Cardiovascular diseases 1


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Magnitude of the problem, clinical features, prevention and control.

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  • What causes heart disease? Two major conditions contribute Atherosclerosis it involves deposits of fatty substances cholesterol, cellular waste and calcium in the lining of an artery. It starts due to elevated levels of cholesterol, high blood pressure, and tobacco smoke.
  • Congestive Heart Failure affects people of all ages from children to senior citizens, there is no cure. The heart has been weakened by an underlying problem. Clogged arteries, high blood pressure, a defect or some other medical condition. It does not mean the heart has failed, simply means the heart is not doing an efficient job.
  • Cerebrovascular Accident – Every 53 seconds someone in America has a stroke. Stroke is the nation’s #3 killer and is the leading cause of long-term disability. People with heart disease have twice the risk of having a stroke. It is caused when a blood vessel in the brain become blocked by artherosclerosis and the tissue supplied b the artery dies. It can also be caused by a traveling blood clot known as an embolus.
  • Unchangeable Risk Factors: Age, the older you get the greater the chance of heart disease. Four out of five people who die of congestive heart disease are 65 years of age or older. Sex, males have a greater rate of congestive heart disease. Race, minorities have a greater chance of heart disease. African Americans have a greater chance of high blood pressure. The risk is also higher in Mexican Americans, America Indians, native Hawaiians and Asian Americans. Also included as unchangeable risk factors is your family history and your own personal medical history.
  • Hypertension Serum Cholesterol: As cholesterol rises so does the risk of congestive heart disease, and obesity. It is unhealthy because excess weight puts more strain on your heart. It can raise blood pressure and blood cholesterol and lead to diabetes. Diabetes Mellitus, Physical Inactivity, and Cigarette Smoking along with Alcohol intake are the other changeable risk factors. A smoker’s risk of a heart attack is more than twice that of a non-smoker.
  • Cholesterol is a soft waxy substance found among the lipids in the bloodstream and in all of your body’s cells. Everybody needs cholesterol, it serves a vital function in the body. It is a component of the nerve tissue of the brain and spinal cord as well as other major organs. We get cholesterol from two ways. Our bodies make it and the rest comes from animal products we eat. It is frequently measured to promote health and prevent disease. Desirable levels of total cholesterol levels should be at 200 or less. 240 is considered high but it will depend on the HDL and LDL levels if at this level there is a risk to your health. It is a major component of the plaque that clogs arteries. Cholesterol and other fats can’t dissolve in the blood. They have to be transported to and from cells by special carriers called lipoproteins.
  • HDL or high density lipoprotein is know as the good cholesterol, it helps to bind to some of the bad cholesterol and carry it out of the body. It does not have the tendency to clog arteries. The target level is greater than 35mg/dl. High levels of >60 can actually negate one other risk factor. Studies suggest that high levels of HDL cholesterol reduce your risk of a heart attack.
  • The Facts About Fat – Certain fats are essential for good nutrition and health. Fats provided essential fatty acids which the body can’t manufacture, they act as insulators to maintain body temperature and they improve the palatability of food and promote digestion. Knowing which fats raise LDL cholesterol and which ones don’t is very important. Saturated fat, trans fatty acids, and dietary cholesterol raise blood cholesterol. Some studies suggest that using monounsaturated and polyunsaturated may lower cholesterol levels slightly.
  • Saturated fats can cause an increase in cholesterol. What is saturated fat? It is fat that is saturated with hydrogen and is a solid at room temperature. Examples are lard and butter. Saturated fats increase levels of LDL, decrease levels of HDL and increases total cholesterol. The American Heart Association recommends you limit saturated fat intake to 7-10% of your total calories.
  • Monounsaturated fat includes canola, olive and peanut oils and avocados.
  • Trans fatty acids have hydrogen added to them to give them a longer shelf life and they also tend to lower HDL levels.
  • The American Heart Association recommends eating fish two times per week. Mention other fish that contain Omega 3 fatting acids. Omega 3 fatty acids are available as a supplement but research is till being done to determine the supplements’ effectiveness.
  • People who are obese have 2 to 6 times the risk of developing hypertension even if they have no other risk factors.
  • About 2/3 of the people with diabetes die of some type of heart or blood vessel disease.
  • Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure.
  • Alcohol Consumption: In small amounts alcohol acts as a vasodilator, this is good and usually occurs in 1-2 drinks. In large amounts it acts as a vasoconstrictor which is bad. The range this occurs is 3-4 drinks. This is a very fine line. Other risk factors that may contribute to a higher risk of heart disease is an individual’s response to stress, sex hormones, and the loss of natural estrogen as women age.
  • How can you stop cardiovascular disease? The heart healthy diet is designed to decrease sodium, saturated fat, including trans fatty acids which are all closely linked to high blood cholesterol and an increased risk of heart disease. It also encourages the increased intake of monounsaturated fat, Omega 3 fatty acids and soluble fiber which helps to lower blood cholesterol levels and reduce the risk of heart disease.
  • The American Heart Association and the National Cholesterol Education Program have developed these diets to treat high blood pressure and hypercholesterolemia. The main goal is to lower LDL levels to reduce the risk of cardiovascular heart disease. These guidelines help patients reduce saturated fat and cholesterol in their diets. The difference between Step 1 and 2 is that Step 1 is carried out in a medical setting. Step 1 is the starting point.
  • Cardiovascular diseases 1

    1. 1. Cardiovascular Disease- The Silent Killer <ul><li>Dr. Gopalrao Jogdand, M.D. Ph.D. </li></ul><ul><li>Professor & Head </li></ul><ul><li>Department of Community Medicine </li></ul>
    2. 3. What is CVD? <ul><li>A general term that covers a number of diseases which affect the heart, including coronary artery disease, heart-failure and angina. </li></ul><ul><li>Heart Disease is the major killer disease in India. </li></ul>
    3. 4. Conditions included in CVD <ul><li>Ischemic heart disease (IHD). </li></ul><ul><li>Hypertension. </li></ul><ul><li>Cerebrovascular disease (Stroke). </li></ul><ul><li>Congenital heart disease, due to developmental defects include, a. patent foramen ovale. b. congenital valvular stenosis, c. congenital coarction of aorta. </li></ul><ul><li>Rheumatic heart disease. </li></ul>
    4. 5. Magnitude of the problem <ul><li>Deaths due to cardiovascular diseases. </li></ul><ul><li>Global: 16.7 million deaths globally. </li></ul><ul><li>Europe: 1 st and 2 nd leading cause of death for men and women. </li></ul><ul><li>INDIA: 2.27 million deaths due to CVD in 1990. </li></ul><ul><li>Over 5 million people suffering with CVD. </li></ul><ul><li>Prevalence: Urban- 96.7/1000, Rural- 27.1% </li></ul>
    5. 6. Trends of CVD in India <ul><li>According to NCHS document, ‘ Burden of disease in India 2005: </li></ul><ul><li>Cases of CVD may increase from about 2.9 crores to as many as 6.4 crores in 2015. </li></ul><ul><li>Deaths from CVD will be more than double. </li></ul><ul><li>Most of the increase will be due to coronary heart disease, AMI, angina CHF, and inflammatory heart diseases. </li></ul>
    6. 7. Continued…. <ul><li>Data also suggests that the prevalence of the disease will be less in the rural areas but will continue to increase, reaching around 13.5% of the rural population in the age group of 60-69% years by 2015. </li></ul><ul><li>The prevalence rates amongst younger adults 40 years and above are likely to increase. </li></ul><ul><li>Prevalence rates amongst women will keep pace with those of men across all age groups. </li></ul>
    7. 9. CVD has largest share in Non-Communicable diseases Reference NCHS data 2005 (INDIA).
    8. 11. Factors influencing CVD in Indian population <ul><li>Indians have involvement of CVD at relatively young age. </li></ul><ul><li>Anatomically Indians have smaller coronary arteries. </li></ul><ul><li>Diffuse distal disease. </li></ul><ul><li>Multi vessel disease. </li></ul><ul><li>Higher incidence in women. </li></ul>
    9. 12. What Causes Heart Disease? <ul><li>Atherosclerosis-fatty deposits of cholesterol in the blood vessels </li></ul><ul><li>Hypertension- Atherosclerotic changes in the blood vessels, secondary to certain diseases. </li></ul>
    10. 13. Coronary Heart Disease <ul><li>Occurs when the coronary arteries that supply the heart muscle become blocked. </li></ul><ul><li>Partially blocked it causes angina. </li></ul><ul><li>Fully blocked it causes a myocardial infarction or a heart attack! </li></ul>
    11. 14. Myocardial Infarction or Heart Attack <ul><li>Symptoms: Pre-cordial pain, squeezing in nature, pain radiating to the shoulders, neck and arms. </li></ul><ul><li>Chest discomfort and light headedness </li></ul><ul><li>Anxiety/nervousness </li></ul><ul><li>Paleness or pallor </li></ul><ul><li>Increased irregular heart rate </li></ul>
    12. 15. Myocardial Infarction contd…. <ul><li>Feeling of impending doom </li></ul><ul><li>If you or someone you know is having these symptoms call 911! </li></ul>
    13. 16. Congestive Heart Failure <ul><li>Fits under the description of heart disease. </li></ul><ul><li>Does not mean the heart has failed, simply means the heart is not doing an efficient job. </li></ul><ul><li>It results from an injury or a reduction of function of the heart muscle. </li></ul><ul><li>Can be due to arteriosclerosis, hypertension, myocardial infarction, rheumatic fever or birth defect. </li></ul>
    14. 17. Congestive Heart Failure <ul><li>The right side of the heart collects the blood returning from the body and sends it to the lungs. </li></ul><ul><li>If it is failing, the blood backs up into the veins, and there are signs of edema. </li></ul><ul><li>The left side of the heart receives the blood from the lungs and pumps it out into the body. If it is failing the blood is not pumped effectively. </li></ul>
    15. 18. Cerebrovascular Episode or Stroke <ul><li>Blood vessel in the brain becomes blocked by atherosclerosis- the tissue supplied by the artery dies. </li></ul><ul><li>Embolus – which is a traveling blood clot. </li></ul>
    16. 19. Symptoms of Stroke <ul><li>Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. </li></ul><ul><li>Sudden confusion, trouble speaking, or understanding. </li></ul><ul><li>Sudden trouble seeing in one or both eyes. </li></ul><ul><li>Sudden trouble walking, dizziness, loss of balance or coordination. </li></ul>
    17. 20. Symptoms of Stroke <ul><li>Sudden severe headache with no known cause. </li></ul><ul><li>If you have any of these symptoms you need immediate medical attention! </li></ul>
    18. 21. Non Modifiable Risk Factors <ul><li>Age- the older you get, the greater the chance. </li></ul><ul><li>Sex- males have a greater rate even after women pass menopause. </li></ul><ul><li>Race- Asians have a greater chance. </li></ul><ul><li>Family history- if family members have had CHD, there is a greater chance. </li></ul>
    19. 22. Continued…. <ul><li>Personal Medical History- other diseases such as Diabetes Mellitus can increase chances. </li></ul>
    20. 23. Risk Factors for CVD
    21. 24. Non modifiable risk factors <ul><li>Age: Increasing prevalence with increasing age. </li></ul><ul><li>Sex: Men suffer more frequently, in some affluent countries it is same for both sexes. </li></ul><ul><li>Family history: It shows familial predisposition. </li></ul><ul><li>Personality : Type A personality is more prone to CVD. </li></ul>
    22. 25. Modifiable Risk Factors <ul><li>Hypertension </li></ul><ul><li>Serum cholesterol </li></ul><ul><li>Obesity </li></ul><ul><li>Diabetes Mellitus </li></ul><ul><li>Physical Inactivity </li></ul><ul><li>Cigarette Smoking </li></ul><ul><li>Alcohol Intake </li></ul>
    23. 26. Hypertension <ul><li>Accelerates the process of atherosclerosis in the presence of hyperlipidaemia. </li></ul><ul><li>Uncontrolled blood pressure causes damage to the target organs. </li></ul><ul><li>Frequent cause of CVE and myocardial infarction. </li></ul>
    24. 27. Cholesterol <ul><li>Everybody needs cholesterol, it serves a vital function in the body. </li></ul><ul><li>It is a component of the nerve tissue of the brain and spinal cord as well as other major organs. </li></ul><ul><li>Frequently measured to promote health and prevent disease. </li></ul><ul><li>A major component of the plaque that clogs arteries. </li></ul>
    25. 28. Types of Cholesterol <ul><li>Lipoproteins- 4 main classes </li></ul><ul><li>Chylomicrons </li></ul><ul><li>Very low density lipoproteins (VLDL) </li></ul><ul><li>Low Density Lipoprotein (LDL) </li></ul><ul><li>High Density Lipoprotein (HDL) </li></ul>
    26. 29. Good vs. BAD <ul><li>LDL is known as bad cholesterol. It has a tendency to increase risk of CHD. </li></ul><ul><li>LDL’s are a major component of the atherosclerotic plaque that clogs arteries. </li></ul><ul><li>Levels should be <130 </li></ul>
    27. 30. Good vs. BAD <ul><li>HDL is known as the good cholesterol. </li></ul><ul><li>It helps carry some of the bad cholesterol out of the body. </li></ul><ul><li>It does not have the tendency to clog arteries. </li></ul><ul><li>Levels should be >35. </li></ul><ul><li>High levels of HDL >60 can actually negate one other risk factor. </li></ul>
    28. 31. The Facts About Fat <ul><li>Certain fats are essential for good nutrition and health. </li></ul><ul><li>Fats provide essential fatty acids which the body can’t manufacture. </li></ul><ul><li>Act as insulators to maintain body temperature. </li></ul><ul><li>Improve the palatability of food and promote digestion. </li></ul>
    29. 32. The Facts About Fat <ul><li>Provide the greatest energy output per gram of any food source. ( 9 cals) </li></ul><ul><li>Carry fat soluble vitamins- A,D,E, and K. </li></ul>
    30. 33. The Skinny on Fat <ul><li>Saturated fats- basically means the fat is saturated with hydrogen, they are solid at room temperature. Examples are lard and butter. </li></ul><ul><li>Why are they bad for you? They increase levels of LDL , decrease HDL and increase total cholesterol. </li></ul>
    31. 34. The Skinny on Fat <ul><li>What are polyunsaturated fats? They are unsaturated fats which are liquid at room temperature and in the refrigerator. </li></ul><ul><li>Why are they good for us? </li></ul><ul><li>They help the body get rid of newly formed cholesterol. </li></ul>
    32. 35. The Skinny on Fat <ul><li>What are monounsaturated fats? </li></ul><ul><li>They are liquid at room temperature but start to solidify in the refrigerator. </li></ul><ul><li>Decrease total cholesterol and lower LDL levels. </li></ul>
    33. 36. The Skinny on Fat <ul><li>What are trans fatty acids? They are unsaturated fats but they tend to raise total and bad cholesterol. </li></ul><ul><li>Where do you find them? </li></ul><ul><li>In fast-food restaurants </li></ul><ul><li>Commercial baked goods. Examples: doughnuts, potato chips, cupcakes. </li></ul>
    34. 37. What about Omega 3? <ul><li>Type of polyunsaturated fat. </li></ul><ul><li>Consistently lowers serum triglycerides and may also have an effect on lowering blood pressure. </li></ul><ul><li>Found in oily fish such as salmon, tuna, and herring. </li></ul><ul><li>Is available as a supplement. </li></ul>
    35. 38. Obesity <ul><li>People who are obese have 2 to 6 times the risk of developing hypertension. </li></ul><ul><li>Location of the body fat is significant. </li></ul><ul><li>Pears of apples? </li></ul>
    36. 39. Diabetes Mellitus <ul><li>At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of atherosclerosis! </li></ul><ul><li>Insulin is required to maintain adequate levels of lipoprotein lipase, an enzyme needed to break down bad cholesterols. </li></ul>
    37. 40. Physical Inactivity <ul><li>Increasing physical activity has been shown to decrease blood pressure. </li></ul><ul><li>Moderate to intense physical activity for 30-45 minutes on most days of the week is recommended. </li></ul>
    38. 41. Cigarette Smoking <ul><li>Causes an increase in blood pressure </li></ul><ul><li>Usually have lower levels of HDL </li></ul><ul><li>Within 1 year of quitting, CHD risk decreases, within 2 years it reaches the level of a nonsmoker. </li></ul>
    39. 42. Alcohol Consumption <ul><li>In small amounts it acts as a vasodilator-Good! 1-2 drinks </li></ul><ul><li>In large amounts it acts as a vasoconstrictor-BAD! 3-4 drinks </li></ul><ul><li>This is a very fine line! </li></ul>
    40. 43. Treatment <ul><li>Cardiac Angiography - Dr. inserts a plastic tube into an artery or vein and injects a dye, this can help to determine where the blockages are. Also a good method to determine the amount of blood and oxygen the heart is receiving. </li></ul>
    41. 44. Treatment <ul><li>Coronary Artery Bypass Surgery (CABG) </li></ul><ul><li>The most frequently performed major surgery in the world. Surgery reroutes or bypasses blood around clogged arteries. </li></ul>
    42. 45. Treatment <ul><li>Baloon Angioplasty (PCTA) </li></ul><ul><li>It involves creating a space in a blocker artery by inserting a small balloon and then inflating it. Now includes the placement of a mesh stent to improve effectiveness. </li></ul>
    43. 46. How can You Stop CVD? <ul><li>Diet and Nutrition , there are several guidelines listed by the American Heart Association: </li></ul><ul><li>Eat a variety of fruits and vegetables every day. ( 5 servings - they are naturally low in fat and high in vitamins and minerals) </li></ul><ul><li>Eat a variety of grain products ( 6 a day) </li></ul>
    44. 47. Diet and Prevention of CVD <ul><li>Choose nonfat or low-fat products. </li></ul><ul><li>Use lean meats- choose chicken, fish, turkey and lean cuts of beef and pork. </li></ul><ul><li>Switch to fat-free milk- gradually reduce the fat content of the milk you drink. </li></ul>
    45. 48. Dietary Guidelines <ul><li>Choose fats with 2 gms or less of saturated fats per serving such as liquid and tub margarines, canola oil and olive oil. </li></ul><ul><li>Balance the # of calories you eat with the number of calories you use each day. </li></ul><ul><li>Maintain a level of physical activity that keeps you fit and matches the # of calories you eat. </li></ul>
    46. 49. Dietary Guidelines <ul><li>Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks and candy. </li></ul><ul><li>Limit foods high in saturated fat, trans fat and cholesterol </li></ul><ul><li>Eat less than 6 gms of salt a day </li></ul><ul><li>Have no more than one alcoholic drink a day. </li></ul>
    47. 50. Step I and II Diets <ul><li>The AHA and NCEP have developed these diets to treat high blood pressure and hypercholesterolemia </li></ul><ul><li>They are designed to lower LDL levels, while at the same time promoting good nutrition. </li></ul>
    48. 51. Step I Step II <ul><li>Total fat- 30% or less </li></ul><ul><li>Sat fat- 7-10% </li></ul><ul><li>Poly - up to 10% </li></ul><ul><li>Mono Up to 15% </li></ul><ul><li>Carb 55% or more </li></ul><ul><li>Pro Approx 15% </li></ul><ul><li>Chol. less than 300mg </li></ul><ul><li>30% or less </li></ul><ul><li>7% </li></ul><ul><li>up to 10% </li></ul><ul><li>up to 15% </li></ul><ul><li>55% or more </li></ul><ul><li>Approx 15% </li></ul><ul><li>less than 200 mg </li></ul>
    49. 52. Exercise and CVD <ul><li>Serves several functions in preventing and treating those at high risk. </li></ul><ul><li>Reduces incidence of obesity. </li></ul><ul><li>Increases HDL </li></ul><ul><li>Lowers LDL and total cholesterol </li></ul><ul><li>Helps control diabetes and hypertension </li></ul><ul><li>Those at high risk should take part in a specially supervised program. </li></ul>
    50. 53. Conclusion <ul><li>Cardiovascular disease is the number one killer. </li></ul><ul><li>It is highly preventable and controllable with diet and exercise. </li></ul><ul><li>Good resource: </li></ul><ul><li>1-800-AHA-USA </li></ul>
    51. 54. Thank You