Transcript High blood pressure

Cardiovascular Diseases
Facts
Risks
Prevention
Facts According to CDC
• About 610,000 people die of heart disease in the United States every year–
that’s 1 in every 4 deaths.
• Coronary heart disease is the most common type of heart disease, killing
over 370,000 people annually.
• Every year about 735,000 Americans have a heart attack. Of these, 525,000
are a first heart attack and 210,000 happen in people who have already had
a heart attack.
• Population of Washington, DC - 658,893 (2014), Montgomery County
1.017 million (2013), Fairfax County 1.131 million (2013).
Deaths Vary by Ethnicity
Heart disease is the leading cause of death for people of most
ethnicities in the United States.
Race or Ethnic Group
African Americans
American Indians or Alaska Natives
Asians or Pacific Islanders
Hispanics
Whites
All
% of Deaths
24.5
18.0
23.2
20.8
25.1
25.0
Leading Causes of Death 2013
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Heart disease: 611,105
Cancer: 584,881
Chronic lower respiratory diseases: 149,205
Accidents (unintentional injuries): 130,557
Stroke (cerebrovascular diseases): 128,978
Alzheimer's disease: 84,767
Diabetes: 75,578
Influenza and Pneumonia: 56,979
Nephritis, nephrotic syndrome, and nephrosis: 47,112
Intentional self-harm (suicide): 41,149
“世界卫生组织在2015年1月19日发表的一份报告
中指出，超过300万中国人在70岁之前死于非传
染性疾病的问题，心脏病在这些非传染性疾病中
居于首位，其次才是肺病、脑卒中、癌症和糖尿
病。另外统计数据显示，在急症死亡中，心脏病
占首位，可见心脏病对人体的危害.” (吴佳)
Risks
Risks that cannot be modified
Age
Gender
Family history
Genetics
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Why?
• A report from the CDC’s National Center for Health
Statistics indicates that “hypertension-related deaths
increased 61.8%, from 2000 to 2013.”
Definition of High Blood Pressure
Blood Pressure
• In persons older than 50 years, systolic blood pressure greater than
140 mmHg is a much more important cardiovascular disease risk
factor than diastolic blood pressure.
• The risk begins at 115/75 mmHg, doubles with each increment of
20/10 mmHg.
• Individuals who have normal blood pressure at age 55 have a 90
percent lifetime risk for developing hypertension.
• Individuals with a systolic blood pressure of 120–139 mmHg or a
diastolic blood pressure of 80–89 mmHg are pre-hypertensive and
require lifestyle modifications to prevent cardiovascular disease.
Benefits of Lowering Blood Pressure
• Blood pressure treatment has been associated with reductions in
stroke incidence averaging 35–40 percent; myocardial infarction,
20–25 percent; and heart failure, more than 50 percent.
Lifestyle Modification for high Blood
Pressure
• Maintain normal weight
• Diet : fruits, vegetables, low fat dairy products with reduced
saturated and total fat.
• Low sodium intake, less than 2.4 gm/day (one tea spoon)
• Physical activity.
• Moderation of alcohol consumption (limit to 2 drinks for men, 1
drink for women of lighter weight persons)
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Cholesterol
• Total cholesterol
• Good cholesterol (high density or HDL)
• Bad cholesterol (low density or LDL)
Who should consider taking
cholesterol medicine?
• Individuals with cardiovascular disease
• Individuals with a bad cholesterol LDL ≥ 190 mg/dL
• Individuals 40 to 75 years of age with diabetes and a
bad cholesterol LDL 70 to 189 mg/dL
• Individuals without clinical cardiovascular diseases or
diabetes who are 40 to 75 years of age with a bad
cholesterol LDL 70 to 189 mg/dL and a 10-year
ASCVD risk of 7.5% or higher
Pooled Cohort Risk Assessment
Equations
Predicts 10-year risk for a first atherosclerotic
cardiovascular disease event
Gender
Age
Race
Total cholesterol
HDL cholesterol
Systolic blood pressure
Medication controlled BP
Diabetes
Smoker
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Smoking
• Tobacco use increases the risk of heart disease and
heart attack. Cigarette smoking promotes
atherosclerosis and increases the levels of blood
clotting factors.
• Nicotine raises blood pressure, and carbon monoxide
reduces the amount of oxygen that blood can carry.
• Exposure to other people's smoke can increase the
risk of heart disease even for nonsmokers.
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Diabetes
• Diabetes increases a person's risk for heart disease.
About three–quarters of people with diabetes die of
some form of heart or blood vessel disease.
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Overweight and Obesity
• Obesity is excess body fat. It is linked to higher LDL
(bad) cholesterol and triglyceride levels and to lower
HDL (good) cholesterol, high blood pressure, and
diabetes.
Obecity
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Diet
• Several aspects of dietary patterns have been linked
to heart disease. These include diets high in saturated
fats and cholesterol, which raise blood cholesterol
levels and promote atherosclerosis. High salt or
sodium in the diet causes raised blood pressure levels.
Leading the News (4/3/2015)
Center for Disease Control: More than half of
food Americans buy contains more than
recommended amount of salt.
The Washington Post (4/3, Bernstein) “To Your Health” blog reports
that “more than half of” the food Americans “buy contains more
than the recommended amount of salt for each serving” consumed.
In the April issue of the journal Preventing Chronic Disease,
researchers from the CDC found that “meat and pasta mixed
dishes...were the top culprits, with better than 80 percent of each
containing too much salt in the three regions of the country
examined (Pacific, East North Central, and South Atlantic).” Other
foods containing more than the recommended amount of salt include
“pizza (better than 70 percent), soups (more than 60 percent) and
cold cuts (50 to 60 percent, depending on the region).”
The ABC News (4/3, Shah) website points out that a high intake of
sodium has been associated with hypertension. In order “for foods to
be deemed healthy by the Food and Drug Administration, they must
contain less than 600 milligrams of sodium per serving for meals or
less than 480 milligrams of sodium per serving of individual food
items,” an amount that is “less than a quarter teaspoon of salt.”
The Today Show Online (4/3, Fox) reports that the study
authors wrote, “In all three divisions, 50 percent or more of
products sold in most food categories exceeded the sodiumper-serving conditions for a ‘healthy’ food.”
The NPR (4/3, Aubrey) “The Salt” blog reports that in the
study, CDC investigators “used Nielsen ScanTrack data, which
captured sales of nearly 4,000 packaged food items sold in big,
chain grocery stores around the country.” They then examined
“regional differences in the sodium content of purchased
foods” and found that “no clear pattern emerged.” In other
words, everywhere across the US, sodium consumption is high.
New American Dietary Guidelines May
Remove Limits on Cholesterol
• A draft of the 2015 edition of Dietary Guidelines for
Americans, created by the Dietary Guidelines Advisory
Committee, now states that “cholesterol is not
considered a nutrient of concern for overconsumption.”
• The current U.S. guidelines call for restricting
cholesterol intake to 300 milligrams daily.
• Cholesterol in: an egg - 187 mg, 145 g lobster - 212 mg
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Physical Inactivity
• Physical inactivity is related to the development of
heart disease. It also can impact other risk factors,
including obesity, high blood pressure, high
triglycerides, a low level of HDL (good) cholesterol,
and diabetes. Regular physical activity can improve
risk factor levels.
Risks
Risks that can be modified
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High blood pressure
High LDL cholesterol
Smoking
Diabetes
Overweight and obesity
Poor diet
Physical inactivity
Excessive alcohol use
Excessive Alcohol Use
• Excessive alcohol use leads to an increase in blood
pressure, and increases the risk for heart disease. It
also increases blood levels of triglycerides which
contributes to atherosclerosis.
Prevention: What You Can Do
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Eat a healthy diet
Maintain a healthy weight
Exercise regularly
Don't smoke
Limit alcohol use
Treat Your Medical Conditions
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Have your cholesterol checked
Monitor your blood pressure
Manage your diabetes
Take your medicine
Talk with your health care provider
The Good News
• Cardiovascular mortality declined by 31% from 2000
to 2010 in the US.
• Stroke mortality declined by 3% per year in the
European countries.
• The American Heart Association 2020 Impact Goals
• By 2020, improve the cardiovascular health of all
Americans by 20%
• By 2020, reduce deaths from cardiovascular diseases
and stroke by 20%
Cardiovascular Health Metrics
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Smoking
Body mass index
Physical activity
Healthy diet score
Total cholesterol
Blood pressure
Fasting plasma glucose
The Not So Good News
(for Chinese in China)
• Chinese smokers consume 1/3 of the world’s
production of cigarettes
• China has the largest number of people with diabetes
(130 million by 2030)
• The prevalence of hypertension and dyslipidemia has
increased
• Chinese cardiovascular mortality increased from
223.5/100,000 to 239.5/100,000 from 2004 to 2010
• Poor cardiovascular health metrics
Status of Cardiovascular Health in
Chinese Adults (JACC Vol 65, No 10, 2015)
Yufang Bi, MD, PhD∗; Yong Jiang, PhD†; Jiang He, MD, PhD‡; Yu Xu, PhD∗;
Limin Wang, PhD†; Min Xu, PhD∗; Mei Zhang, MS†; Yichong Li, MS†; Tiange
Wang, PhD∗; Meng Dai, BS∗; Jieli Lu, MD, PhD∗; Mian Li, PhD∗; Chung-Shiuan
Chen, MS‡; Shenghan Lai, MD, MPH§; Weiqing Wang, MD, PhD∗; Linhong Wang,
PhD†; Guang Ning, MD, PhD∗
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic
Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases,
Collaborative Innovation Center of Systems Biomedicine and Shanghai Clinical Center for
Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of
Medicine, Shanghai, China
† National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese
Center for Disease Control and Prevention, Beijing, China
‡ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine,
New Orleans, Louisiana
§ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Cardiovascular Health Metrics
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Smoking
Body mass index
Physical activity
Healthy diet score
Total cholesterol
Blood pressure
Fasting plasma glucose
Status of Cardiovascular Health in
Chinese Adults (JACC Vol 65, No 10, 2015)
Ideal = 7 (black)
Intermediate = 1-6 (blue)
Poor = 0 (red)
Common Questions
• Diet
• Alcohol
• Aspirin
New American Dietary Guidelines May
Remove Limits on Cholesterol
• A draft of the 2015 edition of Dietary Guidelines for
Americans, created by the Dietary Guidelines Advisory
Committee, now states that “cholesterol is not
considered a nutrient of concern for overconsumption.”
• The current U.S. guidelines call for restricting
cholesterol intake to 300 milligrams daily.
• Cholesterol in: an egg - 187 mg, 145 g lobster - 212 mg
Standard drinks in the United States
• A standard drink is equal to 14.0 grams (0.6 ounces)
of pure alcohol.
• 12-ounces of beer (5% alcohol content).
• 8-ounces of malt liquor (7% alcohol content).
• 5-ounces of wine (12% alcohol content).
• 1.5-ounces or a “shot” of 80-proof (40% alcohol
content) distilled spirits or liquor (e.g., gin, rum,
vodka, whiskey).
What is Moderate Drinking?
• 1 drink/day for women and up to 2 drinks/day for men.
• This definition is referring to the amount consumed on
any single day and is not intended as an average over
several days.
• It is not recommended that anyone begin drinking or
drink more frequently on the basis of potential health
benefits because moderate alcohol intake also is
associated with increased risk of breast cancer,
violence, drowning, and injuries from falls and motor
vehicle crashes.
Aspirin
• Men with no history of heart disease or stroke aged
45-79 years use aspirin to prevent myocardial
infarctions and that women with no history of heart
disease or stroke aged 55-79 use aspirin to prevent
stroke when the benefit of aspirin use outweighs the
potential harm of gastrointestinal hemorrhage or other
serious bleeding.
Air Pollution (PM2.5)
• The World Health Organization estimated in 2005 that "... fine
particulate air pollution (PM 2.5), causes about 3% of mortality
from cardiopulmonary disease, about 5% of mortality from
cancer of the trachea, bronchus, and lung, …...“.
• In 2002, the European Study of Cohorts for Air Pollution Effects
with 100,166 participants, followed for an average of 11.5 years.
An increase in estimated annual exposure to PM 2.5 of just
5 µg/m3 was linked with a 13% increased risk of heart attacks
• The largest US study on acute health effects was published 2008
and found an association with hospital admissions for
cardiovascular diseases.
Questions?