How To Be Healthy Without Killing Yourself B Bottenberg, D.O., FNLA, FACOI

Topics For Today Major Risk Factors For Disease Disease Prevention Diet and Exercise Think About The Big Picture

Cardiovascular Disease Cardiovascular Disease Remains the Biggest Killer of Adult Americans 500,000 Deaths Annually One Third of Cardiovascular Deaths Are In Those Under 55 Years of Age Accounts For More Deaths Than All Cancers Combined

Major Cardiovascular Risk Factors Age/Gender : >= 45 male, >= 55 female HDL < 40 mg/dl (male) HDL < 50 mg/d (female) HTN or on Tx Tobacco use Family History premature events in first degree relative (male < 55) (female < 65) If >1 Risk Factor Then Perform Framingham Risk Scoring

ATP III Risk Categories CHD, PAD, carotid disease, diabetes, 2+ RF (10-year risk >20%) – LDL-C goal <100 mg/dL High Risk Moderately High Risk Moderate Risk Lower Risk 2+ RF (10-yr risk 10–20%) – LDL-C goal <130 mg/dL 2+ RF (10-yr risk <10%) – LDL-C goal <130 mg/dL 0–1 RF – LDL-C goal <160 mg/dL

Ruptured Atheroma

Reduction in Major Coronary Events in Major Statin Trials Secondary Primary *p<0.001; † p=0.0005; ‡ p<0.0001; § p= LaRosa J et al. JAMA. 1999;282: ; HPS Collaborative Group. Lancet. 2002;360:7-22; Sever PS et al. Lancet. 2003;361: * High Risk 4S % AF/ TexCAPS % LIPID % CARE % WOSCOPS % Trial N  LDL- C -25*-25 § -31* -27 ‡ HPS 20, % Risk Reduction, % ASCOT 10, % -36 † Major coronary events defined as: fatal or nonfatal myocardial infarction (MI), unstable angina, sudden cardiac death in AF/TexCAPS; nonfatal MI or coronary death in WOSCOPS, ASCOT, HPS, LIPID, CARE; coronary death, nonfatal MI, silent MI, resuscitated cardiac arrest in 4S.

Heart Attacks 50% LDL.

LDL 20mg/dL Size Matters! LDL 100mg/dL LDL 20mg/dL LDL 20mg/dL LDL 20mg/dL Triglycerides A LDL 20mg/dL

Insulin Is Secreted To Control Sugar Insulin Glucose Insulin Glucose

As You Gain Weight, It Takes More Insulin… Insulin Glucose

And More Insulin… Insulin Glucose

Until the Pancreas Fails Insulin Glucose

80% Loss Of Pancreatic Function Insulin Glucose

Risk FactorDefining Level Abdominal obesityWaist circumference Men>102 cm (>40 in) Women >88 cm (>35 in) Triglycerides  150 mg/dL HDL-C Men<40 mg/dL Women<50 mg/dL Blood pressure  130/  85 mm Hg Fasting glucose  100 mg/dL Reprinted with permission from NCEP ATP III. JAMA. 2001;285: Risk Factors and Defining Levels of Metabolic Syndrome HDL-C = high-density lipoprotein cholesterol.

RISK FACTORS FOR ALZHEIMERS Hypertension Large Waist Low HDL High Triglycerides Borderline High Blood Sugar (Neurology: Feb Vol )

Obesity in the United States Adults… 1 in 3 Children… 1 in 4 (Source: CDC 2010)

Diabetes in the United States Diabetes… 1 in 10 ! Prediabetes… 1 in 3 ! (Source: CDC 2011)

OVEREATING vs. “BUNCH EATING” YOUR BODY BURNS FUEL YOUR TANK ONLY HOLDS SO MUCH NO MORE “BUNCH” EATING “BUT DOC, I’M NOT HUNGRY”

We “Bunch” Eat Triglyceride

Adipose Cells Getting Plump Triglyceride

Adipose Cells Hypertrophy

So… How To Eat? 1500 – 2000 Calories Per Day 500 – 600 Calories Per Meal 3 Servings Per Meal 1 Protein gms. Per Meal (7 gms. / 20 lbs.) 2 Healthy Carbohydrates (colored,crunchy,fruit,grains) Fat Fills In… (MUFA, PUFA)

Exercise Good For Mood Great For Bones Excellent For Circulation Reduces Insulin Resistance (Diabetes) Reduces Vascular Disease Problems Fit People Have 50% Less Mortality ! Probably Doesn’t Affect Your Weight

Exercise 30 Minutes- 5 Times Per Week 2 ½ Hours Per Week Moderate Intensity Walking… Easy Biking… Light Swimming… Gardening… Housework… Softball… Golf… Heavier Intensity Counts Double

Drugs To Reduce Heart Disease Aspirin Reduces Heart Attacks By 18% Niacin Reduces Heart Attacks By 25% Statins Reduces Heart Attacks By 40%

WALKING TWO MILES DAILY REDUCES HEART DISEASE BY 45% Women’s Health Study: JAMA, 2001

3 OR MORE FRUITS AND VEGETABLES DAILY 42% FEWER STROKE DEATHS 27% LESS HEART DISEASE DEATHS 15% OVERALL LESS DEATH NHANES: AJCN. 2002

EATING FISH TWICE WEEKLY (SALMON, TROUT, HERRING, HALIBUT) 31% REDUCTION IN HEART DISEASE Nurses Heart Study: JAMA, % REDUCTION IN SUDDEN DEATH Physician’s Health study: NEJM, 2002

LOSING 5-7% BODY WEIGHT BY EATING BETTER 58% LESS CHANCE OF BECOMING DIABETIC Diabetes Prevention Program: NEJM, 2002

STAY FIT HIGHLY FIT MEN HAVE 50% LOWER DEATH RATES THAN LOWER FIT MEN Circulation: 2008

ADDRESS LIFE

Preventing Disease Get a Flu Shot Annually (for the rest of us) Pneumovax Every 10 Years Zostavax (Shingles) 1-2 Alcoholic Beverages Daily (not more) Colonoscopy at Age 50 * Stop Smoking (are you kidding me?) Check Blood Pressure, Glucose and Cholesterol Annual Physicals, Pap, Mammograms, DEXA Eat Better, Move Around Some, Lose Weight