Risk Factors Associated with CAD

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Risk Factors Associated with CAD

• Mary Sullivan
• Nursing 212

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(No Transcript)
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Non-modifiable Risk Factors associated with CAD

• a) Hereditary- family history increases risk of
  AMI and premature atherosclerosis related to
  genetic and environmental factors
• b) age-associated with cholesterol deposits in
  arteries, decreased elasticity of blood
  vessels.and hypertension

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Non-modifiable Risk Factors Associated With CAD

• c) Gender-highest incidence occurs in men age
  40-55 years
• Women are somewhat immune until after
  menopause- CAD is leading cause of death in women
  over 65 years
• d) Race- Since 1968, mortality in non-whites,
  especially blacks with hypertension has increased

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Modifiable Risk Factors Associated With CAD

• a) Smoking
• - If individual smokes 2 packs/day, the
• risk factor is increased 2-4x
• - If individuals stop smoking for one year
• the individuals risk factor is decreased
• 50

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Modifiable Risk Factors Associated With CAD

• Smoking contributes to CAD by
• 1) Inhaling smoke increases the blood
• CO level . Hemoglobin combines
• more readily with CO than oxygen.
• The oxygen supplied to heart is
• severely limited making the heart
• work faster.

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Cigarette Smoking

• 2) Nicotine in tobacco triggers the release of
  catecholamines which cause arterial constriction
  which compromises blood flow and oxygenation.
• 3) Smoking increases platelet aggregation
  leading to an increase chance of thrombus
  formation

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Modifiable Risk Factors Associated With CAD

• b) Hypertension
• Increased pressure results in increased
  myocardial oxygen demands and pain
  (damages arterial lining)
• Treatment consists of
• Medications
• Low sodium, low fat, diet
• Exercise and stop smoking

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Modifiable Risk Factors Associated With AMI

• c) Hyperlipidemia- lipids are ingested or
  manufactured by the body
• normal cholesterol-150-200mg/100 ml blood
• HDL is inversely related to CAD
• high HDLlower chance of CAD
• low HDLhigher chance of CAD

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Hyperlipidemia

• Controlling the serum levels of total
  cholesterol, LDL, and HDLwithin a therapeutic
  range is the goal of dietary management of CAD
• LDL exerts a harmful effect on the arterial
  wall and accelerates atherosclerosis
• HDL transports LDL to the liver where it is
  biodegraded and then excreted

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Hyperlipidemia

• Goal-have low LDL values ,below 150mg/dl
• and high HDL values, above 50 mg/dl.
• and a total cholesterol level below
• 200mg/dl.

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Hyperlipidemia

• Modified by
• - Diet-Low sodium,low fat,low calorie
• Reducing the amount of fat
• consumed daily will reduce fat
• available for metabolism and
• conversion to cholesterol
• - Exercise
• -Medications

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Pharmacological Agents To Treat Hyperlipidemia

• Drugs that increase lipoprotein removal by
  converting cholesterol to bile salts in liver
• examples- Questran (Cholestyramine)
• - Colestipol (Colestid)
• Drugs that restrict lipoprotein production
• example-Niacin (Nicotinic Acid)

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Pharmacological Agents To Treat Hyperlipidemia

• Drugs that decrease synthesis of lipids
• example-Atromid (Clofibrate)
• Drugs that lower VLDLS and Triglycerides and
  increase HDLS
• example-Lopid (Gemfibrozil)
• Drugs that inhibit biosynthesis of cholesterol
• example- Mevacor (Lovastatin),Zocor.
  Lipitor

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Common Side Effects of Anti-hyperlipemic Agents

• Elevated liver enzymes
• Opacities of eye lens
• GI symptoms
• Rash
• Insomnia

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Modifiable Risk Factors

• d) Glucose Intolerance (Diabetes Mellitus)
• -Elevated sugar, high insulin levels
• -Increased platelets-increased thrombus
• formation with smooth muscle damage
• in vessel lining resulting in athero-
• sclerosis
• Treat with weight reduction and diet control

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Modifiable Risk Factors

• e) Obesity-increase weight causes heart to
• work harder
• - individuals are prone to DM,hyper-
• tension, hyperlipidemia and inactivity
• -usually have increased LDLS
• Treatment includes diet and exercise

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Obesity
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Modifiable Risk Factors For CAD

• f) Oral Contraceptives-increase the risk 5 x
• g) Sedentary living-lack of activity is harmful
  to your heart
• heart needs periods of vigorous pumping to
  keep it healthy
• a sensible exercise program decreases risks
  example- walking 3x/week

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Modifiable Risk Factors to Treat CAD

• h) Psychological Stress
• Tension in family life and on the job
  contributes to added strain on heart and vessels
• Unless high risk persons schedule periods
  to unwind and relax, the constant stress and
  tension only adds to chance of AMI

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Type A Personality

• competitive
• aggressive
• ambitious
• perfectionist
• hardworking
• can never say no
• compulsive

• impatient
• always tense
• suppresses anger and hostility
• unduly irritable
• holds feelings in

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Type B Personality

• easy going
• takes upsets in stride
• knows limitations
• takes time to relax
• is not an overachiever
• keeps priorities in perspective

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Health Promotion and Maintenance

• Appropriate management may prevent, modify or
  retard progression of disease
• Has been a decline in US during 1980s to 1990s
  by 26,7 of AMI
• Screen for high risk individuals
• Encourage life style changes-nurse can teach
  health promoting behaviors