1. Preventing Cardiovascular Disease10
Preventing Cardiovascular Disease

2. Prevalence of Cardiovascular Disease
About 30% of all deaths in the US are attributed to cardiovascular disease (CVD)
CVD: array of conditions that affect the heart and the blood vessels
More than 1/3 of adults have some form of disease of the heart and blood vessels
About 60% of deaths from heart disease have no previous symptoms

3. Prevalence of Cardiovascular Disease (cont’d.)
Examples of CVD
Coronary heart disease
Stroke
Peripheral vascular disease
Narrowing of the peripheral blood vessels
Congenital and rheumatic heart disease
Atherosclerosis
High blood pressure
Congestive heart failure

4. Stroke
Stroke is a condition in which a blood vessel that feeds the brain ruptures or is clogged, disrupting blood flow to the brain
Third leading cause of death in the US
Most significant contributor to mental and physical disability

5. Stroke Risk Factors
Table Stroke Risk Factors

6. Coronary Heart Disease
Coronary heart disease (CHD) is a condition in which arteries that supply the heart muscle with oxygen are narrowed by fatty deposits
Leading cause of death in the U.S.
Several major risk factors for CHD are preventable and reversible
Risk factor analyses evaluate a person’s lifestyle and genetics
Place an individual in one of five risk categories for potential development of CHD

7. Leading Risk Factors for CHD
Medical factors that lower risk:
Blood pressure less than 120/80
Smoking less or quitting
High-density lipoprotein (HDL) cholesterol 40 mg/dL or higher
“Good” cholesterol; helps clear cholesterol from blood
Low-density lipoprotein (LDL) cholesterol less than 100 mg/dL
“Bad” cholesterol; increases blood pressure

8. Critical Thinking

9. Physical Inactivity Physical activity and aerobic exercise
Increase cardiorespiratory endurance
Control blood pressure
Reduce body fat
Lower blood lipids and improve HDL
Prevent and help control diabetes
Decrease low-grade inflammation
Increase and maintain good heart function

10. Abnormal Electrocardiograms
The electrocardiogram (ECG or EKG) measures the heart’s function
Heart rate, heart rhythm, axis of the heart, enlargement or hypertrophy of the heart, and myocardial infarction
Taken at rest, during exercise, during recovery
Stress ECG shows tolerance of heart to increased physical activity
Recovery ECG monitors the return of the heart’s activity to normal conditions

11. Key Terms Electrocardiogram (ECG or EKG) Stress electrocardiogram
Recording of electrical activity of the heart
Stress electrocardiogram
Exercise test during which workload is increased to maximal fatigue
Blood pressure and 12-lead electrocardiographic monitoring

12. Normal Electrocardiogram
Figure Normal electrocardiogram.

13. Abnormal Electrocardiogram
Figure Abnormal electrocardiogram showing a depressed S-T segment.

14. Abnormal Cholesterol Profile
Blood lipids (cholesterol and triglycerides) are carried in the bloodstream by protein molecules of HDLs, LDLs, very-low-density lipoproteins (VLDLs), and chylomicrons
Cholesterol
For building cell membranes, some hormones, fatty sheath around nerve fibers, etc.
Triglycerides
Fats formed by glycerol and three fatty acids

15. Abnormal Cholesterol Profile (cont’d.)
Very-low-density lipoproteins (VLDLs)
Triglyceride, cholesterol, and phospholipid- transporting molecules in the blood
Chylomicrons
Triglyceride-transporting molecules
An abnormal cholesterol profile contributes to atherosclerosis
Typical symptoms of heart disease, such as angina pectoris, do not start until the arteries are about 75% blocked

16. Key Terms Atherosclerosis Myocardial infarction (heart attack)
Fatty/cholesterol deposits in the walls of the arteries leading to formation of plaque
Myocardial infarction (heart attack)
Damage to or death of an area of the heart muscle as a result of an obstructed artery
Angina pectoris
Chest pain associated with CHD

17. Abnormal Cholesterol Profile (cont’d.)
Cholesterol seems not to cause a problem until it is oxidized by free radicals
In reverse cholesterol transport, HDL molecules help preventing plaque from forming in the arteries – they carry cholesterol to the liver, where it is changed to bile and excreted

18. Healthy and Diseased Arteries
Figure Comparison of a normal health artery (A) and diseased arteries (B and C)

19. Cholesterol Guidelines
Table Cholesterol Guidelines

20. Counteracting Cholesterol
Saturated and trans fats (trans fatty acids) raise cholesterol levels more than anything else
Saturated fats are found mostly in meats and dairy products
Unsaturated fats are mainly of plant origin and cannot be converted to cholesterol
Antioxidants may provide benefits
A single unstable free radical (oxygen compound produced during metabolism) can damage LDL and accelerate the atherosclerotic process

21. Trans Fats
Foods containing trans fatty acids, hydrogenated fat, or partially hydrogenated vegetable oil elevate LDLs and lower HDLs
Trans fats are found primarily in processed foods that have been chemically altered through additives, or manufactured through combination or other methods

22. Lowering LDL Cholesterol
LDL cholesterol levels can be lowered through dietary changes, losing body fat, taking medication, and by participating in a regular aerobic exercise program
A diet lower in saturated fat, trans fats, and cholesterol and high in fiber is recommended
NCEP guidelines to decrease LDL cholesterol allow for a diet with up to 35% of calories from fat, including 10% from polyunsaturated fats and 20% from monounsaturated fats

23. Saturated Fat Replacement in the Diet
Research studies involving almost 350,000 people failed to prove a significant association between saturated fat intake and risk of CHD
Researchers are focusing on the foods in the American diet that have replaced saturated fat

24. Elevated Triglycerides
Triglycerides make up most of the fat in our diet and most of the fat that circulates in the blood
Speed up plaque formation
Manufactured in the liver from refined sugars, starches, and alcohol

25. Triglycerides Guidelines
Table Triglycerides Guidelines

26. Elevated Triglycerides
LDL phenotype B
Some people consistently have slightly elevated triglyceride levels (above 140 mg/dL) and HDL cholesterol levels below 35 mg/dL
80% of these people have a genetic condition called LDL phenotype B – higher risk for atherosclerosis and CHD

27. Cholesterol-Lowering Medications
Statin group
Lower cholesterol by 60% in 2 to 3 months
Slow cholesterol production and increase liver’s ability to remove cholesterol
Decrease triglycerides
Produce small HDL increases
Undesireable side effects

28. Cholesterol-Lowering Medications (cont’d.)
Other drugs effective in reducing LDL cholesterol are bile acid sequestrans, which bind the cholesterol found in bile acids
High dosages (1.5 to 3 grams per day) of nicotinic acid or niacin (a B vitamin) also help lower LDL cholesterol, Lp(a), and triglycerides, and increase HDL cholesterol

29. Elevated Homocysteine
Homocysteine is an amino acid that, when allowed to accumulate in the blood, may lead to plaque formation and blockage of arteries
Five servings of fruits and vegetables daily can provide enough folate and vitamin B6 to clear homocysteine from the blood

30. Homocysteine Guidelines
Table Homocysteine Guidelines

31. Inflammation
Inflammation hidden deep in the body is a common trigger of heart attacks
C-reactive protein (CRP) levels increase with inflammation; elevated level are an indicator of potential cardiovascular events

32. High-Sensitivity CRP Guidelines
Table High-Sensitivity CRP Guidelines

33. Diabetes Diabetes mellitus: blood glucose is unable to enter cells
Insulin: hormone secreted by the pancreas; essential for metabolism of blood glucose and maintenance of blood glucose level
Insulin resistance: inability of the cells to respond appropriately to insulin
Chronic high blood sugar leads to CVD, stroke, nerve damage, vision loss, kidney damage, and decreased immune function

34. Blood Glucose Guidelines
Table Blood Glucose Guidelines

35. Types of Diabetes Type 1 diabetes (juvenile diabetes)
Insulin-dependent diabetes mellitus (IDDM)
Pancreas produces little or no insulin
Type 2 diabetes (adult-onset diabetes)
Non–insulin-dependent diabetes (NIDDM)
Insulin is not processed properly

36. Types of Diabetes (cont’d.)
60 to 80% of type 2 diabetes is related to overeating, obesity, and lack of physical activity
Once limited primarily to overweight adults, now half of new cases are diagnosed in children
Regular exercise helps increase insulin sensitivity and decreases risk for diabetes

37. Glycemic Index
Foods high in the glycemic index cause a rapid increase in blood sugar
Diet with many high-glycemic foods increases risk for CVD in people with high insulin resistance and glucose intolerance

38. Hemoglobin A1c Test
Hemoglobin A1c test measures amount of glucose in a person’s blood over last 3 months
Goal for diabetics is to keep HbA1c under 7%
People with type 2 diabetes should have an HbA1c test twice per year

39. Metabolic Syndrome
Metabolic syndrome is an array of metabolic abnormalities that contribute to development of atherosclerosis triggered by insulin resistance:
Low HDL cholesterol
High triglycerides
High blood pressure
Increased blood-clotting mechanism

40. Diagnosis of Metabolic Syndrome

41. Blood Pressure
Blood pressure is the force exerted against the walls of blood vessels by blood; measured in millimeters of mercury (mm Hg)
Systolic blood pressure (higher number)
Pressure exerted against walls of arteries during contraction (systole) of the heart
Diastolic blood pressure (lower number)
Pressure exerted against walls of arteries during relaxation (diastole) of the heart
Ideal blood pressure is 120/80 or lower

42. Hypertension
Hypertension is chronically elevated blood pressure, above 140/90
CVD risk doubles with each additional 20/10
Blood pressures ranging from 120/80 to 139/89 are prehypertension
“Silent killer” damages epithelial lining of arteries, risk factor for CHD, congestive heart failure, stroke, kidney failure, osteoporosis

43. Blood Pressure Guidelines
Table Blood Pressure Guidelines (expressed in mm Hg)

44. Treatment of Hypertension
90% of hypertension has no definite cause (“essential hypertension”) and is treatable
Aerobic exercise and weight reduction
Diet: Low salt/fat, high potassium/calcium
Lower alcohol and caffeine intake
Smoking cessation
Stress management
Antihypertensive medication

45. Long-Term Aerobic Exercise and Resting Blood Pressure
Table Effects of Long-Term (14-18 years) Aerobic Exercise on Resting Blood Pressure

46. Treatment of Hypertension
The remaining 10% of hypertensions are caused by pathological conditions, typically of the kidneys, adrenal glands, or aortic artery
With pathological hypertension, the cause has to be treated before blood pressure is corrected

47. Excessive Body Fat
Excessive body fat is independent risk factor for CHD; augmented by risk factors such as high blood lipids, hypertension, and diabetes
People who store body fat in the abdominal area are at higher risk for disease than people who store fat in the hips and thighs
Abdominal fat stored around internal organs (visceral fat) increases risk more than abdominal fat stored subcutaneously or retroperitoneally

48. Body Weight, Physical Activity, and Heart Failure Risk
Table Relationship Between Body Weight, Physical Activity, and Heart Failure Risk

49. Cigarette Smoking
About 20% of all deaths from CVD are attributable to smoking
Smoke releases nicotine and 1,200 other toxic compounds into the bloodstream
Destructive to arterial lining
Formation of blood clots
Decrease in HDL cholesterol
Raises blood pressure
Fatal cardiac arrhythmias

50. Tension and Stress
The human body responds to stress by producing catecholamines such as epinephrine and norepinephrine
These “fight or flight” hormones increase heart rate, blood pressure, and blood glucose levels
Angina risk increases following an outburst of anger and doubles the risk for a heart attack in the next two hours

51. Personal and Family History
Individuals with previous cardiovascular problems are at higher risk
Many risk factors are reversible
Genetic predisposition for premature CHD
Heart attack before age 55 (males)
Heart attack before age 65 (females)

52. Age Incidence of heart disease increases with age
Less physical activity
Poorer nutrition
Obesity
Process of heart disease begins early in life
Chronological vs. physiological age

53. Other Risk Factors for CHD
Gum disease
Oral bacteria can cause inflammation
Loud snoring
Sleep apnea stops breathing
Low birth weight (under 5.5 pounds)

54. Cardiovascular Risk Reduction
Most risk factors are reversible and preventable
Aspirin therapy
Healthy habits
Willpower and commitment
A healthier lifestyle, free of cardiovascular problems, leads to well-being and longevity

55. Assess Yourself
Is your diet low in saturated fat, trans fats, and refined carbohydrates?
Do you understand the following concepts?
Cardiovascular disease and coronary heart disease
How a healthy lifestyle can prevent cardiovascular disease
Risk factors for coronary heart disease
How to reduce risk for coronary heart disease