Transcript Terror from Within: An Overview of Cardiovascular Disease

Cardiovascular Disease:
an Overview
Jon W. Wahrenberger, MD
February 7, 2009
The Good News
We are living longer!
Heart & stroke death
rates are falling!
So Why Worry about
Cardiovascular Disease?
• Cardiovascular disease is the
number one killer
• About 42% of all deaths
• Nationwide: 921,819
annually
• NH: 3468
• VT: 1751
Septicemia, 1.34
Kidney, 1.63
Alzheimers, 2.22
Influenza, 2.57
Diabetes, 2.95
Injuries, 4.2
Respiratory, 5.09
• Cardiovascular disease
continues to strike young and
middle-aged individuals
• We are losing ground on
several important risk factors
Cancer, 22.91
Cardiovascular,
35.74
Changing demographics
Obesity in the USA
Obesity in Children
Prevalence of Diabetes
1980-2004
Source: Wonder.cdc.gov
Adult Smoking
Smoking in Youth
27.6
Smoking in Last 30 Day
(%)
30
24.3
25
19.7
21.4
20
15
10
5
0
9th
10th
11th
12th
Grade Level
2005 Youth Risk Behavior Survey (YRBS)
Women are not immune to heart
disease!
Death Rate Per 100,000 Population
400
350
300
Men
Women
250
200
150
100
50
0
CVD
Resp. Cancer
Colon Cancer
Breast Cancer
Potential for Falling Longevity?
Life Extending
Technology
Public Health
Measures
Health
adverse
behavior
Evolution of Cardiovascular Disease
Technology
Influences
Normal
Child
Mass
Marketing
of Junk Food
Overweight
Inactive Child
Chain of
Survival
Tobacco
Surgical
Procedures
Overweight
Inactive Adult
Suffering,
Loss of QOL
Sick
Adult
Drugs
Food
Overabundance
Cultural
Changes
Knowledge
Deficits
Devices
We must tackle heart disease at all points!
Premature
Death
What is Cardiovascular Disease?
“Cardiovascular disease” refers to diseases
involving the heart and blood vessels
Peripheral
Heart
Brain
Vasculature
Angina
Heart Attack
Heart Failure
Arrhythmias
Stroke
TIA
Claudication
Ulceration
Amputation
The heart, brain and extremities share a
disease process
Cerebral
Disease
Coronary
Disease
25%
7%
30%
3%
4%
12%
19%
Peripheral Vascular
Disease
The Common Thread?
• Circulatory system
(arteries, veins, etc.)
• Susceptibility to
atherosclerosis
Atherosclerosis
AKA “Arteriosclerosis”, “hardening of the arteries”
• Complex, selfsustaining
inflammatory
process
• Thickens arterial
wall
• Occurs slowly over
decades
Atherosclerosis Progression
Ischemic Heart
Disease
Cerebrovascular
Disease
Peripheral
Vascular Disease
No Symptoms
Mild Symptoms
Severe Symptoms
Time (years to decades)
What causes atherosclerosis?
•
•
•
•
•
•
•
•
Smoking
High Blood Pressure
High Cholesterol
Diabetes
Hereditary Factors
Sedentary Lifestyle
Obesity
Other Factors
The Big 5
Diseased Coronary Artery
Peripheral Vascular Disease
Stroke – “Brain Attack”
Symptoms of Cardiovascular
Disease
Heart Disease
•Chest Discomfort
•Shortness of breath
•Fatigue
•Palpitations
Stroke or TIA
•Sudden numbness
or weakness.
•Sudden confusion,
trouble speaking or
understanding
•Sudden visual loss
•Sudden trouble
walking, instability
•Sudden severe
headache with no
known cause
Peripheral
Vascular
•Pain in calves, thighs
or buttocks
•Non-healing ulcers
Suspected
Stroke or
Heart
Attack?
Call 911
Time = saved heart muscle
Time = saved brain function
Other Causes of Heart Disease
•Heart failure
•Heart rhythm disturbances
(arrhythmias)
•Congenital heart disease
•Heart Valve Disease
•Heart infections
Heart Failure
Heart Failure
Virus
Toxins
Hypertension
Post Partum
Ischemia
Valve Disease
Heart
Muscle
Injury
Heart
Failure
Heart Failure: Symptoms
• Shortness of breath
• Fatigue
• Edema (swelling)
Heart Failure: Treatment
• Salt and fluid restriction
• Medications
•
•
•
•
ACE Inhibitors
Beta blockers
Angiotensin receptor blockers
Digoxin
• Devices (Resynchronization
therapy)
Arrhythmias
Heart Electrical System
A wave of electrical discharge proceeds
mechanical contraction of the heart.
Arrhythmia Consequences and
treatment
Examples
Consequences
Treatment
Rapid
heart
beating
•Supraventricular
tachycardia (SVT)
•Ventricular
tachycardia
•Atrial fibrillation
•Awareness
•Drugs to
(Palpitations)
slow heart;
•Reduced blood
•ablation
delivery
(lightheadedness; loss
of consciousness)
•Possible stroke risk
(AF)
Slow heart
beating
•Sinus bradycardia
•Heart block
Reduced blood
delivery (fatigue;
lightheadedness; loss
of consciousness)
Removal of
offending
drugs;
possible
pacemaker
Arrhythmia Symptoms
• Palpitations (a feeling of thumping, fluttering,
skipping or racing of the heart)
• Lightheadedness/loss of consciousness
• Chest pain or tightness
• Shortness of breath
• Fatigue
• Anxiety
Heart Valve Disease
Valve Disease
Valves are intended to allow blood flow in
only one direction from one heart chamber to
another
Pulmonic
Valve
Aortic
Valve
• Normal Function:
• Allow blood to flow freely
one direction and none
backwards
• Dysfunction:
Mitral
Valve
Tricuspid
Valve
• Become narrow and impede
forward flow (stenosis)
• Become incompetent and
allow backward flow
(regurgitation)
Valve Disease
Congenital
Abnormality
Infection
Age Related
Degeneration
Rheumatic
Fever
Valve
Dysfunction
• Shortness of
breath
• Fatigue
• Chest Pain
• Susceptibility
to infection
• Death
Treatment of Valve Disease
• Medications
• Surgery
• Percutaneous repair
Open Heart Surgery
Percutaneous Valvuloplasty
Mitral Valvuloplasty
Aortic Valvuloplasty
Percutaneous Aortic Valve
Replacement
Percutaneous Aortic Valve
Replacement
What can you do to stay healthy?
Know your Enemies!
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Inactivity
Obesity
Smoking
Elevated cholesterol
Diabetes
Hypertension
Exercise Recommendation
Age 18-65
Age > 65
• Moderate aerobic activity for
30 min 5 x per week, or
• Vigorous aerobic activity 20
minutes 3x per week
• Can reach moderate activity
goal with multiple 10 min
periods
• Same aerobic
recommendations
• Intensity based on fitness
level
• Additional:
• Muscle strengthening
• Flexibility exercises
• Balance exercise
Source: ACSM/AHA Recommendations, 2007
Body Mass Index (BMI)
BMI = Weight (Kg)
Height2 (M2)
Below 18.5 = Underweight
18.5-24.9 = Normal
25-29.9 = Overweight
30 and above = Obese
(Full table provided with
registration materials)
Calculate Your Risk
Framingham Risk Calculator
Men
Women
Make the right choices
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Use the stairs; take a daily walk!
Stay away from all fast food restaurants!
Eat smaller portions
Read food labels
Choose foods made from whole grains
Minimize saturated fats and trans fats
Stay away from restaurants that allow
smoking
Some Unlikely Friends?
Dark Chocolate
• Raises HDL
• Improves insulin
sensitivity
• Lowers blood
pressure
• Improves blood
vessel reactivity
Rx: Recommended Dose – 100 gm per day
Dark Chocolate ≠ Milk Chocolate
Alcohol
• Elevation of HDL
• Antithrombotic
effects
• Promote formation
of nitric oxide (NO)
• Reduced coronary
heart disease
Rx: Recommended Dose – 1-2 drinks per day
Olive Oil
• Increase in HDL
• Reductions
• Total Cholesterol
• Total to HDL Ratio
• Triglycerides
• Reduction in
oxidative stress
markers
Green Tea
• Decrease in total and
cardiovascular mortality
• Decrease in myocardial
infarction
• Decrease in stroke
• Reduced mortality after MI
• Increases coronary flow
reserve
• Improved endothelial
function
Nuts
• Nutritionally
dense
• Associated with
reduction in:
• Heart disease
• Certain cancers
• Inflammation
• Allergic issues?
What’s New?
• A new category of drugs - CETP inhibitors
(anacetrapib) - has been shown to dramatically
increase the levels of protective HDL cholesterol
• FDA advisory panel just voted unanimously in favor
of approving prasugrel, a new platelet inhibiting drug
• The JUPITOR Trial has shown a mortality benefit from
Crestor in healthy people with normal lipids but
elevated CRP
Where are we heading?