Chapter 5

 Women are about as likely to die of cardiovascular disease as they are to die of breast cancer. True or False?  FALSE. Cardiovascular disease kills far more. Among American women, nearly 1 in 3 deaths is due to CVD and about 1 in 30 is due to breast cancer. In addition, more women than men die each year from cardiovascular disease.

 On average, how much earlier does heart disease develop in people who don’t exercise regularly than in people who do? a. 6 months b. 2 years c. 6 years c. Both aerobic exercise ad strength training significantly improve cardiovascular health.

 Which of the following foods would be a good choice for promoting heart health? a. whole grains b. salmon c. bananas  ALL THREE. Whole grains, foods with omega 3 fatty acids, and foods high in potassium and low in sodium all improve cardiovascular health.

 Factors associated with an increased risk of developing CVC are grouped in two categories:  Major risk factors  Contributing risk factors  Controllable aspects (diet, exercise habits, tobacco)  Non – controllable aspects (age, sex, race, heredity)

 Tobacco use: smoking harms the cardiovascular system in several ways:  Damages the lining of arteries  Reduces the level of high density lipoproteins (HDL)  Raises the levels of triglycerides and low-density lipoproteins (LDL)  Nicotine increases blood pressure and heart rate  Carbon monoxide displaces oxygen in blood  Causes platelets to stick together in the blood stream, leading to clotting  Speeds the development of fatty deposits in arteries  Second hand smoking is as damaging as first hand.

 High blood pressure – hypertension  Blood pressure: force exerted by the blood on the vessel walls created by the pumping action of the heart.  High blood pressure results from  increased output of blood by the heart  increased resistance to blood flow in the arteries.  Constriction of smooth muscle surrounding the arteries  Atherosclerosis: clogging and narrowing of arteries.  High blood pressure is common and usually has no symptoms.

Blood Pressure Classification for Healthy Adults CategorySystolic (mm Hg) Diastolic (mm Hg) Normal Prehypertension Hypertension Stage 1 Stage 2 Below – – and above Below – – and above

 Unhealthy cholesterol levels  Cholesterol: fatty, wax like substance that circulates through the bloodstream  Important component of cell membranes, sex hormones, vitamin D, the fluid that coats the lungs and the protective sheaths around nerves.  Excess cholesterol clogs arteries and increases the risk of CVD

CHLOLESTEROL  Produced in the liver  Carried in blood by lipoproteins  LDL shuttle cholesterol from the liver to organs and tissues.  HDL shuttle unused cholesterol back to the liver for recycling.

CHOLESTEROL GUIDELINES Total cholesterol (mg/dl) Less than – or more Desirable Borderline high High LDL cholesterol (mg/dl) Less than – – or more Optimal Near optimal /above optimal Borderline high High Very high HDL Cholesterol (mg/dl) Less than or more Low (undesirable) High (desirable Triglycerides (mg/dl) Less than – – or more Normal Borderline high High Very high Blood cholesterol levels

 Improving cholesterol levels  Reduce your LDL to healthy levels  Choose unsaturated fats  Increase fiber intake  Exercise regularly  Eat more fruits, vegetables, fish and whole grains

 Physical Activity  Lowers CVD risk by  Helping decrease blood pressure and resting heart rate  Increase HDL levels  Maintain desirable weight  Improve the condition of blood vessels  Prevent or control diabetes.

 Obesity  Risk of death from CVD is two to three times higher in obese people  Distribution of body fat is significant  Fat in the abdomen is more dangerous than fat in the hips

 Diabetes  Disorder in which the metabolism of glucose is disrupted causing a buildup of glucose in the bloodstream  Can damage the lining of arteries, making them more vulnerable to atherosclerosis  Other risk factors include: hypertension, obesity, unhealthy cholesterol and triglyceride levels, platelet and blood coagulation abnormalities.

 High triglyceride levels  Triglycerides: blood fats that are absorbed from food and manufactured by the body  Factors involved:  Excess body fat  Physical inactivity  Cigarette smoking  Type 2 diabetes  Excess alcohol intake  Very high carbohydrate diets  Certain diseases and medications

 Psychological and social factors  Chronic stress  Chronic hostility and anger  Lack of social support  Suppressed psychological distress  Depression and anxiety  Social isolation  Low socio-economical status

 Alcohol and drugs  Drinking too much alcohol raises blood pressure and can increase the risk of stroke and heart failure.

 Family History (Heredity)  Multiple genes contribute to the development of CVD and its risk factors  People with an inheritance for CVD are not destined to develop it, but they have to work to prevent it.  Aging  About 50% of adult Americans that develop CVD are over age 65  However, people in their 30s and 40s, specially men can have heart attacks.

 Being male  Men face greater risk of heart attack than women  The incidence of stroke is higher for males than females until age 65,  Ethnicity  African Americans have higher rates of hypertension, heart disease and stroke than other groups.

 C-reactive protein (CRP)  Released into the body during inflammatory response  May be released in arteries injured by smoking, cholesterol, infectious agents.  Homocysteine  Amino acid that may damage the lining of blood vessels  Men generally have higher homocysteine levels than women  Individuals with low levels of folic acid, vitamin B-12 and B-6 also have high levels.  Lipoprotein (a) – Lp(a)  Type of LDL that has a strong genetic component and is difficult to treat.  LDL pattern B  LDL particles differ in size and density  People with high proportion of small, dense LDL particles appear to have a high risk for CVD

 Infectious agents  Chlamydia pneumoniae, cytomegalovirus and Helicobacter pylory  Infections may damage arteries and lead to chronic inflammation.  Fibrinogen  Involved in blood clotting  Metabolic syndrome – Insulin resistance syndrome  Symptoms include abdominal obesity, high triglycerides, lo HDL cholesterol, high blood pressure, and high blood glucose levels.

 Artherosclerosis  Arteries become narrowed by deposits of fat, cholesterol and other substances.  Deposits called plaques accumulate on artery walls  Arteries lose their elasticity and ability to expand and contract  Blood flow becomes restricted  Artery becomes vulnerable to blockage by blood clots.

 Heart Disease and Heart Attacks  Coronary Heart Disease (CHD): caused by the hardening of coronary arteries.  Heart attack – myocardial infarction (MI): damage or death of heart muscle.  Angina pectoris (chest pain): severe pain in the chest, left arm and shoulder due to a lack of oxygen in the heart’s muscle.  Arrhythmia: irregularity in the force or rhythm of the heartbeat.  Sudden cardiac death – cardiac arrest: caused by an arrhythmia called ventricular fibrillation that results in ineffective pumping of blood

 Symptoms  Symptoms differ but include the following:  Extreme tightness in the chest and heavy pressure behind the breastbone or in the shoulder, neck, arm, hand or back.  Shortness of breath, weakness, unusual fatigue, cold sweat, dizziness and nausea.  Diagnosis  Electrocardiogram – ECG or EKG  Magnetic resonance imaging MRI  Electron – beam computed tomography EBC  Echocardiograms  Angiograms

 Treatment  Low fat diet, regular exercise, smoking cessation  Low dose aspirin  Balloon angioplasty  Coronary stents  Coronary Bypass Surgery

 Stroke – cerebrovascular accident (CVA)  Occurs when the blood supply to the brain is cut off  Caused by  A blood clot that blocks an artery  ischemic stroke  Ruptured blood vessel  hemorrhagic stroke  A stroke may cause paralysis, walking disability, speech impairment or memory loss.  Treatment involves the use of clot dissolving and antihypertensive drugs.

 Congestive Heart Failure  Condition resulting from the heart’s inability to pump out all the blood that returns to it. Blood backs up in the veins leading to the heart, causing an accumulation of fluid in various parts of the body, specially legs and ankles.  Causes  High blood pressure  Heart attack  Atherosclerosis  Viral infections  Rheumatic fever  Birth defects  Treatment  Reducing the workload on the heart  Modifying salt intake  Using drugs to eliminate excess fluid

 Eat a heart – healthy diet  Reducing fat intake  no more than 30% (7%)  Substituting unsaturated fat for saturated and trans fats  1/3 from fats  Increasing intake of whole grains and fiber  Fiber traps the bile acids the liver needs to manufacture cholesterol and carries them to the large intestine.  Slows the production of proteins that promote blood clotting.  Interfere with the absorption of dietary fat.  Recommended 25 – 28 gr/day.

 Eat a heart – healthy diet  Reducing the intake of sodium and increasing the intake of potassium  Alcohol  Moderate alcohol consumption reduces the risk of CHD  Dash (Dietary Approaches to Stop Hypertension  6-8 servings a day of grains and grain products  4-5 servings a day of vegetables  4-5 servings a day of fruits  2-3 servings a day of low-fat or nonfat dairy products  6 or fewer 1-ounce servings a day of meats, poultry, and fish  4-5 servings a week of nuts, seeds and legumes  2-3 servings a day of added fats, oils and salad dressings  5 or fewer servings a week of snacks and sweets.

 Exercise regularly  30 – 60 minutes of moderate-intensity physical activity each day  Avoid tobacco  The number one risk factor for CVD that you can control is smoking  Know and manage your blood pressure  Have your blood pressure measured every 2 years

 Know and manage your cholesterol levels  Have a lipoprotein profile (cholesterol, HDL, LDL and triglyceride) once every 5 years  Develop ways to handle stress and anger  Know your risk factors  If you are at moderate to high risk for CVD, consult a physician about taking small doses of aspirin.