Chapter 11 Preventing Cardiovascular Disease CHAPTER OUTLINE Cardiovascular Diseases Coronary Heart...

Chapter 11

Preventing Cardiovascular

Disease

CHAPTER

OUTLINE Cardiovascular Diseases

Coronary Heart Disease Risk Profile

Leading Risk Factors for CHD

Other Risk Factors for CHD

Cardiovascular Diseases





Any disease that affects the heart and the blood vessels

ExamplesCoronary heart disease

Peripheral vascular disease

Congenital heart disease

Rheumatic heart disease

Atherosclerosis, strokes

High blood pressure

Congestive heart failure

Cardiovascular DiseasesAbout 20% of the U.S. population has some form of cardiovascular disease

In the year 2002, more than 35% of all deaths in the U.S. were attributable to heart and blood vessel disease

About 1.2 million people in the U.S. have heart attacks each year—500,000 of them die as a result

About 45% of heart attack deaths occur within 1 hour of the onset of symptoms, before the person reaches a hospital





Cardiovascular DiseasesAlthough heart and blood vessel disease is still the number one health problem in the U.S., the incidence declined by 32% between 1960 and 2000

Health education: more people now are aware of the risk factors for cardiovascular disease and are changing their lifestyle to lower their own risk





11.2Incidence of Cardiovascular Disease in the United States for Selected Years: 1900–2000

Critical ThinkingWhat are your feelings about your own risk for diseases of the cardiovascular system?

Is this something that you need to concern yourself with at this point in your life? Why or why not?





Coronary Heart Disease (CHD)The major form of cardiovascular disease

In CHD the arteries that supply the heart with oxygen and nutrients are narrowed by fatty deposits such as cholesterol and triglycerides

Narrowing of the coronary arteries diminishes blood supply to the heart muscle, which can precipitate a heart attack





11.3The Heart and Its Blood Vessels

Coronary Heart DiseaseSingle leading cause of death in U.S., accounting for 20% of all deaths and half of all cardiovascular deaths

More than half of the people who died suddenly from CHD had no previous symptoms

80% of deaths from CHD in people under age 65 occur during the first heart attack

The risk of death is greater in the least educated segment of the population





Coronary Heart DiseaseAlmost all risk factors are preventable and reversible

The individual can reduce risk by participating in a healthy lifestyle program





Major CHD Risk FactorsPhysical inactivity

Abnormal electrocardiogram

Abnormal cholesterol profile

Elevated triglycerides

Elevated homocysteine

Inflammation

Diabetes





Major CHD Risk FactorsHigh blood pressure

Excessive body fat

Smoking

Tension and stress

Personal and family history

Age





Physical Inactivity

Improving cardiorespiratory endurance through increased physical activity reduces the overall risk for heart disease





Regular Physical Activity

Daily physical activity and a regular aerobic exercise program help control most heart disease risk factors

Increases cardiorespiratory enduranceDecreases and controls blood pressureReduces body fatLowers blood lipids(cholesterol and triglycerides)Improves HDL cholesterolHelps control diabetes





Regular Physical Activity

Decreases low-grade inflammation

Increases and maintains good heart function, sometimes improving certain ECG abnormalities

Motivates toward smoking cessation

Alleviates tension and stress

Counteracts a personal history of heart disease

Daily physical activity and a regular aerobic exercise program help control most heart disease risk factors





“Physical Activity and Exercise

Based on the overwhelming amount of scientific data in this area, evidence of the benefits of aerobic exercise in reducing heart disease is far too impressive to be ignored.”





The electrocardiogram or ECG provides a record of the electrical impulses that stimulate the heart to contract

11.4Normal Electrocardiogram

Stress ElectrocardiogramAlso known as a graded exercise stress test or a maximal exercise tolerance testA stress ECG reveals the tolerance of the heart to increased physical activity





Stress ECG GuidelinesMen over age 45 and women over age 55A total cholesterol level above 200 mg/dl or an HDL cholesterol below 35 mg/dlHypertensive and diabetic patientsCigarette smokersPeople with an abnormalresting ECG

Individuals with a family history of CHD, syncope, or sudden death before age 60

All individuals with symptoms of chest discomfort, dysrhythmias (abnormal heartbeat), syncope, or chronotropic incompetence (heart rate that increases slowly during exercise and never reaches maximum)





Abnormal Cholesterol ProfileBlood lipids are carried in the bloodstream by molecules of protein known as

High density lipoproteins (HDLs)

Low density lipoproteins (LDLs)

Very low density lipoproteins (VLDLs)

Chylomicrons





11.7The Atherosclerotic Process

11.2Cholesterol Guidelines

Heart Disease

Key TermHigh-density lipoproteins (HDLs): Cholesterol transporting molecules in the blood (“good” cholesterol) that help clear cholesterol from the blood





Key TermLow-density lipoproteins (LDLs): Cholesterol transporting molecules in the blood (“bad” cholesterol) that tend to increase blood cholesterol





HDL-CholesterolHDL-cholesterol acts as a "scavenger," removing cholesterol from the body and preventing plaque from forming in the arteries

The strength of HDL is in the protein molecules found in their coatings

When HDL comes in contact with cholesterol-filled cells, these protein molecules attach to the cells and take their cholesterol





HDL-CholesterolFor the most part, HDL-cholesterol is determined genetically

Generally, women have higher levels than men

The female hormone estrogen tends to raise HDL, so premenopausal women have a much lower incidence of heart disease





Ways to Increase HDL-Cholesterol

Habitual aerobic exercise(> 6 METs, 3 times/week for 20 min/session)Weight loss (if necessary)Niacin supplementationQuitting smokingIncreasing consumption of beta caroteneDrug therapy





LDL-CholesterolTends to release cholesterol, which then may penetrate the lining of the arteries and speed up the process of atherosclerosis





Ways to LowerLDL-Cholesterol

Loss of body fat (if necessary)

Dietary changes

Drug therapy

Participation in a regular aerobic exercise program





LDL-CholesterolIt is better to lower LDL-cholesterol without medication, as drugs can cause muscle and joint pain and alter liver enzyme levels

People with heart disease must often take cholesterol-lowering medication, but it is best if medication is combined with lifestyle changes to augment the cholesterol-lowering effect






Choose a diet low in fat, saturated fat, and cholesterol

Saturated fat should be replaced with monounsaturated and polyunsaturated fats because the latter tend to decrease LDL-cholesterol






Total daily fiber intake should be 25 to 38 grams per day, including a minimum of 10 grams of soluble fiberTotal fat consumption must be less than 30% of total daily caloric intakeSaturated fat consumption should be under 7% of the total daily caloric intakeAverage cholesterol consumption should be much lower than 200 mg per day





Diet & CholesterolA drawback of very low fat diets (less than 25% fat) is that they tend to lower HDL-cholesterol and increase triglycerides

If HDL-cholesterol is already low, monounsaturated and polyunsaturated fats should be added to the diet






Consume 25 grams of soy protein a dayConsume red meats fewer than three times per week, and no organ meats (liver, kidneys)Eat fish instead of red meatDo not eat commercially baked foodsAvoid foods that contain transfatty acids, hydrogenated fat, or partially hydrogenated vegetable oilDrink low fat milk (1% or less) and choose low fat dairy products






Limit egg consumption to less than 3 eggs per week

Bake, broil, grill, poach, or steam food instead of frying

Refrigerate cooked meat before adding to other dishes; remove fat hardened in the refrigerator before mixing meat with other foods

Avoid fatty sauces made with butter, cream, or cheese





Cholesterol-Lowering Medications

There are now very effective medications to treat elevated cholesterol and triglyceridesMost notable are the statins group, which can lower cholesterol by up to 60% in 2 to 3 monthsStatins

Slow down cholesterol production and increase the liver's ability to remove blood cholesterolDecrease triglycerides and produce a small increase in HDL levels





TriglyceridesAlso known as free fatty acids

In combination with cholesterol, triglycerides speed up the formation of plaque in arteries

Triglycerides are carried in the bloodstream primarily by very low density lipoproteins (VLDLs) and chylomicrons





11.4Triglycerides Guidelines

Triglycerides

Found inPoultry skin

Lunch meats

Shellfish

Manufactured mainly in the liver, from refined sugars, starches, and alcohol





Ways to Lower TriglyceridesCut down on high-triglyceride foods

Decrease overall fat consumption

Quit smoking

Reduce weight (if necessary)

Participate in aerobic exercise





Critical ThinkingAre you aware of your blood lipid profile?

If not, what keeps you from having a blood chemistry test done?

What are the benefits of having it done now as opposed to later in life?





HomocysteineClinical data indicates that many heart attack and stroke victims have normal cholesterol levels

A high concentration of the amino acid homocysteine in the blood is thought to enhance plaque formation and subsequent blockage of arteries





HomocysteineHomocysteine is an intermediate amino acid in the interconversion of two other amino acids: methionine and cysteine

This interconversion requires the B vitamin folate (folic acid) and vitamins B6 and B12





Homocysteine

A large number of people have high blood levels of homocysteine due to a

Genetic inability to metabolize homocysteine

Deficiency in the vitamins required for its conversion





HomocysteineFive servings of fruits and vegetables daily can provide sufficient levels of folate and vitamin B6 to remove and clear homocysteine from blood





HomocysteineVitamin B12 is found primarily in animal flesh and animal products

Vitamin B12 deficiency is rarely a problem(1 cup of milk or an egg provides the daily requirement)

The body recycles most of this vitamin, thus, a deficiency takes years to develop





InflammationScientists are looking at inflammation as a major risk factor for heart attacksLow-grade inflammation can occur in a variety of places throughout the bodyFor years it has been known that

Inflammation plays a role in CHD Inflammation hidden deep in the body is a common trigger of heart attacks, even when cholesterol levels are normal or low and arterial plaque is minimal





C-reactive protein (CRP)A protein whose blood levels increasewith inflammationPhysicians have turned to CRP to evaluate ongoing inflammation in the bodyPeople with elevated CRP are more prone to cardiovascular eventsThe risk of a heart attack is even higher in people with both elevated CRP and cholesterol, resulting in an almost 9-fold increase in risk





11.8High-Sensitivity CRP Guidelines11.6

Relationship between C-Reactive Protein and Cholesterol and Risk of Cardiovascular Disease

C-reactive Protein (CRP)Levels decrease with statin drugsAlso helpful are exercise, weight loss, proper nutrition, and aspirinOmega-3 fatty acids inhibit proteins that cause inflammationExcessive intake of alcohol and high protein diets increase CRPAspirin therapy may also help control inflammation





Diabetes MellitusA condition in which blood glucose is unable to enterthe cells because

The pancreas totally stops producing insulinThe pancreas does not produce enough to meet thebody's needsThe cells develop insulin resistance

The role of insulin is to “unlock” the cell to escort glucose into the cellDiabetes affects more than 17 million people in the U.S.





DiabetesPeople with chronically elevated blood glucose levels may have problems metabolizing fats, which can make them more susceptible to

Atherosclerosis, coronary heart disease, heart attacks, high blood pressure, and strokes

Diabetics also have lower HDL cholesterol and higher triglyceride levels





DiabetesAn 8-hour fasting blood glucose level above 126 mg/dl on two separate tests confirms a diagnosis of diabetes

A level of 126 or higher should be brought to the attention of a physician





Key TermsType 1 Diabetes: Insulin-dependent diabetes (IDDM)

Also called juvenile diabetesThe pancreas produces little or no insulin

Type 2 Diabetes: Non-insulin-dependent diabetes (NIDDM)

The pancreas either does not produce sufficient insulin or it produces adequate amounts but cells become insulin-resistantAccounts for 90% to 95% of all diabetes cases





DiabetesAlthough diabetes has a genetic predisposition, type 2 is related to

Overeating, obesity, and lack of physical activity

Once limited primarily to overweight adultsNow accounts for almost half of new cases in childrenMore than 80% of all type 2 diabetics are overweight or have a history of excessive weight In most cases, type 2 can be corrected through

Diet, weight loss, and regular exercise





DiabetesBoth moderate and vigorous physical activity are associated with increased insulin sensitivity and decreased risk for diabetes

The key to increase and maintain proper insulin sensitivity is regularity of the exercise program





DiabetesA healthy diet is beneficial because it is

High in complex carbohydrates and water-soluble fibers (found in fruits, vegetables, oats, and beans)

Low in saturated fat and sugar

Aggressive weight loss, especially if combined with exercise, often allows diabetic patients to normalize blood sugar level without the use of medication





Syndrome XAs cells resist insulin's action, the pancreas releases even more insulin in an attempt to keep blood glucose from risingA chronic rise in insulin appears to trigger a series of abnormalities referred to as syndrome X or metabolic syndromeThese abnormal conditions include

Low HDL-cholesterol, high triglycerides, an increased blood clotting mechanism, and high blood pressure





Syndrome XSyndrome X patients should distribute daily caloric intake so that

45% of the calories are derived from carbohydrates (primarily low-glycemic)40% from fat (30% to 35% mono- and polyunsaturated fats, and 5% to 10% saturated fat)

15% from protein Syndrome X patients also benefit from

Weight loss (if overweight)ExerciseSmoking cessation





Key TermsBlood pressure: A measure of the force exerted against the walls of the vessels by the blood flowing through them

Systolic blood pressure: Pressure exerted by the blood against the walls of the arteries during the forceful contraction (systole) of the heart; higher of the two numbers in blood pressure readings

Diastolic blood pressure: Pressure exerted by the blood against the walls of the arteries during the relaxation phase (diastole) of the heart; lower of the two numbers in blood pressure readings

Hypertension: Chronically elevated blood pressure

Hypotension: Low blood pressure





High Blood PressureThe “silent killer”

A blood pressure above 140/90 mm Hg

One in three adults is hypertensive

High blood pressure is a risk factor forCHD, congestive heart failure, strokes, kidney failure, and osteoporosis





Blood Pressure Guidelines

Rating Systolic DiastolicNormal 120 or lower 80 or lower

Prehypertension 121-139 81–89Hypertension 140 or higher 90 or higher





Critical ThinkingDo you know what your most recent blood pressure reading was, and did you know at the time what the numbers meant?

How would you react if your doctor instructed you to take blood pressure medication?





High Blood Pressure Treatment

Increase physical activity

Follow recommended dietary guidelines to reduce blood pressure

Lose weight if above recommended body weight

Practice stress management

Do not smoke cigarettes or use tobacco

Consider drug therapy





Hypertension & ExerciseHypertensive people who are physically active have a lower risk of mortality from all causes than inactive individuals with normal blood pressure

The death rates for unfit individuals with low systolic blood pressure are much higher than in highly fit people with high systolic blood pressure





Effects of Aerobic Exerciseon Blood Pressure

An individual can expect exercise-induced reductions of approximately 3 to 5 mm Hg in resting systolic and diastolic blood pressures (both through aerobic exercise and strength training)





Exercise and High Blood Pressure Treatment

Moderate-intensity aerobic exercise program50% intensity30 to 45 minutes5 to 7 times per week

Moderate-resistance strength-training program8 to 12 exercises1 to 3 sets of 12 to 15 repetitions to near fatigue2 times per week





Hypertension & DietEat less salt and sodium-containing foodsConsume more potassium-rich foods

Such as potatoes, bananas, orange juice, cantaloupe, tomatoes, and beans

Do not consume more than 2 alcoholic beverages a day if you are a man, 1 if you are a womanFollow the dietary approach to stophypertension (DASH)





Dietary Approach to Stop Hypertension (DASH)

7 or 8 daily servings of grains, bread, cereal, or pasta

8 to 10 daily servings of fruits and vegetables

2 or 3 daily servings of nonfat/low-fat dairy products

2 or less daily servings of meat, poultry, or fish (less than 3 ounces per serving)

4 or 5 servings per week of beans, peas, nuts, or seeds





High Blood Pressure Medication

Antihypertensive drugs often are the first choice of treatment

Antihypertensive drugs produce many side effects

Lethargy, sleepiness, sexual difficulties, higher blood cholesterol and glucose levels, lower potassium levels, elevated uric acid levels





Excessive Body Fat (Obesity)Recognized as an independent risk factor for CHD

Risks attributed to obesity, however, often are caused by other risk factors that usually accompany excessive body fat

Risk factors such as high blood lipids, hypertension, and diabetes usually improve with increased physical activity

Overweight people who are physically active may not be at increased risk for premature death





SmokingMore than 47 million adults and 3.5 million adolescents in the U.S. smoke cigarettes

Smoking causes about 435,000 annual deaths in the U.S.

In relation to CHDSmoking speeds up the process of atherosclerosis

Causes a threefold increase in the risk of sudden death following a myocardial infarction





SmokingIncreases heart rate

Raises blood pressure

Irritates the heart, increasing the risk of fatal cardiac arrhythmias

Decreases HDL-cholesterol





Tension & StressPeople who are not able to relax have a constant low-level strain on the cardiovascular system that could manifest itself in heart disease





Tension & StressIndividuals who are under a lot of stress and do not cope well need to take measures to counteract the effects of stress

One way is to identify the sources of stress and learn how to cope with them

Take control: examine and act upon the things that are most important, ignore less meaningful details





Personal HistoryIndividuals who have had cardiovascular problems are at higher risk for disease than those who have never had a problem

People with such history should control other risk factors as much as they can

Most risk factors are reversible, so they can greatly decrease the risk for future problems





Family HistoryGenetic predisposition toward heart disease has been clearly demonstratedAll other factors being equal, a person with blood relatives who now have or have had heart disease runs a greater risk than someone with no such historyIn some cases, there is no way of knowing whether a person has a true genetic predisposition or if it is poor lifestyle habits that led to the problem





Critical ThinkingDo you have any relatives that have suffered from cardiovascular disease?

If so, what steps are you taking to prevent a cardiovascular event in your life?

Is there something you can do to help others in your family do the same?


Coronary Heart Disease Risk

Profile

Leading Risk Factors for

CHD

Other Risk Factors for

CHD

AgeAge is a risk factor because of the higher incidence of heart disease in older people

This tendency may be induced partly by other factors stemming from changes in lifestyle as we get older

Less physical activity, poor nutrition, obesity



Profile


CHD


CHD

AgeAlthough the aging process cannot be stopped, it certainly can be slowed downPhysiological versus chronological age is important in preventing disease

Some individuals in their 60s or older have the body of a 20-year-old20-year-olds often are in such poor condition that they almost seem to have the body of 60-year-olds

Risk factor management and positive lifestyle habits are the best means of slowing down aging



Profile


CHD


CHD

Gum DiseaseOral bacteria that builds up with dental plaque can enter the blood stream and contribute to inflammation and blood vessel plaque formation, increase blood clots, and thus increase heart attack risk

Daily flossing for 1 to 2 minutes is the best way to prevent gum disease



Profile


CHD


CHD

SnoringLoud snoring has been linked tocardiovascular disease

People who snore heavily may suffer from sleep apnea, in which the throat closes for a brief moment, causing breathing to stop

In one study, individuals who snored heavily tripled their risk of a heart attack and quadrupled the risk of a stroke



Profile


CHD


CHD

AspirinAspirin therapy is recommended to prevent heart disease

A daily aspirin dose of 81 mg (equivalent of a baby aspirin) can prevent or dissolve clots that cause heart attacks or strokes

The incidence of a nonfatal heart attack is decreased by about 32% with daily aspirin use



Profile


CHD


CHD

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