health and lifestyle connection links to heart disease, high blood pressure and diabetes candace...

Health and Lifestyle Connection

Links to Heart Disease, High Blood Pressure and Diabetes

Candace Huber, MPH, BSN

Florida Hospital

Center for Community Health Ministry

Heart DiseaseHeart Disease CancerCancer

StrokeStroke

ChronicChronicLungLung

DiseaseDisease

AccidentsAccidentsDiabetesDiabetesAlzheimer’sAlzheimer’sDiseaseDisease

InfluenzaInfluenzaPneumoniaPneumonia

KidneyKidneyDiseaseDisease

SepticemiaSepticemia(Blood Infections)(Blood Infections)

Tobacco UseTobacco UseDiet &Diet &

Activity PatternsActivity Patterns

Alcohol &Alcohol &SubstanceSubstance

AbuseAbuse

InfectiousInfectiousAgentsAgents

Pollutants &Pollutants &Toxic AgentsToxic AgentsFirearmsFirearms

SexualSexualBehaviorBehavior

MotorMotorVehiclesVehicles

IllicitIllicitDrug UseDrug Use

Anger &Anger &FrustrationFrustration

Low SelfLow SelfEsteem orEsteem orSelf WorthSelf Worth

EconomicEconomicDisparityDisparity

HopelessnessHopelessness& Emotional& Emotional

DespairDespair

Lack ofLack ofInformationInformation

Or EducationOr Education

MeaninglessMeaninglessExistenceExistence

ExternalExternal& Internal& Internal

StressStress

PowerlessnessPowerlessnessLonelinessLoneliness


Obesity Trends* Among U.S. AdultsBRFSS, 1985

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10

No Data <10% 10%–14%


Obesity Trends* Among U.S. Adults

Percent of Obese (BMI > 30) in U.S. Adults

www.cdc.gov/obesity/data/trends.html

© 2002 – 2006 LifeLong Health

Overweight and Disease Risk

0123456789

10

Heartdisease

High BP Gallbladder Diabetes

BMI 22

BMI 30

NEJM, Aug. 5, ’99, 430

Rel

ati v

e R

isk


© 2003, PrevMedix LLC

Heart Disease and Lifestyle


Stages of Atherosclerosis

ModerateModerate

Cross-section of an artery

NormalNormal SevereSevere


Blood TestsRecommended Values

Desirable OptimalTotal Cholesterol <200 <160

HDL “good” Cholesterol >40 >60

LDL “bad” Cholesterol <130 <100

Non-HDL Cholesterol <160 <130

Triglycerides less than 200 <100

Glucose levels(nonfasting)<140

Glucose levels (fasting) < 100


Lowering LDL (bad) CholesterolEvery 1% decrease in LDL reduces CHD risk 2%

• Fat - only 25% to 30% of total calories

• Saturated fat - less than 10%, less than 7% for better results, avoid hydrogenated oils

• Fiber - 20 to 35 gm/day (whole grains, fresh fruits and vegetables)

• Be physically active - 30+ minutes most days

• Healthy weight - see your body composition report (BMI less than 25)


Raising HDL (good) Cholesterol

• Get 12 to 20 or more aerobic miles per week

• Achieve and maintain a healthy body weight

• Don’t smoke

Every 1% increase in

HDL lowers CHD risk 2% to 3%


Increasing HDL Lowers HD Risk

160 160

107

50 56 4023 15 2 20

020406080

100120140160

<35 44-35 54-45 74-55 75+

Men

Women

Mortality rate due to coronary heart disease per 100,000

Source: The Framingham Heart Study

HDL Level

100

71

5246

41

0

20

40

60

80

100

120

None 1 hr/wk 3 hr/wk 5 hr/wk Plus Vigor.

Walking Time and Heart Health

Hours of Walking per Week

Rel

ativ

e ri

sk o

f H

eart

Att

ack

223

56

107

160

0

50

100

150

75+ 74-55 54-45 44-35 <35

HDL Levels mg/dL

CH

D m

orta

lity

rat

e, m

en

HDL Cholesterol Factors that improve

HDL– Aerobic exercise,

12-20 aerobic miles per week

– Achieve/maintain ideal body weight

– Avoid smoking– Avoid trans fatty

acids Note: For every 1% you

increase HDL levels, you decrease CHD by 2-3%

0.0

10.0

20.0

30.0

40.0

160 180 200 240 300

Cholesterol and Heart Health

Hea

rt D

i sea

se D

eath

Rat

e

Serum Cholesterol (mg/dL)

22

78

0

20

40

60

80

Persons withno risks

All otherpersons

Clinical Risks and Heart Disease• A 16+ year study of some

366,559 people looked at three major risk factors:

– smoking (currently)– cholesterol (200+)– blood pressure

(>120/80)• People with none of these

risks:– were 80 to 90% less

likely to have a heart attack

– were 40-60% less likely to die from any cause

– and lived 6 to 10 years longer than those with any risks

JAMA, Dec. 1, 1999Source: Framingham Heart Study

New England Jour. Medicine, Aug. 1999 Source: NCEP, MRFIT Study


Fruit and Vegetable Intakeand Risk of Heart Attack

1.00

0.80

0.0

0.3

0.5

0.8

1.0

Lowest Highest

Fruit/Vegetable Intake

• Persons who ate the most fruits and vegetables (top 20%) had a 20% lower risk of heart attack than people who ate the fewest (bottom 20%).

• For every serving of fruit or vegetable eaten per day, the risk of heart attack dropped 4%.

Annals of Internal Medicine, 2001, Jun 19; 134:1106-14

Fruit and Vegetable Intakeand Risk of Stroke

1.00

0.69

0

0.2

0.4

0.6

0.8

1

Lowest<3/Day

Highest8+/Day

• Persons who ate the most fruits and vegetables (top 20%) had a 31% lower risk of stroke than people who ate the fewest (bottom 20%).

• For every serving of fruit or vegetable eaten per day, the risk of stroke drops 6%

Ref. JAMA, p. 1233, Oct. 6, 1999 ©2007 Florida Hospital Center for Community Health Ministry


Coronary Heart Disease (CHD)Factors You Can Change• Blood cholesterol levels:

• Total less than 200 or less than 160 if you have heart disease

• Smoking: If you do smoke, stop! • More smokers die from heart disease than lung cancer • Quitting lowers your risk even if you are a long term smoker

• Blood pressure: Keep blood pressure low• Less than 120/80

• Inactivity: Get regular exercise, 30+ minutes most days• Excess body fat: Maintain a healthy weight

• BMI less than 25


Waist Girth and Health Risk

1.001.19

2.37

0.0

1.0

2.0

<35" 35" 39"

Car

diov

ascu

lar

Dis

ease

Ris

ks (

RR

)

Waist Girth in Inches

The Lancet, Mar. 3, 2001

Men

90 cm 100 cm


Waist Girth and Health Risk

1.00

1.56

3.16

0.0

1.0

2.0

3.0

<33" 33" 37"

Car

diov

ascu

lar

Dis

ease

Ris

ks (

RR

)

Waist Girth in Inches

Women

American Journal of Clinical Nutrition, Oct. 2002

83 cm 93 cm


Waist Girth Action Steps Waist Girth Men Women Action <35” <33” Low risk. Maintain with healthy

eating and regular physical activity.

35” 33” Moderate risk. Warning! Limit future 90 cm 83 cm weight gain, eat more healthfully,

be more physically active.

39” + 37” + High risk. Risk reduction and weight loss 100 cm 93 cm necessary. Develop weight loss program,

diet and physical activity, with health professional’s guidance and support.

American Journal of Clinical Nutrition, Oct. 2002


New Blood Pressure NormsNormal < 120/80

Prehypertension 120-139 / 80-89

High blood pressure 140/90+

Healthy People 2010 Leading Health Indicator

JNC 7 Report, JAMA May 21, 2003


High blood pressure increases the risk for heart attack, angina, stroke, kidney failure and peripheral artery disease (PAD). High blood pressure may also increase the risk of developing fatty deposit in arteries (atherosclerosis). The risk of heart failure also increases due to the increased workload that high blood pressure places on the heart.


Prevalence of High Blood Pressure

28.7 27.130.1 30.9

65.4

0

10

20

30

40

50

60

70

All adults Men Women Blacks Age 60+

BP 140/90+

Per

cent

(%

)

JAMA 290:199-206, Jul 9, 2003


Blood Pressure and Mortality

10.6 15.121.6

74.5

0

20

40

60

80

<120 120-139 140-159 160+

Mortality rate per 100,000

Source: The Framingham Heart Study, 1974

Systolic Blood Pressure


Lowering Blood Pressure

• Achieve a healthy weight (BMI less than 25)

• Watch your diet

• Increase physical activity (30+ minutes most days)

• Don’t smoke

• Get adequate rest and relaxation


Lifestyle Modifications to Lower Blood Pressure

1. Maintain a healthy weight- BMI less than 25, or

- Lose 10-15 pounds

- BP drops 5-20 points with 10 kg wt loss




2. Follow the DASH diet eating plan - Eat an abundance of fruits and vegetables

- 8 to10 servings per day

- Use non or low fat dairy products - Include whole grains, nuts, and legumes - Limit foods high in saturated fat (e.g. meats, butter) - BP drops 8-14 points on the DASH diet



New Food Pyramid



3. Reduce sodium intake - Eat less salt and salty foods

- Limit sodium intake to 2400 mg/day or less

- Limiting sodium reduces BP by 2-8 points




4. Engage in regular aerobic physical activity - At least 30 minutes per day

- Most days of the week, daily when possible

- Moderate activities such as brisk walking

- BP drops 4-9 points with increased activity



Introduce Concept



5. Limit alcohol intake, if used at all - Alcohol raises blood pressure

- BP drops 2-4 points by limiting alcohol



Diabetes and Lifestyle

When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should, or both. This causes sugars to build up too high in your blood. Type 2 diabetes is the most common form. It appears most often in middle-aged adults; however, adolescents and young adults are developing type 2 diabetes at an alarming rate.


Kenneth Cooper


Weight Loss and Health Changes

• Lower blood pressure• Reduce high blood sugar • Reduce high triglycerides and cholesterol levels• Reduce sleep apnea or irregular breathing

during sleep• Decrease risk of osteoarthritis • Decrease depression• Improve appearance and self-esteem

Overweight people who lose 10 to 15 pounds may


Practical Ways to Lose Weight

• Dieting is not recommended

• A change in lifestyle is necessary

• Make changes that you can do for the rest of your life


Weight Loss Goals

• 1/2 to 1 pound weight loss per week

• Any faster and you may begin loosing your muscle

• Make body composition goals as well as weight loss goals


Make a Commitment

Think about your goals and prepare to act • The goal

• The start date

• The timeline

• Your reward system

• Your support system

Health and Lifestyle Connection

Links to Heart Disease, High Blood Pressure and Diabetes

health and lifestyle connection links to heart disease, high blood pressure and diabetes candace...

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