Staying Healthy
The Key to Your Heart
Kim F Gibson, MD, FACP
NNMC Bethesda
Demographics
Growing old is not for sissies!
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Today 13% of Americans > 65 yrs old
By 2030 22% will be older than 65
Over the next decade the most rapid
population increase will be in the
age group > 85 yrs old
 MOST OF THOSE INDIVIDUALS
ARE WOMEN
What is the Goal?
Reaching Your Potential

Health is a state of complete physical,
mental, spiritual and social well-being,
and not merely the absence of disease
or infirmity.

We must continuously improve our
function, not simply delay “inevitable”
losses.
Top 10 Threats to Women’s
Health
Mayo Clinic
1.
2.
3.
4.
5.
Heart Disease
Cancer
Stroke
COPD (chronic
lung disease)
Alzheimer’s
Disease
6.
7.
8.
9.
10.
Injuries
Type II Diabetes
Flu
Kidney Disease
Blood Poisoning
(Septicemia)
Top 10 Threats to Men’s
Health
Mayo Clinic
1.
2.
3.
4.
5.
Heart Disease
Cancer
Injuries
Stroke
COPD (chronic
pulmonary disease)
6.
7.
8.
9.
10.
Type II Diabetes
Flu
Suicide
Kidney Disease
Alzheimer’s Disease
“Live sensibly – among 1000 people, only one dies a
natural death…”
Where to Start?
What is the goal?

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Keep your heart
healthy
Don’t smoke
Maintain weight
Get restful sleep
Keep your bones
strong

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Foster sexuality
Stay current with
health maintenance
Exercise your mind
Be resilient
Fuel your spiritual
growth
Cardiovascular Disease
Keep your heart healthy



Leading cause of death in women
and men
 1 in 2 men have CV disease
 1 in 3 women die of heart
disease
25% adults experience sudden
death as first indication
Coronary heart disease mortality
higher in women than men
Cardiovascular Disease
Diagnostic Categories
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■
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■
Coronary heart
disease
Cerebrovascular
disease
Peripheral vascular
disease
Aortic
atherosclerosis
Coronary Heart Disease
Coronary Heart Disease
Cardiac Risk Factors
Non-modifiable

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Age:
(men >45 / women >55)
Gender
FH Early CAD
(men >55 / women >65)
Elevated CRP
Modifiable
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Tobacco
Hypertension
Total / LDL Cholesterol
HDL Cholesterol
Diabetes
Elevated BMI
Physical Inactivity
Atherogenic Diet
Coronary Heart Disease
Lipid Disorders

Lipid profile measures:
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Total cholesterol
HDL cholesterol
LDL cholesterol
Triglycerides (TG)
Strong genetic component
Significant impact on risk of CHD
Treatment goals influenced by age, sex and
risk assessment
Coronary Heart Disease
Cardiac Risk Assessment

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90% CHD events
predicted by
presence of risk
factors
Framingham risk
prediction
Risk helps plan
treatment
Intermediate risk
may require
additional testing
Cardiac Risk Reduction
Primary Prevention

CVD mortality has declined since 1975

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Earlier diagnosis
More aggressive treatment
Reduction in risk factors
Lowest risk category rare
Focus on lifestyle modification
Role of aspirin, statins and fish oil
It’s never too late to start!
Cardiac Risk Reduction
Modifiable Risk Factors

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Smoking
Dyslipidemia
Hypertension
Diabetes
Abdominal Obesity

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Psychosocial
factors
Daily consumption
of fruits / vegetables
Regular alcohol
intake
Regular physical
activity
Cardiac Risk Reduction
Lifestyle Modifications

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Exercise daily (150 min/week)
Don’t smoke
Weight maintenance
Mediterranean diet
Treat hypertension, diabetes,
high cholesterol
Cardiovascular Fitness

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Exercise has
protective effect
Impacts all other
risk factors
Focus on aerobic
activities
AHA recommends
150 minutes/week
Tobacco Abuse
Prevention is the key – STOP SMOKING

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Leading preventable
cause of all deaths
Increases CHD and
all-cause mortality
Augments effects of
other risk factors
Risk of heart disease
falls rapidly after
cessation
Obesity
The Hard Cold Facts

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65% adults overweight or obese
BMI based on height and weight

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>30% = overweight, >35% = obese
Increases all-cause and CHD
mortality
Interacts with other risk factors
Predisposes to sleep apnea
Critical role of exercise
You only have to exercise on the days you eat!
Cardiovascular Drug Therapy
Tried and True Remedies

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Preventive vs Targeted Therapy
Aggressive management of:
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Known coronary heart disease
Hypertension
Hyperlipidemia
Diabetes
Role of Aspirin in primary prevention
Benefit of Alcohol
Fish Oil supplementation
Alternative Drug Therapies
Evidence Pending…
■
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No evidence for
CVR benefit with
vitamin C, E, betacarotene
No evidence for
CVR benefit with
folate and B
vitamins
■
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Co-enzyme Q10
Hawthorn extract
Prevention Strategies
Keep your heart healthy!
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Educate yourself
Know your risk factors
STOP smoking!!
Exercise 150min/week
Modify diet
Seek treatment for high
BP, high cholesterol
and diabetes
Listen to warning signs