Arteriosclerosis and Coronary Heart Disease (CHD)

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Arteriosclerosis and Coronary Heart Disease (CHD)
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Arteriosclerosis

• Disease of the arteries characterized by
  thickening, loss of elasticity and calcification
  of arterial walls
• Resulting in decreased blood supply particularly
  to the cerebrum and lower extremities
• Often develops with
• aging
• hypertension
• diabetes

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Progression of Arteriosclerosis
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Coronary Heart Disease (CHD)

• Seven million Americans effected
• Caused by narrowing of the coronary arteries
• No. 1 killer of men and women in U.S.
• gt500,000 each year
• gt 60 million Americans have some form of coronary
  vascular disease (CVD) including high BP, CAD,
  CHD, congestive heart failure, myocardial
  infarction and others
• gt2,600 Americans die each day of CVD, i.e., 1
  death/33 sec
• 299 billion cost to the U.S.

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Risk factors

• High blood pressure (hypertension)
• High blood cholesterol
• Smoking
• Obesity
• Physical inactivity
• Diabetes
• Stress (?)

Controllable
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Risk Factors (contd)

• Gender
• Heredity
• Age

Uncontrollable
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Major Risk FactorsThe Big Three

• Hypertension
• High cholesterol
• Cigarette smoking

All three increase risk factor eight times
AND. we should add LACK OF EXERCISE
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Hypertension

• Commonly called high blood pressure
• Systolic and diastolic measurements
• Normal systolic - 110-130 mmHg
• Normal diastolic - 70-90 mm Hg

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Symptoms of CHD

• Chest pain (angina)
• Shortness of breath
• Heaviness, tightness, pain, burning, pressure or
  squeezing
• behind the breastbone or in the arms, neck, or
  jaws
• Pain may vary
• Perhaps no pain

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Cause Consequencess of CHD

• Lack of oxygen due to ischemia (lack of blood
  supply)
• Narrowing of coronary arteries
• Heart responds with angina
• Finally, heart attack (myocardial infarction
• local ischemia usually due to thrombus (clot) or
  embolus (clot that has moved from another site
  and lodged in a smaller vessel)
• Possible permanent damage

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Diagnosis of CHD

• Electrocardiogram (EKG)
• Stress test
• Nuclear scanning
• Coronary angiography

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Treatment for CHD

• Lifestyle changes
• Medication
• Surgery

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Lifestyle Changes

• Change of habits
• Low fat diet
• Lower weight
• Increase exercise
• Stop smoking

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Medications to Treat CHD

• Beta blockers
• Nitroglycerine and other nitrates
• Calcium-channel blockers
• Aspirin
• Cholesterol-lowering drugs
• lovastatin, colestipol, cholestyramine, etc
• Digitalis
• ACE inhibitors
• Diuretics

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Surgery to Treat CHD

• Balloon angioplasty
• Atherectomy
• Laser angioplasty
• Stent insertion
• Coronary artery bypass operation (CABG)

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Gender Disparity

• Coronary Artery Disease (CAD) more common in men
• Women have higher mortality rates
• Older and sicker when first heart attack occurs
• Less aggressively treated than men
• Failure to recognize symptoms in timely fashion
• MI in young, healthy women is rare
• Occurrence greater in those who use OC
• Age 30-39 2.7X 40-44 5.7X (complilcated by
  cigarette use)

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Effects of Smoking

• For adult males, smoking has declined from 53
  to 38
• For women, remains at 30
• Has increased for younger and teenaged women
• Heavy smoker 20- 30 cigs/day

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Effects of Smoking (contd)

• Cigs contain about 2000 compounds
• Main harmful are tar, nicotine and CO
• Tar contains hydrocarbons and other carcinogenic
  substances
• Nicotine causes release of epinephrine and
  norepinephrine resulting in increased HR, BP,
  cardiac output, stroke volume, contractility,
  oxygen consumption, and coronary blood flow
• CO reduces oxygen carrying capacity of the blood
  can precipitate angina

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Effects of Smoking (contd)

• Contributes to development of atherosclerosis
• Lowers levels of HDL
• causes deterioration of elasticity of vessels
• Responsible for 20 of all deaths from heart
  disease
• Female smokers have a higher risk than male
  smokers

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STRESS

• Life Dissatisfaction
• Life Change
• Behavior Pattern

• Sociocultural Mobility
• Socioeconomic Status
• Status Incongruity
• Education Level
• Anxiety and Neuroses

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Signs of Preclinical CVD

• Left ventricular hypertrophy (LVH) associated
  with increased CAD risk (Framingham Study)
• Definite LVH-EKG increased CAD risk threefold

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Blood and Tissue Characteristics

• Type O lower cholesterol
• Higher cholesterol contributes to higher rate of
  CAD
• HDLLDL (high density lipoproteins low density
  lipoproteins) ratio may be more important than
  cholesterol level

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HDL

• High density lipoproteins seem to have protective
  effect against development of atherosclerosis (a
  form or arteriosclerosis in which deposits of
  yellowish plaque containing cholesterol, lipoid
  substances and lipophages are formed within large
  and medium-sized arteries)
• Women have higher concentrations than men
• Most important of all lipid risk factors
• Below 35 mg/dl----- 8X incidence of CAD compared
  to those with 65 mg/dl
• Moderate alcohol intake may have effect
• Exercise has effect
• Greater weight has a negative effect

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DIET

• Reduce saturated fats
• Increase polyunsaturated fats
• Higher protein to fat ratio
• Count calories

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Effects of Exercise
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Additional Information
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