Nurses, and everyone else…it’s time to step up your game. Since February is Heart Health Month, we decided to check in with Judy Hannan, R.N., M.P.H., Senior Advisor for Million Hearts® at the Centers for Disease Control for her thoughts and a bit of advice on having a healthy heart.
Pulse: Judy, can you tell us a little bit about the Million Hearts® Initiative?
Hannan: Million Hearts® set an ambitious five year goal to prevent 1 million heart attacks and strokes in the U.S. by 2017. Co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), the initiative is supported by many federal and private sector partners, all united behind efforts to scale-up proven clinical and community strategies to prevent heart disease and stroke nationwide.
In the community, we are looking for a 10 percent reduction in smoking prevalence; a 20 percent reduction in sodium intake and the elimination of artificial trans fats. We also need changes in the health care system – and believe that by more fully deploying health IT and focusing our health care system on one that values outcomes over process – we can excel in the ABCS (Aspirin use when appropriate, Blood pressure control, Cholesterol management, Smoking cessation) of heart health.
Pulse: What sort of results have you seen since the launch in 2011?
Hannan: In a very short period of time, Million Hearts has made tremendous progress in galvanizing partners to focus on the strategies listed above. And we know where we have made progress. There are almost 4 million fewer smokers in the U.S. than when we started. Numerous companies have agreed to voluntarily lower the sodium content of their food, and some municipalities have begun insisting that vendors provide lower sodium alternatives through alterations in their food services contracts. In addition, the Food and Drug Administration (FDA) issued a final determination on artificial trans fat, meaning that food manufacturers have three years to either remove artificial trans fat from their foods, or petition the FDA for an exemption.
On the clinical side, millions of Americans are covered by health care systems that are recognizing or rewarding performance in the ABCS, and the latest update on hypertension control shows that we are making progress. Millions of dollars in public and private funds have been leveraged to focus on improving the ABCS. Public health professionals like you play a key role in helping prevent heart attacks and strokes and we applaud those involved in our efforts – and welcome anyone else interested in participating.
Pulse: How close are you to meeting objectives by 2017?
Hannan: Despite these successes, we know there’s work to be done. The goal of the initiative isn’t just to prevent a million or so events – it’s also to invest in systems changes that will continue to reap returns over time. With the help of our partners, we can sustain momentum through 2017 and make a real impact on heart health in the years to come.
Pulse: Considering our readership, how likely (or unlikely) are medical professionals, nurses in particular, to pay close attention to heart health?
I don’t have current information about whether or not nurses as a group are more or less healthy than others – though I wouldn’t be surprised if some of you out there know. However, some of my colleagues recently published a study indicating that primary care providers who reported participating in physical activity and eating a healthy diet were more likely than those that didn’t to offer patients more healthy living recommendations.
Pulse: Do the stresses of a job in healthcare add to the risk factor of heart attack?
Hannan: There is research that shows some potential relationships between stressful environments, shift work, disruptions in sleep cycles and cardiovascular outcomes. But I think about it this way: we nurses are human too. And our behavioral choices (smoking, sodium intake, blood pressure, cholesterol, or taking aspirin if advised) likely play a key role in heart health. CDC recently published a study on “heart age,” which calculates the age of a person’s heart and blood vessels based on risk factors for cardiovascular disease. Researchers found one in two U.S. men and two in five U.S. women have a heart age that is five or more years older than their chronological age. And that could mean an increased risk of heart attacks and stroke. I encourage you all to assess your own heart age, and see if changes are in order. The good news is, it’s never too late to take action to lower your heart age and improve your health.
Pulse: What are some daily habits healthcare workers can develop to decrease the likelihood of heart attack or stroke? Any tips for things that can be done daily on the job for example, walk steps instead of take the elevator?
Hannan: If you are smoking, get help to quit. If you have high blood pressure, keep it under control. There are a lot of small steps people can take to reduce the chance of having a heart attack or stroke. For example, eat more fresh fruits and vegetables and focus on reducing the amount of sodium you eat each day, which is primarily found in packaged, processed and restaurant foods. Read the Nutrition Facts label while shopping to find healthier alternatives. Foods with less than 140 mg per serving are considered low in sodium.
Be physically active on a regular basis, such as walking, swimming, cycling or even gardening. If you’re busy, try brisk walking for 10 minutes at a time, a few times each day. Taking the stairs instead of the elevator – or parking further away from your office to increase step count – is a good start to a heart-healthier lifestyle. We really owe it to ourselves to take care of our own bodies.
Pulse: Any advice on smoking cessation for those that still smoke? How much does smoking increase the risk of heart attack or stroke?
Hannan: Smokers are at much greater risk for heart disease, stroke and other cardiovascular diseases, as well as cancer and pulmonary or respiratory diseases. Almost immediately, quitting smoking will improve your heart health. After just one year of quitting, your risk for a heart attack drops sharply – and even if you’ve already had a heart attack, you cut your risk of having another one by a nearly a half if you quit smoking. Two to five years after you quit, your risk for stroke falls to about the same as a nonsmoker’s.
Quitting smoking is hard and may require several attempts. To boost your chances of success; a) write down why you want to quit; b) know that it will take commitment and effort; c) get help if you want it. Smokers can receive free resources and assistance by calling the 1-800-QUIT-NOW quitline or by visiting cdc.gov/tips.
Pulse: What sort of exercise is most beneficial? Cardio? Strength training?
Hannan: Both aerobic and muscle-strengthening activity are important for overall health. The 2008 Physical Activity Guidelines for Americans recommend a combination of aerobic and muscle-strengthening activity for adults. For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity or an equivalent combination. Aerobic activity should be done for at least 10 minutes at a time, and preferably spread throughout the week. Muscle strengthening activities should be done on two or more days a week and should work all major muscle groups. Regardless of what you do or how long, some physical activity is better than none – and adults who participate in any amount of exercise gain at least some health benefits.
Personally, I have struggled with the above recommendation. I have never been one of those people that love exercise. I recently lost 15 pounds, and increasing exercise is a big part of that. I schedule at least 40 minutes on my exercise bike or take a brisk walk on the three days a week where I don’t have to do the morning car pool. I also get exercise in on the weekends. I have really found it helpful for me to track my activity, and on a day when I can’t seem to schedule the 45 minutes, I can almost always find at least 10 minutes, and some days I can find 2 or 3 ten minute increments.
Pulse: Can you offer any tips on eating healthier when you are very busy? Are there shortcuts for at home meals or ways to reduce fat, salt, etc. when dining out?
Hannan: There is a lot of good advice out there, so find what is feasible for you to incorporate. For me, planning ahead helps. I need to have healthy choices available during my work day, and I have to really work at eating a healthy snack in the afternoon, so I don’t arrive home famished. I learned early in my nursing career how to wolf down a meal in record time…who ever really had a half hour for lunch? I still struggle to slow down my eating, which is a very simple act that can lead to reduced calorie consumption.
A few other healthy tips:
o When cooking at home, add spices, herbs or citrus to different recipes, rather than salt. You can also use only half of a seasoning packet or sauce for ready-made foods.
o When eating out, you can request and review nutrition information before ordering to select a healthier choice. You can also ask that no salt or butter be added to your foods – and request any rich sauces or dressings remain on the side. Finally, you can immediately box up half of your meal in a to-go container before eating to ensure sticking to a smaller portion.
You can also check out the Million Hearts Healthy Eating and Lifestyle Resource Center for low-sodium recipes and heart-healthy meal plans and tips. All of the site’s recipes, meal plans and articles have been vetted by CDC experts and reviewed by registered dietitians at EatingWell, so visitors can rely on the integrity of the advice. I admit to feeling very proud of a compliment I received recently from a good friend: “I can always count on Judy bringing something healthy to the party.” While it is tons of fun to bring the world’s most decadent desert, with so many of us struggling to lose or maintain our weight, be the party hero that brings something delicious and nutritious.
Also, I have to confess – my husband is not only a great cook, but also someone that is very conscious of healthy eating. That helps me a lot!
Pulse: Do you have any supplement recommendations?
Hannan: Many U.S. adults are using complementary and alternative medicine (alternative providers, dietary supplements or special diets, body treatments, etc.), so it is important to talk with your health care provider about what therapies you are using and evaluate the benefits and risk of harm.
Pulse: Any final thoughts?
Hannan: Heart disease and stroke are largely avoidable—and many people can reduce their risk of developing or dying from cardiovascular diseases by managing medical conditions or making lifestyle changes. As a nurse, we fulfill so many roles. You can be the change agent in your health care system to get to better blood pressure control; you can be the change agent in your community to get healthier foods in the schools or hospitals; and you can be the change agent in your own life, making sure you put your health front and center where it needs to be. I know it’s easier said than done, but so many people are counting on us.
For information on Million Hearts, visit http://millionhearts.hhs.gov/.