Staying HealthyStaying Healthy

Kim F Gibson, MD, FACPKim F Gibson, MD, FACP

NNMC BethesdaNNMC Bethesda

The Key to Your HeartThe Key to Your Heart

DemographicsDemographics

Today 13% of Americans > 65 yrs oldToday 13% of Americans > 65 yrs old By 2030 22% will be older than 65By 2030 22% will be older than 65 Over the next decade the most rapid Over the next decade the most rapid

population increase will be in the population increase will be in the age group > 85 yrs oldage group > 85 yrs old MOST OF THOSE INDIVIDUALS MOST OF THOSE INDIVIDUALS

ARE WOMEN ARE WOMEN

Growing old is not for sissies!Growing old is not for sissies!

What is the Goal?What is the Goal?

Health is a state of complete physical, Health is a state of complete physical, mental, spiritual and social well-being, mental, spiritual and social well-being, and not merely the absence of disease and not merely the absence of disease or infirmity.or infirmity.

We must continuously improve our We must continuously improve our function, not simply delay “inevitable” function, not simply delay “inevitable” losses.losses.

Reaching Your PotentialReaching Your Potential

Top 10 Threats to Women’s Top 10 Threats to Women’s HealthHealth

1.1. Heart DiseaseHeart Disease

2.2. CancerCancer

3.3. StrokeStroke

4.4. COPD (chronic COPD (chronic lung disease)lung disease)

5.5. Alzheimer’s Alzheimer’s DiseaseDisease

6.6. InjuriesInjuries

7.7. Type II Diabetes Type II Diabetes

8.8. FluFlu

9.9. Kidney DiseaseKidney Disease

10.10. Blood Poisoning Blood Poisoning (Septicemia)(Septicemia)

Mayo Clinic Mayo Clinic

Top 10 Threats to Men’s Top 10 Threats to Men’s HealthHealth

1.1. Heart DiseaseHeart Disease

2.2. CancerCancer

3.3. InjuriesInjuries

4.4. StrokeStroke

5.5. COPD (chronic COPD (chronic pulmonary disease)pulmonary disease)

6.6. Type II DiabetesType II Diabetes

7.7. Flu Flu

8.8. SuicideSuicide

9.9. Kidney DiseaseKidney Disease

10.10. Alzheimer’s DiseaseAlzheimer’s Disease

Mayo Clinic Mayo Clinic

““Live sensibly – among 1000 people, only one dies a Live sensibly – among 1000 people, only one dies a natural death…”natural death…”

Where to Start?Where to Start?

Keep your heart Keep your heart healthyhealthy

Don’t smokeDon’t smoke Maintain weightMaintain weight Get restful sleepGet restful sleep Keep your bones Keep your bones

strongstrong

Foster sexualityFoster sexuality Stay current with Stay current with

health maintenancehealth maintenance Exercise your mindExercise your mind Be resilientBe resilient Fuel your spiritual Fuel your spiritual

growthgrowth

What is the goal?What is the goal?

Cardiovascular DiseaseCardiovascular Disease

Leading cause of death in women Leading cause of death in women and menand men 1 in 2 men have CV disease1 in 2 men have CV disease 1 in 3 women die of heart 1 in 3 women die of heart

diseasedisease 25% adults experience sudden 25% adults experience sudden

death as first indicationdeath as first indication Coronary heart disease mortality Coronary heart disease mortality

higher in women than menhigher in women than men

Keep your heart healthy Keep your heart healthy

Cardiovascular DiseaseCardiovascular Disease

■ Coronary heart Coronary heart diseasedisease

■ Cerebrovascular Cerebrovascular diseasedisease

■ Peripheral vascular Peripheral vascular diseasedisease

■ Aortic Aortic atherosclerosisatherosclerosis

Diagnostic CategoriesDiagnostic Categories

Coronary Heart DiseaseCoronary Heart Disease

Coronary Heart DiseaseCoronary Heart Disease

Non-modifiableNon-modifiable Age: Age:

(men >45 / women >55)(men >45 / women >55) GenderGender FH Early CAD FH Early CAD

(men >55 / women >65)(men >55 / women >65) Elevated CRPElevated CRP

ModifiableModifiable TobaccoTobacco HypertensionHypertension Total / LDL CholesterolTotal / LDL Cholesterol HDL CholesterolHDL Cholesterol DiabetesDiabetes Elevated BMIElevated BMI Physical InactivityPhysical Inactivity Atherogenic DietAtherogenic Diet

Cardiac Risk FactorsCardiac Risk Factors

Coronary Heart DiseaseCoronary Heart Disease

90% CHD events 90% CHD events predicted by predicted by presence of risk presence of risk factorsfactors

Framingham risk Framingham risk prediction prediction

Risk helps plan Risk helps plan treatment treatment

Intermediate risk Intermediate risk may require may require additional testingadditional testing

Cardiac Risk AssessmentCardiac Risk Assessment

Cardiac Risk ReductionCardiac Risk Reduction

CVD mortality has declined since 1975CVD mortality has declined since 1975 Earlier diagnosisEarlier diagnosis More aggressive treatmentMore aggressive treatment Reduction in risk factorsReduction in risk factors

Lowest risk category rareLowest risk category rare Focus on lifestyle modificationFocus on lifestyle modification Role of aspirin, statins and fish oilRole of aspirin, statins and fish oil

Primary PreventionPrimary Prevention

It’s never too late to start!It’s never too late to start!

Cardiac Risk ReductionCardiac Risk Reduction

SmokingSmoking DyslipidemiaDyslipidemia HypertensionHypertension DiabetesDiabetes Abdominal ObesityAbdominal Obesity

Psychosocial Psychosocial factorsfactors

Daily consumption Daily consumption of fruits / vegetablesof fruits / vegetables

Regular alcohol Regular alcohol intakeintake

Regular physical Regular physical activityactivity

Modifiable Risk FactorsModifiable Risk Factors

Cardiac Risk ReductionCardiac Risk Reduction

Exercise daily (150 min/week) Exercise daily (150 min/week) Don’t smokeDon’t smoke Weight maintenance Weight maintenance Mediterranean dietMediterranean diet Treat hypertension, diabetes, Treat hypertension, diabetes,

high cholesterolhigh cholesterol

Lifestyle ModificationsLifestyle Modifications

Cardiovascular FitnessCardiovascular Fitness

Exercise has Exercise has protective effectprotective effect

Impacts all other Impacts all other risk factorsrisk factors

Focus on aerobic Focus on aerobic activitiesactivities

AHA recommends AHA recommends 150 minutes/week150 minutes/week

Physical ActivityPhysical ActivityEndurance, Flexibility and StrengthEndurance, Flexibility and Strength

Aerobic exercise = 150 minutes / weekAerobic exercise = 150 minutes / week Diversify your workoutDiversify your workout

Importance of weight resistance Importance of weight resistance Improve your flexibilityImprove your flexibility

Concept of staying activeConcept of staying active

Tobacco AbuseTobacco Abuse

Leading preventable Leading preventable cause of all deathscause of all deaths

Increases CHD and Increases CHD and all-cause mortalityall-cause mortality

Augments effects of Augments effects of other risk factorsother risk factors

Risk of heart disease Risk of heart disease falls rapidly after falls rapidly after cessationcessation

Prevention is the key – STOP SMOKINGPrevention is the key – STOP SMOKING

ObesityObesity

65% adults overweight or obese65% adults overweight or obese BMI based on height and weightBMI based on height and weight

>30% = overweight, >35% = obese>30% = overweight, >35% = obese Increases all-cause and CHD Increases all-cause and CHD

mortalitymortality Interacts with other risk factorsInteracts with other risk factors Predisposes to sleep apneaPredisposes to sleep apnea Critical role of exerciseCritical role of exercise

The Hard Cold FactsThe Hard Cold Facts

You only have to exercise on the days you eat!

Healthy EatingHealthy Eating

6-9 servings of fruits and vegetables daily6-9 servings of fruits and vegetables daily Grains and fiber Grains and fiber High protein, low fat, low carbsHigh protein, low fat, low carbs Omega-3 fatty acids (fish)Omega-3 fatty acids (fish) Portion control Portion control Low salt or sugarLow salt or sugar Limit caffeine and alcoholLimit caffeine and alcohol Avoid processed foodsAvoid processed foods

Balance, Moderation and VarietyBalance, Moderation and Variety

Coronary Heart DiseaseCoronary Heart Disease

Lipid profile measures:Lipid profile measures: Total cholesterolTotal cholesterol HDL cholesterolHDL cholesterol LDL cholesterolLDL cholesterol Triglycerides (TG)Triglycerides (TG)

Strong genetic componentStrong genetic component Significant impact on risk of CHDSignificant impact on risk of CHD Treatment goals influenced by age, sex and Treatment goals influenced by age, sex and

risk assessmentrisk assessment

Lipid DisordersLipid Disorders

Cardiovascular Drug TherapyCardiovascular Drug Therapy

Preventive vs Targeted TherapyPreventive vs Targeted Therapy Aggressive management of:Aggressive management of:

Known coronary heart diseaseKnown coronary heart disease HypertensionHypertension HyperlipidemiaHyperlipidemia DiabetesDiabetes

Role of Aspirin in primary preventionRole of Aspirin in primary prevention Benefit of AlcoholBenefit of Alcohol Fish Oil supplementationFish Oil supplementation

Tried and True Remedies

Alternative Drug TherapiesAlternative Drug Therapies

■ No evidence for No evidence for CVR benefit with CVR benefit with vitamin C, E, beta-vitamin C, E, beta-carotenecarotene

■ No evidence for No evidence for CVR benefit with CVR benefit with folate and B folate and B vitamins vitamins

■ Co-enzyme Q10 Co-enzyme Q10 ■ Hawthorn extractHawthorn extract

Evidence Pending…

Prevention StrategiesPrevention Strategies

■ Educate yourself Educate yourself ■ Know your risk factorsKnow your risk factors■ STOP smoking!!STOP smoking!!■ Exercise 150min/weekExercise 150min/week■ Modify dietModify diet■ Seek treatment for high Seek treatment for high

BP, high cholesterol BP, high cholesterol and diabetesand diabetes

■ Listen to warning signsListen to warning signs

Keep your heart healthy!