2. CARDIOVASCULAR DISEASE (CVD) “RISKY BUSINESS” CARDIOVASCULAR DISEASE (CVD) “RISKY BUSINESS” Rhonda Jones, RN, BSN, CHES, CCM MESSA Health Promotion Consultant

3. THE LOSS Cardiovascular disease is the leading cause of death in the United States and is a major cause of disability. Almost 652,091 people die of heart disease in the U.S. each year. Someone dies of a heart attack or a stroke every 33 seconds. Strokes are the 3rd leading cause of death in the U.S. The cost of cardiovascular diseases and stroke in the United States in 2009 is estimated to be…………. $475.3 BILLION

4. MAKE THE RIGHT INVESTMENTS IN YOUR HEALTH TO DECREASE YOUR RISK FACTORS FOR HEART DISEASE $ $ $ $ $ $ $ $ $ $ $

5. BASELINE PORTFOLIO NON-MODIFYABLE RISK FACTORS AGE Advanced age significantly raises the risk of heart attacks or strokes. For men, being 45 years or older and for women, being 55 years or older. This doesn’t mean that younger people are immune. GENDER Women develop heart disease about 10 years later in life than men. This difference is attributed o the protective effects of estrogen before menopause. Women’s risk rises after menopause, but it still remains lower than men’s in the same age group. Each year more women than men have a stroke. HEREDITY/ETHNICITY If your parents have heart disease it is more likely that you will develop it. African-Americans have more severe high blood pressure than Caucasians and a higher risk of cardiovascular disease. Risks are also higher for Mexican Americans, American Indians and Pacific Islanders.

6. BAD INVESTMENTS Modifiable risk factors ABNORMAL CHOLESTEROL When there is excess LDL or Triglycerides in the blood it is deposited in the arteries, causing them to become narrow, preventing sufficient amounts of blood flow and oxygen. HDL provides for “reverse cholesterol transport”. Insufficient HDL prevents adequate amounts of cholesterol from being moved back to the liver and eventually removed from the body. LDLHDLTRIGLYCERIDES >160 low risk <40>150 >130 moderate risk >100 high risk

7. BAD INVESTMENTS Modifiable risk factors HIGH BLOOD PRESSURE High blood pressure is a condition when the pressure in the blood flowing inside the arteries is too high. The high pressure causes the arteries to become thick and less pliable and the heart muscle begins to thicken and enlarge resulting in improper function. BP CLASSSYSTOLICDIASTOLIC Normal<120AND<80 Pre- hypertension (HTN) 120 - 139OR80 – 89 Stage 1 HTN140 - 159OR90 – 99 Stage 2 HTN>160OR> 100

8. BAD INVESTMENTS Modifiable risk factors Tobacco Use Cigarette smoking promotes hardening and narrowing of the arteries. It increases the levels of blood clotting factors causing the blood to become thick and sticky increasing chances of blood clot formation. The carbon monoxide being inhaled from the cigarette reduces the amount of oxygen that the blood can carry. Exposure to secondhand smoke narrows the arteries of non-smokers.

9. BAD INVESTMENTS Modifiable risk factors OBESITY and OVERWEIGHT Excess weight especially around the waist increases the work of vital organs. Inactivity and weight gain can increase insulin resistance in the body’s cells. Insulin resistance can lead to type II diabetes which is also a condition that is a risk factor for CHD. Body Mass IndexWaist Circumference Underweight- Below 18.5Women > 35 Normal - 18.5 - 24.9 Men > 40 Overweight - 25.0 - 29.9 Obesity - 30.0 and Above

10. BAD INVESTMENTS Modifiable risk factors PHYSICAL INACTIVITY Inactivity is when someone sits in a chair more than walking or engaging in physical activity (AHA). An inactive lifestyle can lead to a decrease in insulin sensitivity, obesity and overweight. Excess body fat especially around the waist (central adiposity) increases the work of vital organs. Adipose cells secrete chemicals that increase systemic inflammation. STRESS/DEPRESSION Chronic stress, the type of stress that seems never-ending and inescapable. Depression sometimes occurs due to a byproduct of cortisol released during stress acts as a sedative that contributes to feelings of being blue or depressed.

11. BAD INVESTMENTS Modifiable risk factors Poor Dietary Patterns Processed food Saturated fat/Animal fat Inadequate vegetables/fruit Excess Alcohol

12. Atherosclerosis Atherosclerosis is the underlying disease process. Atherosclerosis is the underlying disease process. Individuals can have atherosclerosis throughout the arteries of the circulatory system. Individuals can have atherosclerosis throughout the arteries of the circulatory system. When plaque leads to an occlusion of a coronary artery, a myocardial infarction (MI) occurs. When plaque leads to an occlusion of a coronary artery, a myocardial infarction (MI) occurs. When an occlusion blocks circulation to the brain, a cerebral vascular accident (CVA) occurs. When an occlusion blocks circulation to the brain, a cerebral vascular accident (CVA) occurs. Atherosclerosis in the legs is called peripheral artery disease (PAD). This results in intermittent claudication, which is described as pain in the legs when walking. Atherosclerosis in the legs is called peripheral artery disease (PAD). This results in intermittent claudication, which is described as pain in the legs when walking. Atherosclerosis can also weaken part of the aorta and contribute to abdominal aortic aneurysms (AAA). Atherosclerosis can also weaken part of the aorta and contribute to abdominal aortic aneurysms (AAA).

13. HEALTHY ARTERY A healthy artery consists of 3 layers: – 1.) Intima – 2.) Media –3.) Adventitia

14. The Atherosclerotic process Low Density Lipoprotein (LDL) particles similarly enter the intima. Low Density Lipoprotein (LDL) particles similarly enter the intima. Cholesterol in the LDL is modified by oxidation or glycation. Cholesterol in the LDL is modified by oxidation or glycation. Foam cells are created by a combination of LDL and a type of white blood cell (WBC) called macrophages. Foam cells are created by a combination of LDL and a type of white blood cell (WBC) called macrophages. Foam cells release cytokines prompting an immune response attracting more WBC. Foam cells release cytokines prompting an immune response attracting more WBC. The accumulation of WBC, including the foams cells, forms the “fatty streak” within the artery wall. Fatty streaks are the beginning of the atherosclerotic lesion. The accumulation of WBC, including the foams cells, forms the “fatty streak” within the artery wall. Fatty streaks are the beginning of the atherosclerotic lesion. The fatty streaks develop a fibrous cap made up of smooth muscle cells that originated in the media of the artery. This is now referred to as plaque. The fatty streaks develop a fibrous cap made up of smooth muscle cells that originated in the media of the artery. This is now referred to as plaque.

15. The Atherosclerotic process The process continues with accumulation of smooth muscle cells and calcium, (causing calcification and hardening of the plaque) resulting in a complicated lesion. The process continues with accumulation of smooth muscle cells and calcium, (causing calcification and hardening of the plaque) resulting in a complicated lesion. The artery can become completely occluded by either: The artery can become completely occluded by either: Continued build-up of plaque Continued build-up of plaque Fibrous cap bursts, the lipid core enters the lumen and is attacked as a foreign substance and a thrombus forms and blocks flow of blood through lumen. Fibrous cap bursts, the lipid core enters the lumen and is attacked as a foreign substance and a thrombus forms and blocks flow of blood through lumen.

16. MEDICAL APPROACHES TO LOWERING RISK Cholesterol lowering medications Cholesterol lowering medications Blood Pressure lowering medications Blood Pressure lowering medications ASA, PLAVIX, ETC ASA, PLAVIX, ETC

17. ALTERNATIVE APPOACHES Omega 3 Fatty Acids Omega 3 Fatty Acids Red Yeast Rice Red Yeast Rice Co-enzyme Q-10 (ubinque) Co-enzyme Q-10 (ubinque)

18. LIFESTYLE APPROACHES CARDIOVASCULAR EXERCISE CARDIOVASCULAR EXERCISE –Assists with weight lose/maintenance efforts –Improves cardiovascular endurance by strengthening heart muscle –Builds collateral circulation –Decreases negative effect of stress by way of beta-endorphin release (elevates mood). –Improves insulin sensitivity –Decreases systemic inflammation

19. LIFESTYLE APPROACHES –Accumulate a minimum of 30 minutes moderate- intensity physical activity, on most and preferably all, days of the week. –For weight loss or weight loss maintenance: accumulate 60 to 90 minutes of moderate-intensity physical activity.

20. LIFESTYLE INTERVENTIONS Healthy Eating Pattern –H–H–H–High intake of VEGETABLES and fruit. EEEEnsure adequate vitamins, antioxidants and minerals. –H–H–H–High fiber foods –W–W–W–Whole grains –C–C–C–Consume fish at least 2x/week

21. LIFESTYLE INTERVENTIONS –Limit saturated fat <7-10% –Cholesterol <300 mg a day –No more than 1 drink a day for Women, 2 for Men. –Less than 2.3 grams of sodium a day –Low sugar –Minimal processed food

22. LIFESTYLE INTERVENTIONS Stress Management Techniques –Optimism –Laughter –Altruism –Hobbies –Music

23. LIFESTYLE INTERVENTIONS Rhonda’s Remedy for Relief from Stress –E–E–E–Embrace Your Faith –P–P–P–Pray/Meditate –E–E–E–Exercise (get your heart rate up!) –E–E–E–Exercise some more (GET SWEATY) –L–L–L–LOVE yourself –T–T–T–Treat everyone with RESPECT