This document discusses acute coronary syndromes, risk factors, and prevention. It provides an overview of coronary artery disease and its clinical signs. It then examines major cardiovascular disease risk factors such as smoking, overweight/obesity, physical inactivity, hypertension, alcohol, and diabetes. Prevention strategies are outlined for each risk factor, including the nursing role in primary and secondary prevention. The document also discusses social determinants of cardiovascular health and the importance of prevention beginning in fetal life, childhood, and youth.

1. ACUTE CORONARY
SYNDROMES,
RİSK FACTORS AND
PREVENTİON
KOÇ UNIVERSİTY SCHOOL OF NURSING
SERPİL TOPÇU R.N., M.S.N.

2. ACUTE CORONARY
SYNDROMES
• Acute coronary syndrome (ACS) refers to a group of
conditions due to decreased blood flow in the coronary
arteries such that part of the heart muscle is unable to
function properly.

3. Coronary Artery Disease
Clinical Signs;
• Sudden death
• Heart failure
• Stable angina pectoris,
• Unstable angina pectoris,
• Myocardial infarction (MI)

4. Global Atlas On Cardiovascular Disease
Prevention And Control- 2011

5. Global Atlas On Cardiovascular Disease
Prevention And Control- 2011

6. Cardiovascular Disease
Profile Around theWorld
COUNTRIES CVD MORTALITY RATE
European Union members %40
China (1/5 of the world's
%36
population)
Latin America %31
Middle East %25-45
India (1/6 of the world
%24
population )
Africa %10 (primary stroke)
Türkiye Kalp Ve Damar Hastalıklarını Önleme ve Kontrol Programı 2010-2014

9. Cardiovascular Disease
Profile in Turkey
• Primary cause of the disability-adjusted life
year (DALY) in Turkey is cardiovascular diseases -
%19.32
• DALY results on cardiovascular disease;
o Males -%20,5
o Females -%18
Türkiye Hastalık Yükü Çalışması- UHY (DALY- 2004)

10. RISK FACTORS AND
PREVENTION

12. Türkmen E, Badır A, Ergün A ( 2012). Koroner Arter Hastalıkları Risk Faktörleri: Primer ve Sekonder Korunmada Hemşirelerin Rolü. Acıbadem
Üniversitesi Sağlık Bilimleri Dergisi. Cilt: 3 • Sayı: 4 • Ekim

13. 1- Tobacco Smoking

16. - Turkey is 3rd in Europe and 7th around the world about
smoking
- Smoking rate in;
Men % 47,9
Women % 15,2

19. Prevention of Smoking
In Turkey
• November 25 2004 “Tütün Kontrol Çerçeve
Sözleşmesi-WHO-FCTC Framework Convention on Tobacco
Control” is accepted;
- Raise awareness of the public
- Quit smoking
- Price and taxes
- Passive smoking control
- Advertising and sponsorship
- Product control and consumer education.

20. 2- Overweight and Obesity

21. • Every year 2.6 million people dies due to overweight and
obesity. It is related to CVD.
• In Turkey according to TURDEP- I (2002)results obesity
rate;
- Men - %25.3
- Women - %46.2
• TURDEP- II (2010)
• Obesity - %44 ↑
- Waist circumference - women 6cm↑,
-men 7cm↑

22. Definition of Overweight and
Obesity
Target 1: Waist circumference
Men ≥ 94 cm, w풐풎풆풏 ≥ 80 cm (do not gain weight)
Target 2: Waist circumference
Men ≥ 102 cm, women ≥ 88 cm ( advice losing weight)

23. Prevention of Overweight and Obesity
• Diet, exercise, and behaviour modifications
• Medical therapy with orlistat and/or bariatric surgery for
patients with BMI ≥35 kg/m2 or a BMI ≥35 kg/m2 in the
presence of high-risk comorbid conditions are the only
options.

24. • Saturated fatty acids to account for <10% of total energy
intake, through replacement by polyunsaturated fatty acids
• Avoid processed food,
• <5 g of salt per day
• 30–45 g of fibre per day, from wholegrain products, fruits
and vegetables
• fruits and vegetables per day 2-3 servings
• Fish at least twice a week, one of which to be oily fish.

26. 3- Physical Inactivity

27. Physical Inactivity
With 150 minutes of regular exercise per week.
- Reducing ischemic heart diseases %30
- Reducing Diabetes rate %27

28. Physical Inactivity
In Turkey;
According to the results of : “Sağlıklı Beslenelim, Kalbimizi
Koruyalım (2004)” (N:15.468) ;
Only 3,5% of people are doing regular exercise at least 3
times a week 30 minute.

29. Physical Inactivity and Obesity
Prevention- In Turkey
• Educating children about healthy food by family, teacher
and public health nursing.
• Advertisement control about fast food.
• Regulating menus of branch restaurants which are suitable
for preventing CVD
• Organizing exercise programs.
• The main responsibility belongs to health care providers.
TKD Ulusal Kalp Sağlığı Politikası Raporu

30. 4- Hypertension

31. Hypertension
• HT is the major risk factor MI, stroke, hearth and kidney
failure, vascular dieseases and blindness
• High blood pressure is responsible of the total deaths of
%13around the world.

34. • According to Turkish Hypertension Prevalence Study;
• Nearly 15 milion people have hypertension however
%40 of them are aware of high blood pressure
• Only %31of them are taking antihypertensive therapy.

35. Reduce; Systolic blood pressure 20 mmHg
Diastolic blood pressure 11 mmHg ;
• Decrease Stroke risk % 63
• CVD risk % 46
TKD Ulusal Kalp Sağlığı Politikası Raporu

36. Prevention of
Hypertension
• Weight control, increase pyhsical activity level
• Reduce alcohol intake
• Limiting salt intake
• More Vegetable and fruit
• Prefering saturated dairy products
• It is suggested to all hypertensive and high normal blood
pressure patient ( Class I, Level B).

37. Prevention of Hypertension
1. Social Practice
• Starting prenventive life style changes in childhood.
• Family and school education programs.
• Ministery of Health, Education, Sports, Agriculture and
Religion etc. Should support this cause using media.
• Writing the salt level and calorie in food ingridients.
• Decreasing salt level in all food products.

38. Prevention of
Hypertension
• People should be encourage to exercise and it should be
accessible.
• Necessary prevention should be applied to quit smoking
2- Personal Practice
• Healthy life style
• This is the main responsibiliyt of health care provider.

39. 5- Alcohol

41. • The relationship between alcohol and CVD is not
clarified yet.
• If moderate alcohol use is peep
- CVD risk factors
- Hard to control blood pressure
- Synergetic effect of cigarates.
- Obesity

42. Prevention of CVD
• Moderate alcohol use is suggested.
Women 1 cup per day (10 g alcohol),
Men 2 cups per day (20 g alcohol)

43. 6- Diabetes

45. • Diabetes was accepted by United Nations for the first time a
non-infected diesea is considered as a global health threat
(Dec, 20 2006). They also called the countries in action to
fight againts diabetes.

47. Prevention of CVD with Diabetes;
Target HbA1c <%7.0
• Statines use
• Prevent gaining execisive weigth and hypoglisemi
• BP <140/80 mmHg

48. Prevention of Diabetes
T.C. Ministry of Health Action Plan (2011-2014)
• Prevention of diabetes, to increase quality of care in
patients with diabetes and decrease complications of
diabetes and deaths.
http://www.saglik.gov.tr/HM/dosya/1-71375/h/turkiye-diyabet-onleme-ve-kontrol-programi.
pdf

49. 7- Hyperlipidemia

53. Prevention of
Hyperlipidemia
• Life style changes.
• Drug treatment.

54. 8- Social Factors
• Poverty, lack of education and unplanned urbanization
have a negative impact on cardiovascular health.
• Unfair distribution of power, money and resources
increases exposure to cardiovascular risk factors.

55. 9-Risk Factors Take Root In The Womb,
Childhood And Youth
• Undernutrition in fetal life and infancy increases an
individual’s vulnerability to CVD.
• Low birth weight is related to CVD and DM
• Healthy behaviours are learned in childhood and
continue into adulthood.
• Passive smoking exposure in childhood.

56. TÜRKİYE HASTALIK YÜKÜ
ÇALIŞMASI 2004
RİSK FAKTÖRLERİ ÖNLENEBİLİR ÖLÜM ORANLARI
Hipertansiyon %25,2
Beden Kitle İndeksi ( BKİ) %13,3
Tütün kullanımı %12,7
Hiperlipidemi %11,4
Fiziksel aktivite %10,5
Sebze meyve tüketimi %9
Ilımlı alkol %4,3

58. Nursing Roles in Prevention
Primary prevention;
Primary prevention in providing of CAD is worse than
secondary;
Because of
• Risk calculators focus on short-term risk
• Prediction difficulties (people who are at risk)

59. Nursing Roles in Prevention

61. Results of the study;
• Students were knowledgeable about cardiovascular
disease and associated risk factors,
• There were significant gaps in their knowledge; these
should be addressed through improved nursing curricula.
• While students were generally healthy, they could
improve their practice of health-promoting behaviors.

62. According to nursing case manager models in secondary
prevention;
• Proper medication use results in improvements in risk
factors, exercise toleration, blood glucose level
• CVD
• Mortality
• Coronary atherosclerosis
• Perception of healht improves

64. The EUROACTION trial studying patients with
CHD and those at high risk of CVD in 8 countries;
The approach was;
• Family centred and led to healthier lifestyle changes in
terms of diet and physical activity, improvements in
lifestyle e (diet and physical activity)
• More effective control of risk factors such as blood
pressure in both patients and their partners in the
intervention arm compared with usual care

65. CCNAP: Council on Cardiovascular Nursing and Allied
Professions
and
AHA CVD Nursing Comitte prepare a settelement about
nurses to have an active role in prevention of CVD.