Chapter 9

Maximizing Heart Health

A Wellness Way of Life
Eighth Edition Robbins/Powers/Burgess
2009 McGraw-Hill Higher Education. All rights reserved.

Chapter 9 Objectives
After reading this chapter, you will be able to:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Identify the ten primary heart disease risk factors. Identify the six secondary heart disease risk factors. Identify the 12 controllable and 4 uncontrollable risk factors for coronary heart disease (CHD). Define arteriosclerosis, atherosclerosis, angina pectoris, myocardial infarction, and stroke. Explain the differences between cardiovascular disease (CVD) and coronary heart disease (CHD). Identify the symptoms of a heart attack and of a stroke and explain the S.T.R. approach to stroke awareness. Explain the roles of HDL and LDL in heart health. Explain why smoking cigarettes increases heart disease risk. Define prehypertension, normal blood pressure range, and the blood pressure reading that indicates hypertension. Identify the cholesterol reading that indicates high blood cholesterol. Identify the CVD risk factors that are positively affected by exercise. Identify the positive and negative effects of alcohol on CVD. Discuss the importance of lifestyle and the impact of the mind-body connection on CVD.
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Cardiovascular Disease

#1 overall killer of Americans kills more than cancer, chronic respirator disease, accidents and diabetes combined! Heart Disease is caused by adverse lifestyles. If you want to get rid of the disease, get rid of the lifestyles. More Americans die each year from heart disease than would have been killed in 10 Vietnam wars.

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Deaths from Cardiovascular Diseases

Figure 9-2
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Impact of Cardiovascular Disease

Causes 37% of all deaths in the U.S. Common forms include: heart attack, stroke, high blood pressure, angina, congestive heart failure, rheumatic heart disease, pulmonary disease, renal disease, and congenital heart disease. Coronary heart disease by itself is still the single largest cardiovascular killer (1 in every 5 deaths). 2006 cost estimated at $431.8 billion. Although incidence is declining, we still have lots of work to do in behavior change.

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Coronary Heart Disease (CHD)

Includes angina pectoris (chest pain), myocardial infarction (heart attack), and the atherosclerotic process in the hearts blood vessels. CHD accounts for more than half of all cases of CVD and is the single largest killer of Americans. CHD is most commonly the result of atherosclerosis.

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Atherosclerosis

Deposits of cholesterol and other lipids along with cellular debris accumulate in the artery to form a plaque. As it progresses, the artery wall becomes hard, inelastic, and clogged and may become blocked. Blockage could be from cell debris or a blood clot or excessive stress. If blockage occurs, angina (chest pain), a myocardial infarction (heart attack), or stroke could occur.

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To Reduce Risk of Atherosclerosis

Become

or stay physically fit Consume a diet high in omega-3 fats Dont smoke Avoid secondhand smoke Control blood pressure, reduce weight (if overweight) Control stress
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Progression of Atherosclerosis
ARTERIES OF THE HEART

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Angina Pectoris

Atherosclerosis may lead to angina pectoris, or chest pain/discomfort due to CHD. The pain occurs when an artery becomes partially blocked causing an oxygen debt in the heart muscle. Angina is a sign that someone is at higher risk of a heart attack.
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Myocardial Infarction (MI) Heart Attack

Results when one or more of the coronary arteries is partially blocked by atherosclerotic deposits called plaque. A blood clot can form and choke off the supply of blood to the heart muscle. Common signs uncomfortable constant pressure or pain in center of chest that lasts more than just a few minutes, pain or discomfort in other areas such as the shoulder, neck, jaw, back, stomach, or one or both arms. Less common signs nausea, shortness of breath, weakness, cold sweats, paleness.
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Stroke (Brain Attack)

Occurs when blood flow to the brain is interrupted either by a blockage (ischemic stroke) or by a burst blood vessel (cerebral hemorrhage); primarily caused by atherosclerosis and is the third leading cause of death. Risk factors hypertension, heart disease, gender (women), diabetes, age (over 55), smoking, ethnicity (Blacks), lifestyle (high fat diet, alcohol or cocaine abuse, smoking, and inactivity). Common warning signs sudden numbness or weakness of face, arm or leg (especially on just one side of the body), sudden confusion or trouble speaking, sudden trouble seeing, sudden trouble walking, dizziness, sudden severe headache. STR approach for stroke awareness Smile, Talk, Raise (arms).
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Stroke Risk Reduction

Exercise regularly Control blood pressure Do not smoke Control diabetes (if you have it) See a sleep specialist if you have sleep apnea Optimal levels of homocysteine Avoid infections and inflammation Reduce chronic stress and anger Dont drink alcohol excessively
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Primary Risk Factors for Heart Disease

Controllable Primary Factors (linked directly to development of CHD) inactivity, high blood pressure, high blood lipids, cigarette smoking, obesity, and diabetes. Uncontrollable Primary Factors (linked directly to CHD) family history, male gender (+postmenopausal women), ethnicity, and age.

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Secondary Risk Factors for Heart Disease

Controllable secondary risk factors (contribute to the development of CHD) individual response to stress, emotional behavior (anger and hostility), excessive alcohol (+some illegal drugs), metabolic syndrome, C-reactive protein, homocysteine. All of these are controllable.

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U.S. Population Having Heart Disease Risk Factors

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Inactivity

Only 25% of Americans engage in physical activity at the intensity and duration needed for health benefits. Inactivity is considered the nations most common cardiac threat! 20-60 minutes of moderate to vigorous physical activity at least 3-5 days per week is recommended to reduce risk. Physical activity protects against CHD and improves the survival rate after a heart attack. Remember the activity pyramid!
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High Blood Pressure

Blood pressure is the force against the arteries exerted by the heart while pumping blood. Systolic while the heart is pumping Diastolic while the heart is at rest Normal pressure is less than 119/79 or less (gold standard is 115/76). Prehypertention is between 120/80 and 139/89, and high blood pressure is over 140/90. HBP causes the heart to overwork, become weak, and enlarged. It can also damage the artery walls. One in three Americans have HBP 90% (primary) cause is unknown Common risks include: genetics, smoking, stress, male gender, older, Black, obesity, sodium sensitivity, excessive alcohol consumption, oral contraception, and sedentary lifestyle.
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Prevent or Manage HBP

HBP is the silent killer many dont know they have it. Get your blood pressure checked. Maintain healthy weight. Exercise regularly. Do not smoke. Limit sodium intake below 2,400 mg/day. Avoid or limit alcohol. Eat a balanced diet rich in fruits, grains and veggies. Increase calcium intake. Increase potassium intake. Increase fiber intake. Practice stress management.
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Population with Hypertension in U.S. Adults

Figure 9-8
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High Blood Lipids

High blood lipids are the primary cause of arterial plaque. Cholesterol is a waxy/fatty substance made in the liver (80%) and found in the bloodstream. It is needed for cell structure, digestion, and adrenal glands. Triglycerides are made in the body to store excess fats free fatty acids. They work with LDLs to accelerate plaques in the arteries.

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Cholesterol

High cholesterol is termed hypercholesteremia. Desirable level in total is below 200 (160 target). Cholesterol must attach to a protein to be carried in the blood stream (lipo-protein). Low Density Lipoprotein (LDL) are dangerous to the arteries and accelerate plaque formation. Optimal level is below 100. High Density Lipoprotein (HDL) can protect the system from plaques. Levels above 60 are best for protecting arteries. Triglycerides should be below 150 mg/dL.

2009 McGraw-Hill Higher Education. All rights reserved.

Cholesterol

To increase HDL levels: exercise regularly, dont smoke, control stress, reduce excess body fat, eat a high fiber, low fat diet (use monounsaturated fats). Ratio of total cholesterol to HDL is a better indicator of risk (desired target is 4.0 or less). Total cholesterol of 240 and HDL of 60 (4.0 risk) versus total cholesterol of 180 and HDL of 30 (6.0 risk). Important to know the breakdown.

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Triglycerides

Ways to lower triglycerides include:

Decrease alcohol and sugar consumption Reduce excess body fat Reduce consumption of animal fats (poultry skin, lunch meats, shellfish) Get regular aerobic exercise Last resort take meds

Important to know your levels to know if you are at risk!

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Smoking

Increases heart rate and blood pressure, constricts blood vessels, impairs transportation of O2, decreases HDL, increases LDL, can damage artery walls, increases blood clotting. Kills 400,000 Americans a year (more than the number killed during WW I and Vietnam combined). Causes emphysema, COPD, peripheral vascular disease, and is dangerous to a fetus. Secondhand or side stream smoke is also dangerous and causes disease and deaths. No level is safe. Most smokers want to quit at some level. It is possible to quit. Help is available.

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Obesity

Primary risk factor that has become epidemic. More than 65% of the U.S. population is obese or overweight. Abdominal fat may be more risky than lower body fat. Waist measurement of more than 35 for women and 40 for men is considered high risk. Body mass index of over 25 is considered overweight and over 30 is considered obese. Obesity is a pro-inflammatory state and chronic inflammation causes wide spread tissue damage (leads to plaques in the arteries). Childhood obesity rates have drastically increased. It is very controllable with balanced diet and regular exercise!
Image 100/Corbis

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Diabetes

Both type 1 and type 2 are diseases that affect how the body uses glucose. Both are characterized by the bodys inability to produce enough insulin or use it properly. Too much sugar in the blood or urine is a classic sign of diabetes. High blood sugars damage the circulatory system, kidneys (from processing too much sugar) and can put one at more risk for high blood lipids and atherosclerosis. 90% of diabetes is type 2 or non-insulin dependent that can be controlled with lifestyle changes (weight management/loss and dietary changes).

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Type 2 Diabetes

Risk factors: overfat (especially belly fat) have brother, sister or parent with diabetes are not white had a baby weighing more than 9 lbs have HDL of 35 or less or triglyceride of 250 or more have hypertension have had an elevated fasting glucose test (several tests over 125 is diabetes, 100-125 is pre-diabetic)
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Type 2 Diabetes

Symptoms include: Excessive thirst Frequent urination Flu-like symptoms (tired or weak) Weight loss or weight gain Blurred vision Dry skin Slow healing wound, frequent infections Itching, tingling or numbness in extremities

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Type 2 Diabetes
Prevention or control entails: Consistent exercise

Proper body composition and weight (lose weight if you need to) High fiber, low fat, low sugar diet (eat low glycemic foods) No smoking
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Children born in 2003: Who will have type 2 diabetes?

Figure 9-7
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Family History, Gender, Age, Ethnicity

Family History genetic brothers, sisters, parents or grandparents with heart disease increase your risk. Gender males at more risk (lifestyle? stress levels? lack of estrogen?). Once women reach menopause their risk exceeds that of men. Ethnicity Black and Hispanic are at highest risk (hypertension and diabetes). Individuals should engage in prevention activities and pay attention to family history. Age Heart disease is a chronic disease so age is a risk. Your risk can be reduced with healthy choices.

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Individual Response to Stress

Uncontrolled stress is a factor in high heart rate, high blood pressure, high blood lipids, and can increase smoking, eating, and alcohol patterns. Over time, the stress response causes chemical wear and tear on the body. Coping with stress successfully, and limiting stress is vital in limiting risk for heart disease and other stress-related diseases. How your respond to stress is critical coping in a healthy manner is vital. Exercise, relaxation techniques, meditation and social support can be effective ways to deal with stress.
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Emotional Behavior/Personality Factors

Type A personalities are at greatest risk for heart disease. Type Bs are more relaxed and slow to anger. Type Cs are As that learn to cope by using the 5 Cs. Anger and hostility are the most important factors to control. Hot reactor (those of any personality that react very intensely to stressors) are at increased risk for high blood pressure, heart disease, and stroke. Type D personality tends to be depressive, anxious, irritable and socially distant. They react negatively to stress. May tend to be at more risk for CHD.
Tracy Khan/Corbis

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Controlling Emotional Risk

People can learn to control behavior. Use thought stopping to control angry cynical thoughts. Practice laughing at yourself. Be empathetic. Reason and understand your anger. Learn to relax. Practice patience and trust. Become a good listener. Live as if you have a serious diseasekeep things in perspective. Learn to forgive.
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Excessive Alcohol and Other Drugs

Drinking too much alcohol raises blood pressure and triglyceride levels, damages the heart muscle and increases the risk of stroke and heart failure. Binge drinking may lead to heart failure later in life. No alcohol to moderate levels of alcohol are recommended (one drink for women and two for men per day no saving up for the weekend!) If you dont drink, dont start. Stimulant drugs can cause heart attack, stroke and sudden cardiac death.
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Metabolic Syndrome, C-Reactive Protein and Homocysteine

Metabolic Syndrome is a cluster of symptoms that raise the risk of heart disease, stroke, diabetes and some cancers. Defined as having three or more of: hypertension, elevated glucose, low HDL levels, and obesity. Inflammation of blood vessels may lead to heart attack and stroke by causing fatty deposits in the arteries to rupture. C-reactive protein is a marker for inflammation. Homocysteine is an amino acid in the blood and a natural byproduct of protein metabolism. In some individuals too much homocysteine is related to a higher risk of CHD, stroke and peripheral vascular disease.
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Treatment for Blocked Arteries

Drug therapy Angioplasty Bypass surgery Lifestyle change Dr. Ornishs reversal diet (75% complex carbs, 15% protein, 10% fats), 30 minutes per day of exercise, stress management strategies each day, support groups/spiritual activities weekly, no smoking

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Mind Body Connection

Positive emotions boost health. Selfish, self-centered lifestyles are twice as likely to have heart attacks. Cynical people have a higher rate of heart problems. Positive social support can result in vitality, longevity, lowered blood pressure, and healthier immune systems. Dr. Ornish believes that loneliness can block arteries and feelings of connectedness promote health. Meditation can improve health, ease pain and reduce stress. Thoughts, feelings and emotions influence our health (psychoneuroimmunology). Long-term negative thoughts and/or emotions can damage health and long term positive hardiness can enhance health. Numerous studies are investigating the mind/body connection as a real and valid component of health.
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Rx for Action

Write down the top two reasons your last fitness program didnt work and what you will do to avoid the same pitfalls. Get your blood pressure checked. Do two of the following to maintain health blood pressure: have a high fiber snack, dont smoke or cut back, avoid alcohol, reduce caffeine. Measure your waist. Calculate your BMI. Read food labels and avoid all trans fats. Get 30 minutes of exercise today. Reflect on the meaningful people in your life. Connect with two of them today via email or telephone or write a letter.
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What Do You Think?

What are your risk factors for heart disease? How could you control them? Would you know if you or someone else were having angina, heart attack or stroke? Do you know your blood pressure, cholesterol, HDL, LDL, and triglyceride levels? Do you think peoples thoughts and emotions can have an effect on their health?
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Questions?

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