Chapter 9 Maximizing Heart Health A Wellness Way of Life Ninth Edition Robbins/Powers/Burgess © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter 9 Objectives After reading this chapter, you will be able to: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Identify the ten primary heart disease risk factors and their impact on heart health. Identify the six secondary heart disease risk factors and their impact on heart health. Identify the 12 controllable and 4 uncontrollable risk factors for coronary heart disease (CHD). Identify four lifestyles changes to cut CVD risk. Define arteriosclerosis, atherosclerosis, angina pectoris, myocardial infarction, and stroke. Explain the differences between cardiovascular disease (CVD) and coronary heart disease (CHD). Identify the symptoms of a heart attack and of a stroke and explain the S.T.R. approach to stroke awareness. Explain the roles of HDL and LDL in heart health. Explain why smoking cigarettes increases heart disease risk. Define prehypertension, normal blood pressure range, and the blood pressure reading that indicates hypertension. Identify the cholesterol reading that indicates high blood cholesterol. Identify the CVD risk factors that are positively affected by exercise. Identify the positive and negative effects of alcohol on CVD. Discuss the importance of lifestyle and the impact of the mind-body connection on CVD. © 2011 McGraw-Hill Higher Education. All rights reserved. Cardiovascular Disease #1 overall killer of Americans – kills more than cancer, chronic respirator disease, accidents and diabetes combined! Heart Disease is caused by adverse lifestyles. If you want to get rid of the disease, get rid of the lifestyles. More Americans die each year from heart disease than would have been killed in 10 Vietnam wars. © 2011 McGraw-Hill Higher Education. All rights reserved. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Deaths from Cardiovascular Diseases Figure 9-2 © 2011 McGraw-Hill Higher Education. All rights reserved. Impact of Cardiovascular Disease Causes 37% of all deaths in the U.S. Common forms include: heart attack, stroke, high blood pressure, angina, congestive heart failure, rheumatic heart disease, pulmonary disease, renal disease, and congenital heart disease. Coronary heart disease by itself is still the single largest cardiovascular killer (1 in every 5 deaths). 2010 cost estimated at $475.3 billion. Although incidence is declining, we still have lots of work to do in behavior change. © 2011 McGraw-Hill Higher Education. All rights reserved. Coronary Heart Disease (CHD) Includes angina pectoris (chest pain), myocardial infarction (heart attack), and the atherosclerotic process in the heart’s blood vessels. CHD accounts for more than half of all cases of CVD and is the single largest killer of Americans. CHD is most commonly the result of atherosclerosis. © 2011 McGraw-Hill Higher Education. All rights reserved. Atherosclerosis Deposits of cholesterol and other lipids along with cellular debris accumulate in the artery to form a plaque. As it progresses, the artery wall becomes hard, inelastic, and clogged and may become blocked. Blockage could be from cell debris or a blood clot or excessive stress. If blockage occurs, angina (chest pain), a myocardial infarction (heart attack), or stroke could occur. © 2011 McGraw-Hill Higher Education. All rights reserved. To Reduce Risk of Atherosclerosis Become or stay physically fit Consume a diet high in omega-3 fats Don’t smoke Avoid secondhand smoke Control blood pressure, reduce weight (if overweight) Control stress © 2011 McGraw-Hill Higher Education. All rights reserved. Progression of Atherosclerosis ARTERIES OF THE HEART © 2011 McGraw-Hill Higher Education. All rights reserved. Angina Pectoris Atherosclerosis may lead to angina pectoris, or chest pain/discomfort due to CHD. The pain occurs when an artery becomes partially blocked causing an oxygen debt in the heart muscle. Angina is a sign that someone is at higher risk of a heart attack. © 2011 McGraw-Hill Higher Education. All rights reserved. Myocardial Infarction (MI) Heart Attack Results when one or more of the coronary arteries is partially blocked by atherosclerotic deposits called plaque. A blood clot can form and choke off the supply of blood to the heart muscle. Common signs – uncomfortable constant pressure or pain in center of chest that lasts more than just a few minutes, pain or discomfort in other areas such as the shoulder, neck, jaw, back, stomach, or one or both arms. Less common signs – nausea, shortness of breath, weakness, cold sweats, paleness. © 2011 McGraw-Hill Higher Education. All rights reserved. Stroke (Brain Attack) Occurs when blood flow to the brain is interrupted either by a blockage (ischemic stroke) or by a burst blood vessel (cerebral hemorrhage); primarily caused by atherosclerosis and is the third leading cause of death. Risk factors – hypertension, heart disease, gender (women), diabetes, age (over 55), smoking, ethnicity (Blacks), lifestyle (high fat diet, alcohol or cocaine abuse, smoking, and inactivity) and Family history. Common warning signs – sudden numbness or weakness of face, arm or leg (especially on just one side of the body), sudden confusion or trouble speaking, sudden trouble seeing, sudden trouble walking, dizziness, sudden severe headache. STR approach for stroke awareness – Smile, Talk, Raise (arms). © 2011 McGraw-Hill Higher Education. All rights reserved. Stroke Risk Reduction Exercise regularly Control blood pressure Do not smoke Control diabetes (if you have it) See a sleep specialist if you have sleep apnea Optimal levels of homocysteine Avoid infections and inflammation Reduce chronic stress and anger Don’t drink alcohol excessively © 2011 McGraw-Hill Higher Education. All rights reserved. Primary Risk Factors for Heart Disease Controllable Primary Factors (linked directly to development of CHD) – inactivity, high blood pressure, high blood lipids, cigarette smoking, obesity, and diabetes. Uncontrollable Primary Factors (linked directly to CHD) – family history, male gender (+postmenopausal women), ethnicity, and age. © 2011 McGraw-Hill Higher Education. All rights reserved. Secondary Risk Factors for Heart Disease Controllable secondary risk factors (contribute to the development of CHD) – individual response to stress, emotional behavior (anger and hostility), excessive alcohol (+some illegal drugs), metabolic syndrome, C-reactive protein, homocysteine. All of these are controllable. © 2011 McGraw-Hill Higher Education. All rights reserved. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. U.S. Population Having Heart Disease Risk Factors © 2011 McGraw-Hill Higher Education. All rights reserved. Inactivity Only 30.8% of Americans engage in physical activity at the intensity and duration needed for health benefits. Inactivity is considered the nation’s most common cardiac threat! 20-60 minutes of moderate to vigorous physical activity at least 3-5 days per week is recommended to reduce risk. Physical activity protects against CHD and improves the survival rate after a heart attack. Remember the activity pyramid! © 2011 McGraw-Hill Higher Education. All rights reserved. High Blood Pressure Blood pressure is the force against the arteries exerted by the heart while pumping blood. Systolic – while the heart is pumping Diastolic – while the heart is at rest Normal pressure is less than 119/79 or less (gold standard is 115/76). Prehypertention is between 120/80 and 139/89, and high blood pressure is over 140/90. HBP causes the heart to overwork, become weak, and enlarged. It can also damage the artery walls. One in three Americans have HBP – 90% (primary) cause is unknown Common risks include: genetics, smoking, stress, male gender, older, Black, obesity, sodium sensitivity, excessive alcohol consumption, oral contraception, and sedentary lifestyle. © 2011 McGraw-Hill Higher Education. All rights reserved. Prevent or Manage HBP HBP is the silent killer – many don’t know they have it. Get your blood pressure checked. Maintain healthy weight. Exercise regularly. Do not smoke. Limit sodium intake below 2,300 mg/day. Avoid or limit alcohol. Eat a balanced diet rich in fruits, grains and veggies. Increase calcium intake. Increase potassium intake. Increase fiber intake. Practice stress management. © 2011 McGraw-Hill Higher Education. All rights reserved. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Population with Hypertension in U.S. Adults Figure 9-8 © 2011 McGraw-Hill Higher Education. All rights reserved. High Blood Lipids High blood lipids are the primary cause of arterial plaque. Cholesterol is a waxy/fatty substance made in the liver (80%) and found in the bloodstream. It is needed for cell structure, digestion, and adrenal glands. Triglycerides are made in the body to store excess fats – free fatty acids. They work with LDLs to accelerate plaques in the arteries. © 2011 McGraw-Hill Higher Education. All rights reserved. Cholesterol High cholesterol is termed hypercholesteremia. Desirable level in total is below 200 (160 target). Cholesterol must attach to a protein to be carried in the blood stream (lipo-protein). Low Density Lipoprotein (LDL) are dangerous to the arteries and accelerate plaque formation. Optimal level is below 100. High Density Lipoprotein (HDL) can protect the system from plaques. Levels above 40 are best for protecting arteries. Triglycerides should be below 150 mg/dL. © 2011 McGraw-Hill Higher Education. All rights reserved. Cholesterol To increase HDL levels: exercise regularly, don’t smoke, control stress, reduce excess body fat, eat a high fiber, low fat diet (use monounsaturated fats). Ratio of total cholesterol to HDL is a better indicator of risk (desired target is 4.0 or less). Total cholesterol of 240 and HDL of 60 (4.0 risk) versus total cholesterol of 180 and HDL of 30 (6.0 risk). Important to know the breakdown. © 2011 McGraw-Hill Higher Education. All rights reserved. Triglycerides Ways to lower triglycerides include: – Decrease alcohol and sugar consumption – Reduce excess body fat – Reduce consumption of animal fats (poultry skin, lunch meats, shellfish) – Get regular aerobic exercise – Last resort – take meds Important to know your levels to know if you are at risk! © 2011 McGraw-Hill Higher Education. All rights reserved. Smoking Increases heart rate and blood pressure, constricts blood vessels, impairs transportation of O2, decreases HDL, increases LDL, can damage artery walls, increases blood clotting. Kills 400,000 Americans a year (more than the number killed during WW I and Vietnam combined). Causes emphysema, COPD, peripheral vascular disease, and is dangerous to a fetus. Secondhand or side stream smoke is also dangerous and causes disease and deaths. No level is safe. Most smokers want to quit at some level. It is possible to quit. Help is available. © 2011 McGraw-Hill Higher Education. All rights reserved. Obesity Primary risk factor that has become epidemic. More than 65% of the U.S. © Image 100/Corbis population is obese or overweight. Abdominal fat may be more risky than lower body fat. Waist measurement of more than 35 for women and 40 for men is considered high risk. Body mass index of over 25 is considered overweight and over 30 is considered obese. Obesity is a pro-inflammatory state and chronic inflammation causes wide spread tissue damage (leads to plaques in the arteries). Childhood obesity rates have drastically increased. It is very controllable with balanced diet and regular exercise! © 2011 McGraw-Hill Higher Education. All rights reserved. Diabetes Both type 1 and type 2 are diseases that affect how the body uses glucose. Both are characterized by the body’s inability to produce enough insulin or use it properly. Too much sugar in the blood or urine is a classic sign of diabetes. High blood sugars damage the circulatory system, kidneys (from processing too much sugar) and can put one at more risk for high blood lipids and atherosclerosis. 90% of diabetes is type 2 or non-insulin dependent that can be controlled with lifestyle changes (weight management/loss and dietary changes). © 2011 McGraw-Hill Higher Education. All rights reserved. Type 2 Diabetes Risk factors: overfat (especially belly fat) have brother, sister or parent with diabetes are not white had a baby weighing more than 9 lbs have HDL of 35 or less or triglyceride of 250 or more have hypertension have had an elevated fasting glucose test (several tests over 125 is diabetes, 100-125 is pre-diabetic) © 2011 McGraw-Hill Higher Education. All rights reserved. Type 2 Diabetes Symptoms include: Excessive thirst Frequent urination Flu-like symptoms (tired or weak) Weight loss or weight gain Blurred vision Dry skin Slow healing wound, frequent infections Itching, tingling or numbness in extremities © 2011 McGraw-Hill Higher Education. All rights reserved. Type 2 Diabetes Prevention or control entails: Consistent exercise Proper body composition and weight (lose weight if you need to) High fiber, low fat, low sugar diet (eat low glycemic foods) No smoking © 2011 McGraw-Hill Higher Education. All rights reserved. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Children born in 2003: Who will have type 2 diabetes? Figure 9-7 © 2011 McGraw-Hill Higher Education. All rights reserved. Family History, Gender, Age, Ethnicity Family History – genetic brothers, sisters, parents or grandparents with heart disease increase your risk. Gender – males at more risk (lifestyle? stress levels? lack of estrogen?). Once women reach menopause their risk exceeds that of men. Ethnicity – Black and Hispanic are at highest risk (hypertension and diabetes). Individuals should engage in prevention activities and pay attention to family history. Age – Heart disease is a chronic disease so age is a risk. Your risk can be reduced with healthy choices. © 2011 McGraw-Hill Higher Education. All rights reserved. Individual Response to Stress Uncontrolled stress is a factor in high heart rate, high blood pressure, high blood lipids, and can increase smoking, eating, and alcohol patterns. Over time, the stress response causes chemical wear and tear on the body. Coping with stress successfully, and limiting stress is vital in limiting risk for heart disease and other stress-related diseases. How your respond to stress is critical – coping in a healthy manner is vital. Exercise, relaxation techniques, meditation and social support can be effective ways to deal with stress. © 2011 McGraw-Hill Higher Education. All rights reserved. Emotional Behavior/Personality Factors Type A personalities are at greatest risk for heart disease. Type Bs are more relaxed and slow to anger. Type Cs are As that learn to cope by using the 5 Cs. Anger and hostility are the most © Tracy Khan/Corbis important factors to control. Hot reactor (those of any personality that react very intensely to stressors) are at increased risk for high blood pressure, heart disease, and stroke. Type D personality tends to be depressive, anxious, irritable and socially distant. They react negatively to stress. May tend to be at more risk for CHD. © 2011 McGraw-Hill Higher Education. All rights reserved. Controlling Emotional Risk People can learn to control behavior. Use thought stopping to control angry cynical thoughts. Practice laughing at yourself. Be empathetic. Reason and understand your anger. Learn to relax. Practice patience and trust. Become a good listener. Live as if you have a serious disease—keep things in perspective. Learn to forgive. © 2011 McGraw-Hill Higher Education. All rights reserved. Excessive Alcohol and Other Drugs Drinking too much alcohol raises blood pressure and triglyceride levels, damages the heart muscle and increases the risk of stroke and heart failure. Binge drinking may lead to heart failure later in life. No alcohol to moderate levels of alcohol are recommended (one drink for women and two for men per day – no saving up for the weekend!) If you don’t drink, don’t start. Stimulant drugs can cause heart attack, stroke and sudden cardiac death. © 2011 McGraw-Hill Higher Education. All rights reserved. Metabolic Syndrome, C-Reactive Protein and Homocysteine Metabolic Syndrome is a cluster of symptoms that raise the risk of heart disease, stroke, diabetes and some cancers. Defined as having three or more of: hypertension, elevated glucose, low HDL levels, and obesity. Inflammation of blood vessels may lead to heart attack and stroke by causing fatty deposits in the arteries to rupture. C-reactive protein is a marker for inflammation. Homocysteine is an amino acid in the blood and a natural byproduct of protein metabolism. In some individuals too much homocysteine is related to a higher risk of CHD, stroke and peripheral vascular disease. © 2011 McGraw-Hill Higher Education. All rights reserved. Treatment for Blocked Arteries Drug therapy Angioplasty Bypass surgery Lifestyle change – Dr. Ornish’s reversal diet (75% complex carbs, 15% protein, 10% fats), 30 minutes per day of exercise, stress management strategies each day, support groups/spiritual activities weekly, no smoking © 2011 McGraw-Hill Higher Education. All rights reserved. Mind Body Connection Positive emotions boost health. Selfish, self-centered lifestyles are twice as likely to have heart attacks. Cynical people have a higher rate of heart problems. Positive social support can result in vitality, longevity, lowered blood pressure, and healthier immune systems. Dr. Ornish believes that loneliness can block arteries and feelings of connectedness promote health. Meditation can improve health, ease pain and reduce stress. Thoughts, feelings and emotions influence our health (psychoneuroimmunology). Long-term negative thoughts and/or emotions can damage health and long term positive hardiness can enhance health. Numerous studies are investigating the mind/body connection as a real and valid component of health. © 2011 McGraw-Hill Higher Education. All rights reserved. Rx for Action Write down the top two reasons your last fitness program didn’t work and what you will do to avoid the same pitfalls. Get your blood pressure checked. Do two of the following to maintain health blood pressure: have a high fiber snack, don’t smoke or cut back, avoid alcohol, reduce caffeine. Measure your waist. Calculate your BMI. Read food labels and avoid all trans fats. Get 30 minutes of exercise today. Floss and brush your teeth for 2 minutes. Reflect on the meaningful people in your life. Connect with two of them today via email or telephone or write a letter. © 2011 McGraw-Hill Higher Education. All rights reserved. What Do You Think? What are your risk factors for heart disease? How could you control them? Would you know if you or someone else were having angina, heart attack or stroke? Do you know your blood pressure, cholesterol, HDL, LDL, and triglyceride levels? Do you think people’s thoughts and emotions can have an effect on their health? © 2011 McGraw-Hill Higher Education. All rights reserved. Questions? © 2011 McGraw-Hill Higher Education. All rights reserved.