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A Heart-Health Guide for African Americans

I Have the Power

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If you’re like most Americans, you probably don’t worry too much about heart disease and stroke. Maybe you

should, especially if you’re African American. Because blacks have a high rate of hypertension, we’re 1.5 times more likely to die from heart disease and 1.8 times more likely to have a fatal stroke than whites.

That’s the bad news.

Here’s the good news: You have the power to fi ght heart disease and stroke — and win. You can live a long, healthy life by taking control of your health.

The American Stroke Association and the Black Women’s Health Imperative believe that good health starts with good information. So we developed this brochure to help you take charge of your health.

Let’s start by considering what’s important and what puts us at risk for heart disease and stroke.

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What’s Important to Me?

We often put our family, job and community before our own health. But to help others or to be successful,

you must fi rst understand your own body’s needs.

Think of your body as your temple. It’s designed to last a lifetime. It contains everything you need to live a strong, healthy life. Your job is to take care of it the best you can.

Don’t make the mistake of thinking that you can take your health for granted until you get old. Your risk for heart disease and stroke starts when you’re very young and increases with age. As an African American, your risk often develops much earlier in life and can be much more severe than for people in other groups.

The time for action is now. Invest in your own wellness — take the time to fi nd out if you’re at risk.

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Am I at Risk?

Several factors increase your risk for heart disease and stroke. You can’t do anything about some of them. For instance, having a

family history of heart disease, stroke or high blood pressure means you have a greater chance of developing these diseases. Getting older or being male also increases your risk.

But you can change some risk factors:

Smoking or Breathing Tobacco Smoke

Smoking or breathing tobacco smoke is the single greatest cause of preventable death among African Americans in the United States. It increases your risk of heart disease and stroke, as well as cancer, emphysema and other diseases.

But when you stop smoking — no matter how long or how much you’ve smoked — your risk of heart disease rapidly drops. One year after quitting, the risk of coronary heart disease decreases by 50 percent. Within 15 years, the relative risk of dying from coronary heart disease for an ex-smoker approaches that of a long-term nonsmoker.

So, if you don’t smoke, don’t start! If you do smoke, quit — now!

I’m Proud.

High Blood Cholesterol

High blood cholesterol is another risk factor you can modify. Among blacks age 20 and older, 37 percent of men and 46 percent of women have blood cholesterol levels over 200 mg/dL. That’s a level at which the risk for heart disease and stroke begins to rise.

Know your risk by knowing your numbers. A simple blood test can show if your total blood cholesterol level is desirable, borderline-high or puts you at high risk of developing heart disease and stroke.

If your blood cholesterol level is below 200 mg/dL, your risk for heart attack and stroke is low, unless you have other risk factors. Keep it that way by eating a healthy diet and staying physically active. Have your blood cholesterol level checked every fi ve years — or more often if you’re a man over 45 or a woman over 55.

If your blood cholesterol is between 200 mg/dL and 239 mg/dL, your level is borderline-high. That means you have a somewhat higher risk of heart disease. Have your total cholesterol and HDL-C (“good cholesterol”) rechecked in one to two years if:

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Your total cholesterol is in this range (between 200 mg/dL and 239 mg/dL). Your HDL-C is less than 40 mg/dL. You don’t have other risk factors for heart disease.

You should also eat less of foods high in saturated fat and cholesterol (such as butter, cheese and fats in meat). This will help reduce your total blood cholesterol level to below 200 mg/dL.

If your blood cholesterol is 240 mg/dL or more, it’s high. In general, people whose total cholesterol level is 240 mg/dL have twice the risk for heart attack as people whose level is below 200 mg/dL. But everyone’s situation is different.

Talk to your doctor about monitoring your blood cholesterol levels and develop a plan that’s right for you. Eating a healthier diet and becoming more physically active will help. If that’s not enough, your doctor may also prescribe medicine to help reduce your risk. Be sure to take your medication as you’re told and contact your doctor before you stop taking it. Sticking to the plan is important in taking charge of your health.

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High Blood Pressure (Hypertension)

High blood pressure is often called the “silent killer” because it has no symptoms. It affects more than 40 percent of adult non-Hispanic blacks. In fact, we’re more likely to have high blood pressure, develop it earlier in life, and at any decade in life, it’s more severe.

Blood pressure is recorded as two numbers. The fi rst, higher number is the pressure in the arteries when the heart beats. It’s called systolic pressure. The second number is diastolic pressure. It’s the pressure when the heart is resting between beats. Blood pressure is measured quickly and painlessly using an arm cuff and a gauge called a sphygmomanometer.

Normal blood pressure is less than 120/80 mm Hg (millimeters of mercury). High blood pressure is a systolic pressure of 140 mm Hg or higher and/or a diastolic pressure of 90 mm Hg or higher. If you have high blood pressure, consult with your doctor to develop a plan to control it that’s right for you.

Risk

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Recently released high blood pressure guidelines have introduced a second risk class: prehypertension. It includes people with blood pressures between 120–139/80–89 mm Hg. If you’re in this category, you may be more likely to develop high blood pressure. Lifestyle changes such as eating a healthy diet, exercising regularly and quitting smoking can help prevent, or at least postpone, the development of full-blown hypertension.

If you already have high blood pressure, don’t get discouraged. You can lower your blood pressure and reduce your risk of heart attack and stroke. If you don’t get much exercise, becoming more physically active will help lower your blood pressure. If you’re overweight, losing excess weight also may help lower your blood pressure. And if you’re salt-sensitive, eating less salt will also lower your blood pressure.

If your blood pressure is still too high after you change your lifestyle, your doctor may prescribe medication to lower it. Be sure to take your medicine just as you’re told. If a problem develops, tell your doctor. Never stop taking yourmedication without talking to your doctor fi rst. Uncontrolled high blood pressure can lead to heart attack and stroke.


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Diabetes

You probably grew up knowing at least one person in your family who had what many African Americans refer to as “sugar.” Diabetes is very common in our community; about 11 percent of African Americans have it. But many of us don’t know it.

It’s important to have your glucose (blood sugar) levels checked regularly, especially if you have a family history of diabetes. With just a simple blood test, you can determine if you are at risk. A random glucose test (non-fasting) reading of 185 or more, or a fasting test reading of 126 or more, indicates that you may be diabetic. Prediabetes, also called impaired fasting glucose, is a fasting test reading of 100–125. If your glucose levels fall in either category, consult your healthcare provider to learn how to prevent, monitor and manage your diabetes.

Uncontrolled diabetes can lead to loss of limbs, blindness, heart disease and stroke. Be sure to follow your healthcare provider’s instructions carefully to best manage your diabetes.

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Obesity

Obesity is a major concern for all Americans, including African Americans. Studies show that 77 percent of non-Hispanic black women and 63 percent of non-Hispanic black men age 20 and older are overweight or obese. If you’re obese or overweight, you have a much higher risk of developing heart disease, even if you have no other risk factors. Obesity is linked to coronary heart disease mainly because it raises blood pressure and blood cholesterol levels and makes diabetes more likely to develop.

You can often decrease your heart disease risk factors when you lose as little as 10 to 20 pounds. But don’t buy into fad diets or promises to rapidly lose weight. Work with a healthcare professional to set up a sensible eating and exercise plan that will help you reach and maintain a healthy weight. You didn’t gain the extra weight overnight, so don’t expect to lose it that quickly either.

Obesity is not an appearance issue; it’s a health issue. Whether you like your appearance or not, you owe it to yourself to develop a healthy lifestyle.

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Physical Inactivity

Physical inactivity is another major modifi able risk factor. Nearly 38 percent of African Americans are sedentary. Being physically active improves your cardiovascular fi tness; physical inactivity has the opposite effect.

To learn more about physical activity and fun ways to stay active, see the section “Steps to Wellness” on pages 23 and 24.

Proud.

Proud.I’m Real.

Other (Stroke) Risk Factors You Can Change

The risk factors we’ve just discussed affect the risk for both heart attack and stroke. But there are some additional risk factors that are specifi c to stroke. They include:

Carotid or other artery disease Atrial fi brillation Other heart disease Transient ischemic attacks (TIAs) Sickle cell disease Excessive alcohol Some illegal drugs

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Let’s briefl y discuss these now.

Carotid or other artery disease. The carotid arteries in your neck bring blood to your brain. A carotid artery that’s narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked if the plaque ruptures and a blood clot forms.

People with peripheral artery disease have a higher risk of carotid artery disease and stroke, too. Peripheral artery disease is the buildup of fatty deposits in artery walls of the legs and arms.

Atrial fi brillation. In this heart rhythm disorder, the heart’s upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off and lodges in an artery leading to the brain, a stroke can result.

Other heart disease. Having coronary heart disease, heart failure, dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raises the risk of stroke.

Transient ischemic attacks (TIAs). TIAs are “warning strokes” that produce stroke-like symptoms but no lasting damage. Recognizing and treating TIA can reduce your risk of a major stroke. TIA warning signs are like those of stroke, but they last a very short time. Call 9-1-1 and get medical help immediately if they occur.

Sickle cell disease (also called sickle cell anemia). This is a genetic disorder that mainly affects African Americans. “Sickled” red blood cells are less able to carry oxygen to the body’s tissues and organs. They also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.

Excessive alcohol. Excessive alcohol intake is associated with an increased risk of stroke as well as an increase in blood pressure. If you drink alcohol, do so in moderation. This means an average of one to two drinks per day for men and one drink per day for nonpregnant women.

Some illegal drugs. Intravenous drug abuse carries a high risk of stroke. Cocaine use has been linked to strokes and heart attacks. Some have been fatal in even fi rst-time users.

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You don’t have to be a statistic! As an African American, you can reduce your risk of heart attack and stroke. Start by becoming aware of your risk factors by taking the quiz that follows. This will let you know where you need to focus your efforts. Then work with your doctor to reduce, control or prevent as many risk factors as you can.

In the following pages, we’ve provided some helpful hints on healthy eating, increasing your physical activity, and managing the stress in your life.

Think of your body as your temple. It’s designed to last a lifetime.

I’m Strong.

AGE ____ You are a man over 45 or a woman

over 55 years old.

FAMILY HISTORY ____ You have a close blood relative who had

a heart attack or stroke before age 55 (if father or brother) or before age 65 (if mother or sister).

MEDICAL HISTORY ____ You have coronary artery disease,

or you have had a heart attack.

____You have had a stroke.

____You have an abnormal heartbeat.

Tobacco SMOKE ____ You smoke, or live or work with

people who smoke every day.

CHOLESTEROL____ Your total cholesterol level is

240 mg/dL or higher.

____ Your HDL (“good”) cholesterol level is less than 40 mg/dL.

____ You don’t know your total cholesterol or HDL levels.

BLOOD PRESSURE ____ Your blood pressure is 140/90 mm Hg

or higher, or you’ve been told that your blood pressure is too high.

____ You don’t know what your blood pressure is.

PHYSICAL INACTIVITY ____ You are active less than 30 minutes on

most days of the week.

Excess BODY WEIGHT ____You are 20 pounds or more overweight.

DIABETES____ You have diabetes or take medicine to

control your blood sugar.

RISK ASSESSMENT QUIZCheck all that apply to you.

If you check two or more, see your doctor for a complete assessment of your risk.

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Real.How Can I Reduce My Risk?

Food for the Soul and Body

Fried chicken, collard greens with ham hocks, sweet potatoes, macaroni and cheese, potato salad, cornbread and chess pie ... Just thinking about

these soul-food staples may make your mouth water.

But these and many other soul foods are high in fat, cholesterol, salt and sugar. High-fat, high-cholesterol meals can raise your cholesterol levels, increasing your risk for heart attack and stroke. High-salt foods can lead to high blood pressure in some people, which increases the risk of stroke, heart attack and kidney failure. Foods high in fat and sugar can lead to excess weight if you eat too much of them.

But you don’t have to give up the foods you love. Making small changes in the way you prepare your meals can help reduce your risk for heart disease and stroke. The tips below can help reduce the fat and salt in your diet:

Steam, bake, broil or stir-fry fi sh and vegetables in canola or olive oil instead of deep-frying them in shortening or bacon grease.

Use vinegar, lemon juice, hot red pepper fl akes, garlic and onions instead of salt. Use soft-tub margarine instead of butter. Limit egg yolks to three or four per week, or eat egg whites instead. Use sea salt instead of regular salt. Buy fresh lean cuts of meat and trim the fat before cooking. Use canola, olive, corn or saffl ower oil in cooking.

I’m Strong.

Proud.I’m Strong.

Proud.I’m Strong.

Proud.I’m Strong.I’m Strong.

If it’s hard for you to change your eating habits, start by trying to make just one or two changes each week. The key is to stick with it. Don’t give up on your good health.

To get you started on your road to wellness, we’ve included some soul food favorites — only they’re heart healthy! The National Heart, Lung, and Blood Institute has modifi ed these recipes so they have the same great taste, but with less fat and cholesterol. Enjoy them in moderation as part of an overall balanced diet and a sensible plan for being more physically active.

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Good-For-You Cornbread*

1 cup cornmeal

1 cup fl our1⁄4 cup white sugar

1 tsp baking powder

1 cup buttermilk, 1% fat

1 egg, whole1⁄4 cup margarine, regular, tub

1 tsp vegetable oil (to grease baking pan)

1. Preheat oven to 350° F.

2. Mix together cornmeal, fl our, sugar and baking powder.

3. In another bowl, combine buttermilk and egg. Beat lightly.

4. Slowly add buttermilk and egg mixture to the dry ingredients.

5. Add margarine and mix by hand or with a mixer for 1 minute.

6. Bake for 20 to 25 minutes in an 8 by 8-inch greased baking dish. Cool. Cut into 10 squares.

Makes 10 servings; Serving size: 1 square; Calories: 178; Fat: 6g; Saturated Fat: 1g; Cholesterol: 22mg; Sodium: 94mg

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Candied Yams*

3 medium yams (1 1⁄2 cups)1⁄4 cup brown sugar, packed

1 tsp fl our, sifted1⁄4 tsp salt1⁄4 tsp ground cinnamon1⁄4 tsp ground nutmeg1⁄4 tsp orange peel

1 tsp soft tub margarine

1⁄2 cup orange juice

1. Cut yams in half and boil until tender but fi rm (about 20 minutes). When cool enough to handle, peel and slice into 1⁄4-inch thickness.

2. Combine sugar, fl our, salt, cinnamon, nutmeg and grated orange peel.

3. Place half of the sliced yams in a medium-sized casserole dish. Sprinkle with spiced sugar mixture.

4. Dot with half the amount of margarine.

5. Add a second layer of yams, using the rest of the ingredients in the same order as above. Add orange juice.

6. Bake uncovered in oven preheated to 350°F for 20 minutes.

Makes 6 servings; Serving size: 1⁄4 cup; Calories: 110; Fat: less than 1g; Saturated Fat: less than 1g; Cholesterol: 0 mg; Sodium: 115mg

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Smothered Greens*

3 cups water1⁄4 lb smoked turkey breast, skinless

1 Tbsp hot pepper, freshly chopped1⁄4 tsp cayenne pepper1⁄4 tsp cloves, ground

2 cloves garlic, crushed1⁄2 tsp thyme

1 stalk scallion, chopped

1 tsp ginger, ground1⁄4 cup onion, chopped

2 lbs greens (mustard, turnip, collard, kale or mixture)

1. Place all ingredients except greens into large saucepan and bring to a boil.

2. Prepare greens by washing thoroughly and removing stems.

3. Tear or slice leaves into bite-size pieces.

4. Add greens to turkey stock. Cook 20 to 30 minutes until tender.

Makes 5 servings; Serving size: 1 cup; Calories: 80; Fat: 2g; Saturated Fat: less than 1g; Cholesterol: 16mg; Sodium: 378mg

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Classic Macaroni and Cheese*

2 cups macaroni1⁄2 cup chopped onions1⁄2 cup evaporated skim milk

1 medium egg, beaten1⁄4 tsp black pepper

1 1⁄4 cups sharp cheddar cheese (4 oz.), fi nely shredded

low-fat nonstick cooking oil spray

1. Cook macaroni according to directions. (Do not add salt to the cooking water.) Drain and set aside.

2. Spray casserole dish with nonstick cooking oil spray.

3. Preheat oven to 350° F.

4. Lightly spray saucepan with nonstick cooking oil spray.

5. Add onions to saucepan and sauté for about 3 minutes.

6. In another bowl, combine macaroni, onions and the remaining ingredients, and mix thoroughly.

7. Transfer mixture into casserole dish.

8. Bake for 25 minutes or until bubbly. Let stand for 10 minutes before serving.

Makes 8 servings; Serving size: 1⁄2 cup; Calories: 200; Fat 4g; Saturated Fat: 2g; Cholesterol: 34mg; Sodium: 120mg


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Crispy Oven-Fried Chicken*

1. Preheat oven to 350°F.

2. Add 1⁄2 teaspoon of poultry seasoning to milk.

3. Combine all other spices with cornfl ake crumbs and place in a plastic bag.

4. Wash chicken and pat dry. Dip chicken into milk, shake to remove excess, and then quickly shake in bag with seasoning and crumbs.

5. Refrigerate for 1 hour.

6. Remove from refrigerator and sprinkle lightly with paprika for color.

7. Evenly space chicken on greased baking pan.

8. Cover with aluminum foil and bake 40 minutes. Remove foil and continue baking for an additional 30 to 40 minutes or until the meat can be easily pulled away from the bone with a fork. The drumsticks may require less baking time than the breasts. Crumbs will form a crispy “skin.” (Do not turn chicken during baking.)

Makes 6 servings; Serving size: 1⁄2 breast or 2 small drumsticks; Calories: 256; Fat: 5g; Saturated Fat: 1g; Cholesterol: 83mg; Sodium: 286mg

*Recipes taken from the NHLBI Heart-Healthy Home Cooking African American Style Booklet.

1⁄2 cup fat-free (skim) milk or buttermilk

1 tsp poultry seasoning

1 cup cornfl akes crumbled

1 1⁄2 Tbsps onion powder

1 1⁄2 Tbsps garlic powder

2 tsps black pepper

2 tsps dried hot pepper, crushed

1 tsp ginger, ground

8 pieces chicken, skinless (4 breasts, 4 drumsticks)

a few shakes of paprika

1 tsp vegetable oil (used to grease baking pan)


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Steps to Wellness

Healthy eating and increasing your physical activity go hand in hand. Consider them your tag-team approach to overall wellness.

Being physically active for 30 minutes or more on most or all days of the week has tremendous benefi ts. Combined with heart-healthy food choices, regular physical activity can help:

Keep weight under control. Improve blood cholesterol levels. Prevent and manage high blood pressure. Prevent bone loss. Boost energy levels. Manage stress. Improve self image.

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Physical activity can also be fun. Remember when you used to play hopscotch, or double dutch, or freeze tag with your friends? What about those parties when you did dances like the Funky Chicken or Cabbage Patch? You were having the time of your life — and being physically active.

Now that you’re older, go back to having fun! It’s much easier to stick with something that you enjoy. If you don’t like dancing, fi nd a buddy and start a walking program. Walking is a great way to improve your overall health and reduce your risk for heart disease. It’s easy to do almost anywhere, fi ts easily into your day, costs almost nothing, and works for almost everyone.

The Black Women’s Health Imperative recommends walking 10,000 steps a day (measured by wearing a pedometer) at least three days a week. To begin a personalized walking program, enroll in the Black Women’s Health Imperative online Walking for Wellness program at www.Blackwomenshealth.org or the American Heart Association’s online Choose To Move program at www.americanheart.org/choosetomove.

Remember to start out slowly and build up over time. If you have a health condition or have been sedentary for a long time, be sure to talk with your healthcare provider before starting any vigorous exercise program.

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Finding Inner Peace

Eating right and being more physically active are great ways to improve your heart health. But don’t forget about stress. Stress is your reaction to physical, emotional or environmental factors.

You probably know the feeling of being “stressed out.” It’s when a situation has gotten the best of you. The danger to our health comes when we don’t have effective ways to cope with these situations. Acute and chronic stress may raise blood pressure and cholesterol levels. It may lead to eating and smoking more, too.

There’s no way to get rid of all the stress in your life. Everyone has to deal with finances, deadlines, family issues, etc. As an African American, you may also be dealing with racism and other environmental factors. But the strategies below may help you cope with or reduce stress in your life.

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Talk with family, friends or other trusted advisers about your concerns. Ask for their support. Take 15 to 20 minutes to meditate each day.Learn to accept things you can’t change. Count to 10 before you respond when you feel angry.Don’t use smoking, drinking, overeating, drugs or caffeine to cope with stress. These make things worse.Look for the good in situations instead of the bad.Learn to say “no.” Don’t promise too much.

If you can’t cope on your own, seek out a mental health professional or counselor. There’s no shame in asking for help. Do what’s best for your health and your peace of mind!

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Join The Movement!

Take the pledge to prevent and overcome stroke. Call 9-1-1 immediately if you or someone you know experience these signs of stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body

Sudden confusion/trouble speaking or understanding

Sudden trouble seeing in one or both eyes

Sudden trouble walking, dizziness, loss of balance or coordination

Sudden severe headache with no known cause

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Proud.Proud.Real.Real.

Strong.Strong.Strong.Resources To Help

The American Stroke Association and the Black Women’s Health Imperative want you to be healthy and well. This booklet is a guide to get you started on

your path to healthier living. The resources below offer additional information to help you on your quest. We believe in you and your desire to live a healthier life. Take control. Start your journey to wellness today.

American Association of Diabetes Educatorswww.aadenet.org(800) 338-3633

American Diabetes Associationwww.diabetes.org(800) DIABETES

American Heart Associationwww.americanheart.org(800) AHA-USA1

American Stroke Associationwww.StrokeAssociation.org/power(888) 4-STROKE

Black Women’s Health Imperativewww.Blackwomenshealth.org(202) 548-4000

Centers for Disease Control and Preventionwww.cdc.gov/

Chi Eta Phi Sorority Inc.www.chietaphi.com

National Black Nurses Associationwww.nbna.org

National Heart, Lung, and Blood Institutewww.nhlbi.nih.gov/health/index.htm

National Medical Associationwww.nmanet.org

Resources


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©2005, American Heart Association 50-1534A 6/08

The Body is sacred because it holds life, spirit and senses.To care for the body is to cherish the essence of who we are.

About the American Stroke AssociationThe goal of the American Stroke Association, a division of the American Heart Association, is to reduce disability and death from stroke through research, education and advocacy. In its 2005–06 fiscal year, the association spent more than $157 million on stroke.

How Can I Get Involved?You can help African Americans take steps to protect themselves, their loved ones and others in their community from the devastation of stroke. Get involved today in Power To End Stroke!

• Take the Pledge.

• Call 888-4-STROKE.

• Visit StrokeAssociation.org/power.

• Go to the “Shop Power” Web site and order Power To End Stroke brochures, materials and merchandise online. For more information, log on to the Web site at shoppower.org

National Center

7272 Greenville Avenue Dallas, Texas 75231-4596

StrokeAssociation.org

Documents

I Have the Power - EmPOWERED To Serve · I Have The Power! I ... You have the power to fi ght heart ... is borderline-high. That means you have a somewhat higher risk of heart disease