Transcript Risk Factors: Measure and Modify

Risk Factors:
Measure and Modify
Nina Radford MD
Cardiovascular Medicine Department
Director, Clinic Research
Cooper Clinic, Dallas Texas
Health Screening Values
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Total Cholesterol
HDL, High Density Lipoprotein
LDL, Low Density Lipoprotein
Triglycerides
Glucose
Blood Pressure
BMI, Body Mass Index
Waist Circumference
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Chart 2-6. Prevalence estimates of meeting at least 5 criteria for Ideal Cardiovascular Health,
US adults (age-standardized), overall and by sex and race, and US children (unadjusted), by
sex, National Health and Nutrition Examination Survey (NHANES) 2005–2006 (baseline
available data as of January 1, 2010).
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Basics of the Cholesterol Profile
Total Chol. = LDL + HDL + VLDL
• LDL: Low Density
Lipoprotein
• HDL: High Density
Lipoprotein
• VLDL: Very Low
Density Lipoprotein
LDL Cholesterol
Elevated LDL is a risk factor for
heart disease and stroke.
• An LDL level > 160 mg/dL is high risk.
• An LDL level 130-160 mg/dL is moderate risk
• An LDL level <130 mg/dL is lower risk.
• An LDL level <100 mg/dL is optimal.
HDL Cholesterol
• An HDL level < 40 mg/dL in
adults is considered low and is a
risk factor for HD and stroke.
• An HDL level > 60 mg/dL is
considered protective against heart
disease.
Triglycerides (TG)
• TG are the chemical form in which most fat exists in
food as well as in the body.
• They're also present in blood plasma and, in association
with cholesterol, form the plasma lipids.
• TG in plasma are derived from fats eaten in foods or
made in the body from other energy sources like
carbohydrates.
• Calories ingested in a meal and not used immediately
by tissues are converted to TG and transported to fat cells
to be stored.
• Hormones regulate the release of TG from fat tissue so
they meet the body's needs for energy between meals.
Triglycerides:
The National Cholesterol Education Program
guidelines for triglycerides are:
Normal
Less than 150 (125) mg/dL
Borderline-high
150 to 199 mg/dL
High
200 to 499 mg/dL
Very high
500 mg/dL or higher
These are based on fasting triglyceride levels.
The Lipid Profile:
Modify
• Diet.
• Exercise.
• Medication.
Cholesterol Metabolism:
Genes and Environment
• Cholesterol in our blood comes from two sources:
external (the diet) and internal (production by the
liver).
• Lifestyle is always important even if medications are
needed.
• Sometimes the family history trumps even the best
lifestyle efforts.
Continue On The Road To A
Healthy Heart
• Reduce cholesterol in
the diet
• Plant stanols/sterols
• Soluble fiber
• Weight loss
Where is the Cholesterol in My
Food?
• Found ONLY in food of animal origin and NEVER in foods
of plant origin, even if they contain fat
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Full-fat dairy products
Fatty meats
Egg yolks
Organ meats
Animal fats – lard, butter
Shellfish
Stanols/Sterols*
2 grams per day
• Promise activ
• Benecol
• Cholest Off
*May enhance LDL lowering
by an average of 10%
Soluble Fiber
• Oats: 3 grams per day*
1.5 cups cooked oatmeal/day or 3 plain
packets instant
• Psyllium: 7 grams per day*
Metamucil (1Tbsp. Sugar-free/day)
Konsyl (2 heaping tsp./day)
• Beans, fruits, vegetables
* Supported by research to lower LDL 3-7%.
Blood Pressure
BP Classification
Diastolic BP
Systolic BP
Normal
<120
and
<80
Prehypertension
120–139
80–89
Stage 1 Hypertension
140–159
or
or
Stage 2 Hypertension
>160
or
>100
JNC VII, www.nih.gov
90–99
Risk Factors for High Blood Pressure
 age,
 ethnicity,
 family history of hypertension,
 genetic factors,
 greater weight,
 lower physical activity,
 tobacco use,
 psychosocial stressors,
 sleep apnea,
 dietary factors (including dietary fats, higher sodium intake,
lower potassium intake)
 excessive alcohol intake,
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
High Blood Pressure is common!
Age-adjusted prevalence trends for high blood pressure in adults.
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Why Prevent or Treat High Blood Pressure?
Hypertension is associated with shorter overall life expectancy,
shorter life expectancy free of CVD, and more years lived with
CVD.
— Total life expectancy was 5.1 years longer for normotensive
men and 4.9 years longer for normotensive women than for
hypertensives of the same sex at 50 years of age.
— Compared with hypertensive men at 50 years of age, men
with untreated BP 140/90 mm Hg survived on average 7.2 years
longer without CVD and spent 2.1 fewer years of life with CVD.
Similar results wereobserved for women.
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Lifestyle Modification and BP
Modification
Weight reduction
DASH eating plan
Sodium reduction
SBP reduction (range)
5–20 mmHg/10 kg weight loss
8–14 mmHg
2–8 mmHg
Physical activity
4–9 mmHg
Moderation of alcohol
2–4 mmHg
Glucose (blood sugar)
• Normal level< 100 mg/dL
• Impaired fasting glucose (prediabetes):
100-125 mg/dL
• Diabetes > 126 mg/dL
It is estimated that 18,300,000 Americans > 20
years of age have physician diagnosed DM.
An additional 7,100,000 adults have undiagnosed
DM and about 81,500,000 adults have prediabetes.
The prevalence of prediabetes in US adults is nearly
37%.
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Diabetes Trends Among US Adults,
1994, 2000 and 2008
1994
<4.5%
2000
4.5-5.9%
6.0-7.4%
2008
7.5-8.9%
CDC’s Division of Diabetes Translation. National Diabetes
Surveillance System available at
http://www.cdc.gov/diabetes/statistics
>9.0%
The increasing prevalence of obesity is driving an
increased incidence of type 2 DM.
There has been a doubling in the incidence of DM
over the past 30 years, most dramatically during
the 1990s and primarily among individuals with a
BMI > 30 kg/m2.
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Chart 16-1. Age-adjusted prevalence of physician-diagnosed diabetes mellitus in adults ≥ 20
years of age by race/ethnicity and sex (National Health and Nutrition Examination Survey:
2005–2008). NH indicates non-Hispanic. Source: National Center for Health Statistics and
National Heart, Lung, and Blood Institute.
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Why Prevent Diabetes?
— At least 65% of people with diabetes die of
some form of heart disease or stroke.
— Heart Disease death rates among adults with
diabetes are 2 to 4 times higher than the rates
for adults without diabetes.
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Preventing Diabetes
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Diabetes Prevention Program Study
 25 yrs old, overweight, glucose 95-125
Lifestyle vs medication vs nothing
Lifestyle:
– lose  7% weight,
– calories 1400-1800 day, low fat,
–  150 min activity per week
The DPP Research Group, NEJM 346:393-403, 2002, www.diabetes.org
Chance of Developing Diabetes
Percent developing diabetes
All participants
Lifestyle (n=1079, p<0.001 vs. Met , p<0.001 vs. Plac )
Metformin (n=1073, p<0.001 vs. Plac)
Placebo (n=1082)
Cumulative incidence (%)
40
30
Risk reduction
31% by drug
58% by lifestyle
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10
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0
1
2
Years from randomization
Placebo – nothing new
Metformin – Drug
Lifestyle – weight loss (8 lbs),diet,exercise
The DPP Research Group, NEJM 346:393-403, 2002
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Why avoid unhealthy weight
gain?
Obesity is a strong predictor of sleep-disordered breathing, itself
strongly associated with the development of CVD, as well as with
myriad other health conditions, including numerous cancers,
nonalcoholic fatty liver disease, gallbladder disease,
musculoskeletal disorders, and reproductive abnormalities.
Recent calculations suggest that the gains in life expectancy from
smoking cessation are beginning to be outweighed by the loss of
life expectancy from obesity.
Heart Disease and Stroke Statistics 2011 Update. Circulation 2011;123;e18-e209
Metabolic syndrome refers to a cluster of risk factors for CVD and
type 2 DM. Metabolic syndrome is diagnosed when ≥ 3 of the
following 5 risk factors are present:
— Fasting plasma glucose ≥ 100 mg/dL or undergoing drug
treatment for elevated glucose.
— HDL cholesterol < 40 mg/dL in men or < 50 mg/dL in women or
undergoing drug treatment for reduced HDL cholesterol.
— Triglycerides ≥ 150 mg/dL or undergoing drug treatment for
elevated triglycerides.
— Waist circumference ≥ 40 in men or ≥ 35 in women in the
United States.
— BP ≥ 130 mm Hg systolic or ≥ 85 mm Hg diastolic or
undergoing drug treatment for hypertension or antihypertensive
drug treatment in a patient with a history of hypertension.
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Components of Fitness
• Cardiovascular
• Strength
• Flexibility
Chart 14-2. Prevalence of regular leisure-time physical activity among adults ≥18 years of age
by race/ethnicity and sex (National Health Interview Survey: 2009). Percentages are ageadjusted. “Regular leisure-time physical activity” was defined as 3 sessions per week of
vigorous activity lasting at least 20 minutes or 5 sessions per week of light or moderate activity
lasting at least 30 minutes. NH indicates non-Hispanic. Data derived from Pleis et al.7
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Physical Activity:
Get it where ever you can find it