Along with eating right and exercise, knowing your numbers is a crucial part of managing your heart health correctly.
Below, Dr. Theodore Feldman, a cardiologist at West Kendall Baptist Hospital and the medical director of the Healthy Hub at West Kendall, takes us through the ABCs of cardiovascular health.
Why it’s important to keep track: High blood pressure, or hypertension, negatively impacts the heart in three major ways: It makes the heart work harder, it accelerates the build-up of plaque in the arteries, and it can create imbalances between the supply and demand of oxygen to and from the heart. A leading cause of heart failure, kidney disease and stroke, hypertension is also typically completely asymptomatic, making it a “silent killer,” according to Feldman. Consistently low blood pressure can also indicate a problem, but only if accompanied by symptoms like fatigue, nausea, dizziness or fainting and blurred vision.
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What the numbers mean: Measured in milliliters of mercury (mm Hg) blood pressure readings are rendered as a fraction. The top number, also the higher number, represents systolic blood pressure – the pressure when the heart is contracted. The bottom number represents diastolic blood pressure – the pressure in the arteries when the heart is relaxed. Systolic blood pressure usually fluctuates the most.
Ranges: Healthy systolic readings are below 120 mm Hg; healthy diastolic readings are below 80 mm Hg. Pre-hypertensive systolic readings are 120 – 139 mm Hg; pre-hypertensive diastolic readings are 80 – 89 mm Hg. Systolic readings of 140 – 159 mm Hg and diastolic readings between 90 – 99 mm Hg represent Stage 1 hypertension; systolic readings above 160 mm Hg and diastolic readings above 100 mm Hg represent Stage 2 hypertension. Both Stage 1 and Stage 2 will require lifestyle changes, and possibly drug therapy.
If you get a systolic reading of 180 mm Hg or higher or a diastolic reading of 110 mm Hg or higher, wait a few minutes and re-test yourself. If your readings remain high, seek immediate medical attention for a hypertensive crisis.
Since blood pressure rises with age, one panel in 2013 recommended pushing the threshold for action on systolic readings from 140 mm Hg to 150 mm Hg, but the new guidelines have been controversial among experts.
How often you should check it: At least once a year. Feldman also reminds us that with blood pressure fluctuating throughout the day, especially in response to stressful situations, “one reading does not make a diagnosis.” He recommends that those getting high readings repeat the test at home – a home monitor is a good investment, he said – or in pharmacies or a fire station, which may be less stressful than a doctor’s office. In general, people with hypertension should be checking their blood pressure on a regular basis, and noting the results to consult with their physician later.
Why it’s important to keep track: Diabetes — which can be prevented in about 90 percent of cases, by getting blood sugar down — puts you at an equivalent risk of having a heart attack in the next seven years as somebody who has had a heart attack, Feldman said. Elevated blood sugar requires the body to create more insulin, which in turn accelerates the development of plaque in the arteries — thereby increasing the risk for heart attack and stroke.
It’s also important to tackle the problem early: The more insulin the body makes, the more difficult it becomes to lose weight, the “hallmark of treatment for the pre-diabetic patient,” said Feldman.
Abnormally low blood sugar, or hypoglycemia, can be a problem too, especially for diabetics, and in the worst cases, can lead to seizure, coma or death.
What the numbers mean: They represent the amount of glucose, measured in milliliters per deciliter (mg/dL) in your blood.
Ranges: When fasting (no food for eight hours), normal blood sugar levels are 70 – 99 mg/dL; pre-diabetic blood sugar levels are 100 – 125 mg/dL; and sugar levels of 126 mg/dL indicate diabetes.
How often you should check it: At least once by the time you’re 30, and at least once every two to three years after that if your numbers stay within healthy ranges. After 40, if within healthy ranges, yearly. If pre-diabetic, regularly, as directed by your physician; if diabetic, daily or several times daily, as directed by your physician.
BODY MASS INDEX (BMI) and WAIST CIRCUMFERENCE
Why it’s important to track it: There is marked correlation between excess weight and heart disease, and although the relationship between the two isn’t completely clear, excess weight usually indicates elevated levels of cholesterol and triglycerides. New studies also suggest that fat cells — especially from the fat around your midsection — might accelerate the development of plaque in the arteries.
What the numbers mean: Your BMI is “no magic number,” said Feldman. It’s a measure of your weight in relation to your height. You can plug in your height and weight in any number of BMI calculators online, or do it yourself: divide your weight in kilograms by your height in meters squared.
A disclaimer: BMI doesn’t take into account things like bone or muscle mass. So while people in the obese category — especially in the upper sets — are definitely at an increased risk for heart disease, there’s no clear evidence, said Feldman, that those technically in the “overweight’’ category are at an increased risk for cardiovascular problems. BMIs also don’t apply to pregnant women.
Waist circumference is often considered a good complement to BMIs. To measure, put a tape measurer around your waist, at the level of your bellybutton. Don’t hold your breath.
Ranges: For BMIs, anything below 18.5 is considered underweight; 18.5-24.9 is considered normal; 25-29.9 is considered overweight; 30 and above is considered obese. The obese category itself is subdivided into three sets: BMIs of 30-34.6 indicate mild obesity, BMIs of 35-39.9 indicate moderate obesity and BMIs above 40 indicate morbid obesity.
For waist circumference, women are recommended to stay below 35 inches, and men below 40 inches.
How often you should check it: Weight should be monitored on an ongoing basis, at least several times yearly.
What the numbers mean: A cholesterol test will usually include a measurement of your “bad” cholesterol — that’s low-density lipoproteins, or LDL cholesterol; a measurement of your “good” cholesterol — that’s high-density lipoproteins, or HDL cholesterol; and a measurement of your triglycerides, a type of fat. Your total cholesterol count is your HDL, plus your LDL, plus 20 percent of your triglycerides. In the U.S., cholesterol is measured in milliliters per deciliter (mg/dL) of blood.
Why it’s important to track it: LDL cholesterol is the “basic building block,” of plaque in the arteries, which can directly cause strokes or a heart attack. HDL cholesterol helps clear the arteries of LDL cholesterol.
High triglycerides by themselves don’t appear to put people at higher risk for heart disease (although they can put the pancreas at risk), but for those with elevated levels of LDL cholesterol or low HDL cholesterol, the risk for heart disease is made even worse with a high triglyceride count, said Feldman.
Ranges: Desirable levels of LDL cholesterol vary depending on how at risk you are already of developing heart disease. For those at a very high risk for heart disease, LDL levels below 70 mg/dL are desirable, for those at moderate risk, LDL levels below 100 mg/dL are recommended. For those without any risk factors, the 100-129 mg/dL range is healthy. LDL levels of 130-159 mg/dL are considered borderline high, levels of 160-189 mg/dL are considered high and levels above 190 mg/dL are considered very high.
Desirable levels of HDL cholesterol vary depending on sex. Poor levels for men are below 40 mg/dL, for women below 50 mg/dL. Better levels for men are 40-49 mg/dL, for women, 50-59 mg/dL. Ideal levels for both are at 60 mg/dL and above.
Optimal triglyceride levels are 100 mg/dL and below, although levels below 150 mg/dL are considered good. Levels of 150-199 mg/dL are borderline high, 200-499 mg/dL is high, and levels above 500 mg/dL are very high.
How often should you get checked out: If your numbers are good, and you’re not at risk for heart disease, the American Heart Association recommends getting checked out every four to six years. If your numbers are elevated or you are at risk for heart disease, more regularly, as determined by your health care provider.
To get these tests in 15 minutes for free from a health care professional, you can visit the Healthy Hub in the main lobby of the West Kendall’s Baptist Hospital, located at 9555 SW 162nd Ave. For information on the Healthy Hub, call 786-467-3030.