Eliminating Risk Factors for Heart Disease
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Transcript of Eliminating Risk Factors for Heart Disease
Eliminating Risk Factors for Heart DiseaseHealthy Transitions Summer 2014
Presented to: Insert relevant presenter information Calibri 16ptPresented on: Month day, YearPresented by: Insert relevant presenter information here
Corrine Benacka, RN, BSNBluhm Cardiovascular InstituteJuly 21, 2014
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Eliminating Risk Factors for Heart Disease
• Review the evidence • Define heart disease• Identify the unavoidable and avoidable risk factors for heart disease• Discuss lifestyle changes to decrease your risk of cardiovascular disease• Review the AHA Life’s Simple 7 • Identify resources at NMH to help you achieve your health goals
Objectives
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Eliminating Risk Factors for Heart Disease
• Heart Disease is a broad term which refers to any disease that affects the heart.- Atherosclerotic cardiovascular disease (ASCVD)- Valvular heart disease- Congenital heart disease- Arrhythmias- Heart failure- Heart infections- Tumors of the heart
What is heart disease?
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Eliminating Risk Factors for Heart Disease
A glance at the evidence
1948: Framingham Heart Study began
1950: The Seven
Countries Study
1976:Nurses Health
Study
1999:INTERHEART
Study
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Eliminating Risk Factors for Heart Disease
• Risk Factors- Variable associated with an increased risk of disease
• Risk factors you can’t control- Age, gender, genetics
• Risk factors you CAN control- Being physically inactive- Unhealthy diet- Being overweight- Smoking- High blood cholesterol- High blood pressure- Diabetes
Risk Factors
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Eliminating Risk Factors for Heart Disease
Age• For men, risk begins to climb around
age 45• For women, the risk begins to climb
around 55 and especially with the onset of menopause.
Gender• Men are more likely to develop
cardiovascular disease. • The difference beings to disappear
after women go through menopause. • Cardiovascular disease is the number
one killer of men and women in the United States
Genetics• Family history of premature CVD • Coronary disease in male first-degree
relative < 55 years• Coronary disease in female first-degree
relative < 65 years“Health behaviors can trump a lot of your genetics. Research shows people have control over their heart health. The earlier they start making healthy choices, the more likely they are to maintain a low-risk profile for heart
disease.”Donald Lloyd-Jones, MD
Accept the things we can not change……or can we?
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Eliminating Risk Factors for Heart Disease
Primary Prevention• Aims at preventing the disease• Reduces incidence and prevalence of a
disease• The majority of know CVD risk factors
are preventable!
Secondary Prevention• After the disease has occurred• All patients who have had a CV
event should receive secondary prevention
• Lifestyle changes• Medications
Primary and Secondary Prevention
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Eliminating Risk Factors for Heart Disease
Benefits of Exercise• Improvement in lipid profile• Reduction in blood pressure• Less insulin resistance• Weight loss
Secondary Prevention• Reduction in mortality• Reduction in recurrent MI
Physical Activity
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Eliminating Risk Factors for Heart Disease
Recommendations• Moderate-intensity aerobic exercise for 150
minutes every week AND muscle-strengthening activities involving all major muscle groups at least two days per week, OR
• Vigorous-intensity aerobic exercise for 75 minutes every week AND muscle-strengthening activities involving all major muscle groups at least two days per week, OR
• An equivalent mix of moderate-intensity and vigorous-intensity aerobic exercise AND muscle-strengthening activities involving all major muscle groups at least two days per week
Questions/concerns about starting an exercise program? Talk to your physician first!
Physical Activity
Getting Started• Short intervals
- Several times a day=30min/day• Walking, dancing, active yard work• Free weights
- 10-15 repetitions/2-3 times a week
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Eliminating Risk Factors for Heart Disease
Foods LOW in:• Saturated and trans fats• Cholesterol• Sodium• Added sugars
Quick Tips• Keep a food journal• Keep healthy foods on hand• Bring your own healthy dish to family parties• Eat fish at least twice a week
- Fish rich in omega 3 fatty acids like salmon, trout and herring
Heart-healthy Diet
Foods HIGH in:• Whole grain fiber• Lean proteinFruits and vegetables!
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Eliminating Risk Factors for Heart Disease
• Dietary Approaches to Stop Hypertension- Key foods
• Fruits• Vegetables• Low fat/nonfat dairy
The DASH Diet
http://dashdiet.org/what_is_the_dash_diet.asp
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Eliminating Risk Factors for Heart Disease
Obesity• Overweight is defined as a BMI
between 25 and 29.9 kg/m2 • Obesity as a BMI of 30 kg/m2 or
greater• In the U.S.
- 34 percent of US adults aged 20 years and over are overweight
- 34 percent are obese - 6 percent are extremely obese
• The American Heart Association has named obesity as an independent risk factor
Weight Management
Impact of Weight Loss on Risk Factors~5%
Weight Loss5%-10%
Weight Loss
A1C
Blood pressure
Total cholesterol
HDL cholesterol
Triglycerides
Wing RR et al. Arch Intern Med. 1987;147:1749-1753; Blackburn G. Obes Res. 1995;3 (Suppl 2):211S-216S.Mertens IL, Van Gaal LF. Obes Res. 2000;8:270-278; Ditschuneit HH et al. Eur J Clin Nutr. 2002;56:264-270.
Prevalence* of Self-Reported Obesity Among U.S. AdultsBRFSS, 2012
*Prevalence reflects BRFSS methodological changes in 2011, and these estimates should not be compared to those before 2011.
15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%
http://www.cdc.gov/obesity/data/adult.html
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Eliminating Risk Factors for Heart DiseaseHow does obesity contribute to CVD?
CVD
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Eliminating Risk Factors for Heart Disease
STOP SMOKING!• Smoking is an independent risk factor• Smoking is associated with a higher risk
of:- Stroke- Atherosclerosis- Heart Attack- Aortic Aneurysm
Smoking
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Eliminating Risk Factors for Heart Disease
It’s never too late to quit• Cardiac risk diminishes shortly after
quitting and continues to decrease• Mortality benefit • Risk of stroke reduces after quitting
Smoking
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Eliminating Risk Factors for Heart DiseaseSmoking
Smoking
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Eliminating Risk Factors for Heart Disease
• Cholesterol is a fat-like substance that lines the blood vessels.
• Cholesterol is carried in the blood by carries = lipoproteins- LDL - Low density lipoprotein or
“Bad” cholesterol- HDL - high density lipoprotein or
”Good” cholesterol- Non-HDL cholesterol - Non-HDL
cholesterol is your total cholesterol minus your HDL cholesterol.
- Triglycerides- type of fat found in your blood; high levels may signify metabolic syndrome
Know Your Numbers• HDL ≥ 50mg/dl• LDL <100mg/dl, if CAD < 70 mg/dl• Triglycerides <100 mg/dl• Non HDL <130 mg/dl
Total Cholesterol=HDL + LDL + 20% of your triglyceride
level. A total cholesterol score of less than 180 mg/dL is considered optimal.
Cholesterol
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Eliminating Risk Factors for Heart DiseaseCholesterol
• Why Cholesterol Matters- Major controllable risk factor- If you have other risk factors such as
high blood pressure, DM or you smoke-your risk increases even further
- Cholesterol can form thick deposits called plaque in artery walls=atherosclerosis• CAD• Stroke• Peripheral vascular disease• Aortic atherosclerosis and aneurysms of the
aorta
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Eliminating Risk Factors for Heart Disease
Prevention• Healthy diet• Ideal body weight• Activity• DON’T SMOKE
Treatment• Lifestyle change is first line treatment of
hyperlipidemia for all patients- Diet- Exercise- Don’t smoke
• Simplified into 4 groups to treat for both primary and secondary prevention- Clinical Atherosclerotic CVD- LDL-cholesterol levels ≥ 190 mg/dL- Diabetes Mellitus aged 40-75 yo- 10 year risk of ASCVD ≥ 7.5%
• No LDL targets• Patient-Physician discussion is key to
making informed decisions about treatment
Cholesterol
Stone NJ, et alCirculation: Nov. 12 2013
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Eliminating Risk Factors for Heart DiseaseCholesterol
Cholesterol Lowering Medications
•Statins•Most effective agents to lower LDL-C•Clinically proven to reduce mortality & recurring CV events•Change composition of plaques (especially in vulnerable plaques)•Stabilize atherosclerotic plaques•May result in partial regression•Can be well tolerated
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Eliminating Risk Factors for Heart Disease
Blood Pressure= Systolic BP
Diastolic BP
High Blood Pressure
Hypertension- The Silent Killer•Often no symptoms•1 in 3 adults have high blood pressure•Hypertension can cause: stroke heart attack heart failure peripheral artery disease kidney failure•Defined as ≥ 140/90 mmHg
Blood PressureCategory
Systolicmm Hg (upper #) Diastolic
mm Hg (lower #)
Normal less than 120 and less than 80
Prehypertension 120 – 139 or 80 – 89
High Blood Pressure
(Hypertension) Stage 1
140 – 159 or 90 – 99
High Blood Pressure
(Hypertension) Stage 2
160 or higher or 100 or higher
Hypertensive Crisis
(Emergency care needed)
Higher than 180 or Higher than 110
This chart reflects blood pressure categories defined by the American Heart Association.
www.heart.org
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Eliminating Risk Factors for Heart Disease
Prevention and Treatment• Diet
- Low Na- DASH
• Don’t Smoke• Maintain a healthy weight• Exercise • Coping with stress• Take your medication
High Blood Pressure
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Eliminating Risk Factors for Heart Disease
• Heart disease and stroke are the #1 cause of death for type 2 diabetics
• DM can lead to atherosclerosis• DM can cause damage to your heart,
eyes, nerves and kidneys
Why is DM a risk factor?• AHA considers DM one of the
controllable risk factors for heart disease
• When blood sugars are within normal range, you protect vital organs
• Diabetics often have other risk factors- HTN- High cholesterol and triglycerides- Obesity and lack of exercise- Poorly controlled blood sugars- Smoking
Diabetes
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Eliminating Risk Factors for Heart Disease
Prevention• Control weight• Be active• Control blood pressure• Control cholesterolTreatment• Lifestyle • Medications
- Oral medications- Insulin
You and your doctor can discuss the best treatment plan for you!
Who should be tested?• Overweight and over 45 yrs/old• High cholesterol• Family history of DM• African-American, Asian-American,
Latino/Hispanic-American, Native American or Pacific Islander descent
• A history of gestational diabetes (diabetes during pregnancy) or delivering a baby over 9 lbs.
Diabetes
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Eliminating Risk Factors for Heart DiseaseMetabolic Syndrome
Metabolic Syndrome•Cluster of risk factors that put a person at greater risk of cardiovascular disease
Metabolic Syndrome
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Eliminating Risk Factors for Heart Disease
Who’s at risk?• Obesity/overweight• Insulin resistant• Physically inactive
Treatment• Eat better• Get moving• Lose weight• Medications
Metabolic Syndrome
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Eliminating Risk Factors for Heart Disease
Assess your risk!• My life check assessment
www.heart.org
Life’s Simple 7
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Eliminating Risk Factors for Heart Disease
Bluhm Cardiovascular Institute• The Bluhm Cardiovascular Institute is proud of our
U.S. News & World Report rankings – a reflection of the leading edge cardiac and vascular services we offer and the results we obtain for our patients, their families and the community. #1 in the Chicago metro region
• #1 in Illinois for the seventh straight year• #13 in the nation out of 708 cardiac programs• Highest ranked cardiac program in the region: Indiana, Michigan, Wisconsin,
Missouri and Iowa
Bluhm Cardiovascular Institute
www.heart.nm.org
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Eliminating Risk Factors for Heart Disease
Know your numbers!• BMI or body mass index- goal 18-24.9 • Waist circumference- goal < 35 inches• Blood pressure- goal < 120/80• Cholesterol
- Total cholesterol- goal < 200 mg/dL- HDL- goal ≥ 50 mg/dl- LDL- goal < 100 mg/dL, if CAD < 70 mg/dL- Triglycerides- goal < 100 mg/dL- non-HDL- goal < 130 mg/dL
• Fasting Blood Sugar < 100 mg/dL
Summary
www.heart.nm.org
Thank You