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Prevention & Control of Heart Disease
The Heart of Health
[Dr] Amzad AliEmail: ali.amzad@gmail.com
Skype: ali.amzad
Cell: +8801713 004696
What is Heart Disease?
A general term that covers a number of diseases which affect the heart, including coronary artery disease, heart-failure and angina.
Heart Disease is the number one killer in the United States and 2nd in Bangladesh.
Increasing in Bangladesh among all ages
Are You at Risk?
Classic cardiac risk factors:High blood pressure (even if treated)High cholesterolDiabetesSmokingFamily history of early heart diseaseAge > 55 for women, >45 for men but any
age can be affected ObesityLack of exercise and poor exercise toleranceChronic kidney disease
Category Risk Factors
Predisposing factors Age, sex, family history, genes
Risk-modifying behaviors Smoking, atherogenic diet, alcohol intake, physical activity
Metabolic risk factors Dyslipidemias, hypertension, obesity, diabetes, metabolic syndrome
Disease markers Calcium score, catheterization results, stress test results, left ventricular hypertrophy on echocardiogram, personal history of vascular disease, inflammatory state
Four Basic Categories of Risk Factors
Braunwald, 7th edition page 1058
Myocardial Infarction or
Heart Attack
Symptoms: uncomfortable pressure, fullness, squeezing pain, pain spreading to the shoulders, neck and arms.
Chest discomfort and light headedness Anxiety/nervousness Paleness or pallor Increased irregular heart rate
Cerebrovascular Accidentor
Stroke
Blood vessel in the brain becomes blocked by atherosclerosis- the tissue supplied by the artery dies.
Embolus – which is a traveling blood clot.
Symptoms of Stroke
Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
Sudden confusion, trouble speaking, or understanding.
Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance or
coordination. Sudden severe headache with no known cause. If you have any of these symptoms you need
immediate medical attention!
Unchangeable Risk Factors
Age- the older you get, the greater the chance. Sex- males have a greater rate even after women
pass menopause. Race- minorities have a greater chance. Family history- if family members have had CHD,
there is a greater chance. Personal Medical History- other diseases such as
Diabetes Mellitus can increase chances.
Changeable Risk Factors
Hypertension Serum cholesterol Obesity Diabetes Mellitus Physical Inactivity Cigarette Smoking Alcohol Intake
How can You Stop CVD?
Diet and Nutrition, there are several guidelines listed by the American Heart Association:
Eat a variety of fruits and vegetables every day. ( 5 servings - they are naturally low in fat and high in vitamins and minerals)
Eat a variety of grain products ( 6 a day)
Diet and Prevention of CVD
Choose nonfat or low-fat products. Use lean meats- choose chicken, fish, turkey
and lean cuts of beef and pork. Switch to fat-free milk- gradually reduce the
fat content of the milk you drink. Maintain a level of physical activity that keeps
you fit and matches the # of calories you eat. Balance the # of calories you eat with the
number of calories you use each day.
Exercise and CVD
Serves several functions in preventing and treating those at high risk.
Reduces incidence of obesity. Increases HDL Lowers LDL and total cholesterol Helps control diabetes and hypertension Those at high risk should take part in a
specially supervised program.
Cardiovascular Disease Prevention in Women
A five-step approachAssess and stratify women into high risk, at risk,
and optimal risk categories Lifestyle approaches recommended for all womenOther cardiovascular disease interventions:
treatment of HTN, DM, lipid abnormalitiesHighest priority is for interventions in high risk
patientsAvoid initiating therapies that have been shown to
lack benefit, or where risks outweigh benefits
Risk Stratification: High Risk
Diabetes mellitusDocumented atherosclerotic disease
Established coronary heart diseasePeripheral arterial diseaseCerebrovascular diseaseAbdominal aortic aneurysm
Includes many patients with chronic kidney disease, ObesityHypertensionSmoking Physical inactivity
Different levels of prevention
Prevention: strategies that prevent development of diseases or interrupt progression of disease
Primary prevention: reduce exposure or susceptibility – promote good health; sex education; protection
Secondary prevention: early detection and treatment, reduce risk (treat Sti’s)
IndividualBehaviour Change
Healthy eatingHealthy activityHealthy weight
Environmental Change
Complementary Approaches to Prevention
Modifiable Risk
General population
At-risk individuals
and groups
CVD patients
A FRAMEWORK FOR STRATEGIES
Prevent Modifiable Risk Variables
Prevent Recurrent
Events
End-stage
Acute Care
Population-wide strategies
Treat high risk not high risk factor levels
Implement proven treatments
Address Inequalities
Conclusion
Cardiovascular disease is the number one killer globally and 2nd in Bangladesh.
It is highly preventable and controllable with diet, exercise and reduction of risk factors.
Knowledge, attitude and practices developed in early age and act NOW
Good resource:www.americanheart.org
References
1. WHO. Tech. Report Series 137. WHO. 1952.2. WHO.Constitution Of World Health Organization. 1946.3. WHO. Role of Health sector in Food and Nutrition. Tech.
Report Series 137. Geneva. 1980.4. IGNOU. Concepts in Nursing. Available online at:
http://www.ignou.ac.in/edusat/BNS/BNS101-Blk2-3-4/Block1en/38-66color.pdf
5. WHO. Ageing and Health. A health promotion approach for developing countries. WHO, Regional Office for the Western Pacific United Nations Avenue.Manila, Philippines;2000.11-15.
6. Ghai OP, Gupta P. Essential Preventive Medicine. Vikas Publishing House Pvt Ltd. India;1999:23,817-819.
7. Park K. Park’s textbook of preventive and social medicine. 20th edition, 2013. Banarsidas Bhanot publishers, Jabalpur, India
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