An Invitation to Health – Chapter 15 Preventing Major Disease: Cardiovascular Diseases Slide Show developed by: Richard C. Krejci, Ph.D. Professor of Public Health Columbia College of SC 12.03.14 Topics Of Focus For This Chapter Cardiometabolic Health Heart Attack Diabetes Stroke Hypertension Cancer Cholesterol Others: Epilepsy, Asthma, Ulcers Chapter 15 Objectives Define cardiometabolic health, and distinguish between risk factors that can and cannot be controlled Discuss the types of diabetes mellitus, and describe the early symptoms, health consequences, detection methods and treatments. Discuss hypertension, including health consequences, prevention, and treatments. Identify the types of cholesterol that compose your lipoprotein profile, health consequences, recommended levels, and prevention and treatment for elevated cholesterol. Chapter 15 Objectives Explain heart function and define myocardial infarction. Contrast stroke and transient ischemic attacks. Discuss the most common types of cancer, and describe the treatments of each. Evaluate your personal cardiometabolic and cancer risk factors along with the strategies to decrease your risk. Cardiometabolic Health Cardiometabolic “Cardio” refers to the heart and blood vessels of the cardiovascular system; “metabolic,” to the biochemical processes involved in the body’s functioning. Cardiometabolic Risk Factors • • • • • • • • • Factors You Can Control Physical Inactivity Tobacco use Obesity High Blood Pressure Blood Fats (lipids) Metabolic Syndrome Diabetes Mellitus Stress/Psychosocial Factors Drug/Alcohol Use Factors You Can’t Control • Heredity • Race and Ethnicity • Age • Gender • Bacterial infections Cardiometabolic Risk Factors You Can Control Physical Inactivity The risk for heart disease is 1.5 to 2.4 times higher for people who are inactive compared with those that are regularly active. Cardiometabolic Risk Factors You Can Control Tobacco use The single most significant risk factor for cardiovascular disease. Cardiometabolic Risk Factors You Can Control Obesity Losing weight thru exercise and diet at any age can help reduce the risk of heart problems. Cardiometabolic Risk Factors You Can Control High Blood Pressure The higher the blood pressure reading, the greater the risk of stroke and heart disease. Cardiometabolic Risk Factors You Can Control Blood Fats (lipids) For every 1% drop in blood cholesterol, studies show a 2% decrease in the likelihood of a heart attack. Metabolic Syndrome Syndrome X or Insulin-Resistant Syndrome Definition: • • A cluster of disorders of the body’s metabolism that make diabetes, heart disease, or stroke more likely. Affects 1 in 3 Americans The Five Diagnostic Criteria: 1. Waist Circumference: Men > 40 inches; Women >35 inches. 2. Triglycerides: >150 mg/dL. 3. High-Density Lipoprotein: Men <40 mg/dl; Women <50 mg/dl. 4. Blood Pressure: 130 mm Hg (systole)/85 mm Hg (diastole). 5. Fasting Blood Sugar: >110 mg/dl. Cardiometabolic Risk Factors You Can Control Metabolic Syndrome Men with three factors of metabolic syndrome are nearly twice as likely to have a heart attack or stroke and more then three times more likely to develop heart disease than those with none. Cardiometabolic Risk Factors You Can Control Diabetes Mellitus Increases the likelihood of hypertension and atherosclerosis, thereby increasing the risk of heart attack and stroke. How Diabetes Affects The Body Pancreas produces sufficient insulin Glucose absorbed after a meal Glucose levels in bloodstream rise Pancreas does not produce sufficient insulin Glucose Insulin • Body cells take levels Normal fasting up glucose glucose: • Suppression of liver glucose in blood 70-100 mg/dL output fall • Suppression of fat release from body stores High • Body cells levels of can’t take up glucose glucose • Body uses in blood stored fat • Damage to blood vessels • Risk of kidney damage, blindness, amputation, heart attack, stroke Diabetes Shortens Life Expectancy Women 8.4 years Men 7.8 years Normal Response To Eating Uncontrolled Diabetes Effects Of Uncontrolled Diabetes Damaged blood vessels Blindness Amputation Kidney failure Heart attack and stroke Three Types Of Diabetes Diabetes Signs and Symptoms Increased thirst and frequent urination Flu-like symptoms Weight loss or weight gain Blurred vision Slow-healing sores or frequent infections Nerve damage (neuropathy) Red, swollen, tender gums Detecting Diabetes Random Blood Sugar ScreeningTest Fasting Blood Glucose Test Glucose Challenge Test ABCs of Diabetes Management A is for A1c test (blood sugar) less than 7 percent B is for blood pressure 115/75 or lower C is for cholesterol LDL less than 160 Diabetes Facts in South Carolina… Affects over 350,000 people (~6% of SC population) • Approximately 1 in 8 African-Americans in South Carolina has diabetes – the 21st highest rate of diabetes among AfricanAmericans in the nation. • 50% of those with diabetes have not been diagnosed • Contributes to over 2000 deaths annually • Increases cardiovascular disease risk by 3-4 times and Is associated with obesity, hypertension, high cholesterol, and triglycerides • Causes over 200 new cases of blindness each year • Hospitalization costs exceed $260 million each year • Education and lifestyle changes can prevent many of the complications from diabetes Source List: 2007 Behavior Risk Factor Surveillance Survey, 2007 American Diabetes Association (ADA), DHEC SCAN (South Carolina Community Assessment Network), ADA 2009 Clinical Recommendations Blood Pressure Definition: A measure of the force exerted against the walls of the vessels by the blood flowing through them. Systolic Blood Pressure Highest blood pressure when the heart contracts. Diastolic Blood Pressure Lowest blood pressure between contractions of the heart. Sphygmomanometer & Stethoscope Preventing Hypertension Lifestyle Changes • • • • Lose weight Exercise regularly Consume adequate amounts of folate Follow the DASH Diet • • Dietary Approaches to Stop Hypertension Restrict daily sodium intake What Does Your Blood Pressure Mean? Top Number (systolic) Bottom Number (diastolic) Below 120 and Below 80 Normal blood pressure Maintain a healthy lifestyle 120-139 or 80-89 Prehypertension Adopt a healthy lifestyle 140-159 or 90-99 Stage 1 hypertension Adopt a healthy lifestyle; take medication 100 or more Stage 2 hypertension Adopt a healthy lifestyle; take more than one medication 160 or more or Numbers are expressed in millimeters of mercury (mm Hg). Your Group What to Do Eye damage Prolonged high blood pressure can damage delicate blood vessels on the retina, the layer of cells at the back of the eye. If the damage, known as retinopathy, remains untreated, it can lead to blindness. Heart attack High blood pressure makes the heart work harder to pump sufficient blood through narrowed aterioles (small blood vessels). This extra effort can enlarge and weaken the heart, leading to heart failure. High blood pressure also damages the coronary arteries that supply blood to the heart, sometimes leading to blockages that can cause a heart attack. Stroke High blood pressure can damage vessels that supply blood to the brain, eventually causing them to rupture or clog. The interruption in the blood flow to the brain is known as a stroke. Damage to artery walls Artery walls are normally smooth, allowing blood pressure to flow easily. Over time, high blood pressure can wear rough spots in artery walls. Fatty deposits can collect in the rough spots, clogging arteries and raising the risk of a heart attack or stroke. Rough artery walls Clogged artery Kidney failure Prolonged high blood pressure can damage blood vessels in the kidney, where wastes are filtered from the bloodstream. In severe cases, this damage can lead to kidney failure and even death. Consequences of High Blood Pressure Hypertension Family history Obesity when young Risks Race Death especially for those with Effects diabetes, kidney disease and obesity Lifestyle changes Decrease sodium to 1.5 grams/day Treatment Increase potassium to 4.7 grams/day Exercise Medication Making Heart Healthy Changes Changes You Can Make Today • Eat a good breakfast: whole-grain cereal, juice, yogurt, and so forth. • Skip desert at dinner. • Eat one more serving of vegetables. • Eat one more piece of fruit. • Drink one more glass of water. • Take the stairs for one or two flights rather than riding the elevator to your dorm room or classroom building. • Get seven to eight hours of sleep a night. Making Heart Healthy Changes Changes You Can Make This Week • If you have not had your blood lipoproteins checked within the last year, schedule a screening test. • Block out time for exercise on your calendar. • Make a list of stress-reducing activities. • Hobbies • Arts/Entertainment • Social: get in touch with an old friend. Making Heart Healthy Changes Changes You Can Make Right Now! • Be patient and look for new ways to meet your lifestyle goals. • If you slip up and smoke again or blow your diet, don’t give up. • Develop and use a support system of friends and family members. Making Heart Healthy Changes Becoming More Active Benefits Reduction in body weight Reduction in blood pressure Reduction of harmful LDL cholesterol Increase in beneficial HDL cholesterol Increase in insulin sensitivity American Heart Association, American College of Sports Medicine and the Center for Disease Control 30 to 60 minutes or more of moderate-intensity physical activity on most, if not all, days of the week to reduce heart disease risk by 30-40% Making Heart Healthy Changes Choosing Heart-Healthy Foods • • Dietary Recommendations • Plenty of fruits and vegetables. • Cholesterol lowering foods such as oats, barley, soy protein, and nuts. • Fish 2 times a week (AHA). Insufficient evidence exists to recommend for or against the use of: • Supplements of vitamin A, C, or E. • Multivitamins with folic acid. • Antioxidant combination supplements. Superior vena cava Aorta Right pulmonary artery Left pulmonary artery Right pulmonary veins Left pulmonary veins Right atrium Left atrium Right coronary artery Left coronary artery Right ventricle Left ventricle Inferior vena cava Pericardium The Healthy Heart Capillary beds of lungs, where gas exchange occurs The Path of Blood Flow Pulmonary arteries Venae cavae Pulmonary veins Aorta and branches Left atrium Left ventricle Right Right atrium ventricle Oxygen-poor CO2-rich blood Oxygen-rich CO2-poor blood Capillary beds of all body tissues, where gas exchange occurs Tobacco and Heart Disease • Smoking is the single most significant risk factor for CV disease and peripheral vascular disease. • Each year smoking causes 250,000+ deaths from cardiovascular disease. • Active vs. passive exposure to tobacco smoke. How Smoking Damages The Heart • Nicotine over-stimulates the heart. • Carbon monoxide reduce the oxygen supply to the heart. • Tar and other smoke residues increase the risk of cholesterol build-up in the arteries. • Smoking increases blood clotting. • Smoking causes constriction and irreversible damage to the coronary arteries. Your Lipoprotein Profile Low Density Lipoprotein (LDL) High Density Lipoprotein (HDL) Very Low Density Lipoprotein (VLDL) Triglycerides Fatty substances produced by the liver that carry cholesterol to arterial walls; “bad” cholesterol. Fatty substance that picks up cholesterol in the blood-stream and returns it to the liver; “good” cholesterol. The largest of the lipoproteins which allow cholesterol to circulate in the bloodstream. Fats that flow through the blood after meals and have been linked to increased risk of coronary artery disease. What Is A Healthy Cholesterol Reading? Blood Lipid Level Rating Total Cholesterol < 180 mg/dl 181-239 g/dl > 240 mg/dl Desirable Borderline High High Risk LDL Cholesterol <100 mg/dl 100-129 mg/dl 130-159 mg/dl 160-189 mg/dl 190+ mg/dl Optimal Near Optimal Borderline High High Very High HDL Cholesterol > 45 mg/dl 36-44 mg/dl < 35 mg/dl Desirable Borderline High High Risk Two Approaches to Lowering Cholesterol • • • Therapeutic Life Changes (TLC) Dietary changes Weight management Physical activity Medications • • • • Statins Interactions with Grape Fruit Nicotinic acid (niacin) Fibrates Aspirin Other Risk Indicators • • • C-Reactive Protein (CRP) • Produced in the liver and rises whenever the body responds to inflammation • High- sensitivity CRP test (hsCRP) can predict heart disease before any other risk factors become evident, particularly in women Lowering CRP Levels: • Lifestyle changes (healthy diet, exercise, weight control, and not smoking) • Medications (aspirin, and as needed, drugs to lower cholesterol and blood pressure) Homocysteine • • An amino acid found in the blood which is linked to a greater risk of heart disease and stroke. Lowering Homocysteine Levels: • Adequate intake of folic acid and vitamins B6 and B12. C-Reactive Protein (CRP) Levels and Cardiovascular Disease Risk CRP (milligrams per liter) Less than 0.5 mg/L Less than 1 mg/L 1-3 mg/L Greater than 3 mg/L Level of Cardiovascular Risk Lowest Low Moderate High (risk doubles) Crises of the Heart Coronary Artery Disease (atherosclerosis) (click) Angina Pectoris (chest pain or pressure) Coronary Artery Spasms (symptoms mimic a heart attack) Heart Attack (Myocardial Infarction) Heart Health Conditions Coronary Artery Disease Arteriosclerosis – degeneration and hardening of arterial walls Atherosclerosis – arteriosclerosis plus plaque deposits on walls of arteries Can One Reverse Atherosclerosis? Low Fat, Vegetarian Diet Yoga, Meditation, Imagery Moderate Exercise Stress Counseling Symptoms of a Heart Attack? • A tight ache, heavy, squeezing pain in the center of the chest • Chest pain that radiates to the shoulder, arm, neck, back or jaw • Anxiety • Sweating or cold, clammy skin • Nausea and vomiting • Shortness of breath • Dizziness, fainting, or loss of consciousness Symptoms in Women Heart Attack (Myocardial Infarction) Blood flow Aorta Plaque breaks loose Blood clot Left coronary artery Blockage Right coronary artery Area of myocardial cell death Blood flow Artery spasm can block blood flow Treatments That Save Lives • Clot-dissolving drugs • • Clot-thinning drugs • • • • • • Thrombolytic agents Thrombolytic Platelet receptor blocker Early administration of appropriate medications to dissolve clots. Intravenous nitroglycerin Beta-blockers Angioplasty Saving Hearts During Cardiac Arrest Cardiopulmonary Resuscitation (CPR) • A method of artificial stimulation of the heart and lungs; a combination of mouth-to-mouth breathing and chest compressions. • When the heart stops beating, circulation must be restored in four or five minutes or the brain shuts down completely, and the person dies. Saving Hearts During Cardiac Arrest Defibrillation • A device used to actually restart the heart with a lethal rhythm (AED). • A combination of CPR and defibrillation boosts the survival rate much higher than from CPR alone. Heart Savers Diagnostic Tests • • • Electrocardiogram (ECG, EKG) Thallium scintigraphy Coronary angiography Treatments • • • Aspirin therapy Medications • Diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACE). Surgical Procedures and Mechanical Aids • Coronary bypass, percutaneous transluminal coronary angioplasty, heart transplant, and leftventricular-assist devices (LVADs). Stroke Definition • When the blood supply to a portion of the brain is blocked. Also called a cerebrovascular incident. Statistics • Strokes are the 3rd leading cause of death in the U.S. • Worldwide, strokes are the second leading cause of death. Types • Ischemic stroke: The result of a blockage that disrupts blood flow to the brain. • Hemorrhagic stroke: Occurs when blood vessels rupture. Causes • Cerebral thrombosis, cerebral embolism, head injury and bursting of an aneurysm. How to Recognize a Stroke Ask the individual to smile. Ask him or her to raise both arms. Ask the person to speak a simple sentence, such as “It is sunny out today.” Ask the person to stick out their tongue If he or she has any trouble with any of these tasks, call 9-1-1 immediately and describe the symptoms to the dispatcher. Risk Factors for Strokes Gender Race Age Hypertension High Red Blood Cell Count Heart Disease Blood Fats Diabetes Mellitus Estrogen Therapy A Diet High in Fat and Sodium Prevention and Treatment for Strokes • Low-dose Aspirin Therapy • • Surgery • • • A baby aspirin a day may keep a stroke away. Carotid endartectomy Brain angioplasty Medications • Thrombolytic drugs • • • Tissue-type plasminogen activator (tPa) Heparinoids Nimodipine Effects Of Stroke On Brain Protecting Your Heart • • • • • • • • • • Don’t smoke. Watch your weight. Cut down on saturated fats and cholesterol. Get moving. Lower your stress levels. Know your family history. Get your blood pressure checked regularly. Tame your temper. Get a lipoprotein profile. Take appropriate medications. The End Slide Show developed by: Richard C. Krejci, Ph.D. Professor of Public Health Columbia College of SC All Rights Reserved