1 Cardiovascular Disease and Cancer Chapter 12. © 2012 McGraw-Hill Higher Education. All rights reserved. 2 2 Leading cause of death in the U.S. Affects

© 2012 McGraw-Hill Higher Education. All rights reserved.1

Cardiovascular Disease and Cardiovascular Disease and CancerCancer Chapter 12

© 2012 McGraw-Hill Higher Education. All rights reserved. 2© 2012 McGraw-Hill Higher Education. All rights reserved. 2

Cardiovascular Disease (CVD)

Leading cause of death in the U.S. Affects more than 81 million Americans Claims one life every 38 seconds,

nearly 2300 Americans every day The high rate of CVD is primarily

caused by Americans’ lifestyles

2


The Cardiovascular System

The Heart› Pulmonary circulation

Right side of the heart pumps blood to and from the lungs› Systemic circulation

Left side of the heart pumps blood through the rest of the body

› Path of blood flow:1. Venae Cavae2. Right Atrium3. Right Ventricle4. Pulmonary Artery

To the lungs5. Pulmonary Veins6. Left Atrium7. Left Ventricle8. Aorta

• Body’s largest artery

3


The Cardiovascular System

The Heart › Systole

The period of the heart’s contraction

› Diastole The period of the heart’s relaxation

4


The Cardiovascular System The Blood Vessels

› Veins Carry blood to the heart Thin walls

› Arteries Carry blood away from the heart Thick elastic walls which expand and relax with the

volume of blood Coronary arteries

One of the system of arteries branching from the aorta Two large vessels that supply the heart muscle with

oxygenated blood› Capillaries

Tiny vessels only one cell thick Deliver oxygen and nutrient-rich blood to the tissues

and pick up oxygen-poor, waste-laden blood which returns through a system of veins to the heart to repeat the cycle

5


Risk Factors for Cardiovascular Disease

Two categories of increased risk of CVD1. Major risk factors2. Contributing risk factors

Major risk factors that can be changed:› American Heart Association identified six major

risk factors for CVD that can be changed1. Tobacco use2. High blood pressure3. High cholesterol4. Physical inactivity5. Obesity6. Diabetes

6


Tobacco Use

1 in 5 deaths is attributable to smoking People who smoke a pack a day have twice the risk of a

heart attack as nonsmokers Smoking two or more packs a day triples risk Heart attack victims who smoke are 2 to 3 more times

likely to die from the attack Smoking…

› Damages the lining of arteries › Reduces HDL (good cholesterol)› Raises triglycerides and LDL (bad cholesterol)› Nicotine increases blood pressure and heart rate› CO displaces O2 › Causes platelets to become sticky, leading to clotting › Speeds the development of fatty deposits in the arteries› Doubles risk of stroke

7


High Blood Pressure

Hypertension› Too much pressure against arterial walls

Short periods of high blood pressure is normal but chronic high blood pressure is a health risk

Atherosclerosis› Causes arteries to become clogged and

narrowed 33% of Americans have high blood pressure,

22% of them aren’t aware of their condition African Americans have the highest rate of

hypertension – 41%8


High Cholesterol Cholesterol is a fatty, waxlike substance that

circulates through the bloodstream› Important component of:

Cell membranes Sex hormones Vitamin D Fluid that coats the lungs Protective sheaths around nerves

Excessive cholesterol clogs the arteries› Increased risk of CVD

Good versus bad cholesterol› Low –density lipoproteins (LDL)

“Bad” cholesterol Shuttle cholesterol from the liver to the organs and

tissues› High-density lipoproteins (HDL)

“Good” cholesterol Shuttle unused cholesterol back to the liver for

recycling Benefits of controlling cholesterol

9

© 2012 McGraw-Hill Higher Education. All rights reserved. 10


Physical Inactivity

40-60 million Americans are so sedentary that they are at high risk for developing CVD

Physical activity is closest thing we have to a magic bullet against heart disease

Exercise reduces risk by: Decreasing blood pressure and resting heart rate Increasing HDL levels Maintaining weight Improving the condition of blood vessels Helping to prevent or control diabetes

10



Obesity

Risk of death from CVD is two to three times more likely in obese people (BMI > 30)

Strongly associated with:› Hypertension› High cholesterol levels› Insulin resistance› Diabetes › Physical inactivity› Increasing age› Ventricular hypertrophy (enlargement of the heart)› Failure of the heart muscle

Even moderate weight reduction and moderate cardiorespiratory fitness can lower risk

11



Diabetes

Doubles the risk of CVD for men Triples the risk of CVD for women Higher rates for other CVD risk factors:

› Hypertension› Obesity› Unhealthy blood lipid levels› Damaged endothelial cells› More vulnerable to atherosclerosis› Increased risk of heart attack and strokes› Even pre-diabetes increases risks

12



Contributing Risk Factors That Can Be Changed

High Triglyceride Levels› Reliable predictor of heart disease

Psychological and Social Factors› Stress› Chronic hostility and anger› Suppressing psychological distress› Depression › Anxiety› Social isolation› Low socioeconomic status

Alcohol and Drugs

13



Major Risk Factors That Can’t Be Changed

Heredity › CVD has genetic component which leads to increases in

cholesterol levels, blood clotting and obesity› Risk is modifiable by lifestyle factors

Aging › Over the age of 65

Being male› Men have higher risk earlier in life

Ethnicity › African Americans have higher risk of hypertension, heart

disease, and stroke than other groups; Hispanics have a greater risk of HBP and angina than non-Hispanic whites; Asians have lower rates of CVD than whites

Inflammation and C-Reactive Protein› Caused by damaged arteries

14



Possible Risk Factors Currently Being Studied

Insulin resistance and metabolic syndrome› With weight gain and lack of activity, the body becomes

less sensitive to insulin, causing insulin resistance (pre-diabetes)

› Metabolic syndrome (or insulin resistance syndrome) is the term for a cluster of abnormalities

› About 34% of American adults have metabolic syndrome› To reduce risk of metabolic syndrome, choose a healthy diet

and get plenty of exercise, amount and type of carbohydrate intake matters

Homocysteine› Amino acid circulating in the blood› Appears to damage the lining of blood vessels, resulting in

inflammation and the development of fatty deposits› Can lead to heart attacks, strokes, memory loss

15



Major Forms of Cardiovascular Disease

Atherosclerosis – Arteries become narrowed by deposits of fat, cholesterol, and other substances› Coronary arteries become blocked with

plaque buildup: Coronary heart disease (CHD) or Coronary artery disease (CAD)

› An artery in a limb becomes narrowed or blocked: Peripheral arterial disease (PAD)

Heart Attack – Coronary artery becomes blocked› Myocardial infarction (MI)

16



Heart Attack Symptoms Chest pain or pressure Arm, neck, or jaw pain Difficulty breathing Excessive sweating Nausea and vomiting Loss of consciousness 1/3 of victims don’t feel chest pain: especially women, ethnic minorities, older adults, and people with diabetes

17



Heart Disease and Heart Attack

Angina – Arteries are narrowed by disease but open enough to deliver blood under normal circumstances › During times of stress or exertion, heart

doesn’t receive enough oxygen› Angina pectoris (chest pain)› Usually felt as an extreme tightness in the

chest and heavy pressure behind the breastbone or in the shoulder, neck, arm, hand, or back

Arrhythmias and sudden cardiac death – Electrical conduction system is disrupted

18



Helping a Heart Attack Victim

Most people who die from a heart attack expire within 2 hours of the onset of initial symptoms

Victim should chew and swallow one adult aspirin

Cardiopulmonary resuscitation (CPR) Refer to Box “What to Do in Case of a Heart

Attack, Stroke, or Cardiac Arrest”

19



Detecting and Treating Heart Disease

Electrocardiogram (ECG or EKG) Magnetic resonance imaging (MRI) Positron emission tomography (PET) Angiogram Balloon angioplasty Coronary bypass surgery

20



Stroke

Also called cerebro-vascular accident (CVA) Ischemic stroke – blockage in a blood vessel

› Thrombotic stroke: clot forms in a cerebral artery that has been narrowed or damaged by atherosclerosis

› Embolic stroke - wandering blood clot, linked to atrial fibrillation

Hemorrhagic stroke – blood vessel ruptures in the brain› Intracerebral hemorrhage› Subarachnoid hemorrhage› Aneurysm

21


Figure 12.2 Types of stroke



The Effects of a Stroke

Interruption of the blood supply to any area of the brain prevents the nerve cells there from functioning – in some cases causing death

Those who survive a stroke usually have some lasting disability› Paralysis› Walking disability› Speech impairment› Memory loss› Changes in behavior

23



Detecting and Treating Stroke

Prompt recognition of symptoms› Sudden numbness or weakness of face,

arm, leg or one side of the body› Loss of speech or difficulty speaking› Dizziness› Symptoms may be brief and temporary

24



Detecting and Treating Stroke

Transient ischemic attack (TIA)› Temporary stroke-like symptoms

Computed tomography (CT) MRI Ultrasound Clot-dissolving drugs Rehabilitation

› Nerve cells in the brain can make new pathways › Some functions can be taken over by other parts of the

brain

25



Congestive Heart Failure

Heart is damaged by high blood pressure or other disease conditions and cannot maintain regular pumping rate and force, causing fluids to back up into body tissue Edema (swelling) in legs, ankles, other body parts Pulmonary edema - Fluid accumulates in the lungs Treatment:

› Reducing cardiac workload› Modifying salt intake› Drug therapy to help the body eliminate excess fluid› Heart transplant

26



Other Forms of Heart Disease Congenital Heart Defects

› Malformation of the heart or major blood vessels 36,000 children born each year in the U.S. with defects About 3,600 deaths a year

› Hypertrophic Cardiomyopathy (HCM) 1 out of every 500 people Most common cause of sudden death in athletes younger

than 35 Can be identified by a murmur

Rheumatic Heart Disease (RHD)› Untreated streptococcal throat infections can cause

rheumatic fever which can permanently damage the heart muscle and valves

› Strep throat needs to be treated, primary cause if not treated, up to 3% of infections progress into fever

Heart Valve Disorders› Congenital heart defects and certain types of infections› Mitral valve prolapse (MVP) – occurs in about 3% of the

population

27



Protecting Yourself Against Cardiovascular Disease

Eat heart-healthy diet› Fat and cholesterol

Total fats should be less than 30% of total calories Low intake of saturated fats Limit dietary cholesterol to less than 300 mg per day

› Fiber 25-38 grams of dietary fiber per day

› Sodium and potassium No more than 1500 mg sodium per day Increase potassium

› Alcohol

28



Other Dietary Factors

Omega-3 fatty acids Plant stanols and sterols Folic acid Vitamins B-6 and B-12 Calcium Soy protein Healthy carbohydrates Total calories DASH diet

› Dietary Approaches to Stop Hypertension

29


Protecting Yourself Against Cardiovascular Disease

Exercise regularly Avoid tobacco Know and manage your blood pressure

› Get it monitored at least once every 2 years Know and manage your cholesterol levels

› Get it checked at least once every 5 years Develop effective ways to handle stress

and anger

30


What is Cancer?

Cancer: An abnormal and uncontrolled multiplication of cells , which, if left untreated can lead to death

Tumor: A mass of tissue that serves no physiological purpose› Benign (non-cancerous) tumor: Mass of normal cells

enclosed in a membrane that prevents their penetration of other tissues

› Malignant (cancerous) tumor: Can invade surrounding tissues, can spread via blood and lympatic circulation

› Every case of cancer begins as a change in a cell that allows the cell to grow and divide when it should not

31


Metastasis

The spreading of cancer cells Primary tumor is original location of

cancer Metastasizing – The traveling and

seeding process of cancerous cells New tumors are called secondary

tumors or metastases Can invade nearby tissue or spread to

different parts of the body32


Types of Cancer The behavior of tumors arising in

different body organs is characteristic of the tissue of origin

Classified according to types of cells that give rise to them› Carcinomas › Sarcomas› Lymphomas› Leukemias

33


The Incidence of Cancer 1.5 million Americans are diagnosed

yearly American Cancer Society

› Estimates that the 5-year survival rate for all cancers diagnosed between 1995 and 2005 is 68%

› Nearly 1 in 2 men and more than 1 in 3 women will develop cancer during their lifetime

› 90% of skin cancer could have been prevented› 87% of lung cancer could have been prevented› Regular screening and self-examinations could

save an additional 100,000 lives per year34


Lung Cancer

Most common cause of cancer death in the U.S.› 157,000 deaths per year› Risk factors

Tobacco contributes to 30% of all cancer deaths and 90% of lung cancer deaths

› Detection Difficult to detect Symptoms do not usually appear until cancer has

reached the invasive stage Persistent cough, chest pain, or recurring bronchitis Diagnosis: CT scan, chest x-ray, or sputum examination

35


Lung Cancer

Treatment› If caught early, can be treated with surgery

Only 15% are detected prior to spreading Radiation and chemotherapy are used in

addition to surgery

› Detected early, 53% of patients are alive 5 years post-diagnosis

› Overall, the 5-year survival rate is only 15%

36


Colon and Rectal Cancer Third most common type of cancer

› Risk factors Directly linked to age, genetic predisposition, lifestyle

habits, diet 91% of cases occur after 50 years of age Excessive alcohol use and smoking may increase risk Obesity and diets rich in red and processed meats

increases risk Regular physical exercise and diets rich in fruits,

vegetables, and whole grains may lower risk Research mixed on high-fiber diets Oral contraceptives and hormone replacement may

increase risk in women› Detection and treatment

Regular screening Surgery is primary treatment Radiation and chemotherapy can be used Survival 91% if detected early, 65% overall

37


Breast Cancer Most common cancer in women 1 in 8 American women will develop it during her

lifetime › About 200,000 American women are diagnosed each

year 1 in 30 women will die from the disease

› About 41,000 women die from it each year Risk factors

Incidents rise quickly with age, about 50% occurring in women ages 45-65

Genetic predisposition/family history Early onset of menstruation Late onset of menopause Having first child after 30 Having no children Hormone replacement therapy Estrogen connection Obesity, diet, and alcohol use 38


Detection and Treatment › Early detection – cure most likely when

cancer is detected early Monthly breast self-exam for all women over 20 Clinical breast exam by a physician every 3 years

(every year for women over 40) Mammography- Every 1 year for women over 40 MRIs

› Treatment Ultrasonography Biopsy Lump found to be harmless growth in 90% of cases Surgery: lumpectomy, mastectomy

39


Breast Cancer

› Survival rate 98% if the cells haven’t metastasized 90% for all stages at 5 years

› New strategies for treatment and prevention

SERMs (tamoxifen, raloxifene) Monoclonal antibodies (trastuzumab):

Antibodies designed to bind to specific cancer-related targets


Prostate Cancer Most common cancer in men Second leading cause of cancer death in men Nearly 218,000 new cases per year More than 32,000 deaths per year Risk factors

› Age› Genetic predisposition/family history› Diet› Lifestyle › History of STDs› Type 2 diabetes and insulin resistance

Detection› Prostate-specific antigen (PSA) blood test› Digital rectal examination› Yearly screening beginning between ages 40-50

Treatment › Surgical removal of the prostate and radiation› Implantation of radioactive seeds› 5-year survival rate is nearly 100%

41


Cancers of the Female Reproductive Tract

Cervical cancer › Most cases stem from infection by the human

papillomavirus (HPV)- transmitted by unprotected sex Smoking, immunosuppression, and prolonged use of oral

contraceptives may contribute to incidence› Cervical cancer is most common in women in

their 20’s and 30’s› Prevention

The PAP test is a highly effective screening test for this cancer All sexually active women ages 18-65 should be tested

regularly 2 HPV vaccines approved by FDA (Gardasil, Cervarix)

42



Uterine, or Endometrial, Cancer› Normally occurs after the age 55› Risk factors similar to breast cancer

Prolonged exposure to estrogen Early menstruation Late menopause No pregnancies Obesity Type 2 diabetes

› Treatment is surgery Oftentimes by hysterectomy Radiation, hormones, and chemotherapy may be used

› 96% survivability after 5 years if detected early, less than 68% if cancer has spread

43


Ovarian Cancer› Causes more deaths than cervical and uterine

cancer combined, though it is rarer than both› Difficult to detect and diagnose

Often no warning signs Sometimes increased abdominal size and bloating,

urinary urgency, and pelvic pain are early clues Often diagnosed too late

› Risk factors similar to breast cancer Age, no pregnancy, family history, obesity,

genetic mutations, high number of ovulations during lifespan

› Treatment is surgical removal of the ovaries, the fallopian tubes, and the uterus Radiation and chemotherapy are sometimes used

44



Skin Cancer Most common form of cancer

› More than 1 million cases per year Most are easily treated

› 68,000 are melanoma Most serious type of skin cancer

Risk factors› Excessive exposure to ultraviolet rays (UVA and UVB)› Common causes are sunburns and suntans (including those produced by

sunlamps and tanning beds), especially severe sunburns in childhood› Risk doubles for those who’ve had 5 or more sunburns in their life› Caucasians are 10X more likely than African Americans to develop

melanoma Types of skin cancer

› Basal cell carcinomas› Squamous cell carcinomas› Melanoma

Prevention› Avoid lifelong overexposure to sunlight› Use sunscreens and protective clothing

Detection and treatment› Examine your skin regularly – ABCD test› Check moles› Treatment usually surgical removal under local anesthetic

45


Figure 12.4 The ABCD test for melanoma


Other Cancers Head and Neck Cancers

› Cancers of the oral cavity, pharynx, larynx, and nasal cavity

› Primarily caused by tobacco use and excessive alcohol consumption

› Incidence 2x greater in men than in women› Chemotherapy, radiation, and surgery are primary methods of treatment› Can cause disfigurement, lead to other primary cancers of the head and neck› 61% survival rate after 5 years

Testicular Cancer› Rare› Most common in men ages 20-35› Most common among white men and those with family

history› Undescended testicles increase risk› Detection: self-exam› Treatment: surgical removal of testicle and possible

chemotherapy 47


The Causes of Cancer The Role of DNA

› Certain genes may predispose some people to cancer

› Specific genetic mutations (changes in the normal makeup of a gene) have been associated with cancer Mutations can be inherited or caused by environmental

agents Tobacco Use

› Responsible for 30% of all cancer deaths› Responsible for nearly 1 in 5 deaths, nearly

444,000 premature deaths each year Direct cause of lung, bronchial, larynx, mouth,

pharynx, esophagus, stomach, pancreas, kidney, bladder, and cervical cancers

48


Dietary Factors Food choices affect your cancer risk by exposing

you to potentially dangerous compounds and depriving you of protective compounds

Dietary fat and meat› Diets high in “bad” fats and meat may contribute to

colon, stomach, and prostate cancers› Omega-3 fats are healthier for body

Alcohol› Risk of oral and breast cancer

Fried foods › Some contain Acrylamide, a probable carcinogen

Fruits and vegetables› Contain anti-cancer agents such as anticarcinogens,

carotenoids, and phytochemicals Inactivity and obesity linked to several cancers

49


Carcinogens in the Environment

Ingested chemicals› Nitrosamines: Nitrates and nitrites found in

processed meats that combine with dietary substances and become highly potent carcinogens

› Salt and smoke-cured foods Environmental and industrial pollution Radiation

50


Detecting, Diagnosing, and Treating Cancer

Detecting cancer › Self-monitoring› Routine checkups and screenings

Diagnosing and treating cancer› Biopsy› MRIs, CT scanning, and ultrasonography› Surgery› Chemotherapy› Radiation

New and experimental techniques

51


Cardiovascular Disease and Cardiovascular Disease and CancerCancer Chapter 12

Documents

1 Cardiovascular Disease and Cancer Chapter 12. © 2012 McGraw-Hill Higher Education. All rights reserved. 2 2 Leading cause of death in the U.S. Affects