CVD Medicine Sana'a

Cardiovascular Coronary Heart Leading Risk Other Risk
Diseases Disease Risk Factors for Factors for

Profile CHD CHD
Cardiovascular Diseases
Any disease that affects Examples
the heart and the Coronary heart disease
blood vessels Peripheral vascular
disease
Congenital heart disease
Rheumatic heart disease
Atherosclerosis, strokes
High blood pressure
Congestive heart failure
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Coronary Heart Disease (CHD)

The major form of cardiovascular disease
In CHD the arteries that supply the heart with
oxygen and nutrients are narrowed by fatty
deposits such as cholesterol and triglycerides
Narrowing of the coronary arteries diminishes
blood supply to the heart muscle, which can
precipitate a heart attack
11.3
The Heart and Its Blood Vessels
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Coronary Heart Disease

Single leading cause of death in U.S., accounting for
20% of all deaths and half of all cardiovascular deaths
More than half of the people who died suddenly from
CHD had no previous symptoms
80% of deaths from CHD in people under age 65
occur during the first heart attack
The risk of death is greater in the least educated
segment of the population
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Coronary Heart Disease

Almost all risk factors are preventable and
reversible
The individual can reduce risk by participating
in a healthy lifestyle program
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Major CHD Risk Factors

Physical inactivity
Abnormal electrocardiogram
Abnormal cholesterol profile
Elevated triglycerides
Elevated homocysteine
Inflammation
Diabetes
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Major CHD Risk Factors

High blood pressure
Excessive body fat
Smoking
Tension and stress
Personal and family history
Age
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Physical Inactivity
Improving cardiorespiratory endurance
through increased physical activity
reduces the overall risk for heart disease
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Physical Activity and Exercise
“
Based on the overwhelming amount of
scientific data in this area, evidence of the
benefits of aerobic exercise in reducing heart
disease is far too impressive to be ignored.”
Normal Electrocardiogram
11.4
The electrocardiogram or ECG provides a
record of the electrical impulses that stimulate
the heart to contract
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Stress Electrocardiogram
Also known as a
graded exercise
stress test or a
maximal exercise
tolerance test
A stress ECG
reveals the
tolerance of the
heart to increased
physical activity
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Stress ECG Guidelines

Men over age 45 and women Individuals with a family history
over age 55 of CHD, syncope, or sudden
A total cholesterol level above death before age 60
200 mg/dl or an HDL cholesterol All individuals with symptoms
below 35 mg/dl
of chest discomfort,
Hypertensive and diabetic
dysrhythmias (abnormal
patients
heartbeat), syncope, or
Cigarette smokers
chronotropic incompetence
People with an abnormal (heart rate that increases
resting ECG
slowly during exercise and
never reaches maximum)
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Abnormal Cholesterol Profile

Blood lipids are carried in the bloodstream by
molecules of protein known as
High density lipoproteins (HDLs)
Low density lipoproteins (LDLs)
Very low density lipoproteins (VLDLs)
Chylomicrons
11.7
The Atherosclerotic Process
11.2
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Key Term
High-density lipoproteins
(HDLs): Cholesterol transporting
molecules in the blood (“good”
cholesterol) that help clear
cholesterol from the blood
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Key Term
Low-density lipoproteins
(LDLs): Cholesterol
transporting molecules in
the blood (“bad”
cholesterol) that tend to
increase blood cholesterol
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HDL-Cholesterol
HDL-cholesterol acts as a "scavenger,"
removing cholesterol from the body and
preventing plaque from forming in the arteries
The strength of HDL is in the protein
molecules found in their coatings
When HDL comes in contact with cholesterol-
filled cells, these protein molecules attach to
the cells and take their cholesterol
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HDL-Cholesterol
For the most part, HDL-cholesterol is
determined genetically
Generally, women have higher levels
than men
The female hormone estrogen tends to
raise HDL, so premenopausal women
have a much lower incidence of heart
disease
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LDL-Cholesterol
Tends to release cholesterol, which then may
penetrate the lining of the arteries and speed
up the process of atherosclerosis
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Ways to Lower
LDL-Cholesterol
Loss of body fat (if necessary)
Dietary changes
Drug therapy
Participation in a regular aerobic exercise
program
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LDL-Cholesterol
It is better to lower LDL-cholesterol without
medication, as drugs can cause muscle
and joint pain and alter liver enzyme levels
People with heart disease must often take
cholesterol-lowering medication, but it is
best if medication is combined with
lifestyle changes to augment the
cholesterol-lowering effect
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Cholesterol-Lowering
Medications
There are now very effective medications to treat
elevated cholesterol and triglycerides
Most notable are the statins group, which can lower
cholesterol by up to 60% in 2 to 3 months
Statins
Slow down cholesterol production and increase the
liver's ability to remove blood cholesterol
Decrease triglycerides and produce a small increase in
HDL levels
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Triglycerides
Also known as free fatty acids
In combination with cholesterol, triglycerides
speed up the formation of plaque in arteries
Triglycerides are carried in the bloodstream
primarily by very low density lipoproteins
(VLDLs) and chylomicrons
11.4
Triglycerides Guidelines
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Triglycerides
Found in
Poultry skin
Lunch meats
Shellfish
Manufactured mainly in the liver, from
refined sugars, starches, and alcohol
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Ways to Lower Triglycerides

Cut down on high-triglyceride foods
Decrease overall fat consumption
Quit smoking
Reduce weight (if necessary)
Participate in aerobic exercise
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Homocysteine
Clinical data indicates that many heart
attack and stroke victims have normal
cholesterol levels
A high concentration of the amino acid
homocysteine in the blood is thought to
enhance plaque formation and subsequent
blockage of arteries
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Homocysteine
Homocysteine is an intermediate amino acid
in the interconversion of two other amino
acids: methionine and cysteine
This interconversion requires the B vitamin
folate (folic acid) and vitamins B6 and B12
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Homocysteine
A large number of people have high
blood levels of homocysteine due to a
Genetic inability to metabolize
homocysteine
Deficiency in the vitamins required for its
conversion
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Inflammation
Scientists are looking at inflammation as a
major risk factor for heart attacks
Low-grade inflammation can occur in a variety
of places throughout the body
For years it has been known that
Inflammation plays a role in CHD
Inflammation hidden deep in the body is a common
trigger of heart attacks, even when cholesterol
levels are normal or low and arterial plaque is
minimal
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C-reactive protein (CRP)

A protein whose blood levels increase
with inflammation
Physicians have turned to CRP to evaluate ongoing
inflammation in the body
People with elevated CRP are more prone to
cardiovascular events
The risk of a heart attack is even higher in people with
both elevated CRP and cholesterol, resulting in an
almost 9-fold increase in risk
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C-reactive Protein (CRP)

Levels decrease with statin drugs
Also helpful are exercise, weight loss, proper
nutrition, and aspirin
Omega-3 fatty acids inhibit proteins that
cause inflammation
Excessive intake of alcohol and high protein
diets increase CRP
Aspirin therapy may also help control
inflammation
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Diabetes Mellitus
A condition in which blood glucose is unable to enter
the cells because
The pancreas totally stops producing insulin
The pancreas does not produce enough to meet the
body's needs
The cells develop insulin resistance
The role of insulin is to “unlock” the cell to escort
glucose into the cell
Diabetes affects more than 17 million people in the U.S.
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Diabetes
People with chronically elevated blood
glucose levels may have problems
metabolizing fats, which can make them more
susceptible to
Atherosclerosis, coronary heart disease, heart
attacks, high blood pressure, and strokes
Diabetics also have lower HDL cholesterol
and higher triglyceride levels
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Diabetes
An 8-hour fasting blood glucose level above
126 mg/dl on two separate tests confirms a
diagnosis of diabetes
A level of 126 or higher should be brought to
the attention of a physician
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Key Terms
Type 1 Diabetes: Insulin-dependent diabetes
(IDDM)
Also called juvenile diabetes
The pancreas produces little or no insulin
Type 2 Diabetes: Non-insulin-dependent diabetes
(NIDDM)
The pancreas either does not produce sufficient insulin
or it produces adequate amounts but cells become
insulin-resistant
Accounts for 90% to 95% of all diabetes cases
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Diabetes
Although diabetes has a genetic predisposition, type 2
is related to
Overeating, obesity, and lack of physical activity
Once limited primarily to overweight adults
Now accounts for almost half of new cases in children
More than 80% of all type 2 diabetics are overweight
or have a history of excessive weight
In most cases, type 2 can be corrected through
Diet, weight loss, and regular exercise
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Diabetes
Both moderate and vigorous physical activity
are associated with increased insulin
sensitivity and decreased risk for diabetes
The key to increase and maintain proper
insulin sensitivity is regularity of the exercise
program
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Diabetes
A healthy diet is beneficial because it is
High in complex carbohydrates and water-soluble
fibers (found in fruits, vegetables, oats, and beans)
Low in saturated fat and sugar
Aggressive weight loss, especially if combined
with exercise, often allows diabetic patients to
normalize blood sugar level without the use of
medication
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Syndrome X
As cells resist insulin's action, the pancreas
releases even more insulin in an attempt to
keep blood glucose from rising
A chronic rise in insulin appears to trigger a
series of abnormalities referred to as
syndrome X or metabolic syndrome
These abnormal conditions include
Low HDL-cholesterol, high triglycerides, an
increased blood clotting mechanism, and high
blood pressure
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Key Terms
Blood pressure: A measure of Diastolic blood pressure:
the force exerted against the Pressure exerted by the blood
walls of the vessels by the against the walls of the arteries
blood flowing through them during the relaxation phase
Systolic blood pressure: (diastole) of the heart; lower of
Pressure exerted by the blood the two numbers in blood
against the walls of the arteries pressure readings
during the forceful contraction Hypertension: Chronically
(systole) of the heart; higher of elevated blood pressure
the two numbers in blood Hypotension: Low blood
pressure readings pressure
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High Blood Pressure

The “silent killer”
A blood pressure above 140/90 mm Hg
One in three adults is hypertensive
High blood pressure is a risk factor for
CHD, congestive heart failure, strokes, kidney
failure, and osteoporosis
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Blood Pressure Guidelines
Rating Systolic Diastolic

Normal 120 or lower 80 or lower
Prehypertension 121-139 81–89
Hypertension 140 or higher 90 or higher
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High Blood Pressure

Treatment
Increase physical activity
Follow recommended dietary guidelines to reduce
blood pressure
Lose weight if above recommended body weight
Practice stress management
Do not smoke cigarettes or use tobacco
Consider drug therapy
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Effects of Aerobic Exercise

on Blood Pressure
An individual can expect exercise-induced
reductions of approximately 3 to 5 mm Hg
in resting systolic and diastolic blood
pressures (both through aerobic exercise
and strength training)
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High Blood Pressure

Medication
Antihypertensive drugs often are the first
choice of treatment
Antihypertensive drugs produce many side
effects
Lethargy, sleepiness, sexual difficulties, higher
blood cholesterol and glucose levels, lower
potassium levels, elevated uric acid levels
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Excessive Body Fat (Obesity)

Recognized as an independent risk factor for CHD
Risks attributed to obesity, however, often are caused
by other risk factors that usually accompany
excessive body fat
Risk factors such as high blood lipids, hypertension,
and diabetes usually improve with increased physical
activity
Overweight people who are physically active may not
be at increased risk for premature death
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Smoking
More than 47 million adults and 3.5 million
adolescents in the U.S. smoke cigarettes
Smoking causes about 435,000 annual
deaths in the U.S.
In relation to CHD
Smoking speeds up the process of atherosclerosis
Causes a threefold increase in the risk of sudden
death following a myocardial infarction
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Smoking
Increases heart rate
Raises blood pressure
Irritates the heart, increasing the risk of fatal
cardiac arrhythmias
Decreases HDL-cholesterol
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Tension & Stress

People who are not able to relax have a
constant low-level strain on the cardiovascular
system that could manifest itself in heart
disease
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Tension & Stress

Individuals who are under a lot of stress and
do not cope well need to take measures to
counteract the effects of stress
One way is to identify the sources of stress
and learn how to cope with them
Take control: examine and act upon the things
that are most important, ignore less
meaningful details
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Personal History
Individuals who have had cardiovascular
problems are at higher risk for disease than
those who have never had a problem
People with such history should control other
risk factors as much as they can
Most risk factors are reversible, so they can
greatly decrease the risk for future problems
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Family History
Genetic predisposition toward heart disease
has been clearly demonstrated
All other factors being equal, a person with
blood relatives who now have or have had
heart disease runs a greater risk than
someone with no such history
In some cases, there is no way of knowing
whether a person has a true genetic
predisposition or if it is poor lifestyle habits
that led to the problem
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Age
Age is a risk factor because of the higher
incidence of heart disease in older people
This tendency may be induced partly by other
factors stemming from changes in lifestyle as
we get older
Less physical activity, poor nutrition, obesity
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Age
Although the aging process cannot be stopped, it
certainly can be slowed down
Physiological versus chronological age is important in
preventing disease
Some individuals in their 60s or older have the body of
a 20-year-old
20-year-olds often are in such poor condition that they
almost seem to have the body of 60-year-olds
Risk factor management and positive lifestyle habits
are the best means of slowing down aging
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Gum Disease
Oral bacteria that builds up with dental plaque
can enter the blood stream and contribute to
inflammation and blood vessel plaque
formation, increase blood clots, and thus
increase heart attack risk
Daily flossing for 1 to 2 minutes is the best
way to prevent gum disease
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Snoring
Loud snoring has been linked to
cardiovascular disease
People who snore heavily may suffer from
sleep apnea, in which the throat closes for a
brief moment, causing breathing to stop
In one study, individuals who snored heavily
tripled their risk of a heart attack and
quadrupled the risk of a stroke
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Aspirin
Aspirin therapy is recommended to prevent
heart disease
A daily aspirin dose of 81 mg (equivalent of a
baby aspirin) can prevent or dissolve clots that
cause heart attacks or strokes
The incidence of a nonfatal heart attack is
decreased by about 32% with daily aspirin use

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Cardiovascular Coronary Heart Leading Risk Other Risk

Diseases Disease Risk Factors for Factors for

Coronary Heart Disease (CHD)

Coronary Heart Disease

Coronary Heart Disease

Major CHD Risk Factors

Major CHD Risk Factors

Physical Activity and Exercise

Stress ECG Guidelines

Abnormal Cholesterol Profile

Ways to Lower Triglycerides

C-reactive protein (CRP)

C-reactive Protein (CRP)

High Blood Pressure

Blood Pressure Guidelines

Rating Systolic Diastolic

High Blood Pressure

Effects of Aerobic Exercise

High Blood Pressure

Excessive Body Fat (Obesity)

Tension & Stress

Tension & Stress

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