Following a healthy lifestyle will give you an edge in the fight against heart disease and stroke. The following lifestyle modifications are recommended by the Journal of the American Medical Association:

§ Maintain a normal body mass index (BMI) of 18.5-24.9
§ Adopt the DASH eating plan - consume a diet rich in fruits, vegetables, and low-fat dairy products.
§ Reduce saturated and total fat intake (foods with saturated fats include: meat, cheese, butter and many packaged snacks
§ Reduce salt and foods including high levels of sodium
§ Engage in regular aerobic physical activity at least 30 minutes per day, most days of the week
§ Moderate alcohol consumption - limit consumption to no more than 2 drinks per day (most men), 1 drink per day (women)

Keeping Up with Medication Dosage and Frequency is Vital to Your Health
(winter 2005)

The patient had been diagnosed with hyperlipidemia, or high cholesterol. The doctor prescribed a statin, a lipid lowering drug. After taking the drug for a while, the patient's cholesterol level came down. He stopped taking his medication. The patient later began to experience shortness of breath when exercising and some pressure in his chest. Subsequently, he experienced chest pain and had to have open-heart surgery. This patient was former President Bill Clinton.

President Clinton was fortunate. Other patients who stop taking their cholesterol medication, or do not adhere to their prescribed dosages, are not so lucky. In fact, approximately 125,000 deaths in the United States each year are attributed to noncompliance with a doctor's prescription, twice the number of people killed in automobile accidents, according to LifeClinic, a website devoted to long-term health conditions. The most common types of noncompliance include:
§ Not having a prescription filled
§ Taking an incorrect dose - too much or too little
§ Taking the medication at the wrong time
§ Forgetting to take one or more doses
§ Stopping the medication too soon

According to the World Health Organization, the noncompliance rate for long-term therapies averages 50 percent. Boston Heart Party™ results from last spring's annual enrollment health fairs suggest that GIC enrollees may not be compliant with their heart medications or are not under treatment for their cardiovascular disease risk. More than 1,600 GIC enrollees took advantage of the free screenings. Although participants may not mirror the entire GIC population, and fasting tests provide more accurate cholesterol and glucose readings, over 50% of GIC enrollees taking the test reported having a known risk factor for heart disease and many of these same people still exhibited "at risk" screening results, which suggests that they may not be following doctors recommendations (the GIC received only aggregate data).

High Blood Pressure (Hypertension): High blood pressure, or hypertension, is very common, affecting over 18 million workers in the United States. According to the National Health Information Survey, 35% of those with hypertension have not been diagnosed. Known as "the silent killer", high blood pressure is a condition in which the pressure of the blood in the arteries is too high. The normal range is 120/80 mm Hg (millimeters of mercury). If your pressure is consistently above this range, you have high blood pressure and are at risk of a heart attack, stroke and kidney disease. The top (systolic) number measures the pressure when the heart beats. The bottom (diastolic) number is the pressure when the heart is at rest.

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines high blood pressure for non-diabetics as 140/90 or more. Of the GIC enrollees screened at the fairs, 26% of women and 44% of men had high blood pressure readings. Prehypertensive (at risk for high blood pressure) means the systolic number is between 120-139 or the diastolic is between 80-89. Of the GIC enrollees screened, 60% of women and 68% of men had prehypertensive blood pressure readings.

High Cholesterol (Hyperlipidemia): Over 37 million American workers have hyperlipidemia. Like high blood pressure, many Americans are unaware that they have high cholesterol. Forty-one percent of those with hyperlipidemia have not been diagnosed. Cholesterol travels in the bloodstream in the form of various-sized particles known as lipoproteins. Elevated cholesterol means that you have more cholesterol in your blood than your body needs. Total cholesterol levels should be under 200 milligrams per deciliter (mg/DL), according to the National Institute of Health. Fifty-two percent of GIC women screened had total cholesterol levels greater than 200, including 17% with levels above 240. Forty-four percent of GIC men had total cholesterol levels greater than 200, including 13% with levels above 240.

High Blood Sugar (glucose): Four percent of the workforce has diabetes, which is indicated by high blood sugar levels greater than 126 (mg/DL). Forty-one percent of workers with diabetes are undiagnosed. Levels of glucose rise in the blood because the glucose is not getting into the body's cells. Diabetes more than doubles your risk for a stroke or heart disease. Although fasting is necessary to get the most accurate glucose readings, levels greater than 199, with or without fasting, indicate a need to seek treatment immediately. Fifteen percent of GIC women and 21% of GIC men had glucose levels greater than 126. One percent of GIC women and 3% of GIC men had readings greater than 199.

So why do patients not follow their prescribed drug regimen for lowering risk for heart disease? A 1999 study published in the Journal of the American Geriatrics Society identified 26 factors that lead to noncompliance. Compliance decreased as the complexity, cost and duration of the medication regimen increased. Patient-related factors that contribute to noncompliance include lack of social support, an unstable living environment, mental illness, limited financial resources, denial of the illness, and low perceived susceptibility to the disease. The busiest patients were found to have the lowest rate of compliance. Poor communication between the patient and his/her provider also led to noncompliance.

Patients must take their medication as prescribed in order for the medication to be effective. Failure to do so can cause side effects that may be mild -- or potentially fatal. The American Heart Association recommends the following tips for remembering to take medication as prescribed:
§ Take it at the same time every day; take it along with meals or other routine daily events
§ Use special pill boxes, such as the one divided into sections that can be found at most drug stores
§ Keep a medicine calendar, or use a white board or sticker system to record your medications

Work with your doctor to develop other tools to help you keep up with your drug regimen. NEVER stop taking your medication without first talking to your doctor.