“Health Numbers” You Need to Know

As patients we need to start taking responsibility for our health and understand what our “health numbers” are. Most of us know when the last time we had the oil changed in our car, how many miles it has and when it is due for the next scheduled maintenance. Our vehicles are cared for and monitored better than we care for our bodies-a sad truth. We also know how much money is our checking accounts and what our credit score is, but most people do not know or care to know what their blood pressure is or what their cholesterol levels are. Think of these numbers as your health report card. If you do not know what they are and when the last time they were checked, it is time to make an appointment with your provider to find out. And for providers we need to ensure our patients are aware of these health numbers, their implications, address them during annual visits and follow ups when appropriate. 

Hypertension, also known as the “silent killer” is becoming more prevalent with an estimated 103 million adults greater than 18 with high blood pressure. Uncontrolled hypertension is a risk factor for cardiovascular disease, stroke, kidney disease, and loss of eye sight to mention a few. The new American Heart Association/American College of Cardiology guidelines for blood pressure have been updated. To prevent and treat hypertension, BP should first be categorized as normal (less than 120 mm Hg systolic and less than 80 mm Hg diastolic), elevated (120 to 129 mm Hg systolic and less than 80 mm Hg diastolic), stage 1 hypertension (130 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic), or stage 2 hypertension (at least 140 mm Hg systolic or at least 90 mm Hg diastolic). Lifestyle changes are recommended and effective in lowing blood pressure , and include regular exercise, weight loss, a heart healthy diet, and tobacco cessation. How much lower you may ask? Eating a diet that is rich in whole grains, fruits, vegetables and low-fat dairy products and skimps on saturated fat and cholesterol can lower your blood pressure by up to 11 mm Hg. Regular physical activity such as 150 minutes a week, or about 30 minutes most days of the week can lower your blood pressure by about 5 to 8 mm Hg if you have high blood pressure. 

Diabetes is also on the rise mostly as a result of poor diet, being overweight and sedentary lifestyles. In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Diabetes like hypertension increases heart disease risk, can cause kidney disease, loss of sight, increased risk for infection, and nerve damage. How often should you get screened for diabetes? The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening.

Prevention is the key, maintaining a health weight, normal BMI, exercising regularly, and eating a healthy diet are all preventative steps you can take to avoid getting diabetes.

There are few screening tests for diabetes and we will discuss the differences. The A1C test is sometimes called the hemoglobin A1C, HbA1c, glycated hemoglobin, or glycohemoglobin test. Hemoglobin is the part of a red blood cell that carries oxygen to the cells. Glucose attaches to or binds with hemoglobin in your blood cells, and the A1C test is based on this attachment of glucose to hemoglobin.The higher the glucose level in your bloodstream, the more glucose will attach to the hemoglobin. The A1C test measures the amount of hemoglobin with attached glucose and reflects your average blood glucose levels over the past 3 months.

The A1C test result is reported as a percentage. The higher the percentage, the higher your blood glucose levels have been. A normal A1C level is below 5.7 percent. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have pre-diabetes, and 6.5% or higher indicates you have diabetes.Why should you know your HA1C or glucose levels. Prevention is the key, maintaining a health weight, normal BMI, exercising regularly, and eating a healthy diet are all preventative steps you can take to avoid getting diabetes. 

The Fasting Blood Sugar Test measures your blood sugar after an overnight fast (not eating). A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.

Glucose Tolerance Test. This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.

A Random Blood Sugar Test measures your blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast (not eat) first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.

Cholesterol. Knowing your cholesterol numbers also known as your lipids is very important to know. Why ? Because elevation of cholesterol and lipids cause plaque build up in your arteries and contribute to heart disease. Cholesterol is a waxy, fat-like substance that’s found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly, but if you have too much cholesterol in your blood, you have a higher risk of coronary artery disease.

There are 5 component lab values when you get your lipoprotein panel or “lipids “ checked by a blood test. Before the test, you’ll need to fast (not eat or drink anything but water) for 9 to 12 hours. The test gives information about your:

  • Total cholesterol – a measure of the total amount of cholesterol in your blood. It includes the two types – low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.
  • LDL (bad) cholesterol – the main source of cholesterol buildup and blockage in the arteries
  • HDL (good) cholesterol – HDL helps remove cholesterol from your arteries
  • Non-HDL – this number is your total cholesterol minus your HDL. Your non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).
  • Triglycerides – another form of fat in your blood that can raise your risk for heart disease, especially in women.

Here are the healthy levels of cholesterol, based on your age and gender:

Anyone age 19 or younger:

  • Total cholesterol                              Less than 170mg/dl    
  • Non-HDL                                          Less than 120mg/dl
  • LDL (bad) cholesterol                     Less than 100mg/dl
  • HDL (good) cholesterol                  Less than  45mg/dl

Men age 20 or older:

  • Total cholesterol                              125 to 200mg/dl   
  • Non-HDL                                           Less than 130mg/dl
  • LDL (bad) cholesterol                      Less than 100mg/dl
  • HDL (good) cholesterol                   40mg/dl or higher

Women age 20 or older:

  • Total cholesterol                               125 to 200mg/dl   
  • Non-HDL                                           Less than 130mg/dl
  • LDL (bad) cholesterol                      Less than 100mg/dl
  • HDL (good) cholesterol                   50mg/dl or higher

Triglycerides are not a type of cholesterol, but they are part of a lipoprotein panel (the test that measures cholesterol levels). A normal triglyceride level is below 150 mg/dL. You might need treatment if you have triglyceride levels that are borderline high (150-199 mg/dL) or high (200 mg/dL or more).

How often should I get a cholesterol test?

When and how often you should get a cholesterol test depends on your age, risk factors, and family history. The general recommendations are:

For people who are age 19 or younger:

  • The first test should be between ages 9 to 11
  • Children should have the test again every 5 years
  • Some children may have this test starting at age 2 if there is a family history of high blood cholesterol, heart attack, or stroke

For people who are age 20 or older:

  • Younger adults should have the test every 5 years
  • Men ages 45 to 65 and women ages 55 to 65 should have it every 1 to 2 years

What affects my cholesterol levels?

A variety of things can affect cholesterol levels. These are some things you can do to lower your cholesterol levels:

  • Diet. Saturated fat and cholesterol in the food you eat make your blood cholesterol level rise. Saturated fat is the main problem, but cholesterol in foods also matters. Reducing the amount of saturated fat in your diet helps lower your blood cholesterol level. Foods that have high levels of saturated fats include some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.
  • Weight. Being overweight is a risk factor for heart disease. It also tends to increase your cholesterol. Losing weight can help lower your LDL (bad) cholesterol, total cholesterol, and triglyceride levels. It also raises your HDL (good) cholesterol level.
  • Physical Activity. Not being physically active is a risk factor for heart disease. Regular physical activity can help lower LDL (bad) cholesterol and raise HDL (good) cholesterol levels. It also helps you lose weight. You should try to be physically active for 30 minutes on most, if not all, days.
  • Smoking. Cigarette smoking lowers your HDL (good) cholesterol. HDL helps to remove bad cholesterol from your arteries. So a lower HDL can contribute to a higher level of bad cholesterol.

Things outside of your control that can also affect cholesterol levels include:

  • Age and Gender. As women and men get older, their cholesterol levels rise. Before the age of menopause, women have lower total cholesterol levels than men of the same age. After the age of menopause, women’s LDL (bad) cholesterol levels tend to rise.
  • Hereditary. Your genes partly determine how much cholesterol your body makes. High blood cholesterol can run in families.
  • Race. Certain races may have an increased risk of high blood cholesterol. For example, African Americans typically have higher HDL and LDL cholesterol levels than whites.

How can I lower my cholesterol?

There are two main ways to lower your cholesterol:

  • Heart-healthy lifestyle changes, which include:
    • Heart-healthy eating. A heart-healthy eating plan limits the amount of saturated and trans fats that you eat. Examples include the Therapeutic lifestyle diet and the dash eating plan.
    • Weight Management. If you are overweight, losing weight can help lower your LDL (bad) cholesterol.
    • Physical Activity. Everyone should get regular physical activity (30 minutes on most, if not all, days).
    • Managing stress. Research has shown that chronic stress can sometimes raise your LDL cholesterol and lower your HDL cholesterol
    • Quitting smoking. Quitting smoking can raise your HDL cholesterol. Since HDL helps to remove LDL cholesterol from your arteries, having more HDL can help to lower your LDL cholesterol.
  • Drug Treatment. If lifestyle changes alone do not lower your cholesterol enough, you may also need to take medicines. There are several types of cholesterol medicines available, including statins. The medicines work in different ways and can have different side effects. Talk to your health care provider about which one is right for you. While you are taking medicines to lower your cholesterol, you should continue with the lifestyle changes.

BMI. Body Mass Index. This is a score which takes into account your height and weight and calculates a score of what the mass of your body should be. There are 4 categories underweight <18.5, Normal 18.5 – 24.9, Overweight 25-29.9, and Obese greater than or equal to 30.The BMI is a measure of body fat based on height and weight that applies to both adult men and women, and is a predictor of cardiovascular disease and other serious conditions. If you are overweight or obese you seriously need to look at making positive lifestyle changes.

A high BMI can be an indicator of high body fatness. BMI can be used as a screening tool but is not diagnostic of the body fatness or health of an individual.

To determine if a high BMI is a health risk, a healthcare provider would need to perform further assessments. These assessments might include skinfold thickness measurements, evaluations of diet, physical activity, family history, and other appropriate health screenings.

What are the health consequences of obesity for adults?

People who have obesity are at increased risk for many diseases and health conditions, including the following: 

  • All-causes of death (mortality)
  • High blood pressure (Hypertension)
  • High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
  • Type 2 diabetes
  • Coronary heart disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis (a breakdown of cartilage and bone within a joint)
  • Sleep apnea and breathing problems
  • Chronic inflammation and increased oxidative stress
  • Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
  • Low quality of life
  • Mental illness such as clinical depression, anxiety, and other mental disorders
  • Body pain and difficulty with physical functioning

Atherosclerotic Cardiovascular Disease (ASCVD) Score.This Risk Estimator enables health care providers and patients to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on the Pooled Cohort Equations and lifetime risk prediction tools. 

This article provides a starting point for knowing some of your important “health numbers”. It is not all-inclusive and there are others that your healthcare provider may order and discuss with you as well as the recommendations for treatment if needed. As you can also see there are some common threads throughout in regard to prevention, such as the importance of exercise and a healthy diet. 

The content on the American Family Nurse Practitioner website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own nurse practitioner , physician or other qualified health care professional regarding any medical questions or conditions.

References

1. https://www.uptodate.com/contents/the-prevalence-and-control-of-hypertension-in-adults2. https://www.cdc.gov/diabetes/basics/getting-tested.html

3. https://medlineplus.gov/cholesterollevelswhatyouneedtoknow.html

4. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

5. https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

6. http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/

7. 1https://doi.org/10.1161/HYP.0000000000000065 Hypertension. 2017;HYP.0000000000000065 Originally published November 13, 2017

 

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