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Know Your Heart!

Know Your Heart!. Noa Holoshitz, MD, FACC Columbia St. Mary’s Cardiovascular Specialists. The numbers. Heart disease is the number 1 cause of death in the US Approximately 1 in every 3 Americans will die from cardiovascular disease.

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Know Your Heart!

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  1. Know Your Heart! Noa Holoshitz, MD, FACC Columbia St. Mary’s Cardiovascular Specialists

  2. The numbers • Heart disease is the number 1 cause of death in the US • Approximately 1 in every 3 Americans will die from cardiovascular disease. • Cardiovascular disease claims more lives than all forms of cancer combined • Coronary artery disease is the most common type of cardiovascular disease, killing nearly 380,000 people annually

  3. In the US, someone has a heart attack every 34 seconds. • Every 60 seconds someone in the US dies from a heart disease related event

  4. What does coronary disease look like?

  5. When we are healthy, the walls of our blood vessels are thin and smooth Cholesterol, fat, and other substances build up in the walls and form blockages When blockages become big enough, they prevent the heart muscle from getting the nutrients it needs

  6. Atherosclerosis

  7. What is a heart attack? • Lack of blood flow to the heart muscle • Either from severe narrowing, unable to meet increased demand of the heart during period of physical activity or stress • Or blood clot formation in the artery at the site of atherosclerosis causing sudden complete blockage of blood flow • Can lead to heart muscle damage, irregular and life threatening heart rhythms and death

  8. What can I do? • The longer you are exposed to risk factors, the more severe the disease will become. • If you can alter or even remove these risk factors early enough, then you decrease your lifetime risk of developing heart disease.

  9. Preventable/Modifiable Risk Factors • Obesity/Overweight • Metabolic Syndrome • Diabetes • Sleep apnea • High blood pressure • Abnormal cholesterol

  10. Preventable/Modifiable Risk Factors • Poor diet • Sedentary lifestyle • Stress • Tobacco abuse • Illicit drug use

  11. Non-Modifiable Risk Factors • Age • Gender • Ethnicity • Family History

  12. High Blood Pressure • High blood pressure is the leading cause of stroke • The recommended goal for most people is less than 140/90 • Achieved by: • Lifestyle • Diet • Exercise • Salt avoidance • Medications

  13. Cholesterol: Know your numbers!

  14. Metabolic Syndrome:A High Risk Condition • A form of pre-diabetes • Your body doesn’t process sugars and fats appropriately or efficiently • Identified by a clustering of high-risk features • Chances of dying from heart disease are 5 times higher!

  15. The Metabolic Syndrome If you have 3 or more of the following: Central adiposity Waist > 35 in. High triglycerides ≥ 150* Low HDL (“good”) cholesterol < 50* Elevated Blood Pressure ≥ 130/85* Fasting blood sugar ≥ 100*

  16. Assessing Your Risk • Medical History • Family History • Physical Examination • Blood pressure, weight, etc. • Routine Lab Data • Symptoms

  17. Can I Find Out More About My Risk? • Advanced Imaging Tests • “Heart Scan” • Can find disease before you have symptoms • Advanced blood testing • Cholesterol particle size • hsCRP/CardioCRP • Protein found in the blood that is a marker for injury, infection, or inflammation. • Lp(a) • Homocysteine

  18. What to do to reduce risk factors? • Education • Dietary Changes • Increased Physical Activity • Resources/Support • Supplements • Prescription Medications

  19. Mediterranean Diet

  20. Plant-Based Foods should make up the majority of your diet • Vegetables • Fruits • Beans/Peas/Lentils/Soybeans • Whole Grains • Nuts

  21. Plant-Based Foods should make up the majority of your diet • Why? • Low calorie • Rich in nutrients • Anti-oxidants • Minerals • Vitamins • Fiber • Low glycemic index/load

  22. Anti-oxidants fight inflammationChoose a Diet Full of Color! Plums, prunes, red grapes, raisins Blueberries, beets Strawberries, raspberries, cherries Oranges Carrots, winter squash, papaya Spinach, lettuce, celery, zucchini Brussels sprouts, broccoli florets, kale Red bell peppers Tomatoes, watermelon Onion, garlic, cauliflower Eggplant

  23. Fiber protects your heart • 30 grams of fiber per day lowers LDL cholesterol • Try filling half your plate with fruits and vegetables • Beans, peas and lentils have the most fiber of any whole foods • Foods rich in soluble fiber also have magnesium and potassium, which lower blood pressure.

  24. Whole Grains are a GREAT Source of Fiber • Help improve: • Cholesterol • Blood sugar levels • Blood pressure • Weight • Includes whole wheat bread, oatmeal, barley, quinoa, & corn

  25. Limit Refined Starches/Sugars Avoid sugary drinks sodas, sweet coffees & teas, lemonade, juices Refined starches and sugars raise triglycerides, small LDL particles & weight White Flour White Bread White Rice White Pasta/Noodles Limit starchy foods to palm or fist-size serving

  26. Choose “Smart” Carbs Instead • Choose lower glycemic-load carbs • High in Fiber • Natural • Examples: • Beans • Peas • Lentils • Fruit • Vegetables • Dairy: milk, yogurt

  27. Goals to Consider • Vegetables (other than potatoes) • 2½ cups or more a day • Fruit • 2 or more servings a day • Whole grains (bran cereal, oatmeal, whole-grain crackers, dark breads, brown rice, other grains, popcorn) • 3 or more servings a day • Legumes (peas, beans, lentils or soy) • 2 or more servings a week

  28. Try to increase your intake of “healthy” fats • And decrease your intake of “unhealthy” fats…

  29. Healthy Fats:Monounsaturated Fats • Protect your heart • May modestly help blood sugar • Olive oil, avocados, nuts • walnuts, almonds, peanuts, macadamia, pistachios, and pecans • Eating an ounce (handful) of raw or dry roasted nutsmost days can lower LDL by 6 to 29%

  30. Goals to Consider • 2 or more servings per week of peanut butter, almonds or other nuts or seeds • Consume more unsaturated fats-canola & olive oil

  31. Limit Unhealthy Fats • Consume less saturated fat • Red Meat • Cheese • Butter • Shortening • Sour cream • Creamy dressings • Consume less Trans Fat • Processed foods • Packaged baked products

  32. Artery-Clogging Fats • Decreasing trans fats, saturated fat and cholesterol can reduce LDL cholesterol • Limit fatty beef, pork, sausage, and full-fat dairy products, butter, lard and coconut oil.

  33. Limit trans fats • Avoid stick-type margarines, fried foods, doughnuts, etc., that have “partially hydrogenated” ingredients a.k.a. (trans fats)

  34. Lean proteins • Try more fish, chicken & vegetarian entrées • Soy foods have high-quality protein that reduces LDL (tofu, tempeh, soy milk, veggie burgers)

  35. Goals to Consider • Limiting red or processed meat (Hot dogs, deli meat, bacon, sausage, hamburger, beef, pork )—to fewer than 2 servings a week • Bonus points for eating foods that are baked, grilled or steamed • Limit saturated fats to 15 gm per day

  36. Watch the Salt Please! • Limit sodium to lower blood pressure • 1,500 milligrams sodium for most Americans • Fresh fruits, vegetables, fish, poultry and meats are naturally low sodium • Processed, restaurant & fast foods are high in sodium • Season with herb blends, garlic, lemon juice, curry powder

  37. Your Activity Level • Activity levels predict and prevent heart disease… …better strategy than focusing on weight • It’s all about your Activity Level!

  38. Where do I begin? • Wear a pedometer! • Determine your baseline by wearing the pedometer for one full week without altering your typical routine • Wear on waist band centered above knee • Alternative site is in the middle of your back on waist band • Fitbit, Jawbone etc

  39. Using a Pedometer • For most healthy adults, 10,000 steps per day is a reasonable goal. • Try to increase your activity by 500 steps per day every week until you reach your goal. • Steps per day • <5,000 Sedentary • 5,000 - 7,499 Low Active • 7,500 - 9,999 Somewhat Active • 10,000 - 12,500 Active • >12,500 Highly Active • There are about 2,000 steps in a mile.

  40. Easy Ways to Increase Physical Activity • Take the stairs instead of the elevator • Get dropped off a few bus stops earlier and walk • Walk a few laps in the mall or store before you start to shop • Park farther away in the parking lot • Walk to talk to the person instead of emailing • Take a bike ride or play sports with the children or grandchildren • Go for a walk while waiting during soccer/music lessons • Leave the remote at the TV or telephone on the base • March in place while on the phone or during TV commercials • Add in more scheduled, planned exercise sessions

  41. Benefits of Exercise • Moderate increase in HDL-C (30 minutes of exercise most days of the week can raise HDL-C levels by 3-6 mg/dl) • Decrease in total cholesterol and LDL (bad cholesterol) • Increase in muscle strength • Increase in flexibility • Decrease in metabolic syndrome risk factors • Increase energy levels and self-esteem • Helps prevent osteoporosis • Helps prevent back pain • May prevent some cancers including colon and breast

  42. Physical Activity Guidelines from the American College of Sports Medicine and the American Heart Association • Perform moderate-intensity physical activity for a minimum of 30 - 60 min on 6-7 days/week • If you can’t get 30 minutes all at once try shorter periods of time multiple times during the day. Some studies have shown 10minute intervals of exercise multiple times during the day receive healthy benefits also.

  43. More Is Not Always Better! • Start out slow and gradually increase the time before the intensity of any activity you start. • Results from the Stride Study- High vigorous or intensity had an increase risk of muscular skeletal injuries and decreased compliance rate due to the injuries

  44. Warning signs to stop exercising • Exertional (with activity) chest pressure or heaviness • Pain/discomfort in other areas of upper body • Extreme shortness of breath • Associated symptoms are cold sweats, nausea & lightheadedness • If these symptoms do not resolve in 10 minutes, call 911. • Be sure to notify your health care provider if you are having these symptoms even if they go away when you stop exercising.

  45. Increasing your activity by 2000 steps per day! • 2000 extra steps a day =~100kcal/day x 365 days/year = 36,500 kcal/year =~10 lbs fat/year

  46. Medications • Being on medications does NOTmean: • You failed in your attempts to live a healthy lifestyle. • Sometimes diet and physical activity are just not enough • But they also have other benefits • That you aren’t doing it “the natural way” • You can stop making healthy lifestyle choices • They are not a “magic cure.”

  47. A word about statins • One of the most widely studied classes of medications • One of the most widely prescribed • More than 25% of Americans over the age of 40 • 60% of cardiologists! • Do more than lowering cholesterol, may even be recommended in people with “normal” cholesterol who have a lot of risk factors • Can prevent future heart attacks • They are safe! No longer recommended to check routine liver tests while on them • 90% of people can find a statin they can tolerate without any side effects

  48. Questions??

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