Objectives Define cardiovascular disease and coronary heart disease. Explain the importance of a healthy lifestyle in preventing cardiovascular disease. Become familiar with the major risk factors that lead to the development of coronary heart disease. Assess your own risk for developing coronary heart disease. Outline a comprehensive program for reducing the risk for coronary heart disease and managing the overall risk for cardiovascular disease. Determine your risk for heart disease.
Prevalence of Cardiovascular Disease Most prevalent degenerative diseases in the US. About 30% of all deaths About 33% of the population suffers from cardiovascular disease. 60% die unexpectantly The 2008 estimated cost of heart and blood vessel disease in the US exceeded $475 billion. The incidence declined by 28 percent between 1960 and 2000
Stroke Caused by the narrowed cranial arteries due to fatty deposits, reducing blood supply to specific areas of the brain Third leading cause of death in the United States, accounting for approximately 143,600 deaths each year. About 800,000 new stroke victims are reported each year and more than one-third are left with permanent disabilities.
Coronary Heart Disease Caused by the narrowed coronary arteries due to fatty deposits, reducing the blood supply to the heart muscles. Single leading cause of death in the U.S.
Pulmonaryartery Left main coronary artery Aorta artery Circumflex coronary artery Right coronary artery Anterior descending coronary artery Normal healthy heart Fig. 11-3a, p. 363
Blockage in the anterior descending coronaryAreas arteryof partialobstructio Area ofn myocardia l infarction Myocardial infarction (heart attack) The result of acute reduction in blood flow through the anterior descending coronary artery. Fig. 11-3b, p. 363
Leading Risk Factors for CHD Profile Purpose To screen individuals who may be at high risk for the disease. To educate people regarding the leading risk factors for developing CHD. To implement programs aimed at reducing the risks. To use the analysis as a starting point with which to compare changes induced by the intervention program. Lab 11A
Leading Risk Factors for CHD Weighted system for CHD risk factors Risk categories Very low Low Moderate High Very high
CHD Risk Factors - Physical Inactivity Daily physical activity and aerobic exercise greatly reduces the overall risk for heart disease. AHA strongly suggests incorporating strength training as well PLUS : An active lifestyle can not eliminate the increase CVD risk caused by poor lifestyle habits smoking, eating too many fatty/ salty/sweet foods, being overweight, and having high stress level
Abnormal Electrocardiograms (ECG or EKG) EKG allows doctors to identify abnormalities in heart functioning in five general areas: heart rate, heart rhythm, axis of the heart, enlargement or hypertrophy of the heart, and myocardial infarction. Recommended for: Men over age 45 and women over age 55. Individuals with two or more CHD risk factors who wish to participate in a vigorous exercise program. Stress EKG versus Resting EKG
Abnormal Cholesterol Profile Contributes to atherosclerosis, the build-up of fatty tissue in the walls of the arteries The plaque blocks the coronary arteries that supply the myocardium with oxygen and nutrients. These obstructions can trigger a myocardial infarction (heart attack). Chest pain (angina pectoris) does not start until the arteries are about 75% blocked.
Comparison of a NormalHealthy & Diseased Arteries
Abnormal Cholesterol Profile Cholesterol and triglycerides are transported primarily in the form of HDL, LDL, VLDL and chylomicrons National Cholesterol Education Program (NCEP) recommendations Below 200 mg/dL for all members of the population Total cholesterol is not the best predictor for cardiovascular risk More significant is the way it is carried in the bloodstream.
Abnormal Cholesterol Profile Cholesterol transportation Low Density Lipoproteins LDLs tend to release cholesterol, which may penetrate the lining of arteries and speed up the process of atherosclerosis Oxidized by free radicals Pattern A (large) and Pattern B (small) Lipoprotein-a [Lp(a)] promotes blood clots and earlier development of atherosclerosis and is elevated in 10 percent of the population.
Abnormal Cholesterol Profile Cholesterol transportation Intermediate-Density Lipoproteins These mid-sized particles are more likely to cause atherosclerosis than a similar amount of LDL cholesterol.
Abnormal Cholesterol Profile Cholesterol transportation High-Density Lipoproteins act as scavengers, removing cholesterol from the body and preventing plaque from forming in the arteries. reverse cholesterol transport HDL2 are larger particles that carry cholesterol from the arterial wall to the liver for disposal. These particles also have antioxidant and anti- inflammatory effects. HDL3 also transports cholesterol out of the arterial wall but may not be as effective as HDL2.
Counteracting Cholesterol Saturated and trans fats raise cholesterol and produce approximately 1,000 mg of cholesterol per day. Beef contains more saturated fat than poultry and fish, and increases the risk of dying from heart disease by at least 30 percent and from cancer by about 20 percent. Unsaturated fats are mainly of plant origin and cannot be converted to cholesterol. Vitamin C might inactivate free radicals and slow the oxidation of LDL cholesterol. Vitamin E might protect LDL from oxidation, preventing heart disease before damage takes place.
Trans Fats Elevate LDL cholesterol as much as saturated fats do. Increase triglycerides and lower HDL cholesterol. The AHA limits trans fat intake to less than 1 percent of total daily calories. Read food labels carefully The FDA allows food manufacturers to label any product that has less than half a gram of trans fat per serving as zero. The label terms "partially hydrogenated" and "trans fatty acids" indicate that the product carries a health risk just as high as that of saturated fat.
Lowering LDL Cholesterol Lose body fat Participate in a regular aerobic exercise program Make dietary modifications Replace saturated fat with polyunsaturated and monounsaturated fats with total saturated fat intake providing <7% of the total daily calories. Trans fat intake should be <1% of the daily caloric intake. Consume 25 to 38 grams fiber per day: soluble fiber helps bind and excrete fats from the body. NCEP Guidelines Consuming up to 35% of calories from fat, including 10% from polyunsaturated fats and 20% from monounsaturated fats. Consuming soy protein (25 grams). Consuming about 3 grams of margarine or 6 tablespoons of salad dressing containing stanol ester The best prescription is the combination of a healthy diet, a sound aerobic exercise program, and weight control. Consider drug therapy if, after 6 months on a low-cholesterol, low-saturated-fat diet, cholesterol remains unacceptably high
Elevated Triglycerides Triglycerides are known as free fatty acids and make up most of the fat in our diet and most of the fat that circulates in the blood. Speed up plaque formation in combination with cholesterol. Carried in the blood by VLDLs and chylomicrons. Found in poultry skin, lunch meats, and shellfish. Manufactured mainly in the liver from refined sugars, starches, and alcohol. Manufactured in the liver Lowering triglycerides Avoid pastries, candies, soft drinks, fruit juices, white bread, pasta, and alcohol. Cut down on overall fat consumption. Quit smoking. Reduce weight (if overweight). Do aerobic exercise. Take 2–4 daily grams of fish oil under a physicians supervision.
Cholesterol-Lowering Medications Statins group can lower cholesterol by up to 60 percent in 2 to 3 months. Slow down cholesterol production. Increase the livers ability to remove blood cholesterol. Decrease triglycerides. Produce a small increase in HDL levels. High doses of niacin (a B vitamin) help lower LDL cholesterol, triglycerides, and increase HDL cholesterol. Fibrates are primarily used to lower triglycerides.
Elevated Homocysteine A high level of this amino acid in the blood is thought to enhance plaque formation and subsequent blockage of the arteries. Normally homocysteine helps build proteins and carry out cellular metabolism and is metabolized rapidly. High blood levels of homocysteine might result from either a genetic inability to metabolize homocysteine or a deficiency in the vitamins required for its conversion. Keeping homocysteine from accumulating in the blood: Eating five servings of fruits and vegetables daily provides sufficient levels of folate and vitamin B6 to remove and clear homocysteine from the blood.
Inflammation C-reactive protein (CRP), a protein whose levels in the blood increase with inflammation. Individuals with elevated CRP have twice the risk for a heart attack. An inexpensive high-sensitivity CRP (hs-CRP) test that measures the probability of plaque rupture within the arterial wall has been approved by the FDA (Table 11.8). Excessive intake of alcohol and high-protein diets increase CRP. CRP can be decreased with statin drugs, exercise, weight loss, proper nutrition, quitting smoking, and aspirin.
Relationship Between CRP,Cholesterol, and Risk for CVD People with both elevated CRP and cholesterol have an almost nine-fold increase in the risk for a heart attack
Diabetes A condition in which blood glucose is unable to enter cells because: The pancreas no longer makes enough insulin, or The cells no longer respond to insulin, called insulin resistance. Diabetes affects about 24 million people in the US. Two out of three diabetics will die from cardiovascular disease Chronic high blood sugar can also lead to stroke, nerve damage, vision loss, kidney damage, sexual dysfunction, and decreased immune function. An 8-hour fasting blood glucose level above 125 mg/dL on two separate tests confirms a diagnosis of diabetes (Table 11.9).
Diabetes Types of diabetes Type 1 (insulin-dependent diabetes mellitus; IDDM) Known as "juvenile diabetes," found mainly in young people. The pancreas produces little or no insulin.
Diabetes Type 2 diabetes (non-insulin-dependant diabetes mellitus; NIDDM) Once limited primarily to overweight adults, now accounts for almost one-half of the new cases diagnosed in children. Accounts for 90–95 percent of all diabetes cases. The pancreas either does not produce sufficient insulin or it produces adequate amounts but the cells become insulin-resistant, keeping glucose from entering the cell. About 60–80 percent related to overeating, obesity, and lack of physical activity.
Diabetes In most cases this condition can be corrected through regular exercise, improving nutrition, and weight loss. Regular physical activity increases the bodys sensitivity to insulin. Diet high in complex carbohydrates and water-soluble fibers, low in saturated fat, and low in sugar. Low-fat dairy products.
A1C Test Hemoglobin A1c test Also called Hb A1c. Measures the amount of glucose that has been in a persons blood over the last 3 months. If kept under 7 percent, risk of developing diabetic-related problems of the eyes, kidneys, and nerves is lower.
Metabolic Syndrome Includes abdominal obesity, elevated blood pressure, high blood glucose, low HDL cholesterol, high triglycerides, and an increased blood-clotting mechanism. Increases the risk for CHD and the other diabetic-related conditions (blindness, infection, nerve damage, and kidney failure). Approximately 50 million Americans are afflicted by this condition.
Diagnosis of Metabolic Syndrome Treatment Distribute daily caloric intake so that 45 percent of the calories are derived from carbohydrates (primarily low- glycemic), 40 percent from fat, and 15 percent from protein. Lose weight (if overweight), exercise, and quit smoking.
Hypertension Blood pressure Measured in milliliters of mercury (mm Hg). Systolic blood pressure (the higher number). Diastolic blood pressure (the lower number).
Hypertension Approximately 74 million Americans are hypertensive. More than 57,000 Americans die each year as a result of high blood pressure. Hypertension, "the silent killer," is a risk factor for CHD, congestive heart failure, strokes, kidney failure, and osteoporosis. Hypertension is thought to damage the endothelial lining of blood vessels, beginning the atherosclerosis process. Hypertension makes the heart continually work harder. About 90 percent have no definite cause, called essential hypertension. About 10 percent are caused by pathological conditions
Hypertension A combination of aerobic exercise, weight loss, and less sodium in the diet before recommending medication (Table 11.12) The upper limit (UL) for sodium intake is 2,300 mg per day. New recommendations are significantly lower than 2,000 mg per day
Effects of Long-Term AerobicExercise on Resting BP
Excessive Body Fat Obesity is a risk factor for CHD. Its location is important as well CHD is also associated with high blood lipids, hypertension, and diabetes that tend to accompany obesity. Even slight reduction in body fatness has been found to reduce CHD risk
Cigarette Smoking The single most preventable cause of illness and premature death in the U.S. About 20%of cardiovascular deaths are attributed to smoking. Speeds the process of atherosclerosis and carries a threefold increase in the risk of sudden death after a myocardial infarction. Some of the 1,200 toxic compounds in cigarette smoke damage the inner membrane of blood vessels. Smoking promotes blood clotting. Carbon monoxide in cigarette smoke decreases the bloods oxygen-carrying capacity. Smoking increases heart rate, raises blood pressure, and irritates the heart, which can trigger fatal cardiac arrhythmias. Smoking decreases HDL cholesterol.
Cigarette Smoking Pipe and cigar smoking and tobacco chewing also increase the risk for heart disease. Risk for disease decreases after smoking cessation. One year after quitting, the risk of CHD decreases one-half. Within 15 years, the relative risk of dying from CVD and cancer approaches that of a lifetime nonsmoker.
Tension and Stress It is the response (not the stressor) that creates the health hazard. The body releases catecholamines that prepare the body for "fight or flight." Catecholamines increase heart rate, blood pressure, and blood glucose. Unless metabolized due to the action taken (person fights or flees), the catecholamines remain elevated in the bloodstream. People who are not able to relax place a constant low-level strain on the cardiovascular system that could manifest itself as heart disease. The coronary arteries that feed the heart muscle constrict, reducing the oxygen supply to the heart. Anger and hostility also contribute to heart disease by increasing heart rate, blood pressure, blood glucose, cholesterol, and interleukin-6.
Age Age The higher incidence of heart disease occurs as people get older. Caused partly by other factors stemming from changes in lifestyle as we get older. The process begins early in life. Approximately 70% have early stages of atherosclerosis. Elevated blood cholesterol levels found in children as young as 10 years old. Aging process can be slowed down through risk factor management and positive lifestyle habits.
Other Risk Factors for CHD Gum disease The oral bacteria that build up with dental plaque can enter the bloodstream and contribute to inflammation, formation of blood vessel plaque, and blood clotting and thus increase the risk for heart attack. Daily flossing Loud snoring Heavy snoring may triple the risk of a heart attack and quadruple the risk of a stroke. Low birth weight Under 5.5 pounds Aspirin therapy A daily aspirin dose of about 81 mg per day decreases nonfatal heart attack by about a third by preventing or dissolving clots.
Real Life Stories Critical Thinking Questions 1. What risk factors for coronary heart disease did Peter have prior to changing his lifestyle? Is this something he needed to worry about at such a young age? Explain why or why not. 2. Are there any other changes Peter could implement to further decrease his personal risk for CHD? 3. What risk factors might contribute to your own possibility of developing coronary heart disease? At what age should you concern yourself with them, and what are you willing to do about them?