Cardiovascular Disease: Knowing the Risk Factors, Symptoms, and Prevention Arvi Grover M.D. Director of Cardiovascular Research, Director of Heart Health Program, KMH Cardiology

What are heart disease and stroke? What are the warning signs? Today’s presentation The Heart Truth…………….. What are heart disease and stroke? What are the warning signs? What are the risk factors? How can you reduce your risks? How to talk to your doctor? Today’s presentation is made possible by The Heart Truth campaign, created by the Heart and Stroke Foundation to raise awareness among Canadian women that heart disease and stroke is one of their biggest health risks, killing seven times more women than breast cancer. During the next hour, we will cover a range of topics on heart disease and stroke and how they affect women.

Simple Stats 9 out of 10 Canadians over the age of 20 have at least one of the following risk factors: smoking, physical inactivity during leisure time, less than recommended daily consumption of vegetables and fruit, stress, overweight or obesity, high blood pressure, or diabetes. 2 in 5 have three or more of these risk factors Addressing these risk factors will reduce the risk not only of CVD, but also of many other chronic diseases that share the same risk factors. , AHA Heart Disease and Stroke Statistics 2010 Update. Circulation 2010;121:e41-e215.

Most common type is coronary artery disease What is heart disease? Damage to the heart Most common type is coronary artery disease angina caused by reduced blood supply and oxygen to the heart heart attack caused by reduction or stoppage of blood supply/oxygen What is heart disease? The term heart disease describes a number of conditions that can affect and damage the structure and function of the heart. While there are many kinds of heart disease, most heart disease is a result of a blockage to the arteries that serve the heart. These arteries provide oxygen-rich blood to the heart, so when they’re blocked, the heart muscle becomes starved of oxygen, causing angina or a heart attack. Stroke is very similar - most strokes are a result of a blockage in the blood vessels that serve the brain.

Do you know the warning signs of a heart attack?

Heart Attack Symptoms - MEN Chest pain Discomfort in other areas of the upper body One or both arms Back, neck or jaw Stomach Shortness of breath Other signs Cold sweat Nausea Lightheadedness Fatigue

Heart Attack Symptoms - WOMEN As with men, chest pain or discomfort More likely- other symptoms: Shortness of breath Nausea/vomiting Back or jaw pain Not feeling right Fatigue Palpitations Musculoskeletal complaints Hot flashes

Cardiovascular Disease Risk Factors History of CAD/PAD Male Sex History of TIA/CVA Smoking Hypertension(high blood pressure) Diabetes Mellitus Dyslipidemia (high cholesterol) Low HDL < 1.0 Elevated LDL / TG Family History - event in first degree relative > 55 male, > 65 female Chronic Kidney Disease Obesity Lack of regular physical activity Diet poor in fruits, vegetables, and fiber Age > 45 male, > 55 female

Risk Factors that Can’t Be Changed Age Gender: Male Heredity – Family History Race Previous CAD, PVD or CVA

Exercise is a Medicine Physicians should prescribe it, Patients should take it! Instead of an allergy, exercise may be the long sought vaccine to prevent chronic disease and extend life As the evidence has continued to mount about the health detriments of being physically inactive, it has become clear that exercise is a “medicine” – a vaccine that can prevent multiple chronic and mental diseases, as well as improve and extend our quality of life. Therefore, we have come to the point where we are now asking ourselves - …. Are we reaching a point where NOT prescribing physical activity should be consider patient neglect?

Do You Really Think We have a Chance Without Exercise? Obesity Coronary artery disease Diabetes Hypertension Cancer Depression and anxiety Arthritis Osteoporosis Etc, etc, etc… Patients Physicians NO! EIM takes the position that to make exercise a “pill” that every patient takes, physicians and their healthcare teams must play a major role in helping encourage and support their patients in becoming more physically active!

Physical Activity and Reduced Mortality (Lancet, Vol 378, Issue 9798, Pages 1244-1253, October 2011) Those who exercised for at least 90 min / week or 15 min/day had a 14% reduction in mortality Further extra 15 min/day reduced mortality even more by 4% and reduced cancer risk by another 1% Inactive individuals had a 14% increased mortality risk

Cardiovascular Diet

Cardiovascular Care Smoking cessation Physical activity Diet Cessation-class, medications, counseling Physical activity Goal 30 - 60 minutes daily Risk assessment prior to initiation Diet DASH diet, Mediterranean diet, fiber, omega-3 fatty acids <7% total calories from saturated fats

Cardiac Screening – Heart Health Program Know your personal and family history Appropriate screening for your level of risk Program consists of aprox. 6 visits over 1 year Testing to determine current status Multi-disciplinary approach to increase your education on proper lifestyle, including diet and exercise Take charge of your health

Prevention Begins with You Take one step at a time Replace unhealthy habits with healthier ones Eat for a healthy heart Start walking—try 10 minutes and add time gradually to reach 2 hours and 30 minutes each week

How to Keep Going View changes as a new lifestyle, not quick fixes Set realistic goals Buddy up Don’t worry about slipping up—get back on track Reward your successes Be your own advocate—ask questions and seek information

The Heart Truth® It’s up to you to protect your heart health—start today!

Heart Health Program Speak to your doctor to see if you could benefit from enrollment No cost to patients Services include regular Cardiology/Dietician assessment 6 visits over 14 months Multiple locations across GTA and Southeastern Ontario