Eliminating Risk Factors for Heart Disease Healthy Transitions Summer 2014 Presented to: Insert relevant presenter information Calibri 16pt Presented on:

Eliminating Risk Factors for Heart DiseaseHealthy Transitions Summer 2014

Presented to: Insert relevant presenter information Calibri 16ptPresented on: Month day, YearPresented by: Insert relevant presenter information here

Corrine Benacka, RN, BSNBluhm Cardiovascular InstituteJuly 21, 2014

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Eliminating Risk Factors for Heart Disease

• Review the evidence • Define heart disease• Identify the unavoidable and avoidable risk factors for heart disease• Discuss lifestyle changes to decrease your risk of cardiovascular disease• Review the AHA Life’s Simple 7 • Identify resources at NMH to help you achieve your health goals

Objectives

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• Heart Disease is a broad term which refers to any disease that affects the heart.- Atherosclerotic cardiovascular disease (ASCVD)- Valvular heart disease- Congenital heart disease- Arrhythmias- Heart failure- Heart infections- Tumors of the heart

What is heart disease?

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A glance at the evidence

1948: Framingham Heart Study began

1950:

The Seven Countries Study

1976:Nurses Health

Study

1999:INTERHEART

Study

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• Risk Factors- Variable associated with an increased risk of disease

• Risk factors you can’t control- Age, gender, genetics

• Risk factors you CAN control- Being physically inactive- Unhealthy diet- Being overweight- Smoking- High blood cholesterol- High blood pressure- Diabetes

Risk Factors

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Age• For men, risk begins to climb around

age 45• For women, the risk begins to climb

around 55 and especially with the onset of menopause.

Gender• Men are more likely to develop

cardiovascular disease. • The difference beings to disappear

after women go through menopause. • Cardiovascular disease is the number

one killer of men and women in the United States

Genetics• Family history of premature CVD • Coronary disease in male first-degree

relative < 55 years• Coronary disease in female first-degree

relative < 65 years“Health behaviors can trump a lot of your genetics. Research shows people have control over their heart health. The earlier they start making healthy choices, the more likely they are to maintain a low-risk profile for heart

disease.”Donald Lloyd-Jones, MD

Accept the things we can not change……or can we?

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Primary Prevention• Aims at preventing the disease• Reduces incidence and prevalence of a

disease• The majority of know CVD risk factors

are preventable!

Secondary Prevention• After the disease has occurred• All patients who have had a CV

event should receive secondary prevention

• Lifestyle changes• Medications

Primary and Secondary Prevention

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Benefits of Exercise• Improvement in lipid profile• Reduction in blood pressure• Less insulin resistance• Weight loss

Secondary Prevention• Reduction in mortality• Reduction in recurrent MI

Physical Activity

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Recommendations• Moderate-intensity aerobic exercise for 150

minutes every week AND muscle-strengthening activities involving all major muscle groups at least two days per week, OR

• Vigorous-intensity aerobic exercise for 75 minutes every week AND muscle-strengthening activities involving all major muscle groups at least two days per week, OR

• An equivalent mix of moderate-intensity and vigorous-intensity aerobic exercise AND muscle-strengthening activities involving all major muscle groups at least two days per week

Questions/concerns about starting an exercise program? Talk to your physician first!

Physical Activity

Getting Started• Short intervals

- Several times a day=30min/day• Walking, dancing, active yard work• Free weights

- 10-15 repetitions/2-3 times a week

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Foods LOW in:• Saturated and trans fats• Cholesterol• Sodium• Added sugars

Quick Tips• Keep a food journal• Keep healthy foods on hand• Bring your own healthy dish to family parties• Eat fish at least twice a week

- Fish rich in omega 3 fatty acids like salmon, trout and herring

Heart-healthy Diet

Foods HIGH in:• Whole grain fiber• Lean proteinFruits and vegetables!

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• Dietary Approaches to Stop Hypertension- Key foods

• Fruits• Vegetables• Low fat/nonfat dairy

The DASH Diet

http://dashdiet.org/what_is_the_dash_diet.asp

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Obesity• Overweight is defined as a BMI

between 25 and 29.9 kg/m2 • Obesity as a BMI of 30 kg/m2 or

greater• In the U.S.

- 34 percent of US adults aged 20 years and over are overweight

- 34 percent are obese - 6 percent are extremely obese

• The American Heart Association has named obesity as an independent risk factor

Weight Management

Impact of Weight Loss on Risk Factors

~5%Weight Loss

5%-10%Weight Loss

A1C

Blood pressure

Total cholesterol

HDL cholesterol

Triglycerides

Wing RR et al. Arch Intern Med. 1987;147:1749-1753; Blackburn G. Obes Res. 1995;3 (Suppl 2):211S-216S.

Mertens IL, Van Gaal LF. Obes Res. 2000;8:270-278; Ditschuneit HH et al. Eur J Clin Nutr. 2002;56:264-270.

Prevalence* of Self-Reported Obesity Among U.S. AdultsBRFSS, 2012

*Prevalence reflects BRFSS methodological changes in 2011, and these estimates should not be compared to those before 2011.

15%–<20% 20%–<25% 25%–<30% 30%–<35% ≥35%

http://www.cdc.gov/obesity/data/adult.html

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Eliminating Risk Factors for Heart DiseaseHow does obesity contribute to CVD?

CVD

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STOP SMOKING!• Smoking is an independent risk factor• Smoking is associated with a higher risk

of:- Stroke- Atherosclerosis- Heart Attack- Aortic Aneurysm

Smoking

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It’s never too late to quit• Cardiac risk diminishes shortly after

quitting and continues to decrease• Mortality benefit • Risk of stroke reduces after quitting

Smoking

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Eliminating Risk Factors for Heart DiseaseSmoking

Smoking

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• Cholesterol is a fat-like substance that lines the blood vessels.

• Cholesterol is carried in the blood by carries = lipoproteins- LDL - Low density lipoprotein or

“Bad” cholesterol- HDL - high density lipoprotein or

”Good” cholesterol- Non-HDL cholesterol - Non-HDL

cholesterol is your total cholesterol minus your HDL cholesterol.

- Triglycerides- type of fat found in your blood; high levels may signify metabolic syndrome

Know Your Numbers• HDL ≥ 50mg/dl• LDL <100mg/dl, if CAD < 70 mg/dl• Triglycerides <100 mg/dl• Non HDL <130 mg/dl

Total Cholesterol=HDL + LDL + 20% of your triglyceride

level. A total cholesterol score of less than 180 mg/dL is considered optimal.

Cholesterol

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Eliminating Risk Factors for Heart DiseaseCholesterol

• Why Cholesterol Matters- Major controllable risk factor- If you have other risk factors such as

high blood pressure, DM or you smoke-your risk increases even further

- Cholesterol can form thick deposits called plaque in artery walls=atherosclerosis• CAD• Stroke• Peripheral vascular disease• Aortic atherosclerosis and aneurysms of the

aorta

http://rds.yahoo.com/_ylt=A0WTb_20ctVJxj8B2d6jzbkF/SIG=12dedilq3/EXP=1238811700/**http:/www.lifestreamgroup.com/images/atherosclerosis.jpg

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Prevention• Healthy diet• Ideal body weight• Activity• DON’T SMOKE

Treatment• Lifestyle change is first line treatment of

hyperlipidemia for all patients- Diet- Exercise- Don’t smoke

• Simplified into 4 groups to treat for both primary and secondary prevention- Clinical Atherosclerotic CVD- LDL-cholesterol levels ≥ 190 mg/dL- Diabetes Mellitus aged 40-75 yo- 10 year risk of ASCVD ≥ 7.5%

• No LDL targets• Patient-Physician discussion is key to

making informed decisions about treatment

Cholesterol

Stone NJ, et alCirculation: Nov. 12 2013

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Eliminating Risk Factors for Heart DiseaseCholesterol

Cholesterol Lowering Medications

•Statins•Most effective agents to lower LDL-C•Clinically proven to reduce mortality & recurring CV events•Change composition of plaques (especially in vulnerable plaques)•Stabilize atherosclerotic plaques•May result in partial regression•Can be well tolerated

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Blood Pressure= Systolic BP

Diastolic BP

High Blood Pressure

Hypertension- The Silent Killer•Often no symptoms•1 in 3 adults have high blood pressure•Hypertension can cause: stroke heart attack heart failure peripheral artery disease kidney failure•Defined as ≥ 140/90 mmHg

Blood PressureCategory

Systolicmm Hg (upper #) Diastolic

mm Hg (lower #)

Normal less than 120 and less than 80

Prehypertension 120 – 139 or 80 – 89

High Blood Pressure

(Hypertension) Stage 1

140 – 159 or 90 – 99

High Blood Pressure

(Hypertension) Stage 2

160 or higher or 100 or higher

Hypertensive Crisis

(Emergency care needed)

Higher than 180 or Higher than 110

This chart reflects blood pressure categories defined by the American Heart Association.

www.heart.org

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp

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Prevention and Treatment• Diet

- Low Na- DASH

• Don’t Smoke• Maintain a healthy weight• Exercise • Coping with stress• Take your medication

High Blood Pressure

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• Heart disease and stroke are the #1 cause of death for type 2 diabetics

• DM can lead to atherosclerosis• DM can cause damage to your heart,

eyes, nerves and kidneys

Why is DM a risk factor?• AHA considers DM one of the

controllable risk factors for heart disease

• When blood sugars are within normal range, you protect vital organs

• Diabetics often have other risk factors- HTN- High cholesterol and triglycerides- Obesity and lack of exercise- Poorly controlled blood sugars- Smoking

Diabetes

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Prevention• Control weight• Be active• Control blood pressure• Control cholesterolTreatment• Lifestyle • Medications

- Oral medications- Insulin

You and your doctor can discuss the best treatment plan for you!

Who should be tested?• Overweight and over 45 yrs/old• High cholesterol• Family history of DM• African-American, Asian-American,

Latino/Hispanic-American, Native American or Pacific Islander descent

• A history of gestational diabetes (diabetes during pregnancy) or delivering a baby over 9 lbs.

Diabetes

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Eliminating Risk Factors for Heart DiseaseMetabolic Syndrome

Metabolic Syndrome•Cluster of risk factors that put a person at greater risk of cardiovascular disease

Metabolic Syndrome

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Who’s at risk?• Obesity/overweight• Insulin resistant• Physically inactive

Treatment• Eat better• Get moving• Lose weight• Medications

Metabolic Syndrome

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Assess your risk!• My life check assessment

www.heart.org

Life’s Simple 7

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Bluhm Cardiovascular Institute• The Bluhm Cardiovascular Institute is proud of our

U.S. News & World Report rankings – a reflection of the leading edge cardiac and vascular services we offer and the results we obtain for our patients, their families and the community. #1 in the Chicago metro region

• #1 in Illinois for the seventh straight year• #13 in the nation out of 708 cardiac programs• Highest ranked cardiac program in the region: Indiana, Michigan, Wisconsin,

Missouri and Iowa

Bluhm Cardiovascular Institute

www.heart.nm.org

http://news.nm.org/northwestern-cardiology-and-heart-surgery-13th-among-us-newsrsquo-best-hospitals.html%23.U8V5ho1dWTw

http://news.nm.org/northwestern-cardiology-and-heart-surgery-13th-among-us-newsrsquo-best-hospitals.html%23.U8V5ho1dWTw

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Know your numbers!• BMI or body mass index- goal 18-24.9 • Waist circumference- goal < 35 inches• Blood pressure- goal < 120/80• Cholesterol

- Total cholesterol- goal < 200 mg/dL- HDL- goal ≥ 50 mg/dl- LDL- goal < 100 mg/dL, if CAD < 70 mg/dL- Triglycerides- goal < 100 mg/dL- non-HDL- goal < 130 mg/dL

• Fasting Blood Sugar < 100 mg/dL

Summary

www.heart.nm.org

Thank You

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Eliminating Risk Factors for Heart Disease Healthy Transitions Summer 2014 Presented to: Insert relevant presenter information Calibri 16pt Presented on: