1. By: Emily Bernhardt HW 499_Unit 4_Power Point Food & Drug Interaction Impact on the Heart

2. Food & Drug Interaction Obesity  “More than 35% of U.S. adults are obese”  “Persons with a body mass index (BMI) of >30 have a reduced life expectancy of 2–4 years less than compared with healthy weight adults; adults with severe obesity (BMI >40) lose 8-10 years of life expectancy, comparable to the effects of smoking”  “On its current trajectory, it is estimated that obesity rates for adults could reach or exceed 44% in every state by 2030” (American Heart Association, 2013)

3. Food & Drug Interaction Heart Disease “Nearly 84 million U.S. adults suffer from cardiovascular diseases (CVD)” “These life-threatening conditions include coronary heart disease, heart failure, stroke, and high blood pressure” “According to a 2012 analysis, sedentary behavior is associated with a 147% increase in the risk of CVD, 90% increase in the risk of CVD mortality, and a 49% increase in the risk of all-cause mortality” (American Heart Association, 2013).

4. Food & Drug Interaction Anticoagulants-a blood thinners Commonly prescribed:  Dalteparin (Fragmin), Danaparoid (Orgaran)  Enoxaparin (Lovenox)  Heparin (various)  Tinzaparin (Innohep)  Warfarin (Coumadin)

5. COUMADIN (WARFARIN) Food & Drug Interaction

6. Coumadin Contains an active ingredient called Warfarin Sodium. When taking Coumadin you do not want to take other medication that contains Warfarin Sodium. Many other medicines, as well as food, beverages and some supplements can interact with COUMADIN and impact the dose you need or increase COUMADIN side effects (FDA, 2013)

7. Foods & Beverage interaction with Coumadin Vitamin K-rich foods, Some vegetable oils: (canola oil, soybean oil) Warfarin less effective, increasing the risk of blood clots. Cranberry juice and cranberry products Increases the risk of bleeding.

8. Foods & Beverage interaction with Coumadin Garlic and ginger Increases the risk of bleeding and reduces warfarin’s effectiveness. Alcohol More than three alcoholic drinks per day, enhances blood thinning. More information: http://www.med.unc.edu/im/files/ patient-education- handouts/nutrition-and-diet- files/Vitamin%20K%20%20Content %20of%20Common%20Foods.pdf

9. Supplements interaction with Coumadin Herbal teas, green tea, St. John's Wort & Coenzyme Q-10 Can make warfarin more or less effective. Gingko Increases the risk of bleeding. Ginseng Decreases the effectiveness of warfarin. Glucosamine Reduces warfarin’s effectiveness (Harvard Heart Letter, 2013)

10. FOOD & DRUG INTERACTION “Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088” (FDA, 2013).

11. References: American Heart Association (AHA). (2013). Cardiac Medications. Received August 18, 2013 from http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Cardiac- Medications_UCM_303937_Article.jsp American Heart Association (AHA). (2013). FACTS-Breaking Our Hearts: Still America’s No.1 Killer NIH Funding for Heart and Stroke Research. Received August 18, 2013 from http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_304822.pdf American Heart Association (AHA). (2013). FACTS : With a Very Heavy Heart, Obesity and Cardiovascular Disease (CVD). Received August 18, 2013 from http://www.heart.org/idc/groups/heart- public/@wcm/@adv/documents/downloadable/ucm_305059.pdf Food and Drug Administration (FDA). (2013). Medication Guide: Coumadin. Received August 18, 2013 from http://www.fda.gov/downloads/Drugs/DrugSafety/ucm088578.pdf Med UNC. (2013). Vitamin K Content of Common Foods. Received August 2, 2013 from http://www.med.unc.edu/im/files/patient-education-handouts/nutrition-and-diet- files/Vitamin%20K%20%20Content%20of%20Common%20Foods.pdf Harvard Heart Letter. (2013, June 1). Avoid these with heart medications. Received August 18, 2013 from http://ehis.ebscohost.com.lib.kaplan.edu/eds/pdfviewer/pdfviewer?sid=c9492d79-c8f4-468c-9d99- 25283a8fc92a%40sessionmgr15&vid=7&hid=15 Tufts University Health & Nutrition Letter. (2013, May 1). Understanding Food and Medication Interactions. Received August 18, 2013 from http://ehis.ebscohost.com.lib.kaplan.edu/eds/detail?vid=4&sid=c9492d79-c8f4- 468c-9d99- 25283a8fc92a%40sessionmgr15&hid=15&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=hxh&AN=87374640