Health and Lifestyle Connection Links to Heart Disease, High Blood Pressure and Diabetes Candace Huber, MPH, BSN Florida Hospital Center for Community Health Ministry

©2007 Florida Hospital Center for Community Health Ministry

Heart Disease Cancer Stroke ChronicLungDisease AccidentsDiabetes Alzheimer’sDisease InfluenzaPneumonia KidneyDiseaseSepticemia (Blood Infections) Tobacco Use Diet & Activity Patterns Alcohol & SubstanceAbuse InfectiousAgents Pollutants & Toxic Agents Firearms SexualBehavior MotorVehicles Illicit Drug Use Anger & Frustration Low Self Esteem or Self Worth EconomicDisparity Hopelessness & Emotional Despair Lack of Information Or Education MeaninglessExistence External & Internal Stress PowerlessnessLoneliness ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults BRFSS, 1985 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10 No Data <10% 10%–14% ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults Percent of Obese (BMI > 30) in U.S. Adults

Obesity Trends* Among U.S. Adults BRFSS, 1990 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10 No Data <10% 10%–14% ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults BRFSS, 1995 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10 No Data <10% 10%–14% 15%–19% ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults BRFSS, 2000 Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10 No Data <10% 10%–14% 15%–19% ≥20% ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults BRFSS, 2001 Source: Mokdad A H, et al. J Am Med Assoc 2001;286:10 No Data <10% 10%–14% 15%–19% ≥20% ©2007 Florida Hospital Center for Community Health Ministry

(*BMI  30, or ~ 30 lbs overweight for 5’4” person) (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% ≥20% ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Mokdad A H, et al. J Am Med Assoc 2003;289:1 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC. No Data <10% 10%–14% 15%–19% 20%–24% ≥25% ©2007 Florida Hospital Center for Community Health Ministry

Obesity Trends* Among U.S. Adults Percent of Obese (BMI > 30) in U.S. Adults

© 2002 – 2006 LifeLong Health Overweight and Disease Risk NEJM, Aug. 5, ’99, 430 Relative Risk ©2007 Florida Hospital Center for Community Health Ministry

Heart Disease Cancer Stroke ChronicLungDisease Accidents Diabetes InfluenzaPneumonia Alzheimer’sDisease KidneyDisease ©2007 Florida Hospital Center for Community Health Ministry Septicemia (Blood Infections)

Heart Disease Cancer Stroke ChronicLungDisease AccidentsDiabetes Alzheimer’sDisease InfluenzaPneumonia KidneyDisease Tobacco Use Poor Diet & Inactivity Alcohol & SubstanceAbuse InfectiousAgents Pollutants & Toxic Agents Firearms SexualBehavior MotorVehicles Illicit Drug Use ©2007 Florida Hospital Center for Community Health Ministry Septicemia (Blood Infections)

Heart Disease Cancer Stroke ChronicLungDisease AccidentsDiabetes Alzheimer’sDisease InfluenzaPneumonia KidneyDiseaseSepticemia (Blood Infections) Tobacco Use Poor Diet & Inactivity Alcohol & SubstanceAbuse InfectiousAgents Pollutants & Toxic Agents Firearms SexualBehavior MotorVehicles Illicit Drug Use Anger & Frustration Low Self Esteem or Self Worth EconomicDisparity Hopelessness & Emotional Despair Lack of Information Or Education MeaninglessExistence External & Internal Stress PowerlessnessLoneliness U.S. All Races ©2007 Florida Hospital Center for Community Health Ministry

All Races African – American Hispanic Native American All Races African – American Hispanic Native American Heart Disease Cancer Stroke Lung Disease Accidents Diabetes Alzheimer’s Disease Influenza & Pneumonia Kidney Disease Septicemia Heart Disease Cancer Accidents Diabetes Stroke Liver Disease Lung Disease Suicide Influenza & Pneumonia Kidney Disease Heart Disease Cancer Stroke Accidents Diabetes Homicide Lung Disease Kidney Disease HIV/AIDS Septicemia Heart Disease Cancer Accidents Stroke Diabetes Liver Disease Homicide Lung Disease Influenza & Pneumonia Birth Defects CDC National Vital Statistics Final 2006 ©2007 Florida Hospital Center for Community Health Ministry

© 2003, PrevMedix LLC Heart Disease and Lifestyle

© 2003, PrevMedix LLC Stages of Atherosclerosis Moderate Cross-section of an artery Normal Severe

© 2003, PrevMedix LLC Blood Tests Recommended Values DesirableOptimal Total Cholesterol<200<160 HDL “good” Cholesterol>40>60 LDL “bad” Cholesterol<130<100 Non-HDL Cholesterol<160<130 Triglycerides less than 200 <100 Glucose levels(nonfasting)<140 Glucose levels (fasting) < 100

© 2003, PrevMedix LLC Lowering LDL (bad) Cholesterol Every 1% decrease in LDL reduces CHD risk 2% Fat - only 25% to 30% of total calories Saturated fat - less than 10%, less than 7% for better results, avoid hydrogenated oils Fiber - 20 to 35 gm/day (whole grains, fresh fruits and vegetables) Be physically active minutes most days Healthy weight - see your body composition report (BMI less than 25)

© 2003, PrevMedix LLC Raising HDL (good) Cholesterol Get 12 to 20 or more aerobic miles per week Achieve and maintain a healthy body weight Don’t smoke Every 1% increase in HDL lowers CHD risk 2% to 3%

© 2003, PrevMedix LLC Increasing HDL Lowers HD Risk Mortality rate due to coronary heart disease per 100,000 Source: The Framingham Heart Study HDL Level

Walking Time and Heart Health Hours of Walking per Week Relative risk of Heart Attack HDL Levels mg/dL CHD mortality rate, men HDL Cholesterol Factors that improve HDL –Aerobic exercise, aerobic miles per week –Achieve/maintain ideal body weight –Avoid smoking –Avoid trans fatty acids Note: For every 1% you increase HDL levels, you decrease CHD by 2-3% Cholesterol and Heart Health Heart Disease Death Rate Serum Cholesterol (mg/dL) Clinical Risks and Heart Disease A 16+ year study of some 366,559 people looked at three major risk factors: –smoking (currently) –cholesterol (200+) –blood pressure (>120/80) People with none of these risks: –were 80 to 90% less likely to have a heart attack –were 40-60% less likely to die from any cause –and lived 6 to 10 years longer than those with any risks JAMA, Dec. 1, 1999 Source: Framingham Heart Study New England Jour. Medicine, Aug Source: NCEP, MRFIT Study ©2007 Florida Hospital Center for Community Health Ministry

Fruit and Vegetable Intake and Risk of Heart Attack Fruit/Vegetable Intake Persons who ate the most fruits and vegetables (top 20%) had a 20% lower risk of heart attack than people who ate the fewest (bottom 20%). For every serving of fruit or vegetable eaten per day, the risk of heart attack dropped 4%. Annals of Internal Medicine, 2001, Jun 19; 134: Fruit and Vegetable Intake and Risk of Stroke Persons who ate the most fruits and vegetables (top 20%) had a 31% lower risk of stroke than people who ate the fewest (bottom 20%). For every serving of fruit or vegetable eaten per day, the risk of stroke drops 6% Ref. JAMA, p. 1233, Oct. 6, 1999 ©2007 Florida Hospital Center for Community Health Ministry

© 2003, PrevMedix LLC Coronary Heart Disease (CHD) Factors You Can Change Blood cholesterol levels: Total less than 200 or less than 160 if you have heart disease Smoking: If you do smoke, stop! More smokers die from heart disease than lung cancer Quitting lowers your risk even if you are a long term smoker Blood pressure: Keep blood pressure low Less than 120/80 Inactivity: Get regular exercise, 30+ minutes most days Excess body fat: Maintain a healthy weight BMI less than 25

© 2003, PrevMedix LLC Waist Girth and Health Risk Cardiovascular Disease Risks (RR) Waist Girth in Inches The Lancet, Mar. 3, 2001 Men 90 cm 100 cm

© 2003, PrevMedix LLC Waist Girth and Health Risk Cardiovascular Disease Risks (RR) Waist Girth in Inches Women American Journal of Clinical Nutrition, Oct cm93 cm

© 2003, PrevMedix LLC Waist Girth Action Steps Waist Girth MenWomenAction <35” <33”Low risk. Maintain with healthy eating and regular physical activity. 35” 33”Moderate risk. Warning! Limit future 90 cm 83 cmweight gain, eat more healthfully, be more physically active. 39” + 37”+High risk. Risk reduction and weight loss 100 cm 93 cmnecessary. Develop weight loss program, diet and physical activity, with health professional’s guidance and support. American Journal of Clinical Nutrition, Oct. 2002

© 2003, PrevMedix LLC New Blood Pressure Norms Normal < 120/80 Prehypertension / High blood pressure 140/90+ Healthy People 2010 Leading Health Indicator JNC 7 Report, JAMA May 21, 2003

© 2003, PrevMedix LLC High blood pressure increases the risk for heart attack, angina, stroke, kidney failure and peripheral artery disease (PAD). High blood pressure may also increase the risk of developing fatty deposit in arteries (atherosclerosis). The risk of heart failure also increases due to the increased workload that high blood pressure places on the heart.

© 2003, PrevMedix LLC Prevalence of High Blood Pressure Percent (%) JAMA 290: , Jul 9, 2003

© 2003, PrevMedix LLC

Blood Pressure and Mortality Mortality rate per 100,000 Source: The Framingham Heart Study, 1974 Systolic Blood Pressure

© 2003, PrevMedix LLC Lowering Blood Pressure Achieve a healthy weight (BMI less than 25) Watch your diet Increase physical activity (30+ minutes most days) Don’t smoke Get adequate rest and relaxation

© 2003, PrevMedix LLC Lifestyle Modifications to Lower Blood Pressure 1. Maintain a healthy weight - BMI less than 25, or - Lose pounds - BP drops 5-20 points with 10 kg wt loss JNC 7 Report, JAMA May 21, 2003

© 2003, PrevMedix LLC Lifestyle Modifications to Lower Blood Pressure 2. Follow the DASH diet eating plan - Eat an abundance of fruits and vegetables - 8 to10 servings per day - Use non or low fat dairy products - Include whole grains, nuts, and legumes - Limit foods high in saturated fat (e.g. meats, butter) - BP drops 8-14 points on the DASH diet JNC 7 Report, JAMA May 21, 2003

© 2003, PrevMedix LLC New Food Pyramid

© 2003, PrevMedix LLC Lifestyle Modifications to Lower Blood Pressure 3. Reduce sodium intake - Eat less salt and salty foods - Limit sodium intake to 2400 mg/day or less - Limiting sodium reduces BP by 2-8 points JNC 7 Report, JAMA May 21, 2003

© 2003, PrevMedix LLC Lifestyle Modifications to Lower Blood Pressure 4. Engage in regular aerobic physical activity - At least 30 minutes per day - Most days of the week, daily when possible - Moderate activities such as brisk walking - BP drops 4-9 points with increased activity JNC 7 Report, JAMA May 21, 2003

© 2003, PrevMedix LLC Introduce Concept

© 2003, PrevMedix LLC Lifestyle Modifications to Lower Blood Pressure 5. Limit alcohol intake, if used at all - Alcohol raises blood pressure - BP drops 2-4 points by limiting alcohol JNC 7 Report, JAMA May 21, 2003

© 2003, PrevMedix LLC Diabetes and Lifestyle

When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should, or both. This causes sugars to build up too high in your blood. Type 2 diabetes is the most common form. It appears most often in middle-aged adults; however, adolescents and young adults are developing type 2 diabetes at an alarming rate.

© 2003, PrevMedix LLC Kenneth Cooper

© 2003, PrevMedix LLC Weight Loss and Health Changes Lower blood pressure Reduce high blood sugar Reduce high triglycerides and cholesterol levels Reduce sleep apnea or irregular breathing during sleep Decrease risk of osteoarthritis Decrease depression Improve appearance and self-esteem Overweight people who lose 10 to 15 pounds may

© 2003, PrevMedix LLC Practical Ways to Lose Weight Dieting is not recommended A change in lifestyle is necessary Make changes that you can do for the rest of your life

© 2003, PrevMedix LLC Weight Loss Goals 1/2 to 1 pound weight loss per week Any faster and you may begin loosing your muscle Make body composition goals as well as weight loss goals

© 2003, PrevMedix LLC More Ways to Reduce CHD Risk Eat whole grains Get plenty of folic acid, B-6, and B-12 Eat nuts regularly to reduce risk Eat foods with omega-3 fatty acid (1-3 gm/day) Talk to your doctor about taking aspirin, if you are over age 50 and have other risk factors for CHD

© 2003, PrevMedix LLC Make a Commitment Think about your goals and prepare to act The goal The start date The timeline Your reward system Your support system

Health and Lifestyle Connection Links to Heart Disease, High Blood Pressure and Diabetes