chapter 10 preventing cardiovascular disease chapter outline cardiovascular disease prevention...
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Chapter 10PreventingCardiovascularDisease
ChapterOutline
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
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Cardiovascular diseasesAny disease that affects the heart and the blood vessels
ExamplesCoronary heart disease
Peripheral vascular disease
Congenital heart disease
Rheumatic heart disease
Atherosclerosis, strokes
High blood pressure
Congestive heart failure
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
Cardiovascular diseasesAbout 20% of the U.S. population has some form of cardiovascular disease
1 in 3 men and 1 in 10 women will develop a major cardiovascular problem before age 60
In the year 2000, 40% of all deaths in the U.S. were attributable to heart and blood vessel disease
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
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Heart diseaseAbout 1.1 million people in the U.S. have heart attacks each year—500,000 of them die as a result
More than half of these deaths occur within 1 hour of the onset of symptoms, before the person reaches a hospital
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
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Cardiovascular diseasesAlthough heart and blood vessel disease is still the number one health problem in the U.S., the incidence declined by 32% between 1960 and 2000
Health education: More people now are aware of the risk factors for cardiovascular disease and are changing their lifestyle to lower their own risk
CardiovascularDisease
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Figure 10.2
Incidence of cardiovascular disease in the United States for selected years: 1900–2000
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Critical thinkingWhat are your feelings about your own risk for diseases of the cardiovascular system?
Is this something that you need to concern yourself with at this point in your life? Why or why not?
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CoronaryHeart
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Other CHDRisk Factors
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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
CardiovascularDisease
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CoronaryHeart
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Other CHDRisk Factors
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Figure 10.3
The heart and it’s blood vessels
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Coronary heart diseaseSingle 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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CoronaryHeart
Disease
Major CHDRisk Factors
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Coronary heart diseaseAlmost all risk factors are preventable and reversible
The individual can reduce risk by participating in a healthy lifestyle program
CardiovascularDisease
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CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
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Physical inactivity
Abnormal electrocardiogram
Abnormal cholesterol profile
Elevated triglycerides
Elevated homocysteine
C-reactive protein
Diabetes
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Major CHD risk factors
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Major CHD risk factorsHigh blood pressure
Excessive body fat
Smoking
Tension and stress
Personal and family history
Age
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Other CHDRisk Factors
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Physical inactivityImproving cardiorespiratory endurance through increased physical activity reduces the overall risk for heart disease
CardiovascularDisease
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Regular physical activity
Daily physical activity and a regular aerobic exercise program help control most heart disease risk factors
Increases cardiorespiratory endurance
Decreases and controls blood pressure
Reduces body fat
Lowers blood lipids(cholesterol and triglycerides)
Improves HDL cholesterol
Helps control diabetes
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Regular physical activity
Increases and maintains good heart function, sometimes improving certain ECG abnormalities
Motivates toward smoking cessation
Alleviates tension and stress
Counteracts a personal history of heart disease
Daily physical activity and a regular aerobic exercise program help control most heart disease risk factors
CardiovascularDisease
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“Physical activity and exerciseBased 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.”
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Figure 10.4The electrocardiogram or ECG provides a record of the electrical impulses that stimulate the heart to contract
Normal electrocardiogram
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Stress electrocardiogramAlso 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 guidelinesMen over age 45 and women over age 55
A total cholesterol level above 200 mg/dl or an HDL cholesterol below 35 mg/dl
Hypertensive and diabetic patients
Cigarette smokers
People with an abnormalresting ECG
Individuals with a family history of CHD, syncope, or sudden death before age 60
All individuals with symptoms of chest discomfort, dysrhythmias (abnormal heartbeat), syncope, or chronotropic incompetence (heart rate that increases slowly during exercise and never reaches maximum)
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Abnormal cholesterol profileBlood 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
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Figure 10.7
The atherosclerotic process
Curtesey American Heart Association. © AHA
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Table 10.3
Cholesterol guidelines
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Key termHigh-density lipoproteins (HDLs): Cholesterol transporting molecules in the blood (“good” cholesterol) that help clear cholesterol from the blood
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Key termLow-density lipoproteins (LDLs): Cholesterol transporting molecules in the blood (“bad” cholesterol) that tend to increase blood cholesterol
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HDL-cholesterolHDL-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-cholesterolFor 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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Ways to increase HDL-cholesterol
Habitual aerobic exercise(> 6 METs, 3 times/week for 20 min/session)
Weight loss (if necessary)
Niacin supplementation
Quitting smoking
Increasing consumption of beta carotene
Drug therapy
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LDL-cholesterolTends 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-cholesterolLoss of body fat (if necessary)
Dietary changes
Drug therapy
Participation in a regular aerobic exercise program
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LDL-cholesterolIt 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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Ways to lower LDL-cholesterolChoose a diet low in fat, saturated fat, and cholesterol
Saturated fat should be replaced with monounsaturated and polyunsaturated fats because the latter tend to decrease LDL-cholesterol
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Ways to lower LDL-cholesterolTotal daily fiber intake should be 25 to 38 grams per day, including a minimum of 10 grams of soluble fiber
Total fat consumption must be less than 30% of total daily caloric intake
Saturated fat consumption should be under 7% of the total daily caloric intake
Average cholesterol consumption should be much lower than 200 mg per day
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Diet & cholesterolA drawback of very low fat diets (less than 25% fat) is that they tend to lower HDL-cholesterol and increase triglycerides
If HDL-cholesterol is already low, monounsaturated and polyunsaturated fats should be added to the diet
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Ways to lower LDL-cholesterolConsume 25 grams of soy protein a day
Consume red meats fewer than three times per week, and no organ meats (liver, kidneys)
Eat fish instead of red meat
Do not eat commercially baked foods
Avoid foods that contain transfatty acids, hydrogenated fat, or partially hydrogenated vegetable oil
Drink low fat milk (1% or less) and choose low fat dairy products
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Ways to lower LDL-cholesterolLimit egg consumption to less than 3 eggs per week
Bake, broil, grill, poach, or steam food instead of frying
Refrigerate cooked meat before adding to other dishes; remove fat hardened in the refrigerator before mixing meat with other foods
Avoid fatty sauces made with butter, cream, or cheese
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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
StatinsSlow down cholesterol production and increase the liver's ability to remove blood cholesterolDecrease triglycerides and produce a small increase in HDL levels
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Disease
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TriglyceridesAlso 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
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Disease
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Table 10.5
Triglycerides guidelines
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TriglyceridesFound in
Poultry skin
Lunch meats
Shellfish
Manufactured mainly in the liver, from refined sugars, starches, and alcohol
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Ways to lower triglyceridesCut down on high-triglyceride foods
Decrease overall fat consumption
Quit smoking
Reduce weight (if necessary)
Participate in aerobic exercise
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Critical thinkingAre you aware of your blood lipid profile?
If not, what keeps you from having a blood chemistry test done?
What are the benefits of having it done now as opposed to later in life?
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Disease
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Other CHDRisk Factors
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HomocysteineClinical 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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Disease
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Other CHDRisk Factors
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HomocysteineHomocysteine 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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HomocysteineA 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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HomocysteineFive servings of fruits and vegetables daily can provide sufficient levels of folate and vitamin B6 to remove and clear homocysteine from blood
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HomocysteineVitamin B12 is found primarily in animal flesh and animal products
Vitamin B12 deficiency is rarely a problem(1 cup of milk or an egg provides the daily requirement)
The body recycles most of this vitamin, thus, a deficiency takes years to develop
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C-reactive protein (CRP)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 increasewith 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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Table 10.6Figure 10.8The hs-CRP (for high-sensitivity
CRP) test is used to measure inflammation in the blood vessels
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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 mellitusA condition in which blood glucose is unable to enterthe cells because
The pancreas totally stops producing insulin
The pancreas does not produce enough to meet thebody'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 16 million people in the U S.
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DiabetesPeople 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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DiabetesAn 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 termsType I Diabetes: Insulin-dependent diabetes (IDDM)
Also called juvenile diabetes
The pancreas produces little or no insulin
Type II 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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DiabetesAlthough diabetes has a genetic predisposition, type II 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 II diabetics are overweight or have a history of excessive weight
In most cases, type II can be corrected throughDiet, weight loss, and regular exercise
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DiabetesBoth 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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DiabetesA healthy diet is beneficial
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 XAs 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 includeLow HDL-cholesterol, high triglycerides, an increased blood clotting mechanism, and high blood pressure
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Syndrome XSyndrome X patients should distribute daily caloric intake so that
45% of the calories are derived from carbohydrates (primarily low-glycemic)
40% from fat (30% to 35% mono- and polyunsaturated fats, and 5% to 10% saturated fat)
15% from protein
Syndrome X patients also benefit fromWeight loss (if overweight)
Exercise
Smoking cessation
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Dietary guidelines
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Key termsBlood pressure: A measure of the force exerted against the walls of the vessels by the blood flowing through them
Systolic blood pressure: Pressure exerted by the blood against the walls of the arteries during the forceful contraction (systole) of the heart; higher of the two numbers in blood pressure readings
Diastolic blood pressure: Pressure exerted by the blood against the walls of the arteries during the relaxation phase (diastole) of the heart; lower of the two numbers in blood pressure readings
Hypertension: Chronically elevated blood pressure
Hypotension: Low blood pressure
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High blood pressureThe “silent killer”
A blood pressure above 140/90 mm Hg
Approximately 20% of Americans are hypertensive
High blood pressure is a risk factor for
CHD, congestive heart failure, strokes, kidney failure, and osteoporosis
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Blood pressure guidelinesRating Systolic Diastolic
Optimal 120 80
Normal 121–129 81–84
High Normal 130–139 85–89
Stage 1 Hypertension 140–159 90–99
Stage 2 Hypertension 160–179 100–109
Stage 3 Hypertension 180 110
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Critical thinkingDo you know what your most recent blood pressure reading was, and did you know at the time what the numbers meant?
How would you react if your doctor instructed you to take blood pressure medication?
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High blood pressure treatmentIncrease 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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Hypertension & exerciseHypertensive people who are physically active have a lower risk of mortality from all causes than inactive individuals with normal blood pressure
The death rates for unfit individuals with low systolic blood pressure are much higher than in highly fit people with high systolic blood pressure
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Effects of aerobic exerciseon 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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Exercise and high blood pressure treatment
Moderate-intensity aerobic exercise program50% intensity
30 to 45 minutes
5 to 7 times per week
Moderate-resistance strength-training program8 to 12 exercises
1 to 3 sets of 12 to 15 repetitions to near fatigue
2 times per week
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Hypertension & dietEat less salt and sodium-containing foods
Consume more potassium-rich foodsSuch as potatoes, bananas, orange juice, cantaloupe, tomatoes, and beans
Do not consume more than 2 alcoholic beverages a day if you are a man, 1 if you are a woman
Follow the dietary approach to stophypertension (DASH)
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Dietary approach to stop hypertension (DASH)
7 or 8 daily servings of grains, bread, cereal, or pasta
8 to 10 daily servings of fruits and vegetables
2 or 3 daily servings of nonfat/low-fat dairy products
2 or less daily servings of meat, poultry, or fish (less than 3 ounces per serving)
4 or 5 servings per week of beans, peas, nuts, or seeds
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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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Weight management
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SmokingMore than 47 million adults and 3.5 million adolescents in the U.S. smoke cigarettes
Smoking causes between 435,000 and 440,000 annual deaths in the U.S.
In relation to CHDSmoking speeds up the process of atherosclerosis
Causes a threefold increase in the risk of sudden death following a myocardial infarction
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SmokingIncreases heart rate
Raises blood pressure
Irritates the heart, increasing the risk of fatal cardiac arrhythmias
Decreases HDL-cholesterol
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Tension & stressPeople 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 & stressIndividuals 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 historyIndividuals 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 historyGenetic 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 run 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
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
Critical thinkingDo you have any relatives that have suffered from cardiovascular disease?
If so, what steps are you taking to prevent a cardiovascular event in your life?
Is there something you can do to help others in your family do the same?
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
AgeAge 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
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
AgeAlthough 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
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
Gum diseaseOral 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
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
SnoringLoud snoring has been linked tocardiovascular 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
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
AspirinAspirin 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
CardiovascularDisease
Prevention
CoronaryHeart
Disease
Major CHDRisk Factors
Other CHDRisk Factors
Hoeger & Hoeger. All slides © Wadsworth Publishing.
End of Chapter