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Health and Lifestyle Connection
Links to Heart Disease, High Blood Pressure and Diabetes
Candace Huber, MPH, BSN
Florida Hospital
Center for Community Health Ministry
©2007 Florida Hospital Center for Community Health Ministry
Heart DiseaseHeart Disease CancerCancer
StrokeStroke
ChronicChronicLungLung
DiseaseDisease
AccidentsAccidentsDiabetesDiabetesAlzheimer’sAlzheimer’sDiseaseDisease
InfluenzaInfluenzaPneumoniaPneumonia
KidneyKidneyDiseaseDisease
SepticemiaSepticemia(Blood Infections)(Blood Infections)
Tobacco UseTobacco UseDiet &Diet &
Activity PatternsActivity Patterns
Alcohol &Alcohol &SubstanceSubstance
AbuseAbuse
InfectiousInfectiousAgentsAgents
Pollutants &Pollutants &Toxic AgentsToxic AgentsFirearmsFirearms
SexualSexualBehaviorBehavior
MotorMotorVehiclesVehicles
IllicitIllicitDrug UseDrug Use
Anger &Anger &FrustrationFrustration
Low SelfLow SelfEsteem orEsteem orSelf WorthSelf Worth
EconomicEconomicDisparityDisparity
HopelessnessHopelessness& Emotional& Emotional
DespairDespair
Lack ofLack ofInformationInformation
Or EducationOr Education
MeaninglessMeaninglessExistenceExistence
ExternalExternal& Internal& Internal
StressStress
PowerlessnessPowerlessnessLonelinessLoneliness
©2007 Florida Hospital Center for Community Health Ministry
Obesity Trends* Among U.S. AdultsBRFSS, 1985
Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10
No Data <10% 10%–14%
©2007 Florida Hospital Center for Community Health Ministry
Obesity Trends* Among U.S. Adults
Percent of Obese (BMI > 30) in U.S. Adults
www.cdc.gov/obesity/data/trends.html
© 2002 – 2006 LifeLong Health
Overweight and Disease Risk
0123456789
10
Heartdisease
High BP Gallbladder Diabetes
BMI 22
BMI 30
NEJM, Aug. 5, ’99, 430
Rel
ati v
e R
isk
©2007 Florida Hospital Center for Community Health Ministry
© 2003, PrevMedix LLC
Heart Disease and Lifestyle
© 2003, PrevMedix LLC
Stages of Atherosclerosis
ModerateModerate
Cross-section of an artery
NormalNormal SevereSevere
© 2003, PrevMedix LLC
Blood TestsRecommended Values
Desirable OptimalTotal Cholesterol <200 <160
HDL “good” Cholesterol >40 >60
LDL “bad” Cholesterol <130 <100
Non-HDL Cholesterol <160 <130
Triglycerides less than 200 <100
Glucose levels(nonfasting)<140
Glucose levels (fasting) < 100
© 2003, PrevMedix LLC
Lowering LDL (bad) CholesterolEvery 1% decrease in LDL reduces CHD risk 2%
• Fat - only 25% to 30% of total calories
• Saturated fat - less than 10%, less than 7% for better results, avoid hydrogenated oils
• Fiber - 20 to 35 gm/day (whole grains, fresh fruits and vegetables)
• Be physically active - 30+ minutes most days
• Healthy weight - see your body composition report (BMI less than 25)
© 2003, PrevMedix LLC
Raising HDL (good) Cholesterol
• Get 12 to 20 or more aerobic miles per week
• Achieve and maintain a healthy body weight
• Don’t smoke
Every 1% increase in
HDL lowers CHD risk 2% to 3%
© 2003, PrevMedix LLC
Increasing HDL Lowers HD Risk
160 160
107
50 56 4023 15 2 20
020406080
100120140160
<35 44-35 54-45 74-55 75+
Men
Women
Mortality rate due to coronary heart disease per 100,000
Source: The Framingham Heart Study
HDL Level
100
71
5246
41
0
20
40
60
80
100
120
None 1 hr/wk 3 hr/wk 5 hr/wk Plus Vigor.
Walking Time and Heart Health
Hours of Walking per Week
Rel
ativ
e ri
sk o
f H
eart
Att
ack
223
56
107
160
0
50
100
150
75+ 74-55 54-45 44-35 <35
HDL Levels mg/dL
CH
D m
orta
lity
rat
e, m
en
HDL Cholesterol Factors that improve
HDL– Aerobic exercise,
12-20 aerobic miles per week
– Achieve/maintain ideal body weight
– Avoid smoking– Avoid trans fatty
acids Note: For every 1% you
increase HDL levels, you decrease CHD by 2-3%
0.0
10.0
20.0
30.0
40.0
160 180 200 240 300
Cholesterol and Heart Health
Hea
rt D
i sea
se D
eath
Rat
e
Serum Cholesterol (mg/dL)
22
78
0
20
40
60
80
Persons withno risks
All otherpersons
Clinical Risks and Heart Disease• A 16+ year study of some
366,559 people looked at three major risk factors:
– smoking (currently)– cholesterol (200+)– blood pressure
(>120/80)• People with none of these
risks:– were 80 to 90% less
likely to have a heart attack
– were 40-60% less likely to die from any cause
– and lived 6 to 10 years longer than those with any risks
JAMA, Dec. 1, 1999Source: Framingham Heart Study
New England Jour. Medicine, Aug. 1999 Source: NCEP, MRFIT Study
©2007 Florida Hospital Center for Community Health Ministry
Fruit and Vegetable Intakeand Risk of Heart Attack
1.00
0.80
0.0
0.3
0.5
0.8
1.0
Lowest Highest
Fruit/Vegetable Intake
• Persons who ate the most fruits and vegetables (top 20%) had a 20% lower risk of heart attack than people who ate the fewest (bottom 20%).
• For every serving of fruit or vegetable eaten per day, the risk of heart attack dropped 4%.
Annals of Internal Medicine, 2001, Jun 19; 134:1106-14
Fruit and Vegetable Intakeand Risk of Stroke
1.00
0.69
0
0.2
0.4
0.6
0.8
1
Lowest<3/Day
Highest8+/Day
• Persons who ate the most fruits and vegetables (top 20%) had a 31% lower risk of stroke than people who ate the fewest (bottom 20%).
• For every serving of fruit or vegetable eaten per day, the risk of stroke drops 6%
Ref. JAMA, p. 1233, Oct. 6, 1999 ©2007 Florida Hospital Center for Community Health Ministry
© 2003, PrevMedix LLC
Coronary Heart Disease (CHD)Factors You Can Change• Blood cholesterol levels:
• Total less than 200 or less than 160 if you have heart disease
• Smoking: If you do smoke, stop! • More smokers die from heart disease than lung cancer • Quitting lowers your risk even if you are a long term smoker
• Blood pressure: Keep blood pressure low• Less than 120/80
• Inactivity: Get regular exercise, 30+ minutes most days• Excess body fat: Maintain a healthy weight
• BMI less than 25
© 2003, PrevMedix LLC
Waist Girth and Health Risk
1.001.19
2.37
0.0
1.0
2.0
<35" 35" 39"
Car
diov
ascu
lar
Dis
ease
Ris
ks (
RR
)
Waist Girth in Inches
The Lancet, Mar. 3, 2001
Men
90 cm 100 cm
© 2003, PrevMedix LLC
Waist Girth and Health Risk
1.00
1.56
3.16
0.0
1.0
2.0
3.0
<33" 33" 37"
Car
diov
ascu
lar
Dis
ease
Ris
ks (
RR
)
Waist Girth in Inches
Women
American Journal of Clinical Nutrition, Oct. 2002
83 cm 93 cm
© 2003, PrevMedix LLC
Waist Girth Action Steps Waist Girth Men Women Action <35” <33” Low risk. Maintain with healthy
eating and regular physical activity.
35” 33” Moderate risk. Warning! Limit future 90 cm 83 cm weight gain, eat more healthfully,
be more physically active.
39” + 37” + High risk. Risk reduction and weight loss 100 cm 93 cm necessary. Develop weight loss program,
diet and physical activity, with health professional’s guidance and support.
American Journal of Clinical Nutrition, Oct. 2002
© 2003, PrevMedix LLC
New Blood Pressure NormsNormal < 120/80
Prehypertension 120-139 / 80-89
High blood pressure 140/90+
Healthy People 2010 Leading Health Indicator
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
High blood pressure increases the risk for heart attack, angina, stroke, kidney failure and peripheral artery disease (PAD). High blood pressure may also increase the risk of developing fatty deposit in arteries (atherosclerosis). The risk of heart failure also increases due to the increased workload that high blood pressure places on the heart.
© 2003, PrevMedix LLC
Prevalence of High Blood Pressure
28.7 27.130.1 30.9
65.4
0
10
20
30
40
50
60
70
All adults Men Women Blacks Age 60+
BP 140/90+
Per
cent
(%
)
JAMA 290:199-206, Jul 9, 2003
© 2003, PrevMedix LLC
© 2003, PrevMedix LLC
Blood Pressure and Mortality
10.6 15.121.6
74.5
0
20
40
60
80
<120 120-139 140-159 160+
Mortality rate per 100,000
Source: The Framingham Heart Study, 1974
Systolic Blood Pressure
© 2003, PrevMedix LLC
Lowering Blood Pressure
• Achieve a healthy weight (BMI less than 25)
• Watch your diet
• Increase physical activity (30+ minutes most days)
• Don’t smoke
• Get adequate rest and relaxation
© 2003, PrevMedix LLC
Lifestyle Modifications to Lower Blood Pressure
1. Maintain a healthy weight- BMI less than 25, or
- Lose 10-15 pounds
- BP drops 5-20 points with 10 kg wt loss
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Lifestyle Modifications to Lower Blood Pressure
2. Follow the DASH diet eating plan - Eat an abundance of fruits and vegetables
- 8 to10 servings per day
- Use non or low fat dairy products - Include whole grains, nuts, and legumes - Limit foods high in saturated fat (e.g. meats, butter) - BP drops 8-14 points on the DASH diet
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
New Food Pyramid
© 2003, PrevMedix LLC
Lifestyle Modifications to Lower Blood Pressure
3. Reduce sodium intake - Eat less salt and salty foods
- Limit sodium intake to 2400 mg/day or less
- Limiting sodium reduces BP by 2-8 points
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Lifestyle Modifications to Lower Blood Pressure
4. Engage in regular aerobic physical activity - At least 30 minutes per day
- Most days of the week, daily when possible
- Moderate activities such as brisk walking
- BP drops 4-9 points with increased activity
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Introduce Concept
© 2003, PrevMedix LLC
Lifestyle Modifications to Lower Blood Pressure
5. Limit alcohol intake, if used at all - Alcohol raises blood pressure
- BP drops 2-4 points by limiting alcohol
JNC 7 Report, JAMA May 21, 2003
© 2003, PrevMedix LLC
Diabetes and Lifestyle
When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should, or both. This causes sugars to build up too high in your blood. Type 2 diabetes is the most common form. It appears most often in middle-aged adults; however, adolescents and young adults are developing type 2 diabetes at an alarming rate.
© 2003, PrevMedix LLC
Kenneth Cooper
© 2003, PrevMedix LLC
Weight Loss and Health Changes
• Lower blood pressure• Reduce high blood sugar • Reduce high triglycerides and cholesterol levels• Reduce sleep apnea or irregular breathing
during sleep• Decrease risk of osteoarthritis • Decrease depression• Improve appearance and self-esteem
Overweight people who lose 10 to 15 pounds may
© 2003, PrevMedix LLC
Practical Ways to Lose Weight
• Dieting is not recommended
• A change in lifestyle is necessary
• Make changes that you can do for the rest of your life
© 2003, PrevMedix LLC
Weight Loss Goals
• 1/2 to 1 pound weight loss per week
• Any faster and you may begin loosing your muscle
• Make body composition goals as well as weight loss goals
© 2003, PrevMedix LLC
Make a Commitment
Think about your goals and prepare to act • The goal
• The start date
• The timeline
• Your reward system
• Your support system
Health and Lifestyle Connection
Links to Heart Disease, High Blood Pressure and Diabetes