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Made by: Demah Hegazi, Besra Mohamed, Abdraman Abdelkhani, Rio Alegre & Dan Dimitrakopoulos

Rio Alegre

on 5 October 2012

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HEART AND CARDIOVASCULAR DISEASE P resented B y R i O B e S R a d E m A h A B d r a M A N . . . AND a O verview of Heart & Cardiovascular Diseases Individual Summaries A rticle , , , Lifestyle Practices & Cardiovascular Disease Mortality in the Elderly : The Leiseure World Cohort Study , Introduction Modifiable behaviour risk factors. physical activity light to moderate drinkers having lower risk of CVA A prospective cohort Qualitative research aterials & m ethods M Caffine intake no consistent effect smokers had significant increase (about 30%-130% ) In women alcohol consumption ( <3 drinks/day ) decreased (about 15%-30%) In men +4 drinks/day R e d u c e d (about 15%-30%) risk Woman and men aged 70+ years who participated in active activities (even as little as 30 min/day ) 20%-40% lower risk Underweight & obese women in all age groups were at increased risk of CVA death Underweight men increased risk Limitation and Conclusion 0 Limitations Physical activities, alcohol and caffeine intake, and smoking in the study are crude and self-reported. The subjects are mostly Caucasian, highly educated, upper middle class. This cohort has advantage of population- the based prospective design, large sample size (men women), data on several lifestyle factors. & Conclusion The result from the elderly cohort study with following up, showed a decrease in Cardiovascular mortality with some of the lifestyle. practice. Not smoking, alcohol consumption MODERATE physical activity and normal body weight are important to keep the elderly population healthy . Preventions What is Heart and Cardiovascular Disease ? Cardiovascular disease refers to more than one disease of the circulatory system, the heart and blood vessels. D N ! Cardiovascular diseases are the leading cause of death in  Canadian males and females Examples Heart failure Angina Myocardial Infarction (Heart Attack) Risks for Heart and Cardiovascular Disease Smoking Lack of exercise Unhealthy eating High cholesterol Emotional stress/depression Family history Eat fresh fruit and vegetables that contain fiber and provide antioxidants Reduce dietary intake of saturated fat and cholesterol Learn to cope with stress Practice active lifestyle (e.g. exercise) Avoid tobacco Why is Heart & Cardiovascular Disease important to Aging ? [ He-art ] THE 3 Article 1 Introduction Coronary Heart Disease From a Life-Course Approach: Findings From the Health and Retirement Study, 1998-2004 Life course approach: used in this study to help understand shift in individuals lives over time throughout life transitions, and interaction into social aspects. Individuals studied based on environmental factors and social factors through growing up. Social Economic Status (SES): social status can predispose to onset disease Ex: Mother = low SES No education not enough to sustain family health = Children higher risk to disease Materials & Methods Longitudinal Study (1998-2004), participants from Health Retirement Study aged 50-70 Asked series of questions to see if any ''Transitions'' or any CVD had occurred every 2 years Multilevel Models & Hierarchical Linear Modeling software Fetal Origins Theory (FOT): assumes that health defects begin within the womb due to numerous factors (i.e. environmental factors: smoking, drinking etc) Concluded Hypothesis: Childhood deprivation due to Fathers social class lead to bigger gap in SES, alongside FOT, causing higher chance of CVD. Results Correlation between childhood deprivation factors (low fathers education) and CVD Life Course approach predicts CVD is due to numerous childhood conditions acting independently. Fetal Origins Theory disregarded fathers education due to environmental factors (ex good access to prenatal care = good birth weight) CONCLUSION & L i M T a T i O n S study is conducted based on non institutionalized Americans
no info on childhood history within HRS Childhood deprivation can lead to future socioeconomic and behavior problems. About 80 percent of the people who are 65 years and older have some form of heart disease! (Health at abc News) WHY? As the body ages, the arteries get stiffer  get a little bit thicker. Hardened arteries increase the risk for higher blood pressure therefore leading to cardiovascular disease in the elderly. An older person may have a higher chance (especially if they smoke, do not exercise, or have family history of diseases) for developing other diseases such as high cholesterol, diabetes and obesity which could indirectly cause CVD On average, women develop heart disease about 10 to 15 years later than men. Because for women, as having high levels of the female hormone estrogen in their blood protects the heart. With menopause, the levels of estrogen in a woman's body drop significantly, putting the woman at risk for developing CVD (HeartHealthyWomen.org) Article 2 Effects of exercise and stress management training on markers of cardiovascular risk in patients with Ischemic Heart Disease Introduction Materials & Methods Ischemic Heart Disease, also known as Coronary Artery Disease, is a condition that affects the supply of blood to the heart. The blood vessels are narrowed or blocked due to the deposition of fat on their walls. This reduces the supply of oxygen and nutrients to the heart muscles, which is essential for proper functioning of the heart. C o N T ' D quantitative; randomized controlled trial Examine the effect of aerobic exercise and stress management training on IHD patients Psychosocial factors such stress, depression, smoking and high cholesterol level are to play a role in the development of IHD Sample size consist of 134 IHD patients( 92males and 42 females) age,40-84 years Participants recruited via health fairs, fliers, letter sent to physician and newspaper Patience must have documented IHD or any CVD for the past one year. C o N T D ' Patients were assigned to 35 minutes exercise three times a week, consisted of stretching, walking and jogging. Patients were put on stress management training for about 1.5 hours for 16 weeks. Treatment program was based on emotional and behavioral changes. Results Patients in the exercise training group showed 19% improvement compared with 9% in the stress management. Stress management sessions improved heart rate variability associated with maximal inspiration and expiration Patients in the exercise and stress management training groups showed greater reduction in general distress as measured by health questionnaires. Patients exhibited greater improvement in psychosocial functioning less emotional distress ,low depression compared to medical care group. Behavioral program intervention reduce cardiovascular risk in patients with IHD & CVD disease in general. & L i M T a T i CONCLUSION O n S This study is limited by its relatively small sample size and this will lower their study power. Absence of follow up to determine the long term clinical significance of improved ischemic activity. Lack of background information on the participants. CONCLUSION exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care only. Exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care only. Article 4 Older Patients’ Views on the Relationship Between Depression and Heart Disease Introduction Qualitative; longitudinal study.Aimed to provide more evidence that there is a link between heart disease and clinical depression. Aimed to understand older patients’ views regarding relationships between depression and heart disease.Aimed to facilitate communication between patient and doctor regarding the two conditions and lay groundwork for designing interventions. Materials & Methods Sample size was 33 elderly patients who are 65+.Semi-structured interviews in a primary care clinic. The elderly participants must have a current heart condition and are taking medication for it.Participants must have experienced symptoms of depression along with their cardiovascular treatment. Results Median age was 73.
76% of participants were self-identified as African American.
61% of the participants were women.
The results showed 90% of participants have indicated having mild to moderate depressive symptoms related to their heart condition. Participants gave clear descriptions of how heart disease can lead to depression and depression can lead to heart disease. Participants supported treating depression immediately in the context of heart disease and generally preferred integrated care. Figure 1: Summary of Older Adults’ Descriptions of How Heart Disease Can Lead to Depression Figure 2: Summary of Older Adults’ Descriptions of How Depression Can Lead to Heart Disease DISCUSSION Participants indicated clearly that depression and heart disease are linked. They agreed that heart disease could cause depression due to many factors. Participants said that depression could cause heart disease by creating an unhealthy environment for the body.
Participants described the importance of their primary care physician in providing treatment for depression with heart disease management. CONCLUSION & LIMITATIONS Results were obtained from patients who receive care at one primary care site.Patients’ remarks reflected their perceptions of the relationship between depression and heart disease and might not reflect their actual behavior. Data on medical conditions and medications are based on self-reports and are subject to response bias.
The sample of participants did not include other medical conditions, therefore the study could not determine whether patients’ views generalize to other medical conditions. CONCLUSION CONT'D Older patients felt that a diagnosis of heart disease could be overwhelming and cause a sense of losing control.Older patients with heart disease and/or depression perceive a clear relationship between heart disease and depression. When depression was thought of in terms of heart risk, patients described depression as more serious and warranting clinical attention. Elderly patients have felt that joining a support group was essential to his adjustments and others have felt that they needed more physicians support regarding the two conditions.
An integrated intervention would need to improve adequacy of treatment and adherence. Article 5 METABOLIC SYNDROME, DIABETES, AND CARDIOVASCULAR DISEASE IN ANELDERLY CAUCASIAN COHORT: THE ITALIAN LONGITUDINAL STUDY ON AGING Introduction - Metabolic syndrome is characterized by the presence of three or more of the following
ailments: - Abdominal Obesity- Elevated Plasma Triglycerides- Low HDL Cholesterol (good cholesterol)- Hypertension (high blood pressure)- High Fasting Plasma Glucose (associated with Type II Diabetes) - Study conducted to fill the gap of information on Metabolic Syndrome in the elderlybecause there is evidence that its prevalence increases with age. Materials & Methods Cross-Sectional study based on data from the Italian Longitudinal Study on Aging,following patients for 4 years. Random sample of 5632 aged 65-84, separated by both age and gender. Surveyed on behaviours related to health, medical history, as well as blood tests andexamination by a physician. Second survey for patients with the desired conditions included history ofcardiovascular disease and events.Measurements of plasma lipids, blood glucose, total cholesterol, BMI, waistcircumference, and height were taken. RESULTS ! Analyses for men and women were done separately.Prevalence of MetS was higher in diabetic patients of both sexes. Visceral obesity and low HDL three times more frequent in women.Rates of CHD, diabetes, and stroke were significantly greater in patients with MetS. Significant association with CHD in men only.Even nondiabetic men with MetS showed risk of CVD mortality. STRENGTHS AND LIMITATIONS Strengths:
- Not many studies done on MetS and elderly; good opportunity to shed light onthis topic
- Broad population gives a good idea of the big picture
- Reliable clinical diagnoses and assessment of risk factors. Limitations:
- Cross-sectional study only looks at a specific time and does not get an accurate
depiction of progression of some of these factors (Short follow-up).
- Inadequate sample size of diabetic patients.
- Lack of association with CHD prevalence with CVD mortality in women. CONCLUSIONS - Metabolic Syndrome is bad!- Very common in the elderly Italian population- Strong association with diabetes, stroke, and other cardiovascular diseases.- Specifically in men, risk of CVD mortality is significantly higher with MetS. Future Research ? ARTICLE 1 ARTICLE 2 ARTICLE 3 ARTICLE 4 ARTICLE 5 Studies with longer follow-ups to further our understanding of the true effects of MetS in an aging population.
MetS to be implemented as a standard diagnostic code in hospital records to be used in epidemiological studies. Explore whether older adults are more likely to discuss depressive symptoms or treatment.Consider if medical doctors can explain to their elderly patients the impact of negative emotions on cardiovascular health. Further questions on family medical history to be conducted.
Further investigation towards the transitions and trajectories that occurred throughout individuals lives, and how long the were implemented. IMPROVING CARDIOVASCULAR & HEART DISEASE THANK YOU Bogner H.R, Cahill E., Dahlberg B., Frances K., Vries H. (2008). Older Patients’ Views on the Relationship Between Depression and Heart Disease. US National Library of Medicine. 40 (9). 652-657. Retrieved September 28, 2012 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825038/ Blumenthal, J., Sherwood, A., Babyak, M., Watkins, L., & Waugh, R. (2005). effect of exercise and stress managemnt training on markers of cardiovascular risk in patients with ischemic heart disease. In (13 ed., Vol. 293).
Blumenthal, Sherwood, Babyak, Watkins & Waugh, 2005) http://www.phac-aspc.gc.ca/cd-mc/cvd-mcv/risk-risques-eng.php#tphp A. paganini-Hill.,(2011). Lifestyles Practices and Cardiovascular Disease Mortality in the Elderly: The Leisure World Cohort Study, pp 1-7.doiv10.4061/2011/983764 Bowen, M.E. (2010). Coronary Heart Disease From a Life-Course Approach: Findings From the Health and Retirement Study, 1998-2004. Journal of Aging and Health. Retrieved from http://journals1.scholarsportal.info.proxy.library.brocku.ca/tmp/9457636715880890077.pdf Future research on coping methods with stress related to aging Maggi, S. Noale, M. Gallina, P. Bianchi, D. Marzari, C. et al. (2006). Metabolic Syndrome, Diabetes, and Cardiovascular Disease in an Elderly Caucasian Cohort: The Italian Longitudinal Study on Aging. Journal of Gerontology.
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