health educators If so, join the classes

Pass On the Gift of Heart Health.

When you maintain a healthy weight, you are also setting an example of heart healthy living for your children and the youth in your community Pass on the gift of healthy living and long life to future generations

50 Your Choice for Change!

Section 6: Protect Your Heart: Take Good Care of Your Diabetes for Life

Protect Your Heart: Take Good Care of Your Diabetes for Life.

Did you know that by making simple lifestyle changes, such as being physically active, eating healthy foods, and losing weight if you are overweight, you can do a lot to prevent or control type 2 diabetes? Mary will show you how she and her family took action to prevent and control diabetes

Mary Learns About Type 2 Diabetes.

Mary: “Diabetes runs in my family. I need to know more about diabetes. I want to be a role model for my children and grandchildren.”

What Is Diabetes?

Diabetes results when the body does not make enough insulin or cannot use it well This causes high levels of blood glucose (blood sugar) to build up in your blood Diabetes is a serious disease

Types of diabetes:

There are two main types of diabetes: type 1 and type 2. Type 1 diabetes happens when the body stops making insulin. Type 2 diabetes occurs when some insulin is made, but the body cannot use it well. Type 2 diabetes is more common.

52 Your Choice for Change!

Why Is Diabetes Dangerous?

Diabetes is a major risk factor for heart attack and stroke Over time, high blood glucose damages the body Diabetes can lead to blindness, amputation, and kidney problems

You are more likely to get type 2 diabetes if you:

• Are overweight, especially if you have extra weight around your waist
• Have a parent, brother, or sister with diabetes
• Are American Indian, Latino, African American, Asian American, or Pacific Islander
• Have had diabetes while pregnant (gestational diabetes)
• Have given birth to a baby weighing 9 pounds or more
• Have high blood pressure
• Have cholesterol levels that are not normal
• Are physically active fewer than three times a week

Honoring the Gift of Heart Health for American Indians 53

What Are the Symptoms of Diabetes?

People with type 2 diabetes may develop symptoms slowly or may not have symptoms at all

Feeling tired Sores that do not heal

Often thirsty Very dry skin

Having to urinate often “Pins and needles” feeling in the feet

Increased hunger Blurry vision

Unexplained weight loss Feeling irritable

54 Your Choice for Change!

What Is Prediabetes?

Sally: “The doctor told me that I have prediabetes. My fasting blood sugar was 120 mg/dL. I am also overweight. The news made me change my habits. I do not want to develop diabetes.”

Prediabetes is a condition in which blood glucose levels are higher than normal, but not high enough to have diabetes People with prediabetes are likely to develop diabetes If you have prediabetes, you can take these steps to prevent diabetes:

• Eat foods lower in fat and calories
• Aim for a healthy weight, and lose weight if you are overweight
• Be physically active on most days

Honoring the Gift of Heart Health for American Indians 55

Have Your Blood Glucose Checked.

Your doctor can test your fasting blood glucose Check the chart below to see if your blood glucose level is normal

What Are the ABCs of Diabetes Control?

• A is for the A1C test. This test measures how your blood glucose has been for the last 3 months It lets you know if your blood glucose has been under control Get this test done at least twice a year Number to aim for: 7% or lower
• B is for blood pressure. The higher your blood pressure, the harder your heart has to work Get

Diabetes

your blood pressure checked at

126 mg/dL or higher

every doctor’s visit

Prediabetes

Numbers to aim for: Below 120/80 mmHg 100 mg/dL

to 125 mg/dL

• C is for cholesterol. “Bad” cholesterol—or LDL—builds up and clogs your arteries Get your Normal

Less than 100 mg/dL

blood cholesterol tested at least once a year Number to aim for: below 100 mg/dL

56 Your Choice for Change!

Be Sure To Ask Your Doctor:

• What are the results of my A1C, blood pressure, and cholesterol tests?
• If my numbers are not normal, what actions should I take to lower my ABC numbers?
• How can I find a local diabetes program for education and support?

If you have prediabetes or diabetes, it is important to work with a team of health care providers, such as a doctor, diabetes educator, and registered dietitian. Learn how to take care of your ABCs and empower yourself.

Lose a Little, Win a Lot.

Sally: “I am not waiting to get diabetes. I am taking steps now to prevent it. I walk every day for 40 minutes, and I eat smaller portions. I have lost 8 pounds.”

Honoring the Gift of Heart Health for American Indians 57

Sally’s Family Plan To Prevent Diabetes.

• Get 30 to 60 minutes of moderate physical activity on most days.
• Walk with family or a friend
• Play traditional games
• Dance to your favorite music
• Lift hand weights, stretch, or ride an exercise bike while you watch TV
• Chop wood, do housework, garden, or do other yard work
• Eat less sodium, saturated fat, trans fat, cholesterol, and sugar.
• Season food with herbs and spices instead of salt
• Trim the fat off meat and the skin off chicken
• Bake, broil, boil, or roast instead of frying
• Use a small amount of vegetable oil instead of lard or butter

58 Your Choice for Change!

• Cut down on sausage, bacon, and fried pork
• Drink water and sugar-free beverages
• Eat more fiber.
• Choose whole grains, fruits, vegetables, and beans
• Add fruit to your lunch
• Add vegetables to soups and casseroles
• Stay at a healthy weight. Lose weight if you are overweight.
• Eat smaller portions—Do not go back for a second serving
• Drink water or other calorie-free drinks
• If you smoke, stop.
• Ask your doctor, family, or friends to help you to quit smoking

Honoring the Gift of Heart Health for American Indians 59

• If you have diabetes, add these steps to control your diabetes:
• Check your blood glucose (blood sugar) levels as the doctor tells you
• Take your medicines as the doctor tells you, even when you feel fine
• Ask your doctor about taking aspirin to prevent a heart attack
• Check your feet every day Check for cuts, bruises, red areas, or swelling
• Brush your teeth and use dental floss every day
• See your eye doctor once a year, or more often if you have complications
• See your dentist regularly and consult a registered dietitian if you need help with your eating plan
• Find support to help you handle stress

60 Your Choice for Change!

Take Action: Check the Steps You Will Take To Prevent or Control Diabetes.

Find out if you have diabetes

Get your blood glucose level checked

Get your blood pressure checked

Get your blood cholesterol checked

If you have diabetes, get your A1C checked twice a year

Lose weight if you are overweight Losing weight will help your heart

Be physically active for 30 to 60 minutes on most days

Eat foods lower in fat and calories

Take the “My Heart Health Card” to your next doctor’s appointment Be sure to have it filled out You can help yourself, your family, and your community. It all starts with a few simple lifestyle changes.

Honoring the Gift of Heart Health for American Indians 61

Section 7: Enjoy Living Smoke Free. Take the Path to Heart Healthy Living

We are a smoke-free family.

Enjoy Living Smoke Free. Take the Path to Heart Healthy Living.

For thousands of years, traditional tobacco has had a sacred purpose for many American Indian tribes. It is used for prayer, to show respect, to heal, and to give spiritual protection. Tobacco was never meant to be abused. Sacred use of tobacco does not include the use of commercial tobacco products.

In this section we will be talking about commercial tobacco abuse Commercial tobacco products include cigarettes, cigars, pipe tobacco, and chewing tobacco This section focuses on cigarette smoking, because it is the most common way people use tobacco

What Are the Harmful Effects of Cigarette Smoking?

• Cigarettes contain more than 4,000 chemicals, and many of them are poisonous
• More than one out of every three American Indian and Alaska Native men and women smokes (about 34 1 percent) About one out of every two American Indian and Alaska Native women (44 3 percent) of reproductive age (18 to 44 years) smokes

64 Your Choice for Change!

Mary Will Show You How She Quit Smoking and Made Her Home Smoke Free.

A Wake-Up Call!

Mary: “The doctor said that my smoking was causing my grandson to have asthma attacks. He did not have to say it twice. This gave me the willpower to quit smoking.”

Why Quit Smoking?

To improve your family’s well-being:

• Enjoy a longer and healthier life with your children and grandchildren
• Breathe easier
• Have more energy
• Save money now spent on cigarettes
• Set a good example for your family

Look and smell better:

• Get rid of bad breath
• Have fresh-smelling clothes and hair
• Lose yellow stain on teeth and fingers
• Prevent wrinkles

Honoring the Gift of Heart Health for American Indians 65

How Does Smoking Affect Your Health?

• Smoking can cause:
• Heart disease
• Stroke
• Cancer
• Lung disease

How Does Smoking Affect the Health of Your Loved Ones?

• Children exposed to cigarette smoke may have more:
• Asthma attacks
• Bronchitis
• Ear infections
• Family members exposed to cigarette smoke may develop:
• Heart and lung problems
• Stroke
• Cancer
• Smoking during pregnancy increases the chances that your baby will be born sick

66 Your Choice for Change!

What Should You Expect When You Quit Smoking?

Nicotine is a powerful drug that causes addiction Your body gets used to the nicotine in cigarettes When you stop smoking, getting rid of the nicotine in your body can make you feel sick Tell your doctor that you are trying to quit smoking There are medicines that can help you feel better

How Does It Feel When You Begin To Quit Smoking?

Some people may have headaches, feel cranky, or tired This happens when the body tries to get rid of the nicotine

The good news is:

• Most symptoms go away in about 4 weeks
• Quitting smoking is not easy, but many people are able to quit for good
• If you smoke again, quit again It may take many attempts to stay off cigarettes Just remember you can do it!

Honoring the Gift of Heart Health for American Indians 67

Follow Mary’s Example To Quit Smoking for Good.

Mary: “I chose my grandson’s birthday as my quit date. I got help from my family and friends. The doctor and a health educator also helped me. When I quit, they congratulated me on my hard work and success. I wanted to set a good example for my family to follow.”

Tips That Helped Mary Quit Smoking:

1. Get ready.

• Pick a day to quit smoking
• Write down the reasons you want to quit smoking Put the list where you will see it every day
• Throw away all cigarettes, lighters, and ashtrays Don’t buy any more cigarettes
• Tell your family, friends, and coworkers the day you will quit smoking
• Make a list of the people who will support you

1. Make a plan to stay off cigarettes.

• Don’t go to places that make you want to smoke
• At parties, try not to be around people who smoke
• When someone offers you a cigarette, say, “No, thank you I don’t smoke ” You will soon see yourself as a nonsmoker

68 Your Choice for Change!

1. Ask for help.

• Buy nicotine gum or skin patches, or ask your doctor for a prescription for medicine that will help you stay off cigarettes
• Find a local program to help you quit smoking

Mary Resists the Urge To Smoke.

Mary: “In the beginning, I was stressed and craved a cigarette. Instead of lighting up a cigarette, I called the “Quit Smoking” help line. They suggested that I chew sugarless gum and listen to music to help decrease the urge. It worked.”

Try These Tips To Resist the Urge To Smoke:

• Keep your hands busy:
• Do arts and crafts
• Garden
• Start a project around the house
• Read
• Put something in your mouth that is not a cigarette:
• Drink water
• Chew sugarless gum
• Eat vegetable sticks or apple slices
• Chew on a short straw or a toothpick

Honoring the Gift of Heart Health for American Indians 69

• If you are stressed, angry, tired, or nervous:
• Take a slow, deep breath, count to five, and release it Repeat 10 times
• Talk with a friend
• Take a walk
• Listen to music
• When you get up in the morning:
• Brush your teeth and use mouthwash instead of smoking
• If you’ve always had a cigarette with coffee, switch to tea for a while or drink water
• Remember to keep tobacco sacred

70 Your Choice for Change!

Mary’s Family Is Living Smoke Free.

Mary: “When friends come to our house and light up, I say politely that our house is smoke free and they need to smoke outside.”

Learn From Mary’s Family:

1. Help your children stay smoke free.

• Talk to your children about the harm smoking does to their health
• Help your children make a sign that says: “We are a smoke-free family”

1. Protect your family and friends from secondhand smoke.

• Put a “We are a smoke- We are a

smoke-free family.

free family” sticker or sign in your house and car

• Sit in the nonsmoking section in restaurants

Honoring the Gift of Heart Health for American Indians 71

My Plan To Quit Smoking

Write down the reasons you want to quit smoking. Here are some examples:

• To improve my health.
• To protect my family.
• To have more energy.
• To save money.
• Reasons I want to quit smoking:

Write down the steps you plan to take to quit smoking For example, you might:

• Set a quit date. My quit date is:
• Ask family and friends to help you. Names:
• Find a local program to help you quit smoking.
• Make a list of things to do when you get the urge to smoke.

Save tobacco for ceremonial use. Live healthy, live longer, and live stronger!

72 Your Choice for Change!

My Heart Health Card

Use this card to record the results of your tests Take action to keep your heart healthy

♥ = Normal Values

Name:

Weight Date Result

BMI

♥ 18.5 to 24.9

Waist Measurement

Date

Result

Date

♥ Men—40 inches (102 cm) or less Result ♥Women—35 inches (88 cm) or less

Blood Pressure Date

♥ Less than 120/80 mmHg Result

Tests to measure “fats” in the blood

Tests to check sugar in the blood for diabetes Blood Glucose Date

♥ Fasting—less than 100 mg/dL Result

Result

Honoring the Gift of Heart Health for American Indians 73

For More Information

Selected publications are also available on the NHLBI Web site at www.nhlbi.nih.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 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. 08-6340 July 2008