1. Heart Disease Effects of lifestyle on coronary heart disease Sara Quale ∙ Concordia University-Nebraska 1

2. What is heart disease? Heart disease kills more people each year than anything else. It strikes people of different race, age, and gender. It becomes more prevalent with age. It is caused by both genetic and lifestyle factors. 2

3. Epidemiological Factors 3 Causes of diseaseTrends in the populationResults of treatments

4. Annually, heart disease kills more people than anything else. 4

5. Heart disease becomes more prevalent with age. 5

6. Heart Disease Age-adjusted death rates by Race/Ethnicity 6 Heart Disease death rates by gender, all races

7. 7 Non-modifiable Risk Factors Age Genetics Modifiable Risk Factors High cholesterol High blood pressure Diabetes Smoking Obesity Physical Inactivity

8. 8 Biostatistical Factors Data collectedHow it’s used

9. Framingham Heart Study Researchers followed a large group of Framingham, Mass., residents who did not have cardiovascular disease or previous heart attacks. Each person received a physical every 2 years to track changes in heart health. 9

10. Heart Disease High Blood Pressure High Cholesterol SmokingObesityDiabetes Physical Inactivity 10 Through the study, researchers learned the major risk factors for developing heart disease.

11. In 1913 Nikolai Anichkov found that cholesterol caused changes in the vascular wall – atherosclerosis. This led to better understanding of the role between cholesterol and heart disease. 11

12. With information, public health advocated for primary and secondary preventions measures. 12 Primary prevention is eating healthy and avoiding the main sources of cholesterol. Secondary prevention is taking steps to monitor your health.

13. After decades of research on ways to treat high cholesterol, Merck offered the first commercial statin in 1987. That type of drug in 2010 was given to about 30 million people worldwide. 13

14. Biomedical Basis 14

15. Atherosclerosis – hardening of the arteries – is a major cause of heart disease. Plaque from cholesterol and other material builds up around the arterial wall. The artery narrows and restricts blood and oxygen flow. 15

16. When the flow is blocked entirely because the artery becomes too narrow or a clot breaks off and lodges in the artery, the person may have a heart attack. 16

17. 17 Cigarette smoking damages blood cells and arteries, which also contributes to plaque buildup. Smoking and second hand smoke can lower good cholesterol levels, raise blood pressure and damage heart tissue.

18. Social/behavioral factors 18 Belief in riskBelief in severityBelief that there’s hope

19. 19 Barriers to overcoming heart disease Lack of access to healthy food options Easy access to unhealthy fast foods and tobacco in poor urban areas Lack of access to recreational places for physical activity Poor access to healthcare resources and screenings Even if those are overcome, people still don’t feel they can be successful.

20. Steps to improve 20

21. 21 Intrapersonal: Get to know your family physician. Participate in regular screenings. Interpersonal: Eat healthy and exercise as a family. If an emergency arises, be prepared.

22. 22 Institutional: Strong continuity of care in healthcare systems will help patients who have heart disease manage their illness better. Community: Increase community and home gardening opportunities to increase access to healthy foods.

23. 23 Public Policy: Continued efforts to enforce tobacco laws, policies to limit access to fast foods and sugary drinks. Encourage participation by private businesses in educational outreach.

24. References 1.Atherosclerosis (February 2013). American Heart Association. Retrieved from http://www.heart.org/HEARTORG/Conditions/Cholesterol/WhyCholesterolMatters/Atherosclerosis_UCM_30556 4_Article.jsp 2.Framingham Heart Study, (Dec. 10, 2012). Risk score profiles. Retrieved from http://www.framinghamheartstudy.org/ http://www.framinghamheartstudy.org/ 3.Freeman, M., MD; Jung, C. (2005). The Harvard Medical School Guide to Lowering Your Cholesterol, McGraw- Hill Companies, Retrieved from http://www.health.harvard.edu/newsweek/Understanding_Cholesterol.htm 4.Heart Disease Fact Sheet, (Oct. 18, 2012). Centers for Disease Control. Retrieved from http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_disease.htm 5.How does smoking affect the heart and blood vessels? (Dec. 20, 2011). National Heart, Lung, and Blood Institute. Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/smo/ 6.Lower heart disease risk (Feb. 29, 2012). National Heart Lung and Blood Institute. Retrieved from http://www.nhlbi.nih.gov/educational/hearttruth/lower-risk/risk-factors.htm 7.Million Hearts TM (2013). About heart disease & stroke. Retrieved from http://millionhearts.hhs.gov/abouthds/overview.html 8.Outcome measures, Centers for Medicare and Medicaid (Jan. 19, 2013). CMS.gov. Retrieved from http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/HospitalQualityInits/OutcomeMeasures.html 9.Proceedings of the Japan Academy, Series B Physical and Biological Sciences, (May 10, 2010). U.S. National Library of Medicine, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/ 10.Roger, MD, Veronique; et al, (2012). AHA statistical update. Retrieved from http://circ.ahajournals.org/content/125/1/e2.full http://circ.ahajournals.org/content/125/1/e2.full 11.Schneider, Mary-Jane, (2011). Introduction to public health 3rd ed., p. 180 12.State smoke-free laws (April 22, 2011). Morbidity and Mortality Weekly Report, CDC, Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6015a2.htm 13.Texas Heart Institute Journal, (2006). U.S. National Library of Health Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764970 / http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764970 / 24