Staying Healthy Kim F Gibson, MD, FACP NNMC Bethesda The Key to Your Heart

Demographics Today 13% of Americans > 65 yrs old Today 13% of Americans > 65 yrs old By % will be older than 65 By % will be older than 65 Over the next decade the most rapid population increase will be in the age group > 85 yrs old Over the next decade the most rapid population increase will be in the age group > 85 yrs old MOST OF THOSE INDIVIDUALS ARE WOMEN MOST OF THOSE INDIVIDUALS ARE WOMEN Growing old is not for sissies!

What is the Goal? Health is a state of complete physical, mental, spiritual and social well-being, and not merely the absence of disease or infirmity. Health is a state of complete physical, mental, spiritual and social well-being, and not merely the absence of disease or infirmity. We must continuously improve our function, not simply delay “inevitable” losses. We must continuously improve our function, not simply delay “inevitable” losses. Reaching Your Potential

Top 10 Threats to Women’s Health 1. Heart Disease 2. Cancer 3. Stroke 4. COPD (chronic lung disease) 5. Alzheimer’s Disease 6. Injuries 7. Type II Diabetes 8. Flu 9. Kidney Disease 10. Blood Poisoning (Septicemia) Mayo Clinic

Top 10 Threats to Men’s Health 1. Heart Disease 2. Cancer 3. Injuries 4. Stroke 5. COPD (chronic pulmonary disease) 6. Type II Diabetes 7. Flu 8. Suicide 9. Kidney Disease 10. Alzheimer’s Disease Mayo Clinic “Live sensibly – among 1000 people, only one dies a natural death…”

Where to Start? Keep your heart healthy Keep your heart healthy Don’t smoke Don’t smoke Maintain weight Maintain weight Get restful sleep Get restful sleep Keep your bones strong Keep your bones strong Foster sexuality Foster sexuality Stay current with health maintenance Stay current with health maintenance Exercise your mind Exercise your mind Be resilient Be resilient Fuel your spiritual growth Fuel your spiritual growth What is the goal?

Cardiovascular Disease Leading cause of death in women and men Leading cause of death in women and men 1 in 2 men have CV disease 1 in 2 men have CV disease 1 in 3 women die of heart disease 1 in 3 women die of heart disease 25% adults experience sudden death as first indication 25% adults experience sudden death as first indication Coronary heart disease mortality higher in women than men Coronary heart disease mortality higher in women than men Keep your heart healthy

Cardiovascular Disease ■ Coronary heart disease ■ Cerebrovascular disease ■ Peripheral vascular disease ■ Aortic atherosclerosis Diagnostic Categories

Coronary Heart Disease

Non-modifiable Age: Age: (men >45 / women >55) Gender Gender FH Early CAD FH Early CAD (men >55 / women >65) Elevated CRP Elevated CRP Modifiable Tobacco Hypertension Total / LDL Cholesterol HDL Cholesterol Diabetes Elevated BMI Physical Inactivity Atherogenic Diet Cardiac Risk Factors

Coronary Heart Disease Lipid profile measures: Lipid profile measures: Total cholesterol Total cholesterol HDL cholesterol HDL cholesterol LDL cholesterol LDL cholesterol Triglycerides (TG) Triglycerides (TG) Strong genetic component Strong genetic component Significant impact on risk of CHD Significant impact on risk of CHD Treatment goals influenced by age, sex and risk assessment Treatment goals influenced by age, sex and risk assessment Lipid Disorders

Coronary Heart Disease 90% CHD events predicted by presence of risk factors 90% CHD events predicted by presence of risk factors Framingham risk prediction Framingham risk prediction Risk helps plan treatment Risk helps plan treatment Intermediate risk may require additional testing Intermediate risk may require additional testing Cardiac Risk Assessment

Cardiac Risk Reduction CVD mortality has declined since 1975 CVD mortality has declined since 1975 Earlier diagnosis Earlier diagnosis More aggressive treatment More aggressive treatment Reduction in risk factors Reduction in risk factors Lowest risk category rare Lowest risk category rare Focus on lifestyle modification Focus on lifestyle modification Role of aspirin, statins and fish oil Role of aspirin, statins and fish oil Primary Prevention It’s never too late to start!

Cardiac Risk Reduction Smoking Smoking Dyslipidemia Dyslipidemia Hypertension Hypertension Diabetes Diabetes Abdominal Obesity Abdominal Obesity Psychosocial factors Daily consumption of fruits / vegetables Regular alcohol intake Regular physical activity Modifiable Risk Factors

Cardiac Risk Reduction Exercise daily (150 min/week) Exercise daily (150 min/week) Don’t smoke Don’t smoke Weight maintenance Weight maintenance Mediterranean diet Mediterranean diet Treat hypertension, diabetes, high cholesterol Treat hypertension, diabetes, high cholesterol Lifestyle Modifications

Cardiovascular Fitness Exercise has protective effect Exercise has protective effect Impacts all other risk factors Impacts all other risk factors Focus on aerobic activities Focus on aerobic activities AHA recommends 150 minutes/week AHA recommends 150 minutes/week

Physical Activity Endurance, Flexibility and Strength Aerobic exercise = 150 minutes / week Aerobic exercise = 150 minutes / week Diversify your workout Diversify your workout Importance of weight resistance Importance of weight resistance Improve your flexibility Improve your flexibility Concept of NEAT Concept of NEAT (Non-exercise activity thermogenesis ) (Non-exercise activity thermogenesis )

Tobacco Abuse Leading preventable cause of all deaths Increases CHD and all-cause mortality Augments effects of other risk factors Risk of heart disease falls rapidly after cessation Prevention is the key – STOP SMOKING

Obesity 65% adults overweight or obese 65% adults overweight or obese BMI based on height and weight BMI based on height and weight >30% = overweight, >35% = obese >30% = overweight, >35% = obese Increases all-cause and CHD mortality Increases all-cause and CHD mortality Interacts with other risk factors Interacts with other risk factors Predisposes to sleep apnea Predisposes to sleep apnea Critical role of exercise Critical role of exercise The Hard Cold Facts You only have to exercise on the days you eat!

Healthy Eating 6-9 servings of fruits and vegetables daily 6-9 servings of fruits and vegetables daily Grains and fiber Grains and fiber High protein, low fat, low carbs High protein, low fat, low carbs Omega-3 fatty acids (fish) Omega-3 fatty acids (fish) Portion control Portion control No salt or sugar No salt or sugar Limit caffeine and alcohol Limit caffeine and alcohol Avoid processed foods Avoid processed foods Balance, Moderation and Variety

Healthy Eating DO:DON’T: Fill up on fiberMiss out on sleep Downsize Skip breakfast Veg outEat standing up Limit your caloriesEat in the dark Habits, NOT Diets!! You only have to exercise on the days you eat

Cardiovascular Drug Therapy Preventive vs Targeted Therapy Preventive vs Targeted Therapy Aggressive management of: Aggressive management of: Known coronary heart disease Known coronary heart disease Hypertension Hypertension Hyperlipidemia Hyperlipidemia Diabetes Diabetes Role of Aspirin in primary prevention Role of Aspirin in primary prevention Benefit of Alcohol Benefit of Alcohol Fish Oil supplementation Fish Oil supplementation Tried and True Remedies

Alternative Drug Therapies ■ No evidence for CVR benefit with vitamin C, E, beta- carotene ■ No evidence for CVR benefit with folate and B vitamins ■ Co-enzyme Q10 ■ Hawthorn extract Evidence Pending…

Prevention Strategies ■ Educate yourself ■ Know your risk factors ■ STOP smoking!! ■ Exercise 150min/week ■ Modify diet ■ Seek treatment for high BP, high cholesterol and diabetes ■ Listen to warning signs Keep your heart healthy!