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? What is Heart Disease?

Heart Disease- The Silent Killer

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

What Should I Eat?

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