Heart Health 101
and ProArginine Plus
Janice Heasty RN BSN
Dan Austin RN, High Desert Heart Institute, Nurse
Clinical Coordinator and Directory of the CHF
(Congestive Heart Failure) Unit
“When you know what
you know, you have
the responsibility to
pay it forward.”
Assess Your Risk For a
Heart Attack
1. How old are you?
A.
B.
C.
D.
E.
25-35 (1 point)
36-45 (2 points)
46-55 (3 points)
56-65 (4 points)
>66 ( 5points)
Assess Your Risk For a
Heart Attack
2. Do you have a family history of early
coronary artery disease (a mother or
sister who was younger than 60 years old
or a father or brother younger than 50
years old when he/she had a first heart
attack or symptoms of a heart attack?
A. No (0 points)
B. Yes (2 points)
Assess Your Risk For a
Heart Attack
3. Do you have high Blood Pressure
(BP ≥ 140/90)?
A. No (0 points)
B. Yes (1 point)
C. Don’t know (1 point)
4. Do you have Diabetes or elevated
blood sugar?
A. No (0 points)
B. Yes (3 points)
Assess Your Risk For a
Heart Attack
5. Are you physically active?
A. I accumulate approx. 30” of moderate aerobic activity
(walking, going up stairs, vacuuming, dancing, gardening,
aerobics, swimming, cycling, spinning, or jogging almost
every day. (0 points)
B. I exercise only occasionally: I accumulate thirty minutes
of aerobic activity one or two days per week. (1 point)
C. I rarely engage in regular moderate aerobic
physical activity. (2 points)
D. I never engage in moderate physical activity.
(3 points)
Assess Your Risk For a
Heart Attack
6.
Which of the following best
describes your Cholesterol?
A. <200mg/dL (0 points)
B. 201-239 mg/dL (1 point)
C. >240mg/dL (2 points)
D. Don’t know (2 points)
Assess Your Risk For a
Heart Attack
7.
Which of the following best describes your HDL
(good) cholesterol?
A. <45 mg/dL (2 points)
B. 45-59 mg/dL (1 point)
C. 50-59 mg/dL (0 points)
D. >60 mg/dL (-1 point)
E. Don’t know (1 point)
Assess Your Risk For a
Heart Attack
8. Which of the following best describes you
LDL (bad) cholesterol?
A. <100 mg/dL (0 point)
B. <130 mg/dL (1 point)
C. >160 mg/dL (1 point)
D. Don’t know (1 point)
Assess Your Risk For a
Heart Attack
9.
Which of the following best describes
your triglyceride level?
A. 150-199 mg/dL (0 points)
B. 200-250 mg/dl (1 point)
C. >250 mg/dL (2 points)
D. Don’t know (1 point)
Assess Your Risk For a
Heart Attack
10. Do you smoke?
A. Yes (3 points)
B. Smoked previously, stopped
within the last year. (2 points)
C. Smoked previously, stopped 5
years ago (1 point)
D. Smoked previously, stopped 10
years or more ago (0 points)
E. No (0 points)
Assess Your Risk For a
Heart Attack
11. Flossing and Heart Disease: medical
research has found a correlation between
any level of periodontal disease (including
gingivitis) and atherosclerosis, or
hardening of the arteries.
A. I floss almost every day and see my
hygienist at least once/year, if not
2x’s/year. (0 points)
B. I don’t floss, and maybe see my
hygienist once/year. (1 point)
C. I have no idea what you are talking
about (1 point)
Assess Your Risk For a
Heart Attack
12. Look at a BMI (body mass index)
chart. Determine your personal
BMI which is considered a better indicator
of “fatness” than weight alone. What is
your BMI?
A. 18-22 (0 points)
B. 22-24 (1 point)
C. 25-30 (2 points)
D. 31-35 (3 points)
E. >35 (4 points)
Assess Your Risk For a
Heart Attack
13. How would you describe the way
you handle anger?
A. I avoid getting to the breaking
point. (0 points)
B. I yell or slam doors. (1 point)
C. I always hold my anger in. (2
points)
Assess Your Risk For a
Heart Attack
0: Great! You are presently healthy, and following the
suggestions of the presentation should make you even
healthier.
1-10: Low Risk! It pays to investigate the areas where you
amassed points and modify your lifestyle accordingly. You
should find this presentation particularly motivating and
helpful.
This presentation will help you
understand why it’s important to begin changing
your lifestyle NOW!
11-20: Moderate Risk!
>20: HIGH RISK FOR HEART DISEASE! Though you may
feel well now, get a complete physical ASAP. In the
meantime, understand more about your heart and how it
works. And you’ll learn what changes you need to make to
begin reducing your risk.
Assess Your Risk For a
Heart Attack
My goal is to help you recognize your
personal risk factors for heart
disease and motivate you to make
the necessary lifestyle changes to
keep your heart healthy.
YOUR goal is to change the risk factors
you can control, so that YOU can
greatly reduce the chance of having
a heart attack.
What is Cardiovascular Disease?

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CHD: Coronary Heart Disease
MI: Myocardial infarction (Heart Attack)
CAD: Coronary Artery Disease
Atherosclerosis: plaque in the
arteries
HTN: Hypertension (High Blood Pressure)
CHF: Congestive Heart Failure
CVA: Cerebral Vascular Accident
(stroke)
Coronary Heart Disease
Disorder of the blood vessels in the
heart that can lead to a heart attack.
A heart attack happens when an
artery becomes blocked, preventing
blood flow from getting to the heart
muscle.
Coronary Heart Disease (cont.)
The arteries become narrowed by fatty
deposits which develop into plaque.
The blood supply (that is carrying oxygen,
sugar and nutrients) cannot get to the
heart muscle.
The heart muscle cannot keep up with
increased demands (exercise, stress,
surgery, illness) with these blockages.
How Critical is the Problem?

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C-Shop: Cardiac School age Health
Opportunities Program
Western Nebraska: Bridgeport, NE
1 out of 3 students tested: Elevated
Cholesterol, Triglycerides, or BP
Shocking fact: 5th graders
Education to both students and parents
about curbing heart disease through
healthy lifestyle choices.
Retest will be when they reach 10th grade.
How critical is the problem?



#1 Killer of both men and women
(more than the next 7 causes of death
combined including cancer).
50% of all Americans will die of some
form of Cardiovascular Disease.
1 in 3 will die from Coronary Heart
Disease.
CAUSES OF FEMALE DEATHS 2002
400,000
356,014
350,000
300,000
250,000
200,000
150,000
100,000
50,000
0
100,050
67,542
64,103
41,877
41,514
38,948
37,485
HEART DISEASE
STROKE
LUNG CANCER
COPD
ALZHEIMER'S
BREAST CANCER
DIABETES
ACCIDENTS
How Critical is the Problem? (cont.)



One woman in America dies from
heart disease every minute. (AfricanAmerican women are 30% more likely
to die from CHD).
If you combine Heart Disease and
Stroke, there is one death every 33
seconds.
Heart Disease begins before age 20,
many years before anyone has
symptoms.
How Critical is the Problem? (cont)



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62% of women believe that cancer is a
woman’s greatest threat.
Only 13% of American women consider
heart disease a health risk themselves.
9,000 U.S. women younger than 45 years
old have had a heart attack each year.
In women younger than 65 years who have
a heart attack; their death rate is twice that
of men.
Classic Symptoms of Heart Disease
“It’s the Big One”
Chest discomfort: pain, pressure, tightness
Pain radiating to the left arm or shoulder
Cold Sweats
Nausea
Does everyone experience these symptoms?
Vague symptoms of heart attack
Unusual or sudden extreme fatigue
Shortness of Breath
Flu-like symptoms: nausea or vomiting, cold
sweats, weakness
Feelings of anxiety “Something is wrong”
Pain in one or both arms, shoulders, elbows,
neck, jaw, stomach or back.
Only 30% of people experience classic signs
and symptoms before having a heart attack.



Women, diabetics, and older men do not
experience the classic symptoms of having a
heart attack!
64% of women who died from coronary
heart disease had no previous symptoms.
Symptoms can often be vague so they are
difficult to diagnose. Sometimes, treatment
is delayed because their heart attack
presents as something else.
Women Have Poor Outcomes

The entire artery is lined with diffuse disease rather
than one area.

Women start off with smaller vessels, so a small
amount of disease is much more significant.

The collaterals (small connecting blood vessels,
nature’s little bypasses) are gone.

More complications with angioplasty (ballooning the
artery open) and stenting.

More go for Coronary Artery Bypass Graft surgery
(CABG), which is more invasive, carries more risks
and has more complications.
What Can We Do?

Education is the Key….
• Know the facts.
• Seek the information
• Make the necessary lifestyle changes

TLC (therapeutic lifestyle changes)
• Prevention is the Best Medicine!!!

Research shows you can lower your risk for CHD
enormously (82%) simply by leading a healthy
lifestyle.
Risks Factors That Cannot Be Controlled

Gender

Increasing Age: the average age of our


population is changing so CHD will remain a MAJOR
health issue.
Family History, Genetics
• 1st degree relatives
• Father, Brother: < 55 years old with CVD
Mother, Sister: < 65 years old with CVD
Race
With the many risk factors for
heart disease, a woman’s
greatest Risk is Ignorance”.
“
former 1st lady, Laura Bush
Risk Factors That Can Be Controlled
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Hypertension, High Blood Pressure
High cholesterol, Elevated Blood Lipids
Smoking, Tobacco Use
Diabetes
Obesity, Excessive Body Fat
Physical Inactivity
Stress
Other: Inflammation: CRP (c-reactive protein)
Homocysteine
High Blood Pressure “The Silent Killer”

GOOD < 120/80

BAD
• Mild HTN
140/80 – 159/91
• Moderate HTN
160/100 – 179/109
• Severe HTN
180/100 – 209/109
High Blood Pressure “Facts”

Usually doesn’t cause symptoms.

HTN—increases with age and body weight.

Higher in African-Americans, Hispanics, Native
Americans, and Hawaiians than Caucasians.

½ of all patients with their first heart attack are
hypertensive.

HTN doubles the risk for CVD “heart failure”.

Increased risk for “End-Organ” damage (kidney
failure, CVA (stroke), MI—heart attack).
Pulmonary Hypertension

Elevated pressure in the arteries in
the lungs.

Normal: 25 mmHg pressure at rest

Right ventricular failure.
• Must work harder to pump blood
through the lungs
• Heart muscle weakens and/or fails
Angelo CiCi

Pulmonary artery pressure: 96/

Severe shortness of breath, on oxygen 24/7

Right-sided heart failure: everything backs up: liver
congestion

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On Dec 20, 2008 Angelo had massive heart failure
(congestive heart failure, congestive pulmonary failure
and pacemaker failure) with simultaneous renal failure.
From this point on he was in and out of the emergency
room. "I was so weak I couldn't even open a bottle of
water by myself and I had decided I had had enough. I
told the nurses I wanted all the IV's removed and I just
wanted to go home and die."
Angelo CiCi
Angelo CiCi
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Pro-Arginine Plus (4 scoops/day)
“I have seen a dramatic, a dramatic reversal in
Angelo’s symptoms” Dan Austin RN
“I expected a marginal improvement in the
symptoms…what we ended up seeing was
remarkable, positive, remodeling of the heart,
positive pulmonary artery changes, pulmonary
vascular changes…” Dr. Siva Arunasalam
“The best thing? I can walk through the mall and
hold my wife’s hand.” Angelo CiCi
WHO (World Health Organization) functional
classification for Pulmonary Hypertension
I-
Although you have been diagnosed with
hypertension, you have no symptoms.
pulmonary
II-
You don’t have symptoms at rest, Ordinary physical
activity results in undue fatigue or shortness of breath,
chest pain, or heart syncope.
III-
You are comfortable at rest. Less than ordinary
physical activity causes undue fatigue or shortness of
breath, chest pain, or heart syncope.
IV-
You have symptoms even at rest.
High Blood Pressure—Initial Treatment

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Weight loss
Decrease in salt intake
Stop smoking and avoid 2nd hand
smoke
Regular exercise decreases BP,
stress and weight
Decrease alcohol consumption
Pro-Argi-9 Plus


L-arginine becomes nitric oxide which
relaxes the walls of the artery decreasing
blood pressure.
Dr. Siva’s High Desert Heart Health Study
• 13% decrease in systolic BP (decrease
the workload of the heart).
• 17% decrease in diastolic BP (decrease
end-organ damage).
• CASP (central aortic systolic pressure)
measured by B-Pro decreased 6.2%.
Cholesterol

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Narrowing of the arteries occurs when
extra cholesterol and fat circulates in the
blood and builds up in the walls of the
arteries that supply blood to the heart, the
brain, and other organs.
Cholesterol does not dissolve in the blood.
The lipo-proteins (HDL, LDL) carry the
cholesterol in the bloodstream.
Blood lipid profile—start at age 20 and
retest every 5 years.
Total Cholesterol Level

Desirable: < 200 mg/dL

Borderline High: 200-230 mg/dL

High: 230-259 mg/dL

Very High: 290 mg/dL and >
LDL Low-Density Lipoprotein
“Bad Cholesterol”
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Major carrier of cholesterol in the blood.
Builds up on the arterial walls.
Optimal
Near Optimal
Borderline High
High
Very High
< 100 mg/dL
100-129 mg/dL
130-159 mg/dL
160-189 mg/dL
190 mg/dL and >
HDL High-density lipoprotein
“Good/Healthy” cholesterol

Carries cholesterol from other parts
of the body back to the liver.

Good/Protective:
60 mg/dL and >

Borderline/Desirable: 59-40 mg/dL

Low/Major Risk:
< 40 mg/dL
Triglyceride Levels
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A type of fat found in the body (from food
and produced in the liver). Unused
calories are converted to triglycerides and
transported to fat cells to be stored and
released via hormone signals to be used
as energy.
Good:
Borderline High:
High:
< 150 mg/dL
150-100 mg/dL
200 mg/dL and >
Pro-Argi-9 Plus
Dr. Siva’s study: Remember that these were maximally
medically managed patients…..

Total Cholesterol: no significant change

LDL: no significant change, though we know ProArgi9+
reduces LDL oxidation.

HDL: Increased 18%.
Dr. Siva says: “This is what ‘REVERSES’
disease” We can’t say that!
This is a difficult marker to increase.

heart
Triglycerides: Decreased 45% (released and used for
energy? Is this why we feel so energetic on Pro-Argi-9
Plus?)
Smoking
“America’s Health Crisis”

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Smoking is the leading preventable
cause of death in the nation.
Smoking is the single biggest risk of
Cardiovascular Disease.
Tobacco Use---Tobacco Abuse--includes anything with nicotine
(chewing tobacco, patches, gum)
Smoking
“America’s Health Crisis”
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Nicotine
Decreases oxygen in the blood
Damages the blood vessel which
causes plaque to form
Triggers blood clots to develop
Reduces HDL (“good cholesterol”)
Causes irregular heart rhythms
that could lead to cardiac arrest
Smoking
“America’s Health Crisis”
Smokers are 2-6 X’s more
likely to suffer a heart attack
than nonsmokers.

Male smokers lose 13.2 years of life
expectancy.

Female smokers lose 14.5 years of life
expectancy.

Second-Hand smoke doubles a non-smoker's risk
of heart disease.
Smoking
“America’s Health Crisis”
The Good News
Don’t smoke, and if you do,
QUIT NOW!
Quitting begins to decrease cardiovascular risk
immediately.
Over time (10 years), the risk of heart disease
returns to nearly normal.
Pro-Argi-9 Plus
Pro-Argi-9 Plus provides us with the amino acid L-arginine
which converts to nitric oxide.
On Dr. Siva’s list: smoking consumes nitric oxide, the body
needs more. Every tissue utilizes Nitric Oxide.
* Lowers Blood Pressure
* Protects against heart attack and stroke
(interferes with unwanted blood clotting)
* Keeps the normal endothelial layer as
protective
* Protects against atherosclerosis
Red Wine Extract (Resveratrol): An Antioxidant---acts as a
sponge that absorbs free-radicals. Also, keeps the LDL
from becoming “sticky”.
Diabetes

Now affects 10% of the U.S. population

Has nearly doubled in the last 20-30 years

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About 65% of diabetics die of some type of
heart disease at an earlier age than the rest
of the population.
Diabetes increases the risk of Coronary
Heart Disease
Women: 3-7 X’s
Men:
2-3 X’s
Diabetes

Good Blood Sugar: < 100 mg/dL

ABC’s of Diabetic Control
• A1c (hemoglobin A1c) a blood test that measures your
average blood glucose level over the last 3 months.
• BP (blood pressure) the higher your BP, the harder your
heart has to work and the more damage inside your
arteries.
• Cholesterol: LDL (bad) builds up and “clogs” your
arteries.
Dr. Siva’s study with
Pro-Argi-9 Plus
●Glucose:
Decreased 8% (Dr. Siva rated this a highly significant
finding)
●Blood Pressure:
Systolic BP decreased 13%
Diastolic BP decreased 17%
●Blood Lipids:
HDL increased 18%
Triglycerides decreased 45%
Dr. Siva’s study with
Pro-Argi-9 Plus

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ABI Ankle-Brachial Index
• The # represents the % of decreased
blood flow in the lower extremities.
• PAD (peripheral arterial disease) is
common in diabetic patients.
• ABI increased 16%. HUGE!
When people can walk around with leg pain
(claudication is cramping the calves—the muscles
is screaming for oxygen that the clogged arteries
cannot deliver). When they can walk without leg
pain, their quality of life improves, their ability to
exercise improves.
Obesity

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More than 30% of adults are now
considered obese.
More alarming: at least 15% of
children are obese.
People who are 30 pounds or more
overweight are more likely to
develop heart disease, even if they
have no other risk factors. OUCH!
Obesity

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The risk is greater if the weight is
around the stomach instead of
around the hips (apple vs pear
shape).
Being overweight increases the
chances of developing other major
risk factors (high blood pressure,
high cholesterol, diabetes).
Obesity

Waist measurements
• Men: > 40”
• Women: > 35”

BMI (Body Mass Index)
• Overweight: > 25
• Obese: > 30

Morbid Obesity: 100 pounds over
your desired weight
Pro-Argi-9 Plus


Not a weight loss product, but people
seem to lose 1 pound/month taking this
product.
Dr. Siva spoke about muscle physiology.
(Big improvements in 6-minute walk-test)
•
•
•
•
Performance enhancement
Increased exercise capacity
Delivering more oxygen to the tissue
More efficient to remove lactic acid
Exercise and Heart Disease

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60% of Americans do not get the recommended
amount of physical activity.
Research shows that as little as 30 minutes of
moderate activity on most, preferable all, days of
the week help protect your heart.
The BEST heart healthy exercise program
includes both aerobic exercise and resistance
training. Resistance training helps improve heart
health by decreasing BP, changing fat into
muscle, increasing your Basal Metabolic Rate.
Exercise and Heart Disease


Aerobic exercise increases HDL. The
more the exercising, the higher the
HDL.
Diabetes is better controlled with
regular moderate exercise.
Pro-Argi-9 Plus
Performance enhancement
Increased exercise capacity
Deliver more oxygen to the tissues
More efficient to remove lactic acid
Faster Recovery
Feel Better
Move More
Move Faster
Recover Faster
Lose Weight
Vitamin D & Heart Disease
November 2009 report
Intermountain Medical Center in Utah
Researchers found that low levels of
vitamin D significantly increase the
risk for stroke, heart disease, and
death.
November 2009 report
Intermountain Medical Center in Utah

The study followed 27, 686 people age 50 and older with no
history of CVD.

The participants were divided into 3 groups based on their
Vitamin D levels normal, low, or very low.

After 1 year, the very low levels:
• 77% more likely to die
• 45% more likely to develop CAD
• 78% more likely to have a stroke compared to those with
normal Vit. D levels
“We concluded that among pts 50 years or >, even a
moderate deficiency of Vit. D levels was associated with
developing CAD, heart failure, stroke and death,” said study
co-author Heidi May.
Vitamin D & Heart Disease
Dr. Tracy Stevens, MD, FAAC,
Cardiology, Kansas City, Missouri
“Get your vitamin D levels checked”
She thinks that this essential vitamin is
seriously underrated.
In a recent program involving 600 women, Dr,
Stevens and her colleagues found that 97%
of the participants were deficient in Vitamin
D and low levels of the vitamin have been
linked to marked increases in heart disease.
When the women took supplements, they
reported feeling more energy as their
vitamin D levels increased.
Pro-Argi-9 Plus


D3 (Cholecalciferol) is your best
source of vitamin D.
Each scoop has 2,500 IU of
Vitamin D3 or 625% of your
daily values.
Dr. Siva’s Study with
Pro-Argi9 Plus

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Dr. Siva’s study found their 33 maximally
medically managed patients to be 95%
deficient in vitamin D.
Vitamin D3 increased 183% in their
patients. Many “measureable data points”
improved in this study. In addition to
improvement of lab values and medical test
results, the quality of life (demonstrated by
the 6-minute walk test) dramatically
improved in these 33 patients.
If you don’t take care of
your body,
where will you live?”