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Heart disease 2018
- 1. Healthy Living LectureSeries Stephan Esser MD, USPTA
- 2. TR Story • 58y/o male with a history of high blood pressure and high cholesterol very well controlled on medications • April 29, 2008: “Normal” Stress Test • 1:30 pm June 13, 2008 while at work he had a massive heart attack and died
- 3. JF Story • 52y/o male avid runner • July 20, 1984 found on the side of the road dead in nothing but his running shoes and shorts • Autopsy showed he had blocked one coronary artery 95%, a second 85%, and a third 70%
- 4. • Every 40Seconds someone dies of a Heart Attack in the US
- 5. “Heart disease isa paper tiger that need not exist” Caldwell Esselstyne MD Director of Preventive Cardiology at Cleveland Clinic
- 6. How To Preventand Reverse Heart Disease
- 7. Goals • Educate: – WhyHeart Disease matters – How your body works – The power of lifestyle: Review the Science • Empower: – Develop a personalized Health Plan
- 8. Tonight • Is – Introduction/Review –Inspiration • Is Not – Personalized Recommendations for medication or intervention for your heart problem
- 9. Outline Go to “Mini-MedSchool” Learn just how much of a problem this disease is Review basic anatomy of the heart and cardiovascular system Find out what really causes “Heart Disease” Visit the Market Learn a few basics about healthy nutrition Learn how good nutrition can help keep your heart healthy Put it all together Tips to take home
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- 11. What is HeartDisease? • Heart Disease – Broad term for problems with your “Cardiovascular System” (ie: Heart and Blood Vessels) – Including: – Heart Attacks: Coronary Artery Disease – Heart Arrythmias (Abnormal Heart rhythms) – Heart Valve Problems – ……and others
- 13. Top Ten Causesof Death for Men in the United States
- 14. Spending on HeartDisease • $440 billion (2010 CDC)
- 15. Basic Facts • HeartDisease is the #1 Cause of Death in the US • Heart Disease is a major cause of health care spending Let’s learn more
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- 17. Your Circulation • Bloodtravels: • Heart to Lungs where it gets “Oxygenated” • Back to Heart • Out to the Body via Arteries to bring oxygen and nutrition • Back to the heart via Veins
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- 20. Review • The Heartis the bodies “pump” • Propels Oxygen and Nutrition and carries away cell waste products via the “highways” of the arteries and veins • The vessels are “ Alive”
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- 22. Your Risks • Non-ModifiableRisks: Not in your control – Male gender – Age >55 – Family history of heart disease – Personal history of heart disease – Post-menopausal – Race (African Americans, American Indians, and Mexican Americans are more likely to have heart disease than Caucasians)
- 23. Your Risks • ModifiableRisks: In Your Control – Smoking – High Total Cholesterol, High LDL, Low HDL – Uncontrolled Hypertension (High Blood Pressure) – Obesity – Uncontrolled Diabetes – Exercise – Nutrition – Stress
- 24. 2 of 32of 3
- 25. Associated Pathology • CVD: –Hypertension – Congestive Heart Failure – PVD – Impotence – Claudication • Endocrine: – Diabetes – PCOS – Hypothyroidism – Infertility • Orthopedics: – Osteoarthritis – AVN • Hepatic: – #1 cause of liver dz in US • Obstetrics: – Gestational DM – Macrosomia – Inc. C Section rate – Inc. Perinatal Morbidity – Inc. Pre/Eclampsia • Cancer: – Prostate – Colon – Breast – Endometrial – Renal Cell – Gallbladder – Esophageal Adeno. • Other: • Hyperuricemia, Pancreatitis, Gallstones, Sleep Apnea, Alzheimer’s, Dyslipidemia, Metabolic Syndrome
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- 28. The Problem • HighBlood Pressure: – 1 in 3 adults 1:3 adults1:3 adults
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- 32. Smoking Men: 20.5 (23.9) Women:15.8(18.1) Men: 20.5 (23.9) Women: 15.8(18.1)
- 33. Smoking • Mechanisms ofInjury: – Injury to the Endothelium – Oxidation at the Cellular Level – Potent Vaso-Constrictor
- 34. Cholesterol • Waxy FatLike Substance • Precursor Molecule – Hormones ( Estrogen, Testosterone, Cortisol) • Building Block for Cell Membranes
- 35. Cholesterol • Lipoproteins: – Proteinswhich bind to cholesterol in your blood stream and act as carrier molecules – LDL ( Low-Density Lipoprotein) • Increases deposits of cholesterol in your artery wall – HDL ( High Density Lipoprotein) • Reduces deposits of cholesterol in your artery wall • Triglycerides: Excess calories in meal converted to these
- 36. Cholesterol Goals • Total Cholesterol< 200 • LDL < 100 • HDL > 40 for men and > 60 for women • Triglycerides < 150
- 38. Food Portion Cholesterol/mg VegetablesUnlimited 0 Fruits “ “ 0 Nuts “ “ 0 Seed “ “ 0 Grains “ “ 0 Milk (non-fat) 100g 2 Milk (whole) 100g 10 Butter 1 Tbs 31 Beef 100g 61 Salmon 100g 55 Chicken 100g 65 Shrimp 100g 126 Lobster 100g 127 Egg 100g 372 http://www.nal.usda.gov/fnic/foodcomp/search/
- 39. Cholesterol Production • Increasedwhen you eat – Saturated Fats, Trans Fats
- 40. High Blood Pressure Goal:< 140/90 or < 130/80 if other risks
- 41. Obesity • Do youknow your BMI? (Body Mass Index) • If you fall in the “Obese” Category you have increased risk for: – Heart Disease, High Blood Pressure, Stroke, Diabetes and many Cancers • 1 in 3 Americans are in the Obese category
- 42. What about “Atherosclerosis”? •Most of us think of: – Atherosclerosis: Fatty build up in the blood vessels
- 43. Atherosclerosis Development • Hemodynamicdisturbances – High Blood Pressure • Hypercholesterolemia – High Cholesterol • Inflammation
- 46. Cholesterol • Not oneor the other: Health vs Disease • If you have eaten the Standard American Diet ( SAD) • Then you HAVE Coronary Artery Disease
- 49. Review • Atherosclerosis beginsearly in life • Progresses with habits and age • Is the “heart” of disease • If you have eaten the Standard American Diet you have atherosclerosis • We can “nurture” nature
- 50. Diabetes • Are youPre-Diabetic? • Do you have Diabetes? – Do you know your Hemoglobin A-1-C number? • Diabetes Increases Heart Disease Risk: – Damages blood vessels – Increases blood pressure – Weakens your heart • Good control of your blood sugars is essential
- 51. Exercise • National Recommendationsfor all adults – 150 minutes of moderate intensity exercise each week – 2 days a week of “strength training”
- 52. Exercise • Physical Activity/Exercise= Heart Disease Risk • How? – Decreases Blood Pressure – Improves Heart and Blood Vessel Health – Lowers Body Mass Index – Increases “Good” HDL Cholesterol – Improves Blood Sugars – Other Benefits
- 53. Nutrition • American HeartAssociation: – Fruits and vegetables – Fiber-rich whole grains – Sodium – Sugar-sweetened beverages
- 54. Fruits and Veggies Atleast 4.5 cups a day Primarily Whole Minimally Processed “Plants” Primarily Whole Minimally Processed “Plants”
- 55. Nuts, Legumes, Seeds Atleast 4 servings a week
- 56. Whole Grains At leastthree 1-ounce-equivalent servings a day
- 57. Salt (Sodium) Less than1,500 mg a day
- 58. Chips: 170mgChips: 170mg 1Slice of Bread: 150mg1 Slice of Bread: 150mg Prego Traditional ½ cup: 480mgPrego Traditional ½ cup: 480mg
- 59. Sodium < 1500mg Cholesterol < 200mg Sodium < 1500 mg Cholesterol < 200mg
- 60. Sodium < 1500mg Cholesterol < 200mg Sodium < 1500 mg Cholesterol < 200mg
- 63. Review • Eat MORE –Fruits, Veggies, Whole Grains, Beans, Seeds, Unprocessed foods • Eat less – High fat, cholesterol, high salt, high sugar, highly processed foods Or “Avoid, boxes, bags, cans and crinkly bags.”
- 64. Stress • Elevates BloodPressure • Increases heart rate • Increases production of inflammatory hormones
- 65. Review • Lifestyle factorspowerfully influence our health • How powerfully, which one the most?
- 66. Review • Universal • ReadilyModifiable • Multimodal effects Nutrition
- 67. Nutritional Factors • Reduceor Eliminate Cholesterol • Reduce Saturated, Eliminate Trans fats • Increase Fiber and micronutrients • Reduce Sodium
- 69. Nutrition and HeartDisease • Can Plant-Based Nutrition prevent or reverse Heart Disease?
- 70. Risks • High BloodPressure • High Cholesterol • Obesity • Diabetes • Inflammation
- 72. Healthy living isthe best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study 2009 • 23,153 participants (35 to 65yr) for about 8 years • Rates of type 2 diabetes mellitus, myocardial infarction, stroke, and cancer • 4 Variables: – Never smoking – BMI<30 – 3.5 h/wk or more of physical activity – healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption). If you had all 4 factors at baseline you had • 78% lower risk of developing a chronic disease • • 93% lower risk of diabetes •81% lower risk of myocardial infarction •50% lower risk of stroke, and •36% lower risk of cancer If you had all 4 factors at baseline you had • 78% lower risk of developing a chronic disease • • 93% lower risk of diabetes •81% lower risk of myocardial infarction •50% lower risk of stroke, and •36% lower risk of cancer
- 73. Dietary habits andmortality in 11 000 vegetarians and health conscious people: results of a 17 year follow up BMJ 1996; 313 : 775 (Published 28 September 1996) Results: 2064 (19%) subjects smoked, 4627 (43%) were vegetarian, 6699 (62%) ate wholemeal bread daily, 2948 (27%) ate bran cereals daily, 4091 (38%) ate nuts or dried fruit daily, 8304 (77%) ate fresh fruit daily, and 4105 (38%) ate raw salad daily. After a mean of 16.8 years follow up there were 1343 deaths before age 80. Overall the cohort had a mortality about half that of the general population. Within the cohort, daily consumption of fresh fruit was associated with significantly reduced mortality from ischaemic heart disease (rate ratio adjusted for smoking 0.76 (95% confidence interval 0.60 to 0.97)), cerebrovascular disease (0.68 (0.47 to 0.98)), and for all causes combined (0.79 (0.70 to 0.90)).
- 74. Vegetarian diets: whatdo we know of their effects on common chronic diseases? Am J Clin Nutr May 2009 vol. 89 no. 5 1607S-1612S There is convincing evidence that vegetarians have lower rates of coronary heart disease, largely explained by low LDL cholesterol, probable lower rates of hypertension and diabetes mellitus, and lower prevalence of obesity. Overall, their cancer rates appear to be moderately lower than others living in the same communities, and life expectancy appears to be greater.
- 75. BLOOD-PRESSURE-LOWERING EFFECT OFA VEGETARIAN DIET: CONTROLLED TRIAL IN NORMOTENSIVE SUBJECTS The Lancet, Volume 321, Issue 8314, Pages 5-10I.Rouse 59 healthy, omnivorous subjects aged 25-63 years were randomly allocated to a control group, which ate an omnivorous diet for 14 weeks, or to one of two experimental groups, whose members ate an omnivorous diet for the first 2 weeks and a lacto-ovo-vegetarian diet for one of two 6-week experimental periods. Mean systolic and diastolic blood pressures did not change in the control group but fell significantly in both experimental groups during the vegetarian diet and rose significantly in the experimental group which reverted to the omnivorous diet. Adjustment of the blood-pressure changes for age, obesity, heart rate, weight change, and blood pressure before dietary change indicated a diet-related fall of some 5-6 mm Hg systolic and 2-3 mm Hg diastolic. Although the nutrient(s) causing these blood-pressure changes are unknown, the effects were apparently not mediated by changes in sodium or potassium intake
- 76. • BLOOD PRESSUREIN VEGETARIANS – Am. J. Epidemiol. (1974) 100 (5): 390-398. • Vegetarian diet in mild hypertension: a randomised controlled trial. – 58 subjects aged 30-64 with mild untreated hypertension were allocated either to a control group eating a typical omnivorous diet or to one of two groups eating an ovolactovegetarian diet for one of two six week periods. A fall in systolic blood pressure of the order of 5 mm Hg occurred during the vegetarian diet periods, with a corresponding rise on resuming a meat diet.
- 77. Rapid reduction ofserum cholesterol and blood pressure by a twelve-day, very low fat, strictly vegetarian diet. J Am Coll Nutr. 1995 Oct;14(5):491-6. During this short time period, cardiac risk factors improved: there was an average reduction of total serum cholesterol of 11% (p < 0.001), of blood pressure of 6% (p < 0.001) and a weight loss of 2.5 kg for men and 1 kg for women.
- 79. The calorically restrictedlow-fat nutrient-dense diet in Biosphere 2 significantly lowers blood glucose, total leukocyte count, cholesterol, and blood pressure in humans PNAS December 1, 1992 vol. 89 no. 23 11533-11537 • Biosphere 2 is a 3.15-acre space containing an ecosystem that is energetically open (sunlight, electric power, and heat) but materially closed, with air, water, and organic material being recycled. Since September 1991, eight subjects (four women and four men) have been sealed inside, living on food crops grown within. Their diet, low in calories (average, 1780 kcal/day; 1 kcal = 4.184 kJ), low in fat (10% of calories), and nutrient-dense, conforms to that which in numerous animal experiments has promoted health, retarded aging, and extended maximum life span. We report here medical data on the eight subjects, comparing preclosure data with data through 6 months of closure. Significant changes included: (i) weight, 74 to 62 kg (men) and 61 to 54 kg (women); (ii) mean systolic/diastolic blood pressure (eight subjects), 109/74 to 89/58 mmHg (1 mmHg = 133 Pa); (iii) total serum cholesterol, from 191 +/- 11 to 123 +/- 9 mg/dl (mean +/- SD; 36% mean reduction), and high density lipoprotein, from 62 +/- 8 to 38 +/- 5 (risk ratio unchanged); (iv) triglyceride, 139 to 96 mg/dl (men) and 114 to 78 mg/dl (women); (v) fasting glucose, 92 to 74 mg/dl; (vi) leukocyte count, 6.7 to 4.7 x 10(9) cells per liter. We conclude that drastic reductions in cholesterol and blood pressure may be instituted in normal individuals in Western countries by application of a carefully chosen diet and that a low-calorie nutrient-dense regime shows physiologic features in humans similar to those in other animal species.
- 80. Unhealthy Nutrition • Knowthe Science: – Single HF meal • Alters Endothelial function up to 4 hours after – Effect of a single high-fat meal on endothelial function in healthy subjects.Vogel RA, Corretti MC, Plotnick GDAm J Cardiol. 1997 Feb 1; 79(3):350-4.
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- 82. Alter Risk • ChangeBehaviors • Bigger Changes = Bigger Results • Bigger Results = Lower Risk
- 84. Dean Ornish MD “CanLifestyle Changes Reverse Coronary Heart Disease?”Lancet 1990 Regression of Atherosclerotic plaques “Intensive Lifestyle Changes for Reversal of Coronary Heart Disease” JAMA 1998 5 yr f/u showed continued atherosclerotic regression and ½ the rate of cardiac events “Angina Pectoris and Atherosclerotic Risk Factors in the Multisite Cardiac Lifestyle Intervention Program” AM J Card 2008 By 12 weeks 74% were angina free “The effectiveness and efficacy of an intensive cardiac rehabilitation program in 24 sites” Am J Health Promotion 2010 Significant reductions in BMI/SBP/DBP/A1C/Tchol/LDL/Trig $30,000 per patient in the first year$30,000 per patient in the first year Reduced total health-care costs in those with coronary heart disease by 50 percent after only one year Reduced total health-care costs in those with coronary heart disease by 50 percent after only one year
- 85. Dean Ornish MD •High Mark BCBS : 2 years f/u post 1 year intervention • MI’s: 87 % in Ornish group, 48% for the control group. • Angioplasty: 84% in OG • Bypass Surgery: 80% in OG • Catheterizations: 64% in OG
- 86. Pritikin Program • Effectsof a high-complex-carbohydrate, low- fat, low-cholesterol diet on levels of serum lipids and estradiol American Journal of Medicine 1985 • 26 day program – Total Cholesterol dropped from 229-181 – Triglycerides dropped from 301-151
- 87. Pritikin Program • Effectsof Life-style Modification on Serum Lipids JAMA 1991 – 4587 people in a 3 week program – High-complex-carbohydrate, high-fiber, low-fat, and low-cholesterol diet combined with daily aerobic exercise, primarily walking – 23% reduction in Total Cholesterol – 23% reduction in LDL – 33% reduction in Triglycerides – 5% reduction in weight
- 88. Pritikin Program • Effectsof a High-Complex-Carbohydrate Diet and Daily Walking on Blood Pressure and Medication Status of Hypertensive Patients Journal of Cardiac Rehabilitation, 3: 839, 1983 • 216 adults on 3 week program • 83% were able to discontinue BP medx and had normal BP’s • 17% had their pill dosages substantially reduced
- 89. Pritikin Program • Pritikinet al Long-Term Use of a High-Complex-Carbohydrate, High-Fiber, Low-Fat Diet and Exercise in the Treatment of NIDDM Patients Diabetes Care 1983 – 26 day inpatient stay, 77% off Oral Hypoglycemics, 25% in TC • Effect of Short-Term Pritikin Diet Therapy on the Metabolic Syndrome Journal of Cardio-Metabolic Disease 2006 – 12-15 day stays, BMI 3%, SBP, SG, LDL 10-15% – 37% no longer met criteria for Metabolic Syndrome
- 96. Defining Success • PreventingHeart Disease • Reversing Heart Disease • Reducing Medication needs • Stopping the progression/avoid complications • Improve Quality of life/energy/clarity
- 97. What we know •We can prevent/reverse/eliminate most Heart Disease • This takes work……… but it is all worth it!!!!!!
- 98.
- 99. Stages of Change (Prochaskaand DiClemente) 1: Pre-contemplation 2: Contemplation 3: Preparation/planning 4: Action 5: Maintenance 6: Permanent Maintenance (Termination)
- 100. GROW • Goals • Realitytoday • Options • Will
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- 102. Break Out: 2minutes • Set YOURSELF a SMART Goal for heart helth and share it with your neighbor! • Specific • Measureable • Achievable • Realistic • Timely Exercise Nutrition Toxins Sleep Emotional Poise(Stress) Exercise Nutrition Toxins Sleep Emotional Poise(Stress)
- 103. Conclusion • Personal Choicesare powerful Medicine • Assess YOUR Heart Health Today • Identify your heart health goals • Keep Learning • Develop a support team • Take charge of your heart health!
- 104. Thank You! Stephan EsserMD, USPTA
Editor's Notes
- #3 Lead NBC News anchor and the lead journalist for Meet the Pressf for 16 years
- #4 Icon in modern running and someone credited with starting the “running craze” in America
- #10 First we are going to go to a “mini-med school” where we are going to……….then we are going to hit the gym and
- #13 When it comes to common and dangerous diseases…heart disease is at the top……you can see here the top 10 causes of death in american women. Heart disease is far and away the number one cause of death in america www.cdc.gov/cancer/ breast/statistics/
- #14 The statistics are even more compelling when you look at what is killing American Men………..so we know heart www.cdc.gov/cancer/ breast/statistics/ http://www.cdc.gov/cancer/Prostate/publications/decisionguide/
- #15 As you might guess, since heart disease is the most common disease in America we also spend the most money on it……..when you crunch the numbers we spend nearly 6 times more money each year treating heart disease then we do on the entire budget for the department of education. When you think about the numbers like that you realize just how important it is that each of us does our part to try to reduce the frequency and cost of heart disease http://www.ahrq.gov/research/ria19/expriach4.htm www.cdc.gov/heartdisease/faqs.htm
- #16 So what do we know so far………
- #17 Heart: Sits in the chest wall on the left side, protected by the rib cage, surrounded by the lungs on either side. The heart is connected to blood vessels which branch and spread in an amazing collection of small vessels throughout the body. In fact if you put the blood vessels in an adult end to end it would go go over 100,000 miles. Talk more about the amazing circulatory system…………..Heart is a pump…….an average of 100,000 beats per day…..etc… http://my.clevelandclinic.org/PublishingImages/heart/upper-body-circulation.jpg http://www.nottingham.ac.uk/nursing/practice/resources/cardiology/images/cut_away_chest.gif
- #18 Talk about how amazing the heart is…..how long it takes the blood to get from heart out and back again and how many times it does that every day etc…..whatever fascinating little scientific tidbits you want to share…. http://healthsciencetechnology.wikispaces.com/file/view/10_001.jpg/56805008/10_001.jpg
- #20 Inflammation is key, may take “2 hits” to cause a real problem…smoking and cholesterol, cholesterol and some form of oxidizing or further inflamming agent 68% of heart attacks occur in vessels &lt; 50% occluded 2/3rds of heart attacks occur in people with normal cholesterol Stress Test: can be positive on average if &gt; 70% blockage of an artery is present EKG: Shows abnormal rhyethms and beats only if a problem with the electrical part of your heart or if the heart is already damaged
- #21 Transition……..”…in fact, heart disease is ….the #1 killer ……..feel free to elaborate about the bad stuff that can happen…types of disease etc…just keep in mind your limited time..
- #23 Sample Text: So now that we reviewed the basics about the heart and heart disease, let’s spend some time talking about the risks for heart disease. Risk factors for every disease can be split into non-modifiable risks which means you can’t do anything to change them, and the “modifiable “ risks. We think it is good to know your non-modifiable risks just to know where you stand, but we want you to spend the most time thinking about the next slide………..
- #24 Sample Text: “Modifiable risks” are the things in your control. The things you have a say about. The things that you can make choices about every day. Your choices can then influence your risk of heart disease. Let’s list them here and then we are going to go through them one at a time in the next few slides…..
- #25 --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm
- #26 --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf
- #28 In 2005-2008 11% of adults 20 years of age or older had diabetes. In 2005-2008 the percentage of adults with dm increased with age from 4% of persons 20-44 to 27% of adults 65 years of age or older http://meps.ahrq.gov/mepsweb/ Medical Expenditure Panel survey
- #29 http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf The prevalence of hypertension (defined as high blood pressure or taking antihypertensive medication) increases with age. In 2005–2008, 33%–34% of men and women 45–54 years of age had hypertension, compared with 67% of men and 80% of women 75 years of age and over (Table 67).
- #30 http://www.cdc.gov/nchs/data/databriefs/db92_fig1.png
- #31 http://sas-origin.onstreammedia.com/origin/gallupinc/GallupSpaces/Production/Cms/POLL/yxirhsg6pe-ttjvtlo_uuq.gif These findings are based on 24 months of Gallup-Healthways Well-Being Index daily tracking data from 2009 through 2010, encompassing surveys with more than 650,000 U.S. adults, aged 18 and older. The resulting sample sizes for every age from 18 through 90 -- ranging from roughly 1,500 to 18,000 cases -- allow for age-specific analysis of the data.
- #33 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6302a2.htm?s_cid=mm6302a2_w#tab Sample Text: Show of hands…how many of you know someone who smokes……. Most Powerful thing you can do to reduce heart disease risk is quit smoking/help them quit The effects are immediate, and the longer you stay smoke free the better for your health…it’s not too late If you need or someone you know needs help, reach out, make a plan, there is a lot we can do to support you Talk about how and why smoking damages blood vessels, causes oxidation , narrows arteries etc etc….
- #37 HDL + LDL + 20% Triglycerides = Total Cholesterol Score Sample Text: Talk about Total Cholesterol and the 2 sources Self (Liver) and Food (Meat and Dairy). Only animal-based foods have cholesterol, there is none in plants. Explain what LDL and HDL are….perhaps how they can remember them….HDL=happy cholesterol LDL=Lousy Cholesterol….any fun , playful and informative tips you want to offer……etc…
- #40 Trans Fats: Add hydrogen to liquid vegetable oil chemically and it changes the chemical equation and it lengthens the shelf life of the oil, and makes the fat more solid
- #41 Sample Text: Explain Blood Pressure…….pressure in the blood vessels, similar to the pressure in a hose or your home plumbing…….(or use other analogy) If you have time you can explain what the 2 numbers actually mean. Systolic=when heart is squeezing Diastolic =when heart is relaxing etc…..you decide how much you want to teach on each one of the slides…….you can take a moment to ask how many people have high blood pressure or know someone who does, or how often they check their pressures at home etc….. http://pennstatehershey.adam.com/graphics/images/en/9124.jpg
- #42 We will provide you the presenter with a pdf of a BMI chart taken from the BMI site .gov
- #43 Sample Text: Atherosclerosis is not so much a “risk factor” as it is a result of several risk factors. It is however the cause of the leading type of heart disease….coronary artery disease. I thought you should know a little bit about it though since you often hear this word In the newspaper or on TV. Atherosclerosis is essentially the build up of cholesterol and calcium rich deposits in the lining of the blood vessels. A high cholesterol diet along with a highly inflammatory diet and things that damage the blood vessel walls (like smoking) can increase your risk of atherosclerosis. As you can tell from this picture, the atherosclerosis can build up in your blood vessels and block blood flow. Definitely not what you want to happen………so let’s get back to talking risk factors http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/18020.jpg
- #45 utopsy data from the conflicts in Korea 2 and Vietnam 3 the Bogalusa study,4 and the PDAY5 study all testify to the ubiquitous nature of the disease in young Americans. Recently, intra-arterial ultrasonography confirmed that “normal” segments in patients with coronary artery disease also have diffuse symmetrical atherosclerosis, which is not yet disfiguring the intra-luminal diameter and thus is invisible to angiography.6 This work is further confirmation of the Roberts autopsy data, which demonstrates that essentially all patients with ischemic heart disease have triple vessel involvement.7 Chronic endothelial injury eventually results in endothelial dysfunction and increased permeability and induces LDL oxidation and accumulation in the subendothelial space of the intima[10] as well as the expression of adhesion molecules (e.g., vascular cell adhesion molecule [VCAM]-1, ICAM-1, and P selectin) and chemokines (e.g., monocyte chemoattractant peptide [MCP]-1) that participate in platelet aggregation, lymphocyte and monocyte adhesion and infiltration, thus initiating the inflammatory process.[11–16] As monocytes are attracted to the endothelium and migrate to the subendothelial space, they mature into macrophages and uptake oxidized LDL transforming into &apos;foam&apos; cells that eventually form the lipid core of the atherosclerotic plaque after apoptosis occurs.[17] This inflammatory mediator cascade promotes a phenotype change of vascular smooth muscle cells (VSMCs) from the &apos;contractile&apos; phenotype state to the active &apos;synthetic&apos; state. VSMCs in the synthetic state can migrate and proliferate from the media to the intima, where they produce excessive amounts of extracellular matrix (e.g., collagen, elastin and proteoglycans) that transforms the lesion into a fibrous plaque.[18] The typical atherosclerotic plaque comprises of the lipid
- #47 utopsy data from the conflicts in Korea 2 and Vietnam 3 the Bogalusa study,4 and the PDAY5 study all testify to the ubiquitous nature of the disease in young Americans. Recently, intra-arterial ultrasonography confirmed that “normal” segments in patients with coronary artery disease also have diffuse symmetrical atherosclerosis, which is not yet disfiguring the intra-luminal diameter and thus is invisible to angiography.6 This work is further confirmation of the Roberts autopsy data, which demonstrates that essentially all patients with ischemic heart disease have triple vessel involvement.7
- #48 Bogalusa Heart Study,7) the extent of fatty streaks and fibrous plaques in the aorta and coronary arteries were examined in 204 young patients 2-39-years-of-age. The prevalence of fatty streaks in the coronary arteries increased with age from approximately 50% at 2-15-years-of-age to 85% at 21-39-years-of-age, and the prevalence of raised fibrous-plaque lesions increased with age from 8% at 2-15-years-of-age to 69% at 26-39-years-of-age. The prevalence and the extent of atherosclerosis was greater with increasing age, body mass index (BMI), blood pressure, and levels of serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C).
- #49 National academies press Atherosclerotic heart disease mortality rates for Japanese men aged 55-64 by geographic area 1950-1960’s
- #51 Talk about Diabetes briefly and the importance of seeing your doctor regularly and having good control of your blood sugars thru good diet and exercise along with taking your medications as prescribed
- #52 Sample Text: According to the CDC all adults should……. Discuss the recommendations from the CDC for exercise. Studies show that by achieving 150 minutes per week we get the majority of health benefits. Additional exercise is “icing on the cake” You may define strength training (machines, weights in the YMCA). Remind the audience what a great opportunity to come to the YMCA for their regular fitness programs. Remind them they can break the exercise up into small bursts of activity as short as 10 minutes per time with the same proven health benefits. They can also compress their activity into two or three days if this works better for their schedule. Introduce the “Talk Test.” This is a validated test for people to know how hard they are working. Easy Intensity =Can talk and sing while doing exercise Moderate Intensity= Can Talk but not sing while exercising Intense= Can’t talk or sing while exercising When starting or if they have chronic medical conditions or a history of heart disease etc…people should start at Easy. If no concerning PMH, may start at Moderate Intensity
- #53 Physical Activity is powerful stuff……..it can help reduce your heart disease risk…….how you may ask…….by……………..now let’s look at what else exercise can do for your health
- #54 The American Heart association reccs cover the following…….we will review each one separately http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Healthy-Diet-Goals_UCM_310436_SubHomePage.jsp
- #61 Panera Ham, Egg and Cheese Sandwich Olive Garden Chicken Parmigian Season 52 Cedar Plan Salmon
- #72 Rates of death from Cardiovascular disease in Norway
- #84 http://www.ornishspectrum.com/
- #85 http://www.pmri.org/publications/newsweek/Yes_Prevention_is_Cheaper_than_Treatment_Dean_Ornish.pdf http://www.ncbi.nlm.nih.gov/pubmed/9860380?ordinalpos=33&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Attrition rate of 10-12.7 %
- #86 http://www.prnewswire.com/news-releases/highmark-blue-cross-blue-shields-dr-dean-ornish-program-for-reversing-heart-disease-recognized-by-harvard-medical-school-for-innovative-partnership-with-health-professionals-58968142.html
- #94 Lyon = mediteranean
- #102 SpecificWell definedClear to anyone that has a basic knowledge of the project MeasurableKnow if the goal is obtainable and how far away completion is Know when it has been achievedAgreed UponAgreement with all the stakeholders what the goals should be RealisticWithin the availability of resources, knowledge and time Time BasedEnough time to achieve the goalNot too much time, which can affect project performance