An Ounce of Prevention

Benjamin Franklin is credited with saying, “an ounce of prevention is worth a pound of cure.” With that in mind, let’s talk about chronic disease prevention. Part of what we do in WISEWOMAN is screen for chronic disease risk factors.

After the clinical screening, we sit down with our participants and talk to them about their risk factors. There are some risk factors we can’t do anything about. You cannot change your age, your family medical history, or your personal medical history. However, there are other risk factors that are modifiable.

The modifiable risk factors we screen for in WISEWOMAN are: overweight/obesity; high blood pressure; high total cholesterol; low HDL cholesterol; elevated glucose; physical inactivity; and smoking. When we talk risk factors, we also talk about lifestyle behavior changes. The behavior change areas we focus on are nutrition, physical activity, and smoking cessation. Making a positive change in one of these areas is generally a healthy thing to do. It can also have a positive impact on specific conditions.

In January, the American Heart Association/American Stroke Association came out with their Guidelines for the Primary Prevention of Stroke. I briefly mentioned these guidelines a few weeks ago in the “Eat Your Veggies” blog posting. After looking over the guidelines more closely, I noticed some recommendations related to WISEWOMAN that are worth mentioning.

1) In agreement with the Joint National Committee (JNC 7) report, regular blood pressure (BP) screening and appropriate treatment, including both lifestyle modification and pharmacological therapy are recommended. – Well, guess what? We do this in WISEWOMAN. Our participants have their blood pressure checked at least every year during their clinical screening.

2) Abstention from cigarette smoking by nonsmokers and smoking cessation by current smokers are recommended . . . . status of tobacco use should be addressed at every patient encounter. – When we identify a woman who smokes, we encourage her to stop smoking when she is ready. We also offer help in the form of the Michigan Tobacco Quitline and other smoking cessation resources.

3) A Dietary Approaches to Stop Hypertension (DASH)-style diet, which emphasizes consumption of fruits, vegetables, and low-fat dairy products and is reduced in saturated fat, also lowers BP and is recommended . . . a diet that is rich in fruits and vegetables and thereby high in potassium is beneficial and may lower risk of stroke. – The WISEWOMAN nutrition recommendations are based on a modified DASH diet. Our focus is on fruits and vegetables, low-fat dairy, and whole grains.

4) Increased physical activity is recommended because it is associated with a reduction in risk of stroke . . . adults should engage in at least 150 minutes per week of moderate intensity . . . aerobic physical activity. – Can you believe it? This is yet another modifiable risk factor we focus on in WISEWOMAN! Many of our women are pretty sedentary when they start, so we do not try to move them to 150 minutes the first week. We encourage them to take small steps. Even 5 or 10 minutes a day for someone who is not doing anything will help.

5) Among overweight and obese persons, weight reduction is recommended as a means to lower BP . . . . (and) as a means of reducing risk of stroke. – WISEWOMAN is not a weight loss program, but we do confront overweight and obesity as a modifiable risk factor. Inevitably when we talk about goals, a woman who is overweight will talk about wanting to lose weight.

What does all this mean? Does it mean if you are in WISEWOMAN you will never have a stroke? Of course, not. It does mean there are steps you can take to reduce your risk of having a stroke, and (not so) coincidentally, much of what WISEWOMAN recommends will help reduce the risk of having a stroke. If you talk with someone who has had a stroke, they will tell you preventing the stroke is better than curing the results. Just read Yvette Fields story.

Other Stroke Resources

American Stroke Association: http://www.strokeassociation.org

Power to End Stroke: http://powertoendstroke.org/

National Stroke Association: http://www.stroke.org