Heart Disease

1. Understanding Heart Disease
2. What You Need to Know About Heart Disease
3. Major Risk Factors Explained
4. More Risk Factors
5. Risk Factors in Women Only
6. Action Plan for Heart Health
7. View All

Taking Charge: An Action Plan for Heart Health

You have just learned a great deal about risk factors for heart disease. Now you’re ready for action. The good news: Research shows that people can lower their heart disease risk enormously- by as much as 82 percent-simply by adopting sensible health habits. It’s never too late to start protecting your heart health.

A recent study shows that among people ages 70 to 90, leading a healthy lifestyle reduces the chances of dying from heart disease by nearly two-thirds.

What does it mean to “lead a healthy lifestyle”?
Here are the basics:

If you eat a nutritious diet, get regular physical activity, maintain a healthy weight, and stop smoking, you will help to keep your heart healthy. But doing just one or two of these “Big Four” habits isn’t enough to protect your heart. To keep your heart strong and healthy, it is vital to adopt and practice all four lifestyle habits.

Some people may need to take additional steps to prevent heart disease. For example, if you have diabetes, you also will need to keep your blood sugar levels under control. Eating a nutritious diet, controlling your weight, and getting more physical activity will help you to keep your blood sugar at healthy levels. These steps will also help reduce your chances of developing high blood pressure or high blood cholesterol. Whatever your current health condition or habits, the action plan that follows will make a positive difference in your heart health. Ready to get started? Then keep reading.

Choose Healthy Foods

A healthy heart needs a healthy diet. The “Dietary Guidelines for Americans” offers two examples of eating plans to choose from, and also includes advice for overall health and food safety. These guidelines encourage you to:

• Choose a variety of grains daily; half of your daily grains should come from whole grains
• Choose a variety of fruits and vegetables daily
• Choose a diet that is low in saturated fat, trans fat, and cholesterol
• Choose foods and beverages that are low in added sugar
• Choose and prepare foods with little salt
• If you drink alcoholic beverages, do so in moderation
• Aim for a healthy weight
• Be physically active most days
• Balance the calories you take in with the calories you expend through physical activity.
• Keep foods safe to eat

Now You’re Cookin’

Limiting Saturated Fat, Trans Fat, and Cholesterol

Planning and preparing nutritious meals may take a little extra effort, but the health benefits are huge. Here are some tips for cutting down on saturated fat, trans fat, and dietary cholesterol, which will help lower your LDL cholesterol and reduce your heart disease risk. It will improve heart health for everyone, and may be particularly helpful to those following the TLC eating plan.

Meat, Poultry, and Fish

• Choose fish, poultry, and lean cuts of meat. Trim the fat from meats; remove the skin and fat from chicken. Keep portion sizes moderate. Broil, bake, roast, or poach instead of frying. When you do fry, use a nonstick pan and a nonstick cooking spray or a very small amount of oil or margarine.
• Cut down on sausage, bacon, and processed, high-fat cold cuts (which are also high in sodium).

Milk Products and Eggs

• Instead of whole milk or cream, use fat-free or 1-percent milk.
• Use fat-free or low-fat cheeses and yogurt.
• Replace ice cream with sorbet, sherbet, and fat-free or low-fat frozen yogurt. Keep portion sizes moderate.
• Limit the number of egg yolks you eat. Egg whites contain no fat or cholesterol, so you can eat them often. In most recipes, you can substitute two egg whites for one whole egg.
• Use soft margarines (liquid or tub types) that contain little or no trans fat. Some brands of soft margarines are high in plant sterols or stanols, which lower LDL cholesterol.

Grains and Grain Products

• Eat foods with lots of fiber and nutrients and make sure that half of your grain products are whole grain. These include whole-grain breads, pasta, and cereals, as well as brown rice.
• When you check package labels, look for the word “whole” in the ingredients. Make sure that whole grains appear among the first items listed.

Sauces, Soups, and Casseroles

• After making sauces or soups, cool them in the refrigerator and skim the fat from the top. Do the same with canned soups. Thicken a low-fat sauce with cornstarch or flour.
• Make main dishes with whole-grain pasta, brown rice, or dry peas and beans. If you add meat, use small pieces for flavoring rather than as the main ingredient.

When You Can’t Face Cooking

Check the Nutrition Facts label on food packages to choose frozen dinners and pizzas that are lowest in saturated fat, trans fat, and cholesterol. Also watch the calories and sodium content. Make sure the dinners include vegetables, fruits, and whole grains-or add them on the side.

Choose store-bought baked goods that are lowest in saturated fat, cholesterol, trans fats, and hydrogenated (hardened) fats. Also, remember that even “no cholesterol” and fat-free baked goods still may be high in calories.

Dining Out for Health

With a little planning and a willingness to speak up you can eat healthfully when you dine out. Here are some tips.

Ask for what you want. Most restaurants will honor your requests.

You have nothing to lose by asking!

Order small. To reduce portion size, try ordering appetizers or children’s portions as your main meal. Or, take half of your entrée home with you for lunch the next day.

Ask questions. Don’t hesitate to ask your server how foods are prepared and whether the restaurant will make substitutions.

Ask if they will:

• Serve low-fat or fat-free milk rather than whole milk or cream.
• Tell you the type of cooking oil used. (Preferred types that are lower in saturated fat are canola, safflower, sunflower, corn, and olive oils.)
• Trim the fat off poultry or meat.
• Leave all butter, gravy, and sauces off an entrée or side dish.
• Add no salt during cooking.
• Serve salad dressing on the side.
• Meet special requests if you make them in advance.

Select foods cooked by low-fat methods. Look for terms such as broiled, baked, roasted, poached, or lightly sautéed.

Limit foods high in calories and fats, especially saturated fat and trans fat. Watch out for terms such as fried, crispy, creamed, escalloped, hollandaise, bernaise, casserole, and pastry crust.

Make Healthy Choices

• Breakfast: Fresh fruit, small glass of citrus juice, low-fat or fatfree milk and yogurt, whole-grain bread products and cereals, omelet made with egg whites or egg substitute.
• Beverages: Water with lemon, flavored sparkling water, juice spritzer (half fruit juice and half sparkling water), iced tea, reduced-sodium tomato juice.
• Breads: Most yeast breads are low in calories and fat-as long as you limit the butter, margarine, or olive oil. Choose wholegrain breads, which are packed with important nutrients and are full of fiber to make you feel fuller faster. Also, watch the sodium content.
• Appetizers: Steamed seafood, fresh fruit, bean soups, salad with reduced-fat dressing.
• Entrées: Skinless poultry, fish, shellfish, vegetable dishes, or pasta with red sauce or vegetables. Limit your use of butter, margarine, and salt at the table.
• Salads: Fresh lettuce, spinach, and other greens; other fresh vegetables, chickpeas, and kidney beans. Skip high-fat and high-calorie non-vegetable choices such as deli meats, bacon, egg, cheese, and croutons. Choose lower-calorie, reduced-fat, or fat-free dressings, lemon juice, or vinegar.
• Side Dishes: Vegetables and grain products, including whole-grain rice or noodles. Ask for salsa or low-fat yogurt instead of sour cream or butter.
• Dessert: Fresh fruit; fat-free frozen yogurt, sherbet, or fruit sorbet (usually fat free, but ask for the calorie content). Try sharing a dessert. If you drink coffee or tea with dessert, ask for low-fat or fat-free milk instead of cream or half-and-half.

Tame a Snack Attack

Many snacks, including many types of cookies, crackers, and chips, are high in saturated fat, trans fat, cholesterol, sodium, and calories. But that doesn’t mean you have to cut out all between-meal treats.

Keep the foods listed below on hand for snack attacks. But, keep in mind that while these foods may be low in fat, many are not low in calories. So watch how much you eat, especially if you are trying to control your weight.

Here are some healthier, low-fat snacks:

• 100-percent fruit juices
• Low-fat or fat-free milk
• Fat-free frozen yogurt, sherbet, and sorbet
• Low-fat cookies such as animal crackers, graham crackers, ginger snaps, and fig bars
• Low-fat crackers such as melba toast, or rice, rye, and soda crackers; look for unsalted or low-sodium types
• Fresh or dried fruit, or fruits canned in their own juice
• Vegetable sticks; try a dab of reduced-fat peanut butter on celery sticks
• Air-popped popcorn with no salt or butter; fat-free, low sodium pretzels

Aim for a Healthy Weight

If you are overweight or obese, taking pounds off can reduce your chances of developing heart disease in several ways. First, losing weight will directly lower your risk. Second, weight loss can help to reduce a number of other risk factors for heart disease, as well as lower your risk for other serious conditions. Weight loss can help control diabetes, as well as reduce high blood pressure and high blood cholesterol. Reaching a healthy weight can also help you to sleep more soundly, experience less pain from arthritis, and have more energy to take part in activities you enjoy.

Remember, if you need to lose weight, even a small weight loss will help lower your risk for heart disease and other serious health conditions.

At the very least, you should not gain any additional weight.

A recent study found that young adults who maintain their weight over time, even if they are overweight, have lower risk factors for heart disease in middle age than those whose weight increases. When it comes to weight loss, there are no quick fixes. Successful, lasting weight loss requires a change of lifestyle, not a brief effort to drop pounds quickly. Otherwise, you will probably regain the weight. Aim to lose between 1/2 pound to 2 pounds per week- no more. If you have a lot of weight to lose, ask your doctor, a registered dietitian, or a qualified nutritionist to help you develop a sensible plan for gradual weight loss.

To take off pounds and keep them off, you will need to make changes in both your eating and physical activity habits. Weight control is a question of balance. You take in calories from the foods you eat. You burn off calories during physical activity.

Cutting down on calories, especially calories from fat, is key to losing weight. Combining this change in diet with a regular physical activity program, such as walking or swimming, will help you both shed pounds and stay trim for the long term.

Getting Started

Anyone who has ever tried to lose weight-and keep it off-knows that it can be quite a challenge. Here are some tips to help you succeed:

Eat for health. Choose a wide variety of low-calorie, nutritious foods in moderate amounts. Include vegetables, fruits, whole grains, and low-fat or fat-free milk, as well as fish, lean meat, poultry, or dry beans. Choose foods that are low in fat and added sugars. Choose sensible portion sizes.

Watch calories. To lose weight, most overweight people will need to cut 500 to 1,000 calories per day from their current diet.

Keep milk on the menu. Don’t cut out milk products as you try to reduce calories and fat. Milk and milk products are rich in calcium, a nutrient that helps prevent the bone-thinning disease osteoporosis. Instead, choose low-fat or fat-free milk and milk products, which have the same amount of calcium as whole-milk products. Make the switch gradually. If you are used to drinking whole milk, first cut back to 2 percent, then move to 1 percent, and finally to fat-free milk.

Keep moving. Physical activity is key to successful, long-term weight loss. It can help you burn calories, trim extra fat from your waist, and control your appetite. It can also tone your muscles and increase aerobic fitness. To lose weight and to prevent further weight gain, gradually build up to at least 60 minutes of moderate intensity physical activity on most, and preferably all, days of the week. If you’ve lost weight, in order to keep it off, you’ll need to do even more physical activity-from 60-90 minutes of daily moderate- intensity physical activity. But you don’t need to run yourself ragged. A recent study showed that moderate physical activity, such as brisk walking, helps people lose weight as effectively as more vigorous exercise.

Steer clear of fast food. A single meal from a fast food restaurant may contain as many calories as you need for a whole day! A recent study showed that young adults who eat frequently at fast food restaurants gain more weight and are at higher risk for diabetes in middle age than those who avoid the fast food habit. If you do eat at a fast food restaurant, choose salads and grilled foods, and keep portion sizes small. Ask for salad dressings, mayonnaise, and other high-fat condiments to be served on the side-or not at all.

Know about medicines. If you are very overweight, or if you are overweight and have other weight-related risk factors or diseases, your doctor may advise you to take a medicine to help you take off pounds. You should use a weight-loss drug only after you have tried a low-calorie diet, more moderate-intensity physical activity, and other lifestyle changes for 6 months without successfully losing weight. Because weight-loss medicines have side effects, you should consider all of the risks and benefits before trying one of them.

These drugs should be used along with a low-calorie eating plan and regular physical activity, not as a substitute for these lifestyle changes.

Get support. Tell your family and friends about your weight-loss plans and let them know how they can be most helpful to you. Some people also find it useful to join a structured weight-loss program.

The most effective groups provide support and advice for permanently changing eating and physical activity habits.

Lock in your losses. After reaching your weight-loss goal, switch your efforts to keeping the weight off by continuing to eat a nutritious, lower calorie diet and getting regular physical activity. To maintain your weight, you’ll need to become even more active than before: Aim for 60 to 90 minutes of physical activity per day.

While this may seem like a tall order, remember that you can count the activities that you’re already doing. Common daily activities such as climbing stairs, pushing a stroller, unloading groceries, gardening, and brisk walking all count as physical activity. Just be sure you do enough of them!

Seven Secrets of Weight Management

If you have ever tried to take off weight, you know that it’s more than a matter of promising yourself that you’ll eat less and move more.

You also need to mentally prepare yourself for new behaviors. Here are some tips for getting and staying in a healthy weight mindset.

Start small. Many people set unrealistic goals for the amount of weight they want to lose. But you can greatly improve your health by losing just 5 to 10 percent of your starting weight. While you may choose to lose more weight later, keep in mind that this initial goal is both realistic and valuable.

Set smart goals. It’s important to set goals that are specific, achievable, and “forgiving” (allow you to be less than perfect). For example, “exercise more” is a fine goal, but it’s not very specific.

“Walk for 60 minutes every day” is specific and perhaps achievable.

But what if you have a bad cold one day, and you awake to a drenching rainstorm on another? “Walk 60 minutes, 5 days each week” is specific, achievable, and forgiving. A great goal!

Build on success. Rather than focusing on one big goal, choose a series of smaller goals that will bring you closer and closer to your larger goal. For example, if one of your big goals is to reduce your daily calories from 2,000 to 1,200, first reduce your calories to 1,700, then move to 1,400, and finally to 1,200. Likewise, with physical activity, first establish a “small” new habit-such as walking 10 minutes a day-and then gradually increase it. Everyone can find time to exercise 10 minutes each day. When you experience success at reaching a small goal, it will motivate you to keep moving toward your larger goals.

Reward yourself! Rewards that you control will encourage you to achieve your goals. For a reward to work well, choose something you really want, don’t put off giving it to yourself, and make it dependent on meeting a specific goal. The reward you choose may be something you buy for yourself or an act of self-kindness, such as an afternoon off from your usual responsibilities or an evening spent with a friend. Avoid food as a reward. It usually works better to give yourself frequent, small rewards for reaching short-term goals than bigger rewards that require a long, difficult effort.

Write it down. Regularly record what you do on your weight-loss program, such as your daily calorie intake and amount of physical activity, as well as changes in your weight. (Try to weigh yourself at the same time of day once or twice a week.) Keeping track this way can help you and your health care provider determine what behaviors you may want to improve. Keeping tabs on your progress can also help you stay motivated.

Know your triggers. To lose weight successfully, you’ll need to be aware of your personal eating “triggers.” These are the situations that usually bring on the urge to overeat. For instance, you may get a case of the munchies while watching TV, when you see treats next to the office coffeepot, or when you’re with a friend who loves to snack. To “turn off” the trigger, you’ll need to make a change in the tempting situation. Example: If the pile of doughnuts near the coffeepot is hard to resist, leave the scene as soon as you pour yourself a cup of coffee.

The fine art of feeling full. Changing the way you eat can help you eat less without feeling deprived. Eating slowly can help you feel satisfied sooner, and therefore you will avoid second helpings.

Eating lots of vegetables and fruits and drinking plenty of non-caloric beverages can also make you feel fuller. Another trick is to use smaller plates and taller, narrower glasses so that moderate portions don’t seem skimpy. It can also help to set a regular eating schedule, especially if you tend to skip or delay meals.

How To Choose a Weight-Loss Program

Some people lose weight on their own, while others like the support of a structured program. If you decide to participate in a weight loss program, here are some questions to ask before you join:

Does the program provide counseling to help you change your eating and activity habits?

The program should teach you how to permanently change eating and lifestyle habits such as lack of physical activity, which have contributed to weight gain. Research shows that people who successfully keep weight off are those who make changes in their overall lifestyles, rather than simply join an exercise program.

Does the staff include qualified health professionals, such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists?

Qualified professionals can help you lose weight safely and successfully.

Before getting started, you’ll need to be examined by a doctor if you have any health problems, are currently taking or plan to take any medicine, or plan to lose more than 15 to 20 pounds.

Does the program offer training on how to deal with times when you may feel stressed and slip back into old habits?

The program should provide long-term strategies for preventing and coping with possible weight problems in the future. These strategies might include setting up a support system and a regular physical activity routine.

Do you help make decisions about food choices and weight-loss goals?

In setting weight-loss goals, the program staff should consider your personal food likes and dislikes, as well as your lifestyle. Avoid a “one strategy fits all” program.

Are there fees and costs for additional items, such as dietary supplements?

Before you sign up, find out the total costs of participating in the program. If possible, get the costs in writing.

How successful is your program?

Few weight-loss programs gather reliable information on how well they work. But it’s still worthwhile to ask:

• What percentage of people who start this program complete it?
• What percentage of people experience problems or side effects? What are they?
• What is the average weight loss among those who finish the program?

Get Moving!

Regular physical activity is a powerful way to reduce your risk of heart disease. Physical activity directly helps prevent heart problems.

Staying active also helps prevent and control high blood pressure, keep cholesterol levels healthy, and prevent and control diabetes.

Plus, regular physical activity is a great way to help take off extra pounds-and keep them off.

Regular physical activity has a host of other health benefits. It may help prevent cancers of the breast, uterus, and colon. Staying active also strengthens the lungs, tones the muscles, keeps the joints in good condition, improves balance, and may slow bone loss. It also helps many people sleep better, feel less depressed, cope better with stress and anxiety, and generally feel more relaxed and energetic.

You can benefit from physical activity at any age. In fact, staying active can help prevent, delay, or improve many age-related health problems. As you grow older, weight bearing activities can be particularly helpful for strengthening bones and muscles, improving balance, and lowering the risk for serious falls. Good weight bearing activities include carrying groceries, walking, jogging, and lifting weights. (Start with 1- to 3-pound hand weights and gradually progress to heavier weights.)

Activities that promote balance and flexibility are also important. Practices such as T’ai Chi and yoga can improve both balance and flexibility and can be done alternately with heart healthy physical activities. Check with your health insurance plan, local recreation center, YWCA or YMCA, or adult education program for low-cost classes in your area.

A Little Activity Goes a Long Way

The good news is that to reap benefits from physical activity, you don’t have to run a marathon-or anything close to it. To reduce the risk of disease, you only need to do about 30 minutes of moderate intensity physical activity on most, and preferably all, days of the week. If you’re trying to manage your weight and prevent gradual, unhealthy weight gain, try to boost that level to approximately 60 minutes of moderate- to vigorous-intensity physical activity on most days of the week.

Brisk walking (3 to 4 miles per hour) is an easy way to help keep your heart healthy. One study, for example, showed that regular, brisk walking reduced the risk of heart attack by the same amount as more vigorous exercise, such as jogging. To make physical activity a pleasure rather than a chore, choose activities you enjoy. Ride a bike. Go hiking. Dance. Play ball. Swim. Keep doing physical tasks around the house and yard. Rake leaves. Climb stairs. Mulch your garden. Paint a room.

You can do an activity for 30 minutes at one time, or choose shorter periods of at least 10 minutes each. For example, you could spend 10 minutes walking on your lunch break, another 10 minutes raking leaves in the backyard, and another 10 minutes lifting weights. The important thing is to total about 30 minutes of activity each day. (To avoid weight gain, try to total about 60 minutes per day.)

No Sweat!

Getting regular physical activity can be easy-especially if you take advantage of everyday opportunities to move around. For example:

• Use stairs-both up and down-instead of elevators. Start with one flight of stairs and gradually build up to more.
• Park a few blocks from the office or store and walk the rest of the way. If you take public transportation, get off a stop or two early and walk a few blocks.
• Instead of eating that rich dessert or extra snack, take a brisk stroll around the neighborhood.
• Do housework or yard work at a more vigorous pace.
• When you travel, walk around the train station, bus station, or airport rather than sitting and waiting.
• Keep moving while you watch TV. Lift hand weights, do some gentle yoga stretches, or pedal an exercise bike.
• Spend less time watching TV and using the computer.

Safe Moves

Some people should get medical advice before starting regular physical activity. Check with your doctor if you:

• Are over 50 years old and not used to moderately energetic activity
• Currently have heart trouble or have had a heart attack
• Have a parent or sibling who developed heart disease at an early age
• Have a chronic health problem, such as high blood pressure, diabetes, osteoporosis, or obesity
• Once you get started, keep these guidelines in mind:

Go slow. Before each activity session, allow a 5-minute period of slow-to-moderate movement to give your body a chance to limber up and get ready for more exercise. At the end of the warmup period, gradually increase your pace. Toward the end of your activity, take another 5 minutes to cool down with a slower, less energetic pace. It’s best to wait until after your activity to do stretching exercises.

Listen to your body. A certain amount of stiffness is normal at first.

But if you hurt a joint or pull a muscle, stop the activity for several days to avoid more serious injury. Rest and over-the-counter painkillers can heal most minor muscle and joint problems.

Check the weather report. Dress appropriately for hot, humid days and for cold days. In all weather, drink lots of water before, during, and after physical activity.

Pay attention to warning signals. While physical activity can strengthen your heart, some types of activity may worsen existing heart problems. Warning signals include sudden dizziness, cold sweat, paleness, fainting, or pain or pressure in your upper body just after doing a physical activity. If you notice any of these signs, call your doctor right away.

Use caution. If you’re concerned about the safety of your surroundings, pair up with a buddy for outdoor activities. Walk, bike, or jog during daylight hours.

Stay the course. Unless you have to stop your activity for a health reason, stick with it. If you feel like giving up because you think you’re not going as fast or as far as you should, set smaller, shortterm goals for yourself. If you find yourself becoming bored, try doing an activity with a friend. Or switch to another activity. The tremendous health benefits of regular, moderate-intensity physical activity are well worth the effort.

What’s Your Excuse?

We all have reasons to stay inactive. But with a little thought and planning, you can overcome most obstacles to physical activity. For example:

“I don’t have time to exercise.” While physical activity does take time, remember that you can reduce your heart disease risk by getting just 30 minutes of moderate-intensity physical activity on most days of the week. Plus, you can save time by doubling up on some activities. For example, you can ride an exercise bike or use hand weights while watching TV. Or, you can transform some of your everyday chores-like washing your car or walking the dog-into heart healthy activities by doing them more briskly than usual.

“I don’t like to exercise.” You may have bad memories of doing sit ups or running around the track in high school, forcing yourself through every sweating, panting moment. Now we know that you can get plenty of gain without pain. Activities you already do, such as gardening or walking, can improve your health. So just do more of the activities you like. If possible, get your friends or family members involved so that you can support each other.

“I don’t have the energy to be more active.” Get active first-with brief periods of moderate-intensity physical activity-and watch your energy start to soar. Once you begin regular physical activity, you will almost certainly feel stronger and more vigorous. As you progress, daily tasks will seem easier.

“I want to exercise, but I keep forgetting!” Leave your sneakers near the door to remind yourself to walk, or bring a change of clothes to work and head straight for the gym, yoga class, or walking trail on the way home. Put a note on your calendar to remind yourself to exercise. While you’re at it, get in the habit of adding more activity to your daily routine.

You Can Stop Smoking

The good news is that quitting smoking immediately reduces your risk of heart disease and other serious disorders, with the benefit increasing over time. Just 1 year after you stop smoking, your heart disease risk will drop by more than half. Within several years, it will approach the heart disease risk of someone who has never smoked.

No matter how long you’ve been smoking, or how much, quitting will lessen your chances of developing heart disease.

Prepare to Succeed

• Get motivated. Take some time to think about all the benefits of being “smoke free.” Besides the health benefits of quitting, what else do you have to gain? Money saved from not buying cigarettes? Loved ones no longer exposed to secondhand smoke? A better appearance? No more standing outside in the cold or rain for a smoke? Write down all of the reasons you want to stop smoking.

• Sign on the dotted line. Write a brief contract that states your intention to stop smoking, your quitting date, and some ways you plan to reward yourself for becoming an ex-smoker. Have someone sign it with you.

• Lineup support. Ask the person who cosigns your contract-or another friend or relative-to give you special support in your efforts to quit. Plan to get in touch with your support person regularly to share your progress and to get encouragement. If possible, quit with a friend or family member.

Breaking the Habit

• Know yourself. To quit successfully, you need to know your personal smoking “triggers.” These are the situations and feelings that typically bring on the urge to light up. Some common triggers are drinking coffee, having an alcoholic drink, talking on the phone, watching someone else smoke, and experiencing stress. Make a list of your own personal triggers. Especially during the first weeks after quitting, try to avoid as many triggers as you can.

• Find new habits. Replace your “triggers” with new activities that you don’t associate with smoking. For example, if you’ve always had a cigarette with a cup of coffee, switch to tea for a while. If stress is a trigger for you, try a relaxation exercise such as deep breathing to calm yourself. (Take a slow, deep breath, count to five, and release it. Repeat 10 times.)

• Keep busy. Get involved in activities that require you to use your hands, such as needlework, art projects, jigsaw puzzles, or fix-up projects around your house or apartment. When you feel the urge to put something in your mouth, try some vegetable sticks, apple slices, or sugarless gum. Some people find it helpful to inhale on a straw or chew on a toothpick until the urge passes.

• Keep moving. Walk, garden, bike, or do some yoga stretches. Physical activity will make you feel better and will help prevent weight gain.

• Know what to expect. During the first few weeks after quitting, you may experience temporary withdrawal symptoms such as headaches, irritability, tiredness, and trouble concentrating. While these feelings are not pleasant, it may help to know that they are signs that your body is recovering from smoking. Most symptoms end within 2 to 4 weeks.

• Ask for help. A number of free or low-cost programs are available to help people stop smoking. They include programs offered by local chapters of the American Lung Association and the American Cancer Society. Other low-cost programs can be found through hospitals, health maintenance organizations, workplaces, and community groups.

• Give yourself a break. Get plenty of rest, drink lots of water, and eat three healthy meals each day. If you are not as productive or cheerful as usual during the first weeks after quitting, be gentle with yourself. Give yourself a chance to adjust to your new smoke-free lifestyle. Congratulate yourself for making a major, positive change in your life.

If You “Slip”

A slip means that you’ve had a small setback and smoked a cigarette after your quit date. Most smokers slip three to five times before they quit for good. To get right back on the nonsmoking track:

• Don’t be discouraged. Having a cigarette doesn’t mean you can’t quit smoking. A slip happens to many people who successfully quit. Keep thinking of yourself as a nonsmoker. (You are one.)

• Learn from experience. What was the “trigger” that made you light up? Were you driving home from work, enjoying a glass of wine at a party, feeling angry with your boss? Think back on the day’s events until you remember what the trigger was.

• Take charge. Write a list of things you will do the next time you face that particular trigger situation-and other tempting situations as well. Sign a new contract with your support person to show yourself how determined you are to kick the habit. You’re on your way.

A Change of Heart

Taking care of your heart is one of the most important things you can do for your health and well-being. But, because heart health involves changing daily habits, it can require some real effort. To make the process easier, try tackling only one habit at a time. For example, if you smoke cigarettes and also eat a diet high in saturated fats, work first on kicking the smoking habit. Then, once you’ve become comfortable as a nonsmoker, begin to skim the fat from your diet.

Remember, nobody’s perfect. Nobody always eats the ideal diet or gets just the right amount of physical activity. The important thing is to follow a sensible, realistic plan that will gradually lessen your chances of developing heart disease.

So keep at it. Work with your doctor. Ask family members and friends for support. If you slip, try again. Be good to your heart, and it will reward you many times over-with a better chance for a longer, more vigorous life.

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