STAYING HEART HEALTHY PAVAN PATEL, MD CONSULTANT CARDIOLOGIST FLORIDA HEART GROUP

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1 STAYING HEART HEALTHY PAVAN PATEL, MD CONSULTANT CARDIOLOGIST FLORIDA HEART GROUP

2 What is Heart Disease Cardiovascular Disease (CVD): Heart or Blood vessels are not working properly. Most common reason is cholesterol plaque (Atherosclerosis) build up leading to blockage in the arteries supplying heart muscle. This can lead to Heart Attack and Impairment of function of heart muscle. Similar process can lead to blockage in arteries of brain and lead to stroke

3 Atherosclerosis

4 What Predisposes Someone to Development of Atherosclerosis? Some genetic conditions: Hereditary High Cholesterol Majority of risk factors are modifiable- You can do something about it! Development of atherosclerosis starts in childhood. Atherosclerosis was found in Mummies 4000 years old.

5 Who is Predisposed to Heart Disease?

6 Non-Modifiable Risk Factors (You CAN T do anything about it) Age: Men > 45, Women > 55 Gender Race Family History

7 Things you CAN do something about: Smoking Diabetes High Blood Pressure High Cholesterol Diet Physical Inactivity Obesity

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9 Cigarette Smoking Increases Blood Pressure Decreases Good Cholesterol Damages Arteries Makes cholesterol sticky and causes plaques Increases risk of Heart Attack Leads to many other conditions- Cancers, Lung problems etc.

10 All Tobacco products are Harmful. Second Hand Smoking is Dangerous too! Risk of Heart Attack starts to decrease in 24 hours after quitting smoking and becomes equal to nonsmoker at 2 years.

11 Don t Let Cigarettes Smoke You

12 Heart Healthy Diet Too much conflicting information? Confusing? Difficult to perform experimental studies of different diets/dietary patterns. We know some types of foods that are harmful if consumed in more than recommended quantity. Some data on certain dietary patterns that help reduce heart disease.

13 The Short Version Lots of Fresh Fruits and Vegetables (at least 5 servings a day). Whole Grains for carbohydrate. Limit Sugar- sweets, sugary drinks and sugar. Limit Saturated Fat and Cholesterol (Red Meat, Butter, Egg Yolk, High Fat Dairy products, Tropical Vegetable (Palm/Coconut) oil etc). No Trans Fat (Hydrogenated Oils). Unsaturated Fat is good (Olive Oil, Sunflower oil, Nuts, Fish). Remember, it is still fat and high in calories. Eat Lean Meat/poultry low in Fat. Choose Nuts/Seeds/Legumes. Avoid processed foods. Limit sodium intake 1500 mg daily (3.75 gm of salt). Limit Alcohol 1-2 drinks/day.

14 Read Labels 1. Start here 2. Check the total calories per serving 3. Limit these nutrients 4. Get enough of these nutrients 5. Quick Guide for % Daily Value: 5% or less is low and 20% or more is high

15 Understand Portion Size You may be surprised to learn these are serving sizes: 1 slice of bread ½ cup rice or pasta (cooked) 1 small piece of fruit (super-large apples are 2+ servings) 1 wedge of melon ¾ cup fruit juice =1 cup milk or yogurt 2 oz. cheese (about the size of a domino) 2-3 oz. meat, poultry or fish (this is about the size of a deck of cards)

16 What Can You Do to Eat Heart Healthy? AHA Recommendations: 1. Eat a variety of fresh, frozen and canned vegetables and fruits without high-calorie sauces or added salt and sugars. Replace high-calorie foods with fruits and vegetables. 2. Choose fiber-rich whole grains for most grain servings. 3. Choose poultry and fish without skin and prepare them in healthy ways without added saturated and trans fat. If you choose to eat meat, look for the leanest cuts available and prepare them in healthy and delicious ways. 4. Eat a variety of fish at least twice a week, especially fish containing omega-3 fatty acids (for example, salmon, trout and herring). 5. Select fat-free (skim) and low-fat (1%) dairy products. 6. Avoid foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet.

17 Limit saturated fat and trans fat and replace them with the better fats, monounsaturated and polyunsaturated. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that s about 13 grams of saturated fat. Cut back on beverages and foods with added sugars. Choose foods with less sodium and prepare foods with little or no salt. To lower blood pressure, aim to eat no more than 2,400 milligrams of sodium per day. Reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further. If you can t meet these goals right now, even reducing sodium intake by 1,000 mg per day can benefit blood pressure. If you drink alcohol, drink in moderation. That means no more than one drink per day if you re a woman and no more than two drinks per day if you re a man. Follow the American Heart Association recommendations when you eat out, and keep an eye on your portion sizes.

18 The Mediterranean Diet Shown to improve Heart Health and decrease chance of heart attack. What is Med Diet: high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds olive oil is an important monounsaturated fat source dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten eggs are consumed zero to four times a week wine is consumed in low to moderate amounts Problem with Med Diet: Too much Fat (40% of total calories). Can lead to obesity.

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20 The DASH Diet Shown to reduce High Blood Pressure Much lower Fat/Oil content compared to Mediterranean diet.

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22 Physical Activity At least 30 minutes of moderate intensity exercise every day. More is better- Incremental benefit of more exercise. Reduces blood pressure. Improves good cholesterol, reduces bad cholesterol. Improves diabetes Helps you maintain healthy weight. Helps you live longer (decreased mortality by half in retired men walking 2 miles/day).

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24 Start Walking Look for opportunities to walk/climb stairs in your daily routine (at work, home, grocery stores). Start slow and gradually increase exercise intensity. You don t have to run a Marathon- any level of physical activity is helpful and is better than nothing. Choose type of exercise based on individual preference or medical conditions like arthritis or poor balance.

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26 Obesity Increases risk of diabetes, high blood pressure and heart disease. Abdominal Obesity (increased waist circumference) are at higher risk. Calorie Limited Diet (limiting carbohydrate and fat) and exercise for weight loss.

27 High Blood Pressure Ideal Blood Pressure <130/80 mmhg. Very common in adults. Silent Killer No symptoms. BP should be checked at least once a year. Increases risk of heart disease, stroke, kidney disease. Reduction in systolic BP of mmhg is shown to reduce risk of stroke by 35%. Limit sodium intake 1500 mg daily. Daily exercise and weight loss improves high blood pressure. May need medications in addition to diet and exercise to control BP.

28 High Cholesterol Too much cholesterol increases risk of heart disease. LDL is bad cholesterol and tends to form plaque in arteries. HDL is good cholesterol- reduces risk of heart disease, it increases with exercise. About 25-30% of cholesterol comes from diet- should limit dietary cholesterol. Unsaturated fat reduces cholesterol while trans Fat increases cholesterol. Cholesterol level targets should be individualized based on risk. Cholesterol medications ( statins ) reduce risk of heart attack and stroke in patients at elevated risk.

29 Diabetes Increases risk of heart disease 2 to 3 times. Having diabetes is considered equivalent to having heart disease (risk of heart attack is similar). Majority of patients with diabetes die of heart disease. Uncontrolled diabetes leads to many other complications. Treatment involves dietary changes (low in sugar, more vegetables/fruits/whole grains), exercise and medications- multiple options available for long term control.

30 If You Are Healthy, Stay Healthy! 1. Avoid smoking and using tobacco products 2. Be physically active every day 3. Eat a heart-healthy diet 4. Keep a healthy weight

31 If you have Diabetes, High Blood Pressure or High Cholesterol In addition to Heart Healthy lifestyle, Take medications prescribed by your physician. Medications work when you take them, not when they are in pill box. Controlling diabetes, blood pressure, cholesterol is long term investment. These conditions may not cause lot of symptoms, but left untreated, will increase risk of heart disease, stroke and death. Therefore, need to get regular check ups, at least once a year.

32 Role Of Low Dose Aspirin Baby Aspirin can be used to prevent heart attacks in certain patients at elevated risk of heart disease, but this decision should be individualized in consultation with physician.

33 What Are the Warning Signs of Heart Disease? No symptoms for long time. Chest pain (angina) with exertion is common symptom. Symptoms resolve with resting for few minutes. Some people feel shortness of breath, Jaw or Arm pain only, stomach discomfort. Prolonged chest pain or other symptoms described above, could indicate heart attack. Unfortunately, Sudden death is first manifestation of heart disease in many patients.

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35 Thank You