1 Lifestyle Management Evidence and Guidelines Andrew P. DeFilippis, Ty J. Gluckman, Catherine...
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1 Lifestyle Management Evidence and Guidelines Andrew P. DeFilippis, Ty J. Gluckman, Catherine Campbell, Suzanne Hughes, Gregg Fonarow, & Roger S. Blumenthal
1 Lifestyle Management Evidence and Guidelines Andrew P.
DeFilippis, Ty J. Gluckman, Catherine Campbell, Suzanne Hughes,
Gregg Fonarow, & Roger S. Blumenthal
Slide 2
2 Cigarette Smoking Cessation Evidence and Guidelines
Slide 3
3 Smoking Prevalence in the United States MMWR 1999;48:998
National Center for Health Statistics-1998 %
Slide 4
4 Causes# (%) in 1990# (%) in 2000 Tobacco400,000 (19)435,000
(18) Poor diet and physical activity (obesity)300,000 (14)400,000
(17) Alcohol consumption100,000 (5)85,000 (4) Microbial
agents90,000 (4)75,000 (3) Toxic agents60,000 (3)55,000 (2) Motor
vehicle accidents25,000 (1)43,000 (2) Firearms 35,000 (2)29,000 (1)
Sexual behavior30,000 (1)20,000 (
7 12-24 Years Old 25+ Years Old Less than 66-1516-2526+ Percent
Reporting >1 Indicators of Nicotine Dependence, by Age and
Intensity of Smoking Substance Abuse and Mental Health Services
Administration; United States, National Household Survey on Drug
Abuse, 1991/1992. Cigarette Smoking Cessation: Nicotine
Dependence
9 Limited Behavioral Support Greatest Benefit with Combination
Therapy InterventionEffect Size95% CI Nicotine gum5%4-6% Nicotine
transdermal patch5%4-7% InterventionEffect Size95% CI Nicotine
gum8%6-10% Nicotine transdermal patch6%5-8% Nicotine nasal
spray12%7-17% Nicotine inhaler8%4-12% Nicotine sublingual
tablet8%1-14% Intensive Behavioral Support West R et al. Thorax
2000;55:987-999 Silagy C et al. Cochrane Database Syst Rev
2002;CD000146 CI=Confidence interval
Slide 10
10 Jorenby DE et al. NEJM 1999;340:685-91 Cigarette Smoking
Cessation: Primary Prevention Placebo (n=160) NRT (n=244) Bupropion
(n=244) Nicotine patch and Bupropion (n=245) Abstinence rate at 6
months 18.8%21.3%34.8% a,b 38.8% a,c,d Abstinence rate at 12 months
15.6%16.4%30.3% a,c 35.5% a,c,e a p
18 Prevalence of Obesity in U.S. Adults 1991 1996 2006 No Data
30% CDC Overweight and Obesity Percentage of State Obese (BMI >
30)
Slide 19
19 Risk of Hypertension Increases with BMI Systolic BP >140
mm Hg (%) Body Mass Index Canadian Guidelines for Healthy Weights.
Cat No. H39- 134/1989E; 1988:69 BP=Blood pressure
Slide 20
20 BMI in Youth Predicts Adult Obesity Whitaker RC et al. NEJM
1997;337:869-873 BMI=Body mass index Adult Obesity at Age 21-29
Years (%) Age of Child (Yrs)
Slide 21
21 Risk of DM Increases with Body Mass Index Body Mass Index
Incidence of DM (Per 1,000 Person-Years) Knowler WC et al. Am J
Epidemiol 1981;113:144-156 DM=Diabetes mellitus
Slide 22
22 Mhurchu N et al. Int J Epidemiol 2004;33:751-758 0.5 1.0 2.0
4.0 162024283236 Body Mass Index (kg/m 2 )* Hazard Ratio 0.5 1.0
2.0 4.0 162024283236 0.5 1.0 2.0 4.0 162024283236 Hemorrhagic CVA
Ischemic CVA Ischemic Heart Disease CV Risk Increases with BMI
CV=Cardiovascular BMI is calculated as the weight in kg divided by
the BSA in meters 2.
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23 Very low fat Ornish (Reversal diet and Prevention diet)
Vegetarian with 10% calories from fat. No cooking oils, avocados,
nuts, and seeds. High fiber. No caloric restriction. Pritikin Very
low-fat (primarily vegetarian) diet based on whole grains, fruits,
and vegetables Intermediate Sugar Busters 30% protein, 40% fat, 30%
carbohydrates (low glycemic index) Zone 30% protein, 30% fat, 40%
carbohydrates Diet Evidence: Treatment Programs
Slide 24
24 Diet Evidence: Treatment Programs (Continued) Very low
carbohydrate Atkins (Induction and Maintenance) 1 st 2 weeks (
Slide 25
25 160 overweight and obese patients randomized to the Atkins,
Zone, Weight Watchers, or Ornish diets for 1 year Weight loss is
similar among diet programs, but hard to sustain because of poor
long-term compliance Dansinger ML et al. JAMA 2005;293:43-53 Diet
Evidence: Primary Prevention 20/40* 26/40* 21/40* 0 369 Atkins Zone
Weight Watchers Ornish Wt loss (lbs) *Ratio of individuals
completing the study to those enrolled
Slide 26
26 Goals Recommendations Calculate BMI* and measure waist
circumference Monitor response to treatment BMI 18.5 to 24.9 kg/m 2
Women: