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.
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7.
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11.
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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.
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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.
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Deaths from Cardiovascular Diseases
Figure 9-2
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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).
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2010 cost estimated at $475.3 billion.
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Although incidence is declining, we still have lots of work to do
in behavior change.
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Coronary Heart Disease (CHD)

Includes angina pectoris (chest pain), myocardial
infarction (heart attack), and the atherosclerotic
process in the heart’s blood vessels.
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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.
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Atherosclerosis
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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.
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If blockage occurs, angina (chest pain), a myocardial
infarction (heart attack), or stroke could occur.
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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

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Progression of Atherosclerosis
ARTERIES
OF THE
HEART
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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.
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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.
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Stroke (Brain Attack)
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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).
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Stroke Risk Reduction
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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
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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.
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U.S. Population Having Heart Disease Risk Factors
© 2011 McGraw-Hill Higher Education. All rights reserved.
Inactivity
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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
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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.

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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.
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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
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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
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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!
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Diabetes
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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.
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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.
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90% of diabetes is type 2 or non-insulin dependent that can be
controlled with lifestyle changes (weight management/loss and
dietary changes).
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Type 2 Diabetes
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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)
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Type 2 Diabetes
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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
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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
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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
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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.
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© 2011 McGraw-Hill Higher Education. All rights reserved.
Individual Response to Stress
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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
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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
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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.
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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.
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Metabolic Syndrome, C-Reactive
Protein and Homocysteine
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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.
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Treatment for Blocked Arteries
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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
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Mind Body Connection
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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.
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Rx for Action
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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.
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What Do You Think?
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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?
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Questions?
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