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Modified Lifestyle Factors and Cardiovascular Disease

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on 4 December 2013

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Transcript of Modified Lifestyle Factors and Cardiovascular Disease

Beta Blockers
- Treats angina, high blood pressure, & irregular heart beat. Prevents subsequent heart attacks. Decreased workload on the heart.
Ace Inhibitors
- Blocks the effect of stress hormone which can make the body retain fluid. Opens blood flow, thereby lowering blood pressure, decreasing workload on the heart.
Statins
- Reduces cholesterol.
Antiplatlets & Anticoagulants
- both prevent clots from forming.
Diuretics
- Lowers blood pressure by helping the body get rid of excess water.
Nitrates
- Decreases and controls angina.
Intro Video
Lifestyle Intervention Strategies for Those Suffering From Cardiovascular Diseases
BLOOD FLOW THROUGH
THE HEART
COMMON HEART
DISEASES
Enlargement of the heart
An enlarged heart is a symptom
of an underlying disorder that is causing the heart to work harder
than normal.
Congestive Heart Failure
Congestive heart failure (CHF) is a condition in
which the heart's function as a pump is
inadequate to deliver oxygen rich blood
to the body.
Hypertensive Heart Disease
Hypertensive heart disease
refers to heart problems
that occur because of high
blood pressure.
Valvular Heart Disease
Heart valve disease occurs when
your heart's valves do not work
the way they should.
Cyanotic Congenital Heart Disease
Congenital heart disease is a category
of heart disease that includes abnormalities
in cardiovascular structures that occur
before birth.
What are the risk factors
for heart disease?
PATH TO A HEALTHY
HEART
Melissa Bingham, Leigh Castelo, Sowmya Pramod, David Russell
D4
Epidemiology: Risk Factors
2-7%
of the general population have no risk factors at all
>70%
of at-risk individuals have multiple risk factors
Risk factors include:
Hypertension
Smoking
Abdominal obesity
Abnormal lipids
Diabetes mellitus
Stress
Low consumption of fruits & vegetables
Sedentary behavior
Too little or too much sleep
Epidemiology: Risk Assessment
Using multiple interventions had greater benefits than interventions targeting single risk factors
Of those with multiple risk factors,
fewer than 10%
have all of them adequately controlled
70%
of cardiac events remain unaddressed. Under-treatment is common.
Estimate cardiovascular risk using scoring systems such as Framingham or SCORE
Has limitations: under- or over-estimation
THE GLOBAL BURDEN
CVD is the leading cause of death worldwide accounting for
16.7 million deaths each year

Coronary heart disease is the single largest cause of death in developed countries and is one of the leading causes of disease burden in developing countries
3/4
of global deaths due to CHD occur in low & middle-income countries

According to WHO, global incidence of first-ever stroke was
9 million
in 2004 and
30.7 million
in the world have experienced stroke
Trends in the United States
In the United States alone,
71.3 million
adults have 1 type of CVD
Greater burden of CVD is attributable not to mortality but to nonfatal cardiovascular events & their long-term consequences
Interheart Study
Case control study of acute MI in 52 countries.
EFFECTS OF SMOKING & SMOKING CESSATION
WHO estimated that 4.83 million people died prematurely due to smoking in the year 2000 and it is projected to increase 8 million per year globally by 2030.
Patho-physiological changes induced by smoking
Vascular dysfunction
Atherosclerosis
Development of thrombi
Other potential mechanism: mitochondrial damage to heart muscle.
Interheart Study
Case control study of acute MI in 52 countries.
WHO Monica Project
Cohort Study: Smoking-associated nonfatal acute MI risk appears to be greatest among younger smokers.
Smoking Cessation Program With Exercise
N=130 (sedentary female smokers)
Program =15 weeks
Intervention
: nicotine replacement therapy (transdermal patch), brief behavioral counseling and moderate exercise.
Result
: Improved CVD biomarkers.
N=1432 (Prospective randomized control study- 5 years rehabilitation program)
Mean age=54 years (women)
Intervention:
physical exercise, smoking cessation, and dietary advice.
Result:
intervention reduces the need of hospital care
Hospital based smoking cessation program in CVD patients
Diet and Heart Disease
Mediterranean Diet
High intake of fruits and vegetables
Substantial intake of protein from plant sources
High fat intake from MUFAs
Moderate to high fish intake and low intake of meat
Olive Oil used heavily
Moderate alcohol intake (wine with meals)
Lyon Diet Heart Study
1st randomized-controlled trial on Mediterranean diet on reducing recurrent CVD in patients with previous MI
Rate of cardiac death and non-fatal infarction was 1.24 per 100ppl/year after 46 months vs. 4.07 per 100ppl/year in the control group.
aMed and secondary prevention of CVD
People with CVD analyzed from Nurses Health Study(n=11,278) & Health Professional Follow up Study(n=6137)
7% reduction in total mortality
for every 2-point increase in aMed Score.
PREDIMED Trial
Primary CVD prevention
N=7447
Diets:
Control: Advised to eat low-fat diet
Med Diet + nuts
Med Diet+olive oil
30% risk reduction
in people with high CVD risk but with no prior disease.
Lifestyle Heart Trial
N=48 (28 experimental, 20 control)
Intervention:
low-fat vegetarian diet, smoking cessation, stress management, and moderate exercise).
Control:
Stenosis PROgression
42.7% to 46.1%
Experimental:
Stenosis REgression
40% to 37.8%
DASH
Medications
Current Health Policies
Future Recommendations
Pathology/Pathophysiology of Cardiovascular Disease
Hypertension
D5
Sedentary Behavior
Pharmacological interventions for smoking cessation:
Nicotine replacement therapy
Bupropion
Nortryptyline
Varenecline (Chantix)
Clonidine.

Psychosocial interventions for smoking cessation include individual or group counseling, telephone, internet, or self-help support, such as reading or audio materials.
Women’s Health Initiative Observational Study
: prospective study indicates that sitting for long hours increase risk of CVD.
Sedentary Behavior & CVD
Fruit and Vegetable Intake
Bhupathiraju et al., 2013
Hypertension
+
Atherosclerosis
Stroke
PVD
CVD
/or
Atherosclerosis
Reduced GFR or increase tubular reabsorption of salt and water
Excessive activation of the renin-angiotensin-aldosterone and sympathetic nervous systems
Increased formation of reactive oxygen species,
endothelin
Inflammatory cytokines
Decreased synthesis of nitric oxide and various natriuretic factors
Hypertension
Arteriosclerosis
The Need for Policy
By 2030, 40.5% of the US population is projected to have some form of CVD.

Between 2010 and 2030, real total cost of CVD are projected to triple from $278 billion to $818 billion.

Indirect cost are estimated to increase from $172 billion in 2010 to $276 billion in 2030, and increase of 61%.
Problem for
Health Care Facilities
Hospitals are not reimbursed for expenses related to CVD for patient who are readmitted to the hospital within 30 days of discharge.
What is being done?
Guidelines are being set in place to reduce these anticipated costs.

The American Heart Association has developed criteria that will "improve patient outcomes & save lives."
This improves both patients
& healthcare facilities:
Improves patient compliance
Decreases hospital readmission rates
Improves patient understanding of disease processes
Decrease in overall cost for CVD
An Example:
Get with the Guidelines for CHF
Hospital based initiative
Impact on both prevention & treatment
Reduce readmission rates
Improve patient outcomes by improving adherence

How does it work?
Health care providers are responsible to document whether patient's are being discharged on appropriate medications
A discharge appointment is set with within 7 days of discharge
Why Do It?

Provides data for further improvement
Ensures patients are receiving treatments based upon current research
Receive hospital recognition in such reports as the US News & World Report for their compliance.
Improves business
Policy Improvements for MI
Myocardial Infarction
Provide more CPR training facilities
Increase access to AEDs (automated external defibrillator) in the public
Extend the "Good Samaritan" law to cover all AED users.
Hospital Reimbursement - smoking cessation must be offered
Hospital Setting - patient arriving with MI must receive an aspirin, beta blocker, EKG & oxygen within 24 hours.
Cardiac Rehab
What is it?
A program monitored by MDs, RNs, exercise physiologist that teach patients about diet, exercise and needed lifestyle changes.

Who Pays?
Insurance, Medicare, out-of-pocket
Benefits of Cardiac Rehab
20-30%
reduction of all-cause mortality rates
Reduces symptoms of fatigue, angina, and dyspnea
Decreases the recurrence of non-fatal MIs
Improves adherence with prevention medications & treatments
Increases exercise performance
Increases knowledge of disease processes
Improves quality of life
Improves psychological symptoms
Decreases re-hospitalizations
Other Recommendations
Smoking Cessation Initiatives

Weight Reduction Programs
1.
Pharmacological interventions
for smoking cessation:
Nicotine replacement therapy
Bupropion
Nortryptyline
Varenecline (Chantix)
Clonidine.

2.
Psychosocial interventions
for smoking cessation include individual or group counseling, telephone, internet, or self-help support, such as reading or audio materials.
Smoking Interventions
Relative risk of CVD risk comparing highest and lowest concordance ntiles.
Dietary Approaches to Stop Hypertension
Salehi-Abargouei, A., et. al (2013)
Nasreen, N.A. (2008)
Creager, M.A. (2006)
Full transcript