Eliminating Risk Factors
for Heart Disease
Healthy Transitions Summer 2014
Presented
to: Insert
relevant presenter information Calibri 16pt
Corrine
Benacka,
RN, BSN
Presented
on: Month
day, Year
Bluhm
Cardiovascular
Institute
Presented
July 21,
2014 by: Insert relevant presenter information here
Eliminating Risk Factors for Heart Disease
Objectives
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•
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Review the evidence
Define heart disease
Identify the unavoidable and avoidable risk factors for heart disease
Discuss lifestyle changes to decrease your risk of cardiovascular disease
Review the AHA Life’s Simple 7
Identify resources at NMH to help you achieve your health goals
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Eliminating Risk Factors for Heart Disease
What is heart disease?
• Heart Disease is a broad term which refers to any disease that affects
the heart.
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Atherosclerotic cardiovascular disease (ASCVD)
Valvular heart disease
Congenital heart disease
Arrhythmias
Heart failure
Heart infections
Tumors of the heart
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Eliminating Risk Factors for Heart Disease
A glance at the evidence
1976:
Nurses Health
Study
1948: Framingham
Heart Study began
1950:
1999:
The Seven
Countries Study
INTERHEART
Study
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Eliminating Risk Factors
for Heart Disease
Risk Factors
• Risk Factors
 Variable associated with an increased risk of disease
• Risk factors you can’t control
 Age, gender, genetics
• Risk factors you CAN control
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Being physically inactive
Unhealthy diet
Being overweight
Smoking
High blood cholesterol
High blood pressure
Diabetes
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Eliminating Risk Factors for Heart Disease
Accept the things we can not change……or can we?
Age
• For men, risk begins to climb around
age 45
• For women, the risk begins to climb
around 55 and especially with the
onset of menopause.
Gender
• Men are more likely to develop
cardiovascular disease.
• The difference beings to disappear
after women go through menopause.
• Cardiovascular disease is the number
one killer of men and women in the
United States
Genetics
• Family history of premature CVD
• Coronary disease in male first-degree
relative < 55 years
• Coronary disease in female first-degree
relative < 65 years
“Health behaviors can trump a lot of
your genetics. Research shows people
have control over their heart health.
The earlier they start making healthy
choices, the more likely they are to
maintain a low-risk profile for heart
disease.”
Donald Lloyd-Jones, MD
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7
Eliminating Risk Factors for Heart Disease
Primary and Secondary Prevention
Primary Prevention
• Aims at preventing the disease
• Reduces incidence and prevalence of a
disease
• The majority of know CVD risk factors
are preventable!
Secondary Prevention
• After the disease has occurred
• All patients who have had a CV
event should receive secondary
prevention
• Lifestyle changes
• Medications
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Eliminating Risk Factors for Heart Disease
Physical Activity
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•
•
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Benefits of Exercise
Improvement in lipid profile
Reduction in blood pressure
Less insulin resistance
Weight loss
Secondary Prevention
• Reduction in mortality
• Reduction in recurrent MI
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Eliminating Risk Factors for Heart Disease
Physical Activity
Recommendations
• Moderate-intensity aerobic exercise for 150
minutes every week AND musclestrengthening activities involving all major
muscle groups at least two days per week, OR
• Vigorous-intensity aerobic exercise for 75
minutes every week AND musclestrengthening activities involving all major
muscle groups at least two days per week, OR
• An equivalent mix of moderate-intensity and
vigorous-intensity aerobic exercise AND
muscle-strengthening activities involving all
major muscle groups at least two days per
week
Getting Started
• Short intervals
 Several times a day=30min/day
• Walking, dancing, active yard work
• Free weights
 10-15 repetitions/2-3 times a week
Questions/concerns about starting an exercise
program? Talk to your physician first!
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Eliminating Risk Factors for Heart Disease
Heart-healthy Diet
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Foods LOW in:
Saturated and trans fats
Cholesterol
Sodium
Added sugars
Foods HIGH in:
• Whole grain fiber
• Lean protein
Fruits and vegetables!
Quick Tips
Keep a food journal
Keep healthy foods on hand
Bring your own healthy dish to family parties
Eat fish at least twice a week
 Fish rich in omega 3 fatty acids like salmon, trout
and herring
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Eliminating Risk Factors for Heart Disease
The DASH Diet
• Dietary Approaches to Stop Hypertension
 Key foods
• Fruits
• Vegetables
• Low fat/nonfat dairy
http://dashdiet.org/what_is_the_dash_diet.asp
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Eliminating Risk Factors for Heart Disease
Weight Management
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Obesity
Overweight is defined as a BMI
between 25 and 29.9 kg/m2
Obesity as a BMI of 30 kg/m2 or
greater
In the U.S.
 34 percent of US adults aged 20
years and over are overweight
 34 percent are obese
 6 percent are extremely obese
The American Heart Association has
named obesity as an independent risk
factor
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Impact of Weight Loss on Risk Factors
~5%
Weight Loss
5%-10%
Weight Loss
A1C
Blood pressure
Total cholesterol
HDL cholesterol
Triglycerides
Wing RR et al. Arch Intern Med. 1987;147:1749-1753;
Blackburn G. Obes Res. 1995;3
(Suppl 2):211S-216S.
Mertens IL, Van Gaal LF. Obes Res. 2000;8:270-278;
Ditschuneit HH et al. Eur J Clin Nutr. 2002;56:264-270.
Prevalence* of Self-Reported Obesity Among U.S. Adults
BRFSS, 2012
*Prevalence reflects BRFSS methodological changes in 2011, and these estimates should not be compared to those
before 2011.
15%–<20%
20%–<25%
25%–<30%
30%–<35%
≥35%
http://www.cdc.gov/obesity/data/adult.html
Eliminating Risk Factors for Heart Disease
How does obesity contribute to CVD?
Insulin
Resistance
Endothelial
dysfunction
Obstructive
sleep apnea
Hypertension
CVD
Sympathetic
Nervous
Dysfunction
Type 2
Diabetes
Lipid
abnormalities
Left
Ventricular
hypertrophy
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Eliminating Risk Factors for Heart Disease
Smoking
STOP SMOKING!
• Smoking is an independent risk factor
• Smoking is associated with a higher
risk of:
 Stroke
 Atherosclerosis
 Heart Attack
 Aortic Aneurysm
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Eliminating Risk Factors for Heart Disease
Smoking
It’s never too late to quit
• Cardiac risk diminishes shortly after
quitting and continues to decrease
• Mortality benefit
• Risk of stroke reduces after quitting
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Eliminating Risk Factors for Heart Disease
Smoking
Adverse
effect on
serum lipids
Increases
tendency for
blood to clot
Smoking
Activates
sympathetic
nervous
system
Damage the
vascular
wall/vascular
injury
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Eliminating Risk Factors for Heart Disease
Cholesterol
• Cholesterol is a fat-like substance
that lines the blood vessels.
• Cholesterol is carried in the blood
by carries = lipoproteins
 LDL - Low density lipoprotein or
“Bad” cholesterol
 HDL - high density lipoprotein or
”Good” cholesterol
 Non-HDL cholesterol - Non-HDL
cholesterol is your total cholesterol
minus your HDL cholesterol.
 Triglycerides- type of fat found in
your blood; high levels may signify
metabolic syndrome
Know Your Numbers
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HDL ≥ 50mg/dl
LDL <100mg/dl, if CAD < 70 mg/dl
Triglycerides <100 mg/dl
Non HDL <130 mg/dl
Total Cholesterol=
HDL + LDL + 20% of your triglyceride
level. A total cholesterol score of less
than 180 mg/dL is considered optimal.
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Eliminating Risk Factors for Heart Disease
Cholesterol
• Why Cholesterol Matters
 Major controllable risk factor
 If you have other risk factors such as
high blood pressure, DM or you
smoke-your risk increases even
further
 Cholesterol can form thick deposits
called plaque in artery
walls=atherosclerosis
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CAD
Stroke
Peripheral vascular disease
Aortic atherosclerosis and aneurysms of the
aorta
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Eliminating Risk Factors for Heart Disease
Cholesterol
Prevention
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Healthy diet
Ideal body weight
Activity
DON’T SMOKE
Treatment
• Lifestyle change is first line treatment of
hyperlipidemia for all patients
 Diet
 Exercise
 Don’t smoke
• Simplified into 4 groups to treat for both
primary and secondary prevention
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Clinical Atherosclerotic CVD
LDL-cholesterol levels ≥ 190 mg/dL
Diabetes Mellitus aged 40-75 yo
10 year risk of ASCVD ≥ 7.5%
• No LDL targets
• Patient-Physician discussion is key to
making informed decisions about
treatment
Stone NJ, et al
Circulation: Nov. 12 2013
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Eliminating Risk Factors for Heart Disease
Cholesterol
Cholesterol Lowering Medications
•Statins
•Most effective agents to lower LDL-C
•Clinically proven to reduce mortality & recurring CV events
•Change composition of plaques (especially in vulnerable plaques)
•Stabilize atherosclerotic plaques
•May result in partial regression
•Can be well tolerated
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Eliminating Risk Factors for Heart Disease
High Blood Pressure
Hypertension- The Silent Killer
Blood Pressure=
•Often no symptoms
•1 in 3 adults have high blood pressure
•Hypertension can cause:
Blood Pressure
stroke
Category
Normal
heart attack
heart failure
Prehypertension
peripheral artery disease
High Blood
Pressure
kidney failure
(Hypertension) St
age 1
•Defined as ≥ 140/90 mmHg
High Blood
Pressure
(Hypertension) St
age 2
Systolic BP
Diastolic BP
Systolic
mm Hg (upper #)
Diastolic
mm Hg (lower #)
less than 120
and
less than 80
120 – 139
or
80 – 89
140 – 159
or
90 – 99
160 or higher
or
100 or higher
or
Higher than 110
Hypertensive
Crisis
Higher than 180
(Emergency care
needed)
www.heart.org
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Eliminating Risk Factors for Heart Disease
High Blood Pressure
Prevention and Treatment
• Diet
 Low Na
 DASH
• Don’t Smoke
• Maintain a healthy weight
• Exercise
• Coping with stress
• Take your medication
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Eliminating Risk Factors for Heart Disease
Diabetes
• Heart disease and stroke are
the #1 cause of death for
type 2 diabetics
• DM can lead to atherosclerosis
• DM can cause damage to your heart,
eyes, nerves and kidneys
Why is DM a risk factor?
• AHA considers DM one of the
controllable risk factors for heart
disease
• When blood sugars are within normal
range, you protect vital organs
• Diabetics often have other risk factors
 HTN
 High cholesterol and triglycerides
 Obesity and lack of exercise
 Poorly controlled blood sugars
 Smoking
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Eliminating Risk Factors for Heart Disease
Diabetes
Prevention
Who should be tested?
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Control weight
Be active
Control blood pressure
Control cholesterol
Treatment
• Lifestyle
• Medications
 Oral medications
 Insulin
You and your doctor can discuss the best
treatment plan for you!
Overweight and over 45 yrs/old
High cholesterol
Family history of DM
African-American, Asian-American,
Latino/Hispanic-American, Native
American or Pacific Islander descent
• A history of gestational diabetes
(diabetes during pregnancy) or
delivering a baby over 9 lbs.
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Eliminating Risk Factors for Heart Disease
Metabolic Syndrome
Waist size
>35 inches
Metabolic Syndrome
•Cluster of risk factors
that put a person at
greater risk of
cardiovascular disease
High
triglycerides
>150
Insulin
resistance
Metabolic
Syndrome
High blood
sugar
Low HDL
<50 for
women
> 100
fasting
<40 for men
High blood
pressure
>130/85
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Eliminating Risk Factors for Heart Disease
Metabolic Syndrome
Who’s at risk?
• Obesity/overweight
• Insulin resistant
• Physically inactive
Treatment
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Eat better
Get moving
Lose weight
Medications
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Eliminating Risk Factors for Heart Disease
Life’s Simple 7
Assess your risk!
• My life check assessment
www.heart.org
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Eliminating Risk Factors for Heart Disease
Bluhm Cardiovascular Institute
Bluhm Cardiovascular Institute
• The Bluhm Cardiovascular Institute is proud of our U.S. News & World
Report rankings – a reflection of the leading edge cardiac and vascular
services we offer and the results we obtain for our patients, their families
and the community. #1 in the Chicago metro region
• #1 in Illinois for the seventh straight year
• #13 in the nation out of 708 cardiac programs
• Highest ranked cardiac program in the region: Indiana, Michigan, Wisconsin,
Missouri and Iowa
www.heart.nm.org
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Eliminating Risk Factors for Heart Disease
Summary
Know your numbers!
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BMI or body mass index- goal 18-24.9
Waist circumference- goal < 35 inches
Blood pressure- goal < 120/80
Cholesterol
 Total cholesterol- goal < 200 mg/dL
 HDL- goal ≥ 50 mg/dl
 LDL- goal < 100 mg/dL, if CAD < 70 mg/dL
 Triglycerides- goal < 100 mg/dL
 non-HDL- goal < 130 mg/dL
• Fasting Blood Sugar < 100 mg/dL
www.heart.nm.org
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Thank You