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people from heart attacks and strokes by preventing blood clots. One serving
of fish is about the size of a pack of playing cards. Fish oil supplements are
also good.

Limit alcohol

You do not need to avoid alcohol completely. A man should not drink more
than two alcoholic drinks a day. Women should not drink more than one.
One drink, or unit, of alcohol, contains about 10 grams of alcohol. That is
about one 250-ml bottle of beer, one 100-ml glass of wine, or one 25-ml
glass of whisky.

Eating at least 5
servings of fruit
and vegetables a
day, and limiting
your salt intake
to less than one

heart attacks and

Limit fatty foods

All fats are high in energy and will make you gain weight unless you burn
them off by staying active. Some fats are more likely to increase your risk of
heart attack and stroke:

Saturated fats and trans-fats lead to "bad" cholesterol in your blood, and
increase your risk of heart disease. Try to restrict your use of these fats.

Unsaturated fats are less risky, but they still make you gain weight. You
should eat them in moderation.

Sources of saturated fat, trans-fat, Sources of unsat urated fat
and cholesterol , A .

Restrict your use of:

Butter and ghee

High fat dairy products, such as cream
and creamy cheeses

Palm oil and coconut oil

Food fried in saturated fat

Processed meats, such as burgers and

Liver and other organ meats

Fatty pork

Lard and shortening

Poultry skin

Egg yolks


Use these fats in moderation:

Safflower oil
Canola oil

Nuts, such as peanuts, cashews, walnuts,
and almonds

Sunflower oil

Sesame, pumpkin, or sunflower seeds

Cottonseed oil

Corn oil

Soybean oil

Fish oil

Soft margarine (not hard margarines )

Cooking tips for reducing fat

Use only a very little cooking oil.

Instead of frying foods, bake, broil, boil, grill, steam, roast, poach, or
microwave them.

Trim the fat and skin off meat before cooking.

Eat chicken instead of red meat like beef, pork, and mutton.

8. Stay active and control your weight

Obesity and overweight

If you eat a lot and are not active enough to burn off the calories you take
in, you will put on weight. You could even become obese. People who are
overweight or obese are at higher risk of heart attacks and strokes.

How to know if you are obese

The body mass index (BMI) is a measure of weight in relation to height. It is
calculated as follows:


body weight in kilograms
height (in metres) squared

A person with a BMI over 25 kg/m 2 is considered to be overweight. A person
with a BMI over 30 kg/m 2 is considered obese. The risk of heart attacks,
strokes and diabetes increases as BMI increases. Ideally, the BMI should be
maintained between 18.5 and 24.9 kg/m 2 .

Central obesity increases the risk of heart attacks
and strokes

People who are overweight or obese are at higher risk of heart attacks and
strokes, especially when they have a lot of excess fat in the waist area and
abdomen (stomach area). This is called central obesity. Regular waist meas-
urements are a simple measure of the total fat in your body and of central
obesity. Central obesity is said to be present if the waist measurement is 102
cm or more in men, and 88 cm or more in women.

The best weight for you depends on your height, age and sex. Your doctor
can help you determine your ideal weight.

Being overweight
increases the risk
of heart attacks
and strokes. To
maintain an ideal

What staying active does for your health

Physical activity lowers the risk of heart attacks and strokes by:

lowering your blood sugar, blood pressure and blood fats;

increasing oxygen levels in your body;

helping you lose weight;

reducing stress;

strengthening your heart, muscles and bones;

improving blood circulation;

toning your muscles.

Engaging in

physical activity

for at least 30

minutes on most

days of the week

will help to keep

away heart attacks

and strokes.

Staying active also reduces the risk of some cancers, such as colon cancer
and breast cancer. It makes you feel healthier, helps you sleep, and improves
your state of mind.

Do I have to join a health club to stay active?

No! Physical activity is any form of exercise or movement. It does not only
mean sports and athletics. Daily chores such as walking, gardening, house-
work, and playing games with your children are all forms of physical activ-
ity. Whatever your age, physical activity plays a big role in your health and

There are many ways to increase your activity level. Think about small
changes you could make to your routine, such as taking the stairs instead
of the lift, or walking to work instead of driving. Above all, avoid sitting in
front of the television for too long.

How much physical activity do I need?

Try to get at least 30 minutes of physical activity on most days of the week.
This does not have to be all at once. It can be spread over the course of the

Start slowly. If you have any medical problems, talk to your doctor about
the amount and type of physical activity that is good for you. Listen to your
body, and if you feel unwell when you are active, see your doctor about it
right away.

If you feel comfortable with the amount of physical activity you are doing,
build it up gradually. For most people, the right kind of physical activity
produces a light sweat and makes you slightly breathless. If you are active
on most days of the week, your fitness will gradually increase.

Once you start getting regular exercise, don't stop. You will lose the fitness
you gained and all the benefits it brings. The best thing is to stay active for
your whole life.

9. Reduce high blood pressure

What is high blood pressure?

Blood pressure is measured in millimeters of mercury (mmHg), and it has two
numbers. The first is the systolic blood pressure, and is the pressure when
the heart is contracting. The second is the diastolic blood pressure, and is
the pressure when the heart is resting. A person has high blood pressure, or
hypertension, when the first pressure is above 140 mmHg or the second is
above 90 mmHg.

What causes high blood pressure?

Some people have high blood pressure because it runs in the family. Blood
pressure also tends to increase with age. But lifestyle factors can also cause
high blood pressure or make it worse. These factors include:

being overweight or obese;

eating too much salt in the diet;

drinking too much alcohol.

High blood pressure can also be linked to some illnesses, such as kidney dis-
ease. Some medicines, such as birth control pills, can increase blood pressure.

Why is high blood pressure dangerous?

High blood pressure makes the heart work harder than it should, causing it
to get weaker over time. The higher your blood pressure, the greater your risk
of heart attack and stroke.

How do I know if I have high blood pressure?

You cannot tell if you have high blood pressure unless you have it measured.
You should have it measured once a year. The measurement is quick and

cause a sudden
stroke or heart

attack. Have your
blood pressure

checked regularly.

What should I do if I have high blood pressure?

Maintain a healthy body weight.

Stay active.

Eat a healthy diet that is low in salt and fat and high in fruit and vegeta-

Do not smoke.

Do not drink too much alcohol.

Have your blood pressure taken regularly.

If you are doing these things and your blood pressure is still high, your doc-
tor can prescribe medicines. These do not cure high blood pressure, but they
control it. You must take them as directed, probably for the rest of your life.
You should have your blood pressure checked regularly.

To find out more about medicines for high blood pressure, read the

10. Reduce high blood sugar

People with high blood sugar levels, or diabetes, have a higher risk of heart
attacks and strokes. At least half of the people who have diabetes do not
know they have it.

Diabetes speeds up the development of atherosclerosis - the narrowing and
hardening of the arteries that causes heart attacks and strokes. Untreated dia-
betes can also lead to blindness, kidney failure, nerve damage, leg ulcers and
coma. Pregnancy is much more difficult for diabetic women and their babies
are more likely to have birth defects.

What causes diabetes?

Diabetes occurs when the body fails to produce enough insulin, or cannot
use it properly. Sugar then builds up in the blood. There are two main types
of diabetes:

Type I Diabetes develops most often in children and young adults. Patients
need to have daily injections of insulin to survive.

Type II Diabetes is the most common form almost 95 % of people with
diabetes have this type. Patients with type II diabetes cannot produce enough
insulin or cannot use insulin properly. It occurs mostly in middle-aged peo-
ple, but children and young adults can also develop it, particularly if they
are obese, have an unhealthy diet, and are physically inactive. The number
of children and young adults with type II diabetes is increasing. This type of
diabetes can usually be treated through lifestyle changes and oral medicines.

The causes of diabetes include hereditary factors, obesity, an unhealthy diet
and lack of physical activity. If you keep an ideal body weight, regularly take
physical activity, and consume a healthy diet, you reduce your risk of getting

How do I know if I have diabetes?

Some people have few or no symptoms at all until they start having serious
problems. The early signs of diabetes include:

tiredness and weakness;

frequent need to urinate (pass water);

unusual thirst;

weight loss or gain;

blurred vision;

frequent infections;

wounds that heal slowly.

A doctor can diagnose diabetes by measuring the blood sugar level using a
simple blood test. If necessary, you may be asked to take a special drink with
glucose (sugar) so that your blood sugar level can be measured afterwards.

Diagnostic criteria for diabetes



Blood glucose level

fasting blood glucose:

7.0 mmol/l (126 mg/dl) and above


2 hours after glucose load:

1 1 .1 mmol/l (200mg/dl) and above


fasting blood glucose:

less than 7.0mmol/l (126mg/dl)


2 hours after glucose load:

7.8 mmol/l (140mg/dl) and above

and less than 11.1 mmol/l (200mg/dl)

fasting blood glucose:

6.1 mmol/l (110 mg/dl) and above and less

than 7.0 mmol/l (126mg/dl)


2 hours after glucose load:

less than 7.8 mmol/l (140mg/dl)

Modified from Definition, diagnosis and classification of diabetes mellitus and its complications. Report of
a WHO consultation (WHO, Geneva, 1999) and the International Diabetes Federation IGT/IFG consensus
statement (Unwin N, et al. International Diabetes Federation IGT/IFG Consensus Statement. Report of an Expert
Consensus Workshop 1-4 August 2001, Stoke Poges, UK. Diabetic Medicine 2002; 19: 708-723).

Individuals with a fasting blood sugar level between 6.1 mmol/l (110 mg/
dl) and 7.0 mmol/l (126 mg/dl) are at high risk of developing diabetes and
should improve their lifestyle to reduce the risk.

d glucose
higher than

normal but not

yet diabetes

How can I control my diabetes?

If diabetes is well controlled, the risk of developing heart attack, stroke, or
heart failure will decrease. Lifestyle changes can often help to control blood
sugar levels. These changes include:

eating a healthy diet;

avoiding foods that are high in sugars, fats, and calories;

maintaining a healthy body weight;

drinking less alcohol;

staying active.

If lifestyle changes do not reduce your blood sugar levels enough, you will
need to take medicine. Many people with type II diabetes can be treated with
oral medicine alone. Some may need insulin injections, or sometimes both.

At the time of diagnosis, the doctor will do tests to detect any complications
from the diabetes and will advise on treatment. If you have diabetes, you
should have regular check-ups. You should also follow carefully instructions
for making lifestyle changes and taking medicine. Be sure to ask questions if
there is anything you do not understand.

You may have to measure the sugar levels in your blood or urine in between
check-ups. Your doctor will show you how to do this if it is necessary.

Medicines used to treat diabetes

Many people with type II diabetes can be treated with oral medicines (medi-
cine taken by mouth). You can read more about them in the Annex.

If lifestyle changes and oral medicines are not enough to control the dia-
betes, the doctor will prescribe insulin. This is injected, using a syringe or a
"pen-type" injector.

Patients with type I diabetes need insulin injections; they cannot be treated
with oral medicine.

Watching your blood sugar levels

When you have diabetes, you have to watch your blood sugar level, because
if it is too low or too high you could get very sick. When the blood sugar
level drops, you could become nervous, shaky, and confused. You may be
advised to carry sugar cubes or drops to take when you feel these symptoms.
If level drops very low, it can lead to fainting, coma, and even death. If the
blood sugar level is too high, it can also lead to a diabetic coma.

Here are some tips for keeping your blood sugar level correct:

Never miss doses of your medicine.

Do not stop taking your medicines without asking your doctor.

Do not miss meals.

Be careful about taking your medicine when you are sick and not eating
as much as you usually do (e.g. When you have a cold and your appetite
is less than usual and cannot eat as much as you usually do). Seek your
doctor's advice on this.

Control your blood
pressure and blooc
sugar if you have

11. Reduce high blood fat levels

Healthy diet is

low in fat, low in

salt and sugar and

high in fruits and


Blood fats, or lipids, include cholesterol and triglycerides. The body needs a
certain amount of cholesterol, but when there are too many fats in the blood
(hyperlipidaemia), fatty deposits build up in the arteries, increasing the risk
of heart attacks and strokes.

"Good" and "bad" cholesterol

Cholesterol cannot dissolve in blood, so it needs "carrier" proteins to trans-
port it around the body. The carrier proteins are called lipoproteins. There are
two main kinds:

High density lipoprotein (HDL): When cholesterol is carried by HDL, it is
called HDL cholesterol. This is "good" cholesterol, and reduces the risk of
heart disease and strokes.

Low density lipoprotein (LDL): When cholesterol is carried by LDL, it is called
LDL cholesterol. This is "bad" cholesterol, and increases the risks of heart at-
tacks and strokes.

Current recommended blood fat levels (European guidelines)

Total cholesterol



Triglycerides (fasting)

less than 5.0 mmol/l

less than 3.0 mmol/l

more than 1 .0 mmol/l
(40 mg/dl) in men

more than 1 .2 mmol/l
(46 mg/dl) in women

less than 1 .7 mmol/l
(150 mg/dl)

Modified from: Mackay J, Mensah GA, Mendis S and Greenlund K. The atlas of heart disease and stroke
(Geneva, World Health Organization, 2004).

What causes high blood fat levels?

High cholesterol levels may run in some families. But most often, high blood
fat levels are caused by an unhealthy diet and lack of physical activity. High
blood fat levels rarely produce symptoms or warning signs. When cholesterol
levels are very high, some people develop skin growths called xanthomas. To
check your blood fat levels, ask your doctor for a simple blood test.

In some cases, a high blood fat level may be associated with an undiagnosed
medical condition, like diabetes.

What should I do if I have a high blood fat level?

Eat a healthy diet that is rich in fruits and vegetables, and low in animal
fat, saturated fat, and cholesterol (read about the kinds of fats and oils
you can eat more of in Section 7).

Maintain a healthy body weight.

Stay active.

If these things do not lower your blood fat levels enough, your doctor can
prescribe medicines. You must take these regularly, even if you cannot feel
their effects, and you must keep following a healthy lifestyle.

Annex. Medicines for treating and
managing heart attacks and strokes

This table shows medicines commonly used to treat heart attacks, strokes,
and the physical problems that cause them.

Warning: Most of these medicines are prescribed by doctors and must only
be used under medical care. Never take them without your doctor's advice.
Used wrongly, these medicines can be fatal.

Type of medicine

What it does


Antiplatelet agent

Prevents blood clots that cause
heart attacks and strokes.


Anticoagulant or blood

Prevents blood clots. Used for





Calcium-channel blocker


Angiotensin converting
enzyme (ACE) inhibitor

Centrally acting

Angiotensin II receptor
blocker (ARB)

Cardiac glycoside

patients with an irregular heartbeat
(atrial fibrillation) and after surgery
to replace damaged heart valves.

Relaxes blood vessels, relieves and
prevents angina. Used also for heart
failure to reduce the burden on the
heart by relaxing blood vessels.

Removes excess water from the
body and prevents build-up. Lowers
blood pressure. Used for high blood
pressure and heart failure.

Relaxes blood vessels and lowers
blood pressure. Used for high blood
pressure and angina.

Slows the heart rate and makes it
beat with less force. Used for high
blood pressure and angina. Some
can be used for heart failure to
decrease the workload of the heart.

Relaxes blood vessels and reduces
the strain on the heart. Used for
high blood pressure and to reduce
the risk of heart attacks. Also used
for heart failure to prevent further
damage to the heart.

Lowers blood pressure by acting on
the brain.

Dilates blood vessels and lowers
blood pressure.

Increases the strength of heart
muscles and helps the heart pump
blood. Used for heart failure.

Nitrates (such
as isosorbide





Type of medicine

Blood cholesterol-
lowering agent


What it does

Lowers cholesterol levels in the
blood. Used for high blood fa
(high cholesterol).

Helps the cells of the body to take
in sugar. Used for diabetes to lower
blood sugar level.

Increases the production of insulin.
Used for diabetes to lower blood
sugar level.




Side-effects of heart and stroke medicines

Ask your doctor about possible side-effects before you start taking medicine.
Contact your doctor if you have any symptoms that you think could be side-

Allergic reactions

The most common side-effects are allergic reactions such as:

itching, red or swollen skin;

stomach pain and vomiting;


high heart rate;

feeling giddy or dizzy.

Dry cough

Dry cough sometimes occurs with ACE inhibitors.


If you are using an antiplatelet agent like aspirin, or an anticoagulant like
warfarin, it can produce bleeding. Watch out for:

blood in the urine or faeces (stool);

bleeding from the gums when eating or brushing teeth;

abnormal pain in the stomach area.

If you have any of these symptoms, talk to your doctor before taking another
dose of medicine. People taking warfarin need to be carefully monitored. If
you are taking warfarin, you should follow closely your doctor's recommen-
dations, which will include regular blood tests.

High or low blood sugar

If you are taking medicine for diabetes, you must make sure your blood
sugar levels do not become too low or too high.

Explanation of terms used in this booklet

abdomen: the part of the body between the
chest and the hips.

angina: chest pain caused by a reduction in
blood flow to the heart muscle.

angioplasty: a procedure to open up blocked
blood vessels, particularly coronary arteries.
Often performed with either a balloon or a
wire mesh (stent, see also stenting).

antibiotic: a drug used to treat bacterial

arteriogram: an imaging procedure in which
contrast medium (dye) is injected into the
blood vessels, which are then X-rayed, to find
out whether they are blocked or narrowed.

coronary arteriogram: an arteriogram per-
formed on the heart blood vessels (coronary
arteries) to see if they are narrowed or not.

atrial fibrillation: a type of irregular heart-
beat, which can be a risk factor for stroke.

blood fats/lipids: fats or fat like substances
such as cholesterol and triglyceride present in

blood pressure: the force with which blood
pushes against the walls of arteries.

diastolic blood pressure: blood pressure
when the heart is resting between contrac-

systolic blood pressure: blood pressure
when the heart is contracting.

blood sugar: sugar that circulates in the

body mass index (BMI): a measure of weight
in relation to height, calculated as weight in
kilograms divided by the square of height in

bypass surgery: a type of surgery, in which
blood is rerouted around a blocked artery, of-
ten using a segment of a healthy blood vessel
removed from another part of the body.

coronary artery bypass surgery (CABG):

a bypass surgery performed on coronary
arteries to improve the supply of blood to
the heart.

carotid endarterectomy: a surgical proce-
dure to remove the thickened and hardened
parts inner walls of the artery that supplies
blood to the brain.

cholesterol: a waxy substance that can be
produced by the liver, or absorbed from certain
animal foods, such as dairy products, meat,
animal fats and egg yolks. It can be found in
the blood stream.

high density lipoprotein (HDL) choles-
terol: so-called 'good' cholesterol, which
protects against heart attacks and strokes.

low density lipoprotein (LDL) choles-
terol: so-called 'bad' cholesterol, which can
increase the risk of heart attacks and strokes.

coma: a state in which a person is not con-
scious, usually due to serious illness or injury.

computerized tomography (CT): an imaging
procedure, in which X-rays are used to produce
cross-sectional images of the body.

coronary arteries: blood vessels on the sur-
face of the heart, which feed the heart muscles.

diabetes: a chronic disease characterized by
inability of the body to produce or use insulin
properly. Associated with high levels of sugar
in the blood.

echocardiogram: a medical examination that
uses ultrasound to record the movement and
structure of the heart.

electrocardiogram: a medical examination in
which electrodes are attached to the surface of
the body to record electrical signals associated
with the contractions of the heart.

endocarditis, infective: an infection inside
the heart, which can damage heart valves.

exercise stress test: a medical examination
in which an electrocardiogram is performed on
a person who is exercising, to measure the re-
sponse of the heart to physical activity and how
much physical activity the heart can tolerate.

fasting plasma glucose: blood sugar levels
when you have not had meals at least for 8
hours. Plasma is the yellowish liquid part of the
blood used for the measurement of the blood
sugar levels are measured.

heart attack: death of part of the heart mus-
cle as a result of a coronary artery becoming

heart failure: a condition in which the heart
cannot pump enough blood to meet the needs
of the body.

heart murmur: abnormal heart sounds pro-
duced by blood flow in the heart. Often associ-
ated with an abnormality of the heart (such as
damaged or abnormal heart valves).

heart valves: valves between the heart cham-
bers and the large blood vessels, which control
blood flow by opening and closing in accord-
ance with the heartbeat. If damaged, blood
flow within the heart will becomes erratic.

haemoglobin: substance contained in red
blood cells, which carries oxygen through the

hormone: a substance produced by various
glands in the body with specific functions.
Insulin is an example of a hormone.

insulin: a hormone produced by the body,
which allows cells to use sugar.

magnetic resonance imaging (MRI): an
imaging technique, in which powerful electro-
magnets are used to produce detailed pictures
of the inside of the human body.

Omega-3 fatty acids: 'good fats' that can

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Online LibraryWorld Health OrganizationAvoiding heart attacks and strokes : don't be a victim - protect yourself → online text (page 3 of 4)