Learn about lifestyle disorders from the health care expert!

1. LIFESTYLE AND
CHRONIC DISEASES
Dr. V. Ra vi Andre ws
Consultant Nephrologist
Apollo Health City

2. “I’m tired of all this nonsense
about
beauty being only skin­deep.
That’s deep enough!
What do you want ……..
adorable kidneys ? ! ? !”
­ Jean Kerr

3. LIFESTYLE
DIET EXERCIS E BEHAVIOUR
S UBS TANCE P ERS ONALITY S TRES S
ABUS E

4. CHRONIC /LIFESTYLE DISEASES
• Cardiovascular Disease
• Cerebrovascular Disease
• Diabetes
• Hypertension
• Cancer
• Chronic Kidney Disease
• Dyslipidemia
• Metabolic Syndrome

5. IMPACT OF LIFESTYLE DISEASES
ALL DEATHS
Cardiovascular Disease - 36.3%
Cancer-6.50%
Stroke -22.70%
Other Causes - 34.5%
­ United States Data ­ 2004
• 12% attributed to lack of exercise
­ American Heart Ass, 2004

6. IMPACT OF DIABETES
Diabetes increases the risk of
coronary events :­
• Two­fold in men
• Four­fold in women
­ ADA 2002, Diabetes Care
25:S71­73

7. DIABETES A TICKING TIME BOMB
Over the next 24 hours:
2200 diabetics will be diagnosed
512 diabetics will die
66 diabetics will go blind
77 diabetics will be diagnosed with
ESRD
153 – diabetes related amputations will
be performed
Centre for Disease Control and Prevention. 2000

8. IMPACT OF KIDNEY
DISEASE….
Risk of dying is 100 times more in
a 20 year old with kidney
disease as compared to a healthy
80 year old
­Oxford Textbook of Clinical Neph, 3rd Ed,
(2005)

9. IMPACT OF METABOLIC
SYNDROME
Metabolic Syndrome (Syndrome X)
rated as equivalent to smoking in
magnitude of risk for Coronary Artery
Disease.
Four fold risk of Death from CAD
- National Cholesterol Education Program /
Adult Treatment Panel III (NCEP / ATP III)
Major impact on CVS, CNS, CKD

10. Clinical Criteria for Metabolic
Syndrome
W aist Circumference BP ≥ 130 /85 mm Hg
Men > 102 cm (40 inch)
Women > 88 cm (35 inch)
Metabolic Syndrome
FBS ≥ 110 mg /dl
Triglycerides ≥ 150 mg/
dl
HDL Chol. Men < 40 mg/
dl
W omen < 50 mg/dl
3 / 5 needed – NCEP, Circ. 166:3143 – 3421, 2002

11. Pathogenesis of Metabolic Syndrome
Obesity
+ Physical Inactivity
+ Genetics
↑ Abdominal Fat
Tissue Resistance to Leptin
↑ Pro – infl. Cytokines
↓ Adiponectin ↑ FFA
↓ FFA Breakdown
Insulin Resistance
↑ Insulin ↑ Glucose
↑ Abdominal Fat
- Bagby et al JASN 15:2775 – 91, 2004

12. Prevalence of Metabolic Syndrome
Looking at various studies around the world the prevalence
varies from 8% (India) to 24% (United States) in men and
from 7% (France) to 46% (India) in women.
Prevalence data from Jaipur & Chennai
60
50 Jaipur
40
% 30 Chennai
20
10
0
MS Obesity Elevated TG Hypertension Elevated Plasma
Glucose
Le ge nd: P re va le nce of MS 13% in J a ipur a nd 41% in Che nna i.The pre va le nce of
obe s ity wa s quite s imila r (31% ve rs us 33%). P re va le nce of e le va te d triglyce ride s
(46% vs . 30%), hype rte ns ion (55% vs . 39%) a nd e le va te d fa s ting pla s ma glucos e
(27% vs . 5%).
* Gogia A et al. Ind Journ of Medical Sciences. 2006; 60 (2): 72­81

13. Treatment of Individual Metabolic
Risk factors
Insulin resistance (Abd. Fat )  Weight, Activity
(Lifestyle)
& Metformin, TZDs
Dyslipidemia Lifestyle & Statins, Fibrates
Hyperglycemia Lifestyle & Insulin / OHA
(A1c< 7%)
Hypertension Lifestyle & ACEI, ARB, BB,
CCBs, diuretics
Prothrombotic state Lifestyle & ASA
Proinflammatory state Lifestyle & statins, TZDs,
ACEI/ARB
­ Grundy et al, Circ. 109:433­38 (2004) ­ AHA

14. CLASSIFICATION OF BP FOR
ADULTS ‡ 18 YEARS
(Mean of 2 or more seated B.P readings on each of
2 or more office visits)

NORMAL : SBP < 120 AND DBP <80

PREHYPERTENSION: SBP = 120 – 139
OR DBP = 80 – 89

STAGE 1 HYPERTENSION: SBP = 140 – 159
OR DBP = 90 ­ 99

STAGE 2 HYPERTENSION: SBP ‡ 160 OR
DBP ‡ 100
- A.V Choba nia n, e t a l
J NC – 7, Ma y 2003

15. Benefits of lowering BP ….
Event Average Percentage Reduction
S troke 35 – 40 %
M.I 20 – 25 %
CHF 50 %
10 mmHg reduction of SBP over 10 years
will prevent 1 in 10 deaths!!!
Chobanian et al, JAMA,
289,No.19(2003)

16. IMPACT OF LIFE–STYLE MODIFICATIONS
ON HTN ….
MODIFICATION APPROX SBP REDUCTION
Wt. Re duction 5- 20 mmHg/10Kg wt.
Los s
DAS H Die t 8-14 mmHg
Die ta ry S odium Re s triction 2- 8 mmHg
P hys ica l Activity 4- 9 mmHg
Mode ra tion of Alcohol 2- 4 mmHg
- JNC VII, JAMA (2003)

17. LIFESTYLE CHANGES
Diet
Exercise
Behaviour

18. The DASH Diet: ­
Salt – 6gm/day
+ ++
High K , High Ca
Low fat, low Cholesterol
Less alcohol, less coffee
(Equivalent to one Anti – HTN drug)
­ National Heart,Lung and Blood Institute
(USA) –2003

19. “To date, the only intervention to
delay aging is caloric restriction
by 30­40%. This has been
proved conclusively in rodents
but not yet in humans”
­ Resnick et al, Harrison’s Principles of
Internal Medicine 16th Ed. Pp.44(2005)

20. EXERCISE: ­
30­45 MINS OF BRISK WALKING – 5 DAYS A WEEK
Reduces BP
Reduces Weight
Controls Sugars
Controls Lipids, ›HDL
Endorphins / Enkephalins – Well Being, TCR Activation
Reduces Cardiovascular Risk
Reduces Osteoporosis
Sleep better, energises
Reduces Diet Restrictions
­ JNC VI – Arch. Int.Med. 157:2413­46 (1997)

21. BEHAVIOURAL CHANGES: ­
Stop Smoking
Reduce Alcohol, Coffee
Avoid Substance Abuse
Reduce Stress

22. HTN
Smoking
ROS
Endothelial
Damage
CYTOKINES
Dyslipidemia
Chronic Disease

23. CHRONIC / LIFESTYLE
DISEASE MANAGEMENT
Medication
V/S
Lifestyle
Modification

24. DISEASE MEDICATION
Ca rdiova s cula r Dis e a s e Anti-HTN,
Digoxin,AS A, Nitra te s ,
Inte rve ntions
Ce re brova s cula r Dis e a s e Anti-HTN, AS A,
Thrombolytics e tc
Dia be te s Ins ulin, OHA
Hype rte ns ion Anti-HTN
Ca nce r S urge ry, Ra dia tion,
Che mothe ra py
Chronic Kidne y Dis e a s e Anti-HTN, Vit. D3 ,
Ca lcium,P P I, Dia lys is ,

25. Lifestyle Modifications
Universal applicability
Preventive
No adverse effects
Cheap and easily available
No bitter pills to swallow
Cost – effective
No age restrictions
Fun

26. The Choice is clear………..

27. LIFE STYLE
EXER CISE
BEHAVIOUR
DI ET
Use the ‘Poly ­ Pill’!

28. How soon to start ? ? ?
“Children who cycle to school are
8 % more fit than children who use
other modes of transport”
­ Anderson, BMJ 334:1173(Editorial June 2007)

29. ''Those who think they do not
have time for exercise will
sooner or later have to
find time for illness''.
­Edward Stanley

30. “Di­eting
or
Di­eating …
Its up to you”
­ Ravi Andrews