This document discusses cardiovascular disease and risk factors such as high blood pressure, high cholesterol, smoking, obesity, and family history. It recommends a heart healthy diet low in saturated fat and sugar and high in fruits/vegetables, maintaining a healthy weight, not smoking, managing blood pressure and cholesterol through lifestyle and medical means if needed, and recognizing signs of a heart attack.

1. N I N A H A M M O N D , R N - B C , B S N
D U K E N U R S E P R A C T I T I O N E R S T U D E N T
HEART HEALTH

2. CARDIOVASCULAR DISEASE
• Plaque builds up on the
lining of blood vessels
• Blood vessels become stiff
• Partially or completely
blocked vessels reduce
oxygen and nutrient
delivery to the body
What causes this?

3. RISK FACTORS
• High blood pressure
• Puts strain on the blood vessels causing micro
tears and scarring that leads to increased plaque
buildup
• High pressure damages small blood vessels in the
eyes, kidneys, brain and peripheral tissues such as
in the feet and genitals
• 1 in 3 North Carolinians has high blood pressure
• Caused or contributed to nearly 1000 deaths per
day in 2013
• Costs $46 billion per year in healthcare,
medications and lost days of work

4. RISK FACTORS
• High blood cholesterol
• Can build up on artery walls
• Leads to stiffened and blocked arteries
• LDL is the type of cholesterol that sticks to
blood vessel linings
• The higher the level of LDL,
the more risk of heart disease
• HDL, the “good” cholesterol,
helps to remove LDL
cholesterol

5. RISK FACTORS
• Poor diet
• High in saturated fat
• Low in fiber
• Processed foods
• High in sugar
• High in salt
• Low nutritional value

6. RISK FACTORS
• Obesity
• 3 times more likely to develop diabetes
• Adipocytes of an obese person induce
pro-inflammatory processes
• Adipocytes (especially those of
abdominal obesity) induce
insulin resistance
• 30-70% inherited
• Excess calories in + low calories
burned

7. RISK FACTORS
• Smoking
• Smoking harms nearly every organ in the body,
including the heart, blood vessels, lungs, eyes,
mouth, reproductive organs, bones, bladder, and
digestive organs
• The chemicals in tobacco smoke inflame and damage
the blood vessel walls making them hard and easier
for plaque to stick to
• Major cause of PAD
• Quitting immediately reduces
risk of heart attack

9. FAMILY HISTORY
• If you have a first degree relative, mother,
father, brother, sister, who has had a heart
attack or stroke, you have an increased risk.
• You can’t change your genes but you can
change your environment
• Healthy lifestyle choices can significantly
offset hereditary factors
• Keep track of heart health
indicators like blood pressure,
cholesterol levels, and weight

11. ACTUAL PLAQUE BUILDUP

13. HEART ATTACK

14. CORONARY ARTERIES

15. CARDIAC STENT

17. HEART DISEASE PREVENTION
• Healthy lifestyle
• Heart healthy diet
• Exercise
• No smoking
• Stress management
• Blood pressure management
• Cholesterol management
• Weight management

18. HEART HEALTHY DIET
• Low saturated fat
• Healthy fats- mono and poly unsaturated fats
• Fruits and vegetables
• Antioxidant vitamins
• Fiber
• Limited high sugar/low
nutrient foods and
beverages
• Low sodium

19. HEALTHY FATS
• Monounsaturated fats like olive oil, nuts,
seeds, and avocadoes
• Polyunsaturated fats found mainly in
vegetable oils, fish and seafood
• Omega 3 and Omega 6 fatty acids are
essential to our health and are only
obtained through our food
• Limit saturated fat from meat and butter
• Avoid trans-fat, look for “partially
hydrogenated”

21. FRUITS AND
VEGETABLES
• 5 servings of fruits and vegetables per day had roughly a 20
percent lower risk of coronary heart disease and stroke,
compared with individuals who ate less than 3 servings per
day
• Excellent source of antioxidant vitamins
• Fiber
• Lowers blood cholesterol
• Bowel health
• Helps lower blood pressure
• Helps you feel full
• Helps regulate blood sugar
• Tend to be lower in fat and calories

22. ANTIOXIDANTS

24. LIMIT HIGH SUGAR/NUTRIENT
POOR FOODS & BEVERAGES
• Sugar sweetened beverages provide empty calories
• High sugar diet leads to
• Weight gain
• Impaired immune system
• Chronically high insulin levels that are associated with cancers,
heart disease, acne, and eye problems
• Inflammation
• Sugar not used for energy is
turned Into fat and
stored for later

25. DAILY SUGAR INTAKE
Recommendations
• Men: 150 calories per day (37.5 grams or 9 teaspoons)
• Women: 100 calories per day (25 grams or 6 teaspoons)

26. SODIUM
• Recommendations
• 2,400 mg per day
• 1,500 mg per day if you have high
blood pressure
• Americans get 75% of their
sodium from processed and
restaurant food

27. MEDICAL THERAPY FOR HEART
DISEASE
• Current medical therapy is based on evidence
• Physicians follow guidelines formulated by expert
medical panels like the American Heart Association, the
American College of Cardiology, the American Medical
Association, etc.
• Guidelines provide a template for the most effective care
• Patient individualization is considered
• Treatment should be a collaboration between patient and
provider

28. CURRENT GUIDELINES
• Hypertension
• “Hypertension is one of the most important
preventable contributors to disease and death in the
United States, leading to myocardial infarction,
stroke, and renal failure when it is not detected early
and treated appropriately”
• Healthy lifestyle
• Pharmacologic therapy initiated for BP>140/90 for
under 60 (or 80 according to AHA) and 150/90 for
over 60 or 80

29. BLOOD PRESSURE MEDICATIONS
• Start with a thiazide diuretic, or ace inhibitor, or
angiotensin II receptor blocker (ARB) or calcium channel
blocker
• Recheck in 2-4 weeks
• If not to goal, add a second agent
• If still not to goal, adjust dosage
• If not to goal on max tolerated doses, add a third agent
• Consider testing and/or referral to hypertension
specialist
• Use beta-blocker if existing heart disease

30. CHOLESTEROL THERAPY WITH A
STATIN
• People without cardiovascular disease who are 40 to 75
years old and have a 7.5 percent or higher risk for
having a heart attack or stroke within 10 years.
• People with a history of a cardiovascular event (heart
attack, stroke, stable or unstable angina, peripheral
artery disease, transient ischemic attack, or coronary or
other arterial revascularization).
• People 21 and older who have a very high level of bad
cholesterol (190 mg/dL or higher).
• People with Type 1 or Type 2 diabetes who are 40 to 75
years old.

32. STATIN INTENSITY

33. LOW DOSE
ASPIRIN
Aspirin reduces the risk of heart attacks
and strokes by preventing platelets from
forming blood clots on the surface of ruptured plaques.

34. SIGNS OF HEART ATTACK
• Chest discomfort.
• discomfort in the center of the chest that lasts more than
a few minutes, or that goes away and comes back. It
can feel like uncomfortable pressure, squeezing,
fullness or pain.
• Discomfort in other areas of the upper body.
• pain or discomfort in one or both arms, the back, neck,
jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs breaking out in a cold sweat, nausea or
lightheadedness.

35. TIME IS MUSCLE
Call 911

36. SIGNS THAT SHOULD BE CHECKED
• Progressive fatigue and/or shortness of breath
• Not being able to walk as far as you used to
• Swelling of the extremities, feet and ankles
• Irregular heart beat, especially if it makes you feel weak,
short of breath or lightheaded
• Unusually loud snoring that sounds like a gasping or
choking can be a sign of sleep apnea. That’s when you
stop breathing for brief moments several times at night
while you are still sleeping. This puts extra stress on
your heart.

39. HERBS AND SPICES
Basil Parsley
Rosemary Cilantro
Peppermint Thyme
Dill

40. WATCH FOR LOCAL FARMER’S
MARKETS

47. ZUCCHINI

48. ADD FLAVOR WITH MUSHROOMS

49. TUNA

51. OATMEAL

52. EDAMAME