Researchers at the University of Minnesota School of Public Health analyzed data on food intake and body weight collected on residents in Minneapolis-St. Paul over 27 years. Although the original data focused on heart health, the new study looked at what impact added sugar had on participants’ weight during that period.

Added sugar is sugar added to processed foods, as well as sweeteners added in home cooking and at the table.

More sugar

Among the women in the study, consumption of added sugar rose by 51 percent from 1980-82 to 2000-2002 and then declined somewhat, according to the research. Men followed the same pattern, increasing their intake of added sugar by 38 percent.

The participants’ weight mimicked that fluctuation. When sugar consumption increased, so did the average body mass index (BMI). When sugar consumption leveled out, women’s BMI leveled off, as well. For men, it did not.

Women consumed less added sugar than men, and younger adults ages 25 to 39 ate more than older adults did. That younger age bracket also showed the greatest increase in BMI.

“Added sugars and body weight are increasing concurrently,” said study author Huifen Wang, at the University of Minnesota.

How much?

What’s the limit on added sugar? Most women should eat no more than 100 calories of added sugars a day, according to the American Heart Association. Most men should consume no more than 150 calories of added sugars a day.

In addition to sweetened beverages, added sugar can be found in obvious foods like desserts, but also granola bars, many smoothies, and some trail mixes.

Naturally Sweet Options

If you’re trying to cut down on refined sugar without using artificial sweeteners, try fruits. They add flavor, as well as fiber, vitamins, and minerals. Fruit also contains calories, so keep that in mind if you are watching your weight.

Here are some ideas for adding fruit to your meals:

• Add banana slices or berries to unsweetened breakfast cereal.

• Top fresh fruit with a spoonful of yogurt for dessert.

• Use all-fruit spread on your toast.

Spices also can help bring out sweet flavor in foods without contributing calories:

• Mix ginger with a fruit glaze to top fresh fruit.

• Try cinnamon with hot cereal.

• Enhance flavor in cookies and rice with nutmeg.

• Add cinnamon, ginger, or nutmeg to coffee before brewing.

• Sprinkle ginger over cooked carrots or cinnamon over sweet potatoes.

Always talk with your health care provider to find out more information.

Online Medical Reviewer: Louise Akin, RN, BSN
Online Medical Reviewer: Daphne Pierce-Smith, RN, MSN, FNP, CCRC

Last Annual Review Date: 3/30/2011

]]> http://www.pharmacyeugene.com/2011/06/14/weighing-in-on-added-sugar/feed/ 0 http://www.pharmacyeugene.com/2011/06/13/rheumatoid-arthritis/ http://www.pharmacyeugene.com/2011/06/13/rheumatoid-arthritis/#comments Mon, 13 Jun 2011 18:47:04 +0000 rrhm http://www.pharmacyeugene.com/?p=1536

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic disease that causes inflammation of the joints. The inflammation can become so severe that the function and appearance of the hands, as well as other parts of the body, can become affected. In the hand, rheumatoid arthritis may cause deformities in the joints of the fingers, making it difficult to move the fingers. Lumps, known as rheumatoid nodules, may form over small joints in the hands and the wrist. Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow juvenile rheumatoid arthritis. However, the disease can affect bone development in the growing child.

What causes rheumatoid arthritis?

The exact cause of rheumatoid arthritis is not known. Rheumatoid arthritis is an autoimmune disorder, which means the body’s immune system attacks its own healthy cells and tissues. The response of the body causes inflammation in and around the joints, which then may lead to a destruction of the skeletal system. Rheumatoid arthritis also may have devastating effects to other organs, such as the heart and lungs. Researchers believe certain factors, including heredity, may contribute to the onset of the disease.

Rheumatoid arthritis affects more women than men (70 percent of persons with rheumatoid arthritis are women). The disease most often occurs between the ages of 30 and 50.

What are the symptoms of rheumatoid arthritis?

The joints most commonly affected by rheumatoid arthritis are in the hands, wrists, feet, ankles, knees, shoulders, and elbows. The disease typically causes inflammation symmetrically in the body, meaning the same joints are affected on both sides of the body. Symptoms of rheumatoid arthritis may begin suddenly or gradually. The following are the most common symptoms of rheumatoid arthritis in the hands. However, each individual may experience symptoms differently. Symptoms may include:

• pain
• stiffness
• swelling over the joints
• decreased movement
• pain that is worse with movement of the joints
• bumps may be noted over the small joints
• difficulty performing activities of daily living (ADLs), such as tying shoes, opening jars, or buttoning shirts
• decrease ability to grasp or pinch

If a person has four or more of the following symptoms, he/she may be diagnosed with rheumatoid arthritis:

• morning stiffness that lasts longer than one hour for at least six weeks
• three or more joints that are inflamed for at least six weeks
• presence of arthritis in the hand, wrist, or finger joints for at least six weeks
• blood tests that reveal rheumatoid factor
• x-rays that show characteristic changes in the joints

The symptoms of rheumatoid arthritis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is rheumatoid arthritis diagnosed?

Diagnosis of rheumatoid arthritis may be difficult in the early stages, because symptoms may be very subtle and go undetected on x-rays or blood tests. In addition to a complete medical history and physical examination, diagnostic procedures for rheumatoid arthritis may include the following:

• x-ray – a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• joint aspiration – involves a removal of fluid from the swollen bursa to exclude infection or gout as possible causes.
• biopsy (of nodules tissue) – a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.
• blood tests (to detect certain antibodies, called rheumatoid factor, and other indicators for rheumatoid arthritis)

Treatment for rheumatoid arthritis:

Specific treatment for rheumatoid arthritis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment may include:

• splints
  Splints may be used to help protect the joints and strengthen the weak joints.
• physical therapy
  Physical therapy may be used to help increase the strength and movement of the affected areas.
• surgery
  Surgery may be performed if the above treatment options fail. The decision for surgery should be made in consultation with your physician. Repair or reconstruction of the hand and wrist can be performed in a variety of ways, including the following:
  • surgical cleaning
    This option may be performed on patients with rheumatoid arthritis, or other types of hand arthritis. Inflamed and diseased tissues within the hands can be removed to help increase function.
  • joint replacement
    This type of surgery, also called arthroplasty, may be used in cases of severe arthritis of the hand. This option may be performed on older patients, with a lower activity level. Joint replacement may provide a decrease in pain and an increase in function of the hands and fingers. This involves replacing a joint that has been destroyed by the disease process with an artificial joint. This artificial joint may be made out of metal, plastic, silicone rubber, or the patient’s own body tissue (such as the tendon).
  • joint fusion
    This option usually involves removing the joint and fusing together two ends of bones. This makes one large bone, without a joint. This option is usually used on patients with advanced arthritis. After the fusion of the bone, there is an elimination of movement in the fused joint.

It is important to remember that surgery does not correct the underlying disease. It only helps correct the deformities caused by the disease. Rheumatoid arthritis can continue to cause problems in the hand, and may even require additional surgery. Close follow-up with your physician is required for optimal control of this disease.

Online Medical Reviewer: Akin, Louise RN, BSN
Online Medical Reviewer: Jenkins, Lee

Copyright © 2007 Staywell Content Services, Inc. except where otherwise noted.

Every year, consumers save an estimated $8 to $10 billion dollars by using generic medications, according to the Congressional Budget Office.

The FDA regulates generic medications. They are allowed on the market only after testing has proved they produce the same effect on the body as their brand-name counterparts.

Not every drug has a generic. Generally, when brand-name drugs are first introduced, a patent protects them for 20 years before a generic alternative can be manufactured. Drug companies can apply for extensions of this patent protection period. If the patent period isn’t extended, other companies can introduce their version of the brand-name product after 20 years.

Lower cost

Prescription medications are one of the fastest-growing areas of U.S. health care spending.

One way to reduce the high cost of prescription drugs is to switch to generic drugs, which are priced 25 to 80 percent lower than the equivalent brand-name versions.

One reason generic drugs cost less than their brand-name equivalents is that manufacturers of generics spend less money on advertising and product development because the brand-name equivalent already is well-known.

Quality assured

FDA rules state that a generic drug must be “bioequivalent” to the brand-name drug, meaning it must have the same active ingredients, strength, dosage form, safety, quality, purity, stability and performance. The generic drug also must be absorbed at the same rate. The FDA publishes The Orange Book, which lists drugs that are considered to be “equivalent.”

Drug makers must adhere to strict manufacturing requirements to earn approval to sell their products. Keep in mind that generic drugs bought over the Internet from places outside the United States are not regulated by the FDA and may not meet the same standards for equivalency or safety as those sold in this country.

Differences between brand-name and generic drugs that may make a difference in how compliant a patient is in taking the medication are the size, shape and coating. These differences do not affect the quality, effectiveness or safety of a drug. Other differences between brand-name and generic drugs include taste and inactive ingredients.

Doctor approved

Depending on the medications you take and how often you take them, you could save hundreds of dollars every year by taking generics instead of brand-name medications.

When your health care provider gives you a prescription for a brand-name medication, ask if he or she can prescribe the generic equivalent instead. You also can ask if you can switch from brand names to generics for medications you already take.

In some cases, providers prefer brand names for medical or technical reasons. If so, your provider should be able to explain why.

Online Medical Reviewer: Fraser, Marianne, MSN, RN
Online Medical Reviewer: Stock, Christopher PharmD

Last Annual Review Date: 1/31/2011

Copyright Health Ink & Vitality Communications

Two U.S. Food and Drug Administration advisory committees plan to meet Tuesday and Wednesday to decide whether to recommend that the dosing instructions on the labels of medicines containing acetaminophen need to be fine-tuned to protect children under the age of 2 against possible liver failure and even death.

Currently, the labels of such fever-reducing medications, which include Children’s Tylenol, have dosing instructions for children aged 2 and up. For kids under 2, the labels simply tell parents to “ask a doctor.”

The American Academy of Pediatrics (AAP) and drug manufacturers are both strongly in favor of giving parents the additional dosing information.

“If we give parents better information, they will be able to give enough of the medicine to work well, at the same time minimizing the side effects,” said Dr. Daniel Frattarelli, a pediatrician in Dearborn, Mich. who chairs the academy’s drug committee and who plans to testify before a joint, two-day meeting of the Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee.

“Parents want to do the right thing for their children,” he said. “We as a medical community have to give them that information so they are able to do this.”

Although the evidence shows that acetaminophen is safe for young children, parents have to be careful with it, pediatricians noted. Giving too much can be toxic to the liver, causing poisoning and even liver failure.

In 2010, there were 270,000 reported overdoses of acetaminophen, according to the American Association of Poison Control Centers. Dosing errors involving children’s acetaminophen products accounted for almost 7,500 cases — nearly 3 percent.

In an ideal world, the parents of infants and toddlers would still consult with their pediatrician or pharmacist to get the proper medication dosing, said Dr. William Basco, director of general pediatrics at the Medical University of South Carolina.

But the reality is that many parents aren’t doing that and are instead guessing about proper dosing. “There is no benefit to having parents guess at the right dose,” Basco said.

Drug makers, including McNeil Consumer Healthcare, which makes Tylenol, also support the change.

“McNeil is committed to encouraging the appropriate and safe use of medicines in children, including adding new dosing information on the OTC pediatric acetaminophen label to assist caregivers and health-care providers in appropriately dosing children, especially those 6 to 23 months of age,” the company wrote in materials submitted to the FDA.

By way of comparison, drugs containing ibuprofen — another heavily used over-the-counter fever reducer — already include dosing information for children under age 2.

Children’s medications containing acetaminophen have been sold over-the-counter since 1959, and dosing information for children has been on the labels since the 1970s, according to McNeil.

Back then, doses for kids were somewhat crude — children 12 and up were advised to take the adult dose, kids 6 to 12 were told to take half that, and kids younger than 6 were told to take a quarter of the adult dose.

Since then, as physicians have learned more about the medications, dosing recommendations for infants and toddlers have become more refined and now should be based on weight, not age, according to the AAP. (Age is still listed on package labeling, the AAP explained.) Kids’ weights can range widely at any given age, so the correct dose for a child on the heavier side may not be the correct dose for a smaller child of the same age.

Though acetaminophen is safe even in newborns if used correctly, the drug makers and the AAP are calling for expanding the labeling information for children 6 months old and up.

Parents should still be encouraged to consult with their physicians before giving medication to younger children, especially those under the age of 3 months, Frattarelli said. Fevers of more than 100.4 degrees need to be taken very seriously in infants, whose immune systems are not fully developed and whose vaccinations haven’t yet fully kicked in, he explained.

The AAP will also recommend dosing instructions be given in the milliliters, a more precise measurement than teaspoons. “A lot of parents think they can open the silverware drawer and take out a spoon, but that’s not a good way to do it,” Frattarelli said.

In addition, the AAP will request that acetaminophen only be sold in products marketed to children in “single-agent” formulations, rather than products that contain acetaminophen and other drugs. That would help avoid parents unwittingly giving a double dose of acetaminophen because they’ve given their child say, a cough medication that also contains acetaminophen and Children’s Tylenol on top of that.

Earlier this month, the Consumer Healthcare Products Association, a trade association for over-the-counter drug-makers, agreed to sell only one concentration of acetaminophen in products for infant and children to prevent dosing errors.

Previously, for example, Infant’s Tylenol liquid drops were much more concentrated than Children’s Tylenol, which could easily lead to confusion if parents didn’t read the label or know there was a difference.

Drug-makers agreed to phase out the infant drops concentration starting in the middle of this year.

In any given week, about 23 percent of kids under age 2 are given acetaminophen, according to background information from McNeil.

“Acetaminophen dosing errors are a rare but potentially very severe adverse event that could lead to liver failure or even death for kids,” said Dr. Richard Dart, president of the American Association of Poison Control Centers, in a news release. “This decision will lessen the chance that parents will give their children the wrong dose.”

At the hearing, the FDA will also consider adding a weight-based dosing regimen to the existing age-based dosing regimen for kids 2 to 12 and to make it mandatory to include a universal measuring tool with all children’s formulas.

More information

The U.S. Food and Drug Administration has more on giving over-the-counter medications to children.

SOURCES: William Basco, M.D., director, general pediatrics, Medical University of South Carolina, Charleston; Daniel Frattarelli, M.D., pediatrician, Dearborn, Mich., and chair, American Academy of Pediatrics Committee on Drugs; U.S. Food and Drug Administration Web site

What Those Blood Pressure Numbers Mean

A quick, painless test measures blood pressure: A rubber cuff is wrapped around your arm and inflated; that compresses an artery in your arm and momentarily stops your blood flow. A technician uses a stethoscope to measure your blood pressure when the pressure in the cuff is slowly released.

Blood-pressure readings are a double measurement of the force of the blood against arterial walls. The two measurements indicate how much pressure builds up in the arteries as the heart beats and between beats. The first, higher number is the systolic pressure, which indicates the heart’s pumping force. The second, lower number is the diastolic pressure, which indicates the flexibility and clogging in the arteries.

The higher the blood pressure, the more resistance there is to blood flow. A blood pressure level with the systolic less than 120 and the diastolic less than 80 is considered optimal. If the systolic is 120 to 139 or the diastolic is 80 to 89, this is called pre-hypertension regardless if one of them is normal. If the systolic is 140 or higher or the diastolic is 90 or higher, this is called hypertension regardless whether one of the readings is normal or in the pre-hypertensive range.

To make a diagnosis of pre-hypertension or hypertension, your doctor will measure your blood pressure over several visits. If it is elevated two out of three visits, the diagnosis can be made. Hypertension is a sign that the heart is working too hard to pump blood through the circulatory system because of narrow and/or inflexible arteries.

In recent years, an increasing amount of scientific evidence has supported the idea that people can do quite a lot on their own to lengthen their life span and to enhance the quality of life as they age. Here are five steps to take every day that can promote healthy aging and boost longevity:

1. Eat healthy foods to help prevent diseases such as heart disease, cancer and stroke. In addition, maintain a healthy weight. To maintain a healthy weight, maintain strength and help prevent disease, eat a variety of vegetables, fruits, whole grains and foods low in fat and cholesterol.

2. Exercise regularly to achieve better physical and mental health. There are numerous benefits of exercise. Regular, vigorous exercise—at least 30 minutes, three to five times a week—improves mood and reduces depression; aids weight loss; increases strength, flexibility and balance; strengthens bones; and improves aerobic capacity (the ability of the heart, lungs and blood vessels to deliver adequate oxygen to muscles). Some studies suggest that exercise helps circulation to the brain, improving mental acuity.

3. Perform mentally stimulating activities to help preserve memory. An ongoing study by the Rush Alzheimer’s Disease Center in Chicago among others has provided evidence that continuing mentally stimulating activities throughout life may help maintain memory. These activities include reading, playing cards, doing crossword puzzles, and going to museums. Other mentally challenging activities include learning to play an instrument, changing careers or starting one, trying a new hobby, and volunteering. Although studies have shown an association between certain mentally stimulating activities and a reduced risk for Alzheimer’s disease (and/or cognitive decline), the National Institutes of Health says that researchers still aren’t sure whether these factors can actually prevent the disease.

4. Get preventive health care tests and screenings to catch disease early. Have screenings and other preventive health care tests that are recommended for your age group or disease risk category. Be proactive with doctors and pharmacists by bringing a list of questions or concerns to every visit and not hesitating to speak up or ask questions.

5. Maintain a positive attitude and cultivate relationships to be happier and live longer. Write down all the good things in life. Focus on being satisfied with life as it is. A Finnish study showed that men who were satisfied with their lives tended to live longer. Another study showed that people with high “pessimism scores” had a 19 percent higher risk for premature death than those who were rated as more optimistic. A positive attitude, adaptability, strong social contacts, and religious and cultural convictions all contribute to happiness as people age.

Online Medical Reviewer: Cranwell-Bruce, Lisa MS RN FNP-C
Online Medical Reviewer: Godsey, Cynthia M.S., M.S.N., APRN
Online Medical Reviewer: Lambert, J.G. M.D.
Online Medical Reviewer: Ratini, Melinda DO, MS

TUESDAY, April 12 (HealthDay News) — Eating apples every day may be good for your cardiovascular health, new research suggests.

Women who ate dried apples every day for a year lowered their total cholesterol by 14 percent and their levels of “bad” LDL cholesterol by 23 percent.

“I never expected apple consumption to reduce bad cholesterol to this extent while increasing HDL cholesterol or good cholesterol by about 4 percent,” Bahram Arjmandi, chair of the department of nutrition, food and exercise sciences at Florida State University in Tallahassee, said in a statement.

Arjmandi was to present the findings Tuesday at the Experimental Biology meeting in Washington D.C. The U.S. Department of Agriculture provided partial funding for the study.

Many foods can have an effect on cholesterol levels, according to the U.S. Centers for Disease Control and Prevention. Foods containing saturated fats, trans fats and dietary cholesterol can raise your cholesterol levels, while foods with healthier fats such as olive oil can lower your cholesterol. Foods with fiber, such as fruits, vegetables and whole grains, can reduce cholesterol levels, while carbohydrates that are low in fiber tend to raise triglyceride levels and lower “good” HDL cholesterol levels.

In the current study, the researchers wanted to assess the long-term effect that apple consumption might have on cardiovascular health.

They recruited 160 women between the ages of 45 and 65. The women were randomly assigned to one of two dietary intervention groups. One group was given 75 grams of dried apples every day for a year, while the other group was given dried prunes daily for a year.

The daily serving of dried apples contained about 240 calories, according to the study. An apple contains about 5 grams of fiber, according to the U.S. Department of Agriculture.

The researchers found that women eating dried apples lowered their total cholesterol by 14 percent. LDL cholesterol dropped by 23 percent. Daily apple consumption also significantly lowered levels of C-reactive protein and lipid hydroperoxide, two substances that may indicate an increased risk of heart disease. What effects, if any, the prunes had on cholesterol levels were not mentioned in the study abstract.

The researchers theorized that the nutrients in apples may reduce inflammation in the body.

Despite the addition of several hundred calories a day to their diet, the apple-eating women didn’t gain weight over the course of the study. In fact, they lost an average of 3.3 pounds.

Registered dietician Jessica Shapiro said she wasn’t surprised that the women didn’t gain weight. The addition of apples to the diet probably kept the women feeling fuller because of the fiber content in the apples, she explained.

“Apples really are an amazing fruit for many reasons,” said Shapiro, who is a clinical nutritionist who counsels cardiac patients at Montefiore Medical Center in New York City. “A large reason apples are so good is the fiber. Apples have both soluble and insoluble fiber. Insoluble is found more in the skin, and the pulp is more soluble fiber.”

“The pulp of an apple gets to be a very viscous gel-like substance that grabs cholesterol and pulls it out of the body. It’s kind of like nature’s toothbrush, and it’s brushing the bad stuff out,” she explained.

“Another good thing in apples is pectin. It’s a substance that’s used to make jellies or jams, and pectin contributes to the viscosity of what’s going through the body, and bulks it up to help remove it. Apples also have tons of antioxidants and other natural components,” she said.

Shapiro said she would recommend fresh apples over dried apples, because some nutrients are probably lost in the drying process.

But Shapiro stressed that making healthy changes to what you eat can only do so much.

“Changing your diet can make a big difference, but eating a healthy diet is only part of it. Once your cholesterol is high, diet may not be enough,” she said. “Some people are predisposed because of their genes to having high cholesterol, and a healthy diet may not be enough.”

Shapiro also advised against making any changes to your medications, including cholesterol-lowering drugs, without talking to your doctor first.

Also, she cautioned, when increasing the fiber in your diet, do it slowly. This will help prevent bloating and gas that may occur if you increase your fiber intake too quickly. She said that 25 to 30 grams of fiber daily is the recommended intake, and she suggested increasing your current intake by about 5 grams daily each week to give your body a chance to get used to the increased fiber.

More information

Learn more about the importance of fruits and vegetables from the U.S. Centers for Disease Control and Prevention.

There are more predictors of coronary artery disease and the search continues for knowledge of these risk factors. Your doctor can look at a more complete risk pattern with the new findings in mind. Even if you do not have coronary artery disease, the new predictors can provide a more complete and aggressive plan for reducing the incidence. “This is very much a work in progress,” says Stephen R. Devries, M.D., a cardiology and internal medicine specialist in Chicago. “We can now identify more heart disease triggers than ever before, but there’s a lot to be learned.”

How can you and your doctor use the findings? If you don’t yet have heart disease, the best way is to look at the whole picture, says Dennis L. Sprecher, M.D., a cardiologist in Cleveland. “What these newer predictors can do,” he says, “is provide us with a sense for how aggressive we should be in treating those things we already know how to treat.”

Current predictors of coronary artery disease include too much LDL (“bad”) cholesterol and not enough HDL (“good”) cholesterol. If your levels are abnormal data on the new predictors could influence the decision for more intense treatment.

If you already have heart disease, discuss appropriate treatment with your health care provider.

Potential new predictors

Homocysteine

Homocysteine is an amino acid, a part of protein which seems to be toxic to the cells that line the arteries. This toxicity seems to influence the disruption of plaque. If plaque ruptures, a clot forms, blocking vital blood flow. If this takes place in an artery that supplies blood to the heart, a heart attack occurs. Scientists are studying whether B vitamins—B₁₂, pyridoxine, and folic acid, all of which appear to lower levels of homocysteine in the blood—may help treat high levels of the amino acid. So far, the American Heart Association recommends only that you take in 400 mcg daily of folic acid for its general health benefit. Experts don’t recommend routine blood tests for homocysteine unless you have other heart-disease risk factors, or unless you have heart disease but no known risk factors. Occasionally, your healthcare provider may want to check your homocysteine level if your close family members have high homocysteine levels and premature heart disease. Your homocysteine level could provide a clue to your risk of developing heart disease.

Triglycerides

Triglycerides are no longer the new kid on the block, but many people still don’t realize their importance. They are your body’s most common form of fat and the main source of stored energy. Your liver makes triglycerides and cholesterol from food. Doctors should view high triglyceride levels as a warning sign.

Diet and exercise affect triglycerides, just as they do cholesterol. Obesity, inactivity, and high-sugar foods can cause special trouble. If lifestyle changes, like a low-fat diet and exercise, don’t lower triglycerides, Dr. Devries says, drugs such as statins and fibrates may help, along with the vitamin nicotinic acid, a specific form of niacin. (Other forms of niacin do not affect triglyceride levels.) Labs check triglycerides as part of a full lipid study that also measures HDL and LDL. Talk with your doctor if your level is high.

C-reactive protein

Your C-reactive protein (CRP) level rises if there’s inflammation in your body. Scientists think chronically high levels might predict inflammation in blood vessels. However, even with a bit of a cold, CPR levels will rise.

Testing is very sensitive but not very specific. The AHA does not recommend checking everyone’s CRP level. For people with risk factors for heart disease, however, a CRP level may help a physician decide whether to be more aggressive with treatment to reduce or eliminate risk factors for heart disease. Levels above 3 are considered high. Studies show statins may lower CRP.

Lp(a)

Lp(a) is a fat-carrying particle made up of LDL and protein. A high level of Lp(a) is a risk factor for developing premature atherosclerosis. Scientists agree that your Lp(a) level is set mainly by genetics, so people with a family history of heart disease may have high levels. Knowing this may help doctors decide how aggressively to treat other risk factors, such as high LDL cholesterol.

Like high cholesterol, high Lp(a) levels can also be treated with statin drugs and niacin, but doctors don’t yet know if lowering your Lp(a) level cuts your heart-disease risk. Your doctor would likely order an Lp(a) blood test only if you have other serious risk factors for heart disease.

Cholesterol: Still the top danger sign

A high level of cholesterol in the blood is still the top heart disease predictor. A report from the National Heart, Lung, and Blood Institute urged these changes in cholesterol screening and treatment:

• If you are 20 or older and of average risk for heart disease, you should have a full lipid profile at least every five years. This test is done after fasting and measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. LDL is the lipoprotein that carries the form of cholesterol that builds up in the arteries. HDL is the lipoprotein that carries cholesterol that is being removed from the body, which keeps it from building up on the walls of arteries
• Doctors should treat certain people at risk more aggressively with drugs. The LDL level at which treatment with drugs is advised depends on whether you have other risk factors. People with two or more of the following risk factors are considered at higher risk: an HDL below 40 mg/dL; high blood pressure; a family history of early heart disease (a first-degree relative with heart disease before age 55 if a man, or before 65 if a woman); diabetes; smoking; and age (45 or older if a man, or 55 or older if a woman).
• The metabolic syndrome—a combination of abdominal obesity, high triglycerides, low HDL, high blood pressure, and a high blood sugar level—also puts you at risk.
• If you’re at risk for heart disease, you should make important lifestyle changes. You should cut saturated fats to 7 percent of your total daily calories, lower cholesterol in your diet to less than 200 mg a day, eat more soluble fiber and foods with plant stanols or sterols (found in some margarines and salad dressings), stick to a healthy weight, and make exercise a habit.
• You should learn your risk level. Experts have set up four risk categories. Your doctor can work out your level with a risk assessment tool based on blood tests, blood pressure, and history of smoking.

*You should not eat or drink anything but water for nine to 12 hours before these tests.

Your body’s response to stress was designed to protect you, but if it is constantly activated it can harm you. Studies suggest that the high levels of cortisol from chronic stress can increase blood cholesterol, triglycerides, and blood pressure. These are traditional risk factors for heart disease.

“Chronic stress can cause physiological changes that promote atherosclerosis, the slow buildup of plaque deposits in the heart’s arteries,” says James A. Blumenthal, Ph.D., a psychologist in Durham, N.C., who specializes in the psychosocial factors of heart disease.

Relatively minor stresses also can trigger heart problems, such as myocardial ischemia. This is a condition in which the heart doesn’t get enough blood. Chronic stress can also affect how the blood clots. It can make the blood stickier and increase your risk for stroke. 

Moreover, “people who experience chronic stress may tend to smoke more and be more sedentary,” says Dr. Blumenthal.

What to do

People respond to stressful situations differently. Some react strongly to a situation. Others are relaxed and unconcerned. Fortunately, you can decrease the effect of stress on your body. First, identify situations that cause you stress. Then learn to control your mental and physical reactions to these stressful situations. Adopt lifestyle habits that make you less vulnerable to the effects stress has on your heart.

Dr. Blumenthal offers these suggestions for managing stress and keeping your heart healthy.

Get plenty of exercise

Dr. Blumenthal says that exercise can help counteract the harmful effects of chronic stress. For heart health, aim for at least 30 minutes of moderately intense physical activity, such as brisk walking, every day or most days of the week.

“The amount of exercise certainly affects cardiovascular health, but it also can be an aid to weight control and improving lipids [blood fats], as well as blood pressure and other risk factors for heart disease,” Dr. Blumenthal says.

Exercise has another stress benefit. “People who exercise have a reduced physical response to stress. Their blood pressure and heart rates don’t go up as high as people under stress who don’t exercise,” he says.

Their heart rate also returns to normal more quickly than the heart rate of someone who doesn’t exercise. Regular exercise also can reduce the risk of depression, another risk factor for heart disease.

Need exercise motivation? Get a pedometer and try to log in 11,000 to 12,000 steps per day. This goal also will help you maintain your weight. With a pedometer, you get instant feedback and credit for all you do, such as taking the stairs instead of the elevator.

Bolster your support system

Research suggests that having a strong social support network—such as being married, having someone you can talk to and trust, or belonging to one or more organizations or a religion—can reduce your stress level and, thus, your risk of heart disease.

If you already have heart disease, this same network can help reduce your risk for heart attack. This means having someone to help you with daily activities, such as grocery shopping, cooking, or running errands. Having at least one person you can rely on takes a heavy burden off you and provides comfort.

A strong support system helps you take better care of yourself, too. “A lack of social support influences the extent to which people engage in high-risk behaviors, such as smoking, eating a high-fat diet, and consuming too much alcohol,” says Dr. Blumenthal.

Seek treatment for chronic depression or anxiety

“Both these stresses can increase your risk of heart disease, or dying from the disease if you already have it,” says Dr. Blumenthal.

In one study, people were asked whether they had felt so sad, discouraged, or hopeless during the past month that they had wondered if anything was worthwhile. Those who answered yes had more than double the risk for coronary artery disease.

Other studies suggest that chronic anxiety can increase the risk for sudden cardiac death. To reduce your anxiety level, try stress-reduction techniques such as yoga, walking meditation, traditional meditation, or guided imagery. Experiment until you find one that works for you. If none of these techniques works, ask your doctor about taking medication for anxiety.

Reduce work-related stress

Studies show having a demanding job that offers you few opportunities to make decisions or provides little reward can increase your risk for heart disease.

“The risk from job strain gets compounded when you experience a cluster of stresses, such as not having a strong support system or feeling chronically anxious,” says Dr. Blumenthal.

If you can’t find a different position within your company, do what you can to gain control over your environment. To prevent work-related burnout, set aside 10 minutes of down time each day.

“You can’t just stay on ‘go’ all the time,” says Dr. Blumenthal. “The body and the mind need time to rejuvenate.”

In men, body weight tends to increase until the mid-50s, then begins to decrease, according to the American Geriatric Society (AGS). Women’s body weight tends to increase until the late 60s, then decreases, although at a slower rate than for men.

People in less high-tech cultures don’t show this pattern of weight change, the AGS says. This could mean that it’s not the aging process in itself that causes the weight gain, but changes in eating or activity levels.

In women, hormonal shifts in perimenopause start the process. For women, as menopause approaches the ovaries begin to produce less estrogen, a powerful chemical that influences a variety of physiological factors, including mood, blood cholesterol and bone mineral density. Meanwhile, fat cells begin to take over the ovaries’ job.

In women who have gone through menopause, the biggest factor in weight gain appears to be less physical activity, according to the journal Postgraduate Medicine.

With age, both men and women gradually lose muscle mass at an average of a half-pound a year and gain that much in body fat, according to Tufts University. The loss of muscle mass at midlife is even more pronounced in men because of the loss of testosterone, a male hormone that regulates muscle mass and strength. In both men and women, however, the loss of muscle mass and strength usually leads to becoming less active.

The key to keeping excess pounds at bay at any age is a healthy diet and plenty of exercise, including strength training.

Don’t diet

Dieting by slashing your calorie intake or manipulating your diet’s ratio of fat, protein, and/or carbohydrates to shed pounds is perhaps the worst thing you can do to counter midlife weight gain. 

Altering your intake of fat, protein, or carbohydrates also can further upset the balance your body needs at this time, inviting more hormonal hurricanes.

On the other hand, consuming more than 30 to 35 percent of your total daily calories as fat also can lead to weight gain since fat is a concentrated source of calories.

The solution is to make sure your diet contains small amounts of unsaturated, heart-healthy fat, which is found in olive and canola oil, fish, avocados, and nuts.

Your diet also should contain a mix of fruits, vegetables, whole grains, lean protein, and low-fat foods rich in calcium.

Don’t wait to weight train

If you haven’t started a strength-training routine yet, now is definitely the time to start a two- or three-day-a week program.

Weight training helps boost metabolism by reversing the natural loss of muscle mass that’s otherwise part of the aging process. More muscle mass on board means your body burns calories at a faster rate, even when you’re at rest.

Try mini meals

To boost metabolism—the rate you burn calories—and control hormonally related cravings, it’s also important to eat small, balanced meals or snacks about every three hours.

Keeping your diet and exercise in balance is really the key to maintaining a healthy weight.