How Can a Heart Attack Be Prevented?
Making lifestyle changes is the most effective way to prevent having a heart attack.
Lowering your risk factors for coronary heart disease can help you prevent a heart attack. Even if you already have coronary heart disease.
For more information visit:
www.srisriholistichospitals.com
Living a Heart Healthy Life - Liliana Cohen - West Orange Public Library - 2....Summit Health
Learn how to make healthy choices that impact heart health, the typical mistakes to avoid, and how to recognize the signs and symptoms of a heart attack.
This expert consensus statement from the Lipid Association of India provides guidelines for managing dyslipidemia in Indians. It finds that atherosclerotic cardiovascular disease burden is high in India and Indians are at especially high risk. Dyslipidemia is rising among Indians, who have higher triglycerides and lower HDL than Western populations. The statement provides recommendations for risk stratification, lipid targets, and lifestyle modifications like physical activity, diet, tobacco cessation, and stress management to aid primary prevention of cardiovascular disease in India.
This document provides guidelines from the 2019 ACC/AHA on primary prevention of cardiovascular disease. It discusses assessing cardiovascular risk in adults aged 40-75 using pooled cohort equations to calculate 10-year risk. For those at borderline or intermediate risk, additional risk-enhancing factors can guide treatment decisions such as statin therapy. Lifestyle modifications like diet, exercise, weight management and treating conditions like diabetes and high blood pressure are emphasized. Nutrition recommendations include eating vegetables, fruits, whole grains and fish; limiting sodium, processed meats and sugar-sweetened drinks. Adults should aim for 150 minutes of moderate exercise weekly.
The document provides guidelines for cholesterol management and cardiovascular disease (CVD) risk assessment. It discusses guidelines for measuring cholesterol and lipid levels, calculating LDL and VLDL values, and assessing CVD risk. It recommends starting moderate- or high-intensity statin therapy for most adults aged 40-75 years with diabetes or LDL ≥70 mg/dL. For those without diabetes but with a CVD risk of 7.5% or higher, it recommends discussing statin therapy. The guidelines also provide recommendations for managing statin side effects, evaluating risk factors, and refining risk assessment using coronary artery calcium scoring. The main messages are to emphasize lifestyle changes, use high-intensity statins for high-risk patients, and consider patient risk
This document provides an overview of diabetic dyslipidemia and lipid management recommendations for patients with diabetes. It discusses that excess fat contributes to atherosclerosis and mortality in diabetes. It outlines traditional and non-traditional risk factors for cardiovascular disease. The spectrum of diabetic dyslipidemia includes quantitative changes like high triglycerides and qualitative changes in lipoprotein composition. Lifestyle modifications and statin therapy are recommended to improve lipid profiles and reduce cardiovascular risk according to guidelines. The appropriate screening, interpretation of results, and intensity of statin therapy depends on individual patient risk factors and characteristics.
The document discusses atherosclerosis and its causes like hypercholesterolemia, smoking, high blood pressure, and inflammation. It then covers measuring lipid levels in the blood and classifying different types of dyslipidemias. Global cardiovascular risk is assessed by looking at risk factors and calculating 10-year heart disease risk. Management of dyslipidemia involves therapeutic lifestyle changes like a healthy diet, exercise, weight control, and avoiding smoking. Drug therapy may also be needed. Olive oil is highlighted as it contains beneficial fatty acids and antioxidants that can reduce heart disease risk.
1) A 43-year-old male presented with chest pain and was diagnosed with an acute inferior STEMI while in normal sinus rhythm. His medical history included atherosclerosis.
2) Atherosclerosis is caused by plaque buildup in arteries and accounts for over 70% of cardiovascular deaths in the US. Elevated LDL cholesterol increases the risk of atherosclerosis and heart disease.
3) Therapeutic lifestyle changes like diet and exercise can modestly lower LDL cholesterol by about 5% on average but response varies between individuals. High fat, low carb diets may improve glycemic control in diabetes without worsening lipids.
Living a Heart Healthy Life - Liliana Cohen - West Orange Public Library - 2....Summit Health
Learn how to make healthy choices that impact heart health, the typical mistakes to avoid, and how to recognize the signs and symptoms of a heart attack.
This expert consensus statement from the Lipid Association of India provides guidelines for managing dyslipidemia in Indians. It finds that atherosclerotic cardiovascular disease burden is high in India and Indians are at especially high risk. Dyslipidemia is rising among Indians, who have higher triglycerides and lower HDL than Western populations. The statement provides recommendations for risk stratification, lipid targets, and lifestyle modifications like physical activity, diet, tobacco cessation, and stress management to aid primary prevention of cardiovascular disease in India.
This document provides guidelines from the 2019 ACC/AHA on primary prevention of cardiovascular disease. It discusses assessing cardiovascular risk in adults aged 40-75 using pooled cohort equations to calculate 10-year risk. For those at borderline or intermediate risk, additional risk-enhancing factors can guide treatment decisions such as statin therapy. Lifestyle modifications like diet, exercise, weight management and treating conditions like diabetes and high blood pressure are emphasized. Nutrition recommendations include eating vegetables, fruits, whole grains and fish; limiting sodium, processed meats and sugar-sweetened drinks. Adults should aim for 150 minutes of moderate exercise weekly.
The document provides guidelines for cholesterol management and cardiovascular disease (CVD) risk assessment. It discusses guidelines for measuring cholesterol and lipid levels, calculating LDL and VLDL values, and assessing CVD risk. It recommends starting moderate- or high-intensity statin therapy for most adults aged 40-75 years with diabetes or LDL ≥70 mg/dL. For those without diabetes but with a CVD risk of 7.5% or higher, it recommends discussing statin therapy. The guidelines also provide recommendations for managing statin side effects, evaluating risk factors, and refining risk assessment using coronary artery calcium scoring. The main messages are to emphasize lifestyle changes, use high-intensity statins for high-risk patients, and consider patient risk
This document provides an overview of diabetic dyslipidemia and lipid management recommendations for patients with diabetes. It discusses that excess fat contributes to atherosclerosis and mortality in diabetes. It outlines traditional and non-traditional risk factors for cardiovascular disease. The spectrum of diabetic dyslipidemia includes quantitative changes like high triglycerides and qualitative changes in lipoprotein composition. Lifestyle modifications and statin therapy are recommended to improve lipid profiles and reduce cardiovascular risk according to guidelines. The appropriate screening, interpretation of results, and intensity of statin therapy depends on individual patient risk factors and characteristics.
The document discusses atherosclerosis and its causes like hypercholesterolemia, smoking, high blood pressure, and inflammation. It then covers measuring lipid levels in the blood and classifying different types of dyslipidemias. Global cardiovascular risk is assessed by looking at risk factors and calculating 10-year heart disease risk. Management of dyslipidemia involves therapeutic lifestyle changes like a healthy diet, exercise, weight control, and avoiding smoking. Drug therapy may also be needed. Olive oil is highlighted as it contains beneficial fatty acids and antioxidants that can reduce heart disease risk.
1) A 43-year-old male presented with chest pain and was diagnosed with an acute inferior STEMI while in normal sinus rhythm. His medical history included atherosclerosis.
2) Atherosclerosis is caused by plaque buildup in arteries and accounts for over 70% of cardiovascular deaths in the US. Elevated LDL cholesterol increases the risk of atherosclerosis and heart disease.
3) Therapeutic lifestyle changes like diet and exercise can modestly lower LDL cholesterol by about 5% on average but response varies between individuals. High fat, low carb diets may improve glycemic control in diabetes without worsening lipids.
Dyslipidemia, specially high LDL cholesterol is the key risk factor for cardiovascular diseases. The presentation discusses metabolism and structure of lipoproteins, their screening and interpretation, risk assessment methods, targets for various lipoproteins and its step by step treatment.
We are facing lot of health issues daily . because Our new life style Food , Smoking , use of Alcohol , Stress etc , A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. If blood flow isn't restored quickly, the section of heart muscle begins to die.
Heart attacks are a leading killer of both men and women . This Slides Explain How to Prevent Heart attack .
This document provides guidelines for the diagnosis and management of dyslipidemia for adults over 18 years old. It was developed by a multidisciplinary task force and has been reviewed and approved regularly since 1999. The guidelines establish screening recommendations and lipid treatment goals based on a patient's risk level. They provide a sequence of medication recommendations depending on a patient's lipid patterns. The guidelines are intended to help clinicians manage dyslipidemia and reduce patients' risk of coronary heart disease.
The document provides guidelines for the practical management of dyslipidemia and drug resistant dyslipidemia. It discusses identifying risk factors to guide personalized therapy, assessing cardiovascular risk, screening recommendations for different populations, lipid tests to perform, and the approach to management for different patient groups including those with ASCVD, undergoing PCI, with diabetes, chronic kidney disease, or statin intolerance. It recommends statins, especially atorvastatin, for secondary prevention in ASCVD patients based on landmark trials showing reductions in cardiovascular events.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
Cardiovascular disease is the leading cause of death among women, though it has been declining among men. While traditional risk factors like hypertension, diabetes, and smoking apply to women, they alone do not explain women's full risk. Additional risk factors for women include abdominal obesity, physical inactivity, depression, and postmenopausal status. Assessing a woman's overall cardiometabolic risk involves considering both modifiable risk factors and estimating her 10-year risk of cardiovascular events. Lifestyle interventions targeting smoking cessation, diet, exercise, and weight management can help reduce women's cardiovascular risk.
El Prof. Alberico L. Catapano, profesor de Farmacología en la Facultad de Farmacia de la Universidad de Milán (Italia) y presidente de la European Atherosclerosis Society (EAS), participa en la sesión 'Nuevos enfoques y evidencias cone statinas en ECV y control lipídico', perteneciente a la 'Jornada Galáctica sobre Guías de Lípidos y objetivos a alcanzar en los pacientes de más alto riesgo cardiovascular' (Málaga, 4-5 abril, 2014).
Accede a la jornada completa en http://guiaslipidos.secardiologia.es
The document discusses guidelines for managing dyslipidemia, including interpreting lipid profiles and determining when to treat patients with high LDL or low HDL levels. It recommends treating individuals with clinical atherosclerotic cardiovascular disease, primary LDL elevations over 190 mg/dL, diabetes with LDL between 70-189 mg/dL, or without diabetes or clinical ASCVD but with a 10-year risk over 7.5% and LDL between 70-189 mg/dL. Clinical atherosclerotic cardiovascular disease is defined as conditions like heart attacks, angina, stroke, and peripheral arterial disease presumed to be from atherosclerosis. The document emphasizes determining when treatment is necessary based on a patient's lipid levels and risk factors.
This patient is a 45-year-old premenopausal nonsmoker with a sedentary lifestyle and family history of diabetes, heart disease, and stroke. Her labs show a total cholesterol of 236 mg/dL, triglycerides of 200 mg/dL, LDL-C of 140 mg/dL, and HDL-C of 46 mg/dL. She meets the criteria for metabolic syndrome due to her abdominal obesity, triglycerides, HDL-C, and blood pressure. Though her LDL-C is below threshold for drug therapy, lifestyle changes are recommended to control her metabolic syndrome and lower her cardiovascular risk.
1) This document provides guidelines for screening, assessing cardiovascular risk, and managing dyslipidemia from the 2016 Canadian Cardiovascular Society guidelines.
2) It recommends screening all adults aged 40-75 for lipids and assessing risk every 5 years using the Framingham Risk Score or Cardiovascular Life Expectancy Model.
3) For primary prevention, it recommends considering statin therapy for those at intermediate risk with LDL-C ≥3.5 mmol/L or other risk factors. For high risk it recommends statin therapy.
This document discusses guidelines for managing dyslipidemia with statins. It identifies 4 main groups that benefit from statin treatment based on their ASCVD risk: 1) those with clinical ASCVD, 2) those with LDL-C >190 mg/dL, 3) those with diabetes aged 40-75 with LDL-C 70-189 mg/dL, and 4) those aged 40-75 without clinical ASCVD or diabetes but with LDL-C 70-189 mg/dL and 10-year ASCVD risk >7.5%. The document reviews evidence that moderate- and high-intensity statin therapy lowers ASCVD risk across all baseline LDL-C levels above 70 mg/dL. It provides guidance on
HRR Healthy Life Style Dr Ravi Jandhyala heart healthBhava Swaroop
Being Indian significantly increases the risk of developing heart disease earlier in life. Indians typically experience heart attacks 10 years earlier than other populations and have a much higher risk of heart attacks under age 45. The prevalence of heart disease in India has doubled in rural areas and tripled in urban areas over the past 30 years. Unhealthy lifestyles and risk factors like smoking, diabetes, and abdominal obesity explain much of the early onset and severity of heart disease seen in Indians.
the study was a pilot study done at National Institute of Ayurveda under the Phd Research Programme with an aim to find out new avenues in the managegement of Dyslipidemia - Medoroga and Coronary Heart Disease - Hridroga, thus initiating a new concept of Preventive Cardiology through Ayurveda & Panchakarma
Heart of the Matter - Ali Ahmad, MD, FACC - Livingston Library - 1.6.2020Summit Health
Heart disease is the leading killer of adults nationwide and it carries a significant morbidity for the population at risk. Learn about traditional and non-traditional risk factors associated with coronary artery disease, and how to modify your risk and prevent heart disease. Also, learn about how heart disease affects different ethnic backgrounds, particularly the high-risk groups, such as South Asians.
This document discusses dyslipidemia, including its epidemiology, classification, diagnosis, screening, and management. Some key points:
- Dyslipidemia is characterized by abnormal lipid levels and contributes to atherosclerosis. It can be primary or secondary.
- The prevalence of dyslipidemia in Saudi Arabia ranges from 20-44% according to studies.
- Diagnosis involves measuring lipid levels through a serum profile. Treatment involves lifestyle changes and lipid-lowering drugs like statins.
- Statins are beneficial for both primary and secondary prevention of cardiovascular disease according to clinical trials. Guidelines recommend statin use for those with specific risk factors.
This document discusses coronary heart disease in young adults. It finds that while most coronary disease occurs in older populations, 2-6% of acute coronary events occur in younger "premature" patients under 55 years old. Major risk factors for young adults include smoking, family history of early heart disease, male gender, and hyperlipidemia. Diagnostic tests may include electrocardiograms, stress tests, echocardiograms, CT angiograms, and calcium scoring. Aggressive risk factor modification including smoking cessation and statin therapy is important for prognosis. While short term outcomes of revascularization are good, long term mortality is still elevated compared to the general population.
Dyslipidemia, specially high LDL cholesterol is the key risk factor for cardiovascular diseases. The presentation discusses metabolism and structure of lipoproteins, their screening and interpretation, risk assessment methods, targets for various lipoproteins and its step by step treatment.
We are facing lot of health issues daily . because Our new life style Food , Smoking , use of Alcohol , Stress etc , A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can't get oxygen. If blood flow isn't restored quickly, the section of heart muscle begins to die.
Heart attacks are a leading killer of both men and women . This Slides Explain How to Prevent Heart attack .
This document provides guidelines for the diagnosis and management of dyslipidemia for adults over 18 years old. It was developed by a multidisciplinary task force and has been reviewed and approved regularly since 1999. The guidelines establish screening recommendations and lipid treatment goals based on a patient's risk level. They provide a sequence of medication recommendations depending on a patient's lipid patterns. The guidelines are intended to help clinicians manage dyslipidemia and reduce patients' risk of coronary heart disease.
The document provides guidelines for the practical management of dyslipidemia and drug resistant dyslipidemia. It discusses identifying risk factors to guide personalized therapy, assessing cardiovascular risk, screening recommendations for different populations, lipid tests to perform, and the approach to management for different patient groups including those with ASCVD, undergoing PCI, with diabetes, chronic kidney disease, or statin intolerance. It recommends statins, especially atorvastatin, for secondary prevention in ASCVD patients based on landmark trials showing reductions in cardiovascular events.
What’s new in Lipidology, Lessons from “recent guidelines“Arindam Pande
1. The 2018 ACC/AHA cholesterol guidelines provide 10 key take-home messages focusing on lifestyle management, statin therapy for various risk groups, and risk assessment approaches.
2. The guidelines emphasize lifestyle therapy and statins for secondary prevention, with an LDL-C goal of 70 mg/dL for very high risk patients to consider adding nonstatins.
3. They provide guidance on statin use for various primary prevention groups based on risk levels and discussion, including an expanded definition of intermediate risk factors.
Cardiovascular disease is the leading cause of death among women, though it has been declining among men. While traditional risk factors like hypertension, diabetes, and smoking apply to women, they alone do not explain women's full risk. Additional risk factors for women include abdominal obesity, physical inactivity, depression, and postmenopausal status. Assessing a woman's overall cardiometabolic risk involves considering both modifiable risk factors and estimating her 10-year risk of cardiovascular events. Lifestyle interventions targeting smoking cessation, diet, exercise, and weight management can help reduce women's cardiovascular risk.
El Prof. Alberico L. Catapano, profesor de Farmacología en la Facultad de Farmacia de la Universidad de Milán (Italia) y presidente de la European Atherosclerosis Society (EAS), participa en la sesión 'Nuevos enfoques y evidencias cone statinas en ECV y control lipídico', perteneciente a la 'Jornada Galáctica sobre Guías de Lípidos y objetivos a alcanzar en los pacientes de más alto riesgo cardiovascular' (Málaga, 4-5 abril, 2014).
Accede a la jornada completa en http://guiaslipidos.secardiologia.es
The document discusses guidelines for managing dyslipidemia, including interpreting lipid profiles and determining when to treat patients with high LDL or low HDL levels. It recommends treating individuals with clinical atherosclerotic cardiovascular disease, primary LDL elevations over 190 mg/dL, diabetes with LDL between 70-189 mg/dL, or without diabetes or clinical ASCVD but with a 10-year risk over 7.5% and LDL between 70-189 mg/dL. Clinical atherosclerotic cardiovascular disease is defined as conditions like heart attacks, angina, stroke, and peripheral arterial disease presumed to be from atherosclerosis. The document emphasizes determining when treatment is necessary based on a patient's lipid levels and risk factors.
This patient is a 45-year-old premenopausal nonsmoker with a sedentary lifestyle and family history of diabetes, heart disease, and stroke. Her labs show a total cholesterol of 236 mg/dL, triglycerides of 200 mg/dL, LDL-C of 140 mg/dL, and HDL-C of 46 mg/dL. She meets the criteria for metabolic syndrome due to her abdominal obesity, triglycerides, HDL-C, and blood pressure. Though her LDL-C is below threshold for drug therapy, lifestyle changes are recommended to control her metabolic syndrome and lower her cardiovascular risk.
1) This document provides guidelines for screening, assessing cardiovascular risk, and managing dyslipidemia from the 2016 Canadian Cardiovascular Society guidelines.
2) It recommends screening all adults aged 40-75 for lipids and assessing risk every 5 years using the Framingham Risk Score or Cardiovascular Life Expectancy Model.
3) For primary prevention, it recommends considering statin therapy for those at intermediate risk with LDL-C ≥3.5 mmol/L or other risk factors. For high risk it recommends statin therapy.
This document discusses guidelines for managing dyslipidemia with statins. It identifies 4 main groups that benefit from statin treatment based on their ASCVD risk: 1) those with clinical ASCVD, 2) those with LDL-C >190 mg/dL, 3) those with diabetes aged 40-75 with LDL-C 70-189 mg/dL, and 4) those aged 40-75 without clinical ASCVD or diabetes but with LDL-C 70-189 mg/dL and 10-year ASCVD risk >7.5%. The document reviews evidence that moderate- and high-intensity statin therapy lowers ASCVD risk across all baseline LDL-C levels above 70 mg/dL. It provides guidance on
HRR Healthy Life Style Dr Ravi Jandhyala heart healthBhava Swaroop
Being Indian significantly increases the risk of developing heart disease earlier in life. Indians typically experience heart attacks 10 years earlier than other populations and have a much higher risk of heart attacks under age 45. The prevalence of heart disease in India has doubled in rural areas and tripled in urban areas over the past 30 years. Unhealthy lifestyles and risk factors like smoking, diabetes, and abdominal obesity explain much of the early onset and severity of heart disease seen in Indians.
the study was a pilot study done at National Institute of Ayurveda under the Phd Research Programme with an aim to find out new avenues in the managegement of Dyslipidemia - Medoroga and Coronary Heart Disease - Hridroga, thus initiating a new concept of Preventive Cardiology through Ayurveda & Panchakarma
Heart of the Matter - Ali Ahmad, MD, FACC - Livingston Library - 1.6.2020Summit Health
Heart disease is the leading killer of adults nationwide and it carries a significant morbidity for the population at risk. Learn about traditional and non-traditional risk factors associated with coronary artery disease, and how to modify your risk and prevent heart disease. Also, learn about how heart disease affects different ethnic backgrounds, particularly the high-risk groups, such as South Asians.
This document discusses dyslipidemia, including its epidemiology, classification, diagnosis, screening, and management. Some key points:
- Dyslipidemia is characterized by abnormal lipid levels and contributes to atherosclerosis. It can be primary or secondary.
- The prevalence of dyslipidemia in Saudi Arabia ranges from 20-44% according to studies.
- Diagnosis involves measuring lipid levels through a serum profile. Treatment involves lifestyle changes and lipid-lowering drugs like statins.
- Statins are beneficial for both primary and secondary prevention of cardiovascular disease according to clinical trials. Guidelines recommend statin use for those with specific risk factors.
This document discusses coronary heart disease in young adults. It finds that while most coronary disease occurs in older populations, 2-6% of acute coronary events occur in younger "premature" patients under 55 years old. Major risk factors for young adults include smoking, family history of early heart disease, male gender, and hyperlipidemia. Diagnostic tests may include electrocardiograms, stress tests, echocardiograms, CT angiograms, and calcium scoring. Aggressive risk factor modification including smoking cessation and statin therapy is important for prognosis. While short term outcomes of revascularization are good, long term mortality is still elevated compared to the general population.
Hosted by with Sophie Tully BSc MSc, 10th October
This presentation addresses the role of cholesterol in CVD and the latest evidence into nutritional strategies to manage and treat high cholesterol and support healthy CVD function. Sophie covers the aetiology of CVD and why cholesterol has long been considered an important marker of CVD health and the emergence of newly identified CVD risk factors which may offer a more effective diagnostic tool. Finally she discusses new opinions on nutritional approaches to keep cholesterol levels healthy and prevent CVD events.
Cardiometabolic syndrome is characterized by a clustering of risk factors including abdominal obesity, elevated blood pressure, dyslipidemia, and impaired glucose tolerance. It identifies individuals at high risk for cardiovascular disease and diabetes. The International Diabetes Federation definition focuses on abdominal obesity as the main criteria, requiring this plus two additional risk factors. Lifestyle modifications including diet, exercise and weight loss are the primary treatment approach to reduce cardiometabolic risk by targeting the individual components.
1) The lecture discussed cardiovascular disease (CVD) risk assessment for nursing students. CVD is a major cause of death worldwide and in Ethiopia.
2) It reviewed various CVD risk factors and scoring systems to assess individual risk, such as the WHO/ISH charts. Risk factors include age, smoking status, blood pressure, cholesterol levels, and diabetes.
3) Prevention strategies were outlined for both primary prevention of high-risk individuals and secondary prevention for those with existing CVD. Lifestyle changes and medications aim to reduce modifiable risk factors and prevent further events.
Metabolic syndrome is defined as a cluster of conditions that increase the risk of cardiovascular disease and diabetes. It affects about 25% of US adults and prevalence increases with weight. The diagnostic criteria include central obesity plus two of the following: elevated triglycerides, low HDL cholesterol, high blood pressure, elevated fasting blood glucose. Central obesity, especially visceral fat, leads to insulin resistance which drives the pathogenesis. Treatment involves lifestyle modifications like diet, exercise and weight loss as well as medication for individual components such as hypertension and hyperlipidemia.
Stroke is a major health problem that is largely preventable through lifestyle modifications and treatment of risk factors. Primary prevention focuses on treatment of risk factors like hypertension, diabetes, high cholesterol through medications and lifestyle changes. Secondary prevention for those who have had a stroke centers around the mnemonic ABCDE - antiplatelets, blood pressure control, smoking cessation, diet and exercise. Transient ischemic attacks also require urgent evaluation and treatment to prevent future strokes, with over 10% risk of stroke within 3 months. Risk stratification tools like ABCD2 score can help determine need for hospital admission and guide management.
The document discusses cardiovascular disease (CVD) risk factors and outcomes in patients with diabetes. It finds that CVD is responsible for 60-75% of mortality in type 2 diabetes (T2DM) patients. CVD prevalence increases with both age and duration of T2DM. Patients can develop CVD even in the first few years after being diagnosed with diabetes. Intensive control of blood sugar, blood pressure, and cholesterol is important for reducing CVD risk in T2DM patients.
This document provides an overview of cardiovascular disease (CVD) risk assessment. It discusses the burden of non-communicable diseases like CVD in Ethiopia. It defines primary and secondary CVD prevention strategies and risk factor modification. The document outlines tools for assessing individual CVD risk, like the WHO/ISH risk charts, and recommendations for lifestyle modifications and medical treatment based on assessed risk level, such as the use of statins or aspirin. The goal is to identify those at high risk and prevent future cardiovascular events through optimization of modifiable risk factors.
This document discusses various lifestyle diseases including obesity, type 2 diabetes, cardiovascular disease, and some cancers. It notes that these diseases are caused or promoted by behaviors like poor diet, physical inactivity, tobacco use, and other modifiable risk factors. Key points covered include the definition of metabolic syndrome; statistics on obesity prevalence; complications of diabetes like blindness, kidney failure and limb amputation; leading causes of death in the US like heart disease and cancer; recommended ranges for blood pressure, cholesterol, BMI; and risk factors and ways to control cardiovascular and diabetes risk.
CAD -RISK FACTOR MODIFICATION AND PRIMARY PREVENTIONPraveen Nagula
This document discusses primary prevention of coronary artery disease. It defines primary prevention as action taken prior to disease onset to prevent disease from ever occurring, through screening, health exams, and modifying risk factors. The document outlines modifiable risk factors for heart disease like smoking, hypertension, diabetes, obesity, and high cholesterol. It provides strategies for risk factor modification including lifestyle changes like a healthy diet, exercise, and medication if needed. The goal of primary prevention is to tailor therapy to high risk individuals before significant disease develops.
prevention of heart attacks is the theme on this world heart day.heart disease is increasing in india like an epidemic & affecting younger people with more mortality
CAD is spreading like an epidemic in south east Asia,esp india where its affecting younger ppl with grave prognosis. due to limited resourses, primary prevention becomes the most important tool to arrest this epidemic
Lifestyle Medicine: The Power of Personal Choices, North American Vegetarian...EsserHealth
Lifestyle Medicine focuses on applying behavioral and environmental principles to managing lifestyle-related health problems. Chronic diseases now account for 75% of healthcare costs in the US, many of which are strongly associated with diet and physical inactivity. While genetics play a role, the rise of these "lifestyle diseases" correlates with changes in American diets and exercise patterns over recent decades. Prospective randomized studies demonstrate that organized lifestyle interventions can significantly reduce disease incidence and healthcare costs compared to prescription medications. Lifestyle Medicine aims to educate and empower individuals to make personal choices that can transform health outcomes on both individual and societal levels.
1) Metabolic syndrome is a cluster of conditions including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels that increase the risk of heart disease, stroke and diabetes.
2) It is becoming increasingly common globally, affecting nearly 1 in 5 adults. In India, prevalence rates are as high as 33.5% overall.
3) Lifestyle factors like unhealthy diet, physical inactivity and obesity are major contributors to metabolic syndrome. Initial treatment focuses on lifestyle modifications like diet changes, increased exercise and weight loss.
PERCEPTIONS Vs REALITY:WOMEN AND HEART DISEASEHarilal Nambiar
This document discusses perceptions and realities about women and heart disease. It notes that heart disease is the number one killer of women, yet they are less likely to be correctly diagnosed due to perceptions that heart disease primarily affects men and that women experience different symptoms than men. The document summarizes several risk factors for heart disease in women such as high cholesterol, smoking, high blood pressure, diabetes, obesity, lack of exercise, and family history. It provides statistics on the prevalence of these conditions in women and how they can be managed through lifestyle changes and medical treatment to reduce heart disease risk.
This presentation will show the diagnosttic criteria of metabolic syndrome and life style modification to cope up with this common disease .
also shows some quiz for medical students
This document discusses heart healthy nutrition and reducing risk factors for heart disease. It defines key terms like diet and heart healthy foods. The major sections discuss what causes heart attacks like obesity, insulin resistance, inflammation and related risk factors. Specific foods like eggs, dairy, grains and fats are discussed in terms of their effects on risk factors. The conclusion is that maintaining a low body fat level through a practical nutrition plan is the most important aspect of heart healthy eating.
Emotional and Behavioural Problems in Children - Counselling and Family Thera...PsychoTech Services
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Simple Steps to Make Her Choose You Every DayLucas Smith
Simple Steps to Make Her Choose You Every Day" and unlock the secrets to building a strong, lasting relationship. This comprehensive guide takes you on a journey to self-improvement, enhancing your communication and emotional skills, ensuring that your partner chooses you without hesitation. Forget about complications and start applying easy, straightforward steps that make her see you as the ideal person she can't live without. Gain the key to her heart and enjoy a relationship filled with love and mutual respect. This isn't just a book; it's an investment in your happiness and the happiness of your partner
Health Tech Market Intelligence Prelim Questions -Gokul Rangarajan
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
English Drug and Alcohol Commissioners June 2024.pptxMatSouthwell1
Presentation made by Mat Southwell to the Harm Reduction Working Group of the English Drug and Alcohol Commissioners. Discuss stimulants, OAMT, NSP coverage and community-led approach to DCRs. Focussing on active drug user perspectives and interests
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2024 Media Preferences of Older Adults: Consumer Survey and Marketing Implica...Media Logic
When it comes to creating marketing strategies that target older adults, it is crucial to have insight into their media habits and preferences. Understanding how older adults consume and use media is key to creating acquisition and retention strategies. We recently conducted our seventh annual survey to gain insight into the media preferences of older adults in 2024. Here are the survey responses and marketing implications that stood out to us.
Test bank advanced health assessment and differential diagnosis essentials fo...rightmanforbloodline
Test bank advanced health assessment and differential diagnosis essentials for clinical practice 1st edition myrick.
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2. Magnitude of the Problem:
Global Burden of Cardiovascular
Disease
•½ way through a 2 century transition ; CVD
will dominate as the major cause of Death
Globally
•Although CVD is ↓in EstME it is ↑ in the rest of
the world with 85% of the worlds population.
•10% (1900) → 25% (2000) → 50% (2020)
of Global Deaths.
3. CAUSES OF DEATH
• 1. MYOCARDIAL INFARCTION
(HEART ATTACK)
DUE TO CORONARY ARTERY DISEASE
• 2. CEREBROVASCULAR ACCIDENT
(STROKE)
DUE TO BLOCK IN BRAIN TUBES
• CANCER
5. Prevalence of CAD in Different
Countries
•
0 100 200 300 400 500 600 700 800 900
Russia
Scotland
Finland
England
U.S.A.
Australia
Canada
Sweden
Italy
Urban China
France
Rural China
Japan
Women
Men
6.
7. Coronary Artery Disease – Indian
Scenario: Indians Vs West
•Average Age of first MI in west is 70 years.
In India it is 45 to 55 years.
•At any level of conventional RF – Indians
have X2 CAD than whites with similar RF
8. Coronary Artery Disease – Indian
Scenario: Past Vs Present
•CAD rates have halved in W in last 30 yrs –
Increasing alarmingly (doubled) in India
•Average Total Cholesterol was 120mg% -
increased to 200mg%
•Average Age of first MI has ↓ by 20 yrs- ½
< 50yrs, ¼ < 40 yrs of age
• Diabetes has increased by 60%.
21. Coronary Artery Disease Risk
Factors-Non Modifiable
• Male Sex
• Post Menopausal State
• (+) Family History
• Genetic Susceptibility
• Lp (a)
• Diabetes
• ? Infection
22. Smoking Cessation
• Risk of CAD/Re- MI/CABG failure X2
• Leading preventable cause of Death
• 25% in US to 70% in China
• 80% start before age 18 yrs
• In US: 55% →25% (M), 35% →20% (W)
• Risk falls rapidly after cessation
23. Smoking Cessation (Cont..)
•Cessation highly Cost effective
•Intervention usually short term
•1 yr success rates- 6% Physician
counseling , 20% self help programs, 40%
with Buproprion /nicotine patch
•3 types of Behavioral therapy- Problem
solving, social support in & outside treat
•Most effective after event
24. Alcohol
•20 to 45% risk ↓ with moderate consumption
(60ml-male, 30 ml- Female)
•↑HDL, ↑Fibrinolysis, ↓Platelet aggregation
•10-20% become chronic alcoholics
•Consider HTN, DM, ↑TG, Hgic Stroke, Liver
Disease, f/h alcoholism /Breast Ca/ Colon Ca
•Prescription should be individualized
“Whether wine is a nourishment,medicine, or
poison, is a matter of dosage”-Celsus
25. HTN- The Magnitude of the
Problem
•HTN is the commonest medical diagnosis,
affecting 1 billion worldwide
•Prevalence of HTN: 3% in 18 to 24 yrs age
13% in 35 to 44
yrs age & 70% in those >75 yrs.
•For persons over age 50, SBP is a more
important than DBP as a CVD risk factor.
26. HYPERTENSION
• >120/80-PREHYPERTENSION, >140/90- HTN
• NO SYMPTOMS. 2/3 OF AMERICAN
HYPERTENSIVES NOT AWARE
• SAME GOALS FOR ALL AGES
• SYTOLIC BLOOD PRESSURE MORE
DANGEROUS
• MOST NEED 2 OR MORE DRUGS
• GOALS: <130/80. <115/75 IN DIABETICS
WITH PROTEINURIA.
27. Pre-Hypertension: A New
Disease Is Created
Starting at 115/75 mmHg, CVD risk doubles
every 20/10 mmHg throughout the BP range.
Persons who are normotensive at age 55 have a 90%
lifetime risk for developing HTN.
Intent in creating Pre-HTN(22% of adult population)
is to stress LSM, prevent progression & to treat other
CVRF
28. Hypertension- treatment most
cost effective
• Risk ↑ Linearly from 115/75mmHg.
• 5 mm ↓ in BP Reduces strokes by 40% , CVD by
15% & Heart failure by 25%
• In stage 1 HTN and additional CVD risk factors,
achieving a sustained 12 mmHg reduction in SBP
over 10 years will prevent 1 death for every 11
patients treated
.
29. Lifestyle Modification
Modification Approximate SBP reduction
(range)
Weight reduction 5–20 mmHg/10 kg weight loss
DASH eating plan 8–14 mmHg
Dietary sodium ↓ 2–8 mmHg
Physical activity 4–9 mmHg
Moderation of
alcohol consumption
2–4 mmHg
30. Diabetes Mellitus
• Confers X 4 Risk. Young stroke X 10. No
menstrual protection for women.
• Deemed a Coronary Artery Disease
equivalent by AHA
• Worldwide ↑ by 35% (from 5%) by 2025,
max in China (↑68%) & India (60%)
•Thrifty Gene Hypothesis
31. Calculating your risk of
Developing Diabetes Mellitus
•Overweight – 5
•Sedentary – 5
•Age > (45-64) – 5, > (65) - 9
•Parent DM- 1, Sibling DM- 1
•Women with Baby >9lb - 1
•Asian - 4
•Total > 3-9= Low Risk, 10+ = need test
32. Preventing Diabetes with LSM
•DPP: Weight loss by 7% & 150 mins/
wk of moderate ex – reduced chance of
becoming Diabetic by 55% in IFG/ IGT
compared to 30% with metformin
•Delaying may be preventing- Glitazone
•Once Diabetic no degree of control of
sugars shown to prevent macrovascular
complications
33. OBESITY
1. BODY MASS INDEX: WEIGHT in Kg/
HEIGHT in M.SQ. 25 – 30(OWERWEIGHT)
30 – 35(OBESE)
2. WAIST CIRCUMFERENCE <90Cms(M),
<85Cms
3. PROTRUDING TUMMY
4. WAIST >HIP
34. Physical Inactivity / Exercise
•75% American Adults
•Inverse Linear Dose Response
relationship. Ex & all-cause mortality
•CAD, MI, HTN, DM, Dyslipidemia, MS
•50% Primary, 25% Secondary protection
35. Exercise
• Goals: Maintain 70-80% of THR for 45
Mins 5 days/Week.
• THR= 220-AGE
• Maintain ideal Body Weight & muscle
mass & Flexibility.
36. CHOLESTEROL
• A NATURAL MEMBRANE BUILDER .
• THE FINAL ROUTE TO BLOCKAGES IN ARTERIES
• GOOD - HDL CHOLETEROL
• BAD - LDL CHOLESTEROL
• UGLY - TRIGLYCERIDES
• DEADLY- Lp (a).
37. 1% ↑ Heart Attacks for every 2% ↑ in
LDL or 1% ↓ in HDL
38. Naturalization
AVERAGE IS NOT NORMAL!!
•Average LDL of Hunter-gatherers, Neonates,
Mammals is 50-70mg%. No Atherosclerosis
even in 7th
& 8th
decades.
•Avg American LDL is 130. 50% above 50Yrs
have atherosclerosis.
39. LDL - Naturalisation
HOW LOW IS LOW ENOUGH? IS IT SAFE?
•10% of highest LDL account for 20% of CAD.
• Only 25% risk reduction with current LDL Trt.
•Threshold for atherosclerosis progression is
LDL of 67mg%, CVD event rate 0 at LDL 57
(primary) & 30 mg% (secondary prevention).
•50% ↓ in LDL for secondary & 30% ↓ for
primary prevention.
•? All people above 55yrs should receive statins
40. ACT BEFORE DISEASE IS
FIXED
• More beneficial to Treat High Risk or Low
Risk patients
•50% reduction by bringing LDL to
55mg% in “low risk”- Jupiter trial
41. Metabolic Syndrome
Any 3 of the below:
• TG > 150mg/dl
• HDL-C <40 (M), <50 (F)
• FBS (plasma) >100mg/dl
• BP >130/85
• Waist Circumf > 90cm(M) > 85cm(W)
Incidence: 40%, 28% (No IFG), 75%(DM/IFG)
42. Diet & Cholesterol
• Contribution of dietary cholesterol to Blood
T-C is small (10mg%) compared to dietary
fats (100mg%)
• 4 types of Fatty acids:
• Good - Poly unsaturated (PUFA)
• Great - Mono unsaturated (MUFA)
• Bad - Saturated (SAFA)
• Deadly - Trans saturated (TFA)
43. Diet & Cholesterol- Milk
• In Indians SFA come from diary
products & cooking oils
• Avoid whole fat milk & milk products
Diary products are more saturated &
athero/throbogenic than meat products
• Nonfat Milk- Calcium, B12, ↓ BP,
decreases diabetes risk.
44. Cooking Oils / Fats
• Oils have powerful cholesterol increasing &
lowering actions
• 1/3rd
of the 54% decline in CAD in US attributed
to ↑ PUFA by 5%.
• 30mg% ↓ in T-C by banning palm oil &
substituting it by soybean oil
•Nuts are high in fat(cashew 21%, peanut14%) but
low in SAFA and do not ↑T-C
49. Diet (Cont..)
•Balance Total Calories with expenditure to
maintain ideal BMI
•Minimize Saturated /trans fat to 7% of cal
•Mono-unsaturated fats rest 20% of cal
•Omit rapidly digested Carbs – White Rice
•Whole grains are excellent source of
energy, fiber & protein
50. Diet (Cont…)
•Maximize fruits & fresh Vegetables to 5
servings/day + some nuts
•Use only very low fat Dairy products
•2-3 servings of Fatty fish /week
•Dietary supplements- 1gm/D 3 fatty
acids, Folate, B6&12, Multivitamins
•Alcohol.
52. Indian Paradox
Less RF- More CAD.
1. Genetic predisposition.?Lp(a)
2. Central obesity-Insulin Resistance
3. Metabolic Syndrome
4. Processed carbohydrates, Increased energy.
5. Increased dairy Fats
6. Frying/ Reuse of oils- TFA.
53. Sleep & Obstructive Sleep Apnea
Less than 6 or More than 8 hrs/day
Sleep Deprivation & Altering Cycles
Sun-Ambient Light & Sleep
Getting up and getting ready for work
Snoring, Daytime drowsiness, HTN, Age,
BMI & Neck Cicumference- OSA
54. 3 Main causes of heart Attacks
Food
Exercise
Mental Stress
55. Type A,Type D behavior
•Compulsive overachievers, excessively
competitive & ambitious, aggressive, hostile,
unable to relax, impatient & get easily
frustrated / angry
•Anger, Suppressed Anger, hostility.
•Large Prospective studies of healthy
x 2 risk of developing CAD
•Type D- suppressed negative emotions
56. Psychosocial Factors
• Depression
• Social Isolation
• Anger & Frustration
• Hostility
• Job Strain-High demand with little autonomy
• Marital stress
57. Tackling Negative Emotions
• Connection between Emotions & Breath
• Observe Sensations
• Everything Changes – Including emotions
• Opposite values are complimentary
• Be Centered
• Pranayama & Meditation
58.
59.
60.
61. Lp(a) - The Deadly Cholesterol
• >15-20mg/dl
• Purely Genetic
• Best childhood
predictor
• Highly atherogenic,
thrombogenic,
antifibrinolytic
• Highest among all
races except blacks
• 40 % of Indians.
Tobacco
10%
HTN
10%
Diabetes
10%
TC/LDL
15%
TC/HDL
15%
lp(a)
25%
Hcy
5%
Other
10%
Tobacco
HTN
Diabetes
TC/LDL
TC/HDL
lp(a)
Hcy
Other
62. Contributions of various risk factors
for CAD among Asian Indians
Tobacco
10%
HTN
10%
Diabetes
10%
TC/LDL
15%
TC/HDL
15%
lp(a)
25%
Hcy
5%
Other
10%
Tobacco
HTN
Diabetes
TC/LDL
TC/HDL
lp(a)
Hcy
Other
63. Prevention- From Womb to Tomb
• Womb - Measures to prevent IUGR
• Infancy- Infections?
• Childhood – Physical activity, prevent
obesity, proper nutrition and lifestyle
enforcement. Lp(a)
• Early Adulthood – FLP if F/h, screen for
DM if Obese.
•Adulthood – Screen for all RF, HsCRP
64. Prevention- The Caveats
• Eat Less - Eat a variety
• Be Natural- Exercise, Diet, Sleep
• Learn to Relax
• Act Before Diseases are Fixed
65. Predicting CAD
Biomarkers- Hs CRP
• LP PLA2
Vascular Imaging
• Carotid IMT (<1 to>3 mm)- Young
• CACS by EBCT or MSCT (>100Au)
Genomic markers
• High Density Genotyping- SNP
• Genome expression Assays
66. PRIMARY PREVENTION DRUGS-
ASPRIN & ROSUVASTATIN
• More HDL raising & TG (Stellar)
• Safer than any other Statin
• More reduction in HsCRP
• First IVUS regression (Asteroid Trial)
• Multiple sites of action (HMG, CETP,
PPAR a, ApoA1, Longest half life
67. Life Style & Behavioral
Modifications
• Difficult to qualify,quantify & study in
isolation due to multiple linked factors
• Intensely Individual but the only
modifications possible on a global scale
• Large reductions in mortality with
minimum fear of unexpected side effects
on the long run & cost effective
68. Life Style & Behavioral
Modifications- Doing it
• Understand & be Motivated
• Like it & be part of a group
• Structured program & should become
part of routine life by strength of habit
• Started early in life & should have
social/family/ work place support
70. “SUPERIOR DOCTORS PREVENT
DISEASE; MEDIOCRE DOCTORS
TREAT DISEASE BEFORE IT IS
EVIDENT; INFERIOR DOCTORS
TREAT FULL BLOWN DISEASE”
Huang dee. First Chinese
Medical Text. 2600 BC.
71. How Predictable & Preventable
is CVD
0 100 200 300 400 500 600 700 800 900
Russia
Scotland
Finland
England
U.S.A.
Australia
Canada
Sweden
Italy
Urban China
France
Rural China
Japan
Women
Men
Graph 1: Age-adjusted CAD Death Rates per
100,000 per year (Age 35-74)
72. Cardiac Metaphors of Daily Life
• Races with Excitement
• Pounds in Anticipation
• Stands still in Dread, Skipped a Beat
• Aches with Grief
• With a Heavy Heart
• The Lion Hearted, Large hearted, Heartless
• Broken Hearted
73. Preventing Heart Attacks
Role of Lifestyle Modifications &
Behavioral Changes
V.S.Ramchandra MD,DM,FACC,FSCAI,FESC.
Global Hospitals
Formerly:
Professor & Head of Cardiology, KMC, Manipal
Chief Electrophysiologist, Apollo Hospitals
Associate in Cardiology, UAB Hospital, AL, USA
Staff Cardiologist, St Vincent Health, IN, USA
75. WHAT IS CIRCULATION
• Supplies Nutrients
• Removes Waste
• Supplies Oxygen
• Removes CO2
• Single Pump
• Blood Pressure
• Gradient = 120-10
• Extremely Low
Resistance
76. WHAT HAPPENS IF
CIRCULATION TO PART OF THE
BODY IS STOPPED
• BRAIN (STROKE)
• HEART ( HEART
ATTACK or MI )
• KIDNEY
(HYPERTENSION)
• LEG (GANGRENE)
• EYE (BLINDNESS)
79. Prevalence of Heart Attacks in
Different Countries
•
0 100 200 300 400 500 600 700 800 900
Russia
Scotland
Finland
England
U.S.A.
Australia
Canada
Sweden
Italy
Urban China
France
Rural China
Japan
Women
Men
83. CAUSES OF DEATH
• 1. MYOCARDIAL INFARCTION
(HEART ATTACK)
DUE TO CORONARY ARTERY DISEASE
• 2. CEREBROVASCULAR ACCIDENT
(STROKE)
DUE TO BLOCK IN BRAIN TUBES
• CANCER
84. Heart Attacks – Indian Scenario:
Indians Vs West
•Overseas Indians–CAD X 4 Americans
•Urban Indian Epidemic(10%)Vs USA(2.5%)
•Hear Attack rates have halved in W in last
30 yrs – Increasing alarmingly (doubled) in
India
•Average Age of first Heart Attack in west is
70 years. In India it is 45 to 55 years.
85. Heart Attacks – Indian Scenario:
Past Vs Present
•Heart Attack rates have increased alarmingly
(doubled) in India in last 25 years
•Average Total Cholesterol was 120mg% -
increased to 200mg%
•Average Age of first Heart Attack has ↓ by
20 yrs- ½ < 50yrs, ¼ < 40 yrs of age
• Diabetes has increased by 60%.
86. Heart Attacks – Indian Scenario
Urban Vs Rural
•Rural Vs Urban: ½ Despite higher smoking
•RF incidences: Smoking- 55%®,35(U)
•Diabetes- 3%®, 11% (U)
•Hypertension- 14%®, 25% (U)
•TC/HDL >5 – 28%®, 46% (U)
•Urb Vs Rural: BMI 25Vs20,
WHR0.99Vs.95
•Higher CAD in South India- Urb Kerala13%
87. How Predictable & Preventable
are Heart Attacks
• Interheart Study: 90% Predictable
• Multiple Risk Factor Interventional
Trials: 0 to 60% reduction
•Observational studies in migrant
populations show vast differences in
CVD mortality
88. Heart Attack Risk Factors-
Modifiable
• Smoking
• High BP (Hypertension)
• High Sugars (Diabetes)
• High/ Bad fats/cholesterol (Dyslipidemia)
• Increased weight/fat (Obesity)
• Sedentary Life style (lack of Exercise)
• Metabolic Syndrome
• Lack of fruits, GV & fiber in diet
• Anger, Hostility, Work stress, Depression, LSS
• Alcohol
89. SMOKING
• COMMONEST CAUSE OF DEATH IN YOUNG
ADULTS AND ELDERLY
• NICOTINE + LARGE NUMBER OF TOXINS
• IMMEDDIATE SPASM
• DAMAGES EPITHELIUM (INNER LINING OF
TUBES) EVERYWHERE
• PRECIPITATES DIABETES
• SUDDEN DEATH
90. Smoking Cessation
• Risk of CAD/Re- MI/CABG failure X2
• Leading preventable cause of Death
• 25% in US to 70% in China
• 80% start before age 18 yrs
• In US: 55% →25% (M), 35% →20% (W)
• Risk falls rapidly after cessation
91. Smoking Cessation (Cont..)
•Cessation highly Cost effective
•Intervention usually short term
•1 yr success rates- 6% Physician
counseling , 20% self help programs, 40%
with Buproprion /nicotine patch
•3 types of Behavioral therapy- Problem
solving, social support in & outside treat
•Most effective after event
92. Alcohol
•20 to 45% risk ↓ with moderate consumption
(60ml-male, 30 ml- Female)
•↑HDL, ↑Fibrinolysis, ↓Platelet aggregation
•10-20% become chronic alcoholics
•Consider HTN, DM, ↑TG, Hgic Stroke, Liver
Disease, f/h alcoholism /Breast Ca/ Colon Ca
•Prescription should be individualized
“Whether wine is a nourishment,medicine, or
poison, is a matter of dosage”-Celsus
93. Diabetes Mellitus
• Confers X 4 Risk. Young stroke X 10. No
menstrual protection for women.
• Deemed a Heart attack equivalent by
AHA
• Worldwide ↑ by 35% (from 5%) by 2025,
max in China (↑68%) & India (60%)
•Thrifty Gene Hypothesis
94. Calculating your risk of
Developing Diabetes Mellitus
•Overweight – 5
•Sedentary – 5
•Age > (45-64) – 5, > (65) - 9
•Parent DM- 1, Sibling DM- 1
•Women with Baby >9lb - 1
•Asian - 4
•Total > 3-9= Low Risk, 10+ = need test
95. Preventing Diabetes with LSM
•DPP: Weight loss by 7% & 150 mins/
wk of moderate ex – reduced chance of
becoming Diabetic by 55% in IFG/ IGT
compared to 30% with metformin
•Once Diabetic no degree of control of
sugars shown to prevent heart attacks or
strokes
96. HYPERTENSION
• NO SYMPTOMS. 2/3 OF AMERICAN
HYPERTENSIVES NOT AWARE
• SAME GOALS FOR ALL AGES
• SYTOLIC BLOOD PRESSURE MORE
DANGEROUS
• MOST NEED 2 OR MORE DRUGS
• GOALS: <130/80. <115/75 IN DIABETICS
WITH PROTEINURIA.
97. Hypertension
• >140/90. Prehypertension >120/80
• Risk ↑ Linearly from 115/75mmHg.
• 5 mm ↓ in BP Reduces strokes by 40% , CVD by
15% & Heart failure by 25%
• In stage 1 HTN and additional CVD risk factors,
achieving a sustained 12 mmHg reduction in SBP
over 10 years will prevent 1 death for every 11
patients treated
.
98. Pre-Hypertension: A New
Disease Is Created
Starting at 115/75 mmHg, Heart Attack/Stroke
risk doubles for every 20/10 mmHg increase
throughout the BP range.
Persons who are normotensive at age 55 have a 90%
lifetime risk for developing HTN.
Intent in creating Pre-HTN(22% of adult population)
is to stress LSM, prevent progression & to treat other
CVRF
99. Lifestyle Modification
Modification Approximate SBP reduction
(range)
Weight reduction 5–20 mmHg/10 kg weight loss
DASH eating plan 8–14 mmHg
Dietary sodium ↓ 2–8 mmHg
Physical activity 4–9 mmHg
Moderation of
alcohol consumption
2–4 mmHg
100. Life Style & Behavioral
Modifications
• Difficult to qualify,quantify & study in
isolation due to multiple linked factors
• Intensely Individual but the only
modifications possible on a global scale
• Large reductions in mortality with
minimum fear of unexpected side effects
on the long run & cost effective
101. Life Style & Behavioral
Modifications
• Difficult to qualify,quantify & study in
isolation due to multiple linked factors
• Intensely Individual but the only
modifications possible on a global scale
• Large reductions in mortality with
minimum fear of unexpected side effects
on the long run & cost effective
102. Life Style & Behavioral
Modifications
• Difficult to qualify,quantify & study in
isolation due to multiple linked factors
• Intensely Individual but the only
modifications possible on a global scale
• Large reductions in mortality with
minimum fear of unexpected side effects
on the long run & cost effective
103. Life Style & Behavioral
Modifications- Doing it
• Understand & be Motivated
• Like it & be part of a group
• Structured program & should become
part of routine life by strength of habit
• Started early in life & should have
social/family/ work place support
105. “SUPERIOR DOCTORS PREVENT
DISEASE; MEDIOCRE DOCTORS
TREAT DISEASE BEFORE IT IS
EVIDENT; INFERIOR DOCTORS
TREAT FULL BLOWN DISEASE”
Huang dee. First Chinese
Medical Text. 2600 BC.
106.
107.
108. MENTAL STRESS &
PHYSICAL STRESS
• DEPRESSION, SOCIAL ISOLATION, ANGER,
AGGRESSIVENESS (TYPE A BEHAVIOUR)
• INCREASED MENTAL OR PHYSICAL WORK
NOT DANGEROUS.
109. How Predictable & Preventable
is CVD
0 100 200 300 400 500 600 700 800 900
Russia
Scotland
Finland
England
U.S.A.
Australia
Canada
Sweden
Italy
Urban China
France
Rural China
Japan
Women
Men
Graph 1: Age-adjusted CAD Death Rates per
100,000 per year (Age 35-74)
110. Psychosocial Factors
•Studies hampered by imprecision in
definitions & accepted metrics
•Depression, Chronic Hostility, Social
isolation, Perceived lack of Social
support consistently linked with ↑ risk
•Data inconsistent with anxiety, work
related stress & Type A behavior
111. Psychosocial Factors (Cont..)
• Low socioeconomic status
• Acute mental stress /stress induce SMI
• Sudden emotion-↑RR in 1-2 hrs of event
• Lethal arrhythmias & SCD following
mentally stressful events
• HTN–Relaxation training,meditation &
biofeedback for pt with subjective stress
112. CAUSES (Risk Factors) OF
HEART ATTACK
SMOKING
DIABETES
HYPERTENSION
CHOLESTEROL
OBESITY/ METABOLIC SYNDROME
LACK OF EXERCISE
MENOPAUSE
MENTAL STRESS
113. MENOPAUSE
• SUDDEN SURGE IN HEART ATTACKS
• TOTAL MORTALITY> MALES
• DIABETES TOTALLY NEGATES
PROTECTION OF MENSES.
• HRT HARMFULL
• MALES WILL BE SAVED IF WE KNOW
WHAT PROTECTS FEMALES!
114. Lp(a) - The Deadly Cholesterol
MULTIPLIER EFFECT
115. Contributions of various risk factors
for CAD among Asian Indians
Tobacco
10%
HTN
10%
Diabetes
10%
TC/LDL
15%
TC/HDL
15%
lp(a)
25%
Hcy
5%
Other
10%
Tobacco
HTN
Diabetes
TC/LDL
TC/HDL
lp(a)
Hcy
Other
116. THIS IS WHAT KILLS US!
• INCREASED PROCESSED CARBOHYDATES.
• RAPID ABSORPTION OF SUGAR
• INCREASED INSULIN, ARTERY
THICKENING, TRIGLYCERIDES, DECRESED
HDL.
• RICE IS TOXIC!
• THERE IS AN EPIDEMIC COMING!
126. Magnitude of the Problem:
Global Burden of Cardiovascular
Disease
•½ way through a 2 century transition ; CVD
will dominate as the major cause of Death
Globally
•Although CVD is ↓in EstME it is ↑ in the rest of
the world with 85% of the worlds population.
•10% (1900) → 25% (2000) → 50% (2020)
of Global Deaths.
132. Epidemiological Transitions
•Age of Pestilence & Famine – LE is 30yrs
•Age of Receding Pandemics - ↑ Food & ↓ ↓ in
Infant and child mortality
•Age of Degenerative & Man Made Diseases –
Easier access to cheaper carb/fatty foods,
mechanization leads to ↓ energy expenditure,
Urbanization → ↑ crowding, smoking & work
stress. ↑BP, ↑Sugars, ↑BMI, ↑Lipids → CVD
(>50%), ↑ Cancers. LE>50yrs.
133. Epidemiological Transitions
•Age of Delayed Degenerative Diseases – LSM,
↓Smoking (45% →23%) , Trt of HTN – CHD
↓2% per yr, Stroke ↓ 3% per yr, CVD strikes
later.
•Age of LSM plateau & Early Obesity - ↑
caloric intake & ↓Physical activity- 75%
Overweight or Obese - ↑ HTN/DM. LE =
75yrs(M), 80yrs(W)
•Future Age of Intense LSM , Behavioral
Changes & Naturalization
135. Coronary Artery Disease Risk
Factors-Non Modifiable
• Male Sex
• Post Menopausal State
• (+) Family History
• Genetic Susceptibility
• Lp (a)
• Diabetes
• ? Infection
136. Risk factors- from Womb to
Tomb
•Thrifty Phenotype(Barkers) Hypothesis
•Thrifty Genotype Hypothesis
•Brenners Hypothesis for essential HTN
•IUGR and CAD - ↑LDL & apo B.
137. Risk factors- from Womb to
Tomb- Child/Adulthood
• Increasing T-Chol (from 75 in cord
blood to 120-150 by 2 wks- stable till 20
yrs – rises to 200 - 240 in most adults.
• Catch-up obesity
• Middle age bulge
• Increasing Systolic BP
138. The Magnitude of the Problem
•HTN is the commonest medical diagnosis,
affecting 1 billion worldwide
•Prevalence of HTN: 3% in 18 to 24 yrs age
13% in 35 to 44
yrs age & 70% in those >75 yrs.
•For persons over age 50, SBP is a more
important than DBP as a CVD risk factor.
139. DIABETES MELLITUS
• DECLARED NOW AS A CORONARY ARTERY
DISEASE EQUIVALENT
• MORTALITY ALMOST X 4
• DAMAGES ARTERIES
• PROMOTES THICKENING
• CONTROLL OF BLOOD SUGARS NOT
ENOUGH
• GOALS: FBS<110, PPBS<140
140. LACK OF EXERCISE
• CENTRAL OBESITY.
• DIABETES
• HYPERTENSION.
• CHOLESTEROL
• GOALS: MAINTAIN 80% OF THR FOR 45
MINS 5 DAYS A WEEK. MAINTAIN IDEAL
BODY WEIGHT AND MUSCLE MASS.
• THR= 220-AGE
141. Dyslipidemia-Importance of
Statins
• American Heart Association Diet
Chol Total Fat TC LDL
Step I 300 8 - 10 % 8% 10%
Step II 200 < 7 % 10% 15%
Only 15% motivated, only 1.5% achieved goals
• Marked ↓in Fat intake can ↓ LDL-C by 30%
•Viscous fiber + plant sterols + soy protein + almonds -
30% ↓ equivalent to 10mg lovastatin
•Marked ↓in Fat intake or ↑in Carbs will ↓HDL
142.
143. LDL - Naturalisation
HOW LOW IS LOW ENOUGH? IS IT SAFE?
•10% of highest LDL account for 20% of CAD.
• Only 25% risk reduction with current LDL Trt.
•Threshold for atherosclerosis progression is
LDL of 67mg%, CVD event rate 0 at LDL 57
(primary) & 30 mg% (secondary prevention).
•50% ↓ in LDL for secondary & 30% ↓ for
primary prevention.
•? All people above 55yrs should receive statins
144.
145. Metabolic Syndrome
Indian scenario
Incidence: 40%, 28% (No IFG), 75%(DM/IFG)
Waist Circumf: 30%, Low HDL: 65%, TG:
45%, HTN: 55%, IFG: 27%.
•Diet, Lack of Ex
•Childhood Obesity (20% in U India)
•Indian Obesity Phenotype: lean BMI, High
waist to hip ratio, High % of Body fat.
•Barker’s Fetal priming for Insulin resistance
146. Psychosocial Factors
•Social isolation, Lack of Social support
& Social Disruption
•Life stress (major stressful life events &
minor recurrent irritants/frustrations
•Job Strain – High demand with little
autonomy
•Marital stress
147. Diet
•DASH Trial: Diet rich in Vegetables &
Fruits & Low Fat Dairy ↓ BP
•Marked ↓in Fat intake can ↓ LDL-C by 30%
•Lyon Diet Heart Study: Mediterranean diet ↓
Re-MI/Death by 65% compared to Western Diet
•Marked ↓in Fat intake or ↑in Carbs will ↓HDL
•Marked ↑ in protein ↑load on kidneys
148. Cardiac Metaphors of Daily Life
• Races with Excitement
• Pounds in Anticipation
• Stands still in Dread, Skipped a Beat
• Aches with Grief
• With a Heavy Heart
• The Lion Hearted, Large hearted, Heartless
• Broken Hearted
149. Psychosocial Factor Modifications
• ENRICH Trial: Post MI cognitive behavior
therapy + drugs if necessary
•SADHART: Sertraline AntiDepressant Heart
Attack Randomised Trial
•Antidepressant therapy - significant ↓
reinfarction, heart failure & cardiac deaths
•Meta-analyses of 37 stress management
programs show reduced cardiac mortality
150.
151. Epidemiological Transitions
•Age of Pestilence & Famine – LE is 30yrs
•Age of Receding Pandemics - ↑ Food & ↓ ↓ in
Infant and child mortality
•Age of Degenerative & Man Made Diseases –
Easier access to cheaper carb/fatty foods,
mechanization leads to ↓ energy expenditure,
Urbanization → ↑ crowding, smoking & work
stress. ↑BP, ↑Sugars, ↑BMI, ↑Lipids → CVD
(>50%), ↑ Cancers. LE>50yrs.
152. Life Style & Behavioral
Modifications
• Difficult to qualify,quantify & study in
isolation due to multiple linked factors
• Intensely Individual but the only
modifications possible on a global scale
• Large reductions in mortality with
minimum fear of unexpected side effects
on the long run & cost effective
153. Life Style & Behavioral
Modifications
• Difficult to qualify,quantify & study in
isolation due to multiple linked factors
• Intensely Individual but the only
modifications possible on a global scale
• Large reductions in mortality with
minimum fear of unexpected side effects
on the long run & cost effective
154. •Cancer- Natural Killer Cells
Increase with SK
•Heart Autonomics –
Increased heart rate
variability with SK
•Deaddiction – Smoking,
Alcoholism, Drugs
•Metabolic Syndrome- Central
Obesity
•Hypertension- Respirate
•Insomnia
•Diabetes
155. Core TechniqueCore Technique -- ‘‘Sudarshan KriyaSudarshan Kriya’’
Scientific ValidationsScientific Validations
Regular Practice of the ‘Sudarshan Kriya’ will lead to:
Stress creating hormone Cortisol & Oxygen free radicals will get eliminated
from the blood system.
Natural Killer Cells will Increase (Immunity)
Blood Lactate will decrease
HDL Cholesterol (useful cholesterol) will increase & LDL Cholesterol
(harmful) will decrease. (Effective against blood pressure & Cardiac problems)
Increase in Alpha activity in brain with interspersed Beta activity (create
calmed alertness in the brain - Study done with EEG)
70% of Depression is curable with ‘The Sudarshan Kriya’ practice.
156. Cancer / HIV & Sudarshan Kriya
• Cancer- Natural Killer Cells Increase with SK
• Heart Autonomics – Increased heart rate variability with
SK
• Deaddiction – Smoking, Alcoholism, Drugs
• Metabolic Syndrome- Central Obesity
• Hypertension- Respirate
• Insomnia
• Diabetes
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Biderectional nature of Heart & Psyche.
Biderectional nature of Heart & Psyche.
Biderectional nature of Heart & Psyche.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
&gt;30% of newly detected DM in some states is in children.
&gt;30% of newly detected DM in some states is in children.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
&gt;30% of newly detected DM in some states is in children.
&gt;30% of newly detected DM in some states is in children.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
&gt;30% of newly detected DM in some states is in children.
&gt;30% of newly detected DM in some states is in children.
&gt;30% of newly detected DM in some states is in children.
&gt;30% of newly detected DM in some states is in children.
&gt;30% of newly detected DM in some states is in children.
&gt;30% of newly detected DM in some states is in children.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Biderectional nature of Heart & Psyche.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Biderectional nature of Heart & Psyche.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Biderectional nature of Heart & Psyche.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Biderectional nature of Heart & Psyche.
Biderectional nature of Heart & Psyche.
Biderectional nature of Heart & Psyche.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
&gt;30% of newly detected DM in some states is in children.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
&gt;30% of newly detected DM in some states is in children.
Biderectional nature of Heart & Psyche.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.
Reinforced by Freedman & Rosenbaum in 1960s.
After adjusting for other biological risk factors.
Hostility & smoking, alcoholism, obesity & low socioeconomic status.