Cardiovascular health

1. Cardiovascular health • Will examine what we know re CV health and Coronary heart disease (CHD) • American and Canadian info & resources, mostly allopathic, some web-based • Then look at integrative approaches relying on text chapter 18 as framework

2. Cardiovascular health • CV disease is now “the major cause of death and disability and of rising health care costs in Canada” • In groups of 5, record what you know about CV disease / health and what you know re treatment / prevention – allopathic & less conventional or “alternative”

3. CHD ~ what is it ? • Narrowing of coronary arteries • Atherosclerosis vs arteriosclerosis • Angina (lack of oxygen induced) to full blown heart attack • Cholesterol, vital to hormone & vitamin D production, bile to digest fat etc present everywhere • Excess cholesterol is issue re athero etc

5. CV Disease Deaths by sex, Stats Can, 1994

6. Risk Factors in General • smoking • high blood pressure • high cholesterol • physical inactivity • obesity • diabetes

7. Risk Factors and CHD The risk factors that you cannot  control include: • Age (45 years or older for men; 55 years or older for women) • Family history of early heart disease (father or brother affected before age 55; mother or sister affected before age 65)

8. Risk Factors and CHD The risk factors that you can control include: • High blood cholesterol (high total cholesterol and high LDL ("bad") cholesterol) • Low HDL ("good") cholesterol • Smoking • High blood pressure • Diabetes -- if you have diabetes, your risk for developing heart disease is high, as high as a heart disease patient's risk for having a heart attack; need to lower cholesterol under medical supervision, in much the same way as a heart disease patient, in order to reduce high risk of getting heart disease. • Obesity/overweight • Physical inactivity

10. What makes cholesterol hi or low ? • Your blood cholesterol level is affected not only by what you eat but also by how quickly your body makes LDL ("bad") cholesterol and disposes of it • In fact, your body makes all the cholesterol it needs, and it is not necessary to take in any additional cholesterol from the foods you eat

11. Benefits of cholesterol - lowering • Huge risk reducer (lots of evidence) both for people with high cholesterol & those with avg levels • Studies use ‘statins’ (discussed in your text) as cholesterol lowering drugs – longitudinal studies in Scotland etc showed dramatic reductions in incidences of CHD, 20-37% reductions • *** See notes re studies in ‘Handout’ format below this slide***

12. What makes cholesterol hi or low ? – Factors re LDL levels: • Heredity • What you eat • Weight • Physical activity/exercise • Age and sex • Alcohol • Stress • *** see definitions in Handout format below this slide ***

13. Framingham Heart Study • huge study, “best” one re mass of data on cholesterol reductions • 0n web site; *** see material below this slide re Framingham

15. Types of Blood Pressure Medications • Diuretics • Beta-blockers • ACE inhibitors • Angiotensin antagonists • Calcium channel blockers (CCBs) • Alpha-blockers • Alpha-beta-blockers • Nervous system inhibitors • Vasodilators • *** see definitions of each below this slide ***

20. Integrative medicine re CHD • “when applied to CV disease, preventative medicine in Western society is a concept most people accept, few people practice, and almost no one pays for” [ text 409 ] • Most of the $200 billion annual US price tag is spent on the treatment of symptomatic disease & end-organ failure

21. Integrative medicine re CHD • Reliance on therapeutic vs preventative strategies fosters a “magic bullet” mentality in N America • No single strategy, medication, or intervention program guarantees avoidance of ‘negative cardiac events’

22. Integrative medicine re CHD • Huge sums of $$$ to conquer a largely behavioural disease thru pharmacology, surgery, catheterization-based interventions & genetic engineering • So, what are the integrative suggestions from your text and elsewhere ???

23. Integrative CV Health • CHD as a complex of genetic, environmental, cultural, and behavioural factors • Text notes that “genetic markers,” that is, risk factors we can’t control, are important (lipid metabolism, diabetes, hypertension), CV health / prevention of CHD is remarkably variable • Non-allopathy here is predominantly diet and lifestyle interventions - * consider these as primary or at least adjunctive treatments for CHD and CV health

24. Text & CV Health • Diet – goes thru studies re epidemiological links, avocados, Mediterranean-style diets (mono-unsat fats), and serial monitoring of types of fat intake & body weight/BMI • Exercise – evidence also strong here • Alcohol – red wine vs beer vs hard liquor – what does evidence say ?

25. Text & CV Health • Dietary Supplements & Herbs ~ digoxin (also called digitalis, both derived from plant foxglove) vs angiotensin inhibitors ~ plant-based diets re antioxidants and antiinflammatories [ purslane ] ~ garlic and teas, hawthorn berries rich in flavinoids (anti-inflam), folic acid, Vitamin E-rich foods

26. Text & CV Health • Note the crystal clear summary pp 410-411 esp tables 18-1, 18-2, and 18-3 * what makes this “alternative” is the element of informed, evidence-based choice * • Also, difference betw choices in acute coronary syndromes vs chronic stable CHD vs at-risk • Emphasis is on delay and avoid

27. Last 3 classes: • Tuesday: chronic fatigue & GI system • Thursday: oncology * start wrap-up • Tuesday 11th, last class, synthesis & yes, chapters 31 & 33 are required re this unit

28. Evidence ~ MC Exams • Multiple multiples NOT when they’re logic, don’t test knowledge • So, no more than 8 on exam, and only if content, not logic-based • # of alternatives evidence – 4 good ones better than 5th bad one so I’m going to do that too