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Decreasing Risk of Developing Cardiovascular Disease

Decreasing Risk of Developing Cardiovascular Disease. Jill Birnbaum, State Advocacy Consultant, National Center, American Heart Association. A complete version of this update is available on our Web site, www.americanheart.org/statistics

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Decreasing Risk of Developing Cardiovascular Disease

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  1. Decreasing Risk of Developing Cardiovascular Disease Jill Birnbaum, State Advocacy Consultant, National Center, American Heart Association

  2. A complete version of this update is available on our Web site, www.americanheart.org/statistics Click on “Heart Disease and Stroke Statistics — 2006 Update”

  3. Risk Factors • Tobacco • High Blood Pressure • High Cholesterol • Physical Inactivity • Overweight and Obesity • Diabetes • Nutrition • Metabolic Syndrome

  4. Preventing Cardiovascular Disease Risk • Primary Prevention • Individual • Environmental • Secondary Prevention • Heart disease and stroke are disorders with complex etiologies and multiple risk factors, so a multifaceted approach to their prevention is crucial to success.

  5. Policy and Environmental Change • We need to create policy and environmental changes that will support behavior change and risk factor prevention and control. • To support behavior change, risk factor control, and uniform access to high quality health care, heart disease and stroke prevention programs must address policy, environmental, and systems-level changes in multiple settings.

  6. Preventing Cardiovascular Disease Risk • In direct contrast with conventional thinking, 80% to 90% of patients with coronary heart disease have at lease one conventional risk factor • Although research on nontraditional risk factors and genetic causes of heart disease is important, clinical medicine, public health policies, and research efforts must place significant emphasis on the four conventional risk factors and the lifestyle behaviors causing them to reduce the epidemic of coronary heart disease.

  7. Trends in Cardiovascular Risk Factors in the U.S. Population Aged 20-74 NHES: 1960-62, NHANES:1971-75 to 1999-2000 Source: JAMA 2005. 293: 1868-74.

  8. Tobacco • Mortality • From 1997–2001, an estimated 437,902 Americans died each year of smoking-related illnesses • 34.7 percent of these deaths were cardiovascular-related. • Cigarette smoking results in a two-to-three-fold risk of dying from CHD. • An estimated 35,052 nonsmokers die from CHD each year as a result of exposure to environmental tobacco smoke.

  9. Tobacco • Primary prevention goal • Complete cessation • No exposure to secondhand smoke

  10. Tobacco • Prevention • Individual • Stop smoking • Eliminate exposure to secondhand smoke • Environmental Change: • Increasing the price of cigarettes through tobacco tax increases • Establish smokefree workplace laws • Support tobacco control prevention and treatment programs

  11. Tobacco • The impact to CVD in the first year of making all workplaces smoke free: • 1540 myocardial infarctions and 360 strokes would be averted • Health care consumers would save $48.6 million in direct medical costs. • And, by year seven: • More than 6250 cumulative myocardial infarctions would have been averted. • More than 1270 strokes would have been averted. • Total averted medical costs of $280 million, of which $132 million (or 61%) are from former passive smokers.

  12. High Blood Pressure • Nearly one in three adults has HBP. • The prevalence of hypertension in blacks in the United States is among the highest in the world. • Listed as a primary or contributing cause of death in about 277,000 deaths in 2003. • The estimated direct and indirect cost for HBP in 2006 is $63.5 billion.

  13. High Blood Pressure • Primary prevention goal • Goal: <140/90 mm Hg; <130/85 mm Hg if renal insufficiency or heart failure is present; • Or <130/80 mm Hg if diabetes is present.

  14. High Blood Pressure • Promote healthy lifestyle modification • Advocate weight reduction • Reduction of sodium intake • Consumption of fruits, vegetables, and low-fat dairy products • Moderation of alcohol intake • Physical activity

  15. High Blood Cholesterol A fat-like substance found in animal tissue and carried in the blood. Dietary cholesterol is present only in foods from animal sources such as whole milk dairy products, meat, fish, poultry, animal fats and egg yolks. Build-up (plaque) in a blood vessel

  16. High Blood Cholesterol • Prevalence • About 10 percent of adolescents ages 12–19 have total cholesterol levels exceeding 200 mg/dL. • Almost 100 million American adults have total blood cholesterol above 200 mg/dL.

  17. High Blood Cholesterol • Prevention • Eat foods low in saturated fat, trans fat and cholesterol. • Lose weight if you need to. • Exercise for a total of at least 30 minutes on most or all days of the week. • Some people may also need to take medicine, because changing their diet isn't enough.

  18. High Blood Cholesterol • Aftermath • Less than half of persons who qualify for any kind of lipid-modifying treatment for CHD risk reduction are receiving it. • Less than half of even the highest-risk persons, those who have symptomatic CHD, are receiving lipid-lowering treatment • Only about a third of treated patients are achieving their LDL goal; less than 20 percent of CHD patients are at their LDL goal.

  19. Physical (In)Activity

  20. Physical Inactivity • Prevalence • 31.3 percent of U.S. adults age 18 and older engage in any regular leisure-time physical activity (PA). • The relative risk of CHD associated with physical inactivity ranges from 1.5 to 2.4, an increase in risk comparable to that observed for high blood cholesterol, high blood pressure or cigarette smoking.

  21. Physical Inactivity • Goal: At least 30 minutes of moderate-intensity physical activity for adults. • At least 60 minutes a day for children.

  22. Physical Inactivity • We cannot tell our citizens to walk and bike when there is no safe or welcoming place to pursue these activities that promote heart health. • Promoting healthy and walkable community environments is essential both for personal health and for the long-term health of our communities.

  23. Evidence Based Physical Inactivity Interventions • Support a comprehensive physical activity program in school • School-based physical education (the cornerstone) • Require 150 minutes per week of physical education in grades K-6. • Require 225 minutes per week of physical education in middle school. • Require physical education for graduation. • Do not allow waivers and substitutions for physical education. • Develop quality physical education standards at the state level. • Create PE Coordinators at the State Level • Federal – NCLB/ESEA Policy

  24. Evidence Based Physical Activity Interventions • Support a comprehensive physical activity program in school • Support Physical Activity Before, After, and During School – Support physical activity that is incorporated into the school day through elementary school recess, structured physical activity in classrooms, physical activity breaks, physical activity clubs, and special events. • Promote walk/bike to school programs and the use of safe, well-maintained and close-to-home sidewalks, bike paths, trails, and recreation facilities.

  25. Evidence Based Physical Inactivity Interventions • Community-wide campaigns, including point-of-decision prompts http://www.do-groove.com/

  26. Evidence Based Physical Activity Interventions • Creation of or enhanced access to places for physical activity combined with informational outreach activities • Street-scale urban design and land use policies and practices • Community-scale urban design and land use policies and practices

  27. Overweight and Obesity • Prevalence • An estimated 9.2 million children and adolescents ages 6–19 are considered overweight or obese. • Over 10 percent of preschool children ages 2–5 are overweight, up from 7 percent in 1994. • In 2003, an estimated 136,500,000 American adults were overweight, and 64,000,000 were obese. • Since 1993, the prevalence of those who are obese increased over 61 percent.

  28. Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  29. Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

  30. Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  31. (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. AdultsBRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20%

  32. (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Obesity Trends* Among U.S. AdultsBRFSS, 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  33. Obesity • Impact • Obesity was associated with nearly 112,000 excess deaths • Abdominal obesity is an independent risk factor for ischemic stroke in all racial and ethnic groups

  34. “the first generation where children will die before their parents” • International Congress on Obesity. August 2002 • Actually, 8 million children and adolescents are overweight • Over the last two decades the rates for overweight adolescents have tripled. • Based on current trends 1 in 3 children born in the year 2000 will develop Type II Diabetes. • A National Security Issue

  35. Obesity • Initiate weight-management program through caloric restriction and increased caloric expenditure as appropriate. • Many obese and overweight people may have difficulty losing weight, but by losing even as few as 10 pounds, you can lower your heart disease risk.

  36. The Search for Evidence Based Obesity Interventions • School-based interventions • Worksite interventions • Healthcare system interventions • Community-wide interventions

  37. Diabetes Mellitus • Prevalence • In 2003, the prevalence of physician-diagnosed diabetes was 14,100,000; the prevalence of undiagnosed diabetes was 6,000,000. • Since 1990, the prevalence of those diagnosed with diabetes increased 61 percent.

  38. Diabetes Mellitus • Mortality • At least 65 percent of people with diabetes mellitus die of some form of heart or blood vessel disease. • Heart disease death rates among adults with diabetes are two-to-four times higher than the rates for adults without diabetes.

  39. Diabetes Mellitus • First step is diet and exercise. • Second-step therapy is usually oral hypoglycemic drugs. • Third-step therapy is insulin.

  40. Nutrition • The Economic Research Service of the USDA suggests that the average daily calorie consumption in the United States increased by 12 percent between 1985 and 2000, or roughly 300 calories. • Between 1977 and 1996, portion sizes for key food groups grew markedly in the United States, not only at fast-food outlets but also in homes and at conventional restaurants.

  41. Nutrition • Impact • Each year over $33 billion in medical costs and $9 billion in lost productivity due to heart disease, cancer, stroke and diabetes are attributed to diet.

  42. Nutrition • Consumption of a variety of fruits, vegetables, grains, low-fat or nonfat dairy products, fish, legumes, poultry, and lean meats. • Match energy intake with energy needs and make appropriate changes to achieve weight loss when indicated. • Modify food choices to reduce saturated fats (<10% of calories), cholesterol (<300 mg/d), and trans-fatty acids by substituting grains and unsaturated fatty acids from fish, vegetables, legumes, and nuts. • Limit salt intake • Limit alcohol intake among those who drink.

  43. Evidence Based Nutrition Interventions • School-based nutrition programs; • Food and beverage advertising to children; and • Community approaches to increase fruit & vegetable intake

  44. Metabolic Syndrome • Metabolic syndrome (MetS) is characterized by a group of metabolic risk factors in one person. • The syndrome is associated with obesity and insulin resistance. • Metabolic syndrome is considered a clustering of metabolic complications of obesity.

  45. Metabolic Syndrome • An estimated 1 million 12–19-year-old adolescents in the United States have MetS, or 4.2 percent overall • An estimated 47 million U.S. residents have MetS. The age-adjusted prevalence of MetS for adults is 23.7 percent. • People with MetS are about two times more likely to have prevalent CHD than those without the syndrome after adjusting for established risk factors.

  46. Bottom Line • Primary prevention of CVD risk factors can help prevent 80 percent of coronary heart disease and 90 percent of type 2 diabetes

  47. Secondary Prevention of Cardiovascular Disease • There is a growing body of evidence confirms that aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves the quality of life • The secondary prevention patient population includes those with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease and carotid artery disease.

  48. Components of Secondary Prevention

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