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Staying HealthyStaying Healthy
Kim F Gibson, MD, FACPKim F Gibson, MD, FACP
WRNMMC BethesdaWRNMMC Bethesda
The Key to Your HeartThe Key to Your Heart
DemographicsDemographics
Today 13% of Americans > 65 yrs old By 2030 22% will be older than 65 Over the next decade the most rapid
population increase will be in the age group > 85 yrs old MOST OF THOSE INDIVIDUALS MOST OF THOSE INDIVIDUALS
ARE WOMEN ARE WOMEN
Growing old is not for sissies!Growing old is not for sissies!
What is the Goal?What is the Goal?
Health is a state of complete physical, mental, spiritual and social well-being, and not merely the absence of disease or infirmity.
We must continuously improve our function, not simply delay “inevitable” losses.
Reaching Your PotentialReaching Your Potential
Case PresentationCase Presentation
Mr. R is a 58 yr old WM who presents to his doctor for an annual check up.
He is overweight, has high BP, and abnormal cholesterol test (low HDL, high triglycerides).
Prescribed BP lowering medication and advised to lose weight.
Case PresentationCase Presentation
Three months later:Mr. R collapses at his deskParamedics respond quickly and find him in
cardiac arrestMultiple attempts at resuscitation in the office
and at the emergency room are unsuccessfulHe never recovers and is pronounced deadAutopsy shows a ruptured plaque and clot in
the main artery supplying blood to his heart
Major Causes of Death
A.A. Total CVD Total CVDB.B. Cancer CancerC.C. Accidents Accidents
D.D. Chronic Respiratory Diseases Chronic Respiratory DiseasesE.E. Diabetes Mellitus Diabetes MellitusF.F. Alzheimer’s Disease Alzheimer’s Disease
(United States: 2004). Source: NCHS and NHLBI.
Includes coronary heart disease, heart failure, stroke and hypertensionIncludes coronary heart disease, heart failure, stroke and hypertension
14.8
39.1
71.3
9.4
39.5
75.1 83.0
92.0
0
20
40
60
80
100
20-39 40-59 60-79 80+
Per
cent
of P
opul
atio
n
Males Females
Prevalence of Cardiovascular DiseasePrevalence of Cardiovascular Disease
(NHANES: 1999-2004). (NHANES: 1999-2004). Source: NCHS and NHLBI. Source: NCHS and NHLBI.
Includes MI and fatal CHD but not silent MI’sIncludes MI and fatal CHD but not silent MI’s
30000
265000
180000
290000
235000
9500095000
10000
0
50000
100000
150000
200000
250000
300000
350000
35-44 45-64 65-74 75+
Ages
New
an
d R
ecu
rren
t M
I o
r F
atal
CH
D
Men Women
Annual Number of U.S. Adults with Annual Number of U.S. Adults with Diagnosed Heart Attacks Diagnosed Heart Attacks
Cardiovascular DiseaseCardiovascular Disease
Leading cause of death in women and men 1 in 2 men have CV disease 1 in 3 women die of heart
disease 25% adults experience sudden
death as first indication Coronary heart disease mortality
higher in women than men
Keep your heart healthy Keep your heart healthy
Cardiovascular DiseaseCardiovascular Disease
■ Coronary heart disease
■ Cerebrovascular disease
■ Peripheral vascular disease
■ Aortic atherosclerosis
Diagnostic CategoriesDiagnostic Categories
What is the connection?What is the connection?
AtherosclerosisAtherosclerosis
Contributes to: Heart attack Most strokes Peripheral Vascular
Disease Erectile Dysfunction
Coronary Heart DiseaseCoronary Heart Disease
Non-modifiable Age:
men >45
women >55 Gender / Ethnicity FH Early CAD:
men <55
women <65
Modifiable Tobacco Hypertension Dyslipidemia Abdominal obesity Diabetes Stress / Sleep Physical Activity
Cardiac Risk FactorsCardiac Risk Factors
Coronary Heart DiseaseCoronary Heart Disease
90% CHD events predicted by presence of risk factors
Assessment helps plan treatment
Can prevent onset, alter progression and prevent death
Intermediate risk may require additional testing
Cardiac Risk AssessmentCardiac Risk Assessment
Cardiac Risk ReductionCardiac Risk Reduction
CVD mortality has declined since 1975 Earlier diagnosis More aggressive treatment Reduction in risk factors
Prevention is primary focus Focus on LIFESTYLE modification ?Role of aspirin, statins and fish oil
Primary vs Secondary PreventionPrimary vs Secondary Prevention
ItIt’’s never too late to start!s never too late to start!
Cardiac Risk ReductionCardiac Risk Reduction
Exercise daily (150 min/week) Don’t smoke Weight maintenance Mediterranean diet Restful sleep Treat hypertension, diabetes,
high cholesterol
Lifestyle ModificationsLifestyle Modifications
Cardiovascular FitnessCardiovascular Fitness
Exercise has protective effect
Impacts all other risk factors
Focus on aerobic activities
AHA recommends 150 minutes/week
Physical FitnessPhysical Fitness
Impact on Impact on improving performanceimproving performance sharpening attention and focussharpening attention and focus enhancing efficiencyenhancing efficiency reducing disease risk and morbidityreducing disease risk and morbidity improving recovery from injury improving recovery from injury
Health and PerformanceHealth and Performance
Sitting is the new smoking!!Sitting is the new smoking!!
Physical ActivityPhysical ActivityEndurance, Flexibility, Strength, AgilityEndurance, Flexibility, Strength, Agility
Aerobic exercise: 150 min / week
Diversify your workout Weight resistance Improve your flexibility Challenge your mobility
Concept of staying active
Tobacco AbuseTobacco Abuse
Leading preventable cause of all deaths
Increases CHD and all-cause mortality
Augments effects of other risk factors
Risk of heart disease falls rapidly after cessation
Prevention is the key – STOP SMOKINGPrevention is the key – STOP SMOKING
ObesityObesity
65% adults overweight or obese BMI based on height and weight
>25% = overweight, >30% = obese Increases all-cause and CHD
mortality Interacts with other risk factors Predisposes to sleep apnea
The Hard Cold FactsThe Hard Cold Facts
You only have to exercise on the days you eat!
Healthy EatingHealthy Eating
Practice moderation Eat breakfast Plan ahead and be consistent Avoid processed foods Be physically active Get enough sleep Do not allow a small weight
gain to become a BIGGER weight gain
Failing to Plan means Planning to Fail!Failing to Plan means Planning to Fail!
Healthy EatingHealthy Eating
6-9 servings of fruits and vegetables daily Grains and fiber High protein, low fat, low carbs Omega-3 fatty acids (fish) Portion control Poly or unsaturated fats Limit caffeine and alcohol Avoid fructose corn syrup
Balance, Moderation and VarietyBalance, Moderation and Variety
Coronary Heart DiseaseCoronary Heart Disease
Lipid profile measures: Total cholesterol HDL cholesterol LDL cholesterol Triglycerides (TG)
Strong genetic component Significant impact on risk of CHD Treatment goals influenced by age, sex and
risk assessment
Lipid DisordersLipid Disorders
Cardiovascular Drug TherapyCardiovascular Drug Therapy
Preventive vs Targeted Therapy Aggressive management of:
Known coronary heart disease Hypertension Hyperlipidemia Diabetes
Role of Aspirin Benefit of Alcohol Role of Statins
Tried and True Remedies
Alternative Drug TherapiesAlternative Drug Therapies
■ No evidence for CVR benefit with vitamin C, E, beta-carotene
■ No evidence for CVR benefit with folate and B vitamins
■ No evidence for benefit with fish oil
■ Co-enzyme Q10 ■ Hawthorn extract
Evidence Pending…
Prevention StrategiesPrevention Strategies
■ Educate yourself Educate yourself ■ Know your risk factorsKnow your risk factors■ STOP smoking!!STOP smoking!!■ Exercise 150min/weekExercise 150min/week■ Modify dietModify diet■ Seek treatment for high Seek treatment for high
BP, high cholesterol BP, high cholesterol and diabetesand diabetes
■ Listen to warning signsListen to warning signs
Keep your heart healthy!