Why focus on lifestyle?

 

Therapeutic lifestyle changes involving diet, exercise and stress reduction have been shown to improve longevity and reduce risk for chronic disease.

In the Intervene phase of the AIM to Prevent program, the South Asian Heart Center provides expert counseling focused on personalized lifestyle changes. We know that lifestyle changes are easier said than done. That is the reason why, in the Manage phase of AIM to Prevent, the Center has trained heart health coaches to help participants make and sustain lifestyle habits. All aspects of the AIM to Prevent program, from advanced screening to lifestyle coaching are evidence-based.

The evidence on lifestyle
 
Study
Alameda Seven
1
Health habits of U.S. adults, 1985: the "Alameda 7" revisited. Schoenborn CA. Public Health Rep. 1986 Nov-Dec;101(6):571-80. PMID: 3097736
Swedish Study
2
Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study. Akesson A, Larsson SC, Discacciati A, Wolk A. J Am Coll Cardiol. 2014 Sep 30;64(13):1299-306. doi: 10.1016/j.jacc.2014.06.1190. PMID: 25257629
INTERHEART
3
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Lancet. 2004 Sep 11-17;364(9438):937-52. PMID: 15364185
Study DesignStudy of 7000 people in Alameda
County, CA over 25 years found
seven lifestyle habits that promote
successful aging. Going from three
to seven of these habits extends
longevity by eleven years.
Study of 20,721 healthy individuals over 11 years, showed that a combination of healthy diet and lifestyle practices has a significant impact on primary prevention of myocardial infarction (MI).Large case-control study of
acute myocardial infarction (MI)
in 52 countries with 15,152
cases and 14,820 controls
showed that nine clinical and
lifestyle factors accounted for
90% of heart attacks.
Key Findings7 healthy lifestyle habits
promote longevity
80% of heart attacks preventable
with positive lifestyle habits alone
6 of 9 factors that explain heart
attacks pertain to poor lifestyle
Sleep SleepAdequate 7-8 hours a night  
Stress Stress  Psychological stress
Obesity ObesityMaintaining recommended weightManage abdominal adiposity
(waist circumference < 95 cm)
Obesity
Diet DietEating breakfast regularly  
Not snacking
Healthy dietPoor vegetable and fruit intake
Exercise ExerciseRegular vigorous activity (>3kcal/kg/day)Being physically active
walk/bike ≥40 m/day
& exercise ≥ 1 h/wk
Sedentary lifestyle
Smoking SmokingNot smokingNot smokingSmoking
Alcohol AlcoholNone/moderate alcoholModerate alcohol 10-30g a dayNone/excessive alcohol consumption
Study
Alameda Seven
1
Health habits of U.S. adults, 1985: the "Alameda 7" revisited. Schoenborn CA. Public Health Rep. 1986 Nov-Dec;101(6):571-80. PMID: 3097736
Study DesignStudy of 7000 people in Alameda
County, CA over 25 years found
seven lifestyle habits that promote
successful aging. Going from three
to seven of these habits extends
longevity by eleven years.
Key Findings7 healthy lifestyle habits
promote longevity
Sleep SleepAdequate 7-8 hours a night
Stress Stress 
Obesity ObesityMaintaining recommended weight
Diet DietEating breakfast regularly  
Not snacking
Exercise ExerciseRegular vigorous activity (>3kcal/kg/day)
Smoking SmokingNot smoking
Alcohol AlcoholNone/moderate alcohol
Study
Swedish Study
2
Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study. Akesson A, Larsson SC, Discacciati A, Wolk A. J Am Coll Cardiol. 2014 Sep 30;64(13):1299-306. doi: 10.1016/j.jacc.2014.06.1190. PMID: 25257629
Study DesignStudy of 20,721 healthy individuals over 11 years, showed that a combination of healthy diet and lifestyle practices has a significant impact on primary prevention of myocardial infarction (MI).
Key Findings80% of heart attacks preventable
with positive lifestyle habits alone
Sleep Sleep 
Stress Stress 
Obesity ObesityManage abdominal adiposity
(waist circumference < 95 cm)
Diet DietHealthy diet
Exercise ExerciseBeing physically active
walk/bike ≥40 m/day
& exercise ≥ 1 h/wk
Smoking SmokingNot smoking
Alcohol AlcoholModerate alcohol 10-30g a day
Study
INTERHEART
3
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Lancet. 2004 Sep 11-17;364(9438):937-52. PMID: 15364185
Study DesignLarge case-control study of
acute myocardial infarction (MI)
in 52 countries with 15,152
cases and 14,820 controls
showed that nine clinical and
lifestyle factors accounted for
90% of heart attacks.
Key Findings6 of 9 factors that explain heart
attacks pertain to poor lifestyle
Sleep Sleep 
Stress StressPsychological stress
Obesity ObesityObesity
Diet DietPoor vegetable and fruit intake
Exercise ExerciseSedentary lifestyle
Smoking SmokingSmoking
Alcohol AlcoholNone/excessive alcohol consumption
The role of stress
 

Stress is defined as feeling irritable, anxious, or as having sleep difficulties as a result of conditions at work or at home. Psychological stress results from the inability of an individual to creatively overcome challenges. Physiological stress results from the inability of the body to maintain balance or steady state.

Studies on stress have shown a strong correlation with increase in risk for heart attacks, dyslipidemia, inflammation and obesity.

  • Chronic stress is linked to a 2.67 fold increase in risk for heart attacks
    4
    Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study.Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S; INTERHEART investigators. Lancet.2004 Sep 11-17;364(9438):953-62. PMID: 15364186
  • Work stress is associated with atherogenic lipids and elevated fibrinogen
    5
    Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle-aged men. Siegrist J, Peter R, Cremer P, Seidel D. J Intern Med. 1997 Aug;242(2):149-56. PMID: 9279292
  • Stress exaggerates diet-induced obesity through a mechanism in the abdominal adipose tissue
    6
    Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome. Kuo LE, Kitlinska JB, Tilan JU, Li L, Baker SB, Johnson MD, Lee EW, Burnett MS, Fricke ST, Kvetnansky R, Herzog H, Zukowska Z. Nat Med. 2007 Jul;13(7):803-11. Epub 2007 Jul 1. Erratum in: Nat Med. 2007 Sep;13(9):1120. PMID: 17603492
Intervene with Lifestyle MEDS
 

The key to prevention of heart attacks and diabetes is early and comprehensive assessment followed by personalized lifestyle intervention. The Alameda Seven, INTERHEART, and the Swedish prevention study, illustrate the benefits of good lifestyle behaviors and the disease consequences of poor lifestyle.

Alameda Seven, Swedish prevention study, and INTERHEART illustrate the benefits of good lifestyle behaviors and the disease consequences of poor lifestyle.

MEDITATION
Meditation
EXERCISE
Exercise
DIET
Diet
SLEEP
Sleep

Derived from hallmark studies, these therapeutic components are most relevant for risk reduction in South Asians and are, therefore, the key offering in the AIM to Prevent program.

Other habits like smoking and excessive alcohol consumption, are also important to reduce risk. The South Asian Heart Center refers participants who seek help with these habits to the many dedicated resources available within the community. 

Meditation
 

A growing body of scientific research supports the health benefits of meditation. Meditation is a simple mind-body process which leads to deep relaxation and stress reduction. Meditation helps in managing chronic conditions such as heart disease, high blood pressure, cancer, and depression.

Meditation
M
The South Asian Heart Center's mantra for meditation
Daily practice of restful alertness
Mantra for Meditation: Daily practice of restful alertness

Goal: Meditate for 20 minutes, twice daily

Meditation is a sit-down, eyes-closed, conscious technique, practiced in one of the following ways: Concentration where you focus on an object, contemplation where you observe the object, and transcendental where you lose the object. The South Asian Heart Center suggests you develop the habit of meditation, and recommends Transcendental Meditation for stress reduction because of evidence showing its effectiveness in addressing cardiovascular mortality.

 
  • Restful Sleep and Restful Alertness (South Asian Heart Center TLC Series)

  • Stress Reduction. (South Asian Heart Center)

  • The TM Experience: How TM works

  • An in-depth introduction to the Transcendental Meditation® technique (by Bob Roth, President of the David Lynch Foundation)

  • Single most important thing you can do to manage your stress. (DocMikeEvans)

Sustained practice of meditation or restful alertness has been shown to reduce angina (chest pain) in patients with coronary artery disease.
7
Usefulness of the transcendental meditation program in the treatment of patients with coronary artery disease. Zamarra JW, Schneider RH, Besseghini I, Robinson DK, Salerno JW. Am J Cardiol. 1996 Apr 15;77(10):867-70. PMID: 8623742
The benefits of Transcendental Meditation (TM) for prevention and management of disease are widely researched and well documented. Stress reduction with the regular practice of TM in high risk CAD patients is associated with a 47% reduction in all cause mortality, heart attacks, and stroke and a 61% reduction in events in those patients who practice the technique regularly.
8
Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, Gaylord-King C, Salerno JW, Kotchen JM, Alexander CN. Circ Cardiovasc Qual Outcomes. 2012 Nov;5(6):750-8. doi: 10.1161/CIRCOUTCOMES.112.967406. Epub 2012 Nov 13. PMID: 23149426
Research shows that a direct change in state of consciousness through TM extends human life and reverses age-related declines.
9
Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly.Alexander CN, Langer EJ, Newman RI, Chandler HM, Davies JL. J Pers Soc Psychol. 1989 Dec; 57(6):950-64. PMID: 2693686
TM is associated with decreased hypertension and atherosclerosis, decreased hospitalization rates and improvements in risk factors including decreased smoking and cholesterol and shows promise as an effective prevention and treatment method for CAD.
10
Transcendental meditation, hypertension and heart disease. King MS, Carr T, D'Cruz C Aust Fam Physician. 2002 Feb;31(2):164-8. Review PMID: 11917830
  • Free orientation and discounted instruction on the TM technique
  • Educational workshops and referrals to a network of culturally trained counselors on work-life balance, emotional health and wellbeing

Exercise
 

Exercise is structured physical activity and falls into the following categories: aerobic, strength, and balance and flexibility. Unstructured physical activity such as climbing stairs, gardening, playing with children, also counts. It is important to include the different types of exercise into your daily practice.

Exercise
E
The South Asian Heart Center's mantra for exercise
Regular, varied, and vigorous
Mantra for Exercise: Regular, varied, and vigorous

Goal: 150 minutes of physical activity per week.

It is not necessary to have a gym membership to receive benefits of exercise. Home-based programs do in fact have greater adherence than gym-based programs.

 
  • MYFITNESSPAL

  • MAPMYWALK

  • RUNKEEPER

  • NIKE RUN

  • Get Moving

  • Exercise to lower your triglycerides. (Mayo Clinic)

  • 23 and ½ hours: What is the single best thing we can do for our health? (DocMikeEvans)

  • Benefits of Physical Activity. (Centers for Disease Control and Prevention)

  • Recommendations for Physical Activity. (National Heart Lung and Blood Institute)

  • #chalechalo A way for South Asian Heart Center participants to promote physical activity in their lives

Aerobic and resistance exercise along with a weight reduction diet results in greater mobilization of abdominal fat and improved functional capacity
11
Influence of diet and exercise on skeletal muscle and visceral adipose tissue in men. Ross R, Rissanen J, Pedwell H, Clifford J, Shragge P. J Appl Physiol (1985). 1996 Dec;81(6):2445-55. PMID: 9018491
Fitness is the most important predictor of longevity. Each added minute in an exercise stress test was shown to enhance longevity by 8%.
12
Physical activity, all-cause mortality, and longevity of college alumni. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. N Engl J Med. 1986 Mar 6;314(10):605-13. PMID: 3945246
Sedentary lifestyle habits, such as extended television viewing, increase risk for coronary artery disease.
13
Physical fitness and all-cause mortality. A prospective study of healthy men and women. Blair SN, Kohl HW 3rd, Paffenbarger RS Jr, Clark DG, Cooper KH, Gibbons LW. JAMA. 1989 Nov 3;262(17):2395-401. PMID: 2795824
 
Amount and Regularity of Exercise Matters

The NIDDK's Diabetes Prevention Program results indicate that millions of high-risk individuals can delay or avoid developing Type 2 diabetes by losing weight through regular physical activity. Weight loss and physical activity lower the risk of diabetes by improving the body's ability to use insulin and process glucose.

Amount, not intensity is most important for lipid profile improvements.
14
Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study. Slentz CA, Duscha BD, Johnson JL, Ketchum K, Aiken LB, Samsa GP, Houmard JA, Bales CW, Kraus WE. Arch Intern Med. 2004 Jan 12;164(1):31-9. PMID: 14718319
35-40 minutes a day of brisk walking is associated with a CAD risk reduction of over 50%.
14-1
Effects of the amount of exercise on body weight, body composition, and measures of central obesity: STRRIDE--a randomized controlled study. Slentz CA, Duscha BD, Johnson JL, Ketchum K, Aiken LB, Samsa GP, Houmard JA, Bales CW, Kraus WE. Arch Intern Med. 2004 Jan 12;164(1):31-9. PMID: 14718319
Physical activity and risk of coronary heart disease in India.
15
Rastogi T, Vaz M, Spiegelman D, Reddy KS, Bharathi AV, Stampfer MJ, Willett WC, Ascherio A. Int J Epidemiol. 2004 Aug;33(4):759-67. Epub 2004 Mar 24. PMID:15044412

According to the National Heart, Lung and Blood Institute (NHLBI), adults need to do at least 150 minutes of moderate-intensity aerobic activity on a weekly basis to realize health benefits.

Exercise timing makes a difference
The "weekend warrior" and risk of mortality.
16
Lee IM, Sesso HD, Oguma Y, Paffenbarger RS Jr. Am J Epidemiol. 2004 Oct 1;160(7):636-41. PMID: 15383407
Training in the fasted state improves glucose tolerance during fat-rich diet.
17
Van Proeyen K, Szlufcik K, Nielens H, Pelgrim K, Deldicque L, Hesselink M, Van Veldhoven PP, Hespel P. J Physiol. 2010 Nov 1;588(Pt 21):4289-302. doi: 10.1113/jphysiol.2010.196493. PMID: 20837645
 
Benefits of adopting healthy lifestyle
People who adopt a healthy lifestyle even in middle-age, experience a prompt benefit of lower rates of cardiovascular disease and mortality.
18
Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L, Whelton PK. Am J Clin Nutr. 2002 Jul;76(1):93-9. PMID: 12081821

1 hour free orientation and beginner physical training class, plus a 12-week training program at a discounted rate with exercise physiologists

  • Daly City, CA, Free orientation and discounted 12-week training program.

  • Milpitas, CA, Free orientation and discounted 12-week training program.

  • Sunnyvale, CA. Free orientation and discounted 12-week training program.

  • from Mona Khan Company. Instructor-led, free orientation for a fun Bollywood style aerobic workout and discounted 8-session program.

Diet
 

Good nutrition is another key lifestyle ingredient in the prevention of heart disease and diabetes. Sensible selections and substitutions to the traditional diet may be necessary to make it heart healthy.

Diet
D
The South Asian Heart Center's mantra for diet
More greens than grains
Mantra for Diet: More greens than grains

Goal: 2 fistfuls of vegetables/day, 1 fistful of fruit/day, 12 nuts/day, zero sugared drinks.

The South Asian Heart Center encourages high-fiber, plant based foods, limited consumption of refined carbohydrates, animal fats and processed foods, and discourages sweet beverages and fried snacks.

The Center recommends at least 3 sit down meals per day, inclusive of breakfast, and suggests consuming a fistful of fruit, 12 nuts, and a minimum of two fistfuls of vegetables per day.

 
  • MYFITNESSPAL

  • SEAFOODWATCH

  • Heartier Choices Guidelines. (South Asian Heart Center)

  • Carbohydrate Counting for Traditional Indian and Pakistani Foods. (SJSU)

  • Cooking from the Heart. (South Asian Heart Center)

  • Nutrition Guide to Optimal Health - 1. (AAPI USA)

  • Nutrition Guide to Optimal Health - 2. (AAPI USA)

  • Healthy Eating Handbook. (Whole Foods)

  • 10 Tips to a Great Plate. (choosemyplate.gov)

  • Simple Steps to preventing Diabetes. (Harvard)

  • Heart Healthy Diet Tips. (Helpguide.org)

Questions: food@southasianheartcenter.org

The Center's recommendations on dietary changes are based on evidence behind the importance of increasing consumption of vegetables and fruits, limiting intake of fats and reducing simple carbohydrates to decrease risk of heart disease. Evidence

Vegetables and Fruits
Most fruits and vegetables are low in calories and high in fiber, making them heart healthy. Variety is as vital as quantity because no single fruit or vegetable can provide all of the nutrients you need to be healthy. Consuming fruit and vegetables ≥3 times/day vs <1 time/day is associated with a 27% lower stroke incidence, 42% lower stroke mortality, 24% lower ischemic heart disease mortality, 27% lower cardiovascular disease mortality & 15% lower all-cause mortality.
18
Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L, Whelton PK. Am J Clin Nutr. 2002 Jul;76(1):93-9. PMID: 12081821
Analysis of cohort studies reveals a real benefit to consuming more than 5 servings/day of fruit and vegetables
19
Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. He FJ, Nowson CA, Lucas M, MacGregor GA. J Hum Hypertens. 2007 Sep;21(9):717-28. Epub 2007 Apr 19. PMID: 17443205
to protect against coronary artery disease.
 
Whole Grains
Most carbohydrate intake should come from whole grains rather than refined grains to help prevent Type 2 diabetes.
20
White rice, brown rice, and risk of type 2 diabetes in US men and women. Sun Q, Spiegelman D, van Dam RM, Holmes MD, Malik VS, Willett WC, Hu FB. Arch Intern Med. 2010 Jun 14;170(11):961-9. doi: 10.1001/archinternmed.2010.109. Erratum in: Arch Intern Med. 2010 Sep 13;170(16):1479. PMID: 20548009
 
Fats
Healthy fats like Omega-3 fatty acids add to the primary prevention effects of statin therapy.
21
Effects of different forms of dietary hydrogenated fats on serum lipoprotein cholesterol levels. Lichtenstein AH, Ausman LM, Jalbert SM, Schaefer EJ. N Engl J Med. 1999 Jun 24;340(25):1933-40. Erratum in: N Engl J Med 1999 Sep 9;341(11):856. PMID: 10379016
A cooking oil that is high in monounsaturated  fat such as olive or canola oil seems to offer significant protection against heart disease.
22
Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; Japan EPA lipid intervention study (JELIS) Investigators. Lancet. 2007 Mar 31;369(9567): 1090-8. Erratum in: Lancet. 2007 Jul 21;370(9583):220. PMID: 17398308
Unhealthy transfats (foods that list hydrogenated shortening in ingredients, or reheated cooking oil) can detrimentally increase LDL while decreasing HDL.
23
The impact of olive oil consumption pattern on the risk of acute coronary syndromes: The CARDIO2000 case-control study. Kontogianni MD, Panagiotakos DB, Chrysohoou C, Pitsavos C, Zampelas A, Stefanadis C. Clin Cardiol. 2007 Mar;30(3):125-9. PMID: 17385704
 
Softdrinks
Soft drink consumption is associated with higher prevalence and incidence of multiple metabolic risk factors.
24
Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community. Dhingra R, Sullivan L, Jacques PF, Wang TJ, Fox CS, Meigs JB, D'Agostino RB, Gaziano JM, Vasan RS. Circulation. 2007 Jul 31;116(5):480-8. Epub 2007 Jul 23. Erratum in: Circulation. 2007 Dec 4;116(23):e557. PMID: 17646581
Consumption of more than 1 soft drink a day increases the incidence of metabolic syndrome, obesity, waist circumference and blood pressure.
Timing and Number of Meals
Studies indicate that eating breakfast can significantly lower cardiovascular disease risk.
25
Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals. Cahill LE, Chiuve SE, Mekary RA, Jensen MK, Flint AJ, Hu FB, Rimm EB. Circulation. 2013 Jul 23;128(4):337-43. doi: 10.1161/CIRCULATIONAHA.113.001474. PMID: 23877060
Skipping breakfast is associated with a 450% increased risk of obesity, as was greater frequency of eating breakfast or dinner away from home and eating ≥ 4 meals/day vs ≤ 3 meals/day is associated with a 45% lower risk of obesity.
26
Association between eating patterns and obesity in a free-living US adult population. Ma Y, Bertone ER, Stanek EJ 3rd, Reed GW, Hebert JR, Cohen NL, Merriam PA, Ockene IS. Am J Epidemiol. 2003 Jul 1;158(1):85-92. PMID: 12835290
Sleep
 

Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of most voluntary muscles. At the same time, sleep is also a heightened anabolic state, accentuating the growth and rejuvenation of the immune, nervous, skeletal and muscular systems.

Sleep
S
The South Asian Heart Center's mantra for sleep
Routine of restful sleep
Mantra for Sleep: Routine of restful sleep

Goal: 7-8 hours per night.

The consequences of insufficient or fragmented sleep are neurobehavioral and performance deficits in addition to cardio-metabolic problems like, obesity, Type 2 DM, and hypertension, which in turn lead to increased morbidity/mortality and a decreased quality of life.

 
  • Restful Sleep and Restful Alertness (South Asian Heart Center TLC Series)

  • How much sleep do you need? (Helpguide.org)

  • Natural Patterns of Sleep (Harvard)

  • Brain Basics: Understanding Sleep (NINDS)

During sleep, the brain is still active, performing a variety of biological maintenance tasks that keeps the body performing in peak condition. Sleep occurs in a series of recurring sleep stages that are very different from one another. From deep sleep to dreaming sleep, they are all vital for your body and mind. Without enough hours of restful sleep, you will not feel restored and recharged, and are bound to feel stressed and ill-prepared to meet the challenges of the day.

Studies on sleep have shown the impact of sleep duration (both deprivation and excess) and disorders on diabetes, hypertension, obesity, coronary artery disease and mortality.

Sleep Duration
Short and long sleep durations increase the risk of developing diabetes.
27
Sleep duration as a risk factor for the development of type 2 diabetes Yaggi HK, Araujo AB, McKinlay JB. Diabetes Care. 2006 Mar;29(3):657-61. PMID: 16505522
28
A prospective study of self-reported sleep duration and incident diabetes in women. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, Patel S, Hu FB. Diabetes Care. 2003 Feb;26(2):380-4. PMID: 12547866
, independent of confounding factors indicating that sleep duration may represent a novel risk factor for diabetes. Sleep durations of ≤ 5 hours per night were associated with a significantly increased risk of hypertension.
29
Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, Rundle AG, Zammit GK, Malaspina D. Hypertension. 2006 May;47(5):833-9. Epub 2006 Apr 3. PMID: 16585410
Short and long self-reported sleep durations are independently associated with a modestly increased risk of coronary events
30
A prospective study of sleep duration and coronary heart disease in women. Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, Hu FB. Arch Intern Med. 2003 Jan 27;163(2):205-9. PMID: 12546611
Modest associations between short sleep duration and difficulties maintaining sleep and incident heart attacks were seen in middle-aged women
31
Sleep duration and sleep complaints and risk of myocardial infarction in middle-aged men and women from the general population: the MONICA/KORA Augsburg cohort study. Meisinger C, Heier M, Löwel H, Schneider A, Döring A. Sleep. 2007 Sep;30(9):1121-7. PMID: 17910384
Coaching
 

A unique aspect of South Asian Heart Center's AIM to Prevent program is the use of trained health coaches to engage actively with participants pursuing therapeutic lifestyle changes. Unlike traditional methods where health care providers merely recommend behavior modifications, the Center's coaches get better compliance because they gauge the readiness of participants, understand their reasons for ambivalence, and encourage behavioral change one step at a time.

Heart health coaching is optional to participants after completion of comprehensive screening, individualized risk assessment and behavioral recommendations. Coaches contact enrolled participants regularly for the first year (and annually thereafter) to provide encouragement with behavior change, troubleshoot challenges and assess adherence.

What is unique about the Center's personalized and culturally sensitive coaching and case management program is that the coaches are South Asian community volunteers who undergo specific training. Their effectiveness stems from their ability to relate well to the participants' needs based on their own personal experience, or that of friends and family, with the epidemics, and to understand the challenges of lifestyle changes within the cultural context. Using volunteers to coach participants keeps program costs under control and makes it possible for a dedicated program like the Center's, to scale and have greater impact.

 
Health coaching has been shown to improve compliance, reduce costs and improve health outcomes
32
Health coaching: a fresh approach for improving health outcomes and reducing costs.Huffman MH., AAOHN J. 2010 Jun;58(6):245-50; quiz 251-2. doi: 10.3928/08910162-20100526-02, PMID: 20677720
The use of individualized health coaching has been shown to be an effective strategy for reducing cardiovascular disease risk factors
33,
Community Outreach and Cardiovascular Health (COACH) Trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers, Allen JK, Dennison-Himmelfarb CR, Szanton SL, Bone L, Hill MN, Levine DM, West M, Barlow A, Lewis-Boyer L, Donnelly-Strozzo M, Curtis C, Anderson K., Circ Cardiovasc Qual Outcomes. 2011 Nov 1; 4(6):595-602. doi: 10.1161/CIRCOUTCOMES.111.961573. Epub 2011 Sep 27. PMID: 21953407
34
Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease, Vale MJ, Jelinek MV, Best JD, Dart AM, Grigg LE, Hare DL, Ho BP, Newman RW, McNeil JJ; COACH Study Group., Arch Intern Med. 2003 Dec 8-22;163(22):2775-83. PMID: 14662633
Culturally tailored interventions improve diabetes mellitus care by reducing ER visits.
35
The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial, Gary TL, Batts-Turner M, Yeh HC, Hill-Briggs F, Bone LR, Wang NY, Levine DM, Powe NR, Saudek CD, Hill MN, McGuire M, Brancati FL., Arch Intern Med. 2009 Oct 26; 169(19):1788-94. doi: 10.1001/archinternmed.2009.338., PMID: 19858437
Intensive lifestyle intervention has been shown to lead to significant weight loss and therefore reduction in needed medication, improvement of cardiovascular risk factors, and better diabetes control, in Type 2 DM patients.
36
Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial, Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, Clark JM, Curtis JM, Espeland MA, Foreyt JP, Graves K, Haffner SM, Harrison B, Hill JO, Horton ES, Jakicic J, Jeffery RW, Johnson KC, Kahn S, Kelley DE, Kitabchi AE, Knowler WC, Lewis CE, Maschak-Carey BJ, Montgomery B, Nathan DM, Patricio J, Peters A, Redmon JB, Reeves RS, Ryan DH, Safford M, Van Dorsten B, Wadden TA, Wagenknecht L, Wesche-Thobaben J, Wing RR, Yanovski SZ. Diabetes Care. 2007 Jun;30(6):1374-83. Epub 2007 Mar 15, PMID: 17363746

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