Healthy lifestyle habits can to reduce the risk of heart disease.

1. Lifestyle Change & CAD

2. Shirin Gorjian
Master of science in nursing education,
Public health Nurse.
University of Medical Sciences, UMSHA.
Hamadan-Iran
Lifestyle & CAD

3. “We need to learn where to draw the line
so
We can take care of ourselves.”

4. Are you ready to jump in and join the fight?
We hope so !

5. Normal Anterior Heart Anatomy

6. Normal Posterior Heart Anatomy

7. What is Atherosclerosis ?

8. Myth : fat deposits at old age!
It starts from 2 years of age
Fatty
Streak
Intermediate
Lesion Atheroma
Fibrous
Plaque
Complicated
Lesion/
Rupture
Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).
From First
Decade
From Third
Decade
From Fourth
Decade

9. Are Other organs Affected?
Ischemic Stroke
Peripheral Vascular
Disease
Coronary Heart Disease
•Angina
•MI (Heart Attack)
•Sudden Cardiac Death

10. What are the symptoms of CAD?
No symptoms for long period
Chest pain for short period on exertion also
known as Angina or minor heart attack
Myocardial Infarction or major heart attack-
Severe chest pain, death of heart muscle, heart
failure, irregular heart beats
Sudden Death

11. Why Me ?
Genetic predisposition
Poor handling of fats and metabolic syndrome
Diabetes, obesity, high BP, Coronary artery disease
Environmental insults
Urbanization
Sudden change in lifestyle

12. Factors That Increase Your Risk for CAD
You can’t help it !
Age:
Men > 45;
Women > 55
Gender
Race
Family History
You can !!
High Cholesterol
Smoking
High Blood Pressure
Diabetes
Obesity
Alcohol
Physical Inactivity

13. Cholesterol ( A type of fat)
Everybody needs cholesterol, it serves a vital
function in the body. It circulates in the blood.
Too much cholesterol can deposit in the
arteries in the form of plaque and block
them
No symptoms till heart attack

14. Cholesterol types
LDL (bad) cholesterol: This is the type that, when too much is
present in the blood stream, can clog your arteries and put you at
risk for a heart attack or stroke. It’s produced naturally by the body,
but is also inherited from your parents or even grandparents, and can
cause you to create too much. Eating a diet high in saturated fat,
trans fats and cholesterol also increases how much you have.
HDL (good) cholesterol: It is believed by some experts that high
levels of this type of cholesterol removes excess plaque from your
arteries, slowing its buildup and helping to protect against a heart
attack. Low levels, however, can actually increase your risk.
Triglycerides: This is a form of fat made in the body. If you have
an inactive lifestyle, a diet high in carbohydrates, smoke, are obese
or drink too much alcohol, it can raise total cholesterol levels, and
lead to high LDL and low HDL levels.

15. Cholesterol by the numbers
Total cholesterol:
• Less than 200 mg/dL: Desirable level that puts you at lower risk for heart disease.
• 200 to 239 mg/dL: Considered borderline high.
• 240 mg/dL and above: High blood cholesterol. A person with this level has more than twice the risk of heart
disease.
HDL cholesterol levels:
• Less than 50 mg/dL: Low HDL cholesterol. A major risk factor for heart disease.
• 60 mg/dL and above: High HDL cholesterol. Considered protective against heart disease.
LDL cholesterol levels:
• Less than 100 mg/dL: Optimal
• 100 to 129 mg/dL: Near or above optimal
• 130 to 159 mg/dL: Borderline high
• 160 to 189 mg/dL: High
• 190 mg/dL and above: Very high
Triglyceride levels:
• Less than 100 mg/dL: Optimal
• Less than 150 mg/dL: Normal
• 150–199 mg/dL: Borderline high
• 200–499 mg/dL: High
• 500 mg/dL and above: Very high

16. Know your 4 Number!
Desirable numbers
 Total cholesterol < 200;
 LDL < 100
 HDL > 40
 Triglycerides < 200
Get the levels tested routinely and keep them under
control
The only thing worse than finding out that you have
one of these conditions is…….NOT finding out that
you have it!!

17. 10% reduction of blood cholesterol
produces 20-30% decline in CHD
deaths
Benefits of reducing cholesterol
All Adults >20 yrs must get tested, if normal test again after 5
years, if elevated, work towards normalizing the levels with
lifestyle modification and drugs as needed

18. Where does it come from ?
Two sources of
cholesterol: Food &
made in your body
Food sources: All foods
containing animal fat and
meat products

19. Physical Activity
The American Heart Association recommends that children and
adolescents participate in at least 60 minutes of moderate to
vigorous physical activity every day.

20. Why is exercise or physical activity
important from childhood?
Controlling weight
Reducing blood pressure
Raising HDL (“good”) cholesterol
Reducing the risk of diabetes and some kinds of
cancer
Improved psychological well-being, including
gaining more self-confidence and higher self-
esteem

21. Activities you can do with your kids:
Play catch
Organize a game of tag or capture the flag
On rainy days, try a workout
kickboxing, yoga or cardio dance
Jump rope

22. Obesity
People who are overweight
(10-30 % more than their
normal body weight)
Obese have 2 to 6 times the
risk of developing heart
disease
Diabetes
Heart
Disease
GERD
HBP
Sleep
Apnea
Cancer
Obesity

23. Pears and Apples shaped bodies
Apple-shaped paunch store body fat around the abdomen and
chest, surrounding internal organs
Apple- shaped are at a higher risk
Pear-shaped paunch store fat on the hips and thighs, just below
the surface of the skin.

24. Cigarette Smoking
Increases blood pressure
Decreases HDL
Damages arteries and blood cells
Increases heart attacks
Cigarette smoke contains more than 4,000 chemicals,
and 200 of these chemicals are poisonous

25. It’s time to listen to your heart

26. Alcohol Consumption
In small amounts it is beneficial: 1-2 drinks
In large amounts it adds fat and calories & raises
BP!
4 drinks per day. You end up with gastroenterologist
instead of cardiologist
This is a very fine line! Finer for women as they
are at higher risk

27. Diabetes
At any given cholesterol
level, diabetic persons have
a 2 or 3 x higher risk of
heart attack or stroke
A diabetic is more likely to
die of a heart attack than a
non-diabetic
~80% Diabetics die from
heart disease
Risk of sudden death from a
heart attack for a diabetic is
the same as that of someone
who has already had a heart
attack.

28. Types of diabetes
Type 1. There are two types of diabetes. The less common of the
two is type 1 diabetes, which occurs when the pancreas produces
very little or no insulin. It is a life-long, chronic condition most
often diagnosed in children.
Type 2. The second form of diabetes, type 2, is the one everyone’s
talking about, as the number of adolescents and adults developing
the condition continues to skyrocket. Type 2 diabetes is far more
common, with one in four developing the condition. It is still
primarily diagnosed in middle-aged adults.

29. How do I know if I have diabetes?
High blood pressure
High cholesterol
A family history of diabetes
African American, Asian American, Latino/Hispanic-American,
Native American or Pacific Islander descent
A history of gestational diabetes (diabetes during pregnancy) or
delivering a baby over 9 lbs.
If you any of these risk factors apply to you, or if you’re 45 and
overweight, see your healthcare provider. They may use one or both
of two tests available to determine whether you have diabetes: a
Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance
Test (OGTT).

30. High Blood pressure

31. What Causes Hypertension?
Normal blood pressure readings will fall below 120/80, while higher
results over time can indicate hypertension. In most cases, the
underlying cause of hypertension is unknown. The top number
(systolic) shows the pressure when the heart beats. The lower number
(diastolic) measures pressure at rest between heartbeats, when the heart
refills with blood. Occasionally, kidney or adrenal gland disease can
lead to hypertension.

32. Prehypertension: A Warning Sign
Almost one/third of people have
prehypertension.
Their blood pressure is consistently
just above the normal level falling
anywhere between 120 and 139 for
systolic pressure or 80 to 89 for the
diastolic pressure.
People in this range have a higher
risk of developing heart disease
than those with a lower reading.
Your doctor may recommend
lifestyle changes to help lower your
blood pressure.

33. The Hypertension Danger Zone
You have high blood pressure if
readings average140/90 or higher
though you may still have no
symptoms. At 180/110 and higher,
you may be having a hypertensive
crisis. Rest for a few minutes and
take your blood pressure again. If
it is still very high, call 115. A
hypertensive crisis can lead to a
stroke, heart attack, kidney
damage, or loss of consciousness.
Symptoms of a hypertensive crisis
can include a severe headache,
anxiety, nosebleeds, and feeling
short of breath.

34. Who Gets High Blood Pressure?
Up to the age of 45, more men have
high blood pressure than women. It
becomes more common for both
men and women as they age, and
more women have hypertension by
the time they reach 65. You have a
greater risk if a close family
member has high blood pressure or
if you are diabetic. About 60% of
people with diabetes have high
blood pressure.

35. Hypertension and Sodium
Sodium, a major component of
salt, can raise blood pressure by
causing the body to retain fluid,
which leads to a greater burden
on the heart. The American Heart
Association recommends eating
less than 1,500 milligrams of
sodium per day. You'll need to
check food labels and menus
carefully. Processed foods makes
up the majority of our sodium
intake. Canned soups and lunch
meats are prime suspects.

36. Hypertension and Caffeine
If caffeine can make you jittery,
can it also raise your blood
pressure? It might have a
temporary effect, but studies
haven't shown any link between
caffeine and the development of
hypertension. You can safely drink
one or two cups a day, according to
the American Heart Association.

37. Treatment: The DASH Diet
You may be able to lower your
blood pressure by switching to a
better diet. The DASH Diet --
Dietary Approaches to Stop
Hypertension involves eating more
fruits, vegetables, whole-grain
foods, low-fat dairy, fish, poultry,
and nuts. You should eat less red
meat, saturated fats, and sweets.
Reducing sodium in the diet can
also have a significant effect.

38. Moderate Your Lifestyle!

39. Foods That Can Save Your Heart

40. Fresh Herbs
Fresh herbs can help make other
foods heart-healthy when they
replace salt, sugar, and trans fats.
These flavor powerhouses, along
with nuts, berries even coffee can
be part of heart-wise eating.
Fact: Rosemary, sage, oregano,
and thyme contain antioxidants.
،‫رزماری‬‫مریم‬،‫گلی‬،‫پونه‬‫و‬‫آویشن‬

41. More Beans, Fewer Potatoes
You need carbohydrates for
energy, but some do your body
more good than others. Beans, and
whole grains such as brown rice,
quinoa, and whole wheat, have
more fiber and raise sugar levels
less. These help lower cholesterol
and keep you feeling full longer.
Other carbs, like those found in
white bread, white potatoes, white
rice, and pastries, boost blood
sugar levels more quickly, leading
you to feel hungry sooner, and
may make you more likely to
overeat.

42. Black Beans
Mild, tender black beans are
packed with nutrients including
folate, antioxidants, and
magnesium, along with fiber,
which helps control both
cholesterol and blood sugar
levels.
Tip: Canned black beans are
easy to add to soups and
salads. Rinse to remove extra
sodium.

43. Salmon: Super Food
A top food for heart health, it's rich in
the omega-3s EPA and DHA. Omega-
3s may lessen the risk of heart rhythm
disorders and lower blood pressure.
Salmon also lowers blood triglycerides
and helps curb inflammation.
The American Heart Association
recommends two servings of salmon or
other naturally oily fish a week.

44. Tuna for Omega-3s
Tuna is another good source of
omega-3s, and it generally costs less
than salmon. Albacore (white tuna)
has more omega-3s than other tuna
varieties. Reel in these other sources
of omega-3s, too: mackerel, herring,
lake trout, sardines, and anchovies.
Tips: Grill tuna steak with dill and
lemon. Choose tuna packed in
water, not oil.

45. Extra Virgin Olive Oil
This oil, made from the first
press of olives, is especially rich
in antioxidants called
polyphenols, which can help
protect your blood vessels. It's
also a good source of
monounsaturated fats, which are
a better choice than saturated
fats (such as butter) for your
cholesterol.
Tips: Use a little bit for salads,
on cooked veggies, or with
bread. Look for cold-pressed
and use within 6 months.

46. Walnuts
A small handful of walnuts a day
may lower your cholesterol and
ease inflammation in your heart's
arteries. Walnuts are packed with
omega-3s, monounsaturated fats,
and fiber. The benefits come when
walnuts replace bad fats, those in
chips and cookies.
Tip: Walnut oil has omega-3s, too;
try it in salad dressings.

47. Chard Leaf
The dark green, leafy vegetable is
rich in potassium and magnesium,
minerals that help control blood
pressure. You'll also get fiber,
vitamin A, and the antioxidants
lutein and zeaxanthin from these
greens.
Tip: Serve with grilled meats or as a
bed for fish. Saute with olive oil and
garlic until wilted; season with
herbs and pepper.

48. Almonds
Slivered almonds go well with
vegetables, fish, chicken, and
desserts. They're chock full of plant
sterols, fiber, and heart-healthy fats.
Almonds may help lower "bad" LDL
cholesterol, if you favor them over
other fats. Grab a small handful a
day.
Tip: Toast almonds to enhance their
creamy, mild flavor.

49. Oranges
This sweet, juicy fruit has the
cholesterol-fighting fiber
pectin as well as potassium,
which helps control blood
pressure. Research shows that
OJ may make your blood
vessels work better and lower
blood pressure a bit.
Tip: A medium orange
averages 62 calories with 3
grams of fiber.

50. Carrots
These sweet, crunchy veggies may
help control blood sugar levels and
make diabetes less likely. They
may also help your cholesterol
levels, since they're a source of
soluble fiber -- the kind of fiber
also found in oats.
Tip: Add shredded carrots to
spaghetti sauce and muffin batter.

51. Barley
Try this nutty whole grain in
place of rice with dinner, or
simmer barley into soups and
stews. The fiber in barley can
help lower cholesterol levels
and may lower blood sugar
levels, too.
Tip: Hulled or "whole grain"
barley is the most nutritious.
Barley grits are toasted and
ground nice for cereal or as a
side dish. Pearl barley is quick,
but much of its fiber has been
removed.

52. Low-Fat Yogurt
While low-fat dairy foods are
often touted for bone health,
they can help control high blood
pressure, too. And yogurt has
twice as much calcium and
potassium as milk. To minimize
fat, choose low-fat or non-fat
products. Check the label to see
how much sugar you're getting -
- it might be more than you
expected.
Tip: Use milk instead of water
in instant oatmeal, hot
chocolate, and dried soups.

53. Foods Fortified With Sterols
Some margarines, soy milks,
almond milks, and orange
juices have cholesterol-fighting
sterols and stanols added.
These plant extracts block
cholesterol absorption in the
gut and can lower LDL levels
by 10% without affecting good
cholesterol.
Tip: Eat or drink at least 2
grams of sterols a day.

54. Coffee
Coffee and tea may help protect
your heart even decaf coffee
works! Studies show that people
who drink 3-4 cups a day may
be less likely to get diabetes,
too. If you already have high
blood pressure, be careful, since
caffeine can make it worse.
Tip: Choose black coffee or a
non-fat latte to limit fat and
calories.

55. Cherries
Cherries are packed with
anthocyanin, believed to help
protect blood vessels.
Cherries in any form -- fresh
sweet cherries, the sour
cherries used for baking, as
well as dried cherries and
cherry juice -- all have that
antioxidant.
Tip: Sprinkle dried cherries
into cereal, muffin batter,
green salads, and wild rice.

56. Portion Control: Lend a Hand
Many people eat supersized meals,
with portions that are twice the
size recommended for good health.
That can contribute to weight gain
and high cholesterol. Here's an
easy way to practice portion
control for a meal: Use your hand.
One serving of meat or fish is
about what fits in the palm of your
hand. One serving of fresh fruit is
about the size of your fist. And a
serving of cooked vegetables, rice,
or pasta should fit in your cupped
hand.

57. Serve Up the Heart-Healthy Food
Load your plate with fruits and
vegetables five to nine servings a
day to help lower LDL "bad"
cholesterol. Antioxidants in these
foods may provide the benefit. Or
it may be that when we eat more
fruits and veggies, we eat less
fatty foods. Either way, you'll also
help lower blood pressure and
maintain a healthy weight. Foods
enriched with plant sterols, such
as some margarine spreads,
yogurts, and other foods, can also
help lower LDL cholesterol.

58. Unsaturated Fats Protect the Heart
We all need a little fat in our diet --
about 25% to 35% of our daily
calories. But the type of fat matters.
Unsaturated fats -- like those found
in canola, olive, and safflower oils
help lower LDL "bad" cholesterol
levels and may help raise HDL
"good" cholesterol. Saturated fats --
like those found in butter and palm
oil and trans fats raise LDL
cholesterol. Even good fats have
calories, so eat in moderation.

59. Even 30 minutes of physical activity
5 days a week (or 20 minutes three
times a week for vigorous exercise,
such as jogging) can help lower
LDL cholesterol and raise HDL
cholesterol. More exercise is even
better. Being active also helps you
reach and keep a healthy weight,
cutting your chance of developing
clogged arteries. You don't have to
exercise for 30 minutes straight. You
can break it up into 10-minute
sessions.
Move It!

60. Walk It Off
If you're not used to exercising or
don't want to go to a gym, take a
walk. It's easy, healthy, and all you
need is a good pair of shoes.
Aerobic exercise ("cardio") such
as brisk walking lowers risk of
stroke and heart disease, helps you
lose weight, and keeps bones
strong. If you're just starting out,
try a 10-minute walk and gradually
build up from there.

61. Work Out
You can exercise anywhere.
Gardening, dancing, or walking your
dog counts. Even housework can
qualify as exercise, if it gets your
heart rate up.

62. Check the Label
A close look at nutrition labels
is key for a low-cholesterol,
heart-healthy diet.
Check serving sizes. The
nutrition info may look good,
but does the package contain
two servings instead of one?
If it says "whole grain," read
the ingredients. Whole wheat
or whole grain should be the
first one.
Note the saturated fat and
cholesterol. Are they within
your diet's limits?

63. Don't Stress Out
Chronic stress can raise blood pressure, adding to your risk of
atherosclerosis, which happens when plaque from cholesterol builds
up in arteries. And research shows that for some people, stress might
directly raise cholesterol levels. Lower your stress levels with
relaxation exercises, meditation, or biofeedback. Focus on your
breathing, and take deep, refreshing breaths. It's a simple stress
buster you can do anywhere.

64. Controlling Blood Pressure
Adults should have their blood pressure checked at least
once every two years, as there are no symptoms to tell if
you have high blood pressure
Optimal levels : 120 /80 mm Hg
If high
o Modify your lifestyle Diet, Weight, Exercise, Salt restriction.
o Adhere to the prescribed medication without fail, to decrease
chances of getting heart disease
o Do not stop your medicines without consulting your doctor,
even if the blood pressure becomes normal

65. If you or someone in your family already
diagnosed with heart disease
Don’t get disheartened – science has made significant progress
Just monitor risk factors much more aggressively
 Eat healthy
 Walk regularly
 Watch your weight
 Quit smoking immediately
 Keep your weight under control
 In addition to improving your heart – health these measures are sure to
enhance your appearance !!
Adhere to you medicines & listen to your doctor

66. Sources
• American Heart Association Acls
• American Heart Association Diet
• American Heart Association Bls Requirements
• Acls 2011 Pretest Answer Sheet
• Acls Provider Manual
• Prevention of heart disease via WebMed,
• Omron Blood Pressure Monitor
• Canadian Red Cross
• Webmed