Transcript Staying Healthy

Staying Healthy
The Key to Your Heart
Kim F Gibson, MD, FACP
WRNMMC Bethesda
Demographics
Growing old is not for sissies!
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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
ARE WOMEN
What is the Goal?
Reaching Your Potential
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Health is a state of complete physical,
mental, spiritual and social well-being,
and not merely the absence of disease
or infirmity.
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We must continuously improve our
function, not simply delay “inevitable”
losses.
Case 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 Presentation
Three months later:
 Mr.
R collapses at his desk
 Paramedics respond quickly and find him in
cardiac arrest
 Multiple attempts at resuscitation in the office
and at the emergency room are unsuccessful
 He never recovers and is pronounced dead
 Autopsy shows a ruptured plaque and clot in
the main artery supplying blood to his heart
Major Causes of Death
(United States: 2004). Source: NCHS and NHLBI.
500,000
459,096
410,628
Deaths
400,000
286,830
300,000
267,058
200,000
72,050 58,646
100,000
39,962
63,341
46,991
35,267
0
A
B
C
D
E
Males
A. Total CVD
B. Cancer
C. Accidents
A
B
D
F
C
Females
D. Chronic Respiratory Diseases
E. Diabetes Mellitus
F. Alzheimer’s Disease
Prevalence of Cardiovascular Disease
(NHANES: 1999-2004). Source: NCHS and NHLBI.
92.0
Percent of Population
100
71.3 75.1
80
83.0
60
39.1 39.5
40
20
14.8
9.4
0
20-39
40-59
Males
60-79
80+
Females
Includes coronary heart disease, heart failure, stroke and hypertension
New and Recurrent MI or
Fatal CHD
Annual Number of U.S. Adults with
Diagnosed Heart Attacks
350000
300000
290000
265000
235000
250000
180000
200000
150000
95000
100000
50000
30000
95000
10000
0
35-44
45-64
65-74
75+
Ages
Men
Women
Includes MI and fatal CHD but not silent MI’s
Cardiovascular Disease
Keep your heart healthy
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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
Cardiovascular Disease
Diagnostic Categories
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Coronary heart
disease
Cerebrovascular
disease
Peripheral vascular
disease
Aortic
atherosclerosis
What is the connection?
Atherosclerosis
Contributes
to:
 Heart attack
 Most strokes
 Peripheral Vascular
Disease
 Erectile Dysfunction
Coronary Heart Disease
Cardiac Risk Factors
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
Coronary Heart Disease
Cardiac Risk Assessment
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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 Reduction
Primary vs Secondary Prevention
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CVD mortality has declined since 1975
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Earlier diagnosis
More aggressive treatment
Reduction in risk factors
Prevention is primary focus
Focus on LIFESTYLE modification
?Role of aspirin, statins and fish oil
It’s never too late to start!
Cardiac Risk Reduction
Lifestyle Modifications
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Exercise daily (150 min/week)
Don’t smoke
Weight maintenance
Mediterranean diet
Restful sleep
Treat hypertension, diabetes,
high cholesterol
Cardiovascular Fitness
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Exercise has
protective effect
Impacts all other
risk factors
Focus on aerobic
activities
AHA recommends
150 minutes/week
Physical Fitness
Health and Performance
Impact on
 improving performance
 sharpening attention and focus
 enhancing efficiency
 reducing disease risk and morbidity
 improving recovery from injury
Sitting is the new smoking!!
Physical Activity
Endurance, Flexibility, Strength, Agility
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Aerobic exercise: 150 min / week
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Diversify your workout
 Weight resistance
 Improve your flexibility
 Challenge your mobility
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Concept of staying active
Tobacco Abuse
Prevention is the key – STOP SMOKING
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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
Obesity
The Hard Cold Facts
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65% adults overweight or obese
BMI based on height and weight
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>25% = overweight, >30% = obese
Increases all-cause and CHD
mortality
Interacts with other risk factors
Predisposes to sleep apnea
You only have to exercise on the days you eat!
Healthy Eating
Failing to Plan means Planning to Fail!
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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
Healthy Eating
Balance, Moderation and Variety
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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
Coronary Heart Disease
Lipid Disorders
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Lipid profile measures:
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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
Cardiovascular Drug Therapy
Tried and True Remedies
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Preventive vs Targeted Therapy
Aggressive management of:
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Known coronary heart disease
Hypertension
Hyperlipidemia
Diabetes
Role of Aspirin
Benefit of Alcohol
Role of Statins
Alternative Drug Therapies
Evidence Pending…
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No evidence for
CVR benefit with
vitamin C, E, betacarotene
No evidence for
CVR benefit with
folate and B
vitamins
No evidence for
benefit with fish oil
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Co-enzyme Q10
Hawthorn extract
Prevention Strategies
Keep your heart healthy!
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Educate yourself
Know your risk factors
STOP smoking!!
Exercise 150min/week
Modify diet
Seek treatment for high
BP, high cholesterol
and diabetes
Listen to warning signs