Risk Factors for Heart Disease

Transcription

1 Risk Factors for Heart Disease Risk Factors we cannot change (Age, Gender, Family History) Risk Factors we can change (modifiable) Smoking Blood pressure Cholesterol Diabetes Inactivity Overweight Stress Emerging Risk factors NOTES: 22

2 Research has identified factors that increase the risk for coronary artery disease. The more RISK FACTORS you have, the greater your chances of developing plaque build up in the coronary arteries. Some risk factors you are born with and cannot change (age, gender, family history). The others can be affected by our lifestyle choices. That means habits like regular exercise, healthy eating, living smoke free, coping better with stress, and taking medications regularly can have a big impact on our future health. AGE Coronary Artery Disease (CAD) Risk Factors Men > 45 years Women > 55 years FAMILY HISTORY CIGARETTE SMOKING HIGH BLOOD PRESSURE HIGH CHOLESTEROL DIABETES (DM) PHYSICAL INACTIVITY STRESS INCREASED BODY WEIGHT Heart disease before 55 years of age in father or other male firstdegree relative Heart disease before 65 years of age in mother or other female first degree relative Currently smoking Resting Blood pressure 135/85 mmhg, or 130/80 mmhg for diabetics, confirmed by measurements on at least 3 separate occasions, or on anti-hypertensive medications Total cholesterol above guidelines for people with CAD (see risk factor section) or on cholesterol lowering medications Insulin Dependent persons older than 30, or had diabetes for more than 15 years Non-insulin diabetes older than 35 Sedentary lifestyle and no regular exercise or active recreational pursuits (active <150 mins/wk) Depression/Anxiety, stress reactions, chronic stress Waist Circumference: Male > 102cm (40 ) Asian male> 90 cm(36 ) Female > 88cm (35 ) Asian female > 80 cm (32 ) ACSM s Guidelines for Exercise Testing & Prescription, 10 th ed. Baltimore: Williams & Wilkins,

3 Risk Factors we can change (modifiable) Smoking Smoking (tobacco use) increases your risk of developing heart disease and stroke three times that of living smoke free. Smoking damages the inner lining of the coronary arteries and allows cholesterol to stick more easily to the walls. Smoking increases the heart workload by increasing heart rate and blood pressure, decreasing oxygen in blood, increasing coronary artery spasm. Cigarette smoking decreases the good cholesterol (HDL). People who continue to smoke after a heart attack have a 22-47% greater risk of death or another heart attack (1). Regardless of how long or how many cigarettes people have smoked, stopping smoking reduces the risk for future heart disease and heart attack significantly. See DARK BLUE Tobacco reduction manual section for more information on stopping smoking. Health Benefits of Smoking Cessation 20 min Blood pressure and heart rate decrease 12 hours Carbon monoxide level in blood drops to normal 2 weeks- 3 months Circulation improves and lung function increases 1-9 months Coughing an shortness of breath decrease 1 year Risk of heart attack is about half of a smoker s 5 years Stroke risk is reduced to that of a nonsmoker 10 years Risk of lung cancer falls to half that of smoker; risk of cancer of mouth, throat, esophagus, bladder, cervix and pancreas decreases 15 years Risk of dying from heart attack is same as person who has never smoked Source: World Health Organization High Blood Pressure Blood pressure (BP) is the force of the blood pumped from the heart against the blood vessels. High blood pressure or hypertension occurs when there is too much pressure in your blood vessels. This can lead to damage of blood vessels causing health problems such as an increase risk of heart attack, stroke, heart failure, dementia, kidney disease, eye problems and erectile dysfunction. BP is usually measured at the arm using a blood pressure cuff or you can take it yourself with an automated blood pressure machine. The risk for heart disease is greater with increases of RESTING blood pressure is greater than 135/85 mmhg. The top number is systolic and represents pressure when the heart contracts and ejects blood into the body and the bottom number is diastolic and represents pressure during relaxation and filling of the heart. 24

4 Lifestyle change including weight loss, regular physical activity, reduce dietary sodium (salt) intake, reduce alcohol intake, and stopping smoking all help to lower blood pressure. Blood pressure medications are sometimes prescribed to lower blood pressure. How to take your BP at home: Automated Blood Pressure Monitor 25

5 Blood Cholesterol Low Density Lipoprotein (LDL) or bad cholesterol is a particle measured in a blood sample that is strongly associated with coronary artery disease (CAD) risk. Higher levels increase the risk of developing cholesterol plaque build up in the arteries. However, the risk of coronary disease is not solely dependent on blood LDL levels but rather it depends on the interaction with other CAD risk factors. Heart attacks can occur with normal LDL levels usually when other risk factors are present (ie. smoking, high blood pressure, diabetes). Studies show that medication therapy and lifestyle changes that reduce LDL levels in individuals with CAD will reduce coronary events and death. Dietary changes, including increased fiber, reduction of saturated fat, cholesterol and alcohol, reductions in body weight, increased physical activity, smoking cessation and medication therapy improve blood cholesterol values. Most patients with CAD require both diet and medications to adequately lower cholesterol to optimum levels. Target Cholesterol Levels for Individuals with CAD mmol/l Total Cholesterol <4.5 Non-HDL (TC minus HDL) <2.6 LDL <2.0 or 50% of baseline HDL >1.0 men >1.3 women Triglycerides <1.7 (<1.5 diabetics) Risk Ratio (TC/HDL) <4.0 High Density Lipoprotein (HDL) or good cholesterol is a particle measured in blood sample that is associated with a protective effect against plaque build up in the coronary arteries. Low HDL levels can promote plaque build up. Exercise and stopping smoking are the most effective ways to increase your HDL levels. Diabetes (see Diabetes section, PINK) Diabetes is a condition where your body cannot produce insulin or it cannot properly use the insulin it produces. Insulin is a hormone that is required to allow the body s cells to take in and use blood sugars. In Type 1 diabetes, the pancreas does not produce insulin. In Type 2 diabetes, the body does not properly use the insulin made (body becomes resistant to insulin). In both cases, diabetes can lead to high blood sugar levels that can damage organs, blood vessels and nerves. It can increase the risk for coronary artery disease. Visit the Canadian Diabetes website: 26

6 Physical Inactivity (See Exercise section, YELLOW) The risk of coronary artery disease (CAD) increases as physical activity decreases. Increased physical activity has been shown to lower blood pressure, reduce triglycerides, increase HDL (good) cholesterol, and improve blood sugar control and insulin sensitivity. Studies of physical activity both in animals and humans with established CAD have demonstrated slowing of atherosclerotic progression (plaque build up) and, in some instances, regression of atherosclerosis (reduction of plaque in arteries) (3). A sedentary lifestyle is one with little or no physical activity with an excessive amount of sitting in the day and is associated with increased risk of CAD. Long periods of sitting should be broken up with standing/walking/activity. Increased Body Weight Abdominal (waist) obesity is associated with greater risk for CAD, diabetes and abnormal cholesterol levels. Waist measurement greater than 102 cm(40 ) in men, 90 cm (36 in Asian men) and greater than 88 cm(35 ) in women, 80 cm (32 ) in Asian women A Body Mass Index (BMI) greater than 27 o BMI= weight (kilograms) divided by height (meters squared) o Example: Weight 150 lbs. = 68 kg; Height= 5 7 = 2.89 m 2 o BMI= 68 Kg/ 2.89 m 2 = 23.5 (good range) Even a modest weight loss of 5-10% of initial body weight has positive benefits on CAD risk factors. Improvements in CAD risk factors are not maintained if weight is regained. Psychological factors/coping with Stress (See Stress section, BLUE) Hostility, depression, lack of social support, chronic stress produced by situations of high demand, and low control, and social isolation are examples of psychological factors associated with CAD risk. In addition, adults who become ill suddenly or unexpectedly (cardiac patients) are likely to be highly stressed due to changes in lifestyle, temporary limitations to work capabilities, and threats to identities. Identifying stress factors, developing social support systems and improving coping skills are important steps in reducing physical and emotional effects of stress. Emerging Risk Factors New Research continues to work towards understanding and identifying new risk factors for cardiovascular disease. Emerging risk factors may help to explain why some individuals are at greater risk for developing heart disease than others. Still 1/10 patients with a heart attack seem to lack a identifiable risk factor at fault. Research has identified the following possible emerging risk factors: C-reactive protein (CRP)- inflammatory marker found in the blood Homocysteine- controversial in its role to cause CAD Lp(a) lipoprotein Talk to your doctor(s) if you have or are concerned that you have any of these risk factors. You can keep track of Your Risk Factors and build an action plan on how to improve your risk factors on the next page. 27

7 Your Learning Activities In the first column (on the left) of the chart below, check off the risk factors you have. In the second column (on the right) of the chart below, make a list of what you are doing to help control this risk factor. Place beside your Risk Factor Physical inactivity What am I doing about this risk? Nutrition Stress Smoking and Second-hand Smoke High Blood Pressure High Cholesterol High Blood Glucose Waist Size 28

8 1. What self-monitoring tools do you use to help track and monitor your risk factors? Exercise diary Food diary Blood work (such as cholesterol, HbA 1 C, INR) Regular doctor visit Smoking diary Journaling Blood pressure monitor Blood glucose monitor Others 2. Rate your level of confidence in using the self-monitoring strategy that you have selected to be sure that you have chosen the right one. Confidence scale: Not very confident very confident If you rate lower than 7, you should think about what other strategies would be better for you to use. Self-monitoring strategies that you are confident you can use are the best choices. References 1. Pasternak RC, Grundy SM, Levy D, et al. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 27: , Glantz SA, Parmley W. Passive smoking and heart disease. Mechanisms and Risk. JAMA 273: , Schuler, G, Hambrecht R, Schlierf G, et al. Regular physical exercise and low fat diets: effects on progression of coronary artery disease. Circulation 86:1-11, Gotto A, Pownall H. Manual of Lipid Disorders. 2 nd ed. Liippincott Williams & Wilkins, 249, Fodor J, Frohlich J, Genest J, McPherson P, et al. Report of the Working Group on Hypercholesterolemia and Other Dyslipidemias. CMAJ 162(10):1441-7, American College of Sports Medicine Resource Manual for Guidelines for Exercise Testing and Prescription. 10 th ed. Baltimore: Williams & Wilkins, UHN, An education workbook for people living and thriving with CVD. Toronto Rehabilitation Institute, Canadian HypertensionGuid3lines

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