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How To Prevent Heart Disease & Stroke
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How To Prevent Heart Disease & Stroke

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Practical information from a family doctor on what you can do -- without medicines -- to prevent the most common killers in the world, heart attacks and strokes.

Practical information from a family doctor on what you can do -- without medicines -- to prevent the most common killers in the world, heart attacks and strokes.

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How To Prevent Heart Disease & Stroke Presentation Transcript

  • 1. How To Prevent Heart Disease & Stroke Richard Saint Cyr, MD DABFP
  • 2. What Is #1 Cause Of Death in China?
    • Injuries & Poisonings
    • Strokes
    • Heart Attacks
    • Cancer
    • Lung Diseases
  • 3. What Is #1 Cause Of Death in China?
    • Cancer
    • Strokes
    • Heart Attacks
    • Lung Diseases
    • Injuries & Poisonings
  • 4. Deaths in China Since 1982 A: Urban B: Rural
  • 5. 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
  • 6. Cholesterol Plaque = Heart Attack & Stroke
  • 7. You Can Control Your Risk!
    • Lifestyle factors are a factor in 90% of the risk for a first heart attack
  • 8. 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
  • 9. 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
  • 10. Lifestyle Factors & Survival Data from Paffenberger, RS Jr, Hyde, RT, Wing, AL, et al, N Engl J Med 1993; 328:538
  • 11. Our Patient: John Doe
  • 12. 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
  • 13. 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?)
  • 14. Sample Report
  • 15. Closer Look: Graph
  • 16. Closer Look: The Report
  • 17. Joe’s Report
    • His risk of heart attack & stroke over the next 10 years: 27%
    • Average risk: 3%
    • Anything over 10% = high risk
  • 18. Joe’s Heart Is Too Old
    • His cardiovascular age is 55.8 years
    • He has the heart of a man 11 years older!
  • 19. 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!
  • 20. 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
  • 21. What Is Blood Pressure?   © 1996 Wellsource, Inc.
  • 22. High Blood Pressure Can…
  • 23. How Effective Is Control of Blood Pressure?
    • Every drop of 5 mmHg:
      • Stroke <42%
      • Heart Attack <21%
  • 24. 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
  • 25. 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
  • 26. 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
  • 27. Weight Gain = Disease… PS. “Cholelithiasis” = gallstones Source: uptodate.com 
  • 28. Weight Loss = Lower Blood Pressure Source: uptodate.com 
  • 29. 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”
  • 30. Are You an Apple or Pear? “ Apples” are at higher risk for heart attack, stroke, diabetes, high blood pressure
  • 31. “ 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
  • 32. 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
  • 33. Joe’s BMI Category?
    • BMI = 32.7 (100kg / 1.75m2)
      • = OBESE
    • Waist circumference: 122cm
    • Risk Category: Very High
      • Increased heart attacks, stroke, diabetes
  • 34. 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)
  • 35. How To Prevent Hypertension: Step 2
    • 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
  • 36. 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
  • 37. 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…
  • 38. 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.
  • 39. How To Prevent Hypertension: Step 3
    • 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
  • 40. 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
  • 41. 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)
  • 42. 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)
  • 43. 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
  • 44. One Serving = Source: http://www.wellcome.com.hk/en/kids_corner.html
  • 45. 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
  • 46. 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
  • 47. 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
  • 48. 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
  • 49. How To Prevent Hypertension: Step 4
    • 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
  • 50. 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%
  • 51. 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
  • 52. “ 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
  • 53. Asses Your Risks vs. Benefits
    • Too much alcohol causes early death:
      • Strokes
      • Liver disease
      • Cancers
      • Accidents
      • Sudden death
  • 54. 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!
  • 55. Cholesterol = Atherosclerosis
  • 56. 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
  • 57. How To Lower Your Cholesterol
    • Exercise
      • At least 150 minutes a week
    • Diet
      • Same diet as we discussed
    • Medicines
      • Natural: omega-3; niacin
      • Prescription
  • 58. Joe’s #3 Prevention Step: Stop Smoking
    • In China: 57% men smoke; 5% women
    • Increases your risk:
      • Heart attack >70%
      • Stroke >50%
    • Lung Cancer
  • 59. 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
  • 60. 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
  • 61. 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
  • 62. 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)
  • 63. 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
  • 64. Still A Bit To Go…
  • 65. His Next 6 Month Plan?
    • Continue diet and exercise!
    • Lose 10kg
    • Stop smoking
    • Probably start Rx for cholesterol
    • Start aspirin daily (81mg)
  • 66. 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
  • 67. Always Remember…
    • You have control of 90% of your risk factors for heart attack and stroke!
  • 68. Thank You! More Information at MyHealth Beijing .com