Presented by Liliana Cohen, MD

1. Living a Heart Healthy Life
Liliana Cohen, MD, FACC
February 13, 2018
Livingston Public Library

2. What is Cardiovascular Disease?
Cardiovascular disease (or CVD) includes
heart and blood vessel diseases — diseases
that affect the circulatory system

3. Examples
• Coronary heart disease (heart attack)
• Cerebrovascular disease (stroke and TIA)
• High blood pressure
• Congestive heart failure
• Congenital cardiovascular defects
• Peripheral vascular disease

4. Blockage of the heart arteries by plaque can
cause a heart attack (myocardial infarction) or a
fatal rhythm disturbance (cardiac arrest)

5. Cardiovascular disease is the leading
cause of death for both men and women in
the U.S.

6. The Myth
• The myth that heart disease is a “man’s disease”
has been debunked
• The rate of public awareness of CVD as the
leading cause of death among U.S. women has
increased from 30% in 1997 to 54% in 2009
• The death rate from coronary artery disease in
females in 2007 had decreased to 1/3 of what it
was in 1980

7. Deaths due to CVD* (United States: 1900–2007)
0
200
400
600
800
1000
1200
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2007
DeathsinThousands
Years
Source: NHLBI from NCHS reports. * - CVD does not include congenital.
©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010

8. CVD and other major causes of death for all males and
females (United States: 2007)
391,886
292,857
79,827
61,235
35,478
21,800
421,918
270,018
66,689
52,832
43,879
35,904
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
A B C D E F A B D F C E
Deaths
Males Females
Source: NCHS and NHLBI. A indicates CVD plus congenital CVD; B, cancer; C, accidents; D, CLRD; E, diabetes; and F, Alzheimer's disease.
©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010

9. 14.2
39.3
72.6
80.1
9.7
37.2
71.9
86.7
0
10
20
30
40
50
60
70
80
90
100
20-39 40-59 60-79 80+
PercentofPopulation
Men Women
Prevalence of CVD in adults ≥20 years of age by age and sex
(NHANES: 2005–2008)
Source: NCHS and NHLBI. These data include CHD, HF, stroke, and hypertension.
©2010 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2010

10. Prevalence
• Greater than 1 in 3 Americans have one
or more types of cardiovascular disease
• Cardiovascular disease still causes
approximately one death per minute
among women in the United States
Roger et al. 123 (4): e18. (2011)

11. The Need for Prevention in Women
• Over 10,000 US women younger than 45
sustain a heart attack each year
• The priority for coronary prevention is
substantial for women of all ages
• Mortality associated with acute MI among
women younger than 65 y/o is almost twice
that of men

12. Women ARE Different Than Men
• Women are more likely to be older
• Women are more likely to have high
blood pressure, diabetes, high
cholesterol and heart failure
• Women are less likely to be smokers

13. Symptoms of Heart Disease…
• For both genders, chest pressure/pain is the
most common symptom of heart disease

14. Women May Experience Different
Symptoms Than Men
• Women are more likely to experience:
 Neck and shoulder pain
 Abdominal pain
 Nausea
 Fatigue
 Shortness of breath
• Women are more likely to experience silent heart
attacks

15. Risk Factors
 Age
 Family History of Early Heart Disease
 Smoking
 High Blood Pressure
 High Blood Cholesterol
 Diabetes
 Physical Inactivity
 Being Overweight or Obese

16. What is cholesterol?
• A fat-like substance in the blood
• Made in the liver and comes
from some foods we eat
• Too much cholesterol
can build up in arteries over time
• Can cause heart attacks and strokes
Cholesterol
Normal Artery
Clogged Artery

17. Types of Cholesterol
• LDL- Low density Lipoprotein
 “bad” cholesterol
 Contributes to Atherosclerosis
 The lower your LDL, the lower your risk of heart
attack and stroke
• HDL- High density Lipoprotein
 “good” cholesterol
 Helps remove cholesterol from the arteries

18. The National Cholesterol Education Program
Recommends:
Total Cholesterol = Less than 200 mg/dl
LDL Cholesterol = Less than 100 mg/dl
HDL Cholesterol = Women: Greater than 50 mg/dl
Men: Greater than 40 mg/dl
Triglycerides = Less than 150 mg/dl
To determine how your levels affect your risk of heart disease,
your doctor will also take into account other risk factors.

19. Controlling Cholesterol and Triglycerides
• Healthy Eating
• Physical Activity
• Weight Loss
• Medication

20. Eating Healthy
• Choose more fruits, vegetables, and whole
grain breads, cereals
• Choose baked, skinless chicken and fish, and
low-fat dairy products
• Eat less fat
 Saturated fat
 Trans fatty acids
• Eat Fiber
 Dried beans, peas, oats, fruits and vegetables

21. Improving Fats
• Eat fewer solid fats
 Shortening
 Stick butter/margarine
 Excess fat on meats
• Substitute liquid or soft fats “Heart-Healthy
Fats”
• Monounsaturated oils
 Olive oil, canola oil

22. Improving Fats
• Avoid Trans fats
 Trans fatty acids raise LDL and lower HDL
 Increase risk of heart disease/stroke/Type II
Diabetes
 Found in fried foods, cookies,
cakes, crackers, snack foods
 Replace trans fats with
mono/polyunsaturated fats (fish, seeds)

23. Limit Dietary Cholesterol
• Can raise blood cholesterol
• Limit foods high in cholesterol
 Liver, organ meats, egg yolks,
full-fat dairy products
• The American Heart Association
recommends:
 Less than 300 mg/day
 Less than 200 mg/day (with diabetes or heart
disease)

24. Triglycerides
• Limit sugar and refined carbohydrates
• Limit alcohol consumption
• Substitute mono/polyunsaturated fats for
saturated fats
• Exercise/ weight loss

26. Physical Activity
• Important even as we get older!
HDL Cholesterol
LDL Cholesterol
Lower triglycerides
• 30 minutes or more on most days
 Moderate intensity (150 minutes/week)
 High intensity (75 minutes/week)

27. Weight Management
• Weight loss can…
 LDL
 Triglycerides
 HDL
• Just 5 to 10 pounds will help show
improvements!!!

28. High Blood Pressure
• Systolic pressure — pressure in arteries when
the heart beats
• Diastolic pressure — pressure when the heart
rests between beats
• Goal: below 120/80 mm Hg

29. Hypertension
• 65% of all hypertension remains either
undetected or inadequately treated
• People who are normotensive at 55
have a 90% lifetime risk of developing
HTN
• Prevalence increases with age
• HTN is more common with OCP and
obesity

30. Lifestyle Approaches to
Hypertension
Source: JNC 7 2004, Sacks 2001
 Maintain ideal body weight
 Weight loss of as little as 10 lbs reduces blood pressure
 Heart healthy diet
 Even without weight loss, a diet rich in fruits, vegetables, and
low fat dairy products can help to reduce blood pressure
 Sodium restriction to 1500 mg/d
 Increase physical activity
 Limit alcohol to one drink per day
 Alcohol raises blood pressure
 One drink = 12 oz beer, 4 oz wine, or 1 oz liquor

31. What Is Diabetes?
• A progressive disease in which your body
doesn’t make enough insulin / doesn’t respond
properly to it
• Goal: fasting glucose below 100 mg/dl

32. Why Is Diabetes Bad?
• At least 65% of people with diabetes die of
some form of CVD
• Diabetes lowers “good” cholesterol, and raises
“bad” cholesterol and triglyceride levels
• Many people with diabetes also have high
blood pressure and are overweight

33. Risk Factors: Diabetes
• Diabetes increases the risk of CHD 3-
7 times in women and 2-3 times in
men
• Those who smoke have a 84% higher
risk of developing stroke than
nonsmokers
• 2 of 3 people with diabetes die from
CHD or stroke

34. Smoking
• Smoking is the single most
preventable cause of death in the US
• Cigarette smoking accounts for nearly 440,000
deaths per year in men and women

35. The #1 Preventable Risk
Smoking
• 50% of heart attacks among women are
due to smoking. Smokers tend to have
their first heart attack 10 years earlier
than nonsmokers
• If you smoke, you are 4-6x’s more likely
to suffer a heart attack and increase your
risk of a stroke
• Women who smoke and take OCP’s
increase their risk of heart disease 30x’s

36. Relative Risk of Coronary Events for
Smokers Compared to Non-Smokers
3.12
5.48
1
0
1
2
3
4
5
6
Never Smoked 1-14 Cigarettes per
day
15 Cigarettes per
day
Relative
Risk
Source: Adapted from Stampfer 2000

37. Physical Inactivity
• Increases heart disease and stroke risk
• 30 minutes or more of activity on most or all
days of the week helps
reduce risk! It:
Controls blood cholesterol
Controls diabetes and obesity
Helps lower high blood pressure

38. Body Weight and CHD Mortality
5.8
4.6
3.1
1.4
11
0
1
2
3
4
5
6
19.0-21.9 22.0-24.9 25.0-26.9 27.0-28.9 29.0-31.9 32
BMI
Relative Risk
of CHD
Mortality
Compared to
BMI<19
P for trend < 0.001
Source: Adapted from Manson 1995

39. 1999
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2009
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC

40. Weight Maintenance/Reduction
Goals
• BMI between 18.5 and 24.9
• Waist circumference < 35 inches for women,
<40 inches for men
• Weight loss goals
 10% of body weight over six months or 1-2
pounds
weight loss/week
 Reduce calories by 500-1,000 per day
Source: Mosca 2004, ATP III 2002

44. How To Lower Heart Disease
Risk
• Begin today
• Be physically active—30 minutes of moderate-
intensity activity on most days of the week
• Follow a healthy eating plan
 Low in saturated fat, trans fat, and cholesterol and
moderate in total fat
 Limit salt
 If you drink alcoholic beverages, have no more
than one a day

45. How To Lower Heart Disease
Risk
• Maintain a healthy weight
 Balance calories taken in with those used
up in physical activity
• Stop smoking
• Get checked for high blood pressure
• Manage diabetes
• Take medication, if prescribed

46. How to Survive
• Call 9-1-1
• Emergency medical personnel will begin
treatment at once
• Don’t drive yourself to the hospital
• Uncertainty is normal—don’t be
embarrassed by a false alarm
• Learn the warning signs

47. Questions?