Staying HealthyStaying Healthy

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

WRNMMC BethesdaWRNMMC Bethesda

The Key to Your HeartThe Key to Your Heart

DemographicsDemographics

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

population increase will be in the age 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, mental, spiritual and social well-being, and not merely the absence of disease or infirmity.

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

Reaching Your PotentialReaching Your Potential

Case PresentationCase Presentation

Mr. R is a 58 yr old WM who presents to his doctor for an annual check up.

He is overweight, has high BP, and abnormal cholesterol test (low HDL, high triglycerides).

Prescribed BP lowering medication and advised to lose weight.

Case PresentationCase Presentation

Three months later:Mr. R collapses at his deskParamedics respond quickly and find him in

cardiac arrestMultiple attempts at resuscitation in the office

and at the emergency room are unsuccessfulHe never recovers and is pronounced deadAutopsy shows a ruptured plaque and clot in

the main artery supplying blood to his heart

Major Causes of Death

A.A. Total CVD Total CVDB.B. Cancer CancerC.C. Accidents Accidents

D.D. Chronic Respiratory Diseases Chronic Respiratory DiseasesE.E. Diabetes Mellitus Diabetes MellitusF.F. Alzheimer’s Disease Alzheimer’s Disease

(United States: 2004). Source: NCHS and NHLBI.

Includes coronary heart disease, heart failure, stroke and hypertensionIncludes coronary heart disease, heart failure, stroke and hypertension

14.8

39.1

71.3

9.4

39.5

75.1 83.0

92.0

0

20

40

60

80

100

20-39 40-59 60-79 80+

Per

cent

of P

opul

atio

n

Males Females

Prevalence of Cardiovascular DiseasePrevalence of Cardiovascular Disease

(NHANES: 1999-2004). (NHANES: 1999-2004). Source: NCHS and NHLBI. Source: NCHS and NHLBI.

Includes MI and fatal CHD but not silent MI’sIncludes MI and fatal CHD but not silent MI’s

30000

265000

180000

290000

235000

9500095000

10000

0

50000

100000

150000

200000

250000

300000

350000

35-44 45-64 65-74 75+

Ages

New

an

d R

ecu

rren

t M

I o

r F

atal

CH

D

Men Women

Annual Number of U.S. Adults with Annual Number of U.S. Adults with Diagnosed Heart Attacks Diagnosed Heart Attacks

Cardiovascular DiseaseCardiovascular Disease

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

disease 25% adults experience sudden

death as first indication Coronary heart disease mortality

higher in women than men

Keep your heart healthy Keep your heart healthy

Cardiovascular DiseaseCardiovascular Disease

■ Coronary heart disease

■ Cerebrovascular disease

■ Peripheral vascular disease

■ Aortic atherosclerosis

Diagnostic CategoriesDiagnostic Categories

What is the connection?What is the connection?

AtherosclerosisAtherosclerosis

Contributes to: Heart attack Most strokes Peripheral Vascular

Disease Erectile Dysfunction

Coronary Heart DiseaseCoronary Heart Disease

Non-modifiable Age:

men >45

women >55 Gender / Ethnicity FH Early CAD:

men <55

women <65

Modifiable Tobacco Hypertension Dyslipidemia Abdominal obesity Diabetes Stress / Sleep Physical Activity

Cardiac Risk FactorsCardiac Risk Factors

Coronary Heart DiseaseCoronary Heart Disease

90% CHD events predicted by presence of risk factors

Assessment helps plan treatment

Can prevent onset, alter progression and prevent death

Intermediate risk may require additional testing

Cardiac Risk AssessmentCardiac Risk Assessment

Cardiac Risk ReductionCardiac Risk Reduction

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

Prevention is primary focus Focus on LIFESTYLE modification ?Role of aspirin, statins and fish oil

Primary vs Secondary PreventionPrimary vs Secondary Prevention

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

Cardiac Risk ReductionCardiac Risk Reduction

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

high cholesterol

Lifestyle ModificationsLifestyle Modifications

Cardiovascular FitnessCardiovascular Fitness

Exercise has protective effect

Impacts all other risk factors

Focus on aerobic activities

AHA recommends 150 minutes/week

Physical FitnessPhysical Fitness

Impact on Impact on improving performanceimproving performance sharpening attention and focussharpening attention and focus enhancing efficiencyenhancing efficiency reducing disease risk and morbidityreducing disease risk and morbidity improving recovery from injury improving recovery from injury

Health and PerformanceHealth and Performance

Sitting is the new smoking!!Sitting is the new smoking!!

Physical ActivityPhysical ActivityEndurance, Flexibility, Strength, AgilityEndurance, Flexibility, Strength, Agility

Aerobic exercise: 150 min / week

Diversify your workout Weight resistance Improve your flexibility Challenge your mobility

Concept of staying active

Tobacco AbuseTobacco Abuse

Leading preventable cause of all deaths

Increases CHD and all-cause mortality

Augments effects of other risk factors

Risk of heart disease falls rapidly after cessation

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

ObesityObesity

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

>25% = overweight, >30% = obese Increases all-cause and CHD

mortality Interacts with other risk factors Predisposes to sleep apnea

The Hard Cold FactsThe Hard Cold Facts

You only have to exercise on the days you eat!

Healthy EatingHealthy Eating

Practice moderation Eat breakfast Plan ahead and be consistent Avoid processed foods Be physically active Get enough sleep Do not allow a small weight

gain to become a BIGGER weight gain

Failing to Plan means Planning to Fail!Failing to Plan means Planning to Fail!

Healthy EatingHealthy Eating

6-9 servings of fruits and vegetables daily Grains and fiber High protein, low fat, low carbs Omega-3 fatty acids (fish) Portion control Poly or unsaturated fats Limit caffeine and alcohol Avoid fructose corn syrup

Balance, Moderation and VarietyBalance, Moderation and Variety

Coronary Heart DiseaseCoronary Heart Disease

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

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

risk assessment

Lipid DisordersLipid Disorders

Cardiovascular Drug TherapyCardiovascular Drug Therapy

Preventive vs Targeted Therapy Aggressive management of:

Known coronary heart disease Hypertension Hyperlipidemia Diabetes

Role of Aspirin Benefit of Alcohol Role of Statins

Tried and True Remedies

Alternative Drug TherapiesAlternative Drug Therapies

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

■ No evidence for CVR benefit with folate and B vitamins

■ No evidence for benefit with fish oil

■ Co-enzyme Q10 ■ Hawthorn 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!