 #1 health concern in USA  38% of all deaths  1 in 2.7 Americans die from CVD  80 million Americans suffer from some form of CVD  Lower educational levels directly associated with increased deaths from CVD

 2009 cost estimated at $475.0 billion.  1 death from CVD every 35 seconds-2600 Americans each day.  Coronary heart disease (CHD) by itself is still the single largest cardiovascular killer

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

Intima Adventitia Media Left Main CA Circumflex Left Anterior Descending CA Right CA Marginal Branch Layers of the Arterial Wall

Dead Heart Muscle

Ischemic StrokeHemorrhagic Stroke

Sudden Cardiac Death (SVD) vs. Myocardial Infarction (MI) Who: Men 2 X Ages What: 325,000 deaths 50% of all CVD deaths Why: arrhythmia =ventricular fibrillationarrhythmia Risk: Previous MI (V. tach or V Fib. After MI) CAD Smoking, Obesity, Diabetes, Hypercholestermia Family History

Primary Controllable Risk Factors Primary Uncontrollable Risk Factors 1.Smoking/Tobacco Use 2.Hypertension 3.High Blood Cholesterol (Hyperlipidemia) 4.Physical Inactivity 5.Obesity and Overweight 6.Diabetes Mellitus 1.Heredity 2.Gender 3.Increasing Age

Contributory Risk Factors 1.Stress 2.Excessive Alcohol Consumption

 Metabolic Syndrome (syndrome X)= 3 or more of the following 1. BP > 130/85 2. Fasting Blood Sugar ≥ 100 mg/dl 3. Triglycerides ≥ HDL ≤ 40 for men, 50 for women 5. Obesity ≥ waist 35 inches for women, 40 inches for men.

Blood Pressure Stages (mm Hg) Category Systolic Diastolic Normal < 120 and < 80 Pre-hypertension or High or Hypertension Stage or Stage or higher or 100 or higher

Extent of Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity (NHANES: ). Source: NCHS and NHLBI.

Healthy Arterial Blood Flow Restricted Blood Flow hypertension-overview

 Primary cause of arterial plaque.  Cholesterol is a waxy/fatty substance made in the liver (80%) and found in the bloodstream.  Cell structure, digestion, and adrenal glands.  Triglycerides are made in the body to store excess fats – free fatty acids.

 High cholesterol is termed hypercholestermia.  Cholesterol must attach to a protein to be carried in the blood stream.  Low Density Lipoprotein (LDL) are dangerous to the arteries and accelerate plaque formation.  High Density Lipoprotein (HDL) can protect the system from plaques.  Triglycerides should be below 150 mg/dL.

Where Does Cholesterol Come From?

How Cholesterol Works Cholesterol helps carry digested fat from the liver to destinations throughout your body, using the blood vessels as a highway

Cholesterol-The Numbers (mg/dL ) Risk Total Cholesterol LDL HDL Desirable 60 Borderline High N/A High ≥ 240 > 160 <40 cholesterol

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

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

 Increases heart rate  Increases blood pressure  constricts blood vessels  impairs transportation of O2  decreases HDL  increases LDL  can damage artery walls  increases blood clotting.

 Diabetes is a disease that affects how the body uses glucose.  Type 1: 6% of all diabetes. Body produces no insulin.  Type 2: 90% of all diabetes. It is characterized by the body’s inability to produce enough insulin or use it properly.

Children born in 2003:

Prevalence of Non-Insulin-Dependent (Type 2) diabetes in Adults age 18+ by Race/Ethnicity, and Years of Education (NHANES: ). Source: NCHS and NHLBI.

Symptoms of type 1 diabetes Increased thirst Increased urination Weight loss in spite of increased appetite Fatigue Nausea Vomiting Symptoms of type 2 diabetes Increased thirst Increased appetite Fatigue Blurred vision Slow-healing infections Impotence in men

Risk Factors for Type 2 Diabetes Overweight (Fat) and Obesity Physically Inactive Family history of diabetes Age over 45 Low HDL Race Women with gestational diabetes

RETINOPATHY

Blood Glucose Levels (mg/dl) Fasting Blood Glucose < 110 Normal ≥126 On two or more tests indicates diabetes Random Blood Glucose > 200 indicates diabetes

Pre Diabetes: Insulin Resistance Fasting Blood Glucose level between 100mg/dl and 125mg/dl

Age 45 or older every 3 yrs. fasting blood glucose Age 35 if: Overweight Family history Non-white Gestational diabetes or baby over 9 pounds HDL 250 Hypertension or on medication for Minimally elevated glucose level on previous tests

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

How to Protect Your Heart 1.Exercise regularly 2.Maintain Normal Body Fat Levels 3.Eat a low saturated fat, high complex carbohydrate, high fiber diet. 4.Don’t smoke 5.Control stress 6.Know early signs and symptoms of Angina Pectoris, Heart Attack, and Stroke 7.Know your family’s heart history