1. Cardiovascular Health
Chapter 11

2. Test Your Knowledge
Women are about as likely to die of cardiovascular disease as they are to die of breast cancer? True or False
How much earlier, on average, do sedentary people develop heart disease compared with people who exercise?
6 months, 2 years, 6 years
Which of the following foods would be a good choice for promoting heart health?
Tofu
Salmon
Bananas

3. Answers
False. CVD kills far more. Among American women, about 1 in 2 deaths is due to CVD and about 1 in 30 is due to breast cancer.
6 years. Both endurance exercise and strength training significantly improve cardiovascular health.
ALL THREE! Soy protein (tofu), foods with omega-3 fatty acids (salmon) and foods high in potassium and low in sodium (bananas) all improve cardiovascular health.

4. Cardiovascular Health
Cardiovascular disease (CVD) is a disease of the heart and blood vessels.
CVD is the leading cause of death in the U.S.
CVD claims one life every 37 seconds, about 2400 Americans each day.
CVD is largely a result of our way of life.
CVD is the results from high-fat diets, an overweight, sedentary lifestyle, smoking, poor stress management, HTN, hypercholesteremia and lack of knowledge of the signs and symptoms of CVD or denial of symptoms.
More than one out of every 5 Americans suffers from some form of CVD.
Most body functions and body tissues rely on the cardiovascular system – heart, blood, and blood vessels.

5. Cardiovascular Disease

6. Risk Factors
Risk Factors are genetic tendencies or learned behaviors that increase the chances of disease. The more risk factors a person has, the greater the likelihood of developing the disease.
MAJOR RISK FACTORS THAT CAN’T BE CHANGED
Heredity – Children of parents with CVD are more likely to develop it themselves. It is not your destiny, but you may have to work harder to prevent it.
Being Male –CVD is the leading killer of both men and women in the U.S. but men face a greater risk of heart attack than women, especially earlier in life. Estrogen production may offer premenopausal women some protection against CVD.
Age – The risk of heart attack increases significantly after age 65. Over 70% of all heart attack victims are over age 65.
Race/Ethnicity – Death rates from heart disease vary among the ethnic groups. African Americans have a much higher rate of HTN, heart disease and stroke than other groups. Asian Americans historically have had lower rates of CVD than white Americans.

7. Risk Factors Major Risk Factors That Can Be Changed
Cigarette/Tobacco Use – About 1 in 5 deaths from CVD can be contributed to smoking. 1 ppd = 2 times the risk of CAD. 2 or more ppd = 3x the risk.
Women who smoke and use contraceptives have 39 times more risk of heart attack and 22 times more likely to have a stroke than women who do not smoke and take contraceptives.
When smokers have heart attacks they are 2-4 times more likely than nonsmokers to die from them.
Smoking damages the linings of the arteries, decreases HDL’s, raises LDL’s and triglycerides, increases HR and BP and causes platelets to be stickier.
Carbon monoxide in smoke displaces oxygen in the blood, reducing the amount of oxygen available to the heart.

8. Risk Factors That Can Be Changed
Blood Pressure – It is the force exerted against the walls of the arteries. High blood pressure (hypertension) = sustained abnormally high blood pressure
Systole = pressure when heart contracts
Diastole = pressure when heart relaxes
High blood pressure strains the heart, damages the arteries, and increases risk of heart attack, stroke, kidney failure, and blindness
Reduce with regular exercise, healthy diet (reduced salt, increased potassium and fiber), and moderation of alcohol intake

9. Blood Pressure Classification
Category
Systolic
(mm Hg)
Diastolic
Normal
Below 120
and
Below 80
Prehypertension
120–139 or
80–89
Hypertension
Stage 1
Stage 2
140–159
160 and above
90-99
100 and above

10. Risk Factors That Can Be Changed
Cholesterol – Refers to the fatty substance that circulates the blood stream and is an important component for cell membranes, sex hormones, nerves. Excess cholesterol can clog arteries and ↑ risk for CVD.
~ Any body who has a liver produces cholesterol! Also obtained through the foods we eat.
~Cholesterol is carried in protein-lipid packages called lipoproteins, the shuttles that carry cholesterol to and from the liver through the circulatory system.
Low-density lipoprotein (LDL) = unhealthy (“bad”) cholesterol; excess amounts are deposited in artery walls
High-density lipoprotein (HDL) = healthy (“good”) cholesterol; shuttle unused cholesterol back to the liver for recycling
Levels can be improved by quitting smoking, exercising, and improving diet (less saturated and trans fat, more fruits, vegetables, fiber, and whole grains)
Cholesterol Testing should begin at the age of 20!

11. Cholesterol Guidelines
LDL cholesterol (mg/dl)
Less than 100
Optimal
100–129
Near optimal/above optimal
130–159
Borderline high
High
190 or more
Very high
Total cholesterol (mg/dl)
Less than 200
Desirable
200–239
240 or more
HDL cholesterol (mg/dl)
Less than 40
Low (undesirable)
60 or more
High (desirable)

12. Figure 11.1 Travels with Cholesterol

13. Risk Factors That Can Be Changed
~Physical Inactivity – Is a major modifiable risk factor for CHD. Exercise is the closest “magic bullet” against heart disease.
25% of the population do not perform any physical activity
60% of the population do not get the recommended amount of exercise
As little as 3 hours/week of walking reduces the risk
~ Obesity – In 1998, obesity was declared a major risk factor for heart disease. Greater than 30% are above the recommended weight.
+ Obesity is also a risk factor for HTN, Diabetes and high cholesterol. Fat distribution is also an important factor (apple).

14. Risk Factors That Can Be Changed
Diabetes – A metabolic disorder where the body is unable to regulate the level of glucose (sugar) in the blood. Elevated blood sugar levels damage the lining of the arteries, making them more vulnerable to atherosclerosis.
Type II diabetes can be prevented or delayed by eating a healthy diet, exercise and maintaining a healthy body weight.
Exercise helps to lower the risk of diabetes as it helps to control weight and enhances the cellular sensitivity to insulin.

15. Contributing Risk Factors
Triglycerides – Greater than 190 mg/dl tends to increase blood thickness resulting in sluggish blood flow which makes it more difficult in delivering oxygen and nutrients to the heart.
Triglycerides (mg/dl)
Less than 150
Normal
150–199
Borderline high
200–499
High
500 or more
Very high

16. Possible Risk Factors Under Study
Metabolic syndrome, also known as syndrome X or insulin resistance syndrome
Abdominal obesity (waist circumference)
Greater than 40 inches in men
Greater than 35 inches in women
High blood pressure (130/85 or higher)
High triglycerides (150 mg/dl or higher)
Low HDL cholesterol
Below 40 mg/dl in men
Below 50 mg/dl in women
Insulin resistance (glucose of 110 mg/dl or higher)
Homocysteine – It is an amino acid that is derived from food. It functions to manufacture protein to build and maintain body tissues. It is carried in the blood and normally broken down. But when this does not occur, levels rise and it is a risk for CVD. It damages the lining of the arteries. Levels can be controlled with diet. B vitamins, folate, especially important to break down homocysteine

17. Women and CVD Women underestimate their CVD risk
Nearly 1 in 2 women dies from CVD
About 1 in 30 women dies from breast cancer
Women are protected from CVD at younger ages by natural estrogen
After menopause, women are more likely than men to die after a heart attack
Women are more likely to have a heart attack without chest pain

18. African Americans and CVD
Blacks have higher rates of hypertension and stroke
Genetic, biological, and lifestyle factors may play a role
Lifestyle changes can reduce risk, as can medical treatment

19. Types of Cardiovascular Diseases
Atherosclerosis:
Arteries are narrowed by deposits of fat, cholesterol, and other substances called plaques
Once narrowed by a plaque, an artery is vulnerable to blockage by blood clots
Blockage in the coronary arteries (coronary heart disease) can lead to a heart attack
Blockage in the brain can cause a stroke

20. Atherosclerosis
Figure 11.3

21. Heart Disease and Heart Attacks
Heart attack (myocardial infarction) = Damage to, or death of, heart muscle, sometimes resulting in a failure of the heart to deliver enough blood to the body; myocardial infarction.
Angina pectoris (chest pain) = A condition in which the heart muscle does not receive enough blood, causing severe pain in the chest and often in the left arm and shoulder.
Arrhythmia = An irregularity in the force or rhythm of the heartbeat.
Sudden cardiac death = A nontraumatic, unexpected death from sudden cardiac arrest, most often due to arrhythmia (in association with underlying heart disease).

22. Heart Disease
Peripheral Vascular Disease – Disease of the peripheral vessels. The lack of proper circulation (caused by blockages in arteries that feed the legs) may cause fluids to pool in the extremities. Symptoms include leg pain, cramping, numbness, tingling, coldness and loss of hair to the affected limbs. The disease process may be extensive before the person is symptomatic, as the heart and brain are more sensitive to a decreased blood flow as compared to the extremities.

23. Heart Attack Signs and Symptoms of a Heart Attack
Symptoms of heart attack require immediate action.
Signs and Symptoms of a Heart Attack
~Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest that lasts longer than 2 minutes.
~Pain that spreads to the shoulders, arms, back , stomach or neck.
~Severe pain, dizziness, fainting, sweating, nausea, or shortness of breath can occur.
Heart Attack: Anyone experiencing symptoms of a heart attack should seek immediate medical care.
Source: Keith Brofsky/Getty Images (courtesy of McGraw-Hill Higher Education)

24. Blood Supply to the Heart
Figure 11.4

25. Diagnosis and Treatment for Heart Disease
Exercise stress test
MRI, echocardiogram, angiogram
Treatment
Lifestyle changes (diet and exercise)
Low-dose aspirin therapy
Prescription medications
Balloon angioplasty
Coronary bypass surgery

26. Treatment of Heart Disease
Surgery is one possible treatment for heart disease.
Heart Surgery: For people with heart disease, surgery is one possible type of treatment.
Source: Reed Kaestner/PhotoLink/Getty Image (Courtesy of McGraw-Hill Higher Education)

27. Stroke (Brain Attack)
Stroke = An impeded blood supply to some part of the brain resulting in the destruction of brain cells
Ischemic stroke = caused by blood clot that blocks as artery
Hemorrhagic stroke = caused by ruptured blood vessel
Strokes may cause paralysis, walking disability, speech impairment, or memory loss
Treatment may include clot-dissolving and antihypertensive drugs

28. Stroke Warning Signs
Sudden numbness or weakness of the face, arm, or leg, especially one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble walking, dizziness, or loss of balance or coordination
Sudden severe headache with no known cause
IF YOU OR SOMEONE WITH YOU HAS ONE OR MORE OF THESE SIGNS – CALL 911

29. Congestive Heart Failure
Congestive heart failure = condition resulting from the heart’s inability to pump out all the blood that returns to it
Blood backs up in the veins leading to the heart, causing an accumulation of fluid in various parts of the body
Caused by high blood pressure, heart attack, atherosclerosis, birth defects, rheumatic fever

30. Ways to Reduce Your Heart Attack Risk
Quit Smoking
Know and manage your blood cholesterol level
Maintain a healthy body weight
Exercise regularly
Healthy Eating Plan
Mild-to-moderate alcohol consumption
Know and manage your blood pressure
Handle stress and anger effectively

31. OSTEOPOROSIS
It is a disease characterized by low bone density, structural deterioration of bone tissue which increases the risk of fractures and bone fragility.
Sometimes called the “silent disease”, as often there are no symptoms as the bone density ↓.
Childhood and teen years is when new bone develops more quickly than old bone is reabsorbed.
Peak bone mass at about age 30. After age 30, bone loss exceeds bone formation.
Seems to affect mostly women – 80% are post menopausal.
History of excessive alcohol use or smoking ↑ risk.
Regular physical activity reduces the risk, especially
weight-bearing exercise and weight training.

32. Risk Factors Age Small, thin boned Women Possible genetic factors
Post-menopausal Caucasian and Asian
Poor diets-especially with Ca and Vita-D
Physical inactivity
Alcohol use
Smoking

33. Prevention Get regular physical activity!!
Get adequate Ca and Vita-D intake
Limit caffeine and phosphate containing sodas
Avoid prolonged hi-protein diets
HRT at menopause may help

34. Figure 11.4 Strategies for Reducing Your Risk of Cardiovascular Disease

35. Making excuses does not take talent
Making excuses does not take talent. Only those who persevere find the reward at the end of the day.