2006 Midwest Worksite Health Promotion Conference

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2006 Midwest Worksite Health Promotion Conference
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Blood Pressure and Cholesterol Current
Guidelines and Resources for the Workplace

• Elizabeth Gardner, MA
• Minnesota Department of Health,
• Heart Disease and Stroke Prevention Unit
• Lynn Hoke, MSN, RN, FNP
• University of Minnesota, Ramussen Center

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Learning Objectives

• At the end of the session, participants will be
  able to
• List three reasons why employers should promote
  cardiovascular wellness in the workplace
• Understand blood pressure and cholesterol
  definitions
• Describe three resources for workplace blood
  pressure or cholesterol initiatives

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• Without worry of money, time or resources,
• answer this question
• If you could coordinate an activity
• or program at your work place to
• help prevent high blood pressure
• or high blood cholesterol,
• what would you do?

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Why Should Employers Care About Blood Pressure
and Cholesterol?

• Significant Public Health Problem
• High blood pressure and cholesterol are two
  significant risk factors for heart disease and
  stroke.
• Heart disease is the second leading cause of
  death in Minnesota.
• Stroke is the leading cause of adult disability
  in Minnesota.

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Why Should Employers care about Blood Pressure
and Cholesterol?

• Astronomical Cost
• Heart disease patients incur over 827 million
  in direct hospital costs in Minnesota every year.
  
• High blood pressure and its complications cost
  the U.S. economy more than 100 billion each
  year.
• Loss of Productivity
• Heart disease is the leading cause of
  permanent disability for working age adults.

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Cardiovascular Disease is Preventable

• Employers and employees can take action prevent
  risk for heart disease and stroke.
• Investing in heart disease
• and stroke prevention benefits
• and services can help save money and lives.

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What is blood pressure?

• Everybody has it and needs it. When your heart
  beats, it pumps blood into your arteries and
  creates pressure in them.
• This pressure causes (blood pressure) your blood
  to flow to all parts of your body.

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How is blood pressure measured?

• Two numbers are recorded when measuring your
  blood pressure such as 120/80.
• The top or larger number (systolic pressure)
  measures the pressure in your arteries when your
  heart beats.
• The bottom or smaller number (diastolic pressure)
  measures the pressure while your heart rests
  between beats. Both number are important for good
  health.

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Blood Pressure Classification
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What Causes High Blood Pressure?

• High blood pressure or hypertension (HTN) isnt
  nervous tension. It is very common to have high
  blood pressure and not know it.
• High blood pressure usually has no symptoms and
  is often called the silent killer
• About 90-95 of the cases of high blood pressure
  have no known cause and is called essential or
  primary hypertension.

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High Blood Pressure Risk Factors

• Obesity body mass index over 30 (about 30 pounds
  over weight)
• Eating too much salt
• Alcohol

• Lack of exercise
• Stress
• Smoking
• Race
• Heredity
• Age

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Identifiable (secondary)Causes of Hypertension

• Sleep apnea
• Drug-induced or related causes
• Chronic kidney disease
• Primary aldosteronism
• Renovascular (kidney) disease
• Chronic steroid therapy and Cushings Syndrome
• Pheochromocytoma
• Coarctation of the aorta
• Thyroid or parathyroid disease

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Cardiovascular Disease Risk

• High blood pressure prevalence
• 50 million people in the United States.
• The blood pressure relationship to risk of CVD is
  continuous, consistent, and independent of other
  risk factors.
• Each increment of 20/10 mmHg doubles the risk of
  CVD across the entire blood pressure range
  starting from 115/75 mmHg.
• Prehypertension signals the need for increased
• education to reduce BP in order to prevent
  hypertension.

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Increased Risk of Organ Damage

• Heart
• - Heart enlargement can lead to heart failure
• Heart attack
• Brain
• - Stroke or transient ischemic attack
• Chronic kidney disease
• Peripheral (leg and arm) artery disease
• Retinopathy (eye)

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Dementia

• Dementia (decreased mental capacity)
• and cognitive (thinking) impairment occur
• more commonly in people with HTN.
• Reduced progression of cognitive
• impairment occurs with effective
• antihypertensive therapy.

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Approaches to Hypertension Management

• Increase physical activity
• Maintain a healthy weight
• Avoid excess sodium intake/DASH diet
• Smoking cessation
• Limit alcohol
• Alcohol raises blood pressure
• One drink 12 oz beer, 5 oz wine, or 1.5 oz
  liquor
• Know your blood pressure and check it often
• Take medications when needed

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What is Cholesterol?

• Cholesterol is a waxy, fat-like substance found
  in the walls of cells in all parts of the body,
  from the nervous system to the liver to the
  heart.
• The body uses cholesterol to make hormones, bile
  acids, vitamin D, and other substances.

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What is Cholesterol?

• The body makes all the cholesterol it needs.
  Cholesterol circulates in the bloodstream but
  cannot travel by itself. As with oil and water,
  cholesterol (which is fatty) and blood (which is
  watery) do not mix.
• Cholesterol travels in packages called
  lipoproteins, which have fat (lipid) inside and
  protein outside.

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Types of Lipids/Cholesterol

• Two main kinds of lipoproteins carry cholesterol
  in the blood
• 1.) Low density lipoprotein, or LDL, also called
  the bad cholesterol.
• Carries cholesterol to tissues--including the
  arteries. Most of the cholesterol in the blood is
  the LDL form.
• The higher the level of LDL cholesterol, the
  greater the risk for heart disease.

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Types of Lipids/Cholesterol(Continued)

• 2.) High density lipoprotein, or HDL, also called
  the good cholesterol.
• Takes cholesterol from tissues to the liver,
  which removes it from the body.
• A low level of HDL cholesterol increases your
  risk for heart disease.
• 3.) Triglycerides, produced in the liver, are
  another type of fat found in the blood and in
  food.

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Cholesterol Targets

• Total Cholesterol
• Less than 200 mg/dL Desirable
• 200239 mg/dL Borderline high
• 240 mg/dL and above High
• LDL Cholesterol
• Less than 100 mg/dL Optimal (ideal)
• 100129 mg/dL Near optimal/above optimal
• 130159 mg/dL Borderline high
• 160189 mg/dL High
• 190 mg/dL and above Very high
• HDL Cholesterol
• Less than 40 mg/dL Major heart disease risk
  factor 60 mg/dL and above gives some protection
  against heart disease

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Triglycerides

• Research indicates that triglyceride levels that
  are borderline high
• (150199 mg/dL) or high (200499 mg/dL) may
  increase your risk for heart disease.
• Levels of 500 mg/dL or more need to be lowered
  with medication to prevent the pancreas from
  becoming inflamed.
• A triglyceride level of 150 mg/dL or higher also
  is one of the risk factors of the metabolic
  syndrome.

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Plaque Formation

• If there is too much cholesterol in the blood,
  excess can become trapped in artery walls. Over
  time, this builds up and is called plaque.
• The plaque can narrow vessels and make them less
  flexible, a condition called atherosclerosis or
  hardening of the arteries.
• This process can happen to blood vessels anywhere
  in the body, including those of the heart, called
  the coronary arteries.

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Plaque Formation(Continued)

• If the coronary arteries become partly blocked by
  plaque, the blood may not be able to bring enough
  oxygen and nutrients to the heart muscle.
• Some cholesterol-rich plaques are unstablethey
  have a thin covering and can burst, releasing
  cholesterol and fat into the bloodstream.
• The release can cause a blood clot to form over
  the plaque, blocking blood flow through the
  arteryand causing a heart attack or stroke.

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The Central Role of the Endothelium
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Red Clot
White Clot
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Risk Factors you cant Change

• Age45 or older for men 55 or older for women.
• Family history of early heart diseasefather or
  brother diagnosed before age 55, or mother or
  sister diagnosed before age 65.

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Risk factors you can change

• Smoking
• High blood pressure
• High blood cholesterol
• Overweight/obesity
• Physical inactivity
• Diabetes

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Looking Ahead

• Every small step counts
• Persistence pays off
• To fight cardiovascular disease, we as a nation
  all need to support each other in our efforts to
  be healthy at work, at home and in our
  communities.

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What Can Employers do to Help Control Blood
Pressure and Cholesterol?

• Some keys to success
• Senior management commitment and buy-in from
  middle managers.
• Effective targeting of high-risk employees.
• Incentives to motivate employees to participate
  in the health promotion programs.
• An identified champion and a committed health
  promotion planning committee.

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State of the Art Worksite Program Ideas Blood
Pressure and Cholesterol

• Incentives to motivate employees to participate
  in programs and comply with prevention and
  treatment measures
• For example
• gift cards
• lower health insurance premiums
• tuition reimbursement
• pedometers
• discounts to gyms
• Web-based tools with individual goal setting

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Work with your Health Plan

• Determine if your health plan supports or
  endorses the use of the following interventions
  that can contribute to successful outcomes
• Utilization of national guidelines
• Strategies to eliminate cardiovascular disease
  disparities.
• Patient satisfaction and compliance (annual
  members surveys)

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State of the Art Worksite Program Ideas Blood
Pressure and Cholesterol (Continued)

• Health risk assessments and medical screenings to
  identify and refer high-risk employees for
  treatment.
• Follow-up one-on-one risk factor education and
  counseling. (helps individuals control their risk
  factors.)

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Lower-cost Policies and Environmental
Interventions to Reinforce Healthy Behaviors

• Implement consistent and frequent heart and
  stroke prevention messages to employees.
• posters
• memos
• newsletters
• e-mail appointments and messages
• pay stubs
• Prevent and Control High Blood Pressure Mission
  Possible

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http//hp2010.nhlbihin.net/mission/
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http//www.cholesterollowdown.org/
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Lower-cost Policies and Environmental
Interventions to Reinforce Healthy
Behaviors(Continued)

• 101 Low Cost Ideas for Worksite Wellness
• New York State, Department of Health
• Allow employees to use work time for health
  promotion activities.
• Vending machines and cafeteria choices offer
  heart-healthy choices.
• Accessible blood pressure monitors.
• Signage to encourage stair use.

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Case Study Highsmith Co. Fort Atkinson, WI

• Catalog-based distributor of school and library
  supplies.
• 225 participating employees in their initiative.
  
• Eligibility
• Employee and their families
• Early retirement program retirees

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Case Study (Continued)

• Program Highlights
• Offered a series of classes on heart-healthy
  living, quick and easy cooking, understanding
  diabetes, etc.
• Monetary incentive approach to health
  insurance. Employees and their spouses must meet
  the following eligibility requirements receive
  physical exams based on age and gender be a
  tobacco non-user participate in annual health
  screening.

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Case Study (Continued)

• Annual health screening
• no cost, on company time
• Height/weight and blood pressure measurement
• Carbon monoxide test for tobacco status
• Lipid panel (total cholesterol HDL, LDL,
  triglycerides)
• Treadmill fitness test

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Case Study (Continued)

• A health risk assessment is also completed.
  Employee meets with health educator to review
  results, set goals and learn about
  resources/services.
• On-site physical activity classes and a walking
  trail.

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Results

• About 83 of employees participated in the
  incentive program in 2004.
• Average age 43 years 80 female
• 2000-2004
• A 20 increase in number of participants whose
  total cholesterol was desirable

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Results (continued)

• A 53 decrease in number of participants whose
  total cholesterol was high risk
• A 52 decrease in number of participants whose
  blood pressure was high.

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Resources

• American Heart Association, Midwest Affiliate
• Go Red for Womenwww.goredforwomen.org
• click on Heart Checkup or Join the Movement
• The Heart Profilers www.americanheart.org
• Free personalized profile of treatment options
  for high blood pressure and hypercholesterolemia

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Resources(Continued)

• Successful Business Strategies to Prevent Heart
  Disease and Stroke Toolkit www.cdc.gov/DHDSP/libra
  ry/toolkit/index.htm
• Minnesota Department of Health
  www.health.state.mn.us/cvh

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Learning Objectives

• At the end of the session, participants
• will be able to
• List three reasons why employers should promote
  cardiovascular wellness in the workplace
• Understand the blood pressure and cholesterol
  definitions
• Describe three resources for workplace blood
  pressure or cholesterol initiatives

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For more information

• Elizabeth Gardner, MA
• Community Health Planner
• Heart Disease and Stroke Prevention Unit
• Minnesota Department of Health
• Elizabeth.gardner_at_health.state.mn.us
• [phone]
• www.health.state.mn.us/cvh
• To schedule risk counseling or CVD screening,
• call the Rasmussen Center for Cardiovascular
• Disease Prevention at [phone].