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Other strategies for lowering serum triglycerides include weight loss; reductions in dietary sugar, fat, and alcohol; and the substitution of fish for meat a couple of times during the week. Increasing fish consumption, as long as it is not fried, lowers the dietary intake of calories and saturated fat, and increases the intake of omega 3 fatty acids, which tend to lower serum triglycerides.

Blood pressure, which is recorded in millimeters of mercury (mmHg), is the force exerted against the walls of the arteries as blood travels through the circulatory system. Pressure is created when the heart contracts and pumps blood into the arteries. The arterioles (smallest arteries) offer resistance to blood flow, and if the resistance is persistently high, the pressure rises and remains high. The medical term for high blood pressure is hypertension.

Hypertension is a silent disease that has no characteristic signs or symptoms, so blood pressure should be checked periodically. Blood pressure can be measured quickly with a sphygmomanometer. A rubber cuff is wrapped around the upper arm and inflated with enough air to compress the artery, temporarily stopping blood flow. A stethoscope is placed on the artery below the cuff so that the sound of blood coursing through the artery can be heard when the air is released. The first sound represents the systolic pressure (the maximum pressure of blood flow when the heart contracts), and the last sound heard is the diastolic pressure (the minimum pressure of blood flow between heart beats). A typical pressure for young adults is 120/80. Pressures of 140/90 or greater are considered to be hypertensive. The lower limit of normal is 100/60. From a health perspective, having a low to normal blood pressure and maintaining it as long as bulk l-carnitine is advantageous.

This table represents the latest thinking among medical researchers as they describe the stages of blood pressure values. All hypertensive values in the table represent an increased risk for cardiovascular events and kidney disease. The higher the blood pressure, the greater the risk. For everyone point drop in diastolic blood pressure, there is a 2% to 3% decrease in the risk of heart attack.

Approximately 50 million American adults and children have high blood pressure, and 35,830 people die of its complications annually. The cause of high blood pressure is not known in 90% to 95% of the cases. This is referred to as essential hypertension. Essential is a medical term that means "of unknown origin or cause." Essential hypertension cannot be cured, but it can be controlled. The other 5% to 10% of the cases of hypertension have a specific cause. If the cause can be determined and eliminated, blood pressure returns to normal.

The heart is adversely affected by uncontrolled or undiagnosed hypertension of long duration. Pumping blood for years against high resistance in the arteries increases the workload of the heart, and it hypertrophies in response to the strain. The heart receives inadequate rest because the resistance to blood flow is consistently high, and this produces muscle fibers that become overly stretched. They progressively lose the ability to rebound. The end result is that they contract less forcefully. At this point the heart loses its efficiency and weakens. If intervention does not occur early, congestive heart failure is inevitable. Hypertension also damages the arteries and accelerates atherosclerosis.

Other Possible Risk Factors

Recently, high wholesale dimethylaminoethanol of iron in the blood have been implicated as a risk for heart attack.

A second possible risk factor, one that has considerable and growing scientific support, is a high level of homocysteine circulating in the blood. Homocysteine is an amino acid that is one of protein's building blocks. It is used by the body to construct two other amino acids. This process requires the presence of three B vitamins folate, B6 , and B12. A deficiency of these vitamins inhibits the conversion process so that higher than normal levels of homocysteine remain in the blood. This event is positively correlated with cardiovascular disease and other vascular disorders.

Several long term studies have discovered an inverse relationship between the amount of folate, B 6 , Bw and homocysteine. Subjects with the highest homocysteine levels were three times more likely to suffer a heart attack than those with the lowest levels. Further, subjects with the highest levels of homocysteine had the lowest amounts of the three B vitamins.

The implication for americans relates to the necessity to consume a balanced diet that will insure the proper intake of these vitamins and other nutrients. Folate and B6 are found in green leafy vegetables, dried beans and peas, fruits, and whole grains. But B12 is found almost exclusively in meats and dairy products. Therefore emphasize the low fat items in this food group to avoid increasing the serum cholesterol risk.

For those who do not consume a balanced diet, a multivitamin supplement that contains 100% of the recommended daily allowance for the B vitamins may be taken.

A third possible risk factor is the amount of lipoprotein(a), or lp(a) for short, circulating in the blood. lp(a) is similar to LDL cholesterol except that it is attached to apolipoprotein (a). It also bears an unusual resemblance to plasminogen, which plays an essential role in the breakdown of blood clots that may form in the body. This similarity between lp(a) and plasminogen has led researchers to speculate that lp(a) might be mistaken for plasminogen, thus interfering with the body's clot dissolving mechanism, the fibrinolytic system. The more lp(a) circulating in the blood, the less effective the fibrinolytic system. This increases the possibility of a small blood clot turning into a heart attack.

Now that you have a good foundation of knowledge of the risk factors for cardiovascular disease, refer to . Be as accurate as possible when providing the necessary information for activity 2-1. Read the case studies carefully, and respond to the questions alluding to each.

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