Atherosclerosis is a disease in which plaque builds up inside arteries, restricting blood flow. It is a leading cause of heart attacks and strokes. Symptoms may include chest pain called angina, leg pain with walking called claudication, or no symptoms at all. Risk factors include high cholesterol, smoking, diabetes, high blood pressure, obesity, physical inactivity, and family history of early heart disease. Treatment focuses on lifestyle changes and medications to control risk factors and prevent serious complications.
Blood detectives consumer health discussion guideVictoria Lynn
Blood is vital to overall health, as it transports oxygen, fights infections, and connects to every organ. Understanding blood health and conditions is important, as problems can be detected with a blood test. The documentary profiles patients with common blood-related issues like anemia, bleeding disorders, blood clots, and cancers. It also shows researchers using tools like zebrafish to study these conditions and develop new treatments.
This document discusses women and heart disease. It notes that heart disease is the leading cause of death for American women, killing nearly twice as many women as all cancers combined. However, the symptoms of a heart attack in women can differ from men and be more subtle. After menopause, women are at higher risk of heart disease due to decreasing estrogen levels. While past studies showed hormone replacement therapy could increase heart risks, newer research does not support its use for preventing heart disease. The document outlines risk factors for heart disease in women and provides guidelines for assessing personal risk levels.
As long as knowledge on inherence, diagnosis and preventive measures are limited to very few people, it is difficult to control the spread of the genetic anomaly in our population. Apart from lack of comprehensive knowledge, The findings in this study showed a high level of general awareness about the existence of SCD but comprehensive knowledge about the cause and prevention was low and associated with vast misconceptions. A large percentage did not see its importance in influencing their marital decisions. Perhaps simple interventions that worked in the western countries can also work in India.
This document discusses strategies for lowering blood pressure through diet and lifestyle changes. It recommends following the DASH diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy while restricting salt and saturated fat. Modest weight loss through the DASH diet can help normalize blood pressure. Cutting saturated and trans fats can help control weight and insulin resistance. Moderate coffee intake is recommended, as excess caffeine may raise cortisol levels and interfere with sleep quality.
Systemic lupus erythematosus (SLE) can involve all layers of the heart, including the pericardium, myocardium, valves, and coronary arteries. Patients with SLE have a 4-8 fold increased risk of developing cardiovascular disease compared to the general population. Studies have found significantly higher rates of atherosclerosis in SLE patients compared to age-matched controls, even in younger patients and those without traditional risk factors. Aggressive treatment of modifiable risk factors such as dyslipidemia, hypertension, and smoking is important for reducing cardiovascular risk in SLE patients.
This document discusses the assessment and management of vulnerabilities in patients with sickle cell disease. It outlines how sickle cell disease affects those of African, Caribbean, Middle Eastern, and other descents. Complications include stroke, gallstones, and pain crises. It is important to properly assess patients' vulnerabilities through factors like demographics, medical history, and socioeconomic barriers. The action plan involves developing individualized care plans focused on vulnerabilities, pain management, cultural competency, and compassionate care.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organs. It is more prevalent in women and African Americans. SLE symptoms vary widely and include fatigue, joint pain, skin rashes, and organ involvement such as lupus nephritis. Treatment involves managing symptoms, decreasing inflammation and immunosuppression. Prognosis has improved but lupus still increases risks of heart disease, strokes and disability. Maintaining a healthy lifestyle may help prevent SLE onset or progression.
Diabetes increases the risk of atherosclerosis and heart disease through metabolic abnormalities like high blood sugar and insulin resistance. These alterations affect the function of endothelial cells, platelets, and smooth muscle cells in the arteries, leading to atherosclerosis and destruction of the arteries. A typical type 2 diabetic patient has equal risk of future heart attack as a past heart attack survivor without any other heart problems. Over 75% of people with diabetes die from coronary atherosclerosis and managing diabetes involves following a healthy diet, regular exercise, medication adherence, and regular blood glucose testing.
Blood detectives consumer health discussion guideVictoria Lynn
Blood is vital to overall health, as it transports oxygen, fights infections, and connects to every organ. Understanding blood health and conditions is important, as problems can be detected with a blood test. The documentary profiles patients with common blood-related issues like anemia, bleeding disorders, blood clots, and cancers. It also shows researchers using tools like zebrafish to study these conditions and develop new treatments.
This document discusses women and heart disease. It notes that heart disease is the leading cause of death for American women, killing nearly twice as many women as all cancers combined. However, the symptoms of a heart attack in women can differ from men and be more subtle. After menopause, women are at higher risk of heart disease due to decreasing estrogen levels. While past studies showed hormone replacement therapy could increase heart risks, newer research does not support its use for preventing heart disease. The document outlines risk factors for heart disease in women and provides guidelines for assessing personal risk levels.
As long as knowledge on inherence, diagnosis and preventive measures are limited to very few people, it is difficult to control the spread of the genetic anomaly in our population. Apart from lack of comprehensive knowledge, The findings in this study showed a high level of general awareness about the existence of SCD but comprehensive knowledge about the cause and prevention was low and associated with vast misconceptions. A large percentage did not see its importance in influencing their marital decisions. Perhaps simple interventions that worked in the western countries can also work in India.
This document discusses strategies for lowering blood pressure through diet and lifestyle changes. It recommends following the DASH diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy while restricting salt and saturated fat. Modest weight loss through the DASH diet can help normalize blood pressure. Cutting saturated and trans fats can help control weight and insulin resistance. Moderate coffee intake is recommended, as excess caffeine may raise cortisol levels and interfere with sleep quality.
Systemic lupus erythematosus (SLE) can involve all layers of the heart, including the pericardium, myocardium, valves, and coronary arteries. Patients with SLE have a 4-8 fold increased risk of developing cardiovascular disease compared to the general population. Studies have found significantly higher rates of atherosclerosis in SLE patients compared to age-matched controls, even in younger patients and those without traditional risk factors. Aggressive treatment of modifiable risk factors such as dyslipidemia, hypertension, and smoking is important for reducing cardiovascular risk in SLE patients.
This document discusses the assessment and management of vulnerabilities in patients with sickle cell disease. It outlines how sickle cell disease affects those of African, Caribbean, Middle Eastern, and other descents. Complications include stroke, gallstones, and pain crises. It is important to properly assess patients' vulnerabilities through factors like demographics, medical history, and socioeconomic barriers. The action plan involves developing individualized care plans focused on vulnerabilities, pain management, cultural competency, and compassionate care.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organs. It is more prevalent in women and African Americans. SLE symptoms vary widely and include fatigue, joint pain, skin rashes, and organ involvement such as lupus nephritis. Treatment involves managing symptoms, decreasing inflammation and immunosuppression. Prognosis has improved but lupus still increases risks of heart disease, strokes and disability. Maintaining a healthy lifestyle may help prevent SLE onset or progression.
Diabetes increases the risk of atherosclerosis and heart disease through metabolic abnormalities like high blood sugar and insulin resistance. These alterations affect the function of endothelial cells, platelets, and smooth muscle cells in the arteries, leading to atherosclerosis and destruction of the arteries. A typical type 2 diabetic patient has equal risk of future heart attack as a past heart attack survivor without any other heart problems. Over 75% of people with diabetes die from coronary atherosclerosis and managing diabetes involves following a healthy diet, regular exercise, medication adherence, and regular blood glucose testing.
This document discusses systemic lupus erythematosus (SLE) and its effects on the heart. SLE is a chronic inflammatory disease that can affect multiple organs, including the heart. It can cause valvular heart disease, pericarditis, myocarditis, and conduction defects. SLE is also associated with an increased risk of accelerated atherosclerosis and coronary heart disease. Reasons for this include traditional risk factors, steroid use, inflammation from SLE, and certain autoantibodies that affect blood vessels and cholesterol levels. Screening and monitoring of cardiac involvement is important for lupus patients.
lifestyle choices and Coronary Heart Disease
Presented by
Supervisor of surgical department
Salah Nazar Abdulwahhab
Bachelor of Nursing
اعـــــــداد وتقديم
الممرض الجامعي
صـلاح نــزار عبد الوهاب الحمداني
The Healing Hearts program seeks to prevent recurrences of coronary artery disease (CAD) through community centers that teach healthy lifestyle habits. CAD remains a leading cause of death in the US. Millions are at increased risk from inactivity and unhealthy diets. The program aims to reduce CAD rates in Texas, which has a high prevalence. It would teach individuals who have received CAD treatments about diet, exercise, and lifestyle changes to prevent future incidents through mobile apps and education.
NIH Presentation Nutritional Counseling and Dietetics Practice in Sickle Cell...jeananno
This document summarizes current knowledge about nutrition and nutritional deficiencies in patients with sickle cell disease. It finds that sickle cell patients have increased caloric and protein needs due to higher resting energy expenditure and protein turnover. Many nutrients are commonly deficient, including vitamins A, C, D, folate, calcium, magnesium, zinc, and amino acids like arginine and glutamine. Dietary intake of nutrients often declines with age. Nutritional counseling and supplementation may help address deficiencies and improve outcomes in sickle cell disease.
Coronary Artery Disease and Menopause: A Consequence of Adverse Lipid Changesiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Sickle cell disease is a genetic blood disorder that affects hemoglobin, causing red blood cells to take on a sickle shape. It occurs most often in those with African or Hispanic ancestry. The most severe type is sickle cell anemia, where two copies of the sickle cell gene are inherited. Symptoms include pain crises, acute chest syndrome, and organ damage from blocked blood flow. Treatment focuses on pain management, antibiotics for infections, hydration, and hydroxyurea to reduce symptoms. Nurses play an important role in education, comprehensive care, and advocacy for those with sickle cell disease.
This document defines heart failure as the inability of the heart to pump adequately to meet metabolic demands or leave 40% of blood in its chambers. It discusses the epidemiology, causes, pathophysiology, types, clinical manifestations, diagnosis, treatment, and complications of heart failure. Key points are that heart failure prevalence is increasing with age globally, common causes include hypertension and heart attacks, and treatments involve medications, surgery, and lifestyle changes while managing complications risks.
This document discusses sickle cell crises, which are medical emergencies that can occur in people with sickle cell disease. It describes the four main types of sickle cell crises: splenic sequestration crisis, hemolytic crisis, aplastic crisis, and vaso-occlusive crisis. The vaso-occlusive crisis, where abnormal sickle cells get stuck in small blood vessels and cut off blood flow, is the most common cause of complications in sickle cell disease and can cause pain all over the body. The document provides some details on the signs, symptoms, and treatments for each type of sickle cell crisis.
Pre eclampsia and future cv risk among women ahmed jacc 2014Emidia Felipe
Pre-eclampsia is a pregnancy complication characterized by hypertension and proteinuria that affects 2-8% of pregnancies worldwide. This review examines the association between pre-eclampsia and future cardiovascular risk. It finds that women with a history of pre-eclampsia have a doubled risk of future cardiovascular disease. They are also more likely to develop risk factors like hypertension and metabolic syndrome. Long-term studies tracking women for over 15 years found those with pre-eclampsia had higher rates of heart disease, heart attacks, and stroke compared to those without pre-eclampsia. Therefore, pre-eclampsia identifies women who would benefit from closer monitoring and management of their cardiovascular health long after their pregnancy.
This document provides information about hemophilia, an inherited bleeding disorder caused by deficient or defective clotting factors. It defines hemophilia and describes its causes, types (A, B, C), signs/symptoms, diagnostic evaluation, management, research, complications, and lifestyle recommendations. The main points are that hemophilia prevents proper blood clotting, leading to excessive bleeding from minor injuries; it is inherited through families via the X chromosome; and treatment involves replacing the missing clotting factor through medicines, therapies, and avoiding risky activities.
Leukemia is a type of blood cancer that begins in the bone marrow and is characterized by an abnormal increase in white blood cells. The exact cause is unknown but genetic factors, infections, and environmental exposures are associated with increased risk. Leukemia is classified as either acute or chronic and as affecting myeloid or lymphoid cells. Common symptoms include fatigue, fever, easy bruising and bleeding. Treatment involves chemotherapy, radiation therapy, stem cell transplants or splenectomy depending on the classification and severity.
THIS PPT INCLUDES THE GENETIC DISORDERS SUCH AS, DOWNS SYNDROME, KLINFELTER SYNDROME, TURNERS SYNDROME, ETC. I TRIED TO PUT ALL INFORMATION IN THIS SLIDES. IF ANY SUGGESTION TO IMPROVE THIS PLESE SUGGEST ME IN SUGGESTION BOX. GIVE YOUR LIKES AND COMMENT.
- Atherosclerosis is a chronic inflammatory disease arising from an imbalance in lipid metabolism and inflammation.
- Statin treatment and preventive measures are modifying atherosclerotic plaques and clinical presentation.
- Recent evidence suggests that thin-capped, lipid-rich plaques rarely rupture to cause events. Multiple active plaques often exist, and erosion may be an under-recognized cause of thrombosis.
To Treat or Not to Treat.
This is a frequent question we encounter in practice. Here's looking into the latest studies on whether treating patients with Asymptomatic Hyperuricemia with urate lowering therapy helps improves cardiovascular outcomes.
Sickle cell disease registry and prevalence of sickle cell disease in kenya b...Kesho Conference
This document discusses the feasibility of establishing a sickle cell disease registry and determining the prevalence of sickle cell disease in Kenya. It begins with background information on sickle cell disease, including its genetic inheritance and global burden. It advocates for a national sickle cell disease control program in Kenya to improve education, care, and research. The proposed registry aims to describe patient demographics, care received, and establish a database. It outlines methods for gradual implementation across hospitals while disseminating educational materials to healthcare providers and communities. Determining the feasibility of these efforts could help establish the first steps towards managing sickle cell disease in Kenya.
Leukemia is a malignant disease where the bone marrow and blood-forming organs produce abnormal white blood cells. This suppresses normal blood cell production and can lead to anemia. Risk factors include exposure to radiation, certain chemicals like benzene, chemotherapy for other cancers, genetic disorders like Down syndrome, and smoking. Treatments include chemotherapy, biological therapy, targeted therapy, radiation therapy, and stem cell transplants. While most causes are unknown, exposure to certain risks like radiation, benzene, smoking, and some chemotherapy can be avoided to potentially prevent some types of leukemia.
This document discusses gender differences in cardiac care. It summarizes findings from a study that used MRI scans to analyze how male and female hearts change with age. The study found significant differences: the male heart muscle grows thicker with age while the female heart retains its size or gets slightly smaller. This has implications for the types of heart failure seen in each gender and indicates a need for gender-specific treatments. Currently, diagnostics and treatments are often developed based on the male heart model. The study suggests men and women may develop heart disease for different reasons.
Thalassemia is an inherited blood disorder characterized by less oxygen-carrying haemoglobin and fewer red blood cells. It is caused by genetic mutations that affect haemoglobin synthesis. Common symptoms include fatigue, weakness, and pale skin. Treatment involves frequent blood transfusions, chelation therapy to remove excess iron, and possibly stem cell transplants. The project describes the history, signs, and treatment of thalassemia with a case study example. It aims to increase understanding of this genetic blood disorder.
Leukemia is a type of cancer that affects the blood and bone marrow. It results from abnormal proliferation of white blood cells. There are four main types of leukemia - acute lymphocytic leukemia, acute myelogenous leukemia, chronic lymphocytic leukemia, and chronic myelogenous leukemia. Leukemia is treated through chemotherapy, targeted therapy, radiation therapy or stem cell transplant depending on the type and stage of leukemia. Nursing care focuses on managing side effects of treatment, preventing infections, maintaining nutrition, providing education and supporting the psychological needs of the patient.
Coronary artery disease, also known as atherosclerosis, is the leading cause of death in the United States. It occurs when plaque builds up in the arteries and decreases blood flow to the heart, which can lead to chest pain, heart attack, or heart failure. Some major risk factors include smoking, high blood pressure, diabetes, and high cholesterol. Nurses play an important role in educating patients on modifying risks like diet, exercise, and medication adherence to help prevent cardiovascular events.
Coronary artery disease (CAD) occurs when the coronary arteries become narrowed or blocked, limiting blood flow to the heart. A seminar on CAD covered its definition, causes like smoking and high cholesterol, symptoms like chest pain, diagnostic tests, and management. CAD develops over many years as plaques build up in the arteries. It is the most common cause of death globally.
This document discusses systemic lupus erythematosus (SLE) and its effects on the heart. SLE is a chronic inflammatory disease that can affect multiple organs, including the heart. It can cause valvular heart disease, pericarditis, myocarditis, and conduction defects. SLE is also associated with an increased risk of accelerated atherosclerosis and coronary heart disease. Reasons for this include traditional risk factors, steroid use, inflammation from SLE, and certain autoantibodies that affect blood vessels and cholesterol levels. Screening and monitoring of cardiac involvement is important for lupus patients.
lifestyle choices and Coronary Heart Disease
Presented by
Supervisor of surgical department
Salah Nazar Abdulwahhab
Bachelor of Nursing
اعـــــــداد وتقديم
الممرض الجامعي
صـلاح نــزار عبد الوهاب الحمداني
The Healing Hearts program seeks to prevent recurrences of coronary artery disease (CAD) through community centers that teach healthy lifestyle habits. CAD remains a leading cause of death in the US. Millions are at increased risk from inactivity and unhealthy diets. The program aims to reduce CAD rates in Texas, which has a high prevalence. It would teach individuals who have received CAD treatments about diet, exercise, and lifestyle changes to prevent future incidents through mobile apps and education.
NIH Presentation Nutritional Counseling and Dietetics Practice in Sickle Cell...jeananno
This document summarizes current knowledge about nutrition and nutritional deficiencies in patients with sickle cell disease. It finds that sickle cell patients have increased caloric and protein needs due to higher resting energy expenditure and protein turnover. Many nutrients are commonly deficient, including vitamins A, C, D, folate, calcium, magnesium, zinc, and amino acids like arginine and glutamine. Dietary intake of nutrients often declines with age. Nutritional counseling and supplementation may help address deficiencies and improve outcomes in sickle cell disease.
Coronary Artery Disease and Menopause: A Consequence of Adverse Lipid Changesiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Sickle cell disease is a genetic blood disorder that affects hemoglobin, causing red blood cells to take on a sickle shape. It occurs most often in those with African or Hispanic ancestry. The most severe type is sickle cell anemia, where two copies of the sickle cell gene are inherited. Symptoms include pain crises, acute chest syndrome, and organ damage from blocked blood flow. Treatment focuses on pain management, antibiotics for infections, hydration, and hydroxyurea to reduce symptoms. Nurses play an important role in education, comprehensive care, and advocacy for those with sickle cell disease.
This document defines heart failure as the inability of the heart to pump adequately to meet metabolic demands or leave 40% of blood in its chambers. It discusses the epidemiology, causes, pathophysiology, types, clinical manifestations, diagnosis, treatment, and complications of heart failure. Key points are that heart failure prevalence is increasing with age globally, common causes include hypertension and heart attacks, and treatments involve medications, surgery, and lifestyle changes while managing complications risks.
This document discusses sickle cell crises, which are medical emergencies that can occur in people with sickle cell disease. It describes the four main types of sickle cell crises: splenic sequestration crisis, hemolytic crisis, aplastic crisis, and vaso-occlusive crisis. The vaso-occlusive crisis, where abnormal sickle cells get stuck in small blood vessels and cut off blood flow, is the most common cause of complications in sickle cell disease and can cause pain all over the body. The document provides some details on the signs, symptoms, and treatments for each type of sickle cell crisis.
Pre eclampsia and future cv risk among women ahmed jacc 2014Emidia Felipe
Pre-eclampsia is a pregnancy complication characterized by hypertension and proteinuria that affects 2-8% of pregnancies worldwide. This review examines the association between pre-eclampsia and future cardiovascular risk. It finds that women with a history of pre-eclampsia have a doubled risk of future cardiovascular disease. They are also more likely to develop risk factors like hypertension and metabolic syndrome. Long-term studies tracking women for over 15 years found those with pre-eclampsia had higher rates of heart disease, heart attacks, and stroke compared to those without pre-eclampsia. Therefore, pre-eclampsia identifies women who would benefit from closer monitoring and management of their cardiovascular health long after their pregnancy.
This document provides information about hemophilia, an inherited bleeding disorder caused by deficient or defective clotting factors. It defines hemophilia and describes its causes, types (A, B, C), signs/symptoms, diagnostic evaluation, management, research, complications, and lifestyle recommendations. The main points are that hemophilia prevents proper blood clotting, leading to excessive bleeding from minor injuries; it is inherited through families via the X chromosome; and treatment involves replacing the missing clotting factor through medicines, therapies, and avoiding risky activities.
Leukemia is a type of blood cancer that begins in the bone marrow and is characterized by an abnormal increase in white blood cells. The exact cause is unknown but genetic factors, infections, and environmental exposures are associated with increased risk. Leukemia is classified as either acute or chronic and as affecting myeloid or lymphoid cells. Common symptoms include fatigue, fever, easy bruising and bleeding. Treatment involves chemotherapy, radiation therapy, stem cell transplants or splenectomy depending on the classification and severity.
THIS PPT INCLUDES THE GENETIC DISORDERS SUCH AS, DOWNS SYNDROME, KLINFELTER SYNDROME, TURNERS SYNDROME, ETC. I TRIED TO PUT ALL INFORMATION IN THIS SLIDES. IF ANY SUGGESTION TO IMPROVE THIS PLESE SUGGEST ME IN SUGGESTION BOX. GIVE YOUR LIKES AND COMMENT.
- Atherosclerosis is a chronic inflammatory disease arising from an imbalance in lipid metabolism and inflammation.
- Statin treatment and preventive measures are modifying atherosclerotic plaques and clinical presentation.
- Recent evidence suggests that thin-capped, lipid-rich plaques rarely rupture to cause events. Multiple active plaques often exist, and erosion may be an under-recognized cause of thrombosis.
To Treat or Not to Treat.
This is a frequent question we encounter in practice. Here's looking into the latest studies on whether treating patients with Asymptomatic Hyperuricemia with urate lowering therapy helps improves cardiovascular outcomes.
Sickle cell disease registry and prevalence of sickle cell disease in kenya b...Kesho Conference
This document discusses the feasibility of establishing a sickle cell disease registry and determining the prevalence of sickle cell disease in Kenya. It begins with background information on sickle cell disease, including its genetic inheritance and global burden. It advocates for a national sickle cell disease control program in Kenya to improve education, care, and research. The proposed registry aims to describe patient demographics, care received, and establish a database. It outlines methods for gradual implementation across hospitals while disseminating educational materials to healthcare providers and communities. Determining the feasibility of these efforts could help establish the first steps towards managing sickle cell disease in Kenya.
Leukemia is a malignant disease where the bone marrow and blood-forming organs produce abnormal white blood cells. This suppresses normal blood cell production and can lead to anemia. Risk factors include exposure to radiation, certain chemicals like benzene, chemotherapy for other cancers, genetic disorders like Down syndrome, and smoking. Treatments include chemotherapy, biological therapy, targeted therapy, radiation therapy, and stem cell transplants. While most causes are unknown, exposure to certain risks like radiation, benzene, smoking, and some chemotherapy can be avoided to potentially prevent some types of leukemia.
This document discusses gender differences in cardiac care. It summarizes findings from a study that used MRI scans to analyze how male and female hearts change with age. The study found significant differences: the male heart muscle grows thicker with age while the female heart retains its size or gets slightly smaller. This has implications for the types of heart failure seen in each gender and indicates a need for gender-specific treatments. Currently, diagnostics and treatments are often developed based on the male heart model. The study suggests men and women may develop heart disease for different reasons.
Thalassemia is an inherited blood disorder characterized by less oxygen-carrying haemoglobin and fewer red blood cells. It is caused by genetic mutations that affect haemoglobin synthesis. Common symptoms include fatigue, weakness, and pale skin. Treatment involves frequent blood transfusions, chelation therapy to remove excess iron, and possibly stem cell transplants. The project describes the history, signs, and treatment of thalassemia with a case study example. It aims to increase understanding of this genetic blood disorder.
Leukemia is a type of cancer that affects the blood and bone marrow. It results from abnormal proliferation of white blood cells. There are four main types of leukemia - acute lymphocytic leukemia, acute myelogenous leukemia, chronic lymphocytic leukemia, and chronic myelogenous leukemia. Leukemia is treated through chemotherapy, targeted therapy, radiation therapy or stem cell transplant depending on the type and stage of leukemia. Nursing care focuses on managing side effects of treatment, preventing infections, maintaining nutrition, providing education and supporting the psychological needs of the patient.
Coronary artery disease, also known as atherosclerosis, is the leading cause of death in the United States. It occurs when plaque builds up in the arteries and decreases blood flow to the heart, which can lead to chest pain, heart attack, or heart failure. Some major risk factors include smoking, high blood pressure, diabetes, and high cholesterol. Nurses play an important role in educating patients on modifying risks like diet, exercise, and medication adherence to help prevent cardiovascular events.
Coronary artery disease (CAD) occurs when the coronary arteries become narrowed or blocked, limiting blood flow to the heart. A seminar on CAD covered its definition, causes like smoking and high cholesterol, symptoms like chest pain, diagnostic tests, and management. CAD develops over many years as plaques build up in the arteries. It is the most common cause of death globally.
This document discusses differences in heart disease between men and women. It notes that while heart disease has historically been viewed as a male issue, women now surpass men in both prevalence and mortality from cardiovascular diseases. The document outlines several key differences in pathophysiology, disease presentation, and risk factors between men and women, including differences in plaque formation, hypertension prevalence, and biomarker expression during acute coronary events. Modifiable risk factors like smoking confer higher risk to women than men. Nonmodifiable factors like family history and age also impact risk differently between sexes.
The cardiovascular system is made up of the heart and blood vesselsArooj Attique
Cardiovascular disease (CVD) refers to conditions that involve narrowed or blocked blood vessels that can lead to reduced blood flow. CVD includes numerous conditions such as coronary heart disease, stroke, peripheral artery disease, congenital heart disease, and others. Risk factors for CVD include high blood pressure, high cholesterol, smoking, diabetes, obesity, physical inactivity, and family history of early heart disease. CVD can be prevented by treating risk factors and maintaining a healthy lifestyle through diet, exercise, not smoking, and managing conditions like diabetes.
Here’s Why Heart Problems Are Rising Among Young Indians.pdfShivam Shad
Heart disease (the umbrella term for which heart attack is one subset) kills nearly one in every five adults between the ages of 25 and 64. Young men are the most vulnerable, while young women are vulnerable in a unique way: while men are more likely to have a heart attack, young women are 1.6 times more likely to die in the year following a heart attack. Dr. Sujay Shad, Best Cardiac Surgeon in India at Sir Ganga Ram Hospital, also added that, ‘women are more likely than men to have diabetes which increases the risk of complications from a cardiac attack’.
Basic Science and Forensic Pathology Aspects of AtherosclerosisLuchengam
This document discusses the basics of atherosclerosis from a pathology perspective. It begins by defining different types of arteriosclerosis, focusing on atherosclerosis. It then covers the epidemiology and risk factors for atherosclerosis, including constitutional factors like age and gender as well as modifiable factors like hyperlipidemia, hypertension, smoking, and diabetes. Finally, it discusses the pathogenesis of atherosclerosis according to the response-to-injury hypothesis, whereby endothelial injury allows for accumulation of lipids and inflammatory cells in the artery wall, leading to plaque formation.
Basic Science and Forensic Pathology Aspects of AtherosclerosisLuchengam
This document discusses atherosclerosis and its risk factors. It begins by defining different types of arteriosclerosis, focusing on atherosclerosis. It then discusses the epidemiology and risk factors for atherosclerosis, including constitutional factors like age, gender and genetics. Major modifiable risk factors include hyperlipidemia, hypertension, smoking and diabetes. Inflammation is also noted as an additional risk factor linked to atherosclerosis development and progression. The document provides detailed information on each of these risk factors and their relationships to atherosclerotic disease.
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack).Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.
The document discusses the pathogenesis of atherosclerosis. It begins by describing the normal structure of blood vessel walls, which are composed of three layers. It then explains that atherosclerosis is characterized by endothelial dysfunction, inflammation, and buildup of lipids and other substances within the vessel wall. Over time, this buildup forms plaques that protrude into the vessel lumen. The major risk factors for atherosclerosis are described as age, male sex, genetics, hyperlipidemia, hypertension, smoking, and diabetes. The document concludes by outlining the multi-step process of how atherosclerotic lesions develop, starting with initial endothelial injury and progressing to smooth muscle cell proliferation and inflammation.
Crimson Publishers- Aging Heart: Recent Research and Concepts CrimsonPublishersGGS
This document discusses how aging is the most important risk factor for cardiovascular disease. It notes that the risk and incidence of cardiovascular events increases exponentially with age, with older adults accounting for the majority of cases of heart disease. It also discusses how lifestyle factors like hypertension, diabetes, and smoking interact with the intrinsic aging of the heart and blood vessels to increase oxidative stress and susceptibility to injury over time. This leads to changes in cardiovascular structure and function that raise the risk of cardiovascular morbidity and mortality in older adults.
ATHEROSCLEROSIS
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
Hypertension can lead to several serious health conditions:
1. It increases the risk of heart disease by damaging blood vessels and causing the heart to work harder, which can lead to left ventricular hypertrophy, heart failure, and coronary artery disease with heart attacks.
2. It is a major risk factor for stroke by damaging blood vessels in the brain.
3. It can cause aneurysms by weakening artery walls over time, potentially leading to ruptures with internal bleeding.
(Prevention And Control Of Coronary Heart DiseasesTamanna Rahman
Coronary heart disease is a major cause of death in the United States, claiming over 370,000 lives annually. It is caused by plaque buildup in the arteries that supply the heart with blood and oxygen. This buildup narrows the arteries and reduces blood flow to the heart. Risk factors include diabetes, high blood pressure, high cholesterol, obesity, lack of exercise, stress, and smoking. Symptoms may include chest pain and shortness of breath. Prevention strategies involve lifestyle changes like a healthy diet, exercise, weight management, and not smoking. Seeking medical help is recommended if symptoms occur.
The word “hypertension” means regular increase in arterial pressure. Blood pressure is increased when arteries and arterioles are narrowed. Arteries are like water channels feeding the earth and connecting the seas. But in a human body they are filled with the blood circulating between the heart and other bodies. Vasoconstriction may be observed because of regular spasms. The vessels remain narrowed due to thickenings of arterial walls.
Blood pressure is the pressure of circulating blood on blood vessel walls. Abnormal blood pressure and cardiovascular issues are major causes of chronic diseases in men. The normal blood pressure range for men depends on factors like age and time of measurement. Men under 50 typically have a systolic blood pressure of 108-90 and a diastolic blood pressure of 65-48 during the day and night, respectively. Men over 50 typically have a systolic blood pressure of 108-87 and a diastolic blood pressure of 65-50 during the day and night. Maintaining a healthy lifestyle and regular blood pressure monitoring can help men stay within a normal blood pressure range and reduce health risks.
High or low blood pressure may be the symptom of many diseases and pathologies. Control and a regular blood pressure measurement help to timely start a drug treatment and reducing the risk for health.
If you have high blood pressure, it does not mean that you should use anti-hypertensive pills right away. There are many natural ways to lower blood pressure.
Home remedies for high blood pressure instantlyIshita Patel
According to data of American Heart Association, over 74 millions of people have high blood pressure (hypertension). The danger of hypertension lies in that this disease poses a serious risk for the cardiovascular system.
Systolic pressure refers to the pressure in the blood vessels when the heart contracts and pushes blood into the arteries. It normally increases with age. Abnormal systolic pressure is a major risk factor for conditions like heart disease and stroke. Symptoms of high systolic pressure include dizziness and headaches, while low systolic pressure causes reduced energy and concentration problems. Maintaining a normal systolic pressure of 120 mm Hg or lower through lifestyle changes like exercise, diet, avoiding smoking and limiting alcohol can help control blood pressure without medication for many people. For those who need medication, doctors can prescribe different drug classes including diuretics and ACE inhibitors to safely stabilize systolic pressure.
High blood pressure is also known as hypertension. Blood pressure is the amount of force exerted against the walls of the arteries as blood flows through them.
Every year, nearly five million Americans need blood transfusions. An estimated 43,000 pints (or units) of donated blood are used each day in the United States, and one in seven people entering the hospital needs blood. Women are critical to the country’s blood supply, since their role as caregivers sends a message that donating blood is the right thing to do. However, they are also more likely than men to be temporarily restricted from donating because of low hematocrit, or red blood cell levels if they are still menstruating.
Blood donation and transfusion guidelinesIshita Patel
Every year, nearly five million Americans need blood transfusions. An estimated 43,000 pints (or units) of donated blood are used each day in the United States, and one in seven people entering the hospital needs blood. Women are critical to the country’s blood supply, since their role as caregivers sends a message that donating blood is the right thing to do. However, they are also more likely than men to be temporarily restricted from donating because of low hematocrit, or red blood cell levels if they are still menstruating.
Since the U.S. Food and Drug Administration (FDA) approved “the pill” in 1960, it has become the most popular and one of the most effective forms of reversible birth control ever invented. According to The Guttmacher Institute, among U.S. women who use birth control, more than 27 percent use the pill. A 2013 National Health Statistics Report says that 82 percent of women who use contraceptionhave used the pill at some point.e most popular and one of the most effective forms of reversible birth control ever invented. According to Planned Parenthood, among U.S. couples who use birth control, more than 30 percent use the pill.
Most men consider care to prevent pregnancy feminine duty. And yet, to take active part in the defense of their partners from unintended pregnancy, men can and should. Here are some examples of all currently existing methods of male contraception. Let’s consider the most common and used methods of methods of birth control for men and check their efficacy profile.
After 45-50 years of age, you can feel certain natural changes of health state: from well-known vasomotor disorders to essentially affecting the life quality and potential reasons of serious health problems (cardiovascular diseases and osteoporosis). At the same time, women of mature age have got their life experience and they have reached their career top, however, worsening of health state make them avoid any communication and even leave their job position. With estimation of their healthy life way and their care of own health which are the base of good health state in senior age, it should be noted that a good advice in the period of adaptation to a new stage of life is necessary for any woman. And if in the XIX century there was no reason to discuss this problem, because an average woman’s life did not exceed forty years, nowadays success of modern medicine put new tasks.
Activity of female reproductive system is controlled by sex glands: ovaries produced the female sex hormones, such as estrogen and progesterone. Influence of sex hormones is evident in the development of so-called secondary sexual character: constitution, breast, typical female hair pattern.
Hormones are chemical agents, transmitters among different tissues of our organism. Hormones are produced by the endocrine glands. For example, sex hormones are produced mainly by ovaries and in insignificant quantity by adrenal glands. Hormones penetrate in the blood and make a targeted organ start its function activity or stop its work. The blood contains a large quantity of various biologically active agents at the same time, however, different hormones find their targeted organs. How it is going on?
When using oral contraceptives (oral pills), chances of getting pregnant do not exceed 1%. The duration of using oral pills does not affect the chances of getting pregnant. Therefore, women can take oral pills for many years, without worrying about unplanned pregnancy.
The absolute majority of mature women use hormonal contraceptives to prevent pregnancy. When planning a pregnancy, many women are wondering «How effective is birth control?
Bipolar disorder is a mental illness marked by extreme mood swings from high (mania) to low (depression) and low to high. The mood swings may even become mixed, so you might feel elated and depressed at the same time.
Biofeedback is a technique that teaches people how to control involuntary bodily functions like breathing, muscle tension, and heart rate through the use of electronic or electromechanical devices that provide feedback on these physiological processes. It involves learning to control external signals and eventually internal cues to gain awareness and control over one's body. Biofeedback sessions with a trained professional typically involve sensors attached to the body to monitor functions and provide audio or visual feedback to help the individual learn control through relaxation techniques and practice. While not a cure, biofeedback has been shown to help treat various conditions involving muscle tension and stress and is gaining wider acceptance in mainstream healthcare.
1. The document provides information on self-care options for lower back pain, which is very common and costly.
2. It recommends trying ice or heat, rest, gentle exercise, alternative treatments like acupuncture, and over-the-counter or prescription medications to manage pain.
3. Maintaining good posture, losing weight, reducing stress, and heat/cold therapy can also help lower back pain.
Many men experience symptoms of erectile dysfunction (ED) as they age. Also known as impotence, ED is an occasional (or prolonged) inability to get or maintain an erection. When ED occurs frequently, you might need treatment for an underlying health issue.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
1. ATHEROSCLEROSIS TREATMENT
Overview
Diseasescausedbyatherosclerosisare the leadingcause of illnessanddeathforbothmenand women
inthe UnitedStates,accordingtothe National Heart,Lung,andBloodInstitute.Althoughbreastcancer
isoftenthe illnessmostfearedbywomen,the disease affectsone outof eightwomenoverthe lifetime,
comparedto coronaryheart disease,whichisresponsibleformore thanone inthree female deathsin
America.Atherosclerosisisoftenthe firststage of coronaryheartdisease (CHD).
Oftenreferredtoas“hardeningof the arteries,”atherosclerosisoccurswhenyourarteriesnarrowand
become lessflexible.Thishappenswhencholesterol,fattysubstances,cell waste products,calciumand
fibrin—collectivelycalledplaque—collectonthe innerwalls.The arteriesrespondtothe buildupby
becominginflamed,which,inturn,resultsinthe formationof scartissue andthe collectionof othercells
inthe affectedareas,furthernarrowingthe artery.
Atherosclerosiscanaffectmediumandlarge arteriesanywhereinyourbody.If someone has
atherosclerosisinone partof theirbody,theytypicallywillhave atherosclerosisinotherpartsof their
bodies.Atherosclerosisrestrictsbloodflow,thuslimitingthe amountof oxygenavailabletoyourorgans.
Whenbloodflowtothe heart isreduced,forinstance,chestpain,orangina,mayresult.Similarly,when
bloodflowtothe arteriesinthe legsisreduced,legpaincalledclaudicationmayresult.
As the disease progresses,atherosclerosiscancompletelyclogarteries,cuttingoff bloodflow.This
usuallyhappenssuddenlywhenabloodclotformsinthe damagedarteriesontopof the
atherosclerosis.Thisisespeciallydangerousinarteriesnearthe brain,heartorothervital organs.If
bloodflowtothe heart isnearlyor completelyblocked,aheartattack resultsandmuscle cellsinthe
heartdie.The resultispermanentheartdamage.Similarly,if bloodflow isabruptlycutoff tothe brain,
thiscan cause a stroke,whichmay alsoresultinpermanentbraindamage.Andif bloodflow isabruptly
cut off to the legs,the legmay have tobe amputated.Thusatherosclerosiscanleadtoseriouslife-
threateningcomplicationsif notaddressedearlythroughpreventionandearlytreatment.
Atheroscleroticplaqueshave acholesterol- orlipid-richcore coveredbyafibrouscap.If thiscap
ruptures,itexposesthislipid-richcore toblood.The stickycore attractsplatelets,formingabloodclot,
calleda thrombus,atthe site.Thisclot can completelyclogthe arteryandcut off bloodflow.
More mature plaques(stable plaques) have athickfibrouscap,whichislesslikelytorupture.Softer,
fattierplaques(unstable plaques) have aweakercapandare more likelytorupture.
Surprisingly, the majorityof heartattacksoccur inarteriesthat were lessthan50 percentblocked
before the attack.So the degree of blockage ina particulararterydoesnotnecessarilypredictheart
attack risk.However,the overall total burdenof atherosclerosis throughoutall the arteriesdoesaffect
your riskof a heartattack.
2. We don’tknowwhatcausesplaque tobeginbuildingupinarteries.Some expertsthinkplaquebeginsto
accumulate inplaceswhere the innerlayerof anarteryis damaged.
The specificarteriesmostatriskfor atherosclerosis-inducedblockage are those goingtoyourbrain
(carotid),heart(coronary) andlegs(femoral oriliac).Atherosclerosisinthe legsisthe mostcommon
formof peripheral arterial disease (PAD)andcanleadto intermittentclaudication—severe pain,aching
or crampingwhenwalking,numbness,reducedcirculation,andif leftuntreated,gangrene (deathof
tissue).
While atherosclerosistypicallyprogressesgradually—sometimesevenstartinginchildhood—youare
mostat riskwhenarterial blockage buildsupquickly,completelyclosingoff anartery.Thiscan happenif
the plaque ruptures.
Risk Factors for Atherosclerosis
Overthe last twodecades,researchershave identifiedmanyriskfactorsfordevelopingcardiovascular
diseases.Theyinclude:
Elevatedcholesterol levels(bothtotal cholesterol andLDL[“bad”] cholesterol)
Elevatedtriglyceridelevels
Low HDL cholesterol (the “good”cholesterol,whichclearsawayartery-cloggingLDL
cholesterol—the “bad”cholesterol)
Highbloodpressure (hypertension)
Cigarette smoking
Diabetes(elevatedbloodsugar)
Advancedage
High cholesterol
More than half of womenoverage 55 needto lowertheirbloodcholesterol,andaquarterof all
Americanwomenhave bloodcholesterol levelshigh enoughtopose aseriousriskforcoronary heart
disease—aresultof atherosclerosis.
Cholesterolbeginscollectinginthe wallsof the arteriesatanearlyage.In fact,the earliesttype of
arterial lesion,the “fattystreak,”ispresenteveninyoungchildren.
Accordingto the National CholesterolEducationProgram(NCEP),elevatedLDLcholesterol isamajor
cause of coronaryheart disease.That’swhythe NCEPpanel recommendsaggressive treatment.
Treatmentmayinclude lifestyle changes,suchasexercisingmore andreducingthe amountof saturated
fat inyour diet,andmedication.A combinationof approachesistypicallyrecommended.
3. Otherlipidabnormalities,suchaselevatedtriglyceridesorlow HDL (the goodcholesterol),are also
associatedwithincreasedcardiovascularrisk.
Cigarette smoking
Smokingacceleratesthe developmentof atherosclerosis,increasesbloodpressureandrestrictsthe
amountof oxygenthe bloodsuppliestothe body.Quittingsmokingdramaticallyandimmediately
lowersthe riskof a heart attack and reducesthe riskof a secondheartattack inpeople whohave
alreadyhadone.
Diabetes
Havingdiabetesposesasgreata riskfor havinga heartattack in 10 yearsas heart disease itself,
accordingto NHLBI. Infact, cardiovasculardisease isthe leadingcause of diabetes-relateddeaths.
People withdiabeteswhohave notyethada heartattack have the same riskof future heartattack as
someone withknowncoronaryheartdisease.Because theirriskof heartattack isso high,NHLBI
recommendsthatpeople withdiabetesbe treated aggressivelywithLDLcholesterol–lowering
medicationandcarefullymanage theirbloodsugartoreduce theircardiovascularrisk.
Age
Generally,womenoverage 55 and menoverage 45 are at greatestriskfordevelopingatherosclerosis.
The risk of cardiovasculareventsincreaseswithage.
Other risk factors for coronary heart disease include:
A familyhistoryof earlyheartdisease(before the age of 60) ina memberof yourimmediate
family(parent,sibling,child)
Obesity
Metabolicsyndrome
Physical inactivityandsedentarylifestyle
Postmenopausalstatus
Increasedlevelsof high-sensitivityC-reactiveprotein(CRP),whichisamarker ofinflammation
Family History
Eventhoughit isnot includedinthe FraminghamRiskScore,familyhistoryisone of the biggestrisk
factors overall foratherosclerosis.Yourriskisgreaterif your fatheror brotherwasdiagnosedbefore age
55, if your motheror sisterwasdiagnosedbefore age 65 or if you have a siblingwithearlycoronary
disease.
Obesity
4. Overweightwomenare muchmore likelytodevelopheart-relatedproblems,evenif theyhave noother
riskfactors.Excessbodyweightinwomenislinkedwithcoronaryheartdisease,stroke,congestiveheart
failure anddeathfromheart-relatedcauses.
Inactivity
Notexercisingcontributesdirectlytoheart-relatedproblemsandincreasesthe likelihoodthatyou’ll
developotherriskfactors,suchashighbloodpressure anddiabetes.
Metabolic Syndrome
This deadlyclusterof riskfactorsincludesfivecomponents:abdominal obesity(alarge waistline);high
bloodpressure;glucose intolerance orhighfastingbloodsugarlevels(diabetesorprediabetes);
abnormal lipidssuchasa hightriglyceride level;andlow HDL (good) cholesterol.If youhave three outof
five of these riskfactors,youare diagnosedwithmetabolicsyndrome,whichisassociatedwitha
markedlyincreasedriskof cardiovasculardisease.
Stress
Althoughstresshasbeenimplicatedinthe developmentof atherosclerosis,itsexactrelationshipto
heartdisease has notbeendetermined.Regularexercise canreduce stressandimprove yourmood.
Postmenopausal status
A woman’sriskof developingatherosclerosisandheartdisease increasesonce she reachesmenopause.
Priorto menopause,womenare mainlyprotectedfromheartdisease byestrogen,the reproductive
hormone producedbythe ovaries.Thisprotectioniswhywomentendtodevelopheartdisease 10years
aftermen.Howeverthis10-yearprotectionisnotseeninwomenwhosmoke orhave diabetes.
Amongitsmany roles, estrogenhelpskeeparteriesfree fromplaque byimprovingthe ratioof LDL (low-
densitylipoprotein) andHDL(high-densitylipoprotein) cholesterol.Italsoincreasesthe amountof HDL
cholesterol,whichhelpscleararteriesof LDLcholesterol—thekindthatmostcontributestoplaque
buildup.
Estrogenalsohelpskeepthe liningof yourbloodvesselsstrongandpliable,whichhelpsreduce yourrisk
of atherosclerosis.Despitethe theoretical benefitsof estrogen,replacingnatural estrogenhormones
withdrugsaftermenopause isnotan effectivewaytopreventheartdisease andmayevenbe harmful.
High-sensitivity C-reactive protein
Chronicinflammationhasbeenshowntobe ariskfactor for cardiovasculardisease.While the reasons
are notfullyknown,inflamedatheroscleroticplaquesmaybe more prone torupture.C-reactive protein
(CRP) isa marker of inflammationthatcanbe measuredinthe bloodandisstronglylinkedtoobesity
and sedentarylifestyles.However,CRPhasbeenshowntopredictcardiovascularriskevenabove
traditional riskfactorassessment.Weightlossandexercise canlowerCRPlevels.Statins,acommon
5. classof medicationsusedtotreatcholesterol,canalsolowerCRP.SometimesdoctorswillorderCRP
testingtorefine riskpredictionamongintermediate-riskindividualswhenthe decisiontotreatwith
statintherapyisunclear.Olderorelderlyindividualswho have normal orevenlow levelsof cholesterol
but whohave highlevelsof CRPmayalsobenefitfromstatintherapy.
Global Risk Factor Assessment
The FraminghamRiskScore isa useful,office-basedriskpredictionmodel.Itassignsapointscore for
each majorriskfactor (age,smoking,total cholesterol,HDLcholesterol,systolicbloodpressure) to
predictyour10-year riskof developingfutureCHDevents.
If you have more than a 20 percentriskof future cardiaceventsoverthe next10 years,youshould be
treatedveryaggressively,the same assomeone withknownheartdisease.Intermediate-riskindividuals
withscoresbetween10percentand 20 percentshouldhave furtherevaluation.Low-riskindividuals
withscoresof lessthan 10 percentusuallydon’t needdrugtherapy,butshouldmake lifestyle changes
such as dietandexercise,whichare recommendedforeveryone.
Recently,several studieshave suggestedthatthe FraminghamRiskScore mayunderestimate
cardiovascularriskina substantial numberof individuals,particularlywomenandyoungeradults.The
Adult-TreatmentPanel(ATP) versionof the FraminghamRiskScore onlypredictscoronaryheartdisease
events,butforwomenunderthe age of 75, strokesare more commonthan the CHD eventspredicted
by the riskcalculator.Certainindividualswithlow- orintermediate-riskFraminghamRiskScoresmaybe
candidatesforothertestingif theyhave otherriskfactorssuch as a strongfamilyhistorythatare not
includedinthe FraminghamRiskScore.
Womenand youngadultsoftenhave low FraminghamRiskScoresforshort-termriskoverthe next10-
yearsbut have substantial lifetimerisk.Eventhe presenceof one majorcardiovascularriskfactorbythe
age of 50 is associatedwithincreasedlifetime riskof cardiovasculardisease andshortermediansurvival
comparedto womenwithoptimal riskfactorstatus.Thus“low-risk”overthe next10years isnot the
same as “no risk,”and itis imperative thatriskfactorsare screenedforandtreatedappropriately.Itis
importantto preventriskfactorsfromdevelopingthroughahealthylifestyle.
Recently,anotherglobal riskassessmenttool calledthe ReynoldsRiskScore wasdeveloped,whichhas
beenshowntohave improvedpredictive abilityforall cardiovascularevents comparedtothe
FraminghamRiskScore.Thistool incorporatesmanyof the traditional riskfactorsusedinthe
FraminghamRiskScore,butadds twootherimportantriskfactors:familyhistoryof premature coronary
arterydisease andhigh-sensitivityC-reactive.
Both riskassessmenttoolsweredevelopedamongpredominantlyCaucasianpopulationsandmaynot
applywell toindividualsfromotherracesorethnicities.
Symptoms of Atherosclerosis:
6. Often,youwill experiencenosymptomsof atherosclerosisuntil the disease hasprogressedsignificantly.
However,there are some conditionsthatmaysuggestatherosclerosisispresent,althoughthese
conditionsmayhappenforotherreasons.
Angina
If cloggedarteriespreventenoughoxygen-carryingbloodfromreachingyourheart,the heartmay
respondwithpaincalledanginapectoris.Episodesof anginaoccurwhenthe heart’sneedforoxygen
increasesbeyondthe oxygenavailablefromthe bloodnourishingthe heart.Silentanginaoccurswhen
the same inadequate bloodsupplycausesnosymptoms.Physical exertionisthe mostcommontrigger
for angina.Othertriggerscanbe emotional stress,extreme coldorheat,heavymeals,alcohol and
cigarette smoking.The painisa pressingorsqueezingpain,usuallyfeltinthe chestor sometimesinthe
shoulders,arms,neck,jawsorback.
Anginasuggeststhatcoronaryheart disease exists.People withanginahave anincreasedriskof heart
attack comparedwiththose whohave nosymptoms.Whenthe patternof anginachanges—if episodes
become more frequent,lastlongeroroccur withoutexercise—yourriskof heartattack insubsequent
daysor weeksismuchhigherandyoushouldsee yourhealthcare professionalimmediately.
If you have angina,learnitspattern—whatcausesananginaattack, what itfeelslike,how longepisodes
usuallylastandwhethermedicationrelievesthe attack.Anginaisusuallyrelievedinafew minutesby
restingor takingprescribedanginamedicine,suchasnitroglycerin.
Episodesof stable anginaseldomcause permanentdamage toheartmuscle.
Heart attack painmay be similartoangina,butthe symptomsof anginaquicklydisappearwithrest.
Heart attack pain,however,usuallypersistsdespiterestingortakingnitroglycerinandshouldbe
evaluatedimmediately.Like angina,heartattackpaincan be a pressure ortightnessinchest,arms,back
or neck.
Oftensymptomsincludeshortnessof breath,sweating,nausea,vomiting,indigestionordizziness.
Women,especiallythose withdiabetes,maynothave the typical symptoms of chestpainlike men,but
have othersymptomssuchas shortnessof breathor indigestion.A heartattackisan emergency.A delay
intreatmentcouldmeanmore of the heartmuscle tissue ispermanentlydamaged.
If you thinkyouare havinga heartattack, call 9-1-1. Afteryoucall 9-1-1, the operatormay recommend
that youchewone adult-strength(325mg) aspirinafterhe or she makessure youdon’thave an allergy
to aspirinora conditionthatmaymake takingit toorisky.If the operatordoesn’ttalktoyou about
chewinganaspirin,the emergencymedical techniciansorphysiciansatthe hospital willgive youone if
it’srightfor you.
Cardiac arrhythmias.
7. These occur whenthe heartmomentarilybeatstoofastorbeatsirregularly.Chestpain,dizziness and
shortnessof breathare symptomsof cardiac arrhythmias.Atherosclerosisisone cause of rapidor
irregularheartbeat;however,itcanalsobe causedby angina,valvularheartdisease,bloodclots,thyroid
abnormalities,electrolyte imbalanceorpreviousheartdamage.Arrhythmiasmaybe frequentor
infrequent.
Silent ischemia
Sometimesatherosclerosiscausesnosymptoms.Silentischemiaisaconditioncausedby
atherosclerosis,butisn’tassociatedwiththe chestpainorothersymptomscommonto othertypesof
heartconditions.Thisconditionoccurswhenarterieswithatherosclerosiscan’tdeliverenoughbloodto
the heart.An electrocardiogram(EKGorECG), a measurementof electrical impulsesproducedbythe
heart,may indicate silentischemia.However, unlessyouknow yourrisksforheartdisease anddecide,
withthe advice of your healthcare professional,thatyouneedaheartcheckup,youmay neverknow
youhave ischemia.Peoplewithdiabetesare especiallyatriskfor thiscondition.
Intermittent claudication.
Thislegdisorderpredominantlyaffectselderlypeople.Itcausessevere pain,achingorcrampinginthe
legswhenyouwalkdue toatherosclerosisinthe majorarteriesthatsupplybloodtothe legs(femoral
and iliac).Severecasesof peripheral arterial diseasecanleadtogangrene andamputation.
Transient ischemic attack (TIA) and strokes.
If you experience asuddenonsetof weaknessornumbnessonone side of yourface,armor leg,or an
inabilitytotalkorfindwords,or lose visioninone eye,youmaybe havingastroke or a TIA.Neurological
symptomsthatlastlessthan 24 hoursare calledTIAs,whereassymptomsthatpersistforlongerare
classifiedasstrokes.TIAsandstrokesare oftenthe resultof atherosclerosisinthe arteriesthat supply
bloodto the brain,suchas the carotidarteries.Thisisveryserious.If youthinkyouare experiencinga
stroke,youshouldcall 9-1-1 to seekmedical attentionimmediately.Thisisthe brain’sequivalentof a
“heart attack,”duringwhichthe brain isdeprivedof oxygen-carryingbloodsupply.Anydelayinmedical
treatmentmaypermanentlydamage yourbrain.
Diagnosis
The earlieratherosclerosisisdiagnosedthe better.You’ll wanttotake manyof the followingstepsto
determine if you’reatrisk for thiscondition.Discussotherstepslistedbelowwithyourhealthcare
professional.
Office-based Physical Exam.
All womenshouldundergoanannual examtoassesstheirriskfactorsforcardiovasculardisease andfor
any symptomsof atherosclerosis.The physical examshouldinclude measuringyourbloodpressure and
heightandweighttocalculate a bodymassindex (BMI).A normal bloodpressure islessthan120/80. If
youhave highbloodpressure,youshouldsee yourhealthcare professionalmore frequentlytomake
8. sure your bloodpressure isbeingadequatelytreatedtothe goal of lessthan130/85. If you’re
overweight,youhave ahigherriskof diabetesandmetabolicsyndrome.Yourdoctorshouldencourage
youto followahealthydietandto exercise regularlytoreduce yourrisk.Often,atherosclerosisisnot
diagnoseduntil youhave complications.However,before youexperience complications,yourhealth
care professionalmaybe able tohear a blowingsoundcalledabruitwhenholdingastethoscope over a
damagedartery.Also,youmayhave a decreasedpulseinthe affectedarea.Sometimes,atherosclerosis
causesthe bloodpressure ineachof your arms to be significantlydifferent,anothersymptomyour
healthcare professional caneasilycheck.More commonly,thereare noapparentsignsonphysical
examto suggestthe presence of atherosclerosis,andthusindividualswithriskfactorsmaybe referred
for additional testing.
Laboratory tests.
Beginningatage 20, womenshouldhave theirbloodcholesterol measured.If itisnormal,itcan be
recheckedeveryfiveyears.However,if itisabnormal,itshouldbe monitoredmore frequently,suchas
at leastonce a year.A complete lipoproteinlevel (abloodtestthatmeasurestotal cholesterol,LDL
cholesterol,HDLcholesterol andtriglyceridelevels) isrecommendedbyNHLBIas the initial testto
determine if yourcholesterollevelsare withinnormal ranges.Thistype of test,calledafasting
lipoproteintest,istakenwhenyouhaven’teatenforaprescribedamountof time—usuallybetween
nine and12 hours.Blood-level cholesterol ismeasuredinmilligramsperdeciliter(mg/dL;adeciliteris
one-tenthof aliter).If youare atriskfor highcholesterol orotherconditionsthatcontributetothe
developmentof heartdisease,yourhealthcare professional mayrecommendmore frequenttesting.
Here are “at-a-glance”guidelinesforyourcholesterol levels.Be sure toaskyour healthcare professional
if your bloodcholesterol goalsshouldbe differentbasedonanyindividual heartdisease risksyoumay
have,suchas diabetesandhighbloodpressure,orif yousmoke:
Total cholesterollevels:
Desirable:lessthan200 mg/dL
Borderline high-risk:200 to 239 mg/dL
Highrisk: 240 and above
HDL (highdensitylipoprotein) levels:
Optimal:above 60 mg/dL.(consideredprotectiveagainstheartdisease.)
40 to 50 mg/dL: the highthe level the lessyourriskforheartdisease
Lessthan 40 mg/dL: consideredamajorriskfactor forheart disease
LDL (low-densitylipoprotein) levels:
Optional goal forhigh-riskpatients:lessthan70 mg/dL
9. Optimal:lessthan100 mg/dL
Nearoptimal:100 to 129 mg/dL
Borderline high:130 to 159 mg/dL
High:160 to 189 mg/dL
Veryhigh:190 mg/dL and above
Accodingto NHLBI’supdated2004 cholesterol guidelines:
For indivdualsatveryhighriskforheartattack, such as those whohave hada recentheartattack or
unstable angina,the overall LDLcholesterol goalsshouldbe lessthan70 mg/dL; drugtherapywith
statinsisusuallyrecommendedtoreachthisgoal.
For paientsathighriskfor heart attack,LDL cholesterol goalsshouldbe lessthan100 mg/dL withan
optional goal of lessthan70 mg/dL,and drug therapyisusuallyrecommendedtoreachthese goals.
High-riskindividualsinclude people withknownatherosclerosis(suchasthose withapriorheart attack,
stroke or peripheral arterial disease),people withdiabetesorkidneydiseaseorpeople withenoughrisk
factors to give thema10-year riskof a heart attack of more than 20 percentunderthe FraminghamRisk
Score.Studiessuggestthathigh-riskandveryhigh-riskpatientsmaybenefitfromstatintherapyevenif
theircholesterol levelsare notelevatedtopreventfurtherevents.
For moderatelyhigh-riskpatients:LDLcholesterol goalsshouldbe set forlessthan130 mg/dL (orbetter
yet,lessthan100 mg/dL) anddrug therapyshouldbe usedatLDL levelsof 100 to 129 mg/dLto reach
thisgoal.Moderatelyhigh-riskindividualsincludethose whose10-yearriskof a heartattack is10
percentto 20 percent,those withmore thantworiskfactors forheart disease,thosewithapositive
familyhistoryof premature coronarydiseaseorthose withthe metabolicsyndrome.
For low-riskpatients,LDLcholesterolgoalsshouldbe lessthan160 mg/dL.Low-riskindividualsare those
whose 10-yearriskof heartdisease islessthan10 percent,andwho have lessthantworisk factorsfor
heartdisease.Usually,lifestyle changessuchasdietandexercise are recommendedfirst,butdrug
therapycan be addedif these are not enoughtomeettheirgoal.
Note that lifestylechangessuchasdietandexercise are recommendedforeveryone—eventhose on
drug therapy!Whenlifestylechangesalone are notadequate,the mostcommonclassof medications
usedto treathighcholesterol iscalledstatins(examplesinclude atorvastatin(Lipitor),simvastatin
(Zocor),rosuvastatin(Crestor),pravastatin(Pravachol),lovastatinandfluvastatin).Statinsare highly
effectiveinreducingcholesterol levelsandalsoreduce the riskof havingafirstor recurrentheartattack.
10. In fact,while there are several typesof cholesterol-loweringmedicationsavailable,atthistime the
groupof cholesterol medicationscalledstatinshave beenshowntobe the mosteffectiveatreducing
cardiovascularevents.Thus,if cholesterol-loweringmedicationsare indicated,statintherapyshouldbe
the firsttherapyusedforpreventingsubsequentcardiovasculareventsinmostindividuals,especiallyin
high-riskandveryhigh-riskindividuals.If anindividual cannottolerate one particularstatindue toside
effects,usuallyothertypesof statinsatlowerdosescanbe tried.Once an individual ismaximizedonthe
highestdose of statintolerated,if theirLDLcholesterol isstill notatgoal,anothercategoryof
cholesterol medicationscanbe addedtotheirregimen.
Triglyceride (anothertype of lipid) levels:
Ideal:Lessthan100 mg/dL
Normal:lessthan150 mg/dL
Borderline high:150 to 199 mg/dL
High:200 to 499 mg/dL
Veryhigh:500 mg/dL and higher
Normal triglyceridesare consideredlessthan150 mg/dL.If you’re atmoderate or highriskfor heart
disease andstill have hightriglycerides(despite reachingyourcholesterol goal withastatin),youmay
require anadditional medication.Thisincludesafibrate suchasgemfibrozil (Lopid)orniacin.Fishoil and
omega-3fattyacids mayalso helpreduce triglyceridelevels.The maintargetof therapyisachievingyour
LDL goal.A secondarytargetisyour non-HDLcholesterol.Non-HDLisyourtotal cholesterolminusyour
HDL cholesterol.Thisnumberreflectssome of the otheratherogeniclipidproblems,suchaselevated
triglycerides.The non-HDLgoal istypically30pointshigherthanyour LDL goal.For example,if yourLDL
goal is lessthan100 mg/dL,yournon-HDL goal islessthan130 mg/dL).Specifictreatmentdependson
your cholesterollevel andotherriskfactors,butingeneral,the firststage of treatmentislifestyle
changes,suchas improvementsindietandexercise.If lifestylechangesdon’twork,statindrugsare
usuallytriedfirst,and othermedicationsmaybe addedif necessary.
LDL particles.
Cholesteroliscarriedintothe vessel wallthroughparticlescalledlipoproteins.Dependingonitssize,
each particle carriesdifferentamountsof cholesterol withinit.Manypatientswithdiabetesor
metabolicsyndrome donothave elevatedbloodlevels of total orLDL cholesterol,buttheyhave
elevatedtriglyceridesandlowlevelsof the goodHDL cholesterol.Thisisassociatedwithapatternof
small,dense LDL-particlesize,whichislinkedtopromotingatherosclerosis.A standardlipidbloodtest
will give youthe LDL level concentrationbutdoesnottell youaboutyourtotal particle count.Incertain
caseswhenmore informationisneededtodetermine yourrisk,yourdoctormayorderteststo measure
your LDL particle size oryour total LDL particle count.Ina givenlipidbloodconcentration,therewillbe
more total particlesif yourparticle size issmall andfewertotal particlesif yourparticle size islarge.
11. There isalso a testcalledapolipoproteinB(apoB),whichisagood estimate of yourtotal countof the
bad atherogenicparticles.
Your doctor mayorder bloodtestsotherthanlipidlevels,todetermineyourriskof heartdisease.These
include:
Fastingsugar (highlevelsmaymeandiabetesorprediabetes)
Insulinlevels(highlevelsmaymeandiabetesorprediabetes)
Kidneyfunction(abnormal kidneyfunctionisariskfactor forheart disease)
C-reactive protein(highlevelsof CRPsuggestinflammationinthe bodyandisa markerfor
increasedriskof heartdisease)
Ankle brachial index.
Thissimple testperformedinahealthcare professional’soffice screensforperipheral arterial disease
(PAD).The bloodpressure readingmeasuredineachlegisdividedbythe average bloodpressure
readinginbotharms. Normally,the bloodpressure inthe legsisthe same orhigherthanthe blood
pressure inthe arms,so a value of 1 or higherisnormal.AnABI of lessthan0.90 suggestsperipheral
arterial disease.Evenif youdon’thave anysymptoms,butdohave PAD,youshouldbe treated
aggressivelywithmedical therapybecauseyouhave ahigherriskforfuture cardiovascularevents,
includingheartattacksandstrokes.There are otherteststhatcan helpyourhealthcare professional
determine if youhave atherosclerosis.These are:
Coronary angiography (or arteriography)
. Thistestis usedto explore the coronaryarteries.A dye isinjectedintothe arteryof anarm or legviaa
fine tube,orcatheterthat passesthroughthe aorta intothe arteriesof yourheart.Your heart and blood
vesselsare thenfilmedwhile yourheartpumps.The picture thatisseen,calledanangiogramor
arteriogram,showsanyblockagescausedbyatherosclerosis,aswellasotherproblems.Thisisan
invasive testandisonlyusedforhigh-riskindividualswhoare believedtohave agood chance of having
significantcoronaryheartdisease.Thisisthe mostaccurate way to assessthe presence andseverityof
coronary disease.Sometimesthisisdone incombinationwithanultrasoundprobe,whichispassed
throughthe catheterdownintothe coronary arteries.Thisprocedure iscalledintravascularultrasound
or IVUS.IVUS allowsforevenbetterdetailof the arterial wall toassessthe severityof alesionandthe
type of plaque buildup,suchas“soft”plaquesvs.“hard”plaques.
You may alsobe injectedwithafluidthatblocksX-rays,calleda“contrastmedium”or“dye,”which
allowsgettervisibilityof certaintissues.The injectionmaystingandleave ametallictaste inyour
mouth,a warm or cool sensationatthe injectionsite andinsome cases,hives.Manyof these dyesare
iodine-based,soyouneedtotell yourhealthcare professional if youare allergictoiodine.
12. If your healthcare professional decidesthatyouneedtohave an angiography,youmayhave to fastfour
to six hoursbefore the testbecause of the sedative medicationsyoureceive duringthe test.
If a significantblockageisfoundduringthe angiogram, the cardiologistmaytryto openup the blockage
witha balloonwithorwithouta stent—aprocesscalledangioplasty.
Imaging tests.
To studyyour arteriestodetermine whetherornotyou have hardeningornarrowingof large arteriesor
calciumdepositsonarterywallsorto determine otherinformationaboutthe structure orfunctionof
your heart,yourdoctor may use imagingtechniquessuchasa computerizedtomography(CT) scanor a
magneticresonance angiogram(MRA),anoninvasive testthatgivessimilarinformationtoa CT scan
withoutusingX-rays.A non-contrastcardiacCT can detectcalciumbuildupinthe arteries,whichisa
markerof atheroscleroticplaque (calciumshowsuponthe CT as brightwhite,similartobone,andcan
be seenwithoutcontrast).Thisiscalledacoronary arterycalcium(CAC) score and issometimesordered
inintermediate-riskindividualsforscreeningwhenfurtherassessmentof CHDrisk isneeded.People
withhighlevelsof CAChave alotof plaque intheirarteries,whichisassociatedwithincreasedriskof
cardiovascularevents.If youhave highCACscores,more intensifiedtreatmentsuchasstatinsmaybe
recommended,inadditiontolifestyle changes.
A cardiac CT withdye contrast (calledaCT angiogramor CTA) can furthershow whetherthere isany
narrowingor stenosisof the coronaryarteries.Because CTAshave the increasedriskof dye and
increasedradiationcomparedtonon-contrastCTs,theyare notrecommendedforroutine screening
where nosymptomsare presentbutmaybe usedforevaluationif youhave chestpainorangina.
Doppler ultrasound.
Your doctor mayuse an ultrasound tool calledaDopplerultrasoundtotake yourbloodpressure at
differentpointsonyourarm or leg.Bymeasuringthese pressures,yourdoctorcan gauge the bloodflow
throughyour arteriesaswell asthe degree of anyblockages.
Resting EKG.
An electrocardiogrammayshowsignsof priorheartdamage suchas an enlargedheartor areasof prior
heartattack. For many womenwithangina,the EKGat rest isnormal.Thisisnot surprisingbecause
symptomsof anginaoccur duringstress.Therefore,yourheart’sfunctioningmaybe testedunderstress,
typicallyexercise.
Exercise stress test.
Thistestshowshowwell the heartfunctionswithincreasedphysical activity.AnEKGandbloodpressure
are takenbefore,duringandafterthe workout.Otherstresstestsinadditiontothe EKGuse
radionucleotide markerssuchasthallium, orultrasound(echocardiography),totake picturesof the
heartbefore andafterthe stresstolookfor changesinthe heart that mightsuggestblockages.Usually
the stresstestinvolvesrunningona treadmill,butif youcan’tuse the treadmill,the heartcanbe
13. stressedusingmedicationssuchasdobutamine oradenosine orsome newerstressagentssimilarto
adenosine.
Treatment
Lifestyle changes(Diet,exercise,weightloss):
Diet.
Changingyourdietaryhabitsremainsthe singlemosteffectivewaytostopatherosclerosisfrom
progressing.Eatingadietlowinsaturatedfat andcholesterol reducesbloodcholesterol,aprimary
cause of atherosclerosis.Althoughsaturatedfatandtransfatsare definitelybadforyou,othertypesof
fat,such as polyunsaturatedfatsfoundinfish(omega-3),nutsandflaxseed,ormonounsaturatedfats
foundinolive oil,maybe goodforyou.Eating lesssaturatedfatand reducingcaloriesingeneral should
alsohelpyoulose weight.Inadditiontowatchingsaturatedandtransfats, itis alsoimportanttowatch
excesssugarintake,suchas sugar,honeyandhighfructose corn syrup,whichare frequentlyfoundin
sweetenedbeveragesanddessertsandalsohiddeninmany processedfoods.The bodywillconvert
excesscaloriessuchasfromsugars intotriglyceridesasa wayof storingenergy.Soloweringyoursugar
intake will alsoloweryourtriglyceride levels,inadditiontoyourbloodglucose levels.
Reducingsodiumintake isimportantforboththe preventionandtreatmentof highbloodpressure.The
DASH (DietaryApproachestoStopHypertension) diet,endorsedbythe majorheartorganizations,isone
strategyfor loweringhighbloodpressure.Itisrichin lower-calorie foodssuchasfruitsandvegetables
and whole grainsandlowinsodium.
The TherapeuticLifestyle Changes(TLC) Dietplan,developedbythe NHLBIcallsforlessthan7 percent
of yourcaloriestocome from saturatedfatand for lessthan200 mg of dietary cholesterol.Twenty-five
percentto 35 percentorfewerof total dailycaloriescancome from fat,providedmostof these calories
are fromunsaturatedfat,whichdoesn’traise cholesterol.Sodiumintake shouldbe limitedtonomore
than 2,400 mg per day. In addition,the guidelinesencourage the use of certainfoodsrichinsoluble
fibertoboostthe diet’sLDL-loweringpower.
Exercise.
You alsocan benefitfromexercise.Recentresearchfindsthatevenmoderate amountsof physical
activityare associated withlowerdeathratesfromcoronaryheartdisease.Aslittleas30 minutesof
moderate activityonmost,andpreferablyall,daysof the weekhelpsprotectthe heartandis
recommendedbythe AmericanHeartAssociation.However,the recommendationsrise to60 to 90
minutesof moderate activitymost,andpreferablyall,daysof the weekinwomenwhoneedtolose or
maintainweight.Examplesof moderateactivityare briskwalking,bicycling,rakingleavesandgardening.
Vigorousexercise includesrunning,jogging,swimminglapsandcross-countryskiing.Beingphysicallyfit
and active providescardiovascularbenefitsindependentof weightloss.Wearingapedometermayhelp
youkeeptrack of your physical activity.The AmericanHeartAssociationrecommendsaimingfor10,000
14. stepsa day,whichis five miles(2,000 stepspermile),butall stepscount.Aimtogetmore stepsinyour
day bytakingstairs insteadof elevators,parkingfartherawayandothersmall changes.
Weight loss.
If you are overweight,losingweightcanhelplowerbloodcholesterol levels.Itisalsothe most effective
lifestyle change toreduce highbloodpressure,anotherriskfactorforatherosclerosisandheartdisease.
The bestway to lose weightisthroughacombinationof dietandexercise.
Pharmacologic(drug) therapies:
1. Anti-platelet(orblood-thinning) medications.Yourdoctormay prescribe ananti-plateletmedication,
such as aspirinorclopidogrel (Plavix) toreduce yourchancesof a bloodclotif you have atherosclerosis
or are at highriskfor it.
2. Anticoagulants.Anticoagulants,suchasheparinorwarfarin(Coumadin),canalsohelppreventclots
fromforming.Warfarinmaybe prescribedif youhave heartarrhythmiascalledatrial fibrillationor
flutterorif you have had certaintypesof strokes.Neweranticoagulants,suchasdabigatran,
rivaroxabanandapixaban,canbe usedin place of warfarinforcertainindicationslike atrial fibrillation.
3. Cholesterol-loweringtherapies.Cholesterol- andtriglyceride-loweringmedications thatmaybe
recommendedinclude:
Statins.Six statindrugsare available inthe UnitedStates:atorvastatin(Lipitor),fluvastatin(Lescol),
lovastatin(Mevacor,Altoprev),pravastatin(Pravachol),simvastatin(Zocor) androsuvastatin(Crestor).
In addition,statinsare foundinthe combinationmedicationslovastatinandniacin(Advicor),
atorvastatinandamlodipine (Caduet),andsimvastatinandezetimibe (Vytorin).Statinsare most
effectiveatloweringthe LDLcholesterol,buttheymayalsohave modesteffectsonraisingHDL
cholesterol andloweringtriglycerides.Theyare generallythe first-linemedicationsused.Makesure you
talkto your healthcare professionaltosee if youare a candidate forstatintherapy.If youexperience
any side effectssuchasmuscle achesordark urine,stoptakingthe drug immediatelyandcall your
healthcare professional.
Niacin.Niacinisawater-soluble Bvitamin.Unfortunately,youcan’tloweryourcholesterol bytakinga
vitaminsupplement;tohave suchan effect,it mustbe takenindoseswell above the dailyvitamin
requirement.Althoughnicotinicacidisinexpensive andavailable overthe counter,nevertake itto
loweryourcholesterol withoutguidance fromahealthcare professionalbecause of potential side
effects.The extendedrelease formisavailable byprescriptionasNiaspan.Itdecreasestriglycerides,
raisesHDL-cholesterolandmodestlylowersLDL-cholesterol.Unfortunately,thismedicationcauses
some people toitchand flush(turnred).
15. Bile acidsequestrants.The three mainbileacidsequestrantscurrentlyprescribedinthe UnitedStates
are cholestyramine resin(Questran),colestipol (Colestid) andcolesevalam(WelChol).Available as
powders,tabletsorgranules,thesedrugsworkbybindingwithbile acidsthatcontaincholesterol inthe
intestines.Theycanbe prescribedalone orincombinationwithanotherdrug.
Fibrates.These drugsreduce triglyceridesbyreducingthe liver’sproductionof LDLcholesterol and
assistinginthe removal of triglyceridesfromthe blood.The mostwidelyusedfibratesinthe United
Statesare gemfibrozil (Lopid) andfenofibrate (Tricor).Fibratesare notrecommendedasthe sole drug
therapyforwomenwithheartdisease forwhomLDL cholesterolreductionisthe maingoal.
Cholesterolabsorptioninhibitors.Thisclassof drugslowerscholesterol bypreventingitfrombeing
absorbedinthe intestine.The firstapproveddruginthisclassisezetimibe(Zetia).Itmaybe usedalone
or togetherwitha statin.
Omega-3fatty acids.Omega-3fatty acidssuch as fishoil maybe helpraise HDL cholesterol andlower
elevatedtriglycerides.Itcanbe givenina prescriptionformoroverthe counter.
Drugs forperipheral arterial disease
If you have severe painorcrampinginyour legswhenyouwalk,yourhealthcare professional may
recommendclopidogrel (Plavix),cilostazol(Pletal) orpentoxifylline (Trental).Cilostazol isgenerally
avoidedinindividualswithcongestiveheartfailure.
If you take medicationtoimprove yourcholesterol,lowerbloodpressureortreatotherheart disease
symptoms,be sure toask about potential sideeffects;interactionswithothermedications,foodor
beverages;andwhenandhowyoushouldtake the prescribedmedications.
Revascularizationproceduresfor atherosclerosis
In the past,openingarteriesdamagedbyatherosclerosisaroundthe heartmeantperformingbypass
surgery(openheartsurgery),requiringthatthe chestbe openedsurgicallyandbloodflow redirected
aroundthe damagedartery.Now, alternativestoopenheartsurgery,suchasballoonangioplasty,allow
for a quicker,lesspainfulrecovery.However,noteveryone isacandidate forballoonangioplastyand
some people stillrequiresurgery.Also,noteveryone withatherosclerosisrequiresopeningthe arteries
withangioplasty.Some individualswithstable coronaryarterydisease andstable anginamaybe
16. candidatesfortreatmentwithaggressive medical therapyalone.These decisionsdependonthe
individual,the typesof blockages,the resultsof stresstesting,the severityof symptomsandother
factors.
Coronaryangioplastyorballoonangioplasty.Yourhealthcare professional will firstperformacoronary
angiogramto see whicharteriesare blocked.Throughacatheter(ortube) inyour leg(femoral) orarm
(brachial) artery,acatheterwill be advancedtothe heartand dye will be injectedintothe coronary
arteries.If angioplastyisindicated,the cardiologistwillpositionacatheterwithatinyballoononitstip
inthe narrowedcoronary.The balloonisinflatedanddeflatedtostretchor breakopenthe narrowing
and improve the passage forbloodflow.Typically,yourdoctorwill insertastent,asmall scaffolding
designedtopropthe arteryopen.Asthe ballooninflates,itexpands the stent.Angioplastyisnot
surgery,andit isperformedwhileyouare awake.Ittypicallytakesaboutone ortwo hours.But there is
recoverytime whichgenerallyinvolveslayingflatforthree tosix hoursafterthe procedure toallowthe
leg(or arm) artery to heal topreventbleeding.If angioplastydoesn’twidenthe arteryorif complications
occur, bypasssurgerymaybe needed.Patientswithcertaintypesof blockagesmaynotbe candidates
for angioplastyandmaybe referredforbypasssurgery.
One continuingchallenge cardiologistsface intreatingatherosclerosisisthatplaque depositsmay
return(a conditionreferredtoas restenosis).Evenpatientswho’ve hadangioplastiessometime require
future treatmentstowidenarteriescloggedwithnew blockage.Today,new drug-coatedstents
markedlydecrease the ratesof restenosiscomparedtothe oldergenerationof stents.Additionally,new
drugsand newtypesof stentsare indevelopment,andthe future ispromisingforadvancementsinthis
area.
Atherectomy.Coronaryatherectomyisaprocedure thatremovesplaque fromthe arteriesthatsupply
the heart muscle usingarotatingshaveror lasercatheter.Atherectomymaybe followedwithstenting
or balloonangioplasty.
Endarterectomy.Thissurgical procedure,performedundergeneral anesthesia,removesplaque from
your arteries.Foryourcarotidarteries,the surgeonmakesacut in yourneck,opensthe arterythere,
and removesplaque until the inside of the arteryiscleanandsmooth.
Thrombolytictherapy. If abloodclotis blockinganartery,yourdoctor may insertadrug directlyinto
that arteryat the pointof blockage tobreakup the clot at the time of angiography.Duringanacute
heartattack, if angioplastyisnotimmediatelyavailable atyourhospital,doctorsmaygive thrombolytic
therapyveintobreakup clotsin yourbody.There are some riskstothrombolytictherapyincluding
bleedinginthe brain.Thusif angioplastyisavailable,thisisgenerallypreferredtosystemicthrombolytic
therapyforheart attacks.
Coronaryartery bypass.Inthissurgery,a bloodvessel (usuallytakenfromthe leg,armor chest) issewn
ontothe blockedarterysobloodcan bypassthe blockedarea.Several bypassescanbe performedif
several arteriesare blocked.Bypasssurgeryrelievessymptomsof heartdisease butdoesnotcure it.You
will still needtomake lifestylechangeslike those describedearlierandtake medications.
17. Prevention
Try to follow these tips to prevent atherosclerosis:
Quitsmoking.Smokingacceleratesthe developmentof atherosclerosis,whichoftenleadstocoronary
heartdisease.Womenwhosmoke are twotosix timesas likelytosufferaheartattack as nonsmoking
women,andthe riskincreaseswiththe numberof cigarettessmokedperday.The goodnewsisthat
quittingdramaticallycutsyourrisk,evenduringthe firstyear,nomatterwhatyourage.
Loweryour bloodpressure.Evenslightlyhighbloodpressure levelscandouble yourriskforheart
disease.Normal bloodpressure islessthan120/80 mm Hg. High bloodpressure,orhypertension,isa
bloodpressure readingof 140/90 mm Hg or higher.Between120/80 mm/Hgand 139/89 mmHg is
consideredprehypertension.Highbloodpressure alsoincreasesyourchance of stroke,congestiveheart
failure and kidneydisease.Highbloodpressurecanbe treatedsuccessfullywithmedication.Commonly
prescribeddrugsinclude diuretics,angiotensin-convertingenzyme inhibitors(ACEinhibitors),
angiotensinIIreceptorblockers,betablockersandcalciumchannel blockers(CCBs).
If your bloodpressure isnottoohigh,you maybe able tocontrol it entirelythroughweightloss(if you
are overweight),regularphysical activityandcuttingdownonalcohol,aswell assaltand sodium.
Sodiumisan ingredientinsaltthatis foundinmanypackagedfoods,carbonatedbeverages,bakingsoda
and some antacids.
Get regularexercise andlose weight.Fortunately,itdoesn’ttake alotof time or efforttobecome
physicallyactive.Aslittle as30 minutesof moderate activityon most,andpreferablyall,daysof the
weekhelpsprotectthe heartandisrecommendedbythe AmericanHeartAssociation.The
recommendationsrise to60 to 90 minutesof moderate activitymost,andpreferablyall,daysof the
weekinwomenwhoneedtolose ormaintainweight.Examplesof moderate activityare briskwalking,
bicycling,rakingleavesandgardening.Vigorousexercise includesrunning,jogging,swimminglapsand
cross-countryskiing.Youcandividethe 30 to 90 minutesof moderate activityintoshorterperiodsof at
least10 minuteseach.If youalreadyengage inthislevel of activity,youcangetaddedbenefitsbydoing
more.
Control yourbloodsugar if youhave diabetes.Diabetesistypicallydiagnosedbya fastingglucose
(sugar) over125 mg/dL. Patientswithdiabetesshouldbe treatedtopreventcomplicationsfrom
cardiovasculardisease;treatmenttypicallyconsistsof acombinationof lifestyle changesand
medications.Yourgoal hemoglobinA1Cwithtreatmentshouldbe lessthan7percent.Those with
diabeteswhoalsohave goodsugarcontrol are much lesslikelytodevelopcardiovascularcomplications
than those withpoorsugar control.Those individualswithafastingglucose (sugar) of 100 to 125 mg/dL
may be consideredprediabetesorglucose intolerant.Thisisoftenassociatedwithmetabolicsyndrome,
and individualswithglucose intolerance are athighriskfor developingtrue diabeteswithinthe next10
years.Weightloss,healthydietandexerciseare importanttoimprove bloodsugarlevelsandprevent
the onsetof diabetes.
18. Loweryour LDL-cholesterollevel.Accordingtothe CentersforDisease Control andPrevention,about
one ineverysix adults—or16.3 percentof the UnitedStatesadultpopulation—hashightotal
cholesterol.More womenhave highcholesterol thanmen.
Keeptriglyceridesincheck.The lipoproteinprofilethatdeterminesyourcholesterol levelsalsomeasures
anotherfattysubstance calledtriglyceride.Producedinthe liver,triglyceridesare made upof saturated,
polyunsaturatedandmonounsaturatedfats.The optimaltargettriglyceridelevel forindividualswithout
heartdisease orheartdisease-relatedriskfactorsislessthan100 mg/dL.Formostpeople,cuttingback
on foodshighinsaturatedfatand cholesterol andeating more fiberwill lowerbothtotal andLDL
cholesterol.Regularphysical activityandweightlossif you’re overweightalsoreducesbloodcholesterol
levels.Losingextraweight,quittingsmokingandbecomingmore physicallyactive mayalsohelpboost
HDL cholesterollevels.Losingweight,exercisingandcuttingbackon sugar intake canhelplower
triglycerides.
Facts to Know
1. Atherosclerosisisoftenthe firststage of coronaryheartdisease.
2. Diseasescausedbyatherosclerosisare the leadingcause of illnessanddeathinthe United
States.
3. Atherosclerosisoccurswhenyourarteriesnarrow andbecome lessflexible because cholesterol,
fattysubstances,cell waste products,calciumandfibrin—collectivelycalledplaque—collecton
theirinnerwalls.The arteries respondtothe buildupbybecominginflamed,causingscartissue
and othercellstoform inthe affectedareas,furthernarrowingthe artery.
4. What causesplaque tobeginbuildingupisn’tknown.Some expertsthinkplaque beginsto
accumulate inplaceswhere the innerlayerof anarterybecomesdamaged,possiblybyelevated
cholesterol levels,elevatedtriglyceride levels,highbloodpressureorcigarette smoke.
5. A woman’sriskof developingatherosclerosisandheartdisease increasesasshe ages.Priorto
menopause,estrogenproducedinthe ovariesprovidessome protectionfromheartdisease.
However,hormone replacementinwomenaftermenopausedoesnotreduce the riskof
cardiovasculardisease.Andrememberthatwomenwithdiabetesorthose whosmoke are at
riskfor heartdisease throughouttheirlives.
6. Atherosclerosiscanaffectmediumandlarge arteriesanywhereinyourbody,restrictingblood
flowandlimitingthe amountof oxygenavailabletoorgans.
7. Smokingacceleratesthe developmentof atherosclerosis,increasesbloodpressure andrestricts
the amountof oxygenthe bloodsuppliestothe body.
8. Changinglifestylehabitsremainsthe singlemosteffective waytostopthe atherosclerosisfrom
progressing.Changingyourdiettoone low infat,especiallysaturatedfat,andcholesterol helps
reduce highbloodcholesterol,aprimarycause of atherosclerosis.
9. If you’re overweight,losingweightcanhelplowerbloodcholesterol.Itisthe mosteffective
lifestyle change forreducinghighbloodpressure,another riskfactorforatherosclerosisand
heartdisease.
19. 10. Highbloodpressure,smoking,highcholesterol,elevatedtriglycerides,obesity,diabetesandlack
of exercise jeopardizethe functionof the majorheartarteriesandare particularlythreatening
to women’shealth.
Key Q&A
1. What isatherosclerosis?Oftenreferredtoas“hardeningof the arteries,”atherosclerosisoccurs
whenyourarteriesnarrowand become lessflexible becausecholesterol,fattysubstances,cell
waste products,calciumandfibrin—collectivelycalledplaque—collectontheirinnerwalls.The
arteriesrespondtothe buildupbybecominginflamed.Thiscausesscartissue toformand other
cellstocollectinthe affectedareas,furthernarrowingthe artery.Atherosclerosisisaformof
arteriosclerosis,whichisageneral termfor the natural hardeningof yourarteriesthathappens
withage.
2. What causesplaque tobuildup?We don’tknow.Some expertsthinkplaqueaccumulatesin
placeswhere the innerlayerof anarteryis damaged,possiblybyelevatedcholesterol levels,
elevatedtriglyceride levels,elevatedbloodglucose,highbloodpressure andcigarette smoke.
Smokingespeciallyacceleratesthe developmentof atherosclerosisaswell asincreasingblood
pressure andrestrictingthe amountof oxygenthe bloodsuppliestothe body.Diabetesisalsoa
majorrisk factor,and stresshas alsobeenimplicated,althoughitsexactassociationwithheart
disease hasnotbeendetermined.There are alsogeneticfactorsthatpredispose individualsto
earlyatherosclerosis.
3. Will IknowI have atherosclerosisbyrecognizingthe symptoms?Notnecessarily.Oftenthe
disease progressesforalongwhile before complicationsorsymptomsarise.However,there are
some conditionsthatmayhintat an atherosclerosisdiagnosis,includingchestpain,orangina.
However,itisestimatedthattwo-thirdsof womenwhodie suddenlyfromcoronaryheart
disease hadnopriorsymptoms.Therefore itisimportantthatyougetscreenedfor
cardiovasculardisease riskfactorsandtreated asappropriate because waitingforsymptomsto
developmaybe toolate.
4. What can I do to preventatherosclerosis?Changingyourhabitsremainsthe single mosteffective
wayto stop the disease fromprogressing.Changingyourdiettoone low insaturatedfat and
cholesterol helpsreduce highbloodcholesterol,aprimarycause of atherosclerosis.A moderate
amountof the healthierpolyunsaturatedandmonounsaturatedfatssuchasinfish,nutsand
olive oil maybe helpful butbe aware of total caloriesconsumed perday.Eatinglesssugarand
eatinga dietenrichedinfruits,vegetablesandfibershouldalsohelpyoulose weight.If youare
overweight,losingweightcanhelplowerbloodcholesterol andisthe mosteffectivelifestyle
wayto reduce highbloodpressure,anotherriskfactorforatherosclerosisandheartdisease.
You alsocan benefitfromexercise.
5. Is atherosclerosisdangerous?Yes!Asthe disease progresses,itcancompletelyclogarteries,
cuttingoff bloodflow.Thisisespeciallydangerousinarteriesnearthe brain,the heartorother
vital organs.Completelyornearlyblockedbloodflow tothe heartcan leadtoa heartattack and
kill muscle cellsinthe heart.The resultispermanentheartdamage.Plaque mayalsobreakloose
20. suddenlyandtravel throughthe bloodstreamtoyourbrainor heart,causinga stroke or a heart
attack.
6. Whicharteriesare most at riskfor atherosclerosis?Althoughatherosclerosiscanaffectmedium
and large arteriesanywhere inyourbody,those goingtoyourbrain(carotid), heart(coronary)
and legs(femoral oriliac) are mostat risk.
7. How quicklydoesatherosclerosisoccur?While atherosclerosistypicallyprogressesgradually—
sometimesevenstartinginchildhood—youare mostat riskwhenarterial blockage buildsup
quickly, completelyclosingoff anartery.Thiscan happenif plaque rupturesanda clotforms.
8. Doesmy riskincrease asI age?Yes!Priorto menopause,womenare somewhatprotectedfrom
heartdisease,inpart,byestrogenproducedbythe ovaries.The body’sownnatural estrogen
helpskeepyourarteriesfree fromplaquebyimprovingthe ratioof LDL (low-densitylipoprotein)
and HDL (high-densitylipoprotein) cholesterol.Italsoincreasesthe amountof HDL cholesterol,
whichhelpsclearLDL cholesterol—the kindthatmostcontributestoplaque buildup—fromthe
bloodstream.However,supplemental estrogenorestrogentherapyisnotrecommendedafter
menopause topreventagainstatherosclerosisandheartdisease.Also,if youhave afamily
historyof earlyheartdisease orif youhave diabetesorsmoke,youare at riskforheart disease
evenbefore menopause.
9. Althoughriskincreaseswithage,atherosclerosisisaprocessthat developsoveryears,sodon’t
put off makinglifestylechangesuntilyouare olderbecause itmay be too late.Itis importantto
start withheart-healthyhabitsinyouthandmiddle age topreventcomplicationslaterinlife.
Adultswithevenone majorriskfactorforheart disease bythe age of 50 have an increased
lifetimeriskof cardiovasculardisease andshortermediansurvivalcomparedtoadultswithno
riskfactors.
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