1. Arteriosclerosis and Coronary Heart Disease (CHD)

2. Arteriosclerosis
Disease of the arteries characterized by thickening, loss of elasticity and calcification of arterial walls
Resulting in decreased blood supply particularly to the cerebrum and lower extremities
Often develops with:
aging
hypertension
diabetes

4. Progression of Arteriosclerosis

5. Coronary Heart Disease (CHD)
Seven million Americans effected
Caused by narrowing of the coronary arteries
No. 1 killer of men and women in U.S.
>500,000 each year
> 60 million Americans have some form of coronary vascular disease (CVD) including high BP, CAD, CHD, congestive heart failure, myocardial infarction and others
>2,600 Americans die each day of CVD, i.e., 1 death/33 sec
~ $299 billion cost to the U.S.

6. Risk factors High blood pressure (hypertension) High blood cholesterol
Smoking
Obesity
Physical inactivity
Diabetes
Stress (?)
Controllable

8. Risk Factors (cont’d)
Gender
Heredity
Age
Uncontrollable

9. Major Risk Factors: The Big Three
Hypertension
High cholesterol
Cigarette smoking
All three increase risk
factor eight times
AND…. we should add LACK OF EXERCISE

11. Hypertension Commonly called high blood pressure
Systolic and diastolic measurements
Normal systolic mmHg
Normal diastolic mm Hg

12. Symptoms of CHD Chest pain (angina) Shortness of breath
Heaviness, tightness, pain, burning, pressure or squeezing
behind the breastbone or in the arms, neck, or jaws
Pain may vary
Perhaps no pain

13. Cause & Consequencess of CHD
Lack of oxygen due to ischemia (lack of blood supply)
Narrowing of coronary arteries
Heart responds with angina
Finally, heart attack (myocardial infarction
local ischemia usually due to thrombus (clot) or embolus (clot that has moved from another site and lodged in a smaller vessel)
Possible permanent damage

14. Diagnosis of CHD Electrocardiogram (EKG) Stress test Nuclear scanning
Coronary angiography

15. Treatment for CHD
Lifestyle changes
Medication
Surgery

16. Lifestyle Changes Change of habits Low fat diet Lower weight
Increase exercise
Stop smoking

19. Medications to Treat CHD
Beta blockers
Nitroglycerine and other nitrates
Calcium-channel blockers
Aspirin
Cholesterol-lowering drugs
lovastatin, colestipol, cholestyramine, etc
Digitalis
ACE inhibitors
Diuretics

20. Surgery to Treat CHD Balloon angioplasty Atherectomy Laser angioplasty
Stent insertion
Coronary artery bypass operation (CABG)

22. Gender Disparity Coronary Artery Disease (CAD) more common in men
Women have higher mortality rates
Older and sicker when first heart attack occurs
Less aggressively treated than men
Failure to recognize symptoms in timely fashion
MI in young, healthy women is rare
Occurrence greater in those who use OC
Age 30-39: 2.7X; 40-44: 5.7X; (complilcated by cigarette use)

25. Effects of Smoking
For adult males, smoking has declined from 53 % to 38%
For women, remains at 30%
Has increased for younger and teenaged women
Heavy smoker = cigs/day

26. Effects of Smoking (cont’d)
Cigs contain about 2000 compounds
Main harmful are tar, nicotine and CO
Tar contains hydrocarbons and other carcinogenic substances
Nicotine causes release of epinephrine and norepinephrine resulting in increased HR, BP, cardiac output, stroke volume, contractility, oxygen consumption, and coronary blood flow
CO reduces oxygen carrying capacity of the blood; can precipitate angina

27. Effects of Smoking (cont’d)
Contributes to development of atherosclerosis
Lowers levels of HDL
causes deterioration of elasticity of vessels
Responsible for 20% of all deaths from heart disease
Female smokers have a higher risk than male smokers

30. STRESS Life Dissatisfaction Sociocultural Mobility Life Change
Socioeconomic Status
Status Incongruity
Education Level
Anxiety and Neuroses
Life Dissatisfaction
Life Change
Behavior Pattern

31. Signs of Preclinical CVD
Left ventricular hypertrophy (LVH) associated with increased CAD risk (Framingham Study)
Definite LVH-EKG increased CAD risk threefold

32. Blood and Tissue Characteristics
Type O = lower cholesterol
Higher cholesterol contributes to higher rate of CAD
HDL:LDL (high density lipoproteins: low density lipoproteins) ratio may be more important than cholesterol level

33. HDL
High density lipoproteins seem to have protective effect against development of atherosclerosis (a form or arteriosclerosis in which deposits of yellowish plaque containing cholesterol, lipoid substances and lipophages are formed within large and medium-sized arteries)
Women have higher concentrations than men
Most important of all lipid risk factors
Below 35 mg/dl X incidence of CAD compared to those with 65 mg/dl
Moderate alcohol intake may have + effect
Exercise has + effect
Greater weight has a negative effect

34. DIET Reduce saturated fats Increase polyunsaturated fats
Higher protein to fat ratio
Count calories

36. Effects of Exercise

38. Additional Information