Cardiovascular Health by Mediaplanet_USA

A Mediaplanet Guide to Lowering Your Risk of Cardiovascular Disease

Cardiovascular Health

Jennie Garth The TV actress offers some simple steps for living a hearthealthy life How Amarin is helping minority populations lower their disproportionate risks of heart disease A Heart Hero shares how he made a life-saving discovery of his love for running

SEPTEMBER 2021 | FUTUREOFPERSONALHEALTH.COM

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Healthy heart tips Staying active is one of the best @MEDIAPLANETUSA

How the American Heart Association Can Help You Find Your Fierce

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oday, 1 in 3 adults in the United States report being worried or depressed, and more than half of U.S. adults say COVID-19 has negatively impacted their mental well-being due to worry and stress. Stress may lead to unhealthy habits like overeating, physical inactivity, and smoking, which can worsen risk factors for heart disease and stroke, such as high blood pressure. In addition, stress can cause or worsen depression and anxiety. On the flip side, managing and reducing stress can improve feelings of happiness, purpose, and gratitude, all of which can keep hearts and minds healthier, and make it more likely for people to stick with healthy habits. On this World Heart Day, Sept. 29, the American Heart Association is encouraging you to Find Your Fierce and make time to prioritize physical and mental health. “Reducing stress, and improving psychological health and well-being are more important than ever for improving heart health,” said Glenn N. Levine, M.D., FAHA, master clinician and professor of medicine at Baylor College of Medicine, chief of the cardiology section at the Michael E. DeBakey VA Medical Center, and chair of the writing committee for the American Heart Association’s Scientific Statement on mental well-being.

People in the United States are more stressed than ever, and this constant stress can have real consequences, both on emotional and overall health. ways to keep your body and mind healthy. Not only can it help you feel, think, sleep, and live better, it improves overall quality of life. Physical activity is linked to lower risk of diseases, stronger bones and muscles, improved mental health and cognitive function, and lower risk of depression. The American Heart Association recommends adults get @FUTUREOFPERSONALHEALTH

at least 150 minutes of moderate-intensity or 75 minutes of vigorous activity each week. If you’re just getting started with a workout regimen, start small. Stand, stretch, walk, dance, do whatever gets you moving — any movement is better than no movement, and more is better! Start out with just five minutes of movement and build up from there,

or split up your movement throughout the day. Finding time to get active requires making a commitment by scheduling time throughout the day to move. Set a reminder on your calendar, phone, or a journal — any method that you know you’ll check. A positive mindset can also improve your overall health.

A recent study shows people with higher levels of optimism had a 35 percent decreased risk of cardiovascular disease. Some studies show a more positive mindset can help you live longer, and happy people tend to sleep better, exercise more, eat better, and not smoke. Go to heart.org/BeWell to learn more. n American Heart Association

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Publisher Jackie Broderick, Chloe Addleson Business Developer Joelle Hernandez Managing Director Luciana Olson Lead Designer Tiffany Pryor Designer Keziah Makoundou Lead Editor Mina Fanous Copy Editor Dustin Brennan Director of Content and Production Jordan Hernandez Cover Photo Ryan West All photos are credited to Getty Images unless otherwise specified. This section was created by Mediaplanet and did not involve USA Today.

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Heart Disease Awareness Has Gone Global Since it was first announced in 1999, World Heart Day has been a campaign during which individuals, families, communities, and governments around the world participate in activities to take charge of their heart health and that of others. Why is there need for a global campaign to focus on heart health? Because heart disease is that devastating. Just for perspective, while COVID-19 claimed more than 1.8 million lives worldwide in 2020, heart disease caused the death of more than 18 million people every year. Although the direct toll of COVID-19 has been devastating, many in the medical community have also worried about the indirect toll of the pandemic on patients with cardiovascular disease with fewer people being diagnosed and likely putting many at higher risk for life-threatening events like heart attack or stroke. “Cardiovascular disease has been

the leading cause of death in both men and women and continues throughout the pandemic.” said Dean Karalis, M.D., an expert in cardiology and lipidology and a clinical professor of medicine at Thomas Jefferson University in Philadelphia. Dr. Karalis talked about the importance of heart disease awareness in the pandemic era on a recent edition of the healthcare podcast True to Your Heart, available at bit.ly/TTYHPodcast. Prevention is the key The theme of this year’s World Heart Day effort is to “Use Heart to Connect,” noting that the pandemic that everyone has been living through has highlighted an urgent need to find different and innovative ways to connect people to heart health. A central pillar to this effort is prevention: avoiding heart disease before it becomes a problem. As Dr. Karalis recommended: “What’s important for all of us is to take charge of our own health. We need

to live a healthy lifestyle. We need to try to exercise and eat well. But we also need to know and recognize what the risk factors of heart disease are so we can talk to our doctor about how we reduce our risk factors.” Knowing the risk factors Preventing cardiovascular disease means addressing the risk factors first. As Dr. Karalis explained, the first part is to know your family history. If you have a close family history of heart disease, you need to talk to your doctor about making sure you get screened for your blood pressure, your cholesterol and your blood sugar, and ensuring you don’t smoke. And you need to look beyond cholesterol because we’re also recognizing now that elevated triglycerides — the fat in our blood — also pose a significant risk for heart disease. First steps toward prevention The starting point for prevention, according to Dr. Karalis is to take a

step back and ask yourself: “Do I really ‘know my numbers’ for risk factors?” That is, do you know your own cholesterol values? Do you know your triglyceride levels? Do you remember what your blood pressure was when you last saw your doctor? What is your last blood sugar measurement? If you don’t have the answers to those questions, you need to get those answers and think about it and talk to your doctor so that, together, you can map a plan to address those risk factors and lower your own risk for cardiovascular disease. n Alina Kolomeyer PharmD, Director of Communications, Amarin Pharma, Inc.

Hear more from Dr. Karalis, and other experts, about heart disease on the True to Your Heart podcast, at bit.ly/ TTYHPodcast.

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PATIENT INFORMATION VASCEPA® (pronounced vas-EE-puh) (icosapent ethyl) capsules What is VASCEPA? VASCEPA is a prescription medicine used along with certain medicines (statins) to reduce the risk of heart attack, stroke, and certain types of heart issues requiring hospitalization in adults with heart (cardiovascular) disease, or diabetes and 2 or more additional risk factors for heart disease. It’s also used along with a low-fat and low-cholesterol diet to lower high levels of triglycerides (fats) in adults. It is not known if VASCEPA changes your risk of having inflammation of your pancreas (pancreatitis). It is not known if VASCEPA is safe and effective in children. Do not take VASCEPA if you are allergic to icosapent ethyl or any of the ingredients in VASCEPA. See the end of this summary for a complete list of ingredients in VASCEPA. Before taking VASCEPA, tell your doctor about all of your medical conditions, including if you: • have diabetes. • have a low thyroid problem (hypothyroidism). • have a liver problem. • have a pancreas problem. • are allergic to fish or shellfish. It is not known if people who are allergic to fish or shellfish are also allergic to VASCEPA. • are pregnant, or planning to become pregnant. It is not known if VASCEPA will harm your unborn baby. • are breastfeeding or plan to breastfeed. VASCEPA can pass into your breast milk, and may harm your baby. Talk to your doctor about the best way to feed your baby if you take VASCEPA. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and dietary or herbal supplements. VASCEPA can interact with certain other medicines that you are taking. Especially tell your doctor if you take medicines that affect your blood clotting (anticoagulants or blood thinners). How should I take VASCEPA? • Take VASCEPA exactly as your doctor tells you to take it. • Do not change your dose or stop taking VASCEPA without talking to your doctor. • Do not take more capsules than what is prescribed by your doctor. - If you are prescribed the 0.5 gram capsules, you should not take more than 8 capsules each day with food. - If you are prescribed the 1 gram capsules, you should not take more than 4 capsules each day with food. • Take VASCEPA capsules whole. Do not break, crush, dissolve, or chew VASCEPA capsules before swallowing. • If you miss a dose of VASCEPA, take it as soon as you remember. However, if you miss one day of VASCEPA, do not double your dose when you take it. • Your doctor may start you on a diet that is low in saturated fat, cholesterol, carbohydrates, and low in added sugars before giving you VASCEPA. Stay on this diet while taking VASCEPA. • Your doctor may do blood tests to check your triglyceride and other lipid levels while you take VASCEPA.

What are the possible side effects of VASCEPA? VASCEPA may cause serious side effects, including: • Heart rhythm problems (atrial fibrillation and atrial flutter). Heart rhythm problems which can be serious and cause hospitalization have happened in people who take VASCEPA, especially in people who have heart (cardiovascular) disease or diabetes with a risk factor for heart (cardiovascular) disease, or who have had heart rhythm problems in the past. Tell your doctor if you get any symptoms of heart rhythm problems such as feeling as if your heart is beating fast and irregular, lightheadedness, dizziness, shortness of breath, chest discomfort, or you faint. • Possible allergic reactions if you are allergic to fish or shellfish. Stop taking VASCEPA and tell your doctor right away or get emergency medical help if you have any signs or symptoms of an allergic reaction. • Bleeding. Serious bleeding can happen in people who take VASCEPA. Your risk of bleeding may increase if you are also taking a blood thinner medicine. If you have liver problems and are taking VASCEPA, your doctor should do blood tests during treatment. The most common side effects of VASCEPA include: muscle and joint pain; swelling of the hands, legs, or feet; constipation; gout; and heart rhythm problems (atrial fibrillation). These are not all the possible side effects of VASCEPA. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store VASCEPA? • Store VASCEPA at room temperature between 68° to 77° F (20° to 25° C). • Safely throw away medicine that is out of date or no longer needed. Keep VASCEPA and all medicine out of the reach of children. General information about the safe and effective use of VASCEPA. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use VASCEPA for a condition for which it was not prescribed. Do not give VASCEPA to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about VASCEPA that is written for health professionals. What are the ingredients in VASCEPA? Active ingredient: icosapent ethyl Inactive ingredients: tocopherol, gelatin, glycerin, maltitol, sorbitol, and purified water VASCEPA is a registered trademark of the Amarin group of companies. ©2019 Amarin Pharma, Inc. Bridgewater NJ, 08807. All rights reserved. PP00120M Revised: 12/2019 Distributed by: Amarin Pharma, Inc. Bridgewater, NJ, USA Manufactured for: Amarin Pharmaceuticals Ireland Limited Dublin, Ireland +1-855-VASCEPA (+1-855-827-2372) www.vascepa.com For more information, go to www.vascepa.com or call 1-855-VASCEPA (1-855-827-2372). This Patient Information has been approved by the U.S. Food and Drug Administration.

How Shared Decision-Making Fosters Partnerships in Care

heart disease diagnosis can be a life-altering experience. Heart disease patients may need to navigate a wide array of tough decisions about which treatments or tests are right for them. Thankfully, patients are not alone in making these decisions. In a new frontier, clinicians are committed to helping patients make informed health decisions through shared decision-making. Better together Working together as one team through shared decision-making, clinicians and patients can improve outcomes and facilitate patient involvement in their own healthcare decisions. When done

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Shared decision-making is an essential part of the clinician-patient relationship. When done properly, it helps align values and goals for important healthcare decisions. properly, shared decision-making can help patients increase their knowledge and satisfaction with care, define clearer goals for treatment, and align health decisions with their values. These results are essential to ensuring optimal patient care, and knowing this, the cardiologist and cardiovascular care team members of the American College of Cardiology have made teamwork and collaboration through shared decision-making a pillar of our core values. Decision aids, which are tools to help patients better understand their options, are often used to help facilitate these conversations. They come in many forms, but are usually online worksheets, videos, or brochures. Typ-

ically, decision aids will outline the objective considerations (things we know to be true through clinical evidence) and subjective considerations (a patient’s health goals and feelings) to come to the best possible outcome. It should be noted that decision aids do not take the place of a thoughtful discussion between clinicians and patients, but the best decision aids support quality decision-making. Building trust One of the keys to shared decision-making is fostering the clinician-patient relationship. An involved and committed clinician is more likely to help guide a patient through important and thorough decisions. A patient

who can understand their diagnosis is more likely to be open to learning about treatments and tests available to them. Healthcare decisions are stressful, but shared decision-making works to lift the burden and strengthen the clinician-patient relationship. Remember, you and your loved ones are not alone in navigating heart disease care. Whether you are newly diagnosed or facing a new treatment decision, your cardiovascular care team can work with you every step of the way to find the treatment that is best for you. n Dipti Itchhaporia, M.D., FACC, President, American College of Cardiology

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Easy Steps to Self-Monitor Your Blood Pressure at Home

On this World Heart Day, it’s daunting to hear that more than a billion people around the world have high blood pressure, or hypertension, including 1 in 2 — 116 million — adults in the United States; only about 1 in 4 have it under control. These numbers may be news to many, but most of us know the serious health damage that uncontrolled high blood pressure can cause: heart attacks, strokes, kidney disease, heart failure, dementia, and serious complications during and after pregnancy. What can you do to protect yourself and your family from these preventable health conditions? Although eating a

healthy diet, exercising regularly, and taking medications as prescribed may prevent or control high blood pressure, how do you know these measures are working for you? Studies show that the best way to know for sure is for you to self-measure your blood pressure every day and share your readings with your healthcare team. Regularly monitoring your blood pressure will help you identify the effects of activities, stress, sleep, medications, and other factors, literally putting blood pressure control in your hands. Steps to better heart health How do you get started self-measuring

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your blood pressure? Let’s break it down to a few easy steps. Start by discussing your plan to self-monitor your blood pressure with your healthcare team and set your goal for a healthy range of readings. Ask for help in selecting a home blood pressure monitor, including one with the cuff size that’s right for you. Your insurance company may cover the monitor at low or no cost. Your healthcare team can help you find out. When checking your blood pressure, properly preparing and positioning yourself are important for getting accurate readings. Before you get started, empty your bladder, turn off your phone and TV, and rest quietly in a chair (with

your back supported and feet flat on the floor) for five minutes. Get in the habit of taking your readings at the same time each day, and keep a log of your readings to share with your healthcare team. Ask if they have any recommendations for you. Gradually adjust your exercise, diet (especially your salt intake), and other factors your healthcare team may recommend. Finally, remember to take any blood pressure medications as prescribed by your healthcare team. Soon you’ll understand the ups and downs of your blood pressure, and you’ll be in control! n The Centers for Disease Control and Prevention (CDC)

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sistently trying our products at home prior to bringing them to market has helped us to make our products easier to use and to provide better instructions. Our mission is to make an impact on as many lives as possible. That’s why we’re proud to participate in multiple Health Care Programs, starting in 2020. This enabled us to bring accurate home blood pressure monitors to hundreds of thousands of households across the United States. n

Are You Measuring Your Blood Pressure Correctly? With nearly half of the U.S. population having hypertension and only 1 in 4 adults having their condition under control, monitoring blood pressure becomes more and more crucial. Studies show that monitoring blood pressure at home helps to manage and reduce high blood pressure. It also increases awareness and empowerment of adults with hypertension. An added benefit is that having a blood pressure monitor at home helps to prevent the white coat effect. White coat effect Monitoring blood pressure at the doctor’s office is generally considered the most accurate method. A disadvantage of this method is, however, the so-called “white coat effect”

— being at the doctor’s office can cause stress, heighten a patient’s blood pressure, and cause a measurement to be inaccurately high. Inaccurate measurements should be avoided at all costs, as this may result in inadequate treatment of the patient’s problems. A great solution for this is measuring your blood pressure comfortably at home. However, when using a home blood pressure monitor, users should be aware of how to use it and get proper instructions for accurate home use. At-home devices Whether or not a blood pressure measurement is accurate depends on a lot of factors. For example: having a full bladder can add 10-15 points to a blood pressure reading. Other factors that influence read-

Recommendations for Home Blood Pressure Monitoring

ings include taking a shower right before a measurement or talking while measuring. To better understand how people use iProven blood pressure monitors at home, we asked individuals to take a video of themselves while taking their blood pressure. This allowed us to see how they take a measurement, which inspired us to create a proper instruction video: bit.ly/bpm656. With this video, we can provide people with even better, more thorough instructions. Do’s and don’ts 1. Taking a hot or cold shower or bath right before measuring can raise your numbers. Instead, wait 20-30 minutes. 2. Don’t measure with a full bladder, as this can add 10-15 points to your reading.

3. Sit back, take a deep breath, and relax before you start. Don’t move or talk while taking a measurement. 4. M ake sure to position the cuff at heart height. 5. Don’t eat or drink hot or cold food or drinks right before you start. Apart from the clinical testing procedures, iProven’s products are personally put through the wringer. This means they are tested extensively in the home setting. That’s how we discovered, for one of our thermometers, that a “mute” button would prevent a sleeping child from waking up when their temperature is being taken. Or what a difference it makes for your levels to sit back and relax a few minutes before taking a blood pressure measurement. Con-

1. Start monitoring now, not when there is a problem. When there is a problem, you’re too late. Monitoring once a week is a good start. Contact a medical professional if you’re worried about your numbers. 2. Make sure to compare your readings to professional results. Whether it’s at your yearly check-up or you already see a doctor for your blood pressure, make sure to compare notes. 3. Monitoring is the basis of a good action plan. Only when you know your daily or weekly levels can you see the impact of lifestyle changes. 4. M ake sure to follow the instructions to perform correct measurements, see bit.ly/bpm656 for more information. Arjan Smit, Head of Product Development, iProven

To see iProven’s blood pressure monitor collection, visit iproven.com/collections/ blood-pressure-monitors.

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The First Steps That Changed My Heart Nothing human is alien to us,” so says the famous quote by the ancient Roman playwright Terence. And at 57 years of age, I was living proof of this because I turned over a new leaf. At only 40 years of age, and already 55 pounds overweight, I learned that I was suffering from hypertension, or high blood pressure, with sky-high cholesterol numbers, especially the bad kind — low density lipoproteins (LDLs). For years, I understood the medical report from my cardiologist, and yet could not change my sedentary habits, lose weight (except for short, intermittent periods), nor change what and how I ate and drank. The slogan “just do it” tortured me — just thinking that all I needed to do was to set my mind on changing my situation only added to the guilt I felt at failed attempts to do just that. And so the years went by and the damage added up. If I could send a single message to those who feel that they can’t make a change, it would be this: When we take a step back and reflect, we can usually see the challenges of being human, which makes us sometimes unable to face up to what we know we really need. Sometimes, unexpectedly

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With an alarming medical diagnosis that included soaring cholesterol levels, Alejandro Asprella finally decided to act. Here he shares his powerfully simple story, straight from the heart, and lets us in on the emotions that often accompany difficult but meaningful change.

or incomprehensibly, our subconscious has its own way of influencing our lives and decisions, either helping or hindering us. Seeing things this way helps us understand that forging a change and a new path to health is more complex than simply saying “just do it” or “all you need is willpower.” Adjusting focus And yet, change is not impossible if we are able to adjust our focus. One day, while

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experiencing worrying symptoms, I felt that I had to do something. Fifteen years had already passed since my diagnosis. At first, I pushed myself to do a light jog for 15-20 minutes early every morning. To overcome the burden, boredom, and resistance, I would put the news on my TV while I ran to make the effort seem like less of an uphill battle. I noticed that just doing this for a few days, and without even adjusting my nutritional

habits, I began to lose a bit of weight. Seeing such modest progress each week motivated me to keep going. One morning, while waiting for someone outside, I decided to trot along the sidewalk, stimulated by the fresh air. After a couple of days, I felt up to jogging to the nearby park where I came upon other early morning walkers and joggers. Suddenly, I felt like I was not so alone, that I had company. And I simply wanted to keep going.

Finding support Maintaining this level of effort for a while, I started to build up more physical strength, eventually taking part in a short run in the city center that I really enjoyed. Gradually, going from strength to strength, I began to want to improve. I didn’t just want to lose weight, no, I also wanted to change how much and what I was eating. Now, I had a more clearly defined objective and an overall desire to be more physically fit, and to take part in more races. Willing to let myself be surprised by unsought possibilities that kept coming up, I soldiered on and, almost without realizing or planning it, I found myself at 62 years of age participating in my first marathon — in New York no less! We each have our own drivers for change, whether it’s to feel better about ourselves, improve self-confidence, improve our health, embark on self-discovery, or to be stronger in the face of adversity. Furthermore, exercising outdoors helps us take in fresh air and meet new people. Indeed, taking up physical activity to improve our health and our lives paves the way for life’s pleasant surprises, proving that uplifting and transformative experiences can still be ours at any age. n Alejandro Asprella, Heart Hero, World Heart Federation

How Nutrition, Exercise, and Stress Management Affect Heart Health The road to a healthy heart involves both your mind and body. Healthful eating and regular physical activity can help you decrease your risk of developing high blood pressure, high cholesterol, and obesity, which are some of the leading risk factors for developing heart disease. Take a step in the right direction by eating foods with dietary fiber, such as oats, beans, vegetables, fruits, nuts, and seeds. Incorporating healthful foods into your meals now can help decrease your risk of heart disease in the future. Home-cooked meals gained popularity during the COVID-19 pandemic and gave many people the opportunity to create delicious, heart-healthy dishes.

If you’re looking to make this trend a lifelong habit, start by planning your meals to include foods from each of the five food groups: grains, vegetables, fruits, dairy, and proteins. Fruits and vegetables should comprise half of your plate, and you should choose whole-grain foods — such as brown rice or whole grain bread — whenever possible to increase the amount of dietary fiber you consume. Also make sure to drink plenty of fluids to help your body adjust to a higher amount of fiber. Read the nutrition facts label on foods you buy, and limit the amounts of salt, added sugars, and saturated fat in your diet. You can decrease the amount of saturated fat you eat by

choosing leaner cuts of meat, and lowfat or fat-free dairy products. Mental health A healthy mind also plays a big role in maintaining a healthy heart. Manage your stress by getting enough sleep and practicing relaxation techniques. Health benefits associated with regular physical activity include reduced anxiety and improved sleep, according to the “Physical Activity Guidelines for Americans, 2nd edition.” Regular physical activity may also help you manage your weight, blood pressure, cholesterol, and blood sugar levels — all things that are important for a healthy heart. The “Physical Activity Guidelines for Americans” recommends adults partici-

pate in at least 150-300 minutes of moderate-intensity, or 75-150 minutes of vigorous-intensity aerobic physical activity throughout the week, and include muscle-strengthening activities on two or more days a week. Choose activities according to your ability and ones that you enjoy so you will stick with them. Check with your healthcare provider before increasing physical activity. For more tips, visit the Academy of Nutrition and Dietetics’ online Find a Nutrition Expert service to find a registered dietitian nutritionist who can help you create a nutrition and physical activity plan that fits your lifestyle. n Caroline Susie, RDN, LD, National Spokesperson, Academy of Nutrition and Dietetics

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Not all of us can be professional nutritionists or dieticians, but most of us want to know how to make our diets a little more healthful, without giving up the good stuff. As fad diets come and go, how do you tell the difference between what’s the real deal and what’s not? Lisa Lillien, aka Hungry Girl, would be the first to tell you she’s not a professional nutritionist; she’s just a woman who’s obsessed with food and helping other normal food-eaters like herself learn how to maintain a diet that is both delicious and good for the body. “I’ve always been a bit food-obsessed, and even though I don’t have any kind of a degree relating to health or food, I wanted to find a way to share all my food finds, ideas, and recipes with the world,” Lillien said. “Back in 2004 when I started Hungry Girl, this was not a common thing. Blogs barely existed, and there was no such thing as social media. So when I started my daily emails, there was really no one else doing what I was doing. I love that people were drawn to the content and have found it so relatable and helpful.” So, as a go-to expert layman, what does Lillien suggest for others who want to start improving their nutrition? Change how you stock your fridge, invent healthier versions of unhealthy foods, start taking daily walks, and revamp your breakfast game.

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Nutrition influencer, author, and blogger Lisa Lillien explains why changing the way you eat doesn’t have to be a pain.

An Everywoman’s Advice for Eating Like a Nutritionist “I think it’s difficult to just flip a switch and make that change, and a lot of times, people beat themselves up if they’re not successful right out of the gate,” Lillien said. “People shouldn’t feel the need to strive for perfection. Make a commitment to move more by taking daily walks. Fill your fridge and pantry with a lot of smart staples so it’s easier to grab something healthy when you’re hungry.” A healthy start Science tells us that breakfast is an important way to jumpstart a healthy day, but finding delicious and nutritious breakfasts can be a challenge.

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Lillien said she loves breakfast, and offered a few staples. “I love hard-boiled egg whites and scrambled egg whites,” she said. “I typically avoid the yolks, but that’s just because I prefer to get my healthy fats in other ways, like snacking on nuts.” She also recommends fruit, “That’s a favorite of mine. I especially love watermelon, cantaloupe, oranges, and apples;” and Greek yogurt, “I tend to stick with low-fat or fat-free Greek yogurt. I love it because it tastes great and is packed with protein.” Easy adjustments It can be hard to start a lifestyle

change right away, and many people think that transforming their daily routine might be too time consuming or challenging. But Lillien pushes back: “I say it really doesn’t have to be time-consuming. I think when people say that, it could just be an excuse,” she explained. “It’s more about planning and setting yourself up for success. It doesn’t take a lot of time to make healthier choices, but you have to make it something that’s important in your life. If it’s prioritized, it’s easy.” There are also plenty of readily available products that can help make this change a little simpler. “Bagged salads,

vegetable medleys, riced and spiralized veggies, precooked proteins,” Lillien said, “these things are all readily available.” It’s also not uncommon to worry that you’ll have to give up things like donuts and hamburgers altogether, but Lillien says it’s all about balance. “I live by the 80/20 rule, so I don’t resist them altogether. I indulge every now and then,” she said. “But the main way I deal with guilty pleasure foods is by making smarter and healthier versions that are satisfying and delicious. I’m a little bit of a mad scientist in that way. It’s fun — I love a challenge.” n Lynne Daggett

may have different signs from what we are used to with men, like chest pain,” Dr. Gabbay points out. “Women can get arm pain, jaw or back pain, or other symptoms instead. Educating people with diabetes and women who are at risk for having heart disease about how their symptoms may appear is very important.” Dr. Gabbay says close follow-up with a healthcare team is also critical in preventing and managing cardiovascular events appropriately.

Coping With Diabetes During Challenging Times There’s no disputing the statistics: Adults with diabetes are nearly twice as likely to develop heart disease or stroke as those who don’t have the disease. That’s why it’s crucial for diabetic patients to be proactive. There are many steps people with diabetes can take to reduce their heart disease and stroke risk,” explained Robert Gabbay, M.D., Ph.D., who before joining the American Diabetes Association served as the chief medical officer and senior vice president of Joslin Diabetes Center, the world’s leading diabetes care and research center. “For example, if they are smoking, they need to quit. Also, make smarter food choices, prevent or treat their high cholesterol and high blood pressure, be more physically active, lose weight, and better manage their diabetes.”

Who’s at risk According to Dr. Gabbay, who’s also an associate professor at Harvard Medical School, certain individuals are more likely to develop diabetes. “We screen people who are 45 or older, of certain ethnic backgrounds, have a first-degree family member with diabetes, are overweight or obese, are physically inactive, have low good cholesterol (HDL) and high bad cholesterol (triglycerides), have a history of diabetes during pregnancy, or have been diagnosed with polycystic ovarian syndrome,” he said. The American Diabetes Association® offers a free 60-second

risk test, available at diabetes. org/RiskTest, that you can take to assess your likelihood for developing diabetes. Don’t go overboard Instead of making dramatic changes or taking part in fad diets, Dr. Gabbay believes patients with diabetes, or those who are at risk, should take a more sensible approach. “Studies have shown that a weight change of only 5-7 percent can have a drastic effect on people’s health,” he said. “My suggestion as it pertains to diet is to have people at risk for diabetes work with a dietitian and their healthcare team

to improve what we call their ‘dietary pattern.’” A dietary pattern looks at the quantities, proportions, variety, and a combination of different foods, drinks, and nutrients and how often they are habitually consumed. Once determined, patients can work with their dietitian or healthcare team to make improvements. Raising awareness Cardiovascular disease remains the leading killer in America. For people living with diabetes, it’s essential to remember that heart disease can show no signs at all. “For women, heart disease

Dealing with COVID-19 During the pandemic, researchers have studied activity levels in many countries across the globe, and the numbers are universally down. Dr. Gabbay says programs to increase activity should focus on safe restoration and improvement of previous exercise levels. He’s also concerned about fewer people getting tested for cardiovascular disease. “We are still in the COVID19 pandemic and, unfortunately, an indirect effect is that fewer people were being diagnosed with heart disease, as many have avoided hospitals during the COVID-19 surges,” he said. “That definitely does not help with avoiding deaths due to heart disease. However, efforts to combat this disease are ongoing, and should be intensified during and after the pandemic.” Gabbay adds that we need to all work together to ensure that the various steps and treatments that can prevent heart disease, like better management of the ABCs (A1C, blood pressure, and cholesterol) are taken. n Cindy Riley

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