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

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

3. 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

4. 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

5. 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

6. Ruptured Atheroma

8. Reduction in Major Coronary Events in Major Statin Trials Secondary Primary *p<0.001; † p=0.0005; ‡ p<0.0001; § p=0.002. LaRosa J et al. JAMA. 1999;282:2340-2346; HPS Collaborative Group. Lancet. 2002;360:7-22; Sever PS et al. Lancet. 2003;361:1149-1158. -38* High Risk 4S 4444 -36% AF/ TexCAPS 6605 -27% LIPID 9014 -25% CARE 4159 -28% WOSCOPS 6595 -26% Trial N  LDL- C -25*-25 § -31* -27 ‡ HPS 20,536 -29% Risk Reduction, % ASCOT 10,305 -28% -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.

9. Heart Attacks 50% LDL.

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

11. Insulin Is Secreted To Control Sugar Insulin Glucose Insulin Glucose

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

13. And More Insulin… Insulin Glucose

14. Until the Pancreas Fails Insulin Glucose

15. 80% Loss Of Pancreatic Function Insulin Glucose

16. 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;285:2486-2497. Risk Factors and Defining Levels of Metabolic Syndrome HDL-C = high-density lipoprotein cholesterol.

17. RISK FACTORS FOR ALZHEIMERS Hypertension Large Waist Low HDL High Triglycerides Borderline High Blood Sugar (Neurology: Feb. 2011. Vol 76. 518-525)

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

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

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

21. We “Bunch” Eat 55 10 Triglyceride

22. Adipose Cells Getting Plump Triglyceride

23. Adipose Cells Hypertrophy

24. So… How To Eat? 1500 – 2000 Calories Per Day 500 – 600 Calories Per Meal 3 Servings Per Meal 1 Protein 15-25 gms. Per Meal (7 gms. / 20 lbs.) 2 Healthy Carbohydrates (colored,crunchy,fruit,grains) Fat Fills In… (MUFA, PUFA)

25. 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

26. 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

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

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

29. 3 OR MORE FRUITS AND VEGETABLES DAILY 42% FEWER STROKE DEATHS 27% LESS HEART DISEASE DEATHS 15% OVERALL LESS DEATH NHANES: AJCN. 2002

30. EATING FISH TWICE WEEKLY (SALMON, TROUT, HERRING, HALIBUT) 31% REDUCTION IN HEART DISEASE Nurses Heart Study: JAMA, 2002 81% REDUCTION IN SUDDEN DEATH Physician’s Health study: NEJM, 2002

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

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

33. ADDRESS LIFE

34. 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