1) Adopting healthy lifestyle behaviors like following a nutritious diet low in saturated fat and high in fiber, engaging in regular exercise, managing stress, and avoiding tobacco can significantly reduce risk of cardiovascular disease. 2) Studies have shown that diets high in fruits and vegetables, whole grains, nuts and fish and adherence to a Mediterranean diet are associated with lower risk of heart disease deaths. 3) Engaging in at least 30 minutes of moderate physical activity daily and maintaining a healthy weight through a balanced calorie intake can lower blood pressure and risk of heart disease.

1. Jasmin Anand

2. Healthy Development …….
HOW TO TAKE CHARGE OF YOUR HEALTH ?

3. BURDEN OF CARDIAC DISEASE

5. Cardiac Risk Factors

6. Response To Lifestyle Treatment

7. N –Nutrition
E - Exercise
W - Water
S – Sunshine
T – Temperance
A – Air
T – Trust in God

8. Burden of Cardiovascular diseaseBurden of Cardiovascular disease
Diet and Weight Management Evidence
and Guidelines
NUTRITION

9. Dietry Fiber

10. Pereira MA et al. Arch Int Med 2004;164:370-76
RR=0.73, P<0.001
CV=Cardiovascular, CHD=Coronary heart disease
Diet Evidence:
Benefits of Whole Grains and Fiber
336,244 persons followed for 6-10 years to assess the
relationship between dietary fiber intake and adverse CV
outcomes
Increased dietary fiber intake reduces CV risk
Additional
10gms fibre
reduces risk by 14
%

11. Joshipura KJ, et al. 2001 Ann Intern Med134:1106-14
Nurses’ Health Study and Health Professional’s Follow-up Study
*Includes nonfatal MI and fatal coronary heart disease
CV=Cardiovascular, MI=Myocardial infarction
Diet Evidence:
Benefits of Fruits and Vegetables
126,399 persons followed for 8-14 years to assess the relationship between
fruit and vegetable intake and adverse CV outcomes*
Increased fruit and vegetable intake reduces CV risk
4%
lowered
risk

12. Trichopoulou A, et al. NEJM 2003;348:2595-6
Variable
# of Deaths/
# of Participants
Fully Adjusted Hazard Ratio
(95% CI)
Death from any
cause
275/22,043 0.75 (0.64-0.87)
Death from
CHD
54/22,043 0.67 (0.47-0.94)
Death from
cancer
97/22,043 0.76 (0.59-0.98)
Diet Evidence:
Primary Prevention
22,043 adults evaluated for adherence to a Mediterranean diet, with points
given for high consumption of vegetables, legumes, fruits, nuts, cereal, and fish
and points subtracted for high consumption of meat, poultry, and dairy
High adherence to a Mediterranean diet is associated with a reduction in death

13. • Very low carbohydrate
– Atkins (Induction and Maintenance)
• 1st 2 weeks (<20 grams of carbohydrates/day with no high
glycemic foods).
• Then can add 5 grams of carbohydrates/day each week to
maximum of 90 grams of carbohydrates/day long term.
– South Beach (3 Phases)
• 1st phase (2 weeks) significantly restricts carbohydrates
• 2nd phase reintroduces low glycemic carbohydrates
• 3rd phase attempts to maintain weight
• Caloric restriction
– Weight watchers
• Assigns foods a point value and restricts the number of points
that can be consumed/day.
Diet Evidence:
Types of Treatment Programs (Continued)

14. • Very low fat
– Ornish (Reversal diet and Prevention diet)
• Vegetarian with 10% calories from fat. No cooking oils,
avocados, nuts, and seeds. High fiber. No caloric
restriction.
– Pritikin
• Very low-fat (primarily vegetarian) diet based on whole
grains, fruits, and vegetables
• Intermediate
– Sugar Busters
• 30% protein, 40% fat, 30% carbohydrates (low glycemic
index)
– Zone
• 30% protein, 30% fat, 40% carbohydrates
Diet Evidence:
Types of Treatment Programs

15. *Trans fatty acids also raise LDL-C and should be kept at a low intake
Note: Regarding total calories, balance energy intake and expenditure to maintain desirable body weight.
<200 mg/dCholesterol
~15% of total caloriesProtein
20–30 g/dFiber
50%–60% of total caloriesCarbohydrate (esp. complex carbs)
25%–35% of total caloriesTotal fat
Up to 20% of total caloriesMonounsaturated fat
Up to 10% of total caloriesPolyunsaturated fat
<7% of total caloriesSaturated fat*
Recommended IntakeNutrient
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA
2001;285:2486-97
Adult Treatment Panel (ATP) III
Dietary Recommendations

16. American Heart Association (AHA) Nutrition
Committee Dietary Recommendations
• Balance calorie intake and physical activity to achieve or maintain a healthy
body weight
• Consume a diet rich in fruits and vegetables
• Consume whole-grain, high-fiber foods
• Consume fish, especially oily fish, at least twice a week
• Limit intake of saturated fat to <7%, trans fat to <1% of energy, and
cholesterol <300 mg/day by:
– Choosing lean mean and vegetable alternatives
– Choosing fat free (skim), 1% fat, and low-fat dairy products,
– Minimizing intake of partially hydrogenated fats
• Minimize intake of beverages and foods with added sugar
• Choose and prepare foods with little or no salt (AHA 2011 rec. <1500mg/d)
• If alcohol is consumed, do so in moderation
Recommendations for Cardiovascular Disease Risk Reduction
AHA Nutrition Committee. Circulation 2006;114:82-96

17. 11,324 patients with a history of a MI randomized to w-3 polyunsaturated fatty acids [PUFA] (1
gram), vitamin E (300 mg), both or none for 3.5 years
GISSI Investigators. Lancet 1999;354:447-455
w-3 Fatty Acids Evidence:
Secondary Prevention
CV=Cardiovascular, MI=Myocardial infarction, NF=Non-fatal,
PUFA=Polyunsaturated fatty acids
w-3 fatty acids provide significant CV benefit after a MI
Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico (GISSI-
Prevenzione)

18. Modification Recommendation Approximate SBP
Reduction Range
Weight reduction Maintain normal body weight
(BMI=18.5-24.9)
5-20 mmHg/10 kg weight
lost
Adopt DASH
eating plan
Diet rich in fruits, vegetables, low fat
dairy and reduced in fat
8-14 mmHg
Restrict sodium
intake
<2.4 grams of sodium per day 2-8 mmHg
Physical activity Regular aerobic exercise for at least 30
minutes on most days of the week
4-9 mmHg
Moderate alcohol
consumption
<2 drinks/day for men and <1 drink/day
for women
2-4 mmHg
JNC VII Lifestyle Modifications for BP Control
Chobanian AV et al. JAMA. 2003;289:2560-2572
BMI=Body mass index, SBP=Systolic blood pressure

19. EXERCISE

20. Manson JE et al. NEJM 2002;347:716-25
Quintiles of activity (MET-hour/week**)
0.0
0.2
0.4
0.6
0.8
1.0
Walking
RelativeRiskofCHD
0.0
0.2
0.4
0.6
0.8
1.0
Vigorous exercise*
RelativeRiskofCHD
P=0.004P=0.008
1 2 3 4 5
Women’s Health Initiative Observational Study
1 2 3 4 5
**Average active hours per week  energy expenditure per activity
*Includes aerobics, aerobic dancing, jogging, tennis, and swimming laps
CHD=Coronary heart disease
Exercise Evidence:
Effect on Coronary Heart Disease Risk

21. EXERCISES ? What does it do to you ?
• Lowers BP, HR.
• Strengthens bones .retains Ca.
• Relieves anxiety & stress
• Increases energy levels
• Maintains desirable weight
• Improves circulation

22. EXERCISE –How long ?
• Brisk & continuous for 15 -20 mins.
• 30-40 mins./day
• Obesity reduction 1 hour/day –divide in to 2-
3 sessions if reqd.
• Every step counts –improve fitness as much
as 30%
Goal: 30 minutes 7 days/week, minimum 5
days/week

23. OBESITY

25. Adverse Effects of Physical Inactivity
Age
Diabetes Mellitus
Obesity
Genetics Atherosclerosis
Hypercoagulability
Smoking
Hypertension
Novel Risk Factors
Inflammation Dyslipidemia
Physical Inactivity

26. WATER

27. • Water intrinsic to food
• Water added during cooking
• Water as a beverage
• Water added to other beverages
• Water intrinsic to other beverages
• Unsweetened coffee & tea
• Low fat milk

28. Water, other fluids, and fatal coronary heart disease:
the Adventist Health Study.
Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE.
Whole blood viscosity, plasma viscosity,
hematocrit, and fibrinogen are considered
independent risk factors for coronary heart
disease and can be elevated by dehydration.

29. Heart Disease Linked to
Sunlight Deficiencies

30. Sunlight deficiency could increase
blood cholesterol by allowing squalene
metabolism to progress to cholesterol
synthesis rather than to vitamin D synthesis
Sunlight, cholesterol and coronary heart disease D.S. GRIMES, E. HINDLE and T. DYER1 From the Departments of Medicine and
^Biochemistry, Blackburn Royal Infirmary & Queens Park Hospital, Blackburn, UK Received 31 January 1996 and in revised form 9 May 1996
10-15mins./day ,open your windows

31. REST / SLEEP

32. • Body renews itself
• enhances the adsorption of calcium and
magnesium
• Heals injuries ,infections, assaults to the
body including stress & emotional trauma
• Strengthens immune system
REST/SLEEP – IS IT
IMPORTANT ?

33. Production of melatonin,seratonin,P53
Insufficient rest/sleep was found to
be independently associated with CHD, ‘
stroke, diabetes mellitus and obesity.

34. Temperance
• Smoking
• Alcohol
• Drugs
• Addiction to anything

36. Ask and document tobacco use status
Advise Provide a strong, personalized
message
Assess Readiness to quit in next 30
days
Prevent Relapse
• Congratulate successes
• Encourage
• Discuss benefits experienced by patient
• Address weight gain, negative mood, and
lack of support
Increase Motivation
• Relevance to personal situation
• Risks: short and long-term, environmental
• Rewards: potential benefits of quitting
• Roadblocks: identify barriers and solutions
• Repetition: repeat motivational intervention
• Reassess readiness to quit
Assist: Negotiate plan
• STAR**
• Discuss pharmacotherapy
• Social support
• Provide educational materials
Arrange Follow-up to check plan or adjust meds
• Call right before and after quit date
• Weekly follow-up x 2 weeks, then monthly x 6
months
• Ask about difficulties (withdrawal, depressed
mood)
• Build upon successes
• Seek commitment to stay tobacco-free
**STAR
Set quit date
Tell family, friends, and coworkers
Anticipate challenges: withdrawal,
breaks
Remove tobacco from the house,
car etc.
Recent Quitter
(<6 months)Current User
Not Ready
Ready
Tobacco Cessation Algorithm

37. Do some breathing exercises

38. Air Pollution and Cardiovascular Disease
A Statement for Healthcare Professionals From the Expert Panel on Population and Prevention
Science of the American Heart Association
Several plausible mechanistic pathways have
been described, including enhanced
coagulation/thrombosis, a propensity for
arrhythmias, acute arterial vasoconstriction,
systemic inflammatory responses, and the
chronic promotion of atherosclerosis.

39. TRUST IN GOD

40. The term “Psychosocial”
broadly categorizes
factors which are:
• Psychologic – e.g, anxiety, depression
• Psychosocial – e.g., work stress,
discrimination, emotional support
• Social-structural – e.g., socioeconomic status,
social integration, neighborhood effects

41. Screening for Psychosocial Risk:
AHA Science Advisory on Depression
(Lichtman J et al. Circulation 2008)
• The recommendations, which are endorsed by the
American Psychiatric Association, include:
– early and repeated screening for depression in
heart patients
– the use of two questions to screen patients – if
depression is suspected the remaining questions
are asked (9 questions total)
– coordinated follow-up for both heart disease and
depressive symptoms in patients who have both.