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ACUTE CORONARY 
SYNDROMES, 
RİSK FACTORS AND 
PREVENTİON 
KOÇ UNIVERSİTY SCHOOL OF NURSING 
SERPİL TOPÇU R.N., M.S.N.
ACUTE CORONARY 
SYNDROMES 
• Acute coronary syndrome (ACS) refers to a group of 
conditions due to decreased blood flow in...
Coronary Artery Disease 
Clinical Signs; 
• Sudden death 
• Heart failure 
• Stable angina pectoris, 
• Unstable angina pe...
Global Atlas On Cardiovascular Disease 
Prevention And Control- 2011
Global Atlas On Cardiovascular Disease 
Prevention And Control- 2011
Cardiovascular Disease 
Profile Around theWorld 
COUNTRIES CVD MORTALITY RATE 
European Union members %40 
China (1/5 of t...
Cardiovascular Disease 
Profile in Turkey 
• Primary cause of the disability-adjusted life 
year (DALY) in Turkey is cardi...
RISK FACTORS AND 
PREVENTION
Türkmen E, Badır A, Ergün A ( 2012). Koroner Arter Hastalıkları Risk Faktörleri: Primer ve Sekonder Korunmada Hemşirelerin...
1- Tobacco Smoking
- Turkey is 3rd in Europe and 7th around the world about 
smoking 
- Smoking rate in; 
Men % 47,9 
Women % 15,2
Prevention of Smoking 
In Turkey 
• November 25 2004 “Tütün Kontrol Çerçeve 
Sözleşmesi-WHO-FCTC Framework Convention on T...
2- Overweight and Obesity
• Every year 2.6 million people dies due to overweight and 
obesity. It is related to CVD. 
• In Turkey according to TURDE...
Definition of Overweight and 
Obesity 
Target 1: Waist circumference 
Men ≥ 94 cm, w풐풎풆풏 ≥ 80 cm (do not gain weight) 
Tar...
Prevention of Overweight and Obesity 
• Diet, exercise, and behaviour modifications 
• Medical therapy with orlistat and/o...
• Saturated fatty acids to account for <10% of total energy 
intake, through replacement by polyunsaturated fatty acids 
•...
3- Physical Inactivity
Physical Inactivity 
With 150 minutes of regular exercise per week. 
- Reducing ischemic heart diseases %30 
- Reducing Di...
Physical Inactivity 
In Turkey; 
According to the results of : “Sağlıklı Beslenelim, Kalbimizi 
Koruyalım (2004)” (N:15.46...
Physical Inactivity and Obesity 
Prevention- In Turkey 
• Educating children about healthy food by family, teacher 
and pu...
4- Hypertension
Hypertension 
• HT is the major risk factor MI, stroke, hearth and kidney 
failure, vascular dieseases and blindness 
• Hi...
• According to Turkish Hypertension Prevalence Study; 
• Nearly 15 milion people have hypertension however 
%40 of them ar...
Reduce; Systolic blood pressure 20 mmHg 
Diastolic blood pressure 11 mmHg ; 
• Decrease Stroke risk % 63 
• CVD risk % 46 ...
Prevention of 
Hypertension 
• Weight control, increase pyhsical activity level 
• Reduce alcohol intake 
• Limiting salt ...
Prevention of Hypertension 
1. Social Practice 
• Starting prenventive life style changes in childhood. 
• Family and scho...
Prevention of 
Hypertension 
• People should be encourage to exercise and it should be 
accessible. 
• Necessary preventio...
5- Alcohol
• The relationship between alcohol and CVD is not 
clarified yet. 
• If moderate alcohol use is peep 
- CVD risk factors 
...
Prevention of CVD 
• Moderate alcohol use is suggested. 
Women 1 cup per day (10 g alcohol), 
Men 2 cups per day (20 g alc...
6- Diabetes
• Diabetes was accepted by United Nations for the first time a 
non-infected diesea is considered as a global health threa...
Prevention of CVD with Diabetes; 
Target HbA1c <%7.0 
• Statines use 
• Prevent gaining execisive weigth and hypoglisemi 
...
Prevention of Diabetes 
T.C. Ministry of Health Action Plan (2011-2014) 
• Prevention of diabetes, to increase quality of ...
7- Hyperlipidemia
Prevention of 
Hyperlipidemia 
• Life style changes. 
• Drug treatment.
8- Social Factors 
• Poverty, lack of education and unplanned urbanization 
have a negative impact on cardiovascular healt...
9-Risk Factors Take Root In The Womb, 
Childhood And Youth 
• Undernutrition in fetal life and infancy increases an 
indiv...
TÜRKİYE HASTALIK YÜKÜ 
ÇALIŞMASI 2004 
RİSK FAKTÖRLERİ ÖNLENEBİLİR ÖLÜM ORANLARI 
Hipertansiyon %25,2 
Beden Kitle İndeksi...
Nursing Roles in Prevention 
Primary prevention; 
Primary prevention in providing of CAD is worse than 
secondary; 
Becaus...
Nursing Roles in Prevention
Results of the study; 
• Students were knowledgeable about cardiovascular 
disease and associated risk factors, 
• There w...
According to nursing case manager models in secondary 
prevention; 
• Proper medication use results in improvements in ris...
The EUROACTION trial studying patients with 
CHD and those at high risk of CVD in 8 countries; 
The approach was; 
• Famil...
CCNAP: Council on Cardiovascular Nursing and Allied 
Professions 
and 
AHA CVD Nursing Comitte prepare a settelement about...
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing
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Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing

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Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing

  1. 1. ACUTE CORONARY SYNDROMES, RİSK FACTORS AND PREVENTİON KOÇ UNIVERSİTY SCHOOL OF NURSING SERPİL TOPÇU R.N., M.S.N.
  2. 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. 3. Coronary Artery Disease Clinical Signs; • Sudden death • Heart failure • Stable angina pectoris, • Unstable angina pectoris, • Myocardial infarction (MI)
  4. 4. Global Atlas On Cardiovascular Disease Prevention And Control- 2011
  5. 5. Global Atlas On Cardiovascular Disease Prevention And Control- 2011
  6. 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
  7. 7. 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)
  8. 8. RISK FACTORS AND PREVENTION
  9. 9. 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
  10. 10. 1- Tobacco Smoking
  11. 11. - Turkey is 3rd in Europe and 7th around the world about smoking - Smoking rate in; Men % 47,9 Women % 15,2
  12. 12. 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.
  13. 13. 2- Overweight and Obesity
  14. 14. • 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↑
  15. 15. 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)
  16. 16. 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.
  17. 17. • 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.
  18. 18. 3- Physical Inactivity
  19. 19. Physical Inactivity With 150 minutes of regular exercise per week. - Reducing ischemic heart diseases %30 - Reducing Diabetes rate %27
  20. 20. 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.
  21. 21. 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
  22. 22. 4- Hypertension
  23. 23. 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.
  24. 24. • 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.
  25. 25. Reduce; Systolic blood pressure 20 mmHg Diastolic blood pressure 11 mmHg ; • Decrease Stroke risk % 63 • CVD risk % 46 TKD Ulusal Kalp Sağlığı Politikası Raporu
  26. 26. 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).
  27. 27. 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.
  28. 28. 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.
  29. 29. 5- Alcohol
  30. 30. • 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
  31. 31. Prevention of CVD • Moderate alcohol use is suggested. Women 1 cup per day (10 g alcohol), Men 2 cups per day (20 g alcohol)
  32. 32. 6- Diabetes
  33. 33. • 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.
  34. 34. Prevention of CVD with Diabetes; Target HbA1c <%7.0 • Statines use • Prevent gaining execisive weigth and hypoglisemi • BP <140/80 mmHg
  35. 35. 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
  36. 36. 7- Hyperlipidemia
  37. 37. Prevention of Hyperlipidemia • Life style changes. • Drug treatment.
  38. 38. 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.
  39. 39. 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.
  40. 40. 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
  41. 41. 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)
  42. 42. Nursing Roles in Prevention
  43. 43. 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.
  44. 44. 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
  45. 45. 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
  46. 46. 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.

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