Cardiovascular Disease

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Cardiovascular Disease
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Cardiovascular Disease

• The number one cause of death in the United
  States

• Caused the death of over 900,000 Americans
  each year

• Economic cost of over 351 billion dollars

• Since 1960, a gradual decline in morbidity
  and mortality due to cardiovascular disease

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The Leading Causes of DeathFrom Cardiovascular
Disease

• Data from American Heart Association, 2006.

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Factors Contributingto Decline in Deaths

• Improved public awareness (e.g., concept of risk
  factors)
• Increased use of preventive measures, including
  lifestyle changes
• Better and earlier diagnosis
• Improved drugs for specific treatment
• Better emergency and medical care

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Anatomy and Function of the Cardiovascular System
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Cardiovascular Diseases

• Coronary artery disease (CAD)(CHD)heart
• Hypertension
• Stroke
• Heart failure
• Peripheral vascular disease
• Valvular, rheumatic, and congenital heart disease

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Heart Attack

• Coronary thrombosis or myocardial infarction

• Lack of blood flow or supply to areas of the
  heart

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Coronary Artery Disease

• Coronary artery disease (CAD) involves
  atherosclerosis in the coronary arteries
• Atherosclerosis progressive narrowing of the
  arteries due to plaque formation
• Ischemia a deficiency of blood flow to the heart
  caused by CAD
• Angina pectoris chest pain
• Myocardial infarction a heart attack due to
  ischemia leading to irreversible damage and
  necrosis

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Blood Flow Blockage in the Coronary Arteries
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Percentages of the U.S. Population at Increased
Risk for Coronary Artery Disease Based on Primary
Risk Factors

• Reproduced from Caspersen, C.J. Physical
  activity and coronary heart disease. Physicians
  Sportsmedicine 1987 15(11) 43-44.

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Atheresclerosis
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Angina Pectoris

• Chest pain

• Lack of blood flow and oxygen to areas of the
  heart

• Increased risk of heart attack

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Other Types of Cardiovascular Disease

• Congenital heart defectsabnormal heart
  structures, vessels, and valves at time of
  birth

• Rheumatic heart diseasebacterial infection
  of the heart that damages heart valves

• Congestive heart failurecondition that
  occurs when other diseases have damaged the
  heart and limited its function

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Other Types of Cardiovascular Disease

• Bacterial endocarditisinfection of the
  lining or valves of the heart

• Aneurysmsa weakness or bulge in an artery
  that can burst and lead to massive internal
  bleeding(???)

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Major Unalterable Risk Factors for CHD

• Heredityfamily history and race

• Gendermales are at higher risk

• Ageincreased age relates to increased risk

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Hypertension

• About one in every three adult Americans has
  hypertension
• Causes the heart to work harder
• Strains the systemic arteries and arterioles
• Can lead to atherosclerosis, heart attacks, heart
  failure, stroke, and renal failure

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Reducing the Risk of Hypertension Through Exercise

• People who are active and those who are fit have
  reduced risk for developing hypertension
• Resting blood pressure decreases by training in
  people with hypertension(aerobic and endurance ex)

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Controllable Risk Factorsfor Hypertension

• Insulin resistance
• Obesity and overweight
• Diet (sodium, alcohol)
• Use of oral contraceptives
• Use of tobacco products
• Stress
• Physical inactivity

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Pathophysiology of Hypertension

• More than 90 of people with hypertension have
  essential hypertension
• Risk factors
• Heredity, including race
• Increasing age and male sex
• Sodium sensitivity
• Excessive alcohol consumption and use of tobacco
  products
• Obesity and overweight
• Diabetes or insulin resistance
• Physical inactivity
• Oral contraceptives
• Pregnancy
• Stress

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High Blood Cholesterol

• Cholesterol is a fatlike substance found in
  the bodys cells and bloodstream.

• The body produces cholesterol primarily
  through the liver we also consume cholesterol
  through our diet.

• Two types relevant to CHD are high density
  lipoprotein (HDL-C) and low density
  lipoprotein (LDL-C).

• HDL-C decreases the risk of CHD.

• LDL-C increases the risk of CHD.

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Americans with High Cholesterol
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Standards for Cholesterol
Total Cholesterol (TC)
Desirable less than 200mg/dl Borderline high
between 200 and 239mg/dl High 240mg\dl or higher
LDL-C
Optimal less than 100mg/dl Borderline high
between 130 and 159mg/dl High between 160mg/dl
and 189mg/dl
HDL-C
Low less than 40mg/dl
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The Cholesterol Ratio
Cholesterol ration TC HDL - C
Example TC 140, HDL - C 40
Cholesterol Ratio 180 40 4.5
The American Heart Association recommends a
cholesterol ratio of less than 3.5.
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The Cholesterol Ratio and Risk of CHD
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Other Major Risk Factors for CHD

• Smokingdoubles the risk for CHD

• Diabetesinability to control blood levels
  increases the risk of CHD

• Obesityrelated to many health problems and
  greatly increases the risk of CHD

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Physical Inactivity A Major Risk Factor for CHD

• In 1992, the American Heart Association
  classified physical inactivity as a major risk
  factor for CHD.

• Low levels of physical activity and
  cardiorespiratory fitness can double the risk
  of CHD.

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Contributing Risk Factors for CHD

• Excessive and prolonged stress can increase
  the risk of CHD.

• Personality traits of anger and hostility can
  increase the risk of CHD

• Excessive use of alcohol

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Epidemiological Evidence

• Physical inactivity doubles the risk of CAD
• Low-intensity physical activity is sufficient to
  reduce the risk of this disease
• Health benefits do not require high-intensity
  exercise
• More vigorous exercise likely provides even
  greater benefits

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Physical Activity vs. Physical FitnessDoseRespon
se Curve
Reprinted, by permission, from P.T. Williams,
2001, "Physical fitness and activity as separate
heart disease risk factors A metaanalysis,"
Medicine and Science in Sports and Exercise 33
754-761.
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Aerobic Training Adaptations

• Produce larger coronary arteries which increases
  the capacity for blood flow to the heart
• Increased cardiac pumping capacity
• Improved collateral circulation in the heart
• Improved endothelial function
• Reduce blood pressure (7 mmHg) in individuals
  with mild to moderate hypertension
• Improves cholesterol ratio
• Weight reduction
• Improves insulin sensitivity
• Stress management

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Comparison of the Left Main Coronary Artery in
(a) Sedentary and (b) Exercising Monkeys on
Atherogenic Diets
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Stroke Brain Attack

• Cerebral thrombosisblockage of blood flow to
  the brain.

• Cerebral hemorrhagebursting of an aneurysm
  or a blow to the head that cause bleeding into
  the cranium.

The severity of a stroke relates to the amount of
brain tissue affected.
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Risk Factors for Stroke
Unalterable

• HeredityFamily history and race.
  African-Americans have a much higher risk of
  stroke than white Americans do.

• GenderMales have a higher risk than females.

• AgeAs age increases the risk of stroke
  increases.

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Risk Factors for Stroke
Alterable

• HypertensionThe major risk factor for stroke.

• Smoking

• History of transient ischemic attacks
  (ministrokes)

• High red blood cell counts

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Risk Factors for Stroke
Contributing

• High blood cholesterol and triglycerides

• Physical inactivity

• Obesity