CARDIOVASCULAR DISEASE (CVD)“RISKY BUSINESS”

Rhonda Jones, RN, BSN, CHES, CCM

MESSA Health Promotion Consultant

THE LOSS Cardiovascular disease is the leading cause of

death in the United States and is a major cause of disability.

Almost 652,091 people die of heart disease in the U.S. each year.

Someone dies of a heart attack or a stroke every 33 seconds.

Strokes are the 3rd leading cause of death in the U.S.

The cost of cardiovascular diseases and stroke in the United States in 2009 is estimated to be………….

$475.3 BILLION

MAKE THE RIGHT INVESTMENTS IN YOUR

HEALTH TO DECREASE YOUR RISK FACTORS FOR

HEART DISEASE

$ $ $ $ $ $ $ $ $ $ $

BASELINE PORTFOLIONON-MODIFYABLE

RISK FACTORSAGE

Advanced age significantly raises the risk of heart attacks or strokes. For men, being 45 years or older and for women, being 55 years

or older. This doesn’t mean that younger people are immune.

GENDERWomen develop heart disease about 10 years later in life than men.

This difference is attributed o the protective effects of estrogen before menopause. Women’s risk rises after menopause, but it

still remains lower than men’s in the same age group. Each year more women than men have a stroke.

HEREDITY/ETHNICITYIf your parents have heart disease it is more likely that you will

develop it. African-Americans have more severe high blood pressure than Caucasians and a higher risk of cardiovascular

disease. Risks are also higher for Mexican Americans, American Indians and Pacific Islanders.

BAD INVESTMENTSModifiable risk factors

ABNORMAL CHOLESTEROL

When there is excess LDL or Triglycerides in the blood it is deposited in the arteries, causing them to become narrow, preventing sufficient amounts of blood flow and oxygen.

HDL provides for “reverse cholesterol transport”. Insufficient HDL prevents adequate amounts of cholesterol

from being moved back to the liver and eventually removed from the body.

LDL HDL TRIGLYCERIDES>160

low risk<40 >150

>130 moderate

risk>100

high risk

BAD INVESTMENTSModifiable risk factors

HIGH BLOOD PRESSUREHigh blood pressure is a condition when the pressure in the

blood flowing inside the arteries is too high. The high pressure causes the arteries to become thick and less

pliable and the heart muscle begins to thicken and enlarge resulting in improper function.

BP CLASS SYSTOLIC DIASTOLIC

Normal <120 AND

<80

Pre-hypertension (HTN)

120 - 139 OR 80 – 89

Stage 1 HTN 140 - 159 OR 90 – 99

Stage 2 HTN >160 OR > 100

BAD INVESTMENTSModifiable risk factors

Tobacco UseCigarette smoking promotes hardening and

narrowing of the arteries. It increases the levels of blood clotting factors causing the blood to

become thick and sticky increasing chances of blood clot formation. The carbon monoxide being inhaled from the cigarette reduces the amount of

oxygen that the blood can carry. Exposure to secondhand smoke narrows the arteries of non-

smokers.

BAD INVESTMENTSModifiable risk factors

OBESITY and OVERWEIGHTExcess weight especially around the waist increases

the work of vital organs. Inactivity and weight gain can increase insulin resistance in the body’s

cells. Insulin resistance can lead to type II diabetes which is also a condition that is a risk

factor for CHD. 

Body Mass Index Waist Circumference

Underweight- Below 18.5

Women > 35

Normal - 18.5 - 24.9 Men > 40

Overweight - 25.0 - 29.9

Obesity - 30.0 and Above

BAD INVESTMENTSModifiable risk factors

PHYSICAL INACTIVITYInactivity is when someone sits in a chair more than walking or

engaging in physical activity (AHA). An inactive lifestyle can lead to a decrease in insulin sensitivity, obesity and overweight. Excess body fat especially around the waist (central adiposity) increases the work

of vital organs. Adipose cells secrete chemicals that increase systemic inflammation.

STRESS/DEPRESSIONChronic stress, the type of stress that seems never-ending and inescapable. Depression sometimes occurs due to a byproduct of

cortisol released during stress acts as a sedative that contributes to feelings of being blue or depressed.

BAD INVESTMENTSModifiable risk factors

Poor Dietary Patterns

Processed foodSaturated fat/Animal fat

Inadequate vegetables/fruitExcess Alcohol

Atherosclerosis Atherosclerosis is the underlying disease process. Individuals can have atherosclerosis throughout

the arteries of the circulatory system. When plaque leads to an occlusion of a coronary

artery, a myocardial infarction (MI) occurs. When an occlusion blocks circulation to the brain,

a cerebral vascular accident (CVA) occurs. Atherosclerosis in the legs is called peripheral

artery disease (PAD). This results in intermittent claudication, which is described as pain in the legs when walking.

Atherosclerosis can also weaken part of the aorta and contribute to abdominal aortic aneurysms (AAA).

HEALTHY ARTERYA healthy artery consists of 3 layers:

– 1.) Intima

– 2.) Media

–3.) Adventitia

The Atherosclerotic process Low Density Lipoprotein (LDL) particles similarly enter the intima. Cholesterol in the LDL is modified by oxidation or glycation. Foam cells are created by a combination of LDL and a type of

white blood cell (WBC) called macrophages. Foam cells release cytokines prompting an immune response

attracting more WBC. The accumulation of WBC, including the foams cells, forms the

“fatty streak” within the artery wall. Fatty streaks are the beginning of the atherosclerotic lesion.

The fatty streaks develop a fibrous cap made up of smooth muscle cells that originated in the media of the artery. This is now referred to as plaque.

The Atherosclerotic process The process continues with accumulation of smooth muscle

cells and calcium, (causing calcification and hardening of the plaque) resulting in a complicated lesion.

The artery can become completely occluded by either:• Continued build-up of plaque• Fibrous cap bursts, the lipid core enters the lumen and is

attacked as a foreign substance and a thrombus forms and blocks flow of blood through lumen.

MEDICAL APPROACHES TO LOWERING RISK

Cholesterol lowering medications Blood Pressure lowering medications ASA, PLAVIX, ETC

ALTERNATIVE APPOACHES

Omega 3 Fatty Acids Red Yeast Rice Co-enzyme Q-10 (ubinque)

LIFESTYLE APPROACHES CARDIOVASCULAR EXERCISE

– Assists with weight lose/maintenance efforts

– Improves cardiovascular endurance by strengthening heart muscle

– Builds collateral circulation– Decreases negative effect of stress by

way of beta-endorphin release (elevates mood).

– Improves insulin sensitivity– Decreases systemic inflammation

LIFESTYLE APPROACHES– Accumulate a minimum of 30 minutes

moderate-intensity physical activity, on most and preferably all, days of the week.

– For weight loss or weight loss maintenance: accumulate 60 to 90 minutes of moderate-intensity physical activity.

LIFESTYLE INTERVENTIONSHealthy Eating Pattern

– High intake of VEGETABLES and fruit. Ensure adequate vitamins, antioxidants and

minerals.– High fiber foods– Whole grains– Consume fish at least 2x/week

LIFESTYLE INTERVENTIONS– Limit saturated fat <7-10%– Cholesterol <300 mg a day– No more than 1 drink a day for Women,

2 for Men.– Less than 2.3 grams of sodium a day– Low sugar– Minimal processed food

LIFESTYLE INTERVENTIONSStress Management Techniques

– Optimism – Laughter– Altruism– Hobbies– Music

LIFESTYLE INTERVENTIONS Rhonda’s Remedy for Relief from

Stress– Embrace Your Faith– Pray/Meditate– Exercise (get your heart rate up!)– Exercise some more (GET SWEATY)– LOVE yourself– Treat everyone with RESPECT