Cardiovascular Cardiovascular HealthHealth

Chapter 11Chapter 11

Test Your KnowledgeTest Your Knowledge

1.1. Women are about as likely to die of cardiovascular Women are about as likely to die of cardiovascular disease as they are to die of breast cancer?disease as they are to die of breast cancer? True or True or FalseFalse

2.2. How much earlier, on average, do sedentary people How much earlier, on average, do sedentary people develop heart disease compared with people who develop heart disease compared with people who exercise?exercise?6 months, 2 years, 6 years6 months, 2 years, 6 years

3.3. Which of the following foods would be a good choice Which of the following foods would be a good choice for promoting heart health?for promoting heart health?

1.1. TofuTofu2.2. SalmonSalmon3.3. BananasBananas

AnswersAnswers1.1. False. CVD kills far more. Among American False. CVD kills far more. Among American

women, about 1 in 2 deaths is due to CVD women, about 1 in 2 deaths is due to CVD and about 1 in 30 is due to breast cancer. and about 1 in 30 is due to breast cancer.

2.2. 6 years. Both endurance exercise and 6 years. Both endurance exercise and strength training significantly improve strength training significantly improve cardiovascular health.cardiovascular health.

3.3. ALL THREE! Soy protein (tofu), foods with ALL THREE! Soy protein (tofu), foods with omega-3 fatty acids (salmon) and foods high omega-3 fatty acids (salmon) and foods high in potassium and low in sodium (bananas) all in potassium and low in sodium (bananas) all improve cardiovascular health.improve cardiovascular health.

Cardiovascular HealthCardiovascular Health Cardiovascular disease (CVD) is a disease of the Cardiovascular disease (CVD) is a disease of the heart and blood heart and blood

vessels.vessels. CVD is the leading cause of death in the U.S.CVD is the leading cause of death in the U.S. CVD claims one life every 37 seconds, about 2400 Americans CVD claims one life every 37 seconds, about 2400 Americans

each day.each day. CVD is largely a result of our way of life.CVD is largely a result of our way of life. CVD is the results from high-fat diets, an overweight, sedentary CVD is the results from high-fat diets, an overweight, sedentary

lifestyle, smoking, poor stress management, HTN, lifestyle, smoking, poor stress management, HTN, hypercholesteremia and lack of knowledge of the signs and hypercholesteremia and lack of knowledge of the signs and symptoms of CVD or denial of symptoms.symptoms of CVD or denial of symptoms.

More than one out of every 5 Americans suffers from some form More than one out of every 5 Americans suffers from some form of CVD.of CVD.

Most body functions and body tissues rely on the cardiovascular Most body functions and body tissues rely on the cardiovascular system – heart, blood, and blood vessels.system – heart, blood, and blood vessels.

Cardiovascular DiseaseCardiovascular Disease

Risk FactorsRisk Factors Risk Factors are genetic tendencies or learned behaviors Risk Factors are genetic tendencies or learned behaviors

that increase the chances of disease. The more risk that increase the chances of disease. The more risk factors a person has, the greater the likelihood of factors a person has, the greater the likelihood of developing the disease.developing the disease.

MAJOR RISK FACTORS THAT CAN’T BE CHANGEDMAJOR RISK FACTORS THAT CAN’T BE CHANGED Heredity Heredity – Children of parents with CVD are more likely to develop – Children of parents with CVD are more likely to develop

it themselves. It is not your destiny, but you may have to work it themselves. It is not your destiny, but you may have to work harder to prevent it.harder to prevent it.

Being MaleBeing Male –CVD is the leading killer of both men and women in –CVD is the leading killer of both men and women in the U.S. but men face a greater risk of heart attack than women, the U.S. but men face a greater risk of heart attack than women, especially earlier in life. Estrogen production may offer especially earlier in life. Estrogen production may offer premenopausal women some protection against CVD.premenopausal women some protection against CVD.

AgeAge – The risk of heart attack increases significantly after age 65. – The risk of heart attack increases significantly after age 65. Over 70% of all heart attack victims are over age 65.Over 70% of all heart attack victims are over age 65.

Race/Ethnicity Race/Ethnicity – Death rates from heart disease vary among the – Death rates from heart disease vary among the ethnic groups. African Americans have a much higher rate of HTN, ethnic groups. African Americans have a much higher rate of HTN, heart disease and stroke than other groups. Asian Americans heart disease and stroke than other groups. Asian Americans historically have had lower rates of CVD than white Americans. historically have had lower rates of CVD than white Americans.

Risk FactorsRisk Factors Major Risk Factors That Major Risk Factors That CanCan Be Changed Be Changed

Cigarette/Tobacco UseCigarette/Tobacco Use – About 1 in 5 deaths from CVD – About 1 in 5 deaths from CVD can be contributed to smoking. 1 ppd = 2 times the risk of can be contributed to smoking. 1 ppd = 2 times the risk of CAD. 2 or more ppd = 3x the risk.CAD. 2 or more ppd = 3x the risk. Women who smoke and use contraceptives have 39 times more Women who smoke and use contraceptives have 39 times more

risk of heart attack and 22 times more likely to have a stroke than risk of heart attack and 22 times more likely to have a stroke than women who do not smoke and take contraceptives.women who do not smoke and take contraceptives.

When smokers have heart attacks they are 2-4 times more likely When smokers have heart attacks they are 2-4 times more likely than nonsmokers to die from them.than nonsmokers to die from them.

Smoking damages the linings of the arteries, decreases HDL’s, Smoking damages the linings of the arteries, decreases HDL’s, raises LDL’s and triglycerides, increases HR and BP and causes raises LDL’s and triglycerides, increases HR and BP and causes platelets to be stickier.platelets to be stickier.

Carbon monoxide in smoke displaces oxygen in the blood, Carbon monoxide in smoke displaces oxygen in the blood, reducing the amount of oxygen available to the heart.reducing the amount of oxygen available to the heart.

Risk Factors That Risk Factors That CanCan Be Changed Be ChangedBlood PressureBlood Pressure – It is the force exerted against the – It is the force exerted against the

walls of the arteries. High blood pressure walls of the arteries. High blood pressure (hypertension) = sustained abnormally high blood (hypertension) = sustained abnormally high blood pressurepressure Systole = pressure when heart contractsSystole = pressure when heart contracts Diastole = pressure when heart relaxesDiastole = pressure when heart relaxes

High blood pressure strains the heart, damages the High blood pressure strains the heart, damages the arteries, and increases risk of heart attack, stroke, arteries, and increases risk of heart attack, stroke, kidney failure, and blindnesskidney failure, and blindness

Reduce with regular exercise, healthy diet (reduced Reduce with regular exercise, healthy diet (reduced salt, increased potassium and fiber), and moderation salt, increased potassium and fiber), and moderation of alcohol intakeof alcohol intake

Blood Pressure ClassificationBlood Pressure Classification

CategoryCategory

Systolic Systolic

(mm Hg)(mm Hg)

Diastolic Diastolic

(mm Hg)(mm Hg)

NormalNormal Below 120Below 120 andand Below 80Below 80

PrehypertensionPrehypertension 120–139120–139 oror 80–8980–89

HypertensionHypertension

Stage 1Stage 1

Stage 2Stage 2

140–159140–159

160 and above160 and above

oror

oror

90-9990-99

100 and above100 and above

Risk Factors That Risk Factors That CanCan Be Changed Be ChangedCholesterol Cholesterol – Refers to the fatty substance that circulates the blood – Refers to the fatty substance that circulates the blood

stream and is an important component for cell membranes, sex stream and is an important component for cell membranes, sex hormones, nerves. Excess cholesterol can clog arteries and hormones, nerves. Excess cholesterol can clog arteries and ↑ risk for ↑ risk for CVD.CVD.~ Any body who has a liver produces cholesterol! Also obtained ~ Any body who has a liver produces cholesterol! Also obtained through the foods we eat.through the foods we eat.~Cholesterol is carried in protein-lipid packages called lipoproteins, ~Cholesterol is carried in protein-lipid packages called lipoproteins, the shuttles that carry cholesterol to and from the liver through the the shuttles that carry cholesterol to and from the liver through the circulatory system.circulatory system.

Low-density lipoprotein (LDL) = unhealthy (“bad”) cholesterol; excess Low-density lipoprotein (LDL) = unhealthy (“bad”) cholesterol; excess amounts are deposited in artery wallsamounts are deposited in artery walls

High-density lipoprotein (HDL) = healthy (“good”) cholesterol; shuttle High-density lipoprotein (HDL) = healthy (“good”) cholesterol; shuttle unused cholesterol back to the liver for recyclingunused cholesterol back to the liver for recycling

Levels can be improved by quitting smoking, exercising, and improving Levels can be improved by quitting smoking, exercising, and improving diet (less saturated and trans fat, more fruits, vegetables, fiber, and whole diet (less saturated and trans fat, more fruits, vegetables, fiber, and whole grains)grains)

Cholesterol Testing should begin at the age of 20!Cholesterol Testing should begin at the age of 20!

Cholesterol GuidelinesCholesterol GuidelinesLDL cholesterol (mg/dl)LDL cholesterol (mg/dl)

Less than 100Less than 100 OptimalOptimal

100–129100–129 Near optimal/above optimalNear optimal/above optimal

130–159130–159 Borderline highBorderline high

160-189160-189 HighHigh

190 or more190 or more Very highVery high

Total cholesterol (mg/dl)Total cholesterol (mg/dl)

Less than 200Less than 200 DesirableDesirable

200–239200–239 Borderline highBorderline high

240 or more240 or more HighHigh

HDL cholesterol (mg/dl)HDL cholesterol (mg/dl)

Less than 40Less than 40 Low (undesirable)Low (undesirable)

60 or more60 or more High (desirable)High (desirable)

Figure 11.1 Travels with CholesterolFigure 11.1 Travels with Cholesterol

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Risk Factors That Risk Factors That CanCan Be Changed Be Changed

~~Physical InactivityPhysical Inactivity – Is a major modifiable risk factor – Is a major modifiable risk factor for CHD. Exercise is the closest “magic bullet” against for CHD. Exercise is the closest “magic bullet” against heart disease. heart disease.

25% of the population do not perform any physical activity25% of the population do not perform any physical activity 60% of the population do not get the recommended amount of 60% of the population do not get the recommended amount of

exerciseexercise As little as 3 hours/week of walking reduces the riskAs little as 3 hours/week of walking reduces the risk

~ ~ ObesityObesity – In 1998, obesity was declared a major risk factor – In 1998, obesity was declared a major risk factor for heart disease. Greater than 30% are above the for heart disease. Greater than 30% are above the recommended weight.recommended weight.

+ + Obesity is also a risk factor for HTN, Diabetes and high Obesity is also a risk factor for HTN, Diabetes and high cholesterol. Fat distribution is also an important factor (apple). cholesterol. Fat distribution is also an important factor (apple).

Risk Factors That Risk Factors That CanCan Be Changed Be Changed

Diabetes Diabetes – A metabolic disorder where the body is – A metabolic disorder where the body is unable to regulate the level of glucose (sugar) in the unable to regulate the level of glucose (sugar) in the blood. Elevated blood sugar levels damage the lining blood. Elevated blood sugar levels damage the lining of the arteries, making them more vulnerable to of the arteries, making them more vulnerable to atherosclerosis.atherosclerosis. Type II diabetes can be prevented or delayed by eating a Type II diabetes can be prevented or delayed by eating a

healthy diet, exercise and maintaining a healthy body weight.healthy diet, exercise and maintaining a healthy body weight. Exercise helps to lower the risk of diabetes as it helps to Exercise helps to lower the risk of diabetes as it helps to

control weight and enhances the cellular sensitivity to insulin. control weight and enhances the cellular sensitivity to insulin.

Contributing Risk FactorsContributing Risk Factors

TriglyceridesTriglycerides – – Greater Greater than 190 mg/dl tends to than 190 mg/dl tends to increase blood thickness increase blood thickness resulting in sluggish blood resulting in sluggish blood flow which makes it more flow which makes it more difficult in delivering difficult in delivering oxygen and nutrients to oxygen and nutrients to the heartthe heart..

Triglycerides Triglycerides (mg/dl)(mg/dl)

Less than Less than 150150

NormalNormal

150–199150–199 Borderline Borderline highhigh

200–499200–499 HighHigh

500 or more500 or more Very highVery high

Possible Risk Factors Under StudyPossible Risk Factors Under Study Metabolic syndrome, also known as syndrome X or insulin Metabolic syndrome, also known as syndrome X or insulin

resistance syndromeresistance syndrome Abdominal obesity (waist circumference)Abdominal obesity (waist circumference)

Greater than 40 inches in menGreater than 40 inches in men Greater than 35 inches in womenGreater than 35 inches in women

High blood pressure (130/85 or higher)High blood pressure (130/85 or higher) High triglycerides (150 mg/dl or higher)High triglycerides (150 mg/dl or higher) Low HDL cholesterol Low HDL cholesterol

Below 40 mg/dl in menBelow 40 mg/dl in men Below 50 mg/dl in womenBelow 50 mg/dl in women

Insulin resistance (glucose of 110 mg/dl or higher)Insulin resistance (glucose of 110 mg/dl or higher) HomocysteineHomocysteine – – It is an amino acid that is derived from food. It It is an amino acid that is derived from food. It

functions to manufacture protein to build and maintain body tissues. It functions to manufacture protein to build and maintain body tissues. It is carried in the blood and normally broken down. But when this does is carried in the blood and normally broken down. But when this does not occur, levels rise and it is a risk for CVD. It damages the lining of not occur, levels rise and it is a risk for CVD. It damages the lining of the arteries. Levels can be controlled with diet. B vitamins, folate, the arteries. Levels can be controlled with diet. B vitamins, folate, especially important to break down homocysteineespecially important to break down homocysteine

Women and CVDWomen and CVD Women underestimate their CVD riskWomen underestimate their CVD risk

Nearly 1 in 2 women dies from CVDNearly 1 in 2 women dies from CVD About 1 in 30 women dies from breast cancerAbout 1 in 30 women dies from breast cancer

Women are protected from CVD at younger ages Women are protected from CVD at younger ages by natural estrogenby natural estrogen

After menopause, women are more likely than After menopause, women are more likely than men to die after a heart attackmen to die after a heart attack

Women are more likely to have a heart attack Women are more likely to have a heart attack without chest painwithout chest pain

African Americans and African Americans and CVDCVD

Blacks have higher rates of hypertension Blacks have higher rates of hypertension and strokeand stroke

Genetic, biological, and lifestyle factors Genetic, biological, and lifestyle factors may play a rolemay play a role

Lifestyle changes can reduce risk, as can Lifestyle changes can reduce risk, as can medical treatmentmedical treatment

Types of Cardiovascular DiseasesTypes of Cardiovascular Diseases

Atherosclerosis: Atherosclerosis: Arteries are narrowed by deposits of fat, Arteries are narrowed by deposits of fat,

cholesterol, and other substances called cholesterol, and other substances called plaquesplaques

Once narrowed by a plaque, an artery is Once narrowed by a plaque, an artery is vulnerable to blockage by blood clotsvulnerable to blockage by blood clots

Blockage in the coronary arteries (coronary Blockage in the coronary arteries (coronary heart disease) can lead to a heart attackheart disease) can lead to a heart attack

Blockage in the brain can cause a strokeBlockage in the brain can cause a stroke

AtherosclerosisAtherosclerosis

Heart Disease and Heart AttacksHeart Disease and Heart Attacks Heart attack (myocardial infarction)Heart attack (myocardial infarction) = = Damage to, Damage to,

or death of, heart muscle, sometimes resulting or death of, heart muscle, sometimes resulting in a failure of the heart to deliver enough blood in a failure of the heart to deliver enough blood to the body; myocardial infarction.to the body; myocardial infarction.

Angina pectoris (chest pain)Angina pectoris (chest pain) = = A condition in A condition in which the heart muscle does not receive enough which the heart muscle does not receive enough blood, causing severe pain in the chest and blood, causing severe pain in the chest and often in the left arm and shoulder.often in the left arm and shoulder.

ArrhythmiaArrhythmia = = An irregularity in the force or An irregularity in the force or rhythm of the heartbeat.rhythm of the heartbeat.

Sudden cardiac deathSudden cardiac death = = A nontraumatic, A nontraumatic, unexpected death from sudden cardiac arrest, unexpected death from sudden cardiac arrest, most often due to arrhythmia (in association most often due to arrhythmia (in association with underlying heart disease). with underlying heart disease).

Heart DiseaseHeart Disease

Peripheral Vascular DiseasePeripheral Vascular Disease – – Disease of the Disease of the peripheral vessels. The lack of proper peripheral vessels. The lack of proper circulation (caused by blockages in arteries circulation (caused by blockages in arteries that feed the legs) may cause fluids to pool in that feed the legs) may cause fluids to pool in the extremities. Symptoms include leg pain, the extremities. Symptoms include leg pain, cramping, numbness, tingling, coldness and cramping, numbness, tingling, coldness and loss of hair to the affected limbs. The disease loss of hair to the affected limbs. The disease process may be extensive before the person is process may be extensive before the person is symptomatic, as the heart and brain are more symptomatic, as the heart and brain are more sensitive to a decreased blood flow as sensitive to a decreased blood flow as compared to the extremities.compared to the extremities.

Heart AttackHeart AttackSymptoms of heart attack require immediate action.

Signs and Symptoms of a Signs and Symptoms of a Heart AttackHeart Attack

~~Uncomfortable Uncomfortable pressure, fullness, pressure, fullness, squeezing, or pain in squeezing, or pain in the center of the chest the center of the chest that lasts longer than 2 that lasts longer than 2 minutes.minutes.~Pain that spreads to ~Pain that spreads to the shoulders, arms, the shoulders, arms, back , stomach or neck.back , stomach or neck.~Severe pain, ~Severe pain, dizziness, fainting, dizziness, fainting, sweating, nausea, or sweating, nausea, or shortness of breath can shortness of breath can occur.occur.

Blood Supply to the HeartBlood Supply to the Heart

Diagnosis and Treatment Diagnosis and Treatment for Heart Diseasefor Heart Disease DiagnosisDiagnosis

Exercise stress testExercise stress test MRI, echocardiogram, angiogramMRI, echocardiogram, angiogram

TreatmentTreatment Lifestyle changes (diet and exercise)Lifestyle changes (diet and exercise) Low-dose aspirin therapyLow-dose aspirin therapy Prescription medicationsPrescription medications Balloon angioplastyBalloon angioplasty Coronary bypass surgeryCoronary bypass surgery

Treatment of Heart DiseaseTreatment of Heart Disease

Surgery is one possible treatment for heart disease.

Stroke (Brain Attack)Stroke (Brain Attack) Stroke = An impeded blood supply to some part Stroke = An impeded blood supply to some part

of the brain resulting in the destruction of brain of the brain resulting in the destruction of brain cellscells Ischemic stroke = caused by blood clot that Ischemic stroke = caused by blood clot that

blocks as arteryblocks as artery Hemorrhagic stroke = caused by ruptured Hemorrhagic stroke = caused by ruptured

blood vesselblood vessel Strokes may cause paralysis, walking disability, Strokes may cause paralysis, walking disability,

speech impairment, or memory lossspeech impairment, or memory loss Treatment may include clot-dissolving and Treatment may include clot-dissolving and

antihypertensive drugsantihypertensive drugs

Stroke Warning SignsStroke Warning Signs Sudden numbness or weakness of the face, Sudden numbness or weakness of the face,

arm, or leg, especially one side of the bodyarm, or leg, especially one side of the body Sudden confusion, trouble speaking or Sudden confusion, trouble speaking or

understandingunderstanding Sudden trouble walking, dizziness, or loss of Sudden trouble walking, dizziness, or loss of

balance or coordinationbalance or coordination Sudden severe headache with no known Sudden severe headache with no known

causecause

IF YOU OR SOMEONE WITH YOU HAS ONE IF YOU OR SOMEONE WITH YOU HAS ONE OR MORE OF THESE SIGNS – CALL 911OR MORE OF THESE SIGNS – CALL 911

Congestive Heart FailureCongestive Heart Failure Congestive heart failure = condition Congestive heart failure = condition

resulting from the heart’s inability to pump resulting from the heart’s inability to pump out all the blood that returns to itout all the blood that returns to it

Blood backs up in the veins leading to the Blood backs up in the veins leading to the heart, causing an accumulation of fluid in heart, causing an accumulation of fluid in various parts of the bodyvarious parts of the body

Caused by high blood pressure, heart Caused by high blood pressure, heart attack, atherosclerosis, birth defects, attack, atherosclerosis, birth defects, rheumatic feverrheumatic fever

Ways to Reduce Your Heart Attack Ways to Reduce Your Heart Attack RiskRisk

Quit SmokingQuit Smoking Know and manage your blood cholesterol levelKnow and manage your blood cholesterol level Maintain a healthy body weightMaintain a healthy body weight Exercise regularlyExercise regularly Healthy Eating PlanHealthy Eating Plan Mild-to-moderate alcohol consumptionMild-to-moderate alcohol consumption Know and manage your blood pressureKnow and manage your blood pressure Handle stress and anger effectivelyHandle stress and anger effectively

OSTEOPOROSISOSTEOPOROSIS It is a disease characterized by low bone density, structural It is a disease characterized by low bone density, structural

deterioration of bone tissue which increases the risk of fractures deterioration of bone tissue which increases the risk of fractures and bone fragility.and bone fragility.

Sometimes called the “silent disease”, as often there are no Sometimes called the “silent disease”, as often there are no symptoms as the bone density symptoms as the bone density ↓.↓.

Childhood and teen years is when new bone develops more Childhood and teen years is when new bone develops more quickly than old bone is reabsorbed. quickly than old bone is reabsorbed.

Peak bone mass at about age 30. After age 30, bone loss Peak bone mass at about age 30. After age 30, bone loss exceeds bone formation.exceeds bone formation.

Seems to affect mostly women – 80% are post menopausal.Seems to affect mostly women – 80% are post menopausal. History of excessive alcohol use or smoking ↑ risk.History of excessive alcohol use or smoking ↑ risk. Regular physical activity reduces the risk, especially Regular physical activity reduces the risk, especially

weight-bearing exercise and weight training.weight-bearing exercise and weight training.

Risk FactorsRisk Factors

AgeAge Small, thin bonedSmall, thin boned WomenWomen Possible genetic factorsPossible genetic factors Post-menopausal Caucasian and Asian Post-menopausal Caucasian and Asian Poor diets-especially with Ca and Vita-DPoor diets-especially with Ca and Vita-D Physical inactivityPhysical inactivity Alcohol useAlcohol use SmokingSmoking

Prevention Prevention

Get regular physical activity!!Get regular physical activity!! Get adequate Ca and Vita-D intakeGet adequate Ca and Vita-D intake Limit caffeine and phosphate containing Limit caffeine and phosphate containing

sodassodas Avoid prolonged hi-protein dietsAvoid prolonged hi-protein diets HRT at menopause may helpHRT at menopause may help

Figure 11.4 Strategies for Reducing Your Risk of Figure 11.4 Strategies for Reducing Your Risk of Cardiovascular DiseaseCardiovascular Disease

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Making excuses does not take Making excuses does not take talent. Only those who talent. Only those who

persevere find the reward at persevere find the reward at the end of the day.the end of the day.