Staying Healthy Kim F Gibson, MD, FACP WRNMMC Bethesda The Key to Your Heart

Demographics Today 13% of Americans > 65 yrs old By % will be older than 65 Over the next decade the most rapid population increase will be in the age group > 85 yrs old MOST OF THOSE INDIVIDUALS ARE WOMEN MOST OF THOSE INDIVIDUALS ARE WOMEN Growing old is not for sissies!

What is the Goal? Health is a state of complete physical, mental, spiritual and social well-being, and not merely the absence of disease or infirmity. We must continuously improve our function, not simply delay “inevitable” losses. Reaching Your Potential

Case Presentation   Mr. R is a 58 yr old WM who presents to his doctor for an annual check up.   He is overweight, has high BP, and abnormal cholesterol test (low HDL, high triglycerides).   Prescribed BP lowering medication and advised to lose weight.

Case Presentation Three months later:   Mr. R collapses at his desk   Paramedics respond quickly and find him in cardiac arrest   Multiple attempts at resuscitation in the office and at the emergency room are unsuccessful   He never recovers and is pronounced dead   Autopsy shows a ruptured plaque and clot in the main artery supplying blood to his heart

Major Causes of Death A. Total CVD B. Cancer C. Accidents D. Chronic Respiratory Diseases E. Diabetes Mellitus F. Alzheimer’s Disease (United States: 2004). Source: NCHS and NHLBI.

Includes coronary heart disease, heart failure, stroke and hypertension Prevalence of Cardiovascular Disease (NHANES: ). Source: NCHS and NHLBI.

Includes MI and fatal CHD but not silent MI’s Annual Number of U.S. Adults with Diagnosed Heart Attacks

Where to Start? Keep your heart healthy Keep your heart healthy Don’t smoke Don’t smoke Maintain weight Maintain weight Get restful sleep Get restful sleep Keep your bones strong Keep your bones strong Foster sexuality Foster sexuality Stay current with health maintenance Stay current with health maintenance Exercise your mind Exercise your mind Be resilient Be resilient Fuel your spiritual growth Fuel your spiritual growth What is the goal?

Cardiovascular Disease Leading cause of death in women and men 1 in 2 men have CV disease 1 in 3 women die of heart disease 25% adults experience sudden death as first indication Coronary heart disease mortality higher in women than men Keep your heart healthy

Cardiovascular Disease ■ ■ Coronary heart disease ■ ■ Cerebrovascular disease ■ ■ Peripheral vascular disease ■ ■ Aortic atherosclerosis Diagnostic Categories

What is the connection? Atherosclerosis   Contributes to:   Heart attack   Most strokes   Peripheral Vascular Disease   Erectile Dysfunction

Coronary Heart Disease Non-modifiable Age: men >45 women >55 Gender / Ethnicity FH Early CAD: men <55 women <65 Modifiable Tobacco Hypertension Dyslipidemia Abdominal obesity Diabetes Stress / Sleep Physical Activity Cardiac Risk Factors

Why Worry?  Each of these risk factors increases your risk of heart disease.  The more risk factors you have the greater your risk.  Treating the modifiable risk factors can prevent the onset of heart disease, stop progression of known disease, and prevent death from heart disease.

Coronary Heart Disease 90% CHD events predicted by presence of risk factors Assessment helps plan treatment Can prevent onset, alter progression and prevent death Intermediate risk may require additional testing Cardiac Risk Assessment

Cardiac Risk Reduction CVD mortality has declined since 1975 Earlier diagnosis More aggressive treatment Reduction in risk factors Prevention is primary focus Focus on LIFESTYLE modification ?Role of aspirin, statins and fish oil Primary vs Secondary Prevention It’s never too late to start!

Cardiac Risk Reduction Exercise daily (150 min/week) Don’t smoke Weight maintenance Mediterranean diet Restful sleep Treat hypertension, diabetes, high cholesterol Lifestyle Modifications

Cardiovascular Fitness Exercise has protective effect Impacts all other risk factors Focus on aerobic activities AHA recommends 150 minutes/week

Physical Fitness Impact on improving performance improving performance sharpening attention and focus sharpening attention and focus enhancing efficiency enhancing efficiency reducing disease risk and morbidity reducing disease risk and morbidity improving recovery from injury improving recovery from injury Health and Performance Sitting is the new smoking!!

Physical Activity Endurance, Flexibility, Strength, Agility Aerobic exercise: 150 min / week Diversify your workout Weight resistance Improve your flexibility Challenge your mobility Concept of staying active

Tobacco Abuse Leading preventable cause of all deaths Increases CHD and all-cause mortality Augments effects of other risk factors Risk of heart disease falls rapidly after cessation Prevention is the key – STOP SMOKING

Obesity 65% adults overweight or obese BMI based on height and weight >25% = overweight, >30% = obese Increases all-cause and CHD mortality Interacts with other risk factors Predisposes to sleep apnea The Hard Cold Facts You only have to exercise on the days you eat!

Healthy Eating Practice moderation Eat breakfast Plan ahead and be consistent Avoid processed foods Be physically active Get enough sleep Do not allow a small weight gain to become a BIGGER weight gain Failing to Plan means Planning to Fail!

Healthy Eating 6-9 servings of fruits and vegetables daily Grains and fiber High protein, low fat, low carbs Omega-3 fatty acids (fish) Portion control Poly or unsaturated fats Limit caffeine and alcohol Avoid fructose corn syrup Balance, Moderation and Variety

Coronary Heart Disease Lipid profile measures: Total cholesterol HDL cholesterol LDL cholesterol Triglycerides (TG) Strong genetic component Significant impact on risk of CHD Treatment goals influenced by age, sex and risk assessment Lipid Disorders

Cardiovascular Drug Therapy Preventive vs Targeted Therapy Aggressive management of: Known coronary heart disease Hypertension Hyperlipidemia Diabetes Role of Aspirin Benefit of Alcohol Role of Statins Tried and True Remedies

Alternative Drug Therapies ■ ■ No evidence for CVR benefit with vitamin C, E, beta- carotene ■ ■ No evidence for CVR benefit with folate and B vitamins ■ ■ No evidence for benefit with fish oil ■ Co-enzyme Q10 ■ Hawthorn extract Evidence Pending…

Prevention Strategies ■ Educate yourself ■ Know your risk factors ■ STOP smoking!! ■ Exercise 150min/week ■ Modify diet ■ Seek treatment for high BP, high cholesterol and diabetes ■ Listen to warning signs Keep your heart healthy!