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Chapter 11

CHAPTER. OUTLINE. Chapter 11. Cardiovascular Diseases. Coronary Heart Disease Risk Profile. Leading Risk Factors for CHD. Other Risk Factors for CHD. Preventing Cardiovascular Disease. Any disease that affects the heart and the blood vessels. Cardiovascular Diseases.

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Chapter 11

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  1. CHAPTER OUTLINE Chapter 11 Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Preventing Cardiovascular Disease

  2. Any disease that affects the heart and the blood vessels Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Cardiovascular Diseases • Examples • Coronary heart disease • Peripheralvascular disease • Congenital heart disease • Rheumatic heart disease • Atherosclerosis, strokes • High blood pressure • Congestive heart failure

  3. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Cardiovascular Diseases • About 20% of the U.S. population has some form of cardiovascular disease • In the year 2002, more than 35% of all deaths in the U.S. were attributable to heart and blood vessel disease • About 1.2 million people in the U.S. have heart attacks each year—500,000 of them die as a result • About 45% of heart attack deaths occur within 1 hour of the onset of symptoms, before the person reaches a hospital

  4. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Cardiovascular Diseases • Although heart and blood vessel disease is still the number one health problem in the U.S., the incidence declined by 32% between 1960 and 2000 • Health education: more people now are aware of the risk factors for cardiovascular disease and are changing their lifestyle to lower their own risk

  5. 11.2 Incidence of Cardiovascular Disease in the United States for Selected Years: 1900–2000

  6. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Critical Thinking • What are your feelings about your own risk for diseases of the cardiovascular system? • Is this something that you need to concern yourself with at this point in your life? Why or why not?

  7. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Coronary Heart Disease (CHD) • The major form of cardiovascular disease • In CHD the arteries that supply the heart with oxygen and nutrients are narrowed by fatty deposits such as cholesterol and triglycerides • Narrowing of the coronary arteries diminishes blood supply to the heart muscle, which can precipitate a heart attack

  8. 11.3 The Heart and Its Blood Vessels

  9. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Coronary Heart Disease • Single leading cause of death in U.S., accounting for 20% of all deaths and half of all cardiovascular deaths • More than half of the people who died suddenly from CHD had no previous symptoms • 80% of deaths from CHD in people under age 65 occur during the first heart attack • The risk of death is greater in the least educated segment of the population

  10. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Coronary Heart Disease • Almost all risk factors are preventable and reversible • The individual can reduce risk by participating in a healthy lifestyle program

  11. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Major CHD Risk Factors • Physical inactivity • Abnormal electrocardiogram • Abnormal cholesterol profile • Elevated triglycerides • Elevated homocysteine • Inflammation • Diabetes

  12. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Major CHD Risk Factors • High blood pressure • Excessive body fat • Smoking • Tension and stress • Personal and family history • Age

  13. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Physical Inactivity • Improving cardiorespiratory endurance through increased physical activity reduces the overall risk for heart disease

  14. Daily physical activity and a regular aerobic exercise program help control most heart disease risk factors Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Regular Physical Activity • Increases cardiorespiratory endurance • Decreases and controls blood pressure • Reduces body fat • Lowers blood lipids(cholesterol and triglycerides) • Improves HDL cholesterol • Helps control diabetes

  15. Daily physical activity and a regular aerobic exercise program help control most heart disease risk factors Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Regular Physical Activity • Decreases low-grade inflammation • Increases and maintains good heart function, sometimes improving certain ECG abnormalities • Motivates toward smoking cessation • Alleviates tension and stress • Counteracts a personal history of heart disease

  16. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Physical Activity and Exercise “ Based on the overwhelming amount of scientific data in this area, evidence of the benefits of aerobic exercise in reducing heart disease is far too impressive to be ignored.”

  17. 11.4 Normal Electrocardiogram • The electrocardiogram or ECG provides a record of the electrical impulses that stimulate the heart to contract

  18. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Stress Electrocardiogram • Also known as a graded exercise stress test or a maximal exercise tolerance test • A stress ECG reveals the tolerance of the heart to increased physical activity

  19. Men over age 45 and women over age 55 A total cholesterol level above 200 mg/dl or an HDL cholesterol below 35 mg/dl Hypertensive and diabetic patients Cigarette smokers People with an abnormalresting ECG Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Stress ECG Guidelines Individuals with a family history of CHD, syncope, or sudden death before age 60 All individuals with symptoms of chest discomfort, dysrhythmias (abnormal heartbeat), syncope, or chronotropic incompetence (heart rate that increases slowly during exercise and never reaches maximum)

  20. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Abnormal Cholesterol Profile • Blood lipids are carried in the bloodstream by molecules of protein known as • High density lipoproteins (HDLs) • Low density lipoproteins (LDLs) • Very low density lipoproteins (VLDLs) • Chylomicrons

  21. 11.7 The Atherosclerotic Process

  22. 11.2 Cholesterol Guidelines

  23. Heart Disease

  24. High-density lipoproteins (HDLs): Cholesterol transporting molecules in the blood (“good” cholesterol) that help clear cholesterol from the blood Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Key Term

  25. Low-density lipoproteins (LDLs): Cholesterol transporting molecules in the blood (“bad” cholesterol) that tend to increase blood cholesterol Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Key Term

  26. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD HDL-Cholesterol • HDL-cholesterol acts as a "scavenger," removing cholesterol from the body and preventing plaque from forming in the arteries • The strength of HDL is in the protein molecules found in their coatings • When HDL comes in contact with cholesterol-filled cells, these protein molecules attach to the cells and take their cholesterol

  27. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD HDL-Cholesterol • For the most part, HDL-cholesterol is determined genetically • Generally, women have higher levels than men • The female hormone estrogen tends to raise HDL, so premenopausal women have a much lower incidence of heart disease

  28. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Ways to Increase HDL-Cholesterol • Habitual aerobic exercise(> 6 METs, 3 times/week for 20 min/session) • Weight loss (if necessary) • Niacin supplementation • Quitting smoking • Increasing consumption of beta carotene • Drug therapy

  29. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD LDL-Cholesterol • Tends to release cholesterol, which then may penetrate the lining of the arteries and speed up the process of atherosclerosis

  30. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Ways to LowerLDL-Cholesterol • Loss of body fat (if necessary) • Dietary changes • Drug therapy • Participation in a regular aerobic exercise program

  31. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD LDL-Cholesterol • It is better to lower LDL-cholesterol without medication, as drugs can cause muscle and joint pain and alter liver enzyme levels • People with heart disease must often take cholesterol-lowering medication, but it is best if medication is combined with lifestyle changes to augment the cholesterol-lowering effect

  32. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Ways to LowerLDL-Cholesterol • Choose a diet low in fat, saturated fat, and cholesterol • Saturated fat should be replaced with monounsaturated and polyunsaturated fats because the latter tend to decrease LDL-cholesterol

  33. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Ways to LowerLDL-Cholesterol • Total daily fiber intake should be 25 to 38 grams per day, including a minimum of 10 grams of soluble fiber • Total fat consumption must be less than 30% of total daily caloric intake • Saturated fat consumption should be under 7% of the total daily caloric intake • Average cholesterol consumption should be much lower than 200 mg per day

  34. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Diet & Cholesterol • A drawback of very low fat diets (less than 25% fat) is that they tend to lower HDL-cholesterol and increase triglycerides • If HDL-cholesterol is already low, monounsaturated and polyunsaturated fats should be added to the diet

  35. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Ways to LowerLDL-Cholesterol • Consume 25 grams of soy protein a day • Consume red meats fewer than three times per week, and no organ meats (liver, kidneys) • Eat fish instead of red meat • Do not eat commercially baked foods • Avoid foods that contain transfatty acids, hydrogenated fat, or partially hydrogenated vegetable oil • Drink low fat milk (1% or less) and choose low fat dairy products

  36. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Ways to LowerLDL-Cholesterol • Limit egg consumption to less than 3 eggs per week • Bake, broil, grill, poach, or steam food instead of frying • Refrigerate cooked meat before adding to other dishes; remove fat hardened in the refrigerator before mixing meat with other foods • Avoid fatty sauces made with butter, cream, or cheese

  37. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Cholesterol-Lowering Medications • There are now very effective medications to treat elevated cholesterol and triglycerides • Most notable are the statins group, which can lower cholesterol by up to 60% in 2 to 3 months • Statins • Slow down cholesterol production and increase the liver's ability to remove blood cholesterol • Decrease triglycerides and produce a small increase in HDL levels

  38. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Triglycerides • Also known as free fatty acids • In combination with cholesterol, triglycerides speed up the formation of plaque in arteries • Triglycerides are carried in the bloodstream primarily by very low density lipoproteins (VLDLs) and chylomicrons

  39. 11.4 Triglycerides Guidelines

  40. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Triglycerides • Found in • Poultry skin • Lunch meats • Shellfish • Manufactured mainly in the liver, from refined sugars, starches, and alcohol

  41. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Ways to Lower Triglycerides • Cut down on high-triglyceride foods • Decrease overall fat consumption • Quit smoking • Reduce weight (if necessary) • Participate in aerobic exercise

  42. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Critical Thinking • Are you aware of your blood lipid profile? • If not, what keeps you from having a blood chemistry test done? • What are the benefits of having it done now as opposed to later in life?

  43. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Homocysteine • Clinical data indicates that many heart attack and stroke victims have normal cholesterol levels • A high concentration of the amino acid homocysteine in the blood is thought to enhance plaque formation and subsequent blockage of arteries

  44. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Homocysteine • Homocysteine is an intermediate amino acid in the interconversion of two other amino acids: methionine and cysteine • This interconversion requires the B vitamin folate (folic acid) and vitamins B6 and B12

  45. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Homocysteine • A large number of people have high blood levels of homocysteine due to a • Genetic inability to metabolize homocysteine • Deficiency in the vitamins required for its conversion

  46. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Homocysteine • Five servings of fruits and vegetables daily can provide sufficient levels of folate and vitamin B6 to remove and clear homocysteine from blood

  47. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Homocysteine • Vitamin B12 is found primarily in animal flesh and animal products • Vitamin B12 deficiency is rarely a problem(1 cup of milk or an egg provides the daily requirement) • The body recycles most of this vitamin, thus, a deficiency takes years to develop

  48. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD Inflammation • Scientists are looking at inflammation as a major risk factor for heart attacks • Low-grade inflammation can occur in a variety of places throughout the body • For years it has been known that • Inflammation plays a role in CHD • Inflammation hidden deep in the body is a common trigger of heart attacks, even when cholesterol levels are normal or low and arterial plaque is minimal

  49. Cardiovascular Diseases Coronary Heart Disease Risk Profile Leading Risk Factors for CHD Other Risk Factors for CHD C-reactive protein (CRP) • A protein whose blood levels increasewith inflammation • Physicians have turned to CRP to evaluate ongoing inflammation in the body • People with elevated CRP are more prone to cardiovascular events • The risk of a heart attack is even higher in people with both elevated CRP and cholesterol, resulting in an almost 9-fold increase in risk

  50. 11.6 Relationship between C-Reactive Protein and Cholesterol and Risk of Cardiovascular Disease 11.8 High-Sensitivity CRP Guidelines

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