
The Healthy Heart Handbook for Women


NATIONAL INSTITUTES OF HEALTH
National Heart, Lung, and Blood Institute

For sale by the U.S. Government Printing Office
Superintendent of Documents, Mail Stop: SSOP
Washington, DC 20402-9328
ISBN 0-16-037976-8



Contents


THE HEALTHY HEART

What are Cardiovascular Diseases? 
Who Gets Cardiovascular Diseases?


MAJOR RISK FACTORS

Smoking 
High Blood Pressure 
High Blood Cholesterol 

Other Risk Factors 

Overweight 
Diabetes 
Stress 

Birth Control Pills 
Alcohol


PREVENTION: A PERSONAL PROJECT

Self-Help Strategies for a Healthy Heart 

Kicking the Smoking Habit 
Getting Physical

Eating for Health 
Lowering Blood Cholesterol 
Controlling Blood Pressure 
Losing Weight: Four Ways to Win 

Other Prevention Issues 

Hormones and Menopause 
The Aspirin Question 


RESEARCH: NEW FOCUS ON WOMEN 

The Heart of the Matter 
Meal Planning: A Change of Heart 
A Guide to Choosing Low-Fat, Low-Cholesterol Foods 
Recipes for a Healthy Heart


RESOURCES FOR A HEALTHY HEART



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The Healthy Heart

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You owe it to yourself to take this handbook to heart. For coronary
heart disease is a woman's concern. Every woman's concern. It is not
something that only affects your husband, your father, your brother,
your son. This handbook tells you why you should be concerned about your
own heart health, and what you can do to prevent coronary disease. A
little prevention can have a big payoff--a longer, healthier, more
active life. 

Each year, 245,000 women die of coronary heart disease, making it the
number one killer of American women. Another 90,000 women die each year
of stroke. Although death rates from coronary heart disease and stroke
have declined in recent years, these conditions still rank first and
third, respectively, as causes of death for women. 

Overall, about 10 million American women of all ages suffer from heart
disease. One in ten women 45 to 64 years of age has some form of heart
disease, and this increases to one in four women over 65. Each year,
one-half million women suffer heart attacks. Cardiovascular diseases and
their prevention, therefore, are pressing personal concerns for every
woman. 

What Are Cardiovascular Diseases? 

Cardiovascular diseases are diseases of the heart and blood vessel
system, such as coronary heart disease, heart attack, high blood
pressure, stroke, angina (chest pain), and rheumatic heart disease.
Coronary heart disease--the primary subject of this handbook--is a
disease of the blood vessels of the heart that causes heart attacks. A
heart attack happens when an artery becomes blocked, preventing oxygen
and nutrients from getting to the heart. A stroke results from a lack of
blood to the brain, or in some cases, bleeding in the brain.

Who Gets Cardiovascular Diseases? 

Some women have more "risk factors" for cardiovascular diseases than
others. Risk factors are traits or habits that make a person more likely
to develop a disease. Some risk factors for heart-related problems
cannot be changed, but others can be. The three major risk factors for
cardiovascular disease that you can do something about are cigarette
smoking, high blood pressure, and high blood cholesterol. Other risk
factors, such as overweight, diabetes, and physical inactivity, also are
conditions you have some control over. Although growing older is a risk
factor that cannot be changed, it is important to realize that other
risks can be reduced at any age. This handbook identifies some key risk
factors that you can control, and suggests changes in living habits to
lessen your chances of developing cardiovascular diseases.

Some groups of women are more likely to develop cardiovascular diseases
than other groups. Black women are 24 percent more likely to die of
coronary heart disease than white women, and their death rate for stroke
is 83 percent higher. Older women have a greater chance of developing
cardiovascular diseases than younger women, partly because the tendency
to have heart-related problems increases with age. Older women, for
example, are more likely to develop high blood pressure and high blood
cholesterol levels, to be diabetic, to be overweight, and to exercise
less than younger women. Also, after menopause, women are more apt to
get cardiovascular diseases, in part because their bodies produce less
estrogen. Women who have had early menopause, either naturally or by
means of a hysterectomy, are twice as likely to develop coronary heart
disease as women of the same age who have not begun menopause.

While any one risk factor will raise your chances of developing
heart-related problems, the more risk factors you have, the more
concerned you should be about prevention. If you smoke cigarettes and
have high blood pressure, for example, your chance of developing
coronary heart disease goes up dramatically. Having all three major
changeable risk factors--smoking, high blood pressure, and high blood
cholesterol--can boost your risk to eight times that of women who have
no risk factors. 



We're Making Progress 


Changing habits isn't easy--but experience shows that it works. As
Americans have learned to control blood pressure and make healthful
changes in their eating, smoking, and exercise habits, death rates for
heart attack and stroke have dropped dramatically. Between 1970 and
1988, the death rate for women from coronary heart disease was cut in
half. During the same period, the death rate for stroke went down 55
percent. 

Cardiovascular diseases remain the leading cause of death for American
women. But the message is clear: by taking an active role in your own
heart health, you can make a difference. Beginning with the chapter on
"Self-Help Strategies for a Healthy Heart," this handbook supplies a
number of practical tips to help get you started. Also, for information
about other organizations and materials available to help you, see
"Resources for a Healthy Heart" on page 81. 


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Major Risk Factors

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Smoking 

Cigarette smoking has been described as "the most important individual
health risk in this country." Approximately 26 million American women
smoke. Although the smoking rate for women dropped 8 percent between
1965 and 1988, women who smoke today are apt to smoke more heavily than
they did in the past. 

Surprising as it may seem, smoking by women in the United States causes
almost as many deaths from heart disease as from lung cancer. Women who
smoke are two to six times as likely to suffer a heart attack as
nonsmoking women, and the risk increases with the number of cigarettes
smoked per day. Smoking also boosts the risk of stroke. 

Cardiovascular disease are not the only health risks for women who
smoke. Cigarette smoking greatly increases the chances that a woman will
develop lung cancer. In fact, the lung cancer death rate for women is
now higher than the death rate for breast cancer, the chief cause of
cancer deaths in women for many years. Cigarette smoking is also linked
with cancers of the mouth, larynx, esophagus, urinary tract, kidney,
pancreas, and cervix. Smoking also causes 80 percent of cases of chronic
obstructive lung di sease, which includes bronchitis and emphysema.

Smoking is also linked to a number of reproductive problems. Women who
smoke are more apt to have problems getting pregnant and to begin
menopause at a slightly younger age. Further, cigarette use during
pregnancy poses serious risks for the unborn. Babies of women who smoked
during pregnancy tend to weigh less at birth than babies of nonsmokers.
Smoking while pregnant also increases risks of bleeding, miscarriage,
premature delivery, stillbirth, and sudden infant death syndrome, or
"crib death." Moreover, young children who are exposed to a parent's
cigarette smoke have more lung and ear infections.

There is simply no "safe way" to smoke. Although low-tar and -nicotine
cigarettes may reduce the lung cancer risk to some extent, they do not
lessen the risks of heart diseases or other smoking-related diseases.
The only safe and healthful course is not to smoke at all. 

------------------------------------------------------------------------



Small Dose,
Big Benefit 

If you are one of the 3 million older Americans with a type of high
blood pressure called isolated systolic hypertension (ISH), there is
good news. A recent study shows that treating ISH with a low dose of a
common blood pressure-lowering drug, a diuretic called cholorthalidone,
cut the risk of stroke by more than one-third, and reduced the risk of
coronary heart disease by 27 percent. The dose of the diuretic used in
the study was only half of the smallest dose usually first given to
patients. One in five patients also took a low dose of a second drug, a
beta-blocker, to help lower their blood pressure.

If you have ISH and are already doing well on another type of blood
pressure-lowering drug, you should not necessarily switch medicines. But
you may want to discuss with your doctor whether the treatment used
successfully in this study might work for you. 


------------------------------------------------------------------------




High Blood Pressure 

High blood pressure, also known as hypertension, is another major risk
factor for coronary heart diseases and the most important risk factor
for stroke. Even slightly high levels double the risk. High blood
pressure also boosts the chances of developing kidney disease. 

Nearly 58 million Americans have high blood pressure, and about half of
them are women. Older women have a higher risk, with more than half of
all women over the age of 55 suffering from this condition. High blood
pressure is more common and more severe in black women than it is in
white women. Use of birth control pills can contribute to high blood
pressure in some women. 

Blood pressure is the amount of force exerted by the blood against the
walls of the arteries. Everyone has to have some blood pressure, so that
blood can get to the body's organs and muscles. Usually, blood pressure
is expressed as two numbers, such as 120/80, and is measured in
millimeters of mercury (mmHg). The first number is the systolic blood
pressure, the force used when the heart beats. The second number, or
diastolic blood pressure, is the pressure that exists in the arteries
between heartbeats. Depending on your activities, blood pressure may
move up or down in the course of a day. Blood pressure is considered
high when it stays above normal levels over a period of time.

High blood pressure is sometimes called the "silent killer" because most
people have it without feeling sick. Therefore, it is important to have
it checked each time you see your doctor or other health professional.
Blood pressure can be easily measured by means of the familiar
stethoscope and inflatable cuff placed around one arm. However, since
blood pressure changes so often and is affected by many factors, your
health professional should check it on several different days before
deciding if your blood pressure is too high. If your blood pressure
stays at 140/90 mmHg or above, you have high blood pressure.

Although high blood pressure can rarely be cured, it can be controlled
with proper treatment. If your blood pressure is not too high, you may
be able to control it entirely through weight loss if you are
overweight, regular exercise, and cutting down on alcohol, table salt,
and sodium. (Sodium is an ingredient in salt that is found in many
packaged foods, baking soda, and some antacids.) 

However, if your blood pressure remains high, your doctor will probably
prescribe m medicine in addition to the above changes. The amount you
take may be gradually reduced, especially if you are successful with the
changes you make in your lifestyle. While few people like the idea of
taking any medicine for a long time, the treatment benefits are real and
will reduce the risk of stroke, heart attack, and kidney disease. If you
are prescribed a drug to control high blood pressure and find you have
any uncomfortable side effects, ask your doctor about changing the
dosage or possibly switching to another type of medicine.

During pregnancy, some women develop high blood pressure for the first
time. Between 10 and 20 percent of first-time mothers develop a high
blood pressure problem during pregnancy called preeclampsia. Other women
who already have high blood pressure may find that it worsens during
pregnancy. If untreated, these conditions can be life-threatening to
both mother and baby. Since a woman can feel perfectly normal and still
have one of these conditions, it is important to get regular prenatal
checkups so that your doctor can discover and treat a possible high
blood pressure problem.

High Blood Cholesterol 

High blood cholesterol is a third important risk factor for coronary
heart diseases that you can do something about. Although young women
tend to have lower cholesterol levels than young men, between the ages
of 45 and 55, women's cholesterol levels begin to rise higher than
men's. After age 55, the gap between women and men becomes still wider.
Today, about one-third of American women have blood cholesterol levels
high enough to pose a serious risk for coronary heart diseases. The
higher your blood cholesterol level, the higher your heart disease risk.
For all adults, a desirable blood cholesterol level is less than 200
mg/dL. A level of 240 mg/dL or above is considered "high" blood
cholesterol. But even levels in the "borderline-high" category (200-239
mg/dL) boost the risk of heart disease.

<Picture omitted: chart of blood cholesterol and age comparison>

The body needs cholesterol to function normally. It is found in all
foods that come from animals--that is, all meats and dairy products.
However, the body can make all of the cholesterol that it needs. Over a
period of years, extra cholesterol and fat circulating in the blood
settle on the inner walls of the arteries that supply blood to the
heart. These deposits make the arteries narrower and narrower. As a
result, less blood gets to the heart and the risk of coronary heart
disease increases. 

Ask your health professional to check your blood cholesterol level once
every 5 years. This simple test involves taking a small blood sample and
measuring the amount of cholesterol. The cholesterol level is expressed
as, for example, "215 mg/dL" or 215 milligrams of cholesterol per
deciliter of blood. Be sure to ask what your cholesterol number is and
whether you should take steps to lower it. Before age 45, the total
blood cholesterol level of women averages below 220 mg/dL. But between
the ages of 45 and 55, women's average cholesterol levels soar to
between 240 and 260 mg/dL. Women between 45 and 74 years of age who have
a cholesterol level over 240 mg/dL are more than twice as likely to
develop coronary heart disease as women with levels below 200 mg/dL.

Total blood cholesterol is the first measurement used to identify
persons with high blood cholesterol. As you read above, a blood
cholesterol level of 240 or more means you have "high" blood
cholesterol. But even "borderline-high" levels (200-239) boost your risk
of coronary heart disease. If your total blood cholesterol is in the
high or borderline-high category and you have other risk factors for
coronary heart disease, your doctor will want a more complete
"cholesterol profile" before making a decision about treatment.
Specifically, your doctor will measure your LDL and HDL levels after an
overnight fast.

Cholesterol travels in the blood in packages called lipoproteins.
Cholesterol packaged in low density lipoprotein (LDL) is often called
"bad cholesterol" because LDL carries most of the cholesterol in the
blood and if not removed, cholesterol and fat can build up in the
arteries. Another type of cholesterol, which is packaged in high density
lipoprotein (HDL), is known as "good cholesterol." That is because HDL
helps remove cholesterol from the blood, preventing it from piling up in
the arteries. 

A "cholesterol profile" includes measurements of both HDL and LDL
levels. An LDL level below 130 mg/dL is desirable. LDL levels of 130-159
mg/dL are "borderline-high." Levels of 160 mg/dL or above mean you have
a high risk of developing coronary heart disease. As with total
cholesterol, the higher the LDL number, the higher the risk. On the
other hand, the lower your HDL number is, the greater your risk for
coronary heart disease. Any HDL level below 35 mg/dL is considered too
low. After studying your LDL- and HDL-cholesterol levels and other risk
factors for coronary heart disease, your doctor may recommend a specific
treatment program for you.

For many people, a change in eating habits is the only step needed to
lower blood cholesterol levels. Cutting back on foods rich in fat,
especially saturated fat, and in cholesterol, can lower both total and
LDL-cholesterol. Weight loss for overweight persons also will lower
blood cholesterol levels. Losing extra weight, as well as quitting
smoking and becoming more active, also may help boost your
HDL-cholesterol levels. Although we don't know for sure that raising HDL
levels in this way will reduce the risk of coronary heart disease, these
measures are likely to be good for your heart in any case.


What's Your Number? 
Blood Cholesterol Levels and Heart Disease Risk 

Desirable            Borderline-High                 High
------------------------------------------------------------------------

Total Cholesterol
Less than 200           200-239                 240 and above

LDL Cholesterol
Less than 130           130-159                 160 and above

------------------------------------------------------------------------

While changing the way you eat is the first and most important action
you can take to improve your blood cholesterol levels, your doctor may
also suggest that you take cholesterol-lowering medications. This
recommendation will depend on how much your new diet lowers your blood
cholesterol and whether you have any other risk factors for coronary
heart disease. If your doctor does prescribe medicines, you must also
continue your cholesterol-lowering diet because the combination may
allow you to take less medicine. Also, because diet is still the safest
treatment, you should always try to lower your cholesterol levels with
diet changes before adding medication.

Triglycerides are another type of fat found in the blood and in food.
Triglycerides in food are made up of saturated, polyunsaturated, and
monounsaturated fats. The liver also produces triglycerides. When
alcohol is consumed or when excess calories are taken in, the liver
produces more triglycerides. 

A number of studies have found that some people with coronary heart
disease have high triglyceride levels. However, more research is needed
to determine whether high triglycerides cause narrowing of the arteries
or are just associated with other risk factors like low levels of
HDL-cholesterol and being overweight. 

Extremely high levels of triglycerides can cause a dangerous
inflammation of the pancreas called pancreatitis. 

To reduce blood triglyceride levels, doctors recommend a low-fat,
low-calorie diet, weight control, increased exercise, and no alcohol.
Occasionally drugs are needed. 

Heart Health Record

Use this chart to record your progress
toward your healthy heart goals. 

* Smoking

Quit Date ___________________________


* Cholesterol

Desirable Level: Under 200 mg/dL
  
Date                            Level
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________


* Blood Pressure

Normal: Under 140/90 mmHg

Date                            Blood Pressure
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________






* Weight

Goal ________________________________

Date                            Level

____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________
____________________________    ____________________________



Other Risk Factors
==================

Overweight 

Overweight (obesity) is a proven risk factor for cardiovascular
diseases. People who are obese--more than 30 percent overweight--are
more likely to develop heart-related problems even if they have no other
risk factors. According to an important study of cardiovascular diseases
called the Framingham Heart Study, overweight in women is linked with
coronary heart disease, stroke, congestive heart failure, and death from
heart-related causes. 

The Framingham Heart Study found that the more overweight a woman was,
the higher her risk for heart disease. This was true for women of all
ages, but especially for women under age 50. Among women younger than
50, the heaviest group was two and a half times more likely to develop
coronary heart disease than the group with desirable weight. Overweight
women under age 50 had more than four times the stroke rate of the group
with desirable weight. 

Overweight contributes not only to cardiovascular diseases, but to other
risk factors as well. For example, overweight women under age 50 are
three times as likely to develop high blood pressure as women of
desirable weight. Overweight women also are more apt to have high blood
cholesterol levels and diabetes. Fortunately, these conditions often can
be controlled with weight loss and regular exercise. 



What Should You Weigh?

Desirable Weights for Women Ages 25 and Over*
------------------------------------------------------------------------
Height*         Small Frame     Medium Frame    Large Frame
------------------------------------------------------------------------
4' 10"          92-98           96-107          104-119
4' 11"          94-101          98-110          106-122
5' 0"           96-104          101-113         109-125
5' 1"           99-107          104-116         112-128
5' 2"           102-110         107-119         115-131
5' 3"           105-113         110-122         118-134
5' 4"           108-116         113-126         121-138
5' 5"           111-119         116-130         125-142
5' 6"           114-123         120-135         129-146
5' 7"           118-127         124-139         133-150
5' 8"           122-131         128-143         137-154
5' 9"           126-135         132-147         141-158
5' 10"          130-140         136-151         145-163
5' 11"          134-144         140-155         149-168
6' 0"           138-148         144-159         153-173

* While wearing indoor clothing and 2-inch heels
------------------------------------------------------------------------

Source: Metropolitan Life Insurance

Company Actuarial Tables, 1959. 

------------------------------------------------------------------------


What is a healthy weight for you? Currently, there is no exact answer.
Researchers are trying to develop better ways to measure healthy weight.
In the meantime, here are some guidelines to follow. Check the "What
Should You Weight?" table to find out if your weight is within the range
suggested for your height. (Ranges are given because women of the same
height may have equal amounts of body fat but different amounts of
muscle and bone, which affects weight.) Weights above the suggested
ranges are thought to be unhealthy for most people.

Research also suggests that body shape as well as weight affects heart health. "Apple-shaped" individuals with extra fat at the waistline may have a higher risk than "pear-shaped" people with heavy hips and thighs. If your waist is larger than the size of your hips, you may have a higher risk for coronary heart disease. 

Diabetes 

Diabetes, or high blood sugar, is a serious disorder that raises the
risk of coronary heart disease. More than 80 percent of people who have
diabetes die of some type of cardiovascular disease, usually heart
attack. The risk of death from coronary heart disease is doubled in
women with diabetes. Compared with nondiabetic women, diabetic women are
also more apt to suffer from high blood pressure and high blood
cholesterol. Besides helping to cause coronary heart disease, untreated
diabetes can contribute to the development of kidney disease, blindness,
problems in pregnancy and childbirth, nerve and blood vessel damage, and
difficulties in fighting infection.

Diabetes is often called a "woman's disease" because after age 45, about
twice as many women as men develop diabetes. The type of diabetes that
develops in adulthood is usually "noninsulin-dependent diabetes
mellitus," or NIDDM. This type of diabetes, in which the pancreas makes
insulin but the body is unable to use it well, is the most common form
of the disease. For unknown reasons, the risks of heart disease and
heart-related death are higher for diabetic women than for diabetic men. 

While there is no cure for diabetes, there are steps one can take to
control it. Eighty-five percent of all NIDDM diabetics are at least 20
percent overweight. It appears that overweight and growing older promote
the development of diabetes in certain people. Losing excess weight and
boosting physical activity may help postpone or prevent the disease. For
lasting weight loss, get regular, brisk exercise and eat a diet that is
limited in calories and fat, especially saturated fat. 

Stress 

In recent years, we have read and heard much about the connection
between stress and coronary heart disease. In particular, we have heard
that "type A" behavior--aggressiveness, a need to compete, a constant
concern about time--is linked to the development of heart disease. Some
studies have shown such a relationship in men. But recent research on
type A behavior in women shows no link between this kind of behavior and
coronary heart disease. 

Another factor that has often been connected to women's heart disease is
employment outside the home. The "price of liberation" for working
women, according to many media reports, is a high level of stress
leading to soaring rates of coronary heart disease. But research from
the Framingham Heart Study shows no difference in rates of coronary
heart disease between housewives and employed women. 

But it is too early to rule out stress as a risk factor for women.
Certainly, some common ways of coping with stress, such as overeating
and heavy drinking, are bad for your heart. On the other hand,
stress-relieving activities such as exercise can lower your risk of
heart disease. Researchers will need to study larger groups of women
over time to find out whether certain behaviors, personality types, or
stressful situations are linked to the development of coronary heart
disease in women. 

Birth Control Pills 

Studies show that women who use high-dose birth control pills (oral
contraceptives) are more likely to have a heart attack or a stroke
because blood clots are more likely to form in the blood vessels. These
risks are lessened once the birth control pill is stopped. Using birth
control pills also may worsen the effects of other risk factors, such as
smoking, high blood pressure, diabetes, high blood cholesterol, and
overweight. 

Much of this information comes from studies of birth control pills
containing higher doses of hormones than those commonly used today.
Still, the risks of using low-dose birth control pills are not fully
known. Therefore, if you are now taking any kind of birth control pill
or are considering using one, keep these guidelines in mind: 

Smoking and "the pill" don't mix. If you smoke cigarettes, stop smoking
or choose a different form of birth control. Cigarette smoking boosts
the risks of serious cardiovascular problems from birth control pill
use, especially the risk of blood clots. This risk increases with age
and with the amount smoked. For women over 35, the risk is particularly
high. Women who use oral contraceptives should not smoke. 

Pay attention to diabetes. Glucose metabolism, or blood sugar, sometimes
changes dramatically in women who take birth control pills. Any woman
who is diabetic, or has a close relative who is, should have regular
blood sugar tests if she takes birth control pills. 

Talk with your doctor. If you have a heart defect, if you have suffered
a stroke, or if you have any other kind of cardiovascular disease, oral
contraceptives may not be a safe choice. Be sure your doctor knows about
your condition before prescribing birth control pills for you. 



Alcohol 
------------------------------------------------------------------------

What is Moderate Drinking?

For women, "moderate drinking" is no more than one drink per day,
according to the U.S. Dietary Guidelines for Americans.

Count as one drink: 

 * 12 ounces of beer

 * 5 ounces of wine

 * 1 1/2 ounces of hard liquor (80 proof)


Source: Dietary Guidelines for Americans, U.S. Department of
Agriculture/U.S. Department of Health and Human Services, 1990. 


------------------------------------------------------------------------

Over the last several years, a number of studies have reported that
moderate drinkers--those who have one or two drinks per day--are less
likely to develop heart disease than people who don't drink any alcohol.
Alcohol may help protect against heart disease by raising levels of
"good" HDL cholesterol. On the other hand, it may also raise blood
pressure which could lead to stroke. 

If you are a nondrinker, this is not a recommendation to start using
alcohol. And certainly, if you are pregnant or have another health
condition that could make alcohol use harmful, you should not drink. But
if you're already a moderate drinker, evidence suggests that you may be
at a lower risk for heart attack. 

But remember, moderation is the key. Heavy drinking can definitely cause
heart-related problems. More than two drinks per day can raise blood
pressure, and recent research shows that binge drinking can lead to
stroke. It is well-known that people who drink heavily on a regular
basis have higher rates of heart disease than either moderate drinkers
or nondrinkers. 

Keep in mind, too, that alcohol provides no nutrients--only extra
calories. Most drinks contain 100-200 calories each. Women who are
trying to control their weight may want to cut down on alcohol and
substitute calorie-free iced tea, mineral water, or seltzer with a
squeeze of lemon or lime. 


------------------------------------------------------------------------

Prevention: A Personal Project

------------------------------------------------------------------------

Preventing heart disease, by and large, means making changes in the way
we live. For each individual, a healthy heart requires a personal action
plan. But where does one begin? A complete medical checkup is a sensible
first step. With the help of your doctor or other health professional,
you can find out if you have any cardiovascular disease risk factors,
and if so, work out a practical treatment plan. Even if you don't have
any risk factors now, you can discuss ways to lessen your chances of
developing them. Good communication with your health professional is
very important. Choose someone you trust who will listen to your
questions, answer them fully, and take your concerns seriously.

------------------------------------------------------------------------

To Do!

The Healthy Heart
Action Plan

 * Quit smoking

 * Cut back on foods high in fat, saturated fat, and cholesterol

 * Check blood pressure and blood cholesterol levels

 * Get more exercise

 * Lose weight if you are overweight


------------------------------------------------------------------------

But while advice from a health professional is important, the final
responsibility for heart health lies with each woman. Only you can make
the kinds of lifestyle changes--changes in eating, drinking, smoking,
and exercise habits--that will help protect against cardiovascular
diseases. To learn about the many organizations and reading materials
available to help you, see "Resources for a Healthy Heart." In the
meantime, keep reading. The self-help suggestions that follow can help
you get started on a person al program for a healthy heart.



Self-Help Strategies for a Healthy Heart


Kicking the Smoking Habit 

There is nothing easy about giving up cigarettes. But as hard as
quitting may be, the results are well worth it. In the first year after
stopping smoking, the risk of coronary heart disease drops sharply. It
then gradually returns to "normal"--that is, the same risk as someone
who never smoked. This means that no matter what your age, quitting will
lessen your chances of developing heart disease. 

Quitting will also save you money. Over 10 years, a two-pack-a-day
smoker can spend more than $7,500 on cigarettes. And that price tag
doesn't take into account the extra costs of smoking-related illnesses,
such as doctors' bills, medicines, and lost wages. 

Take some time to think about other benefits of being an ex-smoker.
Check the reasons that apply to you in the box that follows. Add any
others you think are important. This is an important first step in
kicking the smoking habit--figuring out for yourself what you have to
gain. 


Why I Want to Quit Smoking

I will greatly lessen my chances of having a heart attack or stroke.

I will greatly lessen my chances of getting lung cancer, emphysema, and
other lung diseases.

I will have fewer colds or flu each year.

I will have better smelling clothes, hair, breath, home, and car.

I will climb stairs and walk without getting out of breath.

I will have fewer wrinkles.

I will be free of my morning cough.

I will reduce the number of coughs, colds, and earaches my children will
have.

I will have more energy to pursue physical activities I enjoy.

I will have more control over my life.

I will _______________________________________________

I will _______________________________________________

I will _______________________________________________

I will _______________________________________________


Many women fear that if they stop smoking they will gain unwanted
weight. But you do not have to gain a lot of weight. Here are the facts: 

 * The average weight gain for ex-smokers is only about 5 pounds.

 * Only about 3 percent of women gain a lot of weight (more than 20
   pounds) after quitting.


Weight gain may be partly due to changes in the way the body uses
calories after smoking stops. Also, some people eat more when quitting
because they substitute high-calorie food for cigarettes. Choosing more
foods lower in calories and boosting your exercise level will help guard
against weight gain. And if you do gain some weight, you can work on
losing it after you have become comfortable as a nonsmoker. When you
think about the enormous health risks of smoking, the possibility of
putting on a few pounds is not a reason to continue.

Getting Ready to Quit 

Once you decide to stop smoking, a few preparations are in order. Set a
target date for quitting--perhaps the first day of a month. Don't choose
a time when you know you will be under a lot of stress. To help you
stick to your quit date, write the date on the contract that follows and
have someone sign it with you. And don't forget to list how you'll
reward yourself for becoming an ex-smoker. 

Consider asking your contract cosigner--or another friend or family
member--to give you special support in your efforts to quit. Plan to get
in touch with your supporter regularly to share your progress and to ask
for encouragement. Give your "cheerleader" a copy of your list of "Why I
Want to Quit" so that he or she can remind you of your goals. If
possible, quit with a spouse or a friend. 

Ex-Smoker's Contract

I will quit smoking on: (date) __________________

I will reward myself for not smoking as follows:

First 3 days of not smoking:

_______________________________________________________

_______________________________________________________

_______________________________________________________

Each week of not smoking:

_______________________________________________________

_______________________________________________________

_______________________________________________________

Each month of not smoking:

_______________________________________________________

_______________________________________________________

_______________________________________________________

Signed by: ____________________________________________

Cosigned by:

_______________________________________________________

_______________________________________________________ 


Breaking the Habit

Surviving "Day One." On the evening before your quit day, "clean house."
Throw away all cigarettes, matches, and lighters and give away your
ashtrays. Plan some special activities for the next day to keep you
busy, such as a long walk, a bike ride, a movie, or an outing with a
good friend. Ask family members and friends not to offer you cigarettes
or to smoke in front of you. Your goal is to get through that first
important day smoke-free. If you succeed on the first day, it will help
give you the confidence to succeed on the second--and on each day after
that.

Know yourself. To quit successfully, you need to know your personal
smoking "triggers." These are the situations and feelings that typically
bring on the urge to light up. Some common triggers include drinking
coffee, finishing a good meal, watching television, having an alcoholic
drink, talking on the phone, or watching someone else smoke. Stress can
also be a trigger. Make a list of the situations and feelings that
particularly tempt you to smoke. Especially during the first weeks after
quitting, try to avoid as many triggers as you can.

Find new habits. Replace "triggers" with new activities that you don't
associate with smoking. For example, if you always had a cigarette with
a cup of coffee, switch to tea for awhile. If you always smoked at the
table after dinner, get up as soon as the meal is over and go out for a
walk. If you're feeling tense or angry, try a relaxation exercise such
as deep breathing to calm yourself. (Take a slow, deep breath, count to
five, and release it. Repeat 10 times.) 

Keep busy. Get involved in projects that require you to use your hands:
needlework, gardening, jigsaw puzzles. Try out new physical activities
that make smoking impossible, such as swimming, jogging, tennis, or
aerobic dancing. When you feel the need to put something in your mouth,
have low-calorie substitutes on hand, such as vegetable sticks, apple
slices, or sugarless gum. Some people find it helpful to inhale on a
straw or chew on a toothpick until the urge passes. 

Know what to expect. During the first few weeks after quitting, you may
experiences some temporary withdrawal symptoms, such as headaches,
irritability, tiredness, constipation, and trouble concentrating. These
symptoms may come and go, and be stronger or weaker on different days.
While these feelings are not pleasant, it is important to know that they
are signs that your body is recovering from smoking. Most symptoms end
within 2 to 4 weeks. 

Two things to help you. Nicotine chewing gum and a nicotine patch are
both available by prescription. The gum and the patch can help you stay
off cigarettes by lessening your withdrawal symptoms. They give you
nicotine at a lower, more even dose than your cigarettes did. Gradually,
you should chew fewer pieces of the gum each day until you stop using it
altogether. Similarly, you gradually use patches with a lower dose of
nicotine. Nicotine gum and the nicotine patch are not for everyone--talk
to your health professional about using them. Pregnant women, nursing
mothers, and people with serious heart problems cannot use them safely.
But for those who can, both the gum and the patch can help one "over the
hump" and on the road to smoke-free living.

More help is available. There are a number of free or low-cost programs
available to help you stop smoking. They include programs offered by
local chapters of the American Lung Association and the American Cancer
Society (see "Resources for a Healthy Heart"). Other low-cost programs
can be found through hospitals, health maintenance organizations (HMOs),
workplaces, and community groups. Some programs offer special support
for women. 

Be good to yourself. Get plenty of rest, drink lots of fluids, and eat
three balanced, healthful meals per day. If you are not as productive or
cheerful as usual during the first several weeks after quitting, don't
feel guilty. Give yourself a chance to adjust to your new nonsmoking
lifestyle. Ask your friends and family to give you lots of praise for
kicking the habit--and don't forget to pat yourself on the back. You are
making a major change in your life, and you deserve a lot of credit. 

If You "Slip" 

A "slip" means that you have had a small setback and smoked a cigarette
after your quit date. Don't worry. It doesn't mean that you've become a
smoker again. Most smokers "slip" three to five times before they quit
for good. But to get right back on the nonsmoker track, here are some
tips: 

Don't get discouraged. Having a cigarette or two doesn't mean you have
failed. It doesn't mean you can't quit smoking. A slip happens to many,
many people who successfully quit. Keep thinking of yourself as a
nonsmoker. You are one. 

Learn from experience. What was the trigger that made you light up? Were
you driving home from work, having a glass of wine at a party, feeling
angry at your boss? Think back on the day's events until you remember
what the specific trigger was. 

Take charge. Make a list of things you will do the next time you are in
the particular situation--and other tempting situations as well. Sign a
new contract with your support person to show yourself how determined
you are to kick the habit. Reread your list of all the reasons you want
to quit. You're on your way. 

Getting Physical 

Regular exercise can help you reduce your risk of coronary heart
disease. Exercise helps women take off extra pounds, helps to control
blood pressure, lessens a diabetic's need for insulin, and boosts the
level of "good" HDL-cholesterol. 

Some studies also show that being inactive boosts the risk of heart
attack. 



A Sample Walking Program

          Warm Up  |  Target Zone Exercizing  |  Cool Down   | Total Time
          ---------------------------------------------------------------
WEEK 1 
------------------------------------------------------------------------
Session   Walk slowly    Then walk briskly     Then walk slowly     15
   A        5 min.           5 min.                5 min.           min.


Session B               Repeat above Pattern

Session C               Repeat above Pattern

------------------------------------------------------------------------
Continue with at least three exercise sessions during
each week of the program 
------------------------------------------------------------------------

------------------------------------------------------------------------
WEEK 2 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly     17
            5 min.           7 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 3 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly     19
            5 min.           9 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 4 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      21
            5 min.           11 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 5 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      23
            5 min.           13 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 6 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      25
            5 min.           15 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 7 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      28
            5 min.           18 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 8 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      30
            5 min.           20 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 9 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      33
            5 min.           23 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 10 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      36
            5 min.           26 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 11 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      38
            5 min.           28 min.                5 min.           min.

------------------------------------------------------------------------
WEEK 12
and beyond 
------------------------------------------------------------------------
          Walk slowly    Then walk briskly     Then walk slowly      40
            5 min.           30 min.                5 min.           min.
------------------------------------------------------------------------


Exercise has many other benefits. It strengthens the lungs, tones the
muscles, keeps the joints in good condition, and helps many people cope
better with stress. 

While many physical activities are fun, only regular, brisk exercise
will improve heart health. This is called "aerobic" exercise and
includes jogging, swimming, jumping rope, and cross-country skiing.
Walking, biking, and dancing can also strengthen your heart, if you do
them fast enough and long enough. Choose an activity that you think you
will enjoy and that will fit most easily into your schedule. 

Most people do not need to see a doctor before they start a gradual,
sensible exercise program. Some people, however, should get medical
advice. For example, if you have heart trouble or have had a heart
attack, if you are over 50 years old and are not used to energetic
activity, or if you have a family history of developing heart disease at
a young age, check with your doctor before you start. 

Once you get started, keep these guidelines in mind: 

Go slow. Before each exercise session, allow a 5-minute period of
stretching and slow exercise to give your body a chance to "warm up." At
the end of your workout, take another 5 minutes to "cool down" with a
slower, less energetic exercise pace.
------------------------------------------------------------------------

Dietary Guidelines for
Americans


 * Eat a variety of foods
 * Maintain a healthy weight
 * Choose a diet low in fat, saturated fat, and cholesterol
 * Choose a diet with plenty of vegetables, fruits, and grain products
 * Use sugars only in moderation
 * Use salt and sodium only in moderation
 * If you drink alcoholic beverages, do so in moderation

Use these seven guidelines together as you choose a healthful and
enjoyable diet.


------------------------------------------------------------------------


Listen to your body. A certain amount of stiffness is normal at first.
But if you hurt a joint or pull a muscle or tendon, stop exercising for
several days to avoid more serious injury. Most minor muscle and joint
problems can be relieved by rest and over-the-counter painkillers. 

Pay attention to warning signals. While exercise can strengthen your
heart, some types of activity may worsen existing heart problems.
Warning signals include sudden dizziness, cold sweat, paleness,
fainting, or pain or pressure in your upper body just after exercising.
If you notice any of these signs, stop exercising and call your doctor
immediately. 

Keep at it. Unless you have to stop exercising for a health reason, stay
with your exercise program. If you feel like giving up because you think
you're not going as fast or as far as you "should," set smaller,
short-term goals for yourself as well as grander ones. If you find
yourself becoming bored, try exercising with a friend. Or switch to
another activity. The health rewards of regular, brisk exercise are well
worth the effort. 

Eating for Health 

The health of your heart has a lot to do with the food you eat. Changing
your eating habits according to the Dietary Guidelines for Americans
lessens your risk of heart disease in three ways: 

 * It helps reduce high blood cholesterol levels.
 * It helps control high blood pressure.
 * It helps take off extra pounds.

As a bonus, the kinds of eating habits that are good for your heart may
also help prevent certain types of cancer and a number of other health
problems. 

The Healthy Diet: Back to Basics

Each day, choose different foods that you enjoy eating from each of
these food groups:

Food Group              Daily Servings          What Counts as a Serving
------------------------------------------------------------------------
vegetables              3-5 servings            1 cup raw leafy greens
                                                1/2 cup other vegetables

fruits                  2-4 servings            1 medium apple, bannana,
                                                  orange
                                                1/2 fruit -- fresh, cooked,
                                                  canned
                                                3/4 cup juice

breads, cereals,
 rice, and pasta        6-11 servings           1 slice bread
                                                1/2 bun or bagel
                                                1 ounce dry cereal
                                                1/2 cup cooked cereal,
                                                  rice, pasta

milk, yogurt,
 & cheese               2-3 servings            1 cup milk (skim or low-fat)
                                                8 ounces low-fat yogurt
                                                1 1/2 ounces low-fat
                                                  natural cheese
                                                2 ounces low-fat
                                                  processed cheese
meat, poultry,
fish, dry beans
and peas, eggs,
and nuts                2-3 servings            This totals 6 ounces
                                                  of cooked lean
                                                  meat, poultry without
                                                  skin, or fish per day
                                                Count 1/2 cup cooked beans,
                                                  1 egg, or 2 Tbs.
                                                   peanut butter
                                                  as 1 ounce meat
                                                (Limit the use of egg yolks
                                                    and organ meats since
                                                    they are high in
                                                    cholesterol.)
                                                   
------------------------------------------------------------------------


Source: Dietary Guidelines for 

Americans, U.S. Department of
Agriculture/U.S. Department of Health
and Human Services, 1990

------------------------------------------------------------------------


Lowering Blood Cholesterol 

Reducing your blood cholesterol level can greatly lessen the chances of
developing coronary heart disease. One major study showed that each 1
percent reduction in blood cholesterol produced a 2 percent reduction in
the number of heart attacks. This means that if you lower your blood
cholesterol by 25 percent, you may cut your risk of heart attack in
half. 

For most people, blood cholesterol can be lowered by eating less
saturated fat, less total fat, and less cholesterol. Cutting down on the
fat in your diet also protects your heart another way--by helping you
cut back on calories and take off extra pounds. 

Today, about 37 percent of the calories in the average American diet
come from fat--about 13 percent from saturated fat and 24 percent from
monounsaturated and polyunsaturated fat. To lessen your chances of
getting coronary heart disease, the total fat in your diet should be no
more than 30 percent of the total calories you take in each day. Your 30
percent "fat allowance" should be divided up this way: 

 * Saturated fat should make up less than 10 percent of total calories.
 * Polyunsaturated fat should be not more than 10 percent of total
   calories.
 * Monounsaturated fat should make up 10 to 15 percent of total
   calories.

In addition, you should eat less than 300 mg of cholesterol per day.
This eating pattern is recommended for all healthy Americans ages 2 and
over*, and especially for those who want to lower their blood
cholesterol levels. Use the guide to choosing low-saturated fat,
low-cholesterol foods on page 68-69. If you follow this diet for 3 to 6
months and your blood cholesterol does not drop to a normal level, you
may need to cut back still more on saturated fat and cholesterol. 

Fat-Finding 

Now, let's get practical. Which foods belong to which categories? 

Saturated fat is found mainly in foods that come from animals. Whole
milk dairy products such as butter, cheese, milk, cream, and ice cream
all contain high amounts of saturated fat. The fat in meat and poultry
skin is also loaded with saturated fat. A few vegetable fats--coconut
oil, cocoa butter, palm kernel oil, and palm oil--are also high in
saturated fat. These fats are sometimes found in cookies, crackers,
coffee creamers, whipped toppings, and snack foods. Because fats are
invisible in many foods, it is very important to read food labels.

Figuring Out Fat

Your personal "fat allowance" depends on how many calories you take in
each day. Remember, the total fat in your diet should be no more than 30
percent of your daily calories, and saturated fat should be no more than
10 percent. The chart below shows the upper limit on total fat and
saturated fat grams you should eat, depending on how many calories you
consume each day. Check food product labels to find out the number of
fat grams (total and saturated) in each serving.

Total Calories           Total Fat       Saturated Fat
 (Per Day)               (in grams)      (in grams)
------------------------------------------------------------------------
 1,600                   53 or less       18 or less
 2,000                   67 or less       22 or less
 2,400                   80 or less       27 or less
------------------------------------------------------------------------

* Source:
Report of the Expert Panel on Population Strategies for Blood
Cholesterol Reduction, NHLBI, 1990.

------------------------------------------------------------------------

Remember: Saturated fat boosts your blood cholesterol level more than
anything else in your diet. Eating less saturated fat is the best way to
lower your blood cholesterol level. 

Unsaturated fat actually helps to lower cholesterol levels when you use
it in place of saturated fat. One type of polyunsaturated fat, which is
found in many cooking and salad oils, such as safflower, corn, soybean,
cottonseed, sesame, and sunflower oils, and in margarine. Another type
is monounsaturated fat, which is found in olive and canola oils. 

Cholesterol is found only in foods that come from animals. Egg yolks and
organ meats (liver, for example) are very high in cholesterol. Meat and
poultry have similar amounts of cholesterol. 

Now You're Cooking 

Planning and cooking meals aimed at reducing blood cholesterol don't
have to be complicated. Here are a few suggestions: 

* Choose fish, poultry, and lean cuts of meat, and remove fat from meats
and skin from chicken before eating. Eat up to 6 ounces per day.

* Broil, bake, roast, or poach foods rather than fry them.

* Cut down on sausage, bacon, and processed high-fat cold cuts.

* Limit organ meats such as liver, kidney, or brains.

* Instead of whole milk or cream, drink skim or low-fat milk. Try low-fat
yogurt in place of sour cream. Use low-fat cheeses. Sherbet or low-fat
frozen yogurt can be a delicious replacement for ice cream.

* Instead of butter, use margarine or liquid vegetable oils high in
unsaturated fats. All fats and oils should be used sparingly.

* Eat egg yolks only in moderation. Egg whites contain no fat or
cholesterol and can be eaten often.

* Eat plenty of fruits and vegetables, as well as cereals, breads, rice,
and pasta made from whole grains (for example, rye bread, whole wheat
spaghetti, bran cereal). These foods are good sources of starch and
fiber, and usually contain no cholesterol and little or no saturated
fat.

* Liquid vegetable oils are a good choice for sauting vegetables,
browning potatoes, popping corn, and for making baked goods, pancakes,
and waffles. Use small amounts.

* Many store-bought baked goods, snacks, and other prepared foods have
hidden saturated fats because they are made with lard, butter, cream,
coconut oil, or palm oil. Get in the habit of reading product labels,
and choose products that are lowest in fat and saturated fat. New baked
goods have been developed which contain no cholesterol and very little
fat. But keep in mind that they may be high in calories.

For more meal ideas, see "Recipes for a Healthy Heart" and "Meal
Planning: A Change of Heart" at the back of this handbook. 

Controlling Blood Pressure 

More than half of American women will develop high blood pressure at
some point in their lives. Women who have the highest risk include those
who are black, have a family history of high blood pressure, are
overweight, or have "high-normal" blood pressure. To help keep blood
pressure under control, take these steps: 

Lose weight, if you are overweight.

If you drink alcohol, have no more than one drink per day--that means
no more than 12 ounces of beer, 5 ounces of wine, or 1 1/2 ounces of
hard liquor.

Exercise regularly. A regular aerobic exercise program--for example,
brisk walking, bicycling, jogging, or swimming--helps weight control and
is good for your entire cardiovascular system.

Use salt in small amounts, if at all, in cooking and at the table. Try
seasoning foods instead with pepper, garlic, ginger, minced onion or
green pepper, and lemon juice. Keep in mind that sodium, an ingredient
in salt, is "hidden" in many foods such as cured meats, cheese, canned
vegetables and soups, frozen dinners, prepared snacks, and condiments
such as catsup, soy sauce, pickles, and olives. Check product labels for
the amount of sodium in each serving, or buy products labeled "no
sodium," or "reduced in sodium."

While salt substitutes containing potassium chloride may be useful for
some individuals, they can be harmful to people with certain medical
conditions. Ask your doctor before trying salt substitutes.

If your doctor prescribes medication, take it regularly as directed.

Losing Weight: Four Ways to Win 

If you are overweight, taking off pounds can lower the chances of
developing cardiovascular disease in several ways. First, since being
overweight raises the risk of heart disease, losing weight will directly
lower your risk. Secondly, weight loss will also help reduce the risk of
developing diabetes and help control it. Third and fourth, shedding
pounds can lower both high blood pressure and cholesterol. In fact, if
your blood pressure or blood cholesterol count is not too high, weight
loss along with other changes in your diet may be the only treatment you
will need. But even if medication is required, the more healthful your
weight, the less medication you may need.

In a society so concerned about thinness, it may be hard to listen to
yet more advice about the need to take off pounds. But too often, women
are pressured to lose too much weight and for the wrong reasons: to look
better in trendy clothes, to attract male attention, to have today's
super-slim athletic look. The aim here is not to promote the false and
discouraging idea that "thin is beautiful," but to show the link between
reasonable weight and good health--especially the health of your heart.
Weight loss is advised only to reach a healthy weight, not to drop to an
extreme level.

Taking off pounds-and especially keeping them off--can be quite a
challenge. Here are some suggestions for making weight loss an easier,
safer, and more successful process: 

Eat for health. Choose a wide variety of low-calorie, nutritious foods
in moderate amounts from each food group. Make sure that these foods are
low in fat, since fat is the richest source of calories. To make every
calorie count cut out snack foods that are high in calories but provide
few other nutrients. If you have a lot of weight to lose, ask your
doctor, a nutritionist, or registered dietitian to help you develop a
sensible, well-balanced plan for gradual weight loss. To lose weight you
will need to take in fewer calories than you burn. That means that you
must either choose food with fewer calories or boost your physical
activity--and preferably, do both.

Keep milk on the menu. Don't cut out dairy products in trying to reduce
calories and fat. Dairy products are rich in calcium, a nutrient that is
particularly important for women. Instead, choose low-fat, lower-calorie
dairy products. For instance, if you are used to drinking whole milk,
gradually cut back to 2 percent milk, move to 1 percent, and then
perhaps to skim milk. This way the calories are reduced while the amount
of calcium remains the same. 

Beyond dieting. To keep the pounds off, change your basic eating habits
rather than simply "go on a diet." Keep a food diary of what, how much,
when, and why you eat to help you understand your eating patterns and
what affects them. Learn to recognize social and emotional situations
that trigger overeating and figure out ways to cope with them. Set
short-term goals at first. 

Forget the fads. Tempting as their promises are, fad diets are not the
answer. Most provide poor nutrition and cause a number of side effects,
especially those with less than 800 calories. Although fad diets can
give quick and dramatic results, much of the weight loss is due to water
loss. The weight returns quickly once you stop dieting. 

Steer clear of diet pills. Studies show that most diet medicines have
troublesome side effects and don't work for long-term weight loss. 

Get a move on. Although physical activity alone won't take off many
pounds, exercise can help burn calories, tone muscles, and control
appetite. (It will also give you something to do when you feel that
familiar urge for a slice of chocolate fudge cake.) Even moderate
activity, such as brisk walking, will burn up calories and help control
weight. 

Ask for support. Tell your family and friends about your weight-loss
plans and let them know how they can be most helpful to you. You might
also want to join a self-help group devoted to weight control. These
groups provide companionship, support, and practical suggestions on
changing eating habits and long-term weight loss. 

Move It and Lose It

  Activity                                  Calories Burned Per Hour*
------------------------------------------------------------------------

        Sitting Quietly                                  80
        Standing Quietly                                 95

Light Activity                                          240
        Office work
        Cleaning house
        Playing golf

Moderate Activity                                       370
        Walking briskly (3.5 mph)
        Gardening
        Bicycling (5.5 mph)
        Dancing
Strenuous Activity                                      580
        Jogging (9 min. per mile)
        Swimming
Very Strenuous Activity                                 740
        Running (7 min. per mile)
        Racquetball
        Skiing

*For a healthy 140-pound woman. If you weight more than 140 pounds, you
will probably burn more calories per hour. If you weigh less, you will
probably burn fewer calories per hour.

------------------------------------------------------------------------

Source: Dietary Guidelines for 

Americans, U.S. Department
of Agriculture/U.S. Department
of Health and Human Services,
1990. 

------------------------------------------------------------------------




Other Prevention Issues 

Hormones and Menopause 

Should menopausal women use "hormone replacement therapy"? 

There is no simple answer to this question. 

Menopause is caused by a decrease in estrogen and other hormones
produced by a woman's ovaries. It happens naturally in most women
between the ages of 45 and 55, and it also occurs in any woman whose
ovaries are removed by an operation. As estrogen levels begin to drop,
some women develop uncomfortable symptoms such as "hot flashes" and mood
changes. Hormone replacement therapy--a term for prescription hormone
pills that are taken daily--can be used to relieve these symptoms. Some
women are prescribed pills that contain only estrogen. Others take
estrogen combined with a second hormone called progestin.

Estrogen pills have several important benefits. They can help you feel
more comfortable as your body adjusts to lower estrogen levels. They
also help to prevent osteoporosis, a thinning of the bones that makes
them more likely to break in later life. Many studies also have found
that estrogen pills help protect women from developing coronary heart
disease, but more research is needed before we will know this for sure. 

Estrogen therapy also has risks. It may increase the chances of
developing gallbladder disease, and it may worsen migraine headaches. It
may also increase the risk of breast cancer. But by far, the biggest
risk of taking estrogen pills is cancer of the uterus. Women on estrogen
therapy after menopause are up to six times more likely to develop
uterine cancer than women not on this treatment. It is important to
point out that women are much more likely to die of coronary heart
disease than from uterine cancer. Still, the cancer risk exists and must
be taken seriously and discussed with your doctor.

Because of the risk of uterine cancer, some doctors now prescribe
estrogen in combination with the hormone progestin. When progestin is
taken along with estrogen, the risk of cancer of the uterus is reduced.
While this is good news, we don't yet know how this newer "combo"
treatment affects other aspects of women's health. We don't know, for
example, whether the progestin-estrogen combination is a safe and
effective way to prevent heart disease. We don't know whether the
combined hormones are as successful as estrogen alone in protecting
women from osteoporosis. Finally, we don't yet know whether this
combination will boost the risk of breast cancer. Studies are now under
way to find answers to these important questions.

In the meantime, a woman and her doctor must decide whether the benefits
of hormone therapy are worth the risks. If you are considering this
treatment, you will need to consider your overall health and your
personal and family history of heart disease, uterine and breast cancer,
and osteoporosis. 

If you are now on hormone therapy, check with your doctor to be sure you
are taking the lowest possible effective dose. At least every 6 months,
you and your doctor should discuss whether you need to continue
treatment. Be alert for signs of trouble--abnormal bleeding, breast
lumps, shortness of breath, dizziness, severe headaches, pain in your
calves or chest--and report them immediately. See your doctor at least
once a year for a physical examination. 

The Aspirin Question 

You may have heard that taking aspirin regularly can help prevent heart
attacks. Is this a good idea for you? Maybe. 

A recent study of more than 87,000 women found that those who took a low
dose of aspirin regularly were less likely to suffer a first heart
attack than women who took no aspirin. Older women appeared to benefit
most: those over age 50 had a 32 percent lower risk of heart attack,
while women overall had a 25 percent lower risk. While earlier research
has shown that aspirin can help prevent heart attacks in men, this was
the first study to suggest a similar benefit for women. 

Other recent research suggests that only a tiny daily dose of aspirin
may be needed to protect against heart attacks. One study found that for
both women and men, taking only 30 mg of aspirin daily--one-tenth the
strength of a regular aspirin--helped prevent heart attacks as
effectively as the usual 300 mg dose. The smaller dose also caused less
stomach irritation. 

While these recent reports are encouraging, more study is needed before
we can be sure that aspirin is safe and effective in preventing heart
attacks in women. What is known for sure is that you should not take
aspirin to prevent a heart attack without first discussing it with your
doctor. Aspirin is a powerful drug with many side effects. It can
increase your changes of getting ulcers and stroke from a hemorrhage.
Only a doctor who knows your complete medical history and current health
can judge whether the benefit you may gain from aspirin outweighs the
risks.

------------------------------------------------------------------------

Research: New Focus on Women

------------------------------------------------------------------------

As you have read through this handbook, you may have noticed the
recurring words: "more research is needed." This is true. Until very
recently, men were the main subjects of heart disease research. We now
know, however, that coronary heart disease is indeed a woman's concern.
We know that we need to understand more about women's heart problems if
we are to prevent and treat these problems successfully. As a result,
several major research projects are now under way. They include studies
on: 

The effects of hormone replacement therapy on cardiovascular diseases,
uterine cancer, breast cancer, and osteoporosis. Both estrogen pills and
estrogen-progestin combinations are being studied.

Whether low doses of aspirin can safely and successfully protect women
from heart attacks.

The effect of a low-saturated-fat diet on preventing coronary heart
disease in women.

 Whether commonly used programs to encourage exercise, weight control,
and quitting smoking are successful for women.

Possible links between stress, hormonal changes, and risk for coronary
heart disease in women.


These and other important research projects will give us new information
and tools to better protect ourselves from coronary heart disease. They
will also help doctors identify and treat women's heart problems more
successfully. Where women's hearts are concerned, knowledge is
power--the power to improve our health and enrich our lives. 


The Heart of the Matter

Getting serious about heart health may seem like a huge project. Because
it means making basic changes in health and living habits, for many it
is a major effort. But it doesn't have to be an overwhelming one. Some
people find it easier to tackle only one habit at a time. If you smoke
cigarettes and also eat a high-fat diet, for example, work on kicking
the smoking habit first. Then, once you have gotten used to life without
cigarettes, begin skimming the fat from your diet. 

And remember: nobody's perfect. Nobody always eats the ideal diet or
gets just the right amount of exercise. Few smokers are able to swear
off cigarettes without a slip or two along the way. The important thing
is to want to make healthful changes, and then to follow a sensible,
realistic plan that will gradually lessen your chances of developing
cardiovascular diseases. 

Women are taking a more active role in their own health care. We are
asking more questions and we are seeking more self-help solutions. We
are concerned not only about treatment, but about the prevention of a
wide range of health problems. Taking steps to prevent cardiovascular
diseases is part of this growing movement to promote and protect
personal health. The rewards of a healthy heart are well worth the
effort. 

Meal Planning: a Change of Heart 


Average American Diet (37% Fat)         A New Low-Fat Diet (30% Fat)
------------------------------------------------------------------------
Breakfast                               Breakfast

1 fried egg                             1 cup corn flakes with
2 slices white toast with                 blueberries
  1 teaspoon butter                   1 cup 1% milk
1 cup orange juice                      1 slice rye toast with
                                          1 teaspoon margarine
                                        1 cup orange juice
                                        black coffee or tea

Snack

1 doughnut Snack                        1 toasted pumpernickel bagel
                                          with 1 teaspoon margarine

Lunch

1 grilled cheese (2 ounces)             1 tuna salad (3 ounces) sandwich
  sandwich on white bread               on whole wheat bread
2 oatmeal cookies                         with lettuce and tomato
black coffee or tea Lunch               1 graham cracker
                                        tea with lemon

Snack                                   Snack

20 cheese cracker squares               1 crisp apple Dinner


Dinner

3 ounces fried hamburger with           3 ounces broiled lean ground beef
  ketchup                               with ketchup
1 baked potatoe with sour cream         1 baked potatoe with low-fat
3/4 cup steamed broccoli with             plain yogurt and chives
  1 teaspoon butter                   3/4 cup steamed broccoli with
1 cup whole milk                          1 teaspoon margarine
1 piece frosted marble cake Dinner      tossed garden salad with
                                          1 tablespoon oil and vinegar
                                          dressing
                                        1 cup 1% milk
                                        1 small piece homemade gingermade
                                          with maraschino cherry and sprig
                                          of mint

Nutrient Analysis                        Nutrient Analysis

Calories 2,000                           Calories 2,000
Total fat (percent of calories) 37       Total fat (percent of calories) 30
Saturated fat (% of calories) 19         Saturated fat (% of calories) 10
Cholesterol 505 mgs                      Cholesterol 186 mgs


A Guide to Choosing Low-Fat, Low-Cholesterol Foods 

Variety is the spice of life. Choose foods every day from each of the
following food groups. Choose different foods from within groups,
especially foods low in saturated fat and cholesterol (the Choose
column). As a guide, the recommended daily number of servings for adults
is listed for each food group. But you'll have to decide on the number
of servings you need to lose or maintain your weight. If you need help,
as a dietitian or your doctor. 

MEAT, POULTRY, FISH
AND SHELLFISH

(up to 6 ounces a day)
Choose

Lean cuts of meat with fat trimmed, like: 
 -  beef-round, sirloin, chuck, loin
 -  lamb-leg, arm, loin, rib
 -  pork-tenderloin, leg (fresh), shoulder (arm
    or picnic)
 -  veal-all trimmed cuts except ground
 -  poultry without skin
 -  fish, shelfish

Decrease

"Prime" grade fatty cuts of meat like:
 -  beef-corned beef brisket, regular ground,
    short ribs
 -  pork-spareribs, blade roll
Goose, domestic duck
Organ meats, like: liver, kidney, sweetbreads, brain
Sausage, bacon, frankfurters, regular luncheon meats
Cavier, roe 
------------------------------------------------------------------------
DAIRY PRODUCTS

(2 servings a day;
3 servings for women who are
pregnant or breast feeding)
Choose

Skim milk, 1% milk, low-fat buttermilk,
  low-fat evaporated or nonfat milk
Low-fat yogurt and low-fat frozen yogurt
Low-fat soft cheeses, like: cottage, farmer, pot
Cheese labeled no more than 2 to 6 grams of
  fat an ounce

Go Easy On

2% milk
Part-skim ricotta
Part-skim or imitation hard
  cheeses, like:
 -  part-skim mozzarella
 -  "Light" cream cheese
 -  "Light" sour cream

Decrease

Whole milk, like: regular, evaporated,
  condensed
Cream, half-and-half, most nondairy creamers
  and products, real or nondairy whipped
  cream
Cream cheese, sour cream, ice cream, custard-style
  yogurt
Whole-milk ricotta
High-fat cheese, like: Neufchatel, Brie, Swiss,
  American, mozzarella, feta, cheddar,
  Muenster 


------------------------------------------------------------------------
EGGS

(no more than 3 egg
yolks a week)
Choose

Egg whites
Cholesterol-free egg substitutes

Decrease

Egg yolks

------------------------------------------------------------------------
FATS AND OILS 

(up to 6 to 8
teaspoons a day) Choose

Unsaturated vegetable oils like: 
  corn, olive, peanut, 
  rapeseed (canola oil), 
  safflower, sesame,
  soybean
Magerine or shortening made
  with unsaturated
  fats listed above: liquid tub,
  stick
Diet mayonnaise, salad 
  dressings made with
  unsaturated fats listed above
Low-fat dressings

Go Easy On

Nuts and seeds
Avocados and olives

Decrease

Butter, coconut oil, palm 
  kernel oil, palm oil,
  lard, bacon fat
margarine or shortening made
  with saturated fats listed
  above
Dressings made with egg yolk 
------------------------------------------------------------------------
BREADS, CEREALS,
PASTA, RICE, DRIED PEAS
AND BEANS

(6 to 11 servings a day) Choose

Breads, like: white, whole wheat, pumpernickel,
  and rye breads; sandwich buns; 
  dinner rolls; rice cakes
Low-fat crackers, like: matzo, pita; bagels; 
  English muffins; bread sticks,
  rye krisp, saltines, zwieback
Hot cereals, most cold dry cereals
Pasta, like: plain noodles, spaghetti, 
  macaroni
Any grain rice
Dried peas and beans, like: split peas, 
  black-eyed peas, chick peas, 
  kidney beans, navy beans, 
  lentils, soybeans, soybean
  curd (tofu)

Go Easy On

Store-bought pancakes, waffles, biscuits,
  muffins, cornbread

Decrease

Croissants, butter rolls, sweet rolls, Danish
  pastry, doughnuts
Most snack crackers, like: cheese crackers,
  butter crackers, those made with
  saturated fats
Granola-type cereals made with saturated fats
Pasta and rice prepared with cream, butter, or
  cheese sauces, egg noodles 
------------------------------------------------------------------------
FRUITS AND VEGETABLES 

(2 to 4 servings of fruit and
3 to 5 servings of vegetables)
Choose

Fresh, frozen, canned, or dried fruits and
  vegetables

Decrease

Vegetables prepared in butter, cream, or
  sauce 
------------------------------------------------------------------------
SWEETS AND SNACKS

(avoid too many sweets) Choose

Low-fat frozen desserts, like: sherbet, sorbet, Italian 
  ice, frozen yogurt, popsicles
Low-fat cakes, like: angel food cake
Low-fat cookies, like: fig bars, gingersnaps
Low-fat candy, like: jelly beans, hard candy
Low-fat snacks, like: plain popcorn, pretzels
Nonfat beverages, like: carbonated drinks, juices,
  tea, coffee

Go Easy On

Frozen desserts, like: ice milk
Homemade cakes, cookies, and pies using
  unsaturated oils sparingly
Fruit crisps and cobblers
Potato and corn chips prepared with unsaturated
  vegetable oil

Decrease

High-fat frozen desserts, like: ice cream, frozen
  tofu
High-fat cakes, like: most store-bought, pound,
  and frosted cakes
Store-bought pies, most store bought cookies
Most candy, like: chocolate bars
Potato and corn chips prepared with saturated
  fat
Buttered popcorn
High-fat beverages, like: frappes, milkshakes,
  floats, eggnogs 
------------------------------------------------------------------------
LABEL INGREDIENTS 

To avoid much fat, saturated
fat, or cholesterol, go easy
on products that list first
any fat, oil, or ingredients
higher in saturated fat or
cholesterol. Choose more
often those products that 
contain ingredients lower in
saturated fat or cholesterol. Choose

Ingredients Lower in Saturated Fat or
  Cholesterol:
Carob, cocoa
Oils, like: corn cottonseed, olive, safflower,
  sesame, soybean, sunflower
Nonfat dry milk, nonfat dry milk solids,
  skim milk

Decrease

Ingredients Higher in Saturated Fat or
  Cholesterol:
Chocolate
Animal fat, like: bacon, beef, ham,
  lamb, meat, pork, chicken or turkey
  fats, butter, lard
Coconut, coconut oil, palm-kernel or
  palm oil
Cream
Egg and egg-yolk solids
Hardened fat or oil
Hydrogenated vegetable oil
Shortening or vegetable shortening,
  unspecified vegetable oil (could be
  coconut, palm-kernel, palm) 

------------------------------------------------------------------------



Source: Adapted from Report of the Expert Panel
on Detection, Evaluation, and Treatment of 
High Blood Cholesterol in Adults,
NHLBI, 1989. 


------------------------------------------------------------------------

Recipes for a Healthy Heart

Corn Chowder

Add a mixed green salad, whole grain bread, plus
a fruit for a satisfying supper ... 

1 Tbsp margarine
2 Tbsp finely chopped celery
2 Tbsp finely chopped onion
2 Tbsp finely chopped green pepper
1 10-oz pkg frozen whole kernel corn
1 C peeled, diced, raw potatoes
2 Tbsp chopped fresh parsley
1 C water
1/4 tsp salt
Freshly ground black pepper
1/4 tsp paprika
2 Tbsp flour
2 C low-fat (1%) milk

NUTRIENTS PER SERVING
Calories/cup: 182
Total fat: 4 gms
Saturated fat: 1 gm
Polyunsaturated fat: 1 gm
Cholesterol: 5 mgs
Sodium: 236 mgs

Melt margarine in medium saucepan. Add celery, onion, and green pepper
and saute, for 2 minutes. Add corn, potatoes, water, salt, pepper, and
paprika. Bring to a boil; reduce heat to medium; and cook, covered,
about 10 minutes or until potatoes are tender. Place 1/2 cup milk in a
jar with tight-fitting lid. Add flour and shake vigorously. Add
gradually to cooked vegetables and add remaining milk. Cook, stirring
constantly, until mixture comes to a boil and thickens. Serve garnished
with chopped fresh parsley.

4 servings, 1 cup each 


Homemade Turkey Soup

A good recipe to make ahead and refrigerate
or freeze until needed ... 

6 lb turkey breast
2 medium onions
3 stalks celery
1 tsp dried thyme
1/2 tsp dried rosemary
1/2 tsp dried sage
1 tsp dried basil
1/2 tsp dried marjoram
1/2 tsp dried tarragon
1/2 lb Italian pastina
1/2 tsp salt
Pepper to taste

NUTRIENTS PER SERVING
Calories: 226
Total fat: 5 gms
Saturated fat: 1 gm
Polyunsaturated fat: 1 gm
Cholesterol: 93 mgs
Sodium: 217 mgs

Place turkey breast in a large 6-qt pot. Cover with water (at least 3/4
full). Add peeled onions, cut in large pieces. Wash celery stalks,
slice, and add. Simmer covered for about 2 1/2 hours. Remove carcass
from pot and cool soup in refrigerator. After cooling, skim off fat.
While soup is cooling, remove remaining meat from carcass. Cut into
pieces. Add meat to skimmed soup along with herbs and spices. Bring to
boil. Add pastina. Continue cooking, low boil, 20 minutes until pastina
is done. Serve at once or refrigerate and reheat later.

16 servings, 1 cup each 



Very Lemony Chicken

Serve with wild rice and barley casserole, 
a curly endive salad, peas, and sorbet ... 

1 1/2 lb chicken parts (breast, leg, and thigh),
  skinned and fat removed
1/2 C fresh lemon juice
2 Tbsp white wine vinegar
1/2 C fresh sliced lemon peel
3 tsp chopped fresh oregano
  or 1 tsp dried oregano, crushed
1 medium onion, sliced
1/4 tsp salt
Freshly ground black pepper
1/2 tsp paprika

NUTRIENTS PER SERVING
Calories: 154
Total fat: 5 gms
Saturated fat: 2 gms
Polyunsaturated fat: 1 gm
Cholesterol: 63 mgs
Sodium: 202 mgs


Place chicken in a 13x9x2 glass baking dish. Mix lemon juice, vinegar,
lemon peel, oregano, and onion. Pour over chicken, cover, and marinate
in refrigerator several hours or overnight, turning occasionally.
Sprinkle with salt, pepper, and paprika. Cover and bake at 300 degrees
for 30 minutes. Uncover and bake 30 minutes more or until done. 

4 servings 



Barbecue Chicken

Make this your specialty -- serve with cornbread
and a salad of distinctive greens ... 
3 lb chicken parts (breast, leg, and thigh),
  skinned and fat removed
1 large onion, thinly sliced
3 Tbsp vinegar
3 Tbsp Worcestershire sauce
2 Tbsp brown sugar
Dash of pepper
1 Tbsp hot pepper flakes
1 Tbsp chili powder
1 C chicken stock or broth, fat removed

NUTRIENTS PER SERVING
Calories: 180
Total fat: 6 gms
Saturated fat: 2 gms
Polyunsaturated fat: 1 gm
Cholesterol: 68 mgs
Sodium: 242 mgs


Place chicken in a 13x9x2 pan. Arrange onion over the top. Mix together
vinegar, Worcestershire sauce, brown sugar, pepper, hot pepper flakes,
chili powder, and stock. Pour over the chicken and bake at 350 degrees 1
hour or until done. Baste occasionally. 

8 servings 



Fish Veronique

A classic preparation of delicate white fillets
of sole with green grapes in a creamy sauce ... 

1 lb white fish (sole, turbot, etc.)
1/4 tsp salt
1/8 tsp freshly ground pepper
1/4 C dry white wine
1/4 C chicken stock or broth, fat removed
1 Tbsp lemon juice
1 Tbsp margarine
2 Tbsp flour
3/4 C low-fat (1%) milk
1/2 C seedless green grapes

NUTRIENTS PER SERVING
Calories: 148
Total fat: 4 gms
Saturated fat: 1 gm
Polyunsaturated fat: 1 gm
Cholesterol: 53 mgs
Sodium: 316 mgs


Place fish in a lightly oiled 10x6 flameproof baking dish. Sprinkle with
salt and pepper. Mix wine, stock, and lemon juice in small bowl and pour
over fish. Cover and bake at 350 degrees for 15 minutes. Melt margarine
in small saucepan. Remove from heat and blend in flour. Gradually add
milk and cook over moderately low heat, stirring constantly until
thickened. Remove fish from oven and pour liquid from baking dish into
cream sauce, stirring until blended. Pour sauce over fish and sprinkle
with grapes. Broil about 4 inches from heat 5 minutes or until sauce
starts to brown.

4 servings 



Stir-Fried Beef and Vegetables 

This Japanese-style dish is savory and delicious ... 

2 Tbsp dry red wine
1 Tbsp soy sauce
1/2 tsp sugar
1 1/2 tsp grated, peeled ginger root
1 lb boneless round steak, fat trimmed,
  and cut across grain into 1 1/2" strips, raw
1 Tbsp corn oil
2 medium onions, each cut into 8 wedges
1/2 lb fresh mushrooms, rinsed, trimmed, and
  sliced
2 stalks celery, bias cut into 1/4" slices
  (about 1/2 cup)
2 small green peppers, cut into thin
  lengthwise strips
1 C water chestnuts, drained and sliced
2 Tbsp cornstarch
1/4 C water
1 Tbsp corn oil

NUTRIENTS PER SERVING
Calories: 187
Total fat: 8 gms
Saturated fat: 2 gms
Polyunsaturated fat: 3 gms
Cholesterol: 35 mgs
Sodium: 215 mgs


Prepare marinade mixing together wine, soy sauce, sugar, and ginger.
Marinate meat in mixture while preparing vegetables. Heat 1 Tbsp oil in
large skillet or wok. Stir-fry onions and mushrooms 3 minutes over
medium-high heat. Add celery and cook 1 more minute. Add remaining
vegetables and cook 2 minutes or until green pepper is tender crisp.
Transfer vegetables to warm bowl. Add remaining 1 Tbsp oil to skillet.
Stir-fry meat in oil about 2 minutes or until meat loses its pink color.
Blend cornstarch and water. Stir into meat. Cook and stir until
thickened. Return vegetables to skillet; stir gently and serve.

6 servings 



Picnic Potato Salad 

Excellent new low-fat version of an old favorite 
and very good with barbecue chicken ... 

1/2 C plain low-fat (1%) yogurt
1/2 C mayonnaise-type salad dressing
1 Tbsp vinegar
1 tsp salt
1 tsp fresh chopped parsley
2 tsp prepared mustard
1 clove garlic, minced
Freshly ground black pepper
6 C peeled, cooked potatoes, diced (about 4 large)
1 C coarsely chopped celery
1/2 C sliced radishes
1/4 C sliced scallions with tops

NUTRIENTS PER SERVING
Calories: 92
Total fat: 4 gms
Saturated fat: .6 gms
Polyunsaturated fat: 2 gms
Cholesterol: 3 gms
Sodium: 199 mgs


Combine yogurt, salad dressing, vinegar, salt, parsley, mustard, garlic,
and pepper in large mixing bowl. Add vegetables; mix well. Refrigerate
until serving time. Variation: cauliflower salad--omit radishes and
potatoes and substitute 6 cups diced, cooked cauliflower (about 1 lg
head). 

16 servings, 1/2 cup 



Italian Vegetable Bake

Enough colorful vegetables baked together
deliciously to feed a crowd ... 

1 28-oz can whole tomatoes
1/2 lb fresh green beans, sliced
1/2 lb fresh okra, cut into 1/2" pieces
  or 1/2 10-oz pkg frozen okra
1 medium eggplant, pared and cut into 1" cubes
3/4 C finely chopped green pepper
1 Tbsp chopped fresh oregano leaves,
  or 1/2 tsp dried oregano, crushed
1 Tbsp chopped fresh basil, or 1 tsp dried basil,
  crushed
3 7"-long zucchini, cut into 1" cubes
2 Tbsp grated parmesan cheese
1 medium onion, sliced
2 Tbsp lemon juice

NUTRIENTS PER SERVING
Calories: 36
Total fat: .5 gms
Saturated fat: .2 gm
Polyunsaturated fat: .1 gm
Cholesterol: .4 mgs
Sodium: 86 gms


Drain and coarsely chop tomatoes. Reserve liquid. Mix together tomatoes
and reserved liquid, onion, green beans, okra, green pepper, lemon
juice, and herbs. Cover and bake at 325 degrees for 15 minutes. Mix in
zucchini and eggplant and continue baking, covered, 60-70 more minutes
or until vegetables are tender. Stir occasionally. Sprinkle top with
parmesan cheese just before serving. 

18 servings, 1/2 cup 



Apricot-Orange Bread

A moist, rich-tasting bread to round out
  a light meal ... 

6-oz pkg dried apricots cut into small pieces
2 C water
2 Tbsp margarine
1 C sugar
1 egg, slightly beaten
1 Tbsp freshly grated orange peel
3 1/2 C sifted all-purpose flour
1/2 C nonfat dry milk powder
2 tsp baking powder
1 tsp baking soda
1 tsp salt
1/2 C orange juice
1/2 C chopped pecans

NUTRIENTS PER SERVING
Calories: 97
Total fat: 2 gms
Saturated fat:
Polyunsaturated fat:
Cholesterol: 6 mgs
Sodium: 113 mgs


Preheat oven to 350 degrees. Lightly oil two 9x5x3 pans. Cook apricots
in water in a covered medium-size saucepan 10 to 15 minutes or until
tender but not mushy. Drain; reserve 3/4 cup liquid. Set apricots aside
to cool. Cream together margarine and sugar. By hand, beat in egg and
orange peel. Sift together flour, dry milk, baking powder, soda, and
salt. Add to creamed mixture alternately with reserved apricot liquid
and orange juice. Stir apricot pieces and pecans into batter. Turn
batter into prepared pans. Bake 40-45 minutes or until bread springs
back when lightly touched in center. Cool 5 minutes in pans. Remove from
pans and completely cool on wire rack before slicing.

2 loaves, 36 1/2-inch slices 



Rainbow Fruit Salad

A new twist to a back-to-basics favorite ...
either a side dish or dessert ... 

1 large mango, peeled and diced
2 C fresh blueberries
2 bananas, sliced
2 C fresh strawberries, halved
2 C seedless grapes
2 nectarines, unpeeled and sliced
1 kiwi fruit, peeled and sliced


HONEY ORANGE SAUCE
1/3 C unsweetened orange juice
2 Tbsp lemon juice
1 1/2 Tbsp honey
1/4 tsp ground ginger
dash of nutmeg

NUTRIENTS PER SERVING
Calories: 96
Total fat: 1 gm
Saturated fat:
Polyunsaturated fat:
Cholesterol: 0 mgs
Sodium: 4 mgs

Prepare the fruit. Combine all ingredients for sauce and mix. Just
before serving, pour Honey Orange Sauce over fruit.

12 servings 


------------------------------------------------------------------------

Resources for a Healthy Heart

------------------------------------------------------------------------

If you would like more information on the topics discussed in this
booklet, the following organizations may be able to help you. 


Federal Government

------------------------------------------------------------------------

National Heart, Lung, and Blood Institute (NHLBI) Information Center
NHLBI Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
(301) 251-1222

The NHLBI Information Center is a service of the National Heart, Lung,
and Blood Institute (NHLBI). It provides public and patient education
materials on high blood pressure, cholesterol, smoking, obesity, and
heart disease. Publications include: Facts About High Blood Pressure;
Eating to Lower Your High Blood Cholesterol; Check Your Weight and Heart
Disease I.Q.; and Check Your Smoking I.Q.: An Important Quiz for Older
Smokers. The NHLBI also offers a number of fact sheets on heart
disease-related topics such as Facts About Coronary Heart Disease.

A directory of publications is available.


------------------------------------------------------------------------

Consumer Information Center (CIC)
Pueblo, CO 81009

The Consumer Information Catalog from the CIC lists over 200 free or
low-cost booklets on consumer topics. Many are health-related and
include booklets on nutrition, foods, exercise, women's health, and
smoking. Write for a free copy. 


------------------------------------------------------------------------

Food and Drug Administration (FDA)
Office of Consumer Affairs, HFE-88
5600 Fishers Lane
Rockville, MD 20857
(301) 443-3170

The FDA offers publications on topics such as general drug information,
medical devices, and food-related subjects including fiber, fats,
sodium, and cholesterol. The FDA also publishes a monthly journal, FDA
Consumer, which reports on recent developments in the regulation of
foods, drugs, and cosmetics. Recent articles have covered topics such as
heart bypass surgery, balloon angioplasty, dieting, and nutrition for
women. Subscriptions can be ordered through the Consumer Information
Catalog listed above. To order materials, contact the FDA at the address
above or contact the consumer affairs office nearest you. Copies are
available free of charge.

------------------------------------------------------------------------


Food and Nutrition Information Center (FNIC)
National Agricultural Library
10301 Baltimore Avenue, Room 304
Beltsville, MD 20705-2351

The FNIC answers questions concerning food and nutrition and provides
database searches, bibliographies, and resource guides on a wide variety
of food and nutrition topics. 

------------------------------------------------------------------------


Human Nutrition Information Service (HNIS)
Department of Agriculture
6505 Belcrest Road
Room 328 A
Hyattsville, MD 20782
(301) 436-8617

HNIS reports results of research on food consumption, food composition,
and dietary guidance in both technical and popular publications. A list
of Department of Agriculture publications is available. 


------------------------------------------------------------------------


National Cancer Institute (NCI)
Office of Cancer Communications
Bldg. 31, Room 10A24
9000 Rockville Pike
Bethesda, MD 20892
(800) 4-CANCER; (301) 496-5583

The NCI provides information on how to stop smoking. Publications
include: Why Do You Smoke? (a self-test); Clearing the Air: A Guide to
Quitting Smoking; and Guia Para Dejar de Fumar. Publications are
available free of charge. 


------------------------------------------------------------------------

National Clearinghouse for Alcohol and Drug Abuse Information (NCADI)
P.O. Box 2345
Rockville, MD 20852
(800) 729-6686; (301) 468-2600

NCADI is the central point within the Federal Government for current
print and audiovisual information about alcohol and other drugs.
Publications for women include: Alcohol Alert #10; Alcohol and Women;
Alcohol, Tobacco, and Other Drugs May Harm the Unborn; and Women and
Alcohol. A publications catalog is available. 

------------------------------------------------------------------------

National Diabetes Information Clearinghouse (NDIC)
Box NDIC
9000 Rockville Pike
Bethesda, MD 20892
(301) 468-2162

The NDIC provides information to diabetic patients and provides
materials on topics such as diabetes management and treatment,
nutrition, dental care, insulin, and self-blood glucose monitoring.
Topical bibliographies are produced on subjects such as diet and
nutrition, sports and exercise, and pregnancy. A bimonthly newsletter,
Diabetes Dateline, is also available. Some mailing fees may apply. 


------------------------------------------------------------------------


Office of Disease Prevention and Health Promotion
National Health Information Center (ONHIC)
P.O. Box 1133
Washington, DC 20013-1133
(800) 336-4797; (301) 565-4167

The ONHIC helps the public and health professionals locate health
information through identification of health information resources, an
information and referral system, and publications. The ONHIC provides
resource guides on a variety of health-related topics. A publications
list is available. 


------------------------------------------------------------------------


Office on Smoking and Health (OSH)
Center for Chronic Disease Prevention and Health Promotion
Mail Stop K-50
Centers for Disease Control
1600 Clifton Road, N.E.
Atlanta, GA 30333
(404) 488-5705


The Office on Smoking and Health provides information on smoking
cessation. Current titles include: Out of the Ashes: Choosing a Method
to Quit Smoking; At A Glance--The Health Benefits of Smoking Cessation:
A Report of the Surgeon General; Is Your Baby Smoking?; and a poster,
Pregnant? That's Two Good Reasons to Quit. Single copies are available
free of charge. 


------------------------------------------------------------------------


Superintendent of Documents
U.S. Government Printing Office
Washington, DC 20402=9352
(202) 783-3238Z

The Superintendent of Documents makes available many health-related
publications from Government agencies. There are charges for
publications. Write for a free copy of U.S. Government Books and New
Books to receive information on what is available.

Voluntary Health Agencies
------------------------------------------------------------------------


American Cancer Society (ACS)
1599 Clifton Road, N.E.
Atlanta, GA 30329
(404) 320-3333; (800) ACS-2345

Contact the local chapters or the national office for information. The
ACS provides materials, individual and group support, self-help groups,
and a speakers bureau. Publications include: How Can We Reach You?,
which describes risks specific to women who smoke and tips for quitting
without weight gain; Why Start Life Under a Cloud; Eating Smart; and
Nutrition, Common Sense, and Cancer. The Taking Control program provides
an introduction to a healthful, enjoyable lifestyle that may reduce
one's risk of devel/oping cancer. All publications and services are
free.


------------------------------------------------------------------------


American Diabetes Association
1660 Duke Street
Alexandria, VA 22314
(800) 232-3472; (703) 549-1500

Contact the local chapters or the national office. The group offers
patient and family education activities such as educational meetings,
weekend retreats, counseling and discussion, self-help, and support
groups. Patient education publications include: Diabetes in the Family;
Diabetes: A to Z; and the Family Cookbook series. Diabetes Forecast, a
monthly magazine, and Diabetes, a quarterly newsletter, are available.
There are membership fees and costs for some publications. 


------------------------------------------------------------------------


American Heart Association (AHA)
National Center
7320 Greenville Avenue
Dallas, TX 75231
(214) 373-6300

The AHA provides fact sheets, brochures, and audiovisuals on topics such
as general cardiovascular disease risk reduction, exercise, high blood
pressure, smoking, and nutrition. Publications include: What Every Woman
Should Know About High Blood Pressure; About Your Heart and Blood
Pressure; American Heart Association Diet: An Eating Plan for Healthy
Americans; Now You're Cookin': Healthful Recipes to Help Control High
Blood Pressure; Eat Well, But Eat Wisely--To Reduce Your Risk of Heart
Attack; Exercise and Your Heart; and more. Write to the national office
or the local AHA affiliate nearest to you. Single copies of most
publications are free.


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American Lung Association (ALA)
1740 Broadway
New York, NY 10019
(212) 315-8700

The ALA and its local affiliates conduct smoking cessation programs and
offer a catalog of publications, including many on smoking. The Stop
Smoking, Stay Trim booklet explains how stopping smoking affects weight
and what you can do to prevent weight gain. Freedom From Smoking in 20
Days is a self-help quit smoking program. Other publications include: Q
and A of Smoking and Health; Because You Love Your Baby; and Facts About
Nicotine, Addiction, and Cigarettes. Contact your local ALA affiliate or
write to the above address. Some fees may apply.

Professional Association
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American Dietetic Association (ADA)
216 W. Jackson Blvd., Suite 800
Chicago, IL 60606
(312) 899-0040

The ADA offers cookbooks and other materials for consumers designed to
educate about food and nutrition. These include: Lowfat Living: A Guide
to Enjoying a Healthful Diet; Food Facts: What You Should Know About
Nutrition and Health; and Food 3: Eating the Moderate Fat and
Cholesterol Way. Write or call for price information. 

The National Center for Nutrition and Dietetics is the public education
initiative of the ADA. It sponsors a consumer nutrition hotline that can
be reached at (800) 366-1655 (9:00-4:00, central time). Callers can
listen to recorded messages on current issues in nutrition or speak to a
registered dietitian. 


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Discrimination Prohibited: Under provisions of applicable public laws
enacted by Congress since 1964, no person 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 or 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.
Programs of the National Heart, Lung, and Blood Institute are operated
in compliance with these laws and Executive Orders.


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