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SOMNATH KUMAR CONSULTANT CARDIOLOGIST Department of Cardiology LANCASHIRE TEACHING HOSPITALS

HEART DISEASE WHY WE GET THEM AND WHAT TO DO ABOUT THEM. SOMNATH KUMAR CONSULTANT CARDIOLOGIST Department of Cardiology LANCASHIRE TEACHING HOSPITALS UNITED KINGDOM. The Problem…. Cardiovascular disease continues to be the biggest killer in the UK today Almost 200,000 deaths per year

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SOMNATH KUMAR CONSULTANT CARDIOLOGIST Department of Cardiology LANCASHIRE TEACHING HOSPITALS

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  1. HEART DISEASE WHY WE GET THEM AND WHAT TO DO ABOUT THEM SOMNATH KUMAR CONSULTANT CARDIOLOGIST Department of Cardiology LANCASHIRE TEACHING HOSPITALS UNITED KINGDOM

  2. The Problem…. Cardiovascular disease continues to be the biggest killer in the UK today Almost 200,000 deaths per year One in three premature deaths Half of these CHD A quarter stroke Most can be prevented/delayed

  3. Objectives Prevention: Primary versus Secondary Coronary Artery Disease (CHD) Risk Factors Q RISK 2 Risk Assessment Do You Know Your Numbers? AND your Pulse ? Q&A

  4. INTER-HEART:52 Countries - every inhabited continent15,152 cases with14,820 control group • ”Disease” related risk factors • Diabetes • Hypertension • Abdominal obesity • ApoB/ApoA1 • Behaviour related risk factors Alcohol intake Exercise Psychosocial stress Current smoking

  5. INTERHEART Study ”nine potentially modifiable risk factors account for over 90% of the risk of an initial acute myocardial infarction” Population attributable risk fractions Salim Yusuf et al .Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet  2004 364   9437   

  6. Lifetime Risk of Coronary Heart Disease in the Framingham Study Men Women ____________________________________________________________ ______________________________________________________________ At age 40 years:48.6% 31.7% At age 70 years:34.9% 24.2% Lloyd-Jones et al. Lancet 1999; 353:89-92 _________________________________________________________________

  7. Excessivefood intake Physicalinactivity Smoking Stress Obesity Atherosclerosis Atherosclerosis Hypertension Diabetes Dyslipidaemia Arterial & venous thrombosis/ cardiac & cerebral events Arrhythmia Chronic heart failure Life style is a Driver of CVD Life style intervention Risk factor modification

  8. Cardiovascular risk factors Non-modifiable: Modifiable: AgeSmoking Gender Hypertension Family History Obesity Ethnicity Hyperlipidaemia Socio-economic status Salt intake Alcohol intake Diet Diabetes Physical activity Psychosocial factors

  9. Healthy Lifestyle?

  10. Physical activity If maintained BP can be reduced by 3.8 to 2.6 mmHg, systolic and diastolic 30 minutes - on five or more days/wk Reduces the risk of CHD by more than 18%, If no exercise is taken studies show that people are 30% more likely to become hypertensive.

  11. DE-NIAL IS JUST NOT A RIVER IN EGYPT

  12. Abdominal Obesity-KNOW YOUR FIGURES • BMI • Normal < 25 • Obese 25-29.9 • Obese > 30 • Waist circumference • > 40 inches in men • > 35 inches in women • Waist circumference is more sensitive of risk of heart attack than BMI

  13. New Definition of High Blood Pressure • Old – BP a number to keep below 140/90 • New - a disease of the blood vessel where vascular biology is altered • Arteries cannot vasodilate properly and sodium and glucose accumulate in the arterial wall • New Goals 140 systolic / 90 diastolic • Lowers damage to heart brain, eyes, kidneys, pancreas, blood vessels of the legs/feet, sexual function

  14. What is Cholesterol? • Cholesterol is used to form cell membranes • LDL (BAD)  pro-inflammatory • High levels are a predictor of atherosclerosis and heart disease • HDL (GOOD)  anti-inflammatory • Removes excess cholesterol from arteries • Slows the growth of plaques • High levels protect against heart attack • Low levels increase risk http://www.fundaciondiabetes.org/activ/prevenir_obesidad/images/obesidad.jpg

  15. Cholesterol Management Guidelines Increase HDL Exercise Smoking Cessation Weight Reduction Questionable: Alcohol – Red Wine Estrogen • Lower LDL • < 7% saturated fat • 10-25 grams fiber • 2 grams plant stanols • like Take Control • Statins

  16. Definition of Metabolic Syndrome Central obesity (waist circumference ≥ 94cm for European men and ≥ 80cms for European women) and any two of the four factors below: ↑ Trigs ≥ 1.7 mmol/L or treatment for this ↓ HDL < 1.03 mmol/L in men, < 1.29 mmol/L in women or specific treatment for this ↑ BP ≥130/85 or treatment of previously diagnosed hypertension ↑ FPG ≥ 5.6mmol/L or diagnosed T2 diabetes International Diabetes Federation, 2004

  17. Alcohol intake Low to moderate intake is associated with a lower risk of CVD Heavy alcohol is associated with high risk for hypertension and stroke Drinkers of more than 35 units/wk double their risk of mortality Binge drinking strongly associated with a large rise in BP Women drinking more than ever before.

  18. Red Flags • Blood pressure >160/100 mmHg Cholesterol >7.5 mmol/l

  19. GIVE SOUND ADVICE

  20. Smoking Strong association with CVD Smoking as few as 3 per/day doubles risk of MI or death Best quit success with counselling and pharmacological therapy Level of risk falls with abstinence

  21. Health Benefits after Smoking Cessation

  22. Stress Management INTERHEART Study confirmed that psychosocial factors can contribute to sudden cardiac death

  23. Well being

  24. Wellbeing in Lancashire

  25. Q risk-2

  26. Levels of risk <10% risk over the next 10 years - classed as low CVD risk 10-20% risk over the next 10 years - classed as moderately increased CVD risk >20% estimated risk over the next 10 years - classed as high risk.

  27. Putting prevention first National vascular checks programme Commenced 04/09 Comprehensive CV risk assessment to be offered to all aged 40-74 PCT delivery

  28. It’s all atheroma…. Common aetiology Systemic disease Risk factors Common treatment aim Prevention of events

  29. The “Calcium Score” Source: services.epnet.com/getimage.aspx?imageiid=6857 EBCT = electron-beam computed tomography

  30. NHS Health Checks Programme

  31. Individual LevelDemographic factorsBiology; Genetics; Flavour experiences; Learning history Multi-level framework for identifying facilitators and barriers to attaining a healthy life Macro LevelEconomic Policies; Government Policies; Laws; Media; Technology; Industry Relations ; Transport Micro environment LevelLocal Community; School settings; Worksites Fast food outlets; Cafes & restaurants Household Level Food availability; Role models; Culture; Feeding Styles

  32. Action Plan 1. Get a annual check-up, know your numbers and follow-up • Monitor your cholesterol and fasting blood glucose • BP targets vary according to patients • Check thyroid, liver and kidney function, Vitamin D levels, hormones 2. Examine your diet and get a nutrition assessment with a dietitian 3. Exercise Non-Negotiable daily appointment for you 30-60 minutes 5 days a week 4. Develop a management plan to control stress and anxiety and depression... and seek help if no improvement 5. Quit smoking 6. Learn to measure your own pulse – practice brings perfection

  33. Balance your life when possible… …and make time for fun… And help others to achieve well-being

  34. We, the cardiology team at LTH THROUGH IMPROVED PATIENT CARE & COMMUNICATION Between primary and secondary care

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