Heart disease is the leading cause of death in the United States. Some key ways to prevent heart disease include not smoking, following a Mediterranean diet, maintaining normal blood pressure and cholesterol levels, achieving a healthy body weight through diet and exercise, exercising regularly, getting sufficient sleep, and treating medical conditions like diabetes and hypertension. Making lifestyle changes and taking preventive medications if needed can significantly reduce one's risk of heart disease by 50-70% over time.

1. Andrew G. L. McGinn, M.D., FACC Cardiology North Memorial Heart and Vascular Institute 763-581-5400 Heart Health September 21, 2010

2. Normal Heart Anatomy

3. Normal Heart Function Body’s engine Beats 60-80 times each minute =40 million times each year Pumps 5 quarts of blood each minute =1800 gallons each day

5. Leading Causes of Death United States, 2004 2,397,615 Total 1 33,373 Septicemia 10 2 42,480 Kidney Disease 9 2 59,664 Influenza & Pneumonia 8 3 65,965 Alzheimer's Disease 7 3 73,138 Diabetes Mellitus 6 5 112,012 Unintentional Injury 5 5 121,987 Chronic Lung Diseases 4 6 150,074 Stroke 3 23 553,888 Cancer 2 27 652,486 Heart Disease 1 % Number Cause of Death Rank

6. Heart Disease is the #1 Killer of Women & Men One out of every 3 deaths is from Heart Disease or Stroke in the USA Every 26 seconds, an American will suffer a Heart Attack Every 40 seconds, someone will suffer a Stroke One Death every 34 seconds due to Heart Disease

7. You are only as old as your coronary arteries.

8. Atherosclerotic Plaque Development

10. Atherosclerotic Plaque Development

13. Atherosclerotic Plaque Development

15. Myocardial Infarction

16. Coronary Angioplasty and Stent Placement

17. Coronary Artery Stent

18. Coronary Artery Stent

19. Heart Attack (Myocardial Infarction )

20. Coronary Thrombus Extraction

21. Heart Attack Warning Signs Chest Discomfort: pressure, fullness, burning, squeezing or pain lasting more than a few minutes Discomfort in one or both arms, shoulders, back, neck, jaw, or upper abdomen Shortness of breath Other symptoms may include: lightheadedness, nausea, cold sweats, and/or fatigue

22. What To Do Dial 911 if symptoms last more than 10 minutes Have someone drive you to hospital if ambulance wont arrive within 20 minutes Do not drive yourself unless no other option Chew an adult aspirin tablet (325mg) if no symptoms of a stroke

23. Denial Not just a river in Egypt

26. Heart Disease Prevention What you can do to take care of your heart?

27. Heart Disease Prevention Heart Disease develops gradually over many years – so have great opportunity to prevent it 80+% of heart disease may be prevented with healthy lifestyle and appropriate use of medications

28. Modifiable Risk Factors for Heart Disease Hypertension Smoking Abdominal Obesity Physical Inactivity Diabetes or Metabolic Syndrome Abnormal Cholesterol Lack of Daily Fruit and Vegetable Intake Insufficient Sleep

30. Heart Attack Prevention Aspirin Heart Attack Primary Prevention (No known CAD or other Atherosclerosis) Aspirin 81 to 162 mg/Day if at higher risk: Men 45+ years old Diabetic men 40+ if additional risk factor Secondary Prevention (Known CAD or other Atherosclerosis) Aspirin 81-325mg/Day unless contraindicated

31. Hypertension

32. Hypertension “Silent Killer” Major risk factor for Coronary Artery Disease Triples a man’s risk of a heart attack Doubles a woman’s risk Affects >65 million Americans #1 major preventable cause of heart failure Major risk factor for stroke Major cause of kidney disease

33. Blood Pressure Classification Normal Blood Pressure <120/80mmHg Prehypertension 120/80 to 139/89 High Blood Pressure 140/90 or higher Archives of Internal Med 2004; 164:2113

34. Blood Pressure Therapy Goal 130/80 mmHg if Diabetes < 130/80 if Chronic Kidney Disease < 140/<90 for everyone

35. Lifestyle Changes that Lower Blood Pressure Method SBP Decrease Weight loss 5-20 mmHg Healthy diet 8-14 mmHg Reducing sodium 2-8 mmHg Regular Exercise 4-9 mmHg Reducing Alcohol 2-4 mmHg Sleep Apnea Rx 20+ mmHg

36. Deaths from Behavioral Causes United States, 2000 JAMA 2000; 291: 1238

37. Smoking: The Real Reason Dinosaurs Became Extinct

38. Smoking & Heart Disease Risk Tobacco use remains the single most preventable cause of death in America. One in 5 cardiovascular deaths are attributable to smoking. Smoking directly causes 400,000 deaths each year in USA alone 35,000 – 65,000 people die of second hand smoke annually

39. Smoking & Heart Disease Risk Men who smoke have their first heart attack 7 years earlier than non-smokers Smoking 1-5 cigarettes/day increases risk by 38% Smoking 40 cigarettes/day increases risk by 900%

40. Obesity Upgraded to Major Risk Factor for Coronary Artery Disease 27% of Americans, >73 million people Prevalence is increasing in America Responsible for >300,000 deaths/year

41. Obesity Increases risk of Heart Attack, Diabetes, Stroke, Sleep apnea, and Hypertension Even moderate excess weight (10-20#) increases risk of Early Death Intake of an extra 100 calories/day translates into a 10# weight gain/year

42. Body Mass Index (BMI) Weight in Pounds (Ht -inches) (Ht- inches) X 703 Example: 220# and 6ft 3 inches = 220/75x75 x 703 = 27.5

43. Classification of Weight by Body Mass Index (BMI) > 30 Obese 25-29.9 Overweight 18.5-24.9 Normal <18.5 kg/m2 Underweight

44. Abdominal Obesity Doubles your risk of a heart attack Fat tissue produces hormones and chemical messengers that cause coronary artery inflammation Measure waist circumference Goal is: <35 inches for women <40 inches for men

45. Abdominal Obesity

46. Physical Inactivity Upgraded to Major Risk Factor for Coronary Artery Disease Prevalence is increasing in America Brisk walking > 3 hours/week lowers the risk of heart events by 30-40%

47. Exercise

48. Strong Medicine Benefits of Physical Activity Men who walk 30 minutes 5 days/week reduce their risk of heart attack by 23% Improves blood pressure Raises good HDL and lowers bad LDL Cholesterol Reduces obesity and risk of Type II Diabetes or improves control of it Reduces C-reactive protein, a measure of vascular inflammation

49. Physical Activity and Mortality Risk “Survival of the Fittest” Circulation 2000; 102: 1358

50. Exercise

52. Cholesterol Subtypes LDL (Bad) HDL (Good)

53. CHD Mortality Increases with Increasing LDL Cholesterol LDL Cholesterol Death / 1000 Patient years Age-adjusted CHD death per 1000 person years with CHD

54. Cholesterol and CV Risk Lowering cholesterol by 10% lowers risk by 30% for women and men Statin medications lower risk of a heart attack by 30+% If you have coronary artery disease, diabetes, an aneurysm, or a previous stroke, you most likely should be taking a Statin medication

55. Treatment of High Cholesterol Diet and Exercise will lower cholesterol and make cholesterol less likely to be deposited in the blood vessel wall Medication to lower cholesterol can decrease the risk of a heart attack by 30+% The lower the LDL cholesterol the better; the higher the HDL cholesterol the better

56. Diet for Prevention of Coronary Artery Disease Eat fewer animals More plant-based protein Omega-3 fatty acids (oily fish or supplements) More fruit and vegetables Complex carbohydrates: beans, whole grains, sweet potatoes Olive oil Walnuts, almonds, avocadoes

57. Mediterranean Diet N Engl J Med 2003; 346: 26

58. Mediterranean Diet Heart Study Lancet 2002; 360: 1455

59. “ Let your food be your medicine and your medicine be your food ” --Hippocrates 420 B.C.

60. Cholesterol Goals Total Cholesterol < 200 LDL (bad cholesterol) < 130 for everyone; < 100 if 2 or more risk factors; < 70 if coronary artery disease/stroke HDL (good cholesterol) > 50 Triglycerides < 150 (< 100?)

61. Initiating plaque rupture and initiation of platelet rich thrombus Heart Attack Prevention

62. Non-contrast EBCT scans Left Main LAD LCX Ao LA PA No calcification Severe calcification

63. Coronary Calcium Score Screening tool for Coronary Artery Disease Safe Relatively inexpensive Amount of calcium is related to burden of atherosclerosis. As the amount of calcium increases, the likelihood of having obstructive disease increases, as does the likelihood of having a coronary event. Negative calcium score has high negative predictive value for coronary event over next 5 years

64. Diabetes and Heart Disease At any age, Diabetic individuals are 3-7 times more likely to have heart disease than non-diabetics Heart attacks occur 10 years earlier in Diabetics

65. Diabetes and Heart Disease If you have diabetes you should receive the same treatment and medications as if you already had a heart attack, stent or bypass surgery Most diabetics will require medicine for their cholesterol and blood pressure even if they don’t need medicine to control their blood sugar

66. Risk of Coronary Heart Disease Death % N Engl J Med 1998; 339: 229

67. Insufficient Sleep At least 7 hours of restful sleep/night is recommended Adults who sleep 5 or fewer hours/night have: Increased Vascular Inflammation Increased Risk of Diabetes Increased Coronary Calcium

68. Obstructive Sleep Apnea Snoring, daytime sleepiness, not refreshed after hours in bed, morning headaches. If untreated is associated with increased risk of: Hypertension Stroke Heart Attack Congestive Heart Failure Death Arrhythmias Edema

69. Heart Disease is Preventable Heart Disease develops gradually over 20+ years – so have a great opportunity to prevent it 80+% of heart disease events may be preventable through lifestyle changes and appropriate medication

70. “A goal without a plan is just a wish” -Antoine de Saint-Exupery (1099-1944)

72. Heart Disease Risk Reduction Don’t smoke Mediterranean Diet Normal Blood Pressure Normal Cholesterol Body Mass Index <25 Normal or controlled Blood sugar Regular Exercise 30-60 minutes most days Sleep 7+ hours/night

73. Heart Disease Risk Reduction 50-70% Mediterranean Diet 35-55% Ideal Body Weight >45% Regular Exercise 2-3%/mmHg BP drop Treat Hypertension 20-40% less MI Treat Cholesterol 50-70% in 5 yrs Smoking Cessation Reduction Behavior

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