Cardiovascular Disease and Cancer

1. Cardiovascular Disease and Cancer Chapter 12

2. Cardiovascular Disease (CVD) Leading cause of death in the U.S. Affects more than 81 million Americans Claims one life every 38 seconds, nearly 2300 Americans every day The high rate of CVD is primarily caused by Americans’ lifestyles © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 2 2

3. The Cardiovascular System • The Heart • Pulmonary circulation • Right side of the heart pumps blood to and from the lungs • Systemic circulation • Left side of the heart pumps blood through the rest of the body • Path of blood flow: • Venae Cavae • Right Atrium • Right Ventricle • Pulmonary Artery • To the lungs • Pulmonary Veins • Left Atrium • Left Ventricle • Aorta • Body’s largest artery © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 3 3

4. The Cardiovascular System The Heart Systole The period of the heart’s contraction Diastole The period of the heart’s relaxation © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 4 4

5. The Cardiovascular System • The Blood Vessels • Veins • Carry blood to the heart • Thin walls • Arteries • Carry blood away from the heart • Thick elastic walls which expand and relax with the volume of blood • Coronary arteries • One of the system of arteries branching from the aorta • Two large vessels that supply the heart muscle with oxygenated blood • Capillaries • Tiny vessels only one cell thick • Deliver oxygen and nutrient-rich blood to the tissues and pick up oxygen-poor, waste-laden blood which returns through a system of veins to the heart to repeat the cycle © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 5 5

6. Risk Factors for Cardiovascular Disease • Two categories of increased risk of CVD • Major risk factors • Contributing risk factors • Major risk factors that can be changed: • American Heart Association identifiedsix major risk factors for CVD that can be changed • Tobacco use • High blood pressure • High cholesterol • Physical inactivity • Obesity • Diabetes © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 6 6

7. Tobacco Use • 1 in 5 deaths is attributable to smoking • People who smoke a pack a day have twice the risk of a heart attack as nonsmokers • Smoking two or more packs a day triples risk • Heart attack victims who smoke are 2 to 3 more times likely to die from the attack • Smoking… • Damages the lining of arteries • Reduces HDL (good cholesterol) • Raises triglycerides and LDL (bad cholesterol) • Nicotine increases blood pressure and heart rate • CO displaces O2 • Causes platelets to become sticky, leading to clotting • Speeds the development of fatty deposits in the arteries • Doubles risk of stroke © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 7 7

8. High Blood Pressure • Hypertension • Too much pressure against arterial walls • Short periods of high blood pressure is normal but chronic high blood pressure is a health risk • Atherosclerosis • Causes arteries to become clogged and narrowed • 33% of Americans have high blood pressure, 22% of them aren’t aware of their condition • African Americans have the highest rate of hypertension – 41% © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 8 8

9. High Cholesterol • Cholesterol is a fatty, waxlike substance that circulates through the bloodstream • Important component of: • Cell membranes • Sex hormones • Vitamin D • Fluid that coats the lungs • Protective sheaths around nerves • Excessive cholesterol clogs the arteries • Increased risk of CVD • Good versus bad cholesterol • Low –density lipoproteins (LDL) • “Bad” cholesterol • Shuttle cholesterol from the liver to the organs and tissues • High-density lipoproteins (HDL) • “Good” cholesterol • Shuttle unused cholesterol back to the liver for recycling • Benefits of controlling cholesterol © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 9 9

10. Physical Inactivity • 40-60 million Americans are so sedentary that they are at high risk for developing CVD • Physical activity is closest thing we have to a magic bullet against heart disease • Exercise reduces risk by: • Decreasing blood pressure and resting heart rate • Increasing HDL levels • Maintaining weight • Improving the condition of blood vessels • Helping to prevent or control diabetes © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 10 10

11. Obesity Risk of death from CVD is two to three times more likely in obese people (BMI > 30) Strongly associated with: Hypertension High cholesterol levels Insulin resistance Diabetes Physical inactivity Increasing age Ventricular hypertrophy (enlargement of the heart) Failure of the heart muscle Even moderate weight reduction and moderate cardiorespiratory fitness can lower risk © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 11 11

12. Diabetes Doubles the risk of CVD for men Triples the risk of CVD for women Higher rates for other CVD risk factors: Hypertension Obesity Unhealthy blood lipid levels Damaged endothelial cells More vulnerable to atherosclerosis Increased risk of heart attack and strokes Even pre-diabetes increases risks © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 12 12

13. Contributing Risk Factors That Can Be Changed • High Triglyceride Levels • Reliable predictor of heart disease • Psychological and Social Factors • Stress • Chronic hostility and anger • Suppressing psychological distress • Depression • Anxiety • Social isolation • Low socioeconomic status • Alcohol and Drugs © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 13 13

14. Major Risk Factors That Can’t Be Changed • Heredity • CVD has genetic component which leads to increases in cholesterol levels, blood clotting and obesity • Risk is modifiable by lifestyle factors • Aging • Over the age of 65 • Being male • Men have higher risk earlier in life • Ethnicity • African Americans have higher risk of hypertension, heart disease, and stroke than other groups; Hispanics have a greater risk of HBP and angina than non-Hispanic whites; Asians have lower rates of CVD than whites • Inflammation and C-Reactive Protein • Caused by damaged arteries © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 14 14

15. Possible Risk Factors Currently Being Studied • Insulin resistance and metabolic syndrome • With weight gain and lack of activity, the body becomes less sensitive to insulin, causing insulin resistance (pre-diabetes) • Metabolic syndrome (or insulin resistance syndrome) is the term for a cluster of abnormalities • About 34% of American adults have metabolic syndrome • To reduce risk of metabolic syndrome, choose a healthy diet and get plenty of exercise, amount and type of carbohydrate intake matters • Homocysteine • Amino acid circulating in the blood • Appears to damage the lining of blood vessels, resulting in inflammation and the development of fatty deposits • Can lead to heart attacks, strokes, memory loss © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 15 15

16. Major Forms of Cardiovascular Disease • Atherosclerosis – Arteries become narrowed by deposits of fat, cholesterol, and other substances • Coronary arteries become blocked with plaque buildup: Coronary heart disease (CHD) or Coronary artery disease (CAD) • An artery in a limb becomes narrowed or blocked: Peripheral arterial disease (PAD) • Heart Attack – Coronary artery becomes blocked • Myocardial infarction (MI) © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 16 16

17. Heart Attack Symptoms Chest pain or pressure Arm, neck, or jaw pain Difficulty breathing Excessive sweating Nausea and vomiting Loss of consciousness 1/3 of victims don’t feel chest pain: especially women, ethnic minorities, older adults, and people with diabetes © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 17 17

18. Heart Disease and Heart Attack • Angina – Arteries are narrowed by disease but open enough to deliver blood under normal circumstances • During times of stress or exertion, heart doesn’t receive enough oxygen • Angina pectoris (chest pain) • Usually felt as an extreme tightness in the chest and heavy pressure behind the breastbone or in the shoulder, neck, arm, hand, or back • Arrhythmias and sudden cardiac death – Electrical conduction system is disrupted © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 18 18

19. Helping a Heart Attack Victim Most people who die from a heart attack expire within 2 hours of the onset of initial symptoms Victim should chew and swallow one adult aspirin Cardiopulmonary resuscitation (CPR) Refer to Box “What to Do in Case of a Heart Attack, Stroke, or Cardiac Arrest” © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 19 19

20. Detecting and Treating Heart Disease Electrocardiogram (ECG or EKG) Magnetic resonance imaging (MRI) Positron emission tomography (PET) Angiogram Balloon angioplasty Coronary bypass surgery © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 20 20

21. Stroke • Also called cerebro-vascular accident (CVA) • Ischemic stroke – blockage in a blood vessel • Thrombotic stroke: clot forms in a cerebral artery that has been narrowed or damaged by atherosclerosis • Embolic stroke - wandering blood clot, linked to atrial fibrillation • Hemorrhagic stroke – blood vessel ruptures in the brain • Intracerebral hemorrhage • Subarachnoid hemorrhage • Aneurysm © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 21 21

22. Figure 12.2 Types of stroke 22

23. The Effects of a Stroke • Interruption of the blood supply to any area of the brain prevents the nerve cells there from functioning – in some cases causing death • Those who survive a stroke usually have some lasting disability • Paralysis • Walking disability • Speech impairment • Memory loss • Changes in behavior © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 23 23

24. Detecting and Treating Stroke Prompt recognition of symptoms Sudden numbness or weakness of face, arm, leg or one side of the body Loss of speech or difficulty speaking Dizziness Symptoms may be brief and temporary © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 24 24

25. Detecting and Treating Stroke Transient ischemic attack (TIA) Temporary stroke-like symptoms Computed tomography (CT) MRI Ultrasound Clot-dissolving drugs Rehabilitation Nerve cells in the brain can make new pathways Some functions can be taken over by other parts of the brain © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 25 25

26. Congestive Heart Failure • Heart is damaged by high blood pressure or other disease conditions and cannot maintain regular pumping rate and force, causing fluids to back up into body tissue • Edema (swelling) in legs, ankles, other body parts • Pulmonary edema - Fluid accumulates in the lungs • Treatment: • Reducing cardiac workload • Modifying salt intake • Drug therapy to help the body eliminate excess fluid • Heart transplant © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 26 26

27. Other Forms of Heart Disease • Congenital Heart Defects • Malformation of the heart or major blood vessels • 36,000 children born each year in the U.S. with defects • About 3,600 deaths a year • Hypertrophic Cardiomyopathy (HCM) • 1 out of every 500 people • Most common cause of sudden death in athletes younger than 35 • Can be identified by a murmur • Rheumatic Heart Disease (RHD) • Untreated streptococcal throat infections can cause rheumatic fever which can permanently damage the heart muscle and valves • Strep throat needs to be treated, primary cause if not treated, up to 3% of infections progress into fever • Heart Valve Disorders • Congenital heart defects and certain types of infections • Mitral valve prolapse (MVP) – occurs in about 3% of the population © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 27 27

28. Protecting Yourself Against Cardiovascular Disease Eat heart-healthy diet Fat and cholesterol Total fats should be less than 30% of total calories Low intake of saturated fats Limit dietary cholesterol to less than 300 mg per day Fiber 25-38 grams of dietary fiber per day Sodium and potassium No more than 1500 mg sodium per day Increase potassium Alcohol © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 28 28

29. Other Dietary Factors Omega-3 fatty acids Plant stanols and sterols Folic acid Vitamins B-6 and B-12 Calcium Soy protein Healthy carbohydrates Total calories DASH diet Dietary Approaches to Stop Hypertension © 2012 McGraw-Hill Higher Education. All rights reserved. © 2012 McGraw-Hill Higher Education. All rights reserved. 29 29

30. Protecting Yourself Against Cardiovascular Disease Exercise regularly Avoid tobacco Know and manage your blood pressure Get it monitored at least once every 2 years Know and manage your cholesterol levels Get it checked at least once every 5 years Develop effective ways to handle stress and anger 30

31. What is Cancer? Cancer: An abnormal and uncontrolled multiplication of cells , which, if left untreated can lead to death Tumor: A mass of tissue that serves no physiological purpose Benign (non-cancerous) tumor: Mass of normal cells enclosed in a membrane that prevents their penetration of other tissues Malignant (cancerous) tumor: Can invade surrounding tissues, can spread via blood and lympatic circulation Every case of cancer begins as a change in a cell that allows the cell to grow and divide when it should not 31

32. Metastasis The spreading of cancer cells Primary tumor is original location of cancer Metastasizing – The traveling and seeding process of cancerous cells New tumors are called secondary tumors or metastases Can invade nearby tissue or spread to different parts of the body 32

33. Types of Cancer The behavior of tumors arising in different body organs is characteristic of the tissue of origin Classified according to types of cells that give rise to them Carcinomas Sarcomas Lymphomas Leukemias 33

34. The Incidence of Cancer 1.5 million Americans are diagnosed yearly American Cancer Society Estimates that the 5-year survival rate for all cancers diagnosed between 1995 and 2005 is 68% Nearly 1 in 2 men and more than 1 in 3 women will develop cancer during their lifetime 90% of skin cancer could have been prevented 87% of lung cancer could have been prevented Regular screening and self-examinations could save an additional 100,000 lives per year 34

35. Lung Cancer Most common cause of cancer death in the U.S. 157,000 deaths per year Risk factors Tobacco contributes to 30% of all cancer deaths and 90% of lung cancer deaths Detection Difficult to detect Symptoms do not usually appear until cancer has reached the invasive stage Persistent cough, chest pain, or recurring bronchitis Diagnosis: CT scan, chest x-ray, or sputum examination 35

36. Lung Cancer Treatment If caught early, can be treated with surgery Only 15% are detected prior to spreading Radiation and chemotherapy are used in addition to surgery Detected early, 53% of patients are alive 5 years post-diagnosis Overall, the 5-year survival rate is only 15% 36

37. Colon and Rectal Cancer • Third most common type of cancer • Risk factors • Directly linked to age, genetic predisposition, lifestyle habits, diet • 91% of cases occur after 50 years of age • Excessive alcohol use and smoking may increase risk • Obesity and diets rich in red and processed meats increases risk • Regular physical exercise and diets rich in fruits, vegetables, and whole grains may lower risk • Research mixed on high-fiber diets • Oral contraceptives and hormone replacement may increase risk in women • Detection and treatment • Regular screening • Surgery is primary treatment • Radiation and chemotherapy can be used • Survival 91% if detected early, 65% overall 37

38. Breast Cancer • Most common cancer in women • 1 in 8 American women will develop it during her lifetime • About 200,000 American women are diagnosed each year • 1 in 30 women will die from the disease • About 41,000 women die from it each year • Risk factors • Incidents rise quickly with age, about 50% occurring in women ages 45-65 • Genetic predisposition/family history • Early onset of menstruation • Late onset of menopause • Having first child after 30 • Having no children • Hormone replacement therapy • Estrogen connection • Obesity, diet, and alcohol use 38

39. Breast Cancer • Detection and Treatment • Early detection – cure most likely when cancer is detected early • Monthly breast self-exam for all women over 20 • Clinical breast exam by a physician every 3 years (every year for women over 40) • Mammography- Every 1 year for women over 40 • MRIs • Treatment • Ultrasonography • Biopsy • Lump found to be harmless growth in 90% of cases • Surgery: lumpectomy, mastectomy 39

40. Breast Cancer Survival rate 98% if the cells haven’t metastasized 90% for all stages at 5 years New strategies for treatment and prevention SERMs (tamoxifen, raloxifene) Monoclonal antibodies (trastuzumab): Antibodies designed to bind to specific cancer-related targets

41. Prostate Cancer • Most common cancer in men • Second leading cause of cancer death in men • Nearly 218,000 new cases per year • More than 32,000 deaths per year • Risk factors • Age • Genetic predisposition/family history • Diet • Lifestyle • History of STDs • Type 2 diabetes and insulin resistance • Detection • Prostate-specific antigen (PSA) blood test • Digital rectal examination • Yearly screening beginning between ages 40-50 • Treatment • Surgical removal of the prostate and radiation • Implantation of radioactive seeds • 5-year survival rate is nearly 100% 41

42. Cancers of the Female Reproductive Tract • Cervical cancer • Most cases stem from infection by the human papillomavirus (HPV)- transmitted by unprotected sex • Smoking, immunosuppression, and prolonged use of oral contraceptives may contribute to incidence • Cervical cancer is most common in women in their 20’s and 30’s • Prevention • The PAP test is a highly effective screening test for this cancer • All sexually active women ages 18-65 should be tested regularly • 2 HPV vaccines approved by FDA (Gardasil, Cervarix) 42

43. Cancers of the Female Reproductive Tract • Uterine, or Endometrial, Cancer • Normally occurs after the age 55 • Risk factors similar to breast cancer • Prolonged exposure to estrogen • Early menstruation • Late menopause • No pregnancies • Obesity • Type 2 diabetes • Treatment is surgery • Oftentimes by hysterectomy • Radiation, hormones, and chemotherapy may be used • 96% survivability after 5 years if detected early, less than 68% if cancer has spread 43

44. Ovarian Cancer Causes more deaths than cervical and uterine cancer combined, though it is rarer than both Difficult to detect and diagnose Often no warning signs Sometimes increased abdominal size and bloating, urinary urgency, and pelvic pain are early clues Often diagnosed too late Risk factors similar to breast cancer Age, no pregnancy, family history, obesity, genetic mutations, high number of ovulations during lifespan Treatment is surgical removal of the ovaries, the fallopian tubes, and the uterus Radiation and chemotherapy are sometimes used Cancers of the Female Reproductive Tract 44

45. Skin Cancer • Most common form of cancer • More than 1 million cases per year • Most are easily treated • 68,000 are melanoma • Most serious type of skin cancer • Risk factors • Excessive exposure to ultraviolet rays (UVA and UVB) • Common causes are sunburns and suntans (including those produced by sunlamps and tanning beds), especially severe sunburns in childhood • Risk doubles for those who’ve had 5 or more sunburns in their life • Caucasians are 10X more likely than African Americans to develop melanoma • Types of skin cancer • Basal cell carcinomas • Squamous cell carcinomas • Melanoma • Prevention • Avoid lifelong overexposure to sunlight • Use sunscreens and protective clothing • Detection and treatment • Examine your skin regularly – ABCD test • Check moles • Treatment usually surgical removal under local anesthetic 45

46. Figure 12.4 The ABCD test for melanoma 46

47. Other Cancers • Head and Neck Cancers • Cancers of the oral cavity, pharynx, larynx, and nasal cavity • Primarily caused by tobacco use and excessive alcohol consumption • Incidence 2x greater in men than in women • Chemotherapy, radiation, and surgery are primary methods of treatment • Can cause disfigurement, lead to other primary cancers of the head and neck • 61% survival rate after 5 years • Testicular Cancer • Rare • Most common in men ages 20-35 • Most common among white men and those with family history • Undescended testicles increase risk • Detection: self-exam • Treatment: surgical removal of testicle and possible chemotherapy 47

48. The Causes of Cancer • The Role of DNA • Certain genes may predispose some people to cancer • Specific genetic mutations (changes in the normal makeup of a gene) have been associated with cancer • Mutations can be inherited or caused by environmental agents • Tobacco Use • Responsible for 30% of all cancer deaths • Responsible for nearly 1 in 5 deaths, nearly 444,000 premature deaths each year • Direct cause of lung, bronchial, larynx, mouth, pharynx, esophagus, stomach, pancreas, kidney, bladder, and cervical cancers 48

49. Dietary Factors • Food choices affect your cancer risk by exposing you to potentially dangerous compounds and depriving you of protective compounds • Dietary fat and meat • Diets high in “bad” fats and meat may contribute to colon, stomach, and prostate cancers • Omega-3 fats are healthier for body • Alcohol • Risk of oral and breast cancer • Fried foods • Some contain Acrylamide, a probable carcinogen • Fruits and vegetables • Contain anti-cancer agents such as anticarcinogens, carotenoids, and phytochemicals • Inactivity and obesity linked to several cancers 49

50. Carcinogens in the Environment Ingested chemicals Nitrosamines: Nitrates and nitrites found in processed meats that combine with dietary substances and become highly potent carcinogens Salt and smoke-cured foods Environmental and industrial pollution Radiation 50