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Eliminating Risk Factors for Heart Disease. Healthy Transitions Summer 2014. Corrine Benacka , RN, BSN Bluhm Cardiovascular Institute July 21, 2014. Presented to: Insert relevant presenter information Calibri 16pt Presented on: Month day, Year

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Eliminating risk factors for heart disease

Eliminating Risk Factors for Heart Disease

Healthy Transitions Summer 2014

Corrine Benacka, RN, BSN

Bluhm Cardiovascular Institute

July 21, 2014

Presented to: Insert relevant presenter information Calibri 16pt

Presented on: Month day, Year

Presented by: Insert relevant presenter information here


Eliminating risk factors for heart disease1
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


Eliminating risk factors for heart disease2
Eliminating Risk Factors for Heart Disease

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?



Eliminating risk factors for heart disease4
Eliminating Risk Factors for Heart Disease

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


Eliminating risk factors for heart disease5
Eliminating Risk Factors for Heart Disease

Age

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?

  • 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


Eliminating risk factors for heart disease6
Eliminating Risk Factors for Heart Disease

Primary Prevention

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

  • Aims at preventing the disease

  • Reduces incidence and prevalence of a disease

  • The majority of know CVD risk factors are preventable!


Eliminating risk factors for heart disease7
Eliminating Risk Factors for Heart Disease

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


Eliminating risk factors for heart disease8
Eliminating Risk Factors for Heart Disease

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


Eliminating risk factors for heart disease9
Eliminating Risk Factors for Heart Disease

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 protein

Fruits and vegetables!


Eliminating risk factors for heart disease10
Eliminating Risk Factors for Heart Disease

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


Eliminating risk factors for heart disease11
Eliminating Risk Factors for Heart Disease

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
Impact of Weight Loss on Risk Factors

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 ClinNutr. 2002;56:264-270.


Prevalence of self reported obesity among u s adults brfss 2012
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


Eliminating risk factors for heart disease12
Eliminating Risk Factors for Heart Disease

How does obesity contribute to CVD?


Eliminating risk factors for heart disease13
Eliminating Risk Factors for Heart Disease

STOP SMOKING!

  • Smoking is an independent risk factor

  • Smoking is associated with a higher risk of:

    • Stroke

    • Atherosclerosis

    • Heart Attack

    • Aortic Aneurysm

Smoking


Eliminating risk factors for heart disease14
Eliminating Risk Factors for Heart Disease

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



Eliminating risk factors for heart disease16
Eliminating Risk Factors for Heart Disease

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

  • 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


Eliminating risk factors for heart disease17
Eliminating Risk Factors for Heart Disease

  • 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

Cholesterol


Eliminating risk factors for heart disease18
Eliminating Risk Factors for Heart Disease

Cholesterol

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

Stone NJ, et al

Circulation: Nov. 12 2013


Eliminating risk factors for heart disease19
Eliminating Risk Factors for Heart Disease

Cholesterol

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


Eliminating risk factors for heart disease20

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

Eliminating Risk Factors for Heart Disease

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 Pressure=

Systolic BP

Diastolic BP

www.heart.org


Eliminating risk factors for heart disease21
Eliminating Risk Factors for Heart Disease American Heart Association.

High Blood Pressure

Prevention and Treatment

  • Diet

    • Low Na

    • DASH

  • Don’t Smoke

  • Maintain a healthy weight

  • Exercise

  • Coping with stress

  • Take your medication


Eliminating risk factors for heart disease22
Eliminating Risk Factors for Heart Disease American Heart Association.

Diabetes

  • 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


Eliminating risk factors for heart disease23
Eliminating Risk Factors for Heart Disease American Heart Association.

Diabetes

Prevention

  • Control weight

  • Be active

  • Control blood pressure

  • Control cholesterol

    Treatment

  • 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.


Eliminating risk factors for heart disease24
Eliminating Risk Factors for Heart Disease American Heart Association.

Metabolic Syndrome

Metabolic Syndrome

Cluster of risk factors

that put a person at

greater risk of

cardiovascular disease


Eliminating risk factors for heart disease25
Eliminating Risk Factors for Heart Disease American Heart Association.

Metabolic Syndrome

Who’s at risk?

  • Obesity/overweight

  • Insulin resistant

  • Physically inactive

    Treatment

  • Eat better

  • Get moving

  • Lose weight

  • Medications


Eliminating risk factors for heart disease26
Eliminating Risk Factors for Heart Disease American Heart Association.

Life’s Simple 7

Assess your risk!

  • My life check assessment

www.heart.org


Eliminating risk factors for heart disease27
Eliminating Risk Factors for Heart Disease American Heart Association.

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


Eliminating risk factors for heart disease28
Eliminating Risk Factors for Heart Disease American Heart Association.

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
Thank You American Heart Association.


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