prevention for the heart asad pathan tabba heart institute

Prevention For The Heart

Asad Pathan

Tabba Heart Institute

OutlineWhat is heart disease?

Why you need to be concerned?

Risk factors for heart disease

What can you do to prevent it?

What is Heart Disease? Heart : The most hard-working muscle of our

body – pumps 4-5 liters' of blood per minute during resting conditions. Up to 30 L/min during extreme physical stress.

Supplies nutrients and oxygen rich blood to all body parts, including itself

• Coronary arteries surrounding the heart keep it nourished with blood

What is Atherosclerosis?

Over time, fatty deposits called plaque build up within the artery walls. The artery becomes narrow. This is atherosclerosis

What is coronary artery disease?

When this occurs in the coronary arteries, heart does not get sufficient blood, the condition is called coronary artery disease, or coronary heart disease

Myth : Heart disease occurs in old age!Starts in the first or second decade of

life

FoamCells

FattyStreak

IntermediateLesion Atheroma

FibrousPlaque

ComplicatedLesion/Rupture

Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).

From FirstDecade

From ThirdDecade

From FourthDecade

Which organs are effected?

Ischemic StrokeIschemic Stroke

Peripheral Vascular Peripheral Vascular DiseaseDisease

Coronary Heart DiseaseCoronary Heart Disease• AnginaAngina• MI (Heart Attack)MI (Heart Attack)• Sudden Cardiac DeathSudden Cardiac Death

Why Worry?

Major Causes of Death & CV disease Distribution

1/3 of global deaths.

17.3 million/year.

7.3 million coronary heart disease and 6.2 million from stroke.

>80 % in low and middle income countries.

Men and women equally effected.

Males Females

WHO Global Atlas on Cardiovascular Disease Prevention and Control 2011

Source:

World HeartFederation

The Problem

CVD Pandemic: >15 Million Heart Attacks / Year

WHO Country Statistics

CVD24%CVD24%

CVD25%CVD25%

CVD27%CVD27%

CVD30%CVD30%

WHO Country Statistics

KR Bainey, BI Jugdutt. Atherosclerosis 2009;204:1-10

Estimated direct and indirect costs of major cardiovascular diseases and stroke (United States: 2007).Source: NHLBI.

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Risk Factors for Heart DiseaseRisk Factors for Heart DiseaseAge

Family History

Gender

Age

Family History

Gender

• Physical inactivity

• Stress

• Obesity

• Smoking

• Diabetes

• High Cholesterol, high triglycerides, low HDL

• High blood pressure

• High fat diet

• Physical inactivity

• Stress

• Obesity

• Smoking

• Diabetes

• High Cholesterol, high triglycerides, low HDL

• High blood pressure

• High fat diet

High Blood Pressure

What is High Blood PressureThe heart blood pumps through a series a arteries, capillaries

and veins. The force applied by the moving blood on the wall of the artery is measured as blood pressure.

Various derangements' in the blood pressure regulatory mechanisms lead to increased blood pressure.

Modification Recommendation Approximate SBP Reduction Range

Weight reduction Maintain normal body weight (BMI=18.5-24.9)

5-20 mmHg/10 kg weight lost

Adopt DASH eating plan

Diet rich in fruits, vegetables, low fat dairy and reduced in fat

8-14 mmHg

Restrict sodium intake

<2.4 grams of sodium per day 2-8 mmHg

Physical activity Regular aerobic exercise for at least 30 minutes on most days of the week

4-9 mmHg

Moderate alcohol consumption

<2 drinks/day for men and <1 drink/day for women

2-4 mmHg

JNC VII Lifestyle Modifications for BP ControlJNC VII Lifestyle Modifications for BP Control

Chobanian AV et al. JAMA. 2003;289:2560-2572

BMI=Body mass index, SBP=Systolic blood pressure

Cholesterol

Cholesterol ( A type of fat)

Cholesterol ( A type of fat)

Everybody needs cholesterol, it serves a vital function in the body.

It circulates in the blood.

Too much cholesterol can deposit in the arteries in the form of plaque and block them

No symptoms till heart attack.

Where does it come from Where does it come from ??

• Two sources of cholesterol:Food & made in your body

• Major Food sources: All foods containing animal fat and meat products

65%65% 35%35%

Smoking

SMOKINGSMOKING

Smoking related Illnesses

C a n c e r s B la d d e r C a n c e r C e rv ic a l C a n c e r E so p h a g e a l C a n c e r K id n e y C a n c e r L a r y n g e a l C a n c e r L e u k e m ia L u n g C a n c e r O ra l C a n c e r P a n c re a tic C a n c e r S to m a c h C a n c e r

C a r d io v a sc u la r D ise a se A n e u r y sm A rth e ro sc le ro s is C e re b ro v a sc u la r

D ise a se C o ro n a r y H e a rt

D ise a se

R e sp ir a to r y D ise a se C h ro n ic B ro n c h itis E m p h y se m a P n e u m o n ia

R e p r o d u c tiv e E ffe c ts F e ta l D e a th F e rtilit y Issu e s L o w B irth W e ig h t P re g n a n c y

C o m p lic a tio n s

O th e r E ffe c ts C a ta ra c t D im in ish e d H e a lt h L o w B o n e D e n s it y P e p tic U lc e rs

“From a short pleasure can come a long repentance.”French proverb

Mortality Statistics

Average smoker dies 13-14 yearsEarlier than a non-smoker.

Top Facts: HookahsSmoking a hookah is smoking tobacco.

What is a Hookah and Shisha?

• A hookah is a water pipe used to smoke tobacco through cooled water. The tobacco is heated in the bowl at the top of the hookah and the smoke is filtered through the water in the base of the hookah.

• Alternate names for hookahs include: water pipe, goza, hubble bubble, borry, arhile, and narghile.

• Shisha is the tobacco smoked in a hookah. It is a very moist and sticky tobacco that has been soaked in honey or molasses.

• There are a variety of shisha flavors including apple, plum, coconut, mango, mint, and strawberry

Myths and the Truths

MYTH #1: Hookah smoke is filtered through water so it filters out any harmful ingredients.

TRUTH : Smoking tobacco through water does not filter out cancer-causing chemicals. Water-filtered smoke can damage the lungs and heart as much as cigarette smoke.

MYTH #2: Inhaling hookah smoke does not burn the lungs, so it is not unhealthy.

TRUTH: The hookah smoke does not burn the lungs when inhaled because is cooled through the water in the base of the hookah. Even though the smoke is cooled, it still contains carcinogens and it is still unhealthy.

MYTH #3: Smoking hookahs are healthier than smoking cigarettes.

TRUTH: Hookah smoke is just as dangerous as cigarette smoke. Hookahs generate smoke in different ways: cigarette smoke is generated by burning tobacco, while hookah smoke is produced by heating tobacco in a bowl using charcoal. The end product is the same—smoke, containing carcinogens.

Myths and the Truths MYTH #4: Smoking a hookah is not as addictive as smoking a

cigarette because there is no nicotine.

TRUTH: Just like regular tobacco, shisha contains nicotine. In fact, in a 60-minute hookah session, smokers are exposed to 100 to 200 times the volume of smoke inhaled from a single cigarette.

MYTH #5: Herbal shisha is healthier than regular shisha.

TRUTH: Just like smoking herbal or “natural” cigarettes, , herbal shisha exposes the smoker to tar and carcinogens.

MYTH #6: Shisha tobacco contains fruit, so is healthier than regular tobacco.

TRUTH: Tobacco is tobacco, no matter how you look at it. Shisha is often soaked in molasses or honey and mixed with fruit, but it still contains cancer-causing chemicals and nicotine. Stick to traditional methods of getting fruit—eat an orange.

Quick FactsCompared to a single cigarette, hookah smoke is known to

contain Higher levels of arsenic, lead, and nickel 36 times more tar 15 times more carbon monoxide

A 45 to 60 minute hookah session, same amount of tar and nicotine as one pack of cigarettes.

Sharing mouthpieces without washing increase the risk of spreading colds, flu, and infections—even oral herpes.

Health risks of smoking hookahs include cancer, heart disease, lung damage, and dental disease.

If you are just visiting a hookah bar, there is still exposure to high levels of damaging secondhand smoke to all who are present.

It’s Not Too Late

Diabetes

IDF Diabetes Atlas Sixth edition, 2013

Globally Prevalence of Diabetes reported byIDF 2013 and 2035

IDF Diabetes Atlas Sixth edition, 2013

Top 10 countries/territories for number of people with diabetes (20-79 years), 2013 and 2035

Obesity

Disease Risk Associated with Excess Body Mass Index

Willet WC et al. N Engl J Med 1999;341:427-434.

Type 2 diabetes CholelithiasisHypertension CHD

BMI (kg/m2)

Women

Rela

tive R

isk

21 22 23 24 25 26 27 28 29 30

BMI (kg/m2)

Men

21 22 23 24 25 26 27 28 29 30

Increased weight and future risk

45

Inactivity

More Activity and Greater Weight Loss with Shorter Bouts of Exercise

Jakicic JM et al. Int J Obes Relat Metab Disord 1995;19:893-901.

Weekl

y M

inute

s of

Exerc

ise

Long Bouts

Short Bouts

Weig

ht

Loss

(kg

)

Long Bouts

Short Bouts

Mental stress

What Can You Do.

What is Therapeutic Lifestyle Change?

What is Therapeutic Lifestyle Change?

Diet changes to improvecholesterol profile

Daily physical activity

Weight Control

Quit Smoking

Small changes=BIG REWARDS

Diet changes to improvecholesterol profile

Daily physical activity

Weight Control

Quit Smoking

Small changes=BIG REWARDS

Physical Activity RecommendationsPhysical Activity Recommendations

Assess risk with a physical activity history and/or an exercise test, to guide prescription

Encourage 30 to 60 minutes of moderate intensity aerobic activity such as brisk walking, on most, preferably all, days of the week, supplemented by an increase in daily lifestyle activities

Advise medically supervised programs for high-risk patients (e.g. recent acute coronary syndrome or revascularization, HF)

III IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIII IIaIIaIIa IIbIIbIIb IIIIIIIIIIIaIIaIIa IIbIIbIIb IIIIIIIII

Goal: 30 minutes 7 days/week, minimum 5 days/week



Weight Management RecommendationsWeight Management Recommendations


Goal: BMI 18.5 to 24.9 kg/m2Waist Circumference: Men: < 40 inches Women: < 35 inches


Assess BMI and/or waist circumference on each visit and consistently encourage weight maintenance/ reduction through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated.

If waist circumference (measured at the iliac crest) >35 inches in women and >40 inches in men initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated.

The initial goal of weight loss therapy should be to reduce body weight by approximately 10 percent from baseline. With success, further weight loss can be attempted if indicated.

*BMI is calculated as the weight in kilograms divided by the body surface area in meters2. Overweight state is defined by BMI=25-30 kg/m2. Obesity is defined by a BMI >30 kg/m2.


My Life CheckSimplified healthy living -– 7 things to measure

and track.

62

ConclusionHeart disease cost money, it disables and leads to

premature death.

It strikes young and old, rich and poor with little gender bias.

You can do something about it. Be proactive.

Know your numbers.

Follow the 7 Life Steps.

Heart Attack Usually central chest pain, constant, varying severity.

Pain can also be in the arm, shoulder, right side chest, neck, jaw, teeth, ear, upper back.

Usually associated with shortness of breath, sweating, nausea or dizziness.

What to do? If readily available take an aspirin. Stay seated. Ask someone to take you to the nearest emergency room equipped

to handle cardiac emergencies. Do not go to your GP or cardiologist office/clinic.

M. Z.I.Hydrie, A.S.Shera, A.Fawwad, Abdul Basit, A.Hussain Prevalence of Metabolic Syndrome in Urban Pakistan: (Karachi): Comparison of newly proposed IDF and modified ATP III Criterions. Journal of

Metabolic Syndrome & Related Disorder, 2009, 7(2): 119-124.

Pre-diabetes or Metabolic SyndromeUrban Setting-Karachi

Lyari Town

Total population:

Total households:

Metabolic Syndrome

0

10

20

30

40

50

60

70

80

High T.Cholesterol

(>170mg/dL)

High Triglycerides(>130mg/dL)

High LDL(>110mg/dL)

LowHDL(<35mg/dL)

Insulin resistance(HOMA >2)

High Insulin (>8uIU/mL)

%

Low

Medium

High

A. Basit, et al. Journal of Health, Population and Nutrition. 2005; 23(1); 34-43

Childhood dyslipidemia and insulin resistance according to arm-fat % terciles

A study on 8-10 Year old children of Karachi (Pakistan)

Overweight 9.8%

Obesity 4.3%

Poor fruits/vegetables intake 80%

Daily soft drink and fast food 40%

consumption.

Diabetes Res Clin Pract. 2005 Aug 17

Misra A, Basit A, Vikram NK, Sharma R.

9.6 million children are OW and obese

Metabolic Syndrome and Childhood Obesity Metabolic Syndrome and Childhood Obesity

Temporal changes….2002 and 2010Temporal changes….2002 and 2010

Basit A et al. Temporal changes in the prevalence of diabetes, impaired fasting glucose and its associated risk factors in the rural area of Baluchistan. Diabetes Res Clin Pract. 2011 Dec;94(3):456-62.

http://www.ncbi.nlm.nih.gov/pubmed/21890227

Diabetes Risk Factors

P<0.001

A study on 15-25 years old adolescents of Hub- Baluchistan

Asher F, et al. Changing pattern in the risk factors for diabetes in young adults from the rural area of Baluchistan. Journal of Pakistan Medical Association 2013; 63 (9):1089-1093

SmokingSmoking

4.06% to 21.3%(2002) (2009)

P<0.001

P<0.001

prevention for the heart asad pathan tabba heart institute

Documents

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coronary heart diseasemyth

prevalence of heart

heart attacks year

coronary artery disease

hospital discharges

hfchf discharges

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