1. Heart Health 101 and ProArginine Plus
Janice Heasty RN BSN

2. Dan Austin RN, High Desert Heart Institute, Nurse Clinical Coordinator and Directory of the CHF (Congestive Heart Failure) Unit
“When you know what you know, you have the responsibility to pay it forward.”

3. Assess Your Risk For a Heart Attack
1. How old are you?
A (1 point)
B (2 points)
C (3 points)
D (4 points)
E. >66 ( 5points)

4. Assess Your Risk For a Heart Attack
2. Do you have a family history of early coronary artery disease (a mother or sister who was younger than 60 years old or a father or brother younger than 50 years old when he/she had a first heart attack or symptoms of a heart attack?
A. No (0 points)
B. Yes (2 points)

5. Assess Your Risk For a Heart Attack
3. Do you have high Blood Pressure
(BP ≥ 140/90)?
A. No (0 points)
B. Yes (1 point)
C. Don’t know (1 point)
4. Do you have Diabetes or elevated blood sugar?
B. Yes (3 points)

6. Assess Your Risk For a Heart Attack
5. Are you physically active?
A. I accumulate approx. 30” of moderate aerobic activity (walking, going up stairs, vacuuming, dancing, gardening, aerobics, swimming, cycling, spinning, or jogging almost every day. (0 points)
B. I exercise only occasionally: I accumulate thirty minutes of aerobic activity one or two days per week. (1 point)
C. I rarely engage in regular moderate aerobic physical activity. (2 points)
D. I never engage in moderate physical activity.
(3 points)

7. Assess Your Risk For a Heart Attack
6. Which of the following best describes your Cholesterol?
A. <200mg/dL (0 points)
B mg/dL (1 point)
C. >240mg/dL (2 points)
D. Don’t know (2 points)

8. Assess Your Risk For a Heart Attack7.
Which of the following best describes your HDL (good) cholesterol?
A. <45 mg/dL (2 points)
B mg/dL (1 point)
C mg/dL (0 points)
D. >60 mg/dL (-1 point)
E. Don’t know (1 point)

9. Assess Your Risk For a Heart Attack
8. Which of the following best describes you LDL (bad) cholesterol?
A. <100 mg/dL (0 point)
B. <130 mg/dL (1 point)
C. >160 mg/dL (1 point)
D. Don’t know (1 point)

10. Assess Your Risk For a Heart Attack
Which of the following best describes your triglyceride level?
A mg/dL (0 points)
B mg/dl (1 point)
C. >250 mg/dL (2 points)
D. Don’t know (1 point)

11. Assess Your Risk For a Heart Attack
10. Do you smoke?
A. Yes (3 points)
B. Smoked previously, stopped within the last year. (2 points)
C. Smoked previously, stopped years ago (1 point)
D. Smoked previously, stopped years or more ago (0 points)
E. No (0 points)

12. Assess Your Risk For a Heart Attack
11. Flossing and Heart Disease: medical research has found a correlation between any level of periodontal disease (including gingivitis) and atherosclerosis, or hardening of the arteries.
A. I floss almost every day and see my hygienist at least once/year, if not 2x’s/year. (0 points)
B. I don’t floss, and maybe see my hygienist once/year. (1 point)
C. I have no idea what you are talking about (1 point)

13. Assess Your Risk For a Heart Attack
12. Look at a BMI (body mass index)
chart. Determine your personal
BMI which is considered a better indicator of “fatness” than weight alone. What is your BMI?
A (0 points)
B (1 point)
C (2 points)
D (3 points)
E. >35 (4 points)

14. Assess Your Risk For a Heart Attack
13. How would you describe the way you handle anger?
A. I avoid getting to the breaking
point. (0 points)
B. I yell or slam doors. (1 point)
C. I always hold my anger in. (2
points)

15. Assess Your Risk For a Heart Attack
0: Great! You are presently healthy, and following the suggestions of the presentation should make you even healthier.
1-10: Low Risk! It pays to investigate the areas where you amassed points and modify your lifestyle accordingly. You should find this presentation particularly motivating and helpful.
11-20: Moderate Risk! This presentation will help you understand why it’s important to begin changing your lifestyle NOW!
>20: HIGH RISK FOR HEART DISEASE! Though you may feel well now, get a complete physical ASAP. In the meantime, understand more about your heart and how it works. And you’ll learn what changes you need to make to begin reducing your risk.

16. Assess Your Risk For a Heart Attack
My goal is to help you recognize your personal risk factors for heart disease and motivate you to make the necessary lifestyle changes to keep your heart healthy.
YOUR goal is to change the risk factors you can control, so that YOU can greatly reduce the chance of having a heart attack.

18. What is Cardiovascular Disease?
CHD: Coronary Heart Disease
MI: Myocardial infarction (Heart Attack)
CAD: Coronary Artery Disease
Atherosclerosis: plaque in the arteries
HTN: Hypertension (High Blood Pressure)
CHF: Congestive Heart Failure
CVA: Cerebral Vascular Accident (stroke)

28. Coronary Heart Disease
Disorder of the blood vessels in the heart that can lead to a heart attack.
A heart attack happens when an artery becomes blocked, preventing blood flow from getting to the heart muscle.

33. Coronary Heart Disease (cont.)
The arteries become narrowed by fatty deposits which develop into plaque.
The blood supply (that is carrying oxygen, sugar and nutrients) cannot get to the heart muscle.
The heart muscle cannot keep up with increased demands (exercise, stress, surgery, illness) with these blockages.

34. How Critical is the Problem?
C-Shop: Cardiac School age Health Opportunities Program
Western Nebraska: Bridgeport, NE
1 out of 3 students tested: Elevated Cholesterol, Triglycerides, or BP
Shocking fact: 5th graders
Education to both students and parents about curbing heart disease through healthy lifestyle choices.
Retest will be when they reach 10th grade.

35. How critical is the problem?
#1 Killer of both men and women (more than the next 7 causes of death combined including cancer).
50% of all Americans will die of some form of Cardiovascular Disease.
1 in 3 will die from Coronary Heart Disease.

37. How Critical is the Problem? (cont.)
One woman in America dies from heart disease every minute. (African-American women are 30% more likely to die from CHD).
If you combine Heart Disease and Stroke, there is one death every 33 seconds.
Heart Disease begins before age 20, many years before anyone has symptoms.

38. How Critical is the Problem? (cont)
62% of women believe that cancer is a woman’s greatest threat.
Only 13% of American women consider heart disease a health risk themselves.
9,000 U.S. women younger than 45 years old have had a heart attack each year.
In women younger than 65 years who have a heart attack; their death rate is twice that of men.

41. Classic Symptoms of Heart Disease
“It’s the Big One”
Chest discomfort: pain, pressure, tightness
Pain radiating to the left arm or shoulder
Cold Sweats
Nausea
Does everyone experience these symptoms?

42. Vague symptoms of heart attack
Unusual or sudden extreme fatigue
Shortness of Breath
Flu-like symptoms: nausea or vomiting, cold sweats, weakness
Feelings of anxiety “Something is wrong”
Pain in one or both arms, shoulders, elbows, neck, jaw, stomach or back.

43. Only 30% of people experience classic signs and symptoms before having a heart attack.
Women, diabetics, and older men do not experience the classic symptoms of having a heart attack!
64% of women who died from coronary heart disease had no previous symptoms.
Symptoms can often be vague so they are difficult to diagnose. Sometimes, treatment is delayed because their heart attack presents as something else.

44. Women Have Poor Outcomes
The entire artery is lined with diffuse disease rather than one area.
Women start off with smaller vessels, so a small amount of disease is much more significant.
The collaterals (small connecting blood vessels, nature’s little bypasses) are gone.
More complications with angioplasty (ballooning the artery open) and stenting.
More go for Coronary Artery Bypass Graft surgery (CABG), which is more invasive, carries more risks and has more complications.

46. What Can We Do? Education is the Key…. Know the facts.
Seek the information
Make the necessary lifestyle changes
TLC (therapeutic lifestyle changes)
Prevention is the Best Medicine!!!
Research shows you can lower your risk for CHD enormously (82%) simply by leading a healthy lifestyle.

47. Risks Factors That Cannot Be Controlled
Gender
Increasing Age: the average age of our population is changing so CHD will remain a MAJOR health issue.
Family History, Genetics
1st degree relatives
Father, Brother: < 55 years old with CVD
Mother, Sister: < 65 years old with CVD
Race

48. “With the many risk factors for heart disease, a woman’s greatest Risk is Ignorance”. former 1st lady, Laura Bush

49. Risk Factors That Can Be Controlled
Hypertension, High Blood Pressure
High cholesterol, Elevated Blood Lipids
Smoking, Tobacco Use
Diabetes
Obesity, Excessive Body Fat
Physical Inactivity
Stress
Other: Inflammation: CRP (c-reactive protein)
Homocysteine

50. High Blood Pressure “The Silent Killer”
GOOD < 120/80
BAD
Mild HTN /80 – 159/91
Moderate HTN /100 – 179/109
Severe HTN /100 – 209/109

51. High Blood Pressure “Facts”
Usually doesn’t cause symptoms.
HTN—increases with age and body weight.
Higher in African-Americans, Hispanics, Native Americans, and Hawaiians than Caucasians.
½ of all patients with their first heart attack are hypertensive.
HTN doubles the risk for CVD “heart failure”.
Increased risk for “End-Organ” damage (kidney failure, CVA (stroke), MI—heart attack).

53. Pulmonary Hypertension
Elevated pressure in the arteries in the lungs.
Normal: 25 mmHg pressure at rest
Right ventricular failure.
Must work harder to pump blood through the lungs
Heart muscle weakens and/or fails

55. Angelo CiCi Pulmonary artery pressure: 96/
Severe shortness of breath, on oxygen 24/7
Right-sided heart failure: everything backs up: liver congestion
On Dec 20, 2008 Angelo had massive heart failure (congestive heart failure, congestive pulmonary failure and pacemaker failure) with simultaneous renal failure.
From this point on he was in and out of the emergency room. "I was so weak I couldn't even open a bottle of water by myself and I had decided I had had enough. I told the nurses I wanted all the IV's removed and I just wanted to go home and die." Angelo CiCi

56. Angelo CiCi Pro-Arginine Plus (4 scoops/day)
“I have seen a dramatic, a dramatic reversal in Angelo’s symptoms” Dan Austin RN
“I expected a marginal improvement in the symptoms…what we ended up seeing was remarkable, positive, remodeling of the heart, positive pulmonary artery changes, pulmonary vascular changes…” Dr. Siva Arunasalam
“The best thing? I can walk through the mall and hold my wife’s hand.” Angelo CiCi

57. IV- You have symptoms even at rest.
WHO (World Health Organization) functional classification for Pulmonary Hypertension
I- Although you have been diagnosed with pulmonary hypertension, you have no symptoms.
II- You don’t have symptoms at rest, Ordinary physical activity results in undue fatigue or shortness of breath, chest pain, or heart syncope.
III- You are comfortable at rest. Less than ordinary physical activity causes undue fatigue or shortness of breath, chest pain, or heart syncope.
IV- You have symptoms even at rest.

58. High Blood Pressure—Initial Treatment
Weight loss
Decrease in salt intake
Stop smoking and avoid 2nd hand smoke
Regular exercise decreases BP, stress and weight
Decrease alcohol consumption

59. Pro-Argi-9 Plus
L-arginine becomes nitric oxide which relaxes the walls of the artery decreasing blood pressure.
Dr. Siva’s High Desert Heart Health Study
13% decrease in systolic BP (decrease the workload of the heart).
17% decrease in diastolic BP (decrease end-organ damage).
CASP (central aortic systolic pressure) measured by B-Pro decreased 6.2%.

60. Cholesterol
Narrowing of the arteries occurs when extra cholesterol and fat circulates in the blood and builds up in the walls of the arteries that supply blood to the heart, the brain, and other organs.
Cholesterol does not dissolve in the blood. The lipo-proteins (HDL, LDL) carry the cholesterol in the bloodstream.
Blood lipid profile—start at age 20 and retest every 5 years.

61. Total Cholesterol Level
Desirable: < 200 mg/dL
Borderline High: mg/dL
High: mg/dL
Very High: 290 mg/dL and >

62. LDL Low-Density Lipoprotein “Bad Cholesterol”
Major carrier of cholesterol in the blood. Builds up on the arterial walls.
Optimal < 100 mg/dL
Near Optimal mg/dL
Borderline High mg/dL
High mg/dL
Very High mg/dL and >

63. HDL High-density lipoprotein “Good/Healthy” cholesterol
Carries cholesterol from other parts of the body back to the liver.
Good/Protective: mg/dL and >
Borderline/Desirable: mg/dL
Low/Major Risk: < 40 mg/dL

64. Triglyceride Levels
A type of fat found in the body (from food and produced in the liver). Unused calories are converted to triglycerides and transported to fat cells to be stored and released via hormone signals to be used as energy.
Good: < 150 mg/dL
Borderline High: mg/dL
High: mg/dL and >

65. Pro-Argi-9 Plus
Dr. Siva’s study: Remember that these were maximally medically managed patients…..
Total Cholesterol: no significant change
LDL: no significant change, though we know ProArgi9+ reduces LDL oxidation.
HDL: Increased 18%.
Dr. Siva says: “This is what ‘REVERSES’ heart disease” We can’t say that!
This is a difficult marker to increase.
Triglycerides: Decreased 45% (released and used for energy? Is this why we feel so energetic on Pro-Argi-9 Plus?)

66. Smoking “America’s Health Crisis”
Smoking is the leading preventable cause of death in the nation.
Smoking is the single biggest risk of Cardiovascular Disease.
Tobacco Use---Tobacco Abuse--- includes anything with nicotine (chewing tobacco, patches, gum)

67. Smoking “America’s Health Crisis”
Nicotine
Decreases oxygen in the blood
Damages the blood vessel which causes plaque to form
Triggers blood clots to develop
Reduces HDL (“good cholesterol”)
Causes irregular heart rhythms that could lead to cardiac arrest

68. Smoking “America’s Health Crisis”
Smokers are 2-6 X’s more likely to suffer a heart attack than nonsmokers.
Male smokers lose 13.2 years of life expectancy.
Female smokers lose 14.5 years of life expectancy.
Second-Hand smoke doubles a non-smoker's risk of heart disease.

69. Smoking “America’s Health Crisis”
The Good News
Don’t smoke, and if you do,
QUIT NOW!
Quitting begins to decrease cardiovascular risk immediately.
Over time (10 years), the risk of heart disease returns to nearly normal.

70. Pro-Argi-9 Plus
Pro-Argi-9 Plus provides us with the amino acid L-arginine which converts to nitric oxide.
On Dr. Siva’s list: smoking consumes nitric oxide, the body needs more. Every tissue utilizes Nitric Oxide.
* Lowers Blood Pressure
* Protects against heart attack and stroke (interferes with unwanted blood clotting)
* Keeps the normal endothelial layer as protective
* Protects against atherosclerosis
Red Wine Extract (Resveratrol): An Antioxidant---acts as a sponge that absorbs free-radicals. Also, keeps the LDL from becoming “sticky”.

71. Diabetes Now affects 10% of the U.S. population
Has nearly doubled in the last years
About 65% of diabetics die of some type of heart disease at an earlier age than the rest of the population.
Diabetes increases the risk of Coronary Heart Disease
Women: 3-7 X’s
Men: X’s

72. Diabetes Good Blood Sugar: < 100 mg/dL ABC’s of Diabetic Control
A1c (hemoglobin A1c) a blood test that measures your average blood glucose level over the last 3 months.
BP (blood pressure) the higher your BP, the harder your heart has to work and the more damage inside your arteries.
Cholesterol: LDL (bad) builds up and “clogs” your arteries.

73. Dr. Siva’s study with Pro-Argi-9 Plus
●Glucose:
Decreased 8% (Dr. Siva rated this a highly significant finding)
●Blood Pressure:
Systolic BP decreased 13%
Diastolic BP decreased 17%
●Blood Lipids:
HDL increased 18%
Triglycerides decreased 45%

76. Dr. Siva’s study with Pro-Argi-9 Plus
ABI Ankle-Brachial Index
The # represents the % of decreased blood flow in the lower extremities.
PAD (peripheral arterial disease) is common in diabetic patients.
ABI increased 16%. HUGE!
When people can walk around with leg pain (claudication is cramping the calves—the muscles is screaming for oxygen that the clogged arteries cannot deliver). When they can walk without leg pain, their quality of life improves, their ability to exercise improves.

77. Obesity More than 30% of adults are now considered obese.
More alarming: at least 15% of children are obese.
People who are 30 pounds or more overweight are more likely to develop heart disease, even if they have no other risk factors. OUCH!

78. Obesity
The risk is greater if the weight is around the stomach instead of around the hips (apple vs pear shape).
Being overweight increases the chances of developing other major risk factors (high blood pressure, high cholesterol, diabetes).

79. Obesity Waist measurements BMI (Body Mass Index)
Women: > 35”
BMI (Body Mass Index)
Overweight: > 25
Obese: > 30
Morbid Obesity: 100 pounds over your desired weight

80. Pro-Argi-9 Plus
Not a weight loss product, but people seem to lose 1 pound/month taking this product.
Dr. Siva spoke about muscle physiology.
(Big improvements in 6-minute walk-test)
Performance enhancement
Increased exercise capacity
Delivering more oxygen to the tissue
More efficient to remove lactic acid

82. Exercise and Heart Disease
60% of Americans do not get the recommended amount of physical activity.
Research shows that as little as 30 minutes of moderate activity on most, preferable all, days of the week help protect your heart.
The BEST heart healthy exercise program includes both aerobic exercise and resistance training. Resistance training helps improve heart health by decreasing BP, changing fat into muscle, increasing your Basal Metabolic Rate.

83. Exercise and Heart Disease
Aerobic exercise increases HDL. The more the exercising, the higher the HDL.
Diabetes is better controlled with regular moderate exercise.

84. Pro-Argi-9 Plus Move Faster Recover Faster Lose Weight
Performance enhancement
Increased exercise capacity
Deliver more oxygen to the tissues
More efficient to remove lactic acid
Faster Recovery
Feel Better
Move More
Move Faster
Recover Faster
Lose Weight

85. Vitamin D & Heart Disease
November 2009 report
Intermountain Medical Center in Utah
Researchers found that low levels of vitamin D significantly increase the risk for stroke, heart disease, and death.

86. November 2009 report Intermountain Medical Center in Utah
The study followed 27, 686 people age 50 and older with no history of CVD.
The participants were divided into 3 groups based on their Vitamin D levels normal, low, or very low.
After 1 year, the very low levels:
77% more likely to die
45% more likely to develop CAD
78% more likely to have a stroke compared to those with normal Vit. D levels
“We concluded that among pts 50 years or >, even a moderate deficiency of Vit. D levels was associated with developing CAD, heart failure, stroke and death,” said study co-author Heidi May.

87. Vitamin D & Heart Disease
Dr. Tracy Stevens, MD, FAAC, Cardiology, Kansas City, Missouri
“Get your vitamin D levels checked”
She thinks that this essential vitamin is seriously underrated.
In a recent program involving 600 women, Dr, Stevens and her colleagues found that 97% of the participants were deficient in Vitamin D and low levels of the vitamin have been linked to marked increases in heart disease. When the women took supplements, they reported feeling more energy as their vitamin D levels increased.

88. Pro-Argi-9 Plus D3 (Cholecalciferol) is your best source of vitamin D.
Each scoop has 2,500 IU of Vitamin D3 or 625% of your daily values.

89. Dr. Siva’s Study with Pro-Argi9 Plus
Dr. Siva’s study found their 33 maximally medically managed patients to be 95% deficient in vitamin D.
Vitamin D3 increased 183% in their patients. Many “measureable data points” improved in this study. In addition to improvement of lab values and medical test results, the quality of life (demonstrated by the 6-minute walk test) dramatically improved in these 33 patients.

90. If you don’t take care of your body, where will you live?”