血管保健 三對(duì)策
高血壓、高血脂和高血糖，統(tǒng)稱為“代謝綜合癥”。這三高之間互相牽連，難分難解，共同做惡，致使血管冠狀動(dòng)脈硬化程度加劇。醫(yī)學(xué)報(bào)告已經(jīng)證實(shí)，高血脂除了會(huì)導(dǎo)致心臟病之外，與腦血管疾病、高血壓及糖尿病等慢性疾病息息相關(guān)。因此，只要有高血壓、高血脂或高血糖中任何“一高”，就必須留意有罹患其它“兩高”的可能性。對(duì)此，除了定期檢查“三高”外，平時(shí)還要注意均衡飲食、積極運(yùn)動(dòng)來預(yù)防“三高”，一見“三高”數(shù)據(jù)偏高，就應(yīng)該接受?？漆t(yī)生的治療。
對(duì)策一：飲食控制，運(yùn)動(dòng)養(yǎng)生
要診斷血脂異常，只要抽血檢查就可以了。血脂正常值：總膽固醇＜5.17毫摩爾/升；甘油三酯＜1.47毫摩爾/升；低密度脂蛋白＜3.36毫摩爾/升；高密度脂蛋白≥1.16毫摩爾/升。如果您已經(jīng)超過了正常值，代表您的血脂已經(jīng)異常。
治療血脂異常的步驟，第一步應(yīng)該選擇非藥物療法，一般至少3--6個(gè)月仍然無效后，才進(jìn)行藥物治療。非藥物療法包括飲食控制、運(yùn)動(dòng)養(yǎng)生和戒煙限酒。
1、控制飲食
對(duì)于血脂高的人飲食一定要清淡，要低油、低鹽，選擇低膽固醇食物和避開高膽固醇食物。
①拒絕油膩：油膩食物不但讓血脂升高，還會(huì)長(zhǎng)胖。所以在日常生活中藥少吃油炸、油煎或油酥的食物：少吃含有脂高的豬皮、雞皮、鴨皮、魚皮、肥肉及奶油。含隱性油脂的各式火鍋料、獅子頭、點(diǎn)心等也應(yīng)該少吃。
②炒菜油秘方：炒菜最好用不飽和脂肪酸高的植物油：如橄欖油、花生油、菜籽油等，少用飽和脂肪酸高的動(dòng)物油。多采用清蒸、水煮、涼拌等不用油或者少用油的烹調(diào)方式，搭配橄欖油、醬油、醋來調(diào)味。
③減少吃高膽固醇的食物：包括動(dòng)物內(nèi)臟（腦、肝、腎等）、蟹黃、魚子、蛋黃、蛋黃素或餅干等。若干固醇過高，每周以不超過3個(gè)雞蛋為原則。肉類應(yīng)多選擇魚類及去皮家禽，盡量少用羊、牛、豬等脂肪高的肉類。還要在飲食中常搭配富含ω—3的深海魚、黃豆及其制品，有助于高血脂的預(yù)防和治療。
研究證明，植物油經(jīng)過氫化制成人造奶油、烤酥油等，含有反式脂肪酸，對(duì)心血管的危害更嚴(yán)重。因此，凡在食品包裝上標(biāo)有“氫化”、“半氫化”、“精制植物油”的字句，均可能含有反式脂肪酸，須當(dāng)心。
④富含高纖維食物：高纖維食物可在腸道內(nèi)結(jié)合膽固醇，對(duì)心血管健康有利。包括未精制的谷類如糙米、全麥面、燕麥、玉米、薏仁等；未加工的黃豆、紅豆、綠豆等各種葉類蔬菜、四季豆、胡蘿卜等；各類水果如橙子、梨、柚子等。
2、堅(jiān)持運(yùn)動(dòng)
許多研究發(fā)現(xiàn)，現(xiàn)代人活動(dòng)減少，是造成許多慢性病的原因。因?yàn)椴贿\(yùn)動(dòng)的人比較胖，一般體重增加10%,膽固醇平均增加18.5毫克/分升，冠心病的危險(xiǎn)就增加38%；體重增加20%，冠心病的危險(xiǎn)就增加86%。不運(yùn)動(dòng)的人血管耐受力也比較差，無法承受壓力引發(fā)的血壓升高。所以運(yùn)動(dòng)養(yǎng)生十分重要。
①333運(yùn)動(dòng)計(jì)劃：研究指出，要想有效提高心肺功能，最好進(jìn)行大肌肉群運(yùn)動(dòng)項(xiàng)目，如慢跑、游泳、騎自行車等。運(yùn)動(dòng)頻度要執(zhí)行333計(jì)劃，即：每周運(yùn)動(dòng)3--5次，每次運(yùn)動(dòng)30--60分鐘；運(yùn)動(dòng)心跳為130次/分鐘。只要運(yùn)動(dòng)，不管做多久，都比不運(yùn)動(dòng)好。
②少量多次分時(shí)運(yùn)動(dòng)：美國(guó)哈佛大學(xué)的研究證實(shí)，只要消耗的熱量夠多，每天進(jìn)行少量多次的分時(shí)運(yùn)動(dòng)，其效果和一周三次運(yùn)動(dòng)一樣有效。哈佛大學(xué)公共學(xué)院對(duì)7307名平均66歲的人進(jìn)行調(diào)查，發(fā)現(xiàn)每周散步的距離能達(dá)到4.8公里，平均每天散步700米，使心血管病的發(fā)病率降低10%。
③運(yùn)動(dòng)前須做心肺測(cè)試：凡年齡在40歲以上，體檢學(xué)膽固醇過高者，在運(yùn)動(dòng)前一定要進(jìn)行心肺測(cè)試。因?yàn)橛械娜搜軓埩Σ缓茫\(yùn)動(dòng)時(shí)可能會(huì)發(fā)生運(yùn)動(dòng)型高血壓，或產(chǎn)生運(yùn)動(dòng)誘發(fā)型氣喘。為防止發(fā)生意外，注意在進(jìn)行各種運(yùn)動(dòng)時(shí)，都要控制在自己能耐受的范圍內(nèi)，采取漸進(jìn)式增加，千萬不要勉強(qiáng)增加而發(fā)生危險(xiǎn)。
3、戒煙限酒
吸煙在對(duì)于心臟的危害極大，據(jù)美國(guó)的統(tǒng)計(jì)顯示，美國(guó)所有冠狀動(dòng)脈心臟病死亡報(bào)告病例中30%可歸于長(zhǎng)期吸煙，若患者合并有糖尿病，吸煙引起的死亡可高達(dá)60%。研究發(fā)現(xiàn)，對(duì)比治療高血壓、降膽固醇的藥物以及補(bǔ)充阿司匹林預(yù)防血栓等，戒煙對(duì)預(yù)防心血管病再發(fā)的成效最高。
任何人都應(yīng)少喝酒，尤其是甘油三酯高者。雖然研究發(fā)現(xiàn)紅酒有助于降低心血管疾病，但也僅限于“少喝一點(diǎn)”。事實(shí)上，適量飲酒有益健康僅限于健康者。對(duì)于患心臟病的人來說，飲酒不僅會(huì)增加心臟負(fù)擔(dān)，使血壓升高，心肌收縮力降低，還會(huì)導(dǎo)致心律失常。酒精還會(huì)引發(fā)甘油三酯升高，影響代謝，促進(jìn)動(dòng)脈硬化進(jìn)一步惡化。所以，心血管疾病患者還是應(yīng)戒煙限酒好。
對(duì)策二：保護(hù)血管
從飲食中攝取所需要的營(yíng)養(yǎng)來保護(hù)血管時(shí)最好的，目前也有不少具有降血脂功效的保健食品。
1、保健食品
①魚油：魚油有降血脂、減少心血管疾病及中風(fēng)發(fā)作等作用。目前魚油不僅是一般人的保健食品，還是心血管患者術(shù)前術(shù)后的保健營(yíng)養(yǎng)品，但是魚油過高可能降低血凝結(jié)作用，增加出血機(jī)會(huì)，故需征求醫(yī)生意見后服用。
②大蒜素：大蒜中含有甲烷蒜基三硫化物，具有擴(kuò)張血管及降低血壓作用，它也能減少血液的凝結(jié)。
③大豆蛋白：大豆蛋白可降低體內(nèi)總膽固醇、甘油三酯能改善動(dòng)脈粥樣硬化。
④紅曲：紅曲有降低總膽固醇、甘油三酯的作用，但對(duì)正在服用抗生素及甲狀腺藥物者不宜服用。
⑤燕麥：燕麥中含有多種可溶性纖維素及優(yōu)質(zhì)蛋白，可降低血中膽固醇及降低血壓，每天只要吃一碗燕麥?zhǔn)称罚陀薪档脱懝檀嫉淖饔谩?br>
⑥甲殼素：研究證明，每克甲殼素可吸收12克脂肪，效果優(yōu)于大多數(shù)纖維素，既預(yù)防了肥胖，也保護(hù)了心血管。
⑦花青素：葡萄籽中的抗氧化成份——花青素，是生物類黃酮的一種，抗氧化能力是維生素C和E的100倍，不僅能抗血中脂質(zhì)過氧化，還能強(qiáng)化血管，甚至阻斷癌細(xì)胞生長(zhǎng)。
⑧茄紅素：茄紅素有強(qiáng)大的抗氧化作用，也能保護(hù)心血管不受脂質(zhì)過氧化的破壞。
⑨茶多酚：綠茶中的有益成分是茶多酚，茶多酚不僅有抗癌作用，還能減少肝臟合成膽固醇的作用。實(shí)驗(yàn)證明，讓老鼠連續(xù)服綠茶粉53周，體重減輕18%，膽固醇和甘油三酯降低30%，而低密度脂蛋白也降低了20%。
⑩甘蔗原素：它是從甘蔗表皮蠟質(zhì)及葉中提取的，具有降低總膽固醇、低密度脂蛋白作用，可起到減少動(dòng)脈粥樣硬化的功效。
2、有益心血管的食品
據(jù)美國(guó)食品局建議，有益于心血管的食品包括粘稠性纖維、植物性蛋白質(zhì)、植物性固醇、堅(jiān)果等。粘稠性纖維食物有：番茄、燕麥、何海帶，以及茄子、秋葵、木耳等；植物性蛋白質(zhì)及固醇包括各種豆類、豆腐、豆?jié){等黃豆制品；堅(jiān)果包括杏仁、松子及核桃等。
另外，有助于將血壓的食物有芹菜、香蕉、菠菜等。近幾年研究證實(shí)，薏仁也具有降低膽固醇的作用。實(shí)驗(yàn)發(fā)現(xiàn)，每天只要食用煮熟的薏仁100克，血中膽固醇可明顯下降，還有助于降低體重。
研究發(fā)現(xiàn)，山楂有降血脂的作用；黑芝麻能維持血管彈性，預(yù)防動(dòng)脈粥樣硬化；日本傳統(tǒng)的發(fā)酵食物納豆，含有天然的血栓溶解酵素。此外，多吃深海魚、拌橄欖油生菜、洋蔥、青花菜，都有預(yù)防心血管疾病的作用。
除飲茶外，富含保護(hù)血管的水果有含花青素的紅葡萄、草莓、櫻桃、復(fù)盆子、黑莓、藍(lán)莓登既能保護(hù)泌尿道，又能保護(hù)心血管，真是一舉兩得！
對(duì)策三：積極治療，控制三高
控制高血壓、高血脂、高血糖，治療血脂異常非常重要。在經(jīng)過3--6個(gè)月非藥物治療仍無效后，就應(yīng)該進(jìn)行藥物治療，以降低總膽固醇，減少低密度脂蛋白及甘油三酯濃度。提高高密度脂蛋白濃度。目前效果最強(qiáng)的降膽固醇藥物是他汀類降脂藥，常用的有阿托伐他汀、洛伐他汀、普伐他汀、辛伐他汀、佛伐他汀等，可在醫(yī)生指導(dǎo)下應(yīng)用。
對(duì)于血脂異常的治療，長(zhǎng)期追蹤是非常重要的，醫(yī)生必須根據(jù)病情的復(fù)雜性，制定追蹤計(jì)劃，使血脂恢復(fù)正常。另外，為了避免并發(fā)癥的發(fā)生，遵從醫(yī)囑是非常重要的。
為了避免“三高”文明病的發(fā)生，中老年人一定要定期檢查血脂。40歲以下，每2—3年檢查一次；40歲以上，每—2年檢查一次；50歲以上每年檢查一次，至于高危人群，每半年檢查一次。
《健康指南》 2006 3期
《美國(guó)食物指引》原文，英文版
Dietary Guidelines for Americans
Although early versions of food-group systems provided practical guidelines for avoiding nutrient deficiencies, they did not directly address the prevention of other diet-related health problems. To deal with this matter, the U.S. Department of Agriculture and the U.S. Department of Health and Human Services have published Dietary Guidelines for Americans to help individuals meet nutrient requirements, promote health, support active lives, and reduce chronic disease risks. The current (1995) report notes that eating is one of life's great pleasures, but that diet is important to health at all stages of life. The Dietary Guidelines apply to food intake over several days and not to single meals or foods. They are:
1. Eat a variety of foods. No single food can supply all the nutrients in needed amounts. To ensure variety and a well-balanced diet, choose foods each day from the five major food groups displayed in the Food Guide Pyramid: vegetables (3-5 servings); fruits (2-4 servings); breads, cereals, rice, and pasta (6-11 servings); milk, yogurt, and cheese (2-3 servings); and meat, poultry, fish, dry beans, eggs, and nuts (2-3 servings). Since foods within each group vary somewhat in nutrient content, it is best to vary one's choices within each group. Vitamin or mineral supplements at or below the RDA are safe but rarely needed by people who eat an appropriate variety of foods. Supplements may be appropriate for certain people, but they are not a substitute for proper food choices.
2. Balance the food you eat with physical activity -- maintain or improve your weight. Obesity is associated with many serious illnesses. Being too thin is linked to osteoporosis in women. For those who are overweight, the recommended loss of 1/2 to 1 pound per week should be accomplished by increasing physical activity and eating less fatty foods; more fruits, vegetables and cereals; less sugar and sweets; and little or no alcohol.
3. Choose a diet with plenty of grain products, vegetables, and fruits. Most of the calories in the diet should come from these foods, which also are low in fat and provide fiber. The daily average for adults should include at least six servings of grain products, three servings of vegetables, and two servings of fruit. Because foods differ in the kinds of fiber they contain, it is best to include a variety of fiber-rich foods. Fiber should be obtained from foods, not supplements.
4. Choose a diet low in fat, saturated fat, and cholesterol. Diets low in fat are associated with a lower risk of heart disease and certain cancers. The recommended limits are a fat intake of no more than 30% of calories, with less than 10% of the calories as saturated fat, and no more than 300 mg of cholesterol daily.
5. Choose a diet moderate in sugars. The only legitimate concern with sugar consumption is tooth decay. However, the risk of tooth decay does not depend simply on the amount of sugar consumed but on the frequency of consumption of sugars and starches and how long they remain in contact with the teeth. Frequent eating of foods high in sugars and starches may be more harmful to teeth than eating them at meals and then brushing. Regular daily dental hygiene, including brushing, flossing, and an adequate intake of fluoride, will help prevent tooth decay. Children who live in communities whose water is not fluoridated should take a fluoride supplement. Individuals whose caloric needs are low should be cautious about eating high-sugar foods that contain unnecessary calories and few nutrients.
6. Choose a diet moderate in salt and sodium. This can be accomplished by learning to enjoy the flavors of unsalted foods, adding little or no salt during cooking or at the table, flavoring foods with herbs or spices, and limiting intake of foods that are obviously salty or contain significant amounts of hidden salt. (The relationship between sodium intake and high blood pressure is discussed later in this chapter.)
7. If you drink alcoholic beverages, do so in moderation. Alcohol itself contains seven calories per gram, and alcoholic beverages provide contain few or no nutrients. Moderate drinking (no more than one drink per day for women and two drinks per day for men) is associated with a lower-than-average risk of coronary heart disease, but higher levels of alcohol intake increase the risk of high blood pressure and stroke and can cause many other problems. Complete abstention is advisable for women who are pregnant or trying to conceive and for people planning to drive a car, engage in another activity that requires attention or skill, or use medications that can enhance alcohol's effects.
