CARDIOVASCULAR DISEASE WHAT IS IT? WHAT IS THE ROLE OF CHOLESTEROL? HOW CAN WE REDUCE RISK?

Transcription

1 1

2 CARDIOVASCULAR DISEASE WHAT IS IT? WHAT IS THE ROLE OF CHOLESTEROL? HOW CAN WE REDUCE RISK? Perry J Weinstock, MD, F.A.C.C. Head, Division of Cardiovascular Disease Director of Clinical Cardiology Cooper University Health Care Professor of Medicine Cooper Medical School of Rowan University 2

3 The Coronary Artery and Atherosclerosis 3

4 Atherosclerosis Timeline 4

5 Glagov s Coronary Remodeling Hypothesis 5

6 Worldwide Causes of Death Secondary to Chronic Diseases Fuster V et al. Lancet 2005; 366:

7 Epidemiology Death in the US by Cause, 2011 Number of patients 1,000, , , , , , , , ,777 CVD Cancer COPD Trauma 7

8 1,000 Deaths in Thousands Years Deaths from diseases of the heart (United States: ) Source: NCHS. 8

9 Deaths in Thousands Years Males Females 9

10 10

11 Cardiovascular Risk Factors Are Many and Diverse Hypertension* Age (older than 55 for men, 65 for women) Diabetes mellitus* Elevated LDL (or total) cholesterol or low HDL cholesterol* Estimated GFR <60 ml/min Family history of premature CVD: women <65 years men <55 years Microalbuminuria Obesity* (body mass index 30 kg/m 2 ) Physical inactivity Tobacco usage, particularly cigarettes GFR=glomerular filtration rate. *Components of the metabolic syndrome. Reduced HDL and elevated triglycerides are components of the metabolic syndrome. Abdominal obesity is also a component of metabolic syndrome. Increased risk begins at approximately 55 and 65 for men and women, respectively. Adult Treatment Panel III used earlier age cutpoints to suggest the need for earlier action. Adapted from Chobanian AV et al. Hypertension. 2003;42:

12 Focus: Lipids and the Endothelium Vascular Biology Working Group 12

13 What Is Desirable Cholesterol? Cholesterol Levels Among Different Human Populations Hazda Inuit!Kung Pygmy San Adult American Huntergatherer humans Mean total cholesterol, mg/dl Adapted from O Keefe JH Jr et al. J Am Coll Cardiol. 2004;43:

14 Class 3-Hydroxy-3-methylglutaryl Coenzyme A (HMG-Co-A) reductase inhibitors [Statins] Bile acid sequestrants Cholesterol absorption inhibitor Nicotinic acid Dietary adjuncts Proprotein Convertase Subtilisin Kexin 9 (PCSK9) inhibitors Pharmacologic Therapies to Lower LDL-C Drug(s) Atorvastatin (Lipitor) Fluvastatin (Lescol) Lovastatin (Mevacor) Pitavastatin (Livalo) Pravastatin (Pravachol) Rosuvastatin (Crestor) Simvastatin (Zocor) Cholestyramine (Questran) Colesevelam (Welchol) Colestipol (Colestid) Ezetimibe (Zetia) Niacin Soluble fiber Soy protein Stanol esters Alirocumab (Praluent) Evolocumab (Repatha)

15 Conclusions Cardiovascular Disease is the leading killer of adults in the US (men and women) Risk Factors are well defined and include elevated LDL cholesterol Risk Reduction Strategies to lower LDL (bad cholesterol) must be optimized at any age 15

16 HEART DISEASE MEN AND WOMEN Kathleen M Heintz, D.O., F.A.C.C. Clinical Cardiologist Assistant Professor of Medicine Cooper Medical School of Rowan University 16

17 Cardiovascular Deaths: Men and Women 17

18 Women and Heart Disease 1 in 8 breast cancer in a lifetime 1 in 3 heart disease in a lifetime 366,000 women/us die from heart disease 42,000 women/us die from breast cancer 18

19 Risk Factors for Women Same As for Men Diabetes/The Metabolic Syndrome Smoking Hyperlipidemia/LDL Hypertension Family history of early heart disease Obesity..some are more important for women.. 19

20 Risk Factors Important for Women The presence of obesity increases the risk of heart disease by 46% in men, but by 64% in women Archives of Internal Medicine, 2001;162 Diabetes increases the risk of heart disease 2-3 fold in men, and 3-7 fold in women Brit Med Jour 2006;

21 Reasons We are Doing Worse Obesity and the Metabolic Syndrome Persistent rates of cigarette smoking Physical inactivity after menopause Worsening lipid profile after menopause 21

22 Wake Up Call: Smoking and Women 22

23 Wake Up Call 2 WEIGHT 23

24 Obesity Trends: Projected 24

25 Estrogen Protective Until Menopause Women probably present with heart disease 10 years later than men because of endogenous estrogen 25

26 Menopause Women spend approximately one third of their life in menopause Women experience a greater loss in physical function, as compared to men This loss of physical activity contributes to a greater weight gain, insulin resistance and hypertension 26

27 Menopausal Transition There is a weight increase of 1 to 1 ½ lbs. per year with menopause This increase in abdominal adiposity is independent of total body adiposity Women with larger waist circumferences walk on average 1,000 less steps per day 27

28 Menopause Higher incidence of cardiac disease is more likely caused by the clustering of risk factors and inflammation Obesity, hypertension, dyslipidemia, and physical inactivity create the hostile cluster, making heart attack more likely 28

29 Women: Myths of Presentation 29

30 Heart Attack in Women 30

31 Do Women Really Present Differently? Although women present with atypical chest pain more often than men, the most common presentation is still typical Atypical chest pain may be more common in women due to vasospastic and microvascular disease 31

32 AHA Evidenced Based Guidelines: Women Aspirin (75 to 325 mg) should be used in all high risk women Aspirin (81 mg/day every other day) may be considered in women >65 to reduce risk of an ischemic stroke or MI HRT (hormone replacement therapy) and SERMS (selective estrogen receptor modulators) should not be considered protective and may increase the risk of stroke 32

33 Evidenced Based Guidelines: Women Unregulated dietary supplements are not proven to prevent heart disease Anti-oxidants (A, E, C) should not be used for prevention Folic acid, vitamin B-6 and vitamin B-12 are no longer recommended It is now recommended to eat fish rich in omega-3 fatty acids 2/week 33

34 Evidenced Based Guidelines Women with CVD should consider taking mg EPA (eicosapentaenoic acid) and DHA (docosahexaeoic acid) daily Women with CVD and high triglycerides should take 2-4 grams of EPA and DHA Women who want to lose weight or sustain a weight loss should exercise minutes of moderate-intensity activity on most, and preferably all days of the week 34

35 HEART MATTERS DIET TIPS AND SUGGESTIONS FOR A HEALTHY HEART Evelyn Arteche, RD, CPT, GFI Registered Dietician Cooper University Health Care 35

36 Dietary Fats? Saturated Fats Monounsaturated Fats Polyunsaturated Fats Trans-Fats Other Nutritional Considerations Cholesterol Triglycerides Sodium Dietary Fiber 36

37 Saturated Fat and Trans Fat Saturated Fat (Less than 7%) Often solid at room temperature Found in animal products e.g. cheese, butter, cream Also found in tropical oils coconut Research shows it elevates bad cholesterol Trans Fat Increases LDL Cholesterol Levels (Bad Cholesterol). Should be avoided along with Saturated Fats Read the label Labeled free free Trans fat free = <0.5 grams per serving Zero grams of trans fat = <0.5 grams per serving 37

38 Monounsaturated Fat and Polyunsaturated Fat Monounsaturated FAT (up to 20%) May decrease "bad" cholesterol and maintain "good" cholesterol Sources include: olive oil, peanut oil, canola oil, avocado, nuts & seeds Polyunsaturated FAT (up to 10%) May decrease "bad" and "good" cholesterol levels Sources include: safflower oil, corn oil sunflower oil & products containing Omega 3 & Omega 6 Fatty Acids 38

39 Triglycerides HIGH TRIGLYCERIDES Diabetes- Uncontrolled Excessive alcohol consumption Hypothyroidism, gout, lupus Cholesterol lowering drugs or estrogens Lack of exercise LOWER TRIGLYCERIDES Eliminate or limit concentrated sugars such as candy, fruit juices, table sugar, corn syrup, honey and sodas Eliminate or limit alcohol Limit red meat Increase exercise 39

40 Increase HDL How to Increase HDL Exercise Stop smoking o Smoking lowers HDL Cholesterol levels Alcohol in moderation o 1-2 drinks per day may increase HDL Cholesterol levels Note: Alcohol consumption has been associated with other health dangers including high blood pressure, obesity, stroke, cancer, and alcoholism 40

41 Decrease LDL LDL is the major carrier of cholesterol in the blood Too much LDL in the blood can block the flow of blood to the arteries feeding to the heart and brain Commonly referred to as BAD cholesterol Blood level should not exceed 130 mg/dl How To Decrease Decrease intake of Saturated Fats Decrease intake of Trans Fats Limit dietary Cholesterol intake to less than 300 mg/day Consume adequate fiber LDL 41

42 Omega 3 Fatty Acids A form of polyunsaturated fats Essential for the human body- (Body does not produce them) Often deficient in the American diet Required by the brain to function properly Benefits Heart disease protection Improved rheumatoid arthritis, lupus and other autoimmune diseases Improvements with depression and mental health problems Cancer prevention and support Improved blood sugar control with Diabetes 42

43 Sodium Sodium can increase blood pressure Reduced sodium = reduced risk of heart attack or stroke associated with high blood pressure One teaspoon Salt (sodium chloride) = 2,300 mg sodium Most Americans consume 1-4 tsp. salt/day Processing of food drastically increases the sodium content 43

44 Nutrition Facts Labels WHAT DOES IT ALL MEAN? Free Low Lean & Extra Lean High Good Source Reduced or Less Light 44

45 45