1. Reducing Risk of Heart Disease & Stroke - A Life Long Quest Jeffrey P. Gold, M.D. University of Toledo Medical Center

3. Reducing Risk of Heart Disease & Stroke - A Life Long Quest

5. Coronary Artery Disease

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9. Heart Disease & Stroke in 2007 A Few Facts & Figures

10. Heart Disease in 2007 15.8 Million Americans have CAD 0.45 Million Americans die of CAD 1234 Americans die of CAD every day Lifetime Risk for American Male @ 40 - 40% Lifetime Risk for American Female @ 40 - 25%

11. Percentage breakdown of deaths from cardiovascular diseases (United States:2004) Source: NCHS and NHLBI. Coronary Heart Disease Heart Failure Diseases of the Arteries Defects Rheumatic Fever/ Rheumatic Heart Disease Stroke High Blood Pressure Congenital Cardiovascular Other

12. Cardiovascular disease mortality trends for males and females United States: 1979-2004). Source: NCHS and NHLBI. Cardiovascular disease mortality trends for males and females (United States: 1979-2004). Source: NCHS and NHLBI. 0

13. Deaths from diseases of the heart (United States: 1900– 2004.) Note: See Glossary for an explanation of “Diseases of the Heart. Total CVD data are not available for much of the period covered by this chart. Source: NCHS and NHLBI.

14. Hospital discharges for cardiovascular diseases. (United States: 1970-2004). Note: Hospital discharges include people discharged alive, dead and status unknown. Source: NCHS and NHLBI.

15. Trends in the age-adjusted prevalence of health conditions, U.S. adults ages 20-74 (NHANES: 1971-74 to 1999-2000). Source: Briefel and Johnson. Annu Rev Nutr. 2004;24:401-431. Printed with permission from the Annual Review of Nutrition.

16. Age-adjusted death rates for coronary heart disease, stroke, and lung and breast cancer for white and black females (United States: 2004). Source: NCHS and NHLBI.

17. Prevalence of cardiovascular diseases in adults age 20 and older by age and sex (NHANES: 1999-2004). Source: NCHS and NHLBI. These data include coronary heart disease, heart failure, stroke and hypertension.

18. A B C D A B C D Blood Pressure (mm Hg)120/80140/90140/90140/90 Total Cholesterol (mg/dL) 200 240 240 240 HDL Cholesterol (mg/dL) 50 50 40 40 Diabetes No No Yes Yes Cigarettes No No No Yes mm Hg = millimeters of mercury. mg/dL = milligrams per deciliter of blood Estimated 10-Year CHD risk in 55-year-old adults according to levels of various risk factors (Framingham Heart Study). Source: Wilson et al., Circulation. 1998;97:1837-47.

19. Annual number of Adults having diagnosed heart attack by age and sex (ARIC: 1987-2000). Source: Extrapolated from rates in the NHLBI’s ARIC surveillance study, 1987-2000. These data don’t include silent MIs.

20. Prevalence of coronary heart disease by age and sex (NHANES :1999-2004). Source: NCHS and NHLBI.

21. Note: Hospital discharges include people discharged alive, dead, and status unknown. Hospital discharges for coronary heart disease by sex (United States: 1970-2004). Source: NHDS, /NCHS and NHLBI. (United States: 1970-2004). Source: NHDS, /NCHS and NHLBI.

22. Prevalence of high blood pressure in Adults by age and sex (NHANES: 1999-2004). Source: NCHS and NHLBI.

23. Extent of awareness, treatment and control of high blood pressure by age (NHANES : 1999-2004.) Source: NCHS and NHLBI.

24. Prevalence of heart failure by age and sex (NHANES: 1999-2004). Source: NCHS and NHLBI.

25. Note: Hospital discharges include people discharged alive, dead and status unknown.. Hospital discharges for heart failure by sex (United States: 1979-2004). Source: NHDS, NCHS and NHLBI.

26. Incidence of Heart Failure* by age and sex. (FHS: 1980-2003). Source: NHLBI. * HF based on physicians review of medical records and strict diagnostic criteria.

27. Prevalence of high school students in grades 9-12 reporting current cigarette smoking by race/ethnicity and sex. (YRBS:2005). Source: MMWR. 2006;55:SS-5. June 9, 2006.. NH – non-Hispanic.

28. Prevalence of current smoking for Adults age 18 and older by race/ethnicity and sex (NHIS:2004). Source: MMWR. 2004;54:1121-24. NH – non-Hispanic.

29. Trends in mean total blood cholesterol among adolescents ages 12-17 by race, sex, and survey (NHES: 1966-70; NHANES: 1971-74 and 1988-94). Source: NCHS and NHLBI.

30. Age-adjusted prevalence of Adults age 20 and older with LDL cholesterol of 130 mg/dL or higher, by race/ethnicity and sex (NHANES: 2003-2004). Source: NCHS and NHLBI. NH – non-Hispanic.

31. Age-adjusted prevalence of Adults age 20 and older with HDL cholesterol <40 mg/dL, by race/ethnicity and sex (NHANES: 2003-2004). Source: NCHS and NHLBI. NH – non-Hispanic.

32. Trends in cardiovascular risk factors in the U.S. population ages 20-74 (NHES: 1960-62, NHANES:1971-75 to 1999-2000). Source: Gregg et al., JAMA 2005;293:1868-74. In this study, high total cholesterol was defined as greater than or equal to 240 mg/dL; high blood pressure was defined as greater than or equal to 140/90 mm Hg.

33. Prevalence of students in grades 9-12 who met currently recommended levels of physical activity during the past 7 days by race/ethnicity and sex (YRBS: 2005). Source: MMWR. 2006;55:No. SS-5. NH – non-Hispanic.

34. Prevalence of leisure-time physical inactivity among adults age 18 and older by race/ethnicity, and sex. (BRFSS: 1994 and 2004). Source: MMWR, 2005;54:No. 39. NH – non-Hispanic.

35. Prevalence of overweight among students in grades 9-12 by race/ethnicity and sex (YRBS: 2005). Source: BMI 95 th percentile or higher. MMWR. 2006 55: No. SS-5. NH – non-Hispanic.

36. Note: Obesity is defined as a BMI of 30.0 or higher. Age-adjusted prevalence of obesity in Adults ages 20-74 by sex and survey (NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004). Source: Health, United States, 2006, unpublished data. NCHS.

37. Trends in prevalence of overweight among U.S. children and adolescents by age and survey (NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004). Source: Health, United States, 2006, unpublished data. NCHS.

38. Trends in Heart Transplants (UNOS: 1970-2005). Source: United Network for OrganSharing (UNOS), scientific registry data.

39. Trends in Cardiovascular Operations and Procedures (United States: 1979-2004). Source: NCHS and NHLBI. Note: Inpatient procedures only.

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

41. Reducing Risk of Heart Disease & Stroke - A Life Long Quest Recognize: Heart Attack & StrokeRecognize: Heart Attack & Stroke –Number 1 Killer in Western World –Prevention is more effective than treatment –Progression of Atherosclerosis –Age & Gender Related Issues –Concept of Risk Factors –Prevention = Risk Factor Control

42. Reducing Risk of Heart Disease & Stroke - A Life Long Quest Understand: Risk Factors for Heart Disease & StrokeUnderstand: Risk Factors for Heart Disease & Stroke –Genetics & Related Issues u Gender, Ethnicity –Diet & Related Issues –Lipids, Calories, Body Weight –Exercise & Related Issues –Types, Duration, Frequency –Blood Pressure Control u Normal, Diet, Medications –Tobacco & Drugs –Metabolic Conditions u Diabetes, SLE, etc.

43. Reducing Risk of Heart Disease & Stroke - A Life Long Quest Medical Care: Detect & Prevent Heart Disease & StrokeMedical Care: Detect & Prevent Heart Disease & Stroke –History of Patient & Family –Physical Examination u Blood Pressure & Cardiac Exam u Blood Lipid Measurements –Exercise Stress Tests u Radionucleide Scans u Echocardiography u MRI & PET Scans –CTT, Cath & Angiography –Education

44. Reducing Risk of Heart Disease & Stroke - A Life Long Quest Five Steps to PreventionFive Steps to Prevention –Diet- Lipids –Exercise - Weight –Hypertension - Diabetes –Tobacco - Drugs –Medical Screening

45. Reducing Risk of Heart Disease & Stroke - A Life Long Quest Four Steps of TherapyFour Steps of Therapy –Risk Factor Control –Education –Medical Care u Pharmaceuticals u Angioplasty u Surgery u Gene Therapy, etc.

46. Reducing Risk of Heart Disease & Stroke - A Life Long Quest More Information?More Information? –Ask Your Physician, Nurse, Parent –The American Heart Association u 1-800-AHA-USA1 u http://www.amhrt.org http://www.amhrt.org –Ask University of Toledo Medical Center u 1-800-383-5454 u http://www.utoledo.edu

47. Reducing Risk of Heart Disease & Stroke - A Life Long Quest Where will you be in 33 seconds?