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Heart DiseaseHeart Disease

and its Preventionand its Prevention

PRUDELEINE F. OBIENA, R.N., PADPRUDELEINE F. OBIENA, R.N., PAD

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What is Heart Disease?What is Heart Disease?

HeartHeart : The most hard-working muscle ofour body pumps 4-5 litres of blood every

minute during rest

Supplies nutrients and oxygen rich blood

to all body parts, including itself

Coronary arteriessurrounding the heart

keep it nourished withblood

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What is AtherosclerosisW at s At erosc eros swhat is coronary arterywhat is coronary artery

disease?disease?

Over time, fatty deposits called plaqueplaque build up within the

artery walls. The artery becomes narrow. This is

atherosclerosis When this occurs in the coronary arteries, heart does not get

sufficient blood, the condition is called coronary artery

disease, or coronary heart disease

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Myth : fat deposits at old age!Myth : fat deposits at old age!It starts from 2 years of ageIt starts from 2 years of age

Foam

Cells

Fatty

Streak

Intermediate

Lesion Atheroma

Fibrous

Plaque

ComplicatedLesion/

Rupture

Adapted from Pepine CJ.Am J Cardiol. 1998;82(suppl 104).

From FirstDecade

From ThirdDecade

From FourthDecade

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Are Other organs Affected?Are Other organs Affected?

Ischemic StrokeIschemic Stroke

Peripheral VascularPeripheral Vascular

DiseaseDisease

Coronary Heart DiseaseCoronary Heart DiseaseAnginaAngina

MI (Heart Attack)MI (Heart Attack)

Sudden Cardiac DeathSudden Cardiac Death

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What are the symptoms ofWhat are the symptoms of

Coronary artery disease?Coronary artery disease?

No symptoms for long period Chest pain for short period on

exertion also known as Angina or

minor heart attack Myocardial Infarction or major heart

attack-Severe chest pain, death of

heart muscle, heart failure, irregularheart beats

Sudden Death

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How Big is the Problem ?How Big is the Problem ?

No. 1 killer disease worldwide

12 Million deaths annually

During last 30 years large declines indeveloped countries -rising healthawareness and governmentprogrammes

Alarming increase in developingcountries especially India

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Why Me ?Why Me ?

Genetic predisposition

Poor handling of fats and metabolic

syndrome

Diabetes, obesity, high BP, Coronary artery

disease

Environmental insults

Urbanization

Sudden change in lifestyle

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What Increases Risk?What Increases Risk?

You cant help it ! Age:

Men > 45;Women > 55

Sex Race

Family History

You can !! High Cholesterol

Smoking

High Blood Pressure Diabetes

Obesity

Alcohol

Physical Inactivity

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Cholesterol ( A type of fat)Cholesterol ( A type of fat)Cholesterol ( A type of fat)Cholesterol ( A type of fat) Everybody needs cholesterol, it

serves a vital function in the body.

It circulates in the blood.

Too much cholesterolcan deposit in the

arteries in the form of

plaque and block them No symptoms till heart

attack

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Where does it come from ?Where does it come from ?

Two sources ofcholesterol:Food & made inyour body

Food sources: Allfoods containinganimal fat and

meat products

65%65% 35%35%

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Good vs. BAD CholesterolGood vs. BAD CholesterolGood vs. BAD CholesterolGood vs. BAD Cholesterol

LDL cholesterol is known as badcholesterol. It has a tendency toincrease risk of heart disease

LDL cholesterol is a major

component of the plaque that clogsarteries

HDL cholesterol is known as the good

cholesterol. Higher in women,increases with exercise

HDL cholesterol helps carry some ofthe bad cholesterol out of arteries.

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ObesityObesityObesityObesity

People who are overweight (10-30 % more

than their normal body weight)

Obese have 2 to 6 times the risk of

developing heart disease Normal Waist-Hip Ratio

< 0.85 for women;

< 0.95 for men

Pears or apples?

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Pears and ApplesPears and Apples

Apple-shaped paunch store body fat

around the abdomen and chest,

surrounding internal organs

Pear-shaped paunch store fat on the

hips and thighs, just below the surface of

the skin.

Apple- shaped are at a higher riskApple- shaped are at a higher risk

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Physical InactivityPhysical InactivityPhysical InactivityPhysical Inactivity

Every morning mybrain tells me to

exercise.. and my bodylaughs at the idea

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Cigarette SmokingCigarette SmokingCigarette SmokingCigarette Smoking

Increases blood pressure Decreases HDL

Damages arteries and blood cells

Increases heart attacks Cigarette smoke contains more than

4,000 chemicals, and 200 of thesechemicals are poisonous

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Cigarette SmokingCigarette SmokingCigarette SmokingCigarette SmokingIf you think YOU are smoking the cigarette, you are

mistaken Its the other way round !

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Creative strategies do not work !Creative strategies do not work !

Karva Chauth!

Never had a test or retest

Never been to Doctor !

I hate them

Never take medicines!

My BP is normal, so stopped

meds!

Miracle men and Miracle

Medicines! So many of them

I am my own doctor! No feestoo

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Preventing Heart DiseasePreventing Heart DiseaseRule #1 Look before your eatRule #1 Look before your eat

Preventing Heart DiseasePreventing Heart DiseaseRule #1 Look before your eatRule #1 Look before your eat

Eat a variety of fruits and vegetables everyday. (5 servings - they are naturally low in fatand high in vitamins and minerals and antioxidants). Eat colored vegetables and fruits

Eat a variety of grain products

Choose nonfat or low-fat products.

Use less fat meats- chicken, fish and lean cuts

Switch to fat-free milktoned/skimmed milk

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Dietary GuidelinesDietary GuidelinesDietary GuidelinesDietary Guidelines

Limit your intake of foods high incalories and low in nutrition, includingfoods like soft drinks, candy, junk food

Limit foods high in saturated fat, trans-fat and cholesterol

Eat less than 6 gms of salt a day

Have no more than1-2 alcoholic drinka day if you are a regular drinker

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Limit / AvoidLimit / AvoidLimit / AvoidLimit / Avoid

Foods rich in Cholesterol andSaturated fats Egg Yolk

Fatty meat & organ meat( Liver)

Butter chicken / Batter fried fish ! Milk fat Desi Ghee, Butter, Cheese,

Malai, Rabri, Khurchan, Doda, Ice Cream,full cream milk,

Hidden Fat like Bakery biscuits, Patties (!),Cakes, Pastries,

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Cooking Oils: The mystery ofCooking Oils: The mystery of

PUFA / MUFAPUFA / MUFACooking Oils: The mystery ofCooking Oils: The mystery of

PUFA / MUFAPUFA / MUFA

Saturated Fats : Increase Cholesterol Avoid Coconut oil, Palm oil, Vanaspati ghee

Monounsaturated Fats (MUFA): Heart

healthy Olive oil, Groundnut oil, Canola oil, Mustard oil

Polyunsaturated Fats (PUFA): Heart healthy

Sunflower oil, Soybean oil

Omega-3-Fatty acids Fish oil : Heart Healthy

Rotate the oils or Mixture of oils

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Preventing Heart DiseasePreventing Heart DiseaseRule #2 ExerciseRule #2 Exercise

Preventing Heart DiseasePreventing Heart DiseaseRule #2 ExerciseRule #2 Exercise

Maintain a level of physical activity thatkeeps you fit and matches the caloriesyou eat

Serves several functions in preventingand treating those at high risk

Reduces incidence of obesity

Increases HDL Lowers LDL and total cholesterol

Helps control diabetes andhypertension

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Exercise, Exercise, ExerciseExercise, Exercise, ExerciseMortality is halved in retired men who walkmore than two miles every day

Regular exercise can halve the risk of heartdisease, particularly in men who walk briskly

Someone who is inactive has as great a risk

of having heart disease as someone whosmokes, has high blood pressure or has highcholesterol

Exercise significantly reduces the chances of

diabetes and strokeWith regular exercise, blood pressure inthose with hypertension is reduced by asmuch as 20mms Hg

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Exercise and Heart DiseaseExercise and Heart DiseaseExercise and Heart DiseaseExercise and Heart DiseaseModerate to intense physical activity for 30-45

minutes on most days of the week isrecommended

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Walking for a healthy heartWalking for a healthy heart

Complicated exercise machines orsweating it out in the gym not essential

JUST WALK!

R l 3 S S kiR l # 3 St S ki

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Rule # 3 Stop SmokingRule # 3 Stop Smoking

NOW!NOW!

The risk of heart attack starts decreasingwithin 24 hours of quitting smoking, within1 year of quitting, CHD risk decreasessignificantly, within 2 years it reaches the

level of a nonsmoker

Smell and taste improve within days

Within three months of quitting, thesmokers' cough disappears in most people

R l # 3 S S kiR l # 3 St S ki

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Rule # 3 Stop SmokingRule # 3 Stop Smoking

NOW!NOW!

R l # 4 KR l # 4 K

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Rule # 4 Know yourRule # 4 Know your

Number!Number!

Desirable numbersTotal cholesterol < 200; LDL < 100

HDL > 40 triglycerides < 200

Get the levels tested routinely and keep

them under control The only thing worse than finding out thatyou have one of these conditionsis.NOT finding out that you have it!!

And thats not your Mobile Number!And thats not your Mobile Number!

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10% reduction of bloodcholesterol produces 20-30%

decline in CHD deaths

Benefits of reducingBenefits of reducing

cholesterolcholesterol

All Adults >20 yrs must get tested- if normal test again

after 5 years, if elevated, work towards normalizing thelevels with lifestyle modification and drugs as needed

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Controlling Blood PressureControlling Blood Pressure

Adults should have their blood pressurechecked at least once every two years, asthere are no symptoms to tell if you havehigh blood pressure

Optimal levels : 120 /80 mm Hg If high Modify your lifestyle Diet, Weight, Exercise,

Salt restriction

Adhere to the prescribed medication withoutfail, to decrease chances of getting heartdisease Do not stop your medicines withoutconsulting your doctor, even if the blood

pressure becomes normal

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Controlling Blood SugarControlling Blood Sugar

All adults should have their blood sugarchecked regularly, as there are no earlysymptoms of diabetes

Normal blood sugar:

Fasting < 100; post meals

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If you or someone in your familyIf you or someone in your family

already diagnosed with heartalready diagnosed with heart

diseasedisease

Dont get disheartened science has madesignificant progress

Just monitor risk factors much more aggressively

Eat healthy

Walk regularly

Watch your weight

Quit smoking immediately

Keep your weight under control

In addition to improving your heart health these

measures are sure to enhance your appearance !!

Adhere to you medicines & listen to your doctor

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Dont wait for a heart attack toDont wait for a heart attack to

take an action !take an action !

Dont wait for a second lifeDont wait for a second lifewe are not cats!we are not cats!

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Heart disease is often avoidable. Following a heart-

healthy lifestyle doesn't have to be complicated, and itdoesn't mean you need to live a life of self-deprivation.

Instead, find ways to incorporate heart-healthy habits

into your lifestyle and you may well enjoy a healthier

life for years to come.

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THANK YOU!!!THANK YOU!!!