Heart Disease Risk Factors: Prevention and Management 2005

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Heart Disease Risk FactorsPrevention and
Management 2005

• Deepika Gopal, M.D., F.A.C.C.
• Dallas Heart Group
• Medical City

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Cardiovascular Disease Mortality Trends for
Males and Females
United States 1979-2002
Source CDC/NCHS.
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Percentage Breakdown of Deaths From
Cardiovascular Diseases United States2002
Preliminary
Source CDC/NCHS.
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Prevalence of Cardiovascular Diseases in
Americans Age 20 and Older by Age and Sex NHANES
1999-2002
Source CDC/NCHS and NHLBI. These data include
coronary heart disease, congestive heart failure,
stroke and hypertension.
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Recent Statistics

• CVD is the 1 killer of women men
• In USA, 500,000 women die of CVD per year,
  exceeds the number of deaths in men and the next
  7 causes of death in women combined
• 1 death per minute!!
• Disproportionately affects racial and ethnic
  minorities
• Often FATAL, 2/3 of those who die have no prior
  symptoms!!

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Women Everywhere Are at Risk of CVD

• AA women have high rates of high blood pressure,
  cholesterol of 200 mg/dL or higher,
  overweight/obesity and diabetes
• Mexican women have high rates of diabetes,
  cholesterol of 200 mg/dL or higher and
  overweight/obesity

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Women Everywhere Are at Risk of CVD

• Asian/Pacific Islander females have high rates of
  physical inactivity and high cholesterol of 240
  mg/dL and higher
• Native American /Alaska Native females have high
  rates of smoking, high cholesterol or 240 mg/dL
  and higher, and overweight and obesity

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Warning signs of a heart attack!

• Chest discomfort. 
• -lasts more than a few minutes, or that goes
  away and comes back. It can feel like
  uncomfortable pressure, squeezing, fullness or
  pain. 
•   
• Discomfort in other areas of the upper body
• - pain or discomfort in one or both arms, the
  back, neck, jaw or stomach.   
•  

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Warning signs of a heart attack!

• Shortness of breath 
• This feeling often comes along with chest
  discomfort. But it can occur before the chest
  discomfort.   
• Other signs include breaking out in a cold
  sweat, nausea or lightheadedness

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Atypical symptoms in Women

• Nausea
• Indigestion
• Backache
• Dizziness
• Fatigue
• Numbness

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Warning Signs Of Stroke!

• 1. Sudden numbness or weakness of the face, arm
  or leg, especially on one side of the body   
• 2. Sudden confusion, trouble speaking or
  understanding   
• 3. Sudden trouble seeing in one or both
  eyes   

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Warning Signs Of Stroke!

• Sudden trouble walking, dizziness, loss of
  balance or coordination
• Sudden severe headache with no known cause

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Call 911

• Both heart attack and stroke are medical
  emergencies
• Call 911
• Get to the hospital ER immediately!!

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Recognizing Cardiac Arrest

• Cardiac arrest strikes immediately and without
  warning
• Sudden loss of responsiveness. No response to
  gentle shaking
• No normal breathing. The victim does not take a
  normal breath when you check for several seconds.

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Recognizing Cardiac Arrest

• No signs of circulation. No movement or coughing.
  
• If cardiac arrest occurs, call 9-1-1 and begin
  CPR immediately.
• If an automated external defibrillator (AED) is
  available and someone trained to use it is
  nearby, involve them.

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Knowledge is Power!!Know and learn your risk
factors!

• Risk Factors you cannot control
• Age
• Gender
• Race
• Family history
• Previous heart attack

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Knowledge is Power!!Know and learn your risk
factors!

• Risk Factors you can control
• High blood pressure
• Cholesterol and Triglycerides
• Diabetes
• Smoking
• Obesity
• Physical Inactivity

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Metabolic Syndrome

•  Abdominal obesity, defined as a waist
  circumference in men 102 cm (40 in) and in women
  88 cm (35 in)
• Triglycerides 150 mg/dL

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Metabolic Syndrome

• HDL cholesterol
• Blood pressure 130/ 85 mmHg
• Fasting glucose 110 mg/dL

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Blood Pressure- Silent Killer know your numbers

• Category Systolic Diastolic
• Normal
• Pre HTN 120-139 80-89
• HTN 140 90

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Cholesterol numbers to remember

• Category Total Cholesterol
• Desirable lower risk
• Borderline higher risk 200-239
• High more than x2 risk 240

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Cholesterol numbers to rememberYour Goals

• Total cholesterol
• LDL (bad)
• HDL (good) 50
• TGL
• Non HDL chol (TC-HDL)

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Diabetes

• HbA1c level
• Diet
• Exercise
• Weight loss
• Compliance with medications

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Are you at risk for heart disease?

• Have you experienced any of the following
  events, conditions or procedures?
• Stroke      
• Mini strokes (TIA)    
• Heart attack,  Angioplasty or Stent
  procedure      

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Are you at risk for heart disease?

• Coronary artery bypass graft (CABG) surgery      
• Chest Pain      
• Diabetes     

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Are you at risk for heart disease?

• Peripheral arterial disease or surgery for a
  circulation problem in your legs
• Abdominal aortic aneurysm      
• Symptomatic carotid artery disease (buildup of
  plaque in your carotid neck arteries)

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Spectrum of CVD Risk

• High Risk 20 10-y absolute CHD
• Established CHD
• Cerebrovascular disease
• Peripheral arterial disease
• Abdominal aortic aneurysm
• Diabetes Mellitus
• Chronic kidney Disease

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Spectrum of CVD Risk

• Intermediate 10-20 Risk
• Subclinical CHD (Cor Calcification)
• Metabolic syndrome
• Multiple Risk Factors
• Markedly elevated levels of single risk factor
• 1st degree relatives with early onset ASCVD (y in men,

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Spectrum of CVD Risk

• Lower Risk
• 1 or no risk factors
• Optimal Risk
• Optimal levels of risk factors and heart healthy
  lifestyle

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Clinical Recommendations

• Lifestyle Interventions
• Smoking cessation
• Physical Activity
• Heart Healthy Diet
• Weight maintenance/reduction
• Psychosocial factors
• Omega 3 fatty acids

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Smoking- interesting facts!

• Smoking Smoking has been associated with
  one-half of all coronary events
• Furthermore, coronary risk is elevated even in
  women with minimal use (relative risk 2.4 for 1.4
  cigarettes/day)
• Cessation of smoking is associated with a rapid
  reduction in the risk of MI.

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Smoking- interesting facts!

• Most of the increased risk induced by smoking
  dissipates within two to three years of cessation
  of smoking
• The relative risk in those who had not smoked for
  three or more years was indistinguishable from
  that in those who had never smoked

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Smoking and CVD

• Carbon monoxide levels are elevated and decreases
  blood oxygen levels
• Lowers the good cholesterol
• Increases risk of forming blood clot in arteries

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Lifestyle Interventions

• Weight Maintenance/ reduction thru diet and
  exercise
• Maintain or achieve BMI between 18.5 and 24.9
  kg/m2
• Waist circumference inches in men

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Diet tips

• Out of sight out of mouth!
• Eat lean to be lean!
• Cultivate healthy habits in your children

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Diet guidelines

• Calories from saturated fats should be less than
  7 per day
• Cholesterol less than 200 mg/day
• Trans fatty acid intake should be reduced

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FATS

• Saturated fats butter, lard, cream cheese
• Transfats partially hydrogenated veg oils found
  in snacks
• Monounsaturated fats good fats in olive and
  canola oils, peanut oil, avocados
• Polyunsaturated fats acceptable fats as in
  margarine from corn and vegetable oils, and in
  some nuts

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Diet guidelines

• 6 servings whole grains, legumes
• 5 servings Fruits, vegetables
• 3 servings low fat or nonfat dairy products
• 2 servings lean meats or soy protein
• 2 servings per week fatty fish
• Omega 3 fatty acids- fish walnuts

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Physical activity

• Moderate to intense physical activity 30-60
  minutes a day on most days of the week
• 2 of your day!!
• Exercise reduces risk of CVD by 50
• Brisk walking 3 mph on treadmill

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What is BMI??

• Body mass index weight kg/ ht in m2
• 18.5-24.9 healthy low
• 25-29.9 10 over ideal body wt mod
• 30-40 30 lbs overweight high
• 40 extreme obesity

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Obesity and heart disease risk

• Independent of other risk factors !!

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10 ways to go RED take charge

• Make a date and keep it
• Tone up as you tune in
• Water on the go
• Keep out of sight, out of mouth
• Eat lean to be lean
• Shake the salt habit
• Kick butts
• Be a good loser
• Dont let a slip keep you down
• Say Yea for me

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Early diagnosis of heart disease
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Medical City Heart

• Risk assessment
• Cardiovascular conditioning
• Hearts and Soles
• No ifs, ands or butts
• Log on to medicalcityheart.com

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Go Red for Women

• 1-888-MYHEART to receive a brochure on Women and
  heart disease, a wallet card with healthy heart
  tips, and a red dress pin!

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The DASH diet Reduce the overall amount of fat,
saturated fat and cholesterol. Increase the
number of fruits, vegetables and low-fat dairy
foods. Increase fiber intake by including
whole grain products. Reduce the amount of
sodium (e.g., salt) to preferably 2,400
milligrams or 1,500 milligrams per day. Reduce
sweets and sugar-containing beverages. Overall,
the DASH diet is rich in minerals such as
magnesium, potassium and calcium, as well as
protein and fiber, while low in fat, cholesterol
and sodium.