How To Prevent Heart Disease & Stroke

How To Prevent Heart Disease & Stroke Richard Saint Cyr, MD DABFP

What Is #1 Cause Of Death in China?
Injuries & Poisonings
Strokes
Heart Attacks
Cancer
Lung Diseases

What Is #1 Cause Of Death in China?
Cancer
Strokes
Heart Attacks
Lung Diseases
Injuries & Poisonings

Deaths in China Since 1982 A: Urban B: Rural

Heart Disease
High Blood Pressure 高血压 [gāoxuèyā]
Heart Attacks 心脏病发作
Strokes 中风
Chest pains –“Angina” 心绞痛 [xīnjiǎotòng]
Poor Circulation 静脉性跛行

Cholesterol Plaque = Heart Attack & Stroke

You Can Control Your Risk!
Lifestyle factors are a factor in 90% of the risk for a first heart attack

How Can You Prevent It?
Control high blood pressure
Stop smoking
Control cholesterol
Prevent diabetes
Decrease your obesity
Daily fruits & vegetables
Physical activity
Moderate alcohol

How Good Is Prevention?
You can reduce your chances by 55-84% by following those 8 prevention steps
Nurses Health Study: 55% reduction
Weight, diet, exercise, not smoking
Womens Health Study: 84% reduction
Same profile

Lifestyle Factors & Survival Data from Paffenberger, RS Jr, Hyde, RT, Wing, AL, et al, N Engl J Med 1993; 328:538

Our Patient: John Doe

Joe’s Stats
Age: 45
Weight: 100kg
Height: 175cm
Waist size: 48 inches (122 cm)
Smoker: ½ pack a day
Alcohol: 2-3 beers a day
Blood Pressure: 152/92
Cholesterol: 250; LDL 189; HDL 30

First, Let’s Assess Joe’s Cardiovascular Risk
www.myhealthcheckup.com
You input cholesterol, blood pressure, age, etc
It reports:
10 year risk of heart attack & stroke
>10% risk is high risk
Cardiovascular age (is your heart young or old?)

Sample Report

Closer Look: Graph

Closer Look: The Report

Joe’s Report
His risk of heart attack & stroke over the next 10 years: 27%
Average risk: 3%
Anything over 10% = high risk

Joe’s Heart Is Too Old
His cardiovascular age is 55.8 years
He has the heart of a man 11 years older!

Yikes! 怎么办？
Three Major Things To Do:
Lower his blood pressure to 140mmHg
Improve his cholesterol numbers 25%
Stop smoking
Doing all this can bring his risk down 80% to normal!

Prevention Tip #1: Control High Blood Pressure
AKA “hypertension”
“ The silent killer” – no symptoms for years
You have high blood pressure when:
Systolic (the 1 st number) >140
Diastolic (2 nd number) >90
This is the #1 cause of heart attack & stroke

High Blood Pressure Can…

How Effective Is Control of Blood Pressure?
Every drop of 5 mmHg:
Stroke <42%
Heart Attack <21%

Get Checked!
Every Two Years If Healthy:
Systolic <120mmHg
Diastolic <80 mmHg
(Healthy!)
Every Year If Borderline:
Systolic between 120-139 mmHg
Diastolic between 80-89 mmHg

How To Prevent Hypertension
Keep weight down (BMI <25)
<5-20 mmHg for each 10-kg weight loss
Exercise at least 150 minutes a week
<4 to 9 mmHg
Lower your salt intake
<2 to 8 mmHg
Healthy diet
<8 to 14 mmHg
Moderate your alcohol use
<2 to 4 mmHg

Joe Needs To Lose Weight
Lowering weight is the most effective way to prevent & treat high blood pressure
Your blood pressure drops 5-20 mmHg for each 10-kg weight loss

Weight Gain = Disease… PS. “Cholelithiasis” = gallstones Source: uptodate.com

Weight Loss = Lower Blood Pressure Source: uptodate.com

Do You Know Your BMI?
BMI = “Body Mass Index”
weight (kg) / height (meters) squared
Assesses your obesity risk
Normal : 18.5 – 24.9
Overweight: 25.0 – 29.9
Obesity: 30.0 and Above
Many websites do this: just Google “BMI calculator”

Are You an Apple or Pear? “ Apples” are at higher risk for heart attack, stroke, diabetes, high blood pressure

“ Apple” Fat Is Worst Risk
Abdominal circumference is best when:
Men 102 cm (40 in) or less
Women 88 cm (35 in) or less
Measure yourself above hip bone

Risk Factor Chart * Disease risk for type 2 diabetes, hypertension, and CVD. + Increased waist circumference can also be a marker for increased risk even in persons of normal weight. Extremely High Extremely High III 40.0 + Extreme Obesity Very High Very High II 35.0 – 39.9 Very High High I 30.0 – 34.9 Obesity High Increased 25.0 – 29.9 Overweight - - 18.5 – 24.9 Normal - - < 18.5 Underweight Men > 102 cm (40 in) Women > 88 cm (35 in) Men 102 cm (40 in) or less Women 88 cm (35 in) or less Obesity Class BMI (kg/m 2 ) Disease Risk* Relative to Normal Weight and Waist Circumference

Joe’s BMI Category?
BMI = 32.7 (100kg / 1.75m2)
= OBESE
Waist circumference: 122cm
Risk Category: Very High
Increased heart attacks, stroke, diabetes

Joe Needs To Lose 23kg
At 77kg, that would bring his BMI to 25 (now just “overweight” and not “obese”
This could lower his blood pressure 10-40 mmHg without medicines
A more reasonable first goal is to lose 10% weight (10kg)

How To Prevent Hypertension: Step 2
<4 to 9 mmHg
<2 to 8 mmHg
Healthy diet
<8 to 14 mmHg
<2 to 4 mmHg

Exercise: How Much Is Enough?
A brisk walk 20 minutes a day is great
Out of breath
Tired
Sweating
Fast heart rate is not so important
Moderate rate helps the heart
Fast rate loses weight

How Does It Help Your Heart?
Lowers blood pressure
Raises your “good” cholesterol, HDL
Lowers risk for heart attacks and angina
Many non-cardiac benefits, of course…

Any Exercise Helps Your Heart Coronary events are less frequent among those who exercise. In a study of 5159 men, aged 40 to 49 years, followed for an average of almost 19 years, the age-adjusted coronary heart disease event rate per 1000 person-years is lower in those who perform any physical activity compared to inactive subjects. Data from Wannamethee, SG, Shaper, AG, Alberti, KG, Arch Intern Med 2000; 160:2108.

<4 to 9 mmHg
<2 to 8 mmHg
Healthy diet
<8 to 14 mmHg
<2 to 4 mmHg

Low Salt = Low Blood Pressure
Goal is under 2.4 grams of sodium each day
=1 teaspoon
Average in US: 4-5 grams a day
80% salt intake is from processed foods
Low salt also protects your kidneys…
Image: mayoclinic.com

Read The Labels!
High Salt Foods:
Soy sauce
1 tablespoon (15ml) = 1,000mg salt
Instant noodles & soups
Ramen – 1,800mg salt
Canned anything
MSG (monosodium glutamate)

Change Diet = Avoid Pills Data from Stamler, R, Stamler, J, Grimm, R, et al, JAMA 1987; 257:1484. Intervention: weight loss, salt restriction, and avoidance of excess alcohol (squares)

The Ideal Diet: Each Day…
Four-five servings of fruit
Four-five servings of vegetables
Two-three servings of low-fat dairy
<25 percent fat
Low salt = under 2.4 grams
= “DASH Diet” (“Dietary Approaches to Stop Hypertension”) lowers blood pressure >11 mmHg

One Serving = Source: http://www.wellcome.com.hk/en/kids_corner.html

Fruits & Vegetables
Five servings a day lowers risk of heart attack & stroke by 25%
Three servings: 11%
Cruciferous vegetables
Broccoli, cabbage, cauliflower, brussels sprouts
Green leafy vegetables
Citrus fruits
Vitamin C

Fiber is Important
High fiber lowers risk of heart attack & stroke by 40-50%
Where to get fiber:
Cereals #1
10grams per day of cereals lowers risk 29%
Vegetables
Fruit

Fats: Bad vs Good
Type of fat is more important than amount
Trans-fatty acids 反试脂肪 : bad
Margarine, most fast foods, pre-packaged snack foods
Polyunsaturated & monounsaturated fats: good
Butter, olive oil, natural foods

Fish is Good!
The more, the better:
>4 a week: 38% decrease
2-4 per week: 23% decrease
Once a week: 15% decrease
1-3 times a month: 11% decrease
Benefit is from the omega-3 fatty acid
Best fish: salmon, mackerel, sardines

<4 to 9 mmHg
<2 to 8 mmHg
Healthy diet
<8 to 14 mmHg
<2 to 4 mmHg

How much is “moderate?”
Women: one drink a day
Men: two drinks a day
Moderate drinking can decrease risk of heart disease and stroke by ~30%

How Much Is “One Drink”?
Standard drink = 0.5oz (12g) alcohol
12 oz (360ml) of beer
5 oz (150ml) wine
1.5 oz (45ml) of 80 proof spirits

“ Moderate” Is Important!
Moderate drinking: low risk for alcohol problems
Women: <2 drinks per day
Men: <3 drinks per day
Heavy drinking: at risk for alcohol problems
Women: >7 drinks per week or 3 drinks per occasion
Men: >14 drinks per week or 4 drinks per occasion
Binge drinking: high risk
Women: 4 or more drinks in a row
Men: 5 or more drinks in a row

Asses Your Risks vs. Benefits
Too much alcohol causes early death:
Strokes
Liver disease
Cancers
Accidents
Sudden death

Joe’s Other Lifestyle Choices:
Three Major Things To Do:
Lower his blood pressure to 140mmHg
Improve his cholesterol numbers 25%
Stop smoking
Doing all this can bring his risk down 80% to normal!

Cholesterol = Atherosclerosis

Prevention Tip: Lower cholesterol
Each 30% decrease in cholesterol lowers risk by 30%
Who Should Be Screened?
Men at 35
Women at 45
Younger if risk factors

How To Lower Your Cholesterol
Exercise
At least 150 minutes a week
Diet
Same diet as we discussed
Medicines
Natural: omega-3; niacin
Prescription

Joe’s #3 Prevention Step: Stop Smoking
In China: 57% men smoke; 5% women
Increases your risk:
Heart attack >70%
Stroke >50%
Lung Cancer

How To Stop Smoking
Never start!
Taper off and stop
Use nicotine patches or gum
Some prescription medicines can help
TCM & Acupuncture may help
Keep trying!
It usually takes 7 tries before someone stops

It’s Never Too Late To Quit
One Year After Stopping:
Risk of heart attacks & strokes <50%
After 5-10 years:
Risk almost similar to nonsmokers

Joe’s Action Plan
Exercise
Fast walk, 30 minutes, after dinner
Lose 10kg in 6 months
Diet change
Less KFC; more salads; smaller portions
Cut back on smoking
Fish oil supplement (1 gram a day)
Cut back alcohol to 1 or 2 a day

Back To Joe, 6 Months Later
Weight: from 100 to 88kg
Smoking: “a couple a day”
Blood pressure: 138/88
Cholesterol: Total 213 (from 250), HDL 38 (from 30), LDL 140 (from 189)
Glucose: 102 (from 120)

His New Profile: Much Better
10 Year Risk: now 15.7% (from 27%)
58% improvement
Heart Age: now 51.6 (from 55.8)
He just gained back 3 years of his life

Still A Bit To Go…

His Next 6 Month Plan?
Continue diet and exercise!
Lose 10kg
Stop smoking
Probably start Rx for cholesterol
Start aspirin daily (81mg)

Summary
Assess your risk!
Know your BMI & waist circumference
Know your blood pressure & cholesterol
Know your 10-year cardiovascular risk
If your risk is high:
think about lifestyle changes
see your doctor

Always Remember…
You have control of 90% of your risk factors for heart attack and stroke!

Thank You! More Information at MyHealth Beijing .com

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How To Prevent Heart Disease & Stroke

by Richard Saint Cyr MD on Aug 30, 2009

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How To Prevent Heart Disease & Stroke — Presentation Transcript