Transcript Links to Heart Disease, High Blood Pressure and Diabetes

Health and Lifestyle Connection
Links to Heart Disease, High Blood Pressure and Diabetes
Candace Huber, MPH, BSN
Florida Hospital
Center for Community Health Ministry
©2007 Florida Hospital Center for Community Health Ministry
Septicemia
(Blood Infections)
Cancer
Heart Disease
Illicit
Drug Use
Diet &
Activity Patterns
Tobacco Use
Kidney
Disease
Stroke
External
& Internal
Stress
Motor
Vehicles
Meaningless
Existence
Influenza
Pneumonia
Sexual
Behavior
Anger &
Frustration
Powerlessness
Loneliness
Lack of
Information
Or Education
Economic
Disparity
Chronic
Infectious Lung
Agents Disease
Hopelessness
& Emotional
Despair
Pollutants &
Toxic Agents
Firearms
Alzheimer’s
Disease
Alcohol &
Substance
Abuse
Low Self
Esteem or
Self Worth
Diabetes
Accidents
©2007 Florida Hospital Center for Community Health Ministry
Obesity Trends* Among U.S. Adults
BRFSS, 1985
No Data
<10%
10%–14%
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10
©2007 Florida Hospital Center for Community Health Ministry
Obesity Trends* Among U.S. Adults
Percent of Obese (BMI > 30) in U.S. Adults
www.cdc.gov/obesity/data/trends.html
Overweight and Disease Risk
10
9
8
7
6
5
4
3
2
1
0
BMI 22
BMI 30
Heart
disease
© 2002 – 2006 LifeLong Health
High BP
Gallbladder Diabetes
NEJM, Aug. 5, ’99, 430
©2007 Florida Hospital Center for Community Health Ministry
Heart Disease and Lifestyle
© 2003, PrevMedix LLC
Stages of Atherosclerosis
Normal
Moderate
Severe
Cross-section of an artery
© 2003, PrevMedix LLC
Blood Tests
Recommended Values
Desirable
Optimal
Total Cholesterol
<200
<160
HDL “good” Cholesterol >40
>60
LDL “bad” Cholesterol <130
<100
Non-HDL Cholesterol
<160
<130
Triglycerides
less than 200 <100
Glucose levels(nonfasting)<140
Glucose levels (fasting)
< 100
© 2003, PrevMedix LLC
Lowering LDL (bad) Cholesterol
Every 1% decrease in LDL reduces CHD risk 2%
• Fat - only 25% to 30% of total calories
• Saturated fat - less than 10%, less than 7% for
better results, avoid hydrogenated oils
• Fiber - 20 to 35 gm/day (whole grains, fresh
fruits and vegetables)
• Be physically active - 30+ minutes most days
• Healthy weight - see your body composition
report (BMI less than 25)
© 2003, PrevMedix LLC
Raising HDL (good) Cholesterol
Every 1%
increase in
HDL lowers
CHD risk
2% to 3%
• Get 12 to 20 or
more aerobic miles
per week
• Achieve and
maintain a healthy
body weight
• Don’t smoke
© 2003, PrevMedix LLC
Increasing HDL Lowers HD Risk
Mortality rate due to coronary heart disease per 100,000
160
140
120
100
80
60
40
20
0
160 160
Men
Women
107
50
<35
44-35
56 40
54-45
23 15
2
74-55
75+
20
HDL Level
Source: The Framingham Heart Study
© 2003, PrevMedix LLC
Walking Time and Heart Health
120
Cholesterol and Heart Health
40.0
100
80
100
30.0
71
60
20.0
52
40
46
41
20
0
None
1 hr/wk
3 hr/wk
5 hr/wk
Plus Vigor.
Hours of Walking per Week
CHD mortality rate, men
New England Jour. Medicine, Aug. 1999
HDL Cholesterol
•
Factors that improve
HDL
– Aerobic exercise,
160
150
12-20 aerobic miles
per week
100
107
– Achieve/maintain
•
ideal body weight
50
56
– Avoid smoking
– Avoid trans fatty
23
2
0
acids
75+ 74-55 54-45 44-35 <35
Note: For every 1% you
HDL Levels mg/dL
increase HDL levels, you
decrease CHD by 2-3%
Source: Framingham Heart Study
10.0
0.0
160
180
200
240
300
Serum Cholesterol (mg/dL)
Source: NCEP, MRFIT Study
Clinical Risks and Heart Disease
A 16+ year study of some
366,559 people looked at
three major risk factors:
–
smoking (currently)
–
cholesterol (200+)
–
blood pressure
(>120/80)
People with none of these
risks:
–
were 80 to 90% less
likely to have a heart
attack
–
were 40-60% less
likely to die from any
cause
–
and lived 6 to 10 years
longer than those with
any risks
80
78
60
40
20
22
0
Persons with
no risks
All other
persons
JAMA, Dec. 1, 1999
©2007 Florida Hospital Center for Community Health Ministry
Fruit and Vegetable Intake
and Risk of Heart Attack
•
•
Persons who ate the most
fruits and vegetables (top
20%) had a 20% lower risk
of heart attack than people
who ate the fewest (bottom
20%).
For every serving of fruit or
vegetable eaten per day,
the risk of heart attack
dropped 4%.
1.0
1.00
0.8
0.80
0.5
0.3
0.0
Lowest
Highest
Fruit/Vegetable Intake
Annals of Internal Medicine, 2001, Jun 19; 134:1106-14
Fruit and Vegetable Intake 1
and Risk of Stroke
0.8
•
•
Persons who ate the most
fruits and vegetables (top
20%) had a 31% lower risk
of stroke than people who
ate the fewest (bottom
20%).
For every serving of fruit or
vegetable eaten per day,
the risk of stroke drops 6%
Ref. JAMA, p. 1233, Oct. 6, 1999
1.00
0.69
0.6
0.4
0.2
0
Lowest
<3/Day
Highest
8+/Day
©2007 Florida Hospital Center for Community Health Ministry
Coronary Heart Disease (CHD)
Factors You Can Change
• Blood cholesterol levels:
• Total less than 200 or less than 160 if you have heart disease
• Smoking: If you do smoke, stop!
• More smokers die from heart disease than lung cancer
• Quitting lowers your risk even if you are a long term smoker
• Blood pressure: Keep blood pressure low
• Less than 120/80
• Inactivity: Get regular exercise, 30+ minutes most days
• Excess body fat: Maintain a healthy weight
• BMI less than 25
© 2003, PrevMedix LLC
Cardiovascular Disease Risks (RR)
Waist Girth and Health Risk
Men
2.37
2.0
1.0
1.00
1.19
90 cm
100 cm
35"
39"
0.0
<35"
Waist Girth in Inches
© 2003, PrevMedix LLC
The Lancet, Mar. 3, 2001
Cardiovascular Disease Risks (RR)
Waist Girth and Health Risk
3.0
Women
3.16
2.0
1.56
1.0
1.00
83 cm
93 cm
33"
37"
0.0
<33"
Waist Girth in Inches
© 2003, PrevMedix LLC
American Journal of Clinical Nutrition, Oct. 2002
Waist Girth Action Steps
Waist Girth
Men Women
Action
<35”
Low risk. Maintain with healthy
eating and regular physical activity.
<33”
35”
33”
90 cm 83 cm
Moderate risk. Warning! Limit future
weight gain, eat more healthfully,
be more physically active.
39” + 37” +
100 cm 93 cm
High risk. Risk reduction and weight loss
necessary. Develop weight loss program,
diet and physical activity, with health
professional’s guidance and support.
© 2003, PrevMedix LLC
American Journal of Clinical Nutrition, Oct. 2002
Healthy People 2010
Leading Health Indicator
New Blood Pressure Norms
Normal
< 120/80
Prehypertension
120-139 / 80-89
High blood pressure 140/90+
© 2003, PrevMedix LLC
JNC 7 Report, JAMA May 21, 2003
High blood pressure
increases the risk for
heart attack, angina,
stroke, kidney failure
and peripheral artery
disease (PAD). High
blood pressure may
also increase the risk
of developing fatty
deposit in arteries
(atherosclerosis).
The risk of heart
failure also increases
due to the increased
workload that high
blood pressure
places on the heart.
© 2003, PrevMedix LLC
Prevalence of High Blood Pressure
70
Percent (%)
60
65.4
50
40
BP 140/90+
30
20
28.7
27.1
All adults
Men
30.1
30.9
Women
Blacks
10
0
© 2003, PrevMedix LLC
Age 60+
JAMA 290:199-206, Jul 9, 2003
© 2003, PrevMedix LLC
Blood Pressure and Mortality
Mortality rate per 100,000
80
74.5
60
40
20
0
21.6
10.6
15.1
<120
120-139
140-159
160+
Systolic Blood Pressure
Source: The Framingham Heart Study, 1974
© 2003, PrevMedix LLC
Lowering Blood Pressure
• Achieve a healthy weight (BMI
less than 25)
• Watch your diet
• Increase physical activity (30+
minutes most days)
• Don’t smoke
• Get adequate rest and relaxation
© 2003, PrevMedix LLC
Lifestyle Modifications to
Lower Blood Pressure
1. Maintain a healthy weight
- BMI less than 25, or
- Lose 10-15 pounds
- BP drops 5-20 points with 10 kg wt loss
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Lifestyle Modifications to
Lower Blood Pressure
2. Follow the DASH diet eating plan
- Eat an abundance of fruits and vegetables
- 8 to10 servings per day
- Use non or low fat dairy products
- Include whole grains, nuts, and legumes
- Limit foods high in saturated fat (e.g. meats, butter)
- BP drops 8-14 points on the DASH diet
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
New Food Pyramid
© 2003, PrevMedix LLC
Lifestyle Modifications to
Lower Blood Pressure
3. Reduce sodium intake
- Eat less salt and salty foods
- Limit sodium intake to 2400 mg/day or less
- Limiting sodium reduces BP by 2-8 points
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Lifestyle Modifications to
Lower Blood Pressure
4. Engage in regular aerobic physical activity
- At least 30 minutes per day
- Most days of the week, daily when possible
- Moderate activities such as brisk walking
- BP drops 4-9 points with increased activity
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Introduce Concept
© 2003, PrevMedix LLC
Lifestyle Modifications to
Lower Blood Pressure
5. Limit alcohol intake, if used at all
- Alcohol raises blood pressure
- BP drops 2-4 points by limiting alcohol
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Diabetes and Lifestyle
© 2003, PrevMedix LLC
When you have
diabetes, your body
either doesn’t make
enough insulin or
can’t use its own
insulin as well as it
should, or both. This
causes sugars to
build up too high in
your blood. Type 2
diabetes is the most
common form. It
appears most often
in middle-aged
adults; however,
adolescents and
young adults are
developing type 2
diabetes at an
alarming rate.
Kenneth Cooper
© 2003, PrevMedix LLC
Weight Loss and Health Changes
Overweight people who lose 10 to 15 pounds may
• Lower blood pressure
• Reduce high blood sugar
• Reduce high triglycerides and cholesterol
levels
• Reduce sleep apnea or irregular breathing
during sleep
• Decrease risk of osteoarthritis
• Decrease depression
• Improve appearance and self-esteem
© 2003, PrevMedix LLC
Practical Ways to Lose Weight
• Dieting is not
recommended
• A change in
lifestyle is
necessary
• Make changes that
you can do for the
rest of your life
© 2003, PrevMedix LLC
Weight Loss Goals
• 1/2 to 1 pound weight loss
per week
• Any faster and you may begin
loosing your muscle
• Make body composition goals
as well as weight loss goals
© 2003, PrevMedix LLC
Make a Commitment
Think about your goals and prepare to act
•
•
•
•
•
The goal
The start date
The timeline
Your reward system
Your support system
© 2003, PrevMedix LLC
Health and Lifestyle Connection
Links to Heart Disease, High Blood Pressure and Diabetes