Childe Hassam: “The South Ledges”Early 20th Century American Impressionist: Note: light And color! (Very European…)

Preventing Heart Disease

Chapter 12: 219-239

Cardiovascular Disease:Cardiovascular Disease:#1 Killer in America (500K/Yr) Increased incidence since the “Industrial

Revolution” What effect will the “Technology

Revolution” Have?Epidemiology

Population Studies to discover associations between disease/FACTORS

PRIMARY RISK PRIMARY RISK FACTORS:FACTORS: HYPERTENSIONHYPERTENSIONHYPERLIPIDEMIAHYPERLIPIDEMIATOBACCO USETOBACCO USEPHYSICAL INACTIVITYPHYSICAL INACTIVITY

All of These are Preventable All of These are Preventable “LIFESTYLE CHOICES”…“LIFESTYLE CHOICES”…

Secondary Risk Factors

Family History (close relative <60)AgeGenderRaceObesityDiabetes

• Tough to Modify, eh?

What is Atherosclerosis?

In a Word…”Fatty” “Arteries” (ok, so two words…)

Normal Atherosclerotic

Ouch!

Myocardial InfarctionMyocardial InfarctionComplete blockage of blood All cells “downstream” will die

without blood supplyFirst symptom of Infarct?... SUDDEN DEATH (only 50%

survive)

Primary Risk Factor #1: Primary Risk Factor #1: HypertensionHypertension

>140 /90 CHRONICALLYDamages Blood VesselsCAD is 6X as great in hypertensivesIncidence of stroke & heart/kidney

failure is directly related to HTNMost causes of HTN are not known

TreatmentTreatmentReduced Na+ diet (Na+ may

constrict vessels & Incr. fluid volume)MODERATE exerciseBody Fat reductionReduce alcohol intakeDrugs (diuretics, beta blockers, ACE

inhibitors)

HyperlipidemiaHyperlipidemiaTotal Cholesterol: Protein Carriers: HDL / LDLDesirable TOTAL levels:

< 200 mg/dl: Desirable 200-239: Borderline > 240 mg/dl: Very High

Low Density Lipoproteins Low Density Lipoproteins (LDLs)(LDLs)

“Bad” Cholesterol/Protein Complex

Deposits Fat onto artery wallsLinked to High Triglycerides

(Associated with high fatty-sweet diet and glucose intolerance…more on that later)

High Density Lipoproteins High Density Lipoproteins (HDLs)(HDLs)

“Good” Cholesterol/Protein Complex

Carries Cholesterol to liver other organs for hormone synthesis etc.

Activity, mono-unsaturated fats in diet may increase HDLs

HYPERLIPIDEMIAHYPERLIPIDEMIADesired Blood Lipid Levels: Total Cholesterol < 200 mg/dl LDL-C < 130 mg/dl HDL-C > 35 mg/dl Triglycerides < 130

A poor lipid profile will accelerate the atherogenic process.

Tobacco use (smoking, Tobacco use (smoking, chew)chew)

Increases Blood Clotting activityIncreases Blood PressureIncreases Heart RateAs if that’s not bad enough –

Decreases O2 Content of Blood

Sounds like STRESS to me…

Physical InactivityPhysical InactivityIndependent Risk Factor!And Contributes to:

ObesityHypertensionHyperlipidemia (especially the

worst kind)Diabetes

Percent of U.S. Population at Risk

%

BP0

10

20

30

40

50

60

TC Smoke Inact

How do WSC Freshmen Rate?

Based on Study by S.C. Glass & K.K. Glass 1995

Gender CharacteristicsWomenMen

Number

Age

Activity(1-5)

T-C

HDL-C

LDL-C

TC/HDL

20319.91 + 3.573.42 + 1.30

169.08 + 32.68*42.63 + 8.94

126.14+ 59.28*4.14 + 1.23

26820.15 + 4.043.22 + 1.61

175.09 + 30.1049.49 + 10.94

112.82 + 53.253.70 + 1.07

* = p<.05

Smokers vs Non-Smokers

Smokers Non

Number

Male

Female

Activity

T-C

HDL-C

LDL-C* = p<.05

60 (15%)28 (17%)32 (14%)

2.67 + 1.4*171.59 + 34.647.98 + 12.0104.2 + 32.8

329 (85%)139 (36%)190 (49%)3.43 + 1.5

172.15 + 31.646.61 + 10.7

101.21 + 27.1

HDL-Cholesterol by HDL-Cholesterol by GenderGender

Percent of Students Below Desirable (35 mg/dl)13.8% Males5% FemalesAverage = 9.4%

Activity Level Distribution

%

Activity Level

0

5

10

15

20

25

30

35

1 2 3 4 5

Most Frequently Listed Activities: Men

1. Basketball25.1 %2. Wt. Lifting17.5 %3. Jogging 14.2 %4. Racquetball 5.9 %5. Football 5.2 %6. Walking 4.6 %7. Golf 4.6 %8. Biking 3.6 %9. Baseball 2.3 %

Most Frequently Listed Activities: Women

1. Walking 19.3 %2. Volleyball 14.0 %3. Jogging 13.3 %4. Biking 9.5 %5. Wt. Lifting8.8 %6. Basketball7.3 %7. Aerobics 6.8 %8. Racquetball 4.0 %9. Swimming3.5 %

Total Cholesterol by Activity Level

140

160

180

200

1 2 3 4 5

mg/dl

Activity Level

HDL by Activity Level

35

40

45

50

55

1 2 3 4 5

mg/dl

Activity Level

LDL by Activity Level

80

90

100

110

120

130

1 2 3 4 5

mg/dl

Activity Level

Lab Wednesday: Cardiovascular Risk Assessment and Blood Pressure Measurement

Lab 12A: Pages 377-379Lab 1A: Page 307