How to Prevent Cardiovascular Diseases (CVD) - LiveLifeMore Best Diet & Wellness Clinic

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2. How to Prevent Cardiovascular Diseases (CVD)

3. Introduction • CVD is a major cause of morbidity and premature mortality throughout the world. • 80% of all CVD mortality is contributed from developing countries. • The underlying pathology is atherosclerosis, which develops over years and get manifested from middle age onwards. Atherosclerosis-Cholesterol and fat deposition in arterial wall. • Heart attack and strokes have high mortality, if a timely medical care is not given.

4. Indian Scenario • The burden of cardiovascular disease is rising in India. • The estimated prevalence • is 3-4% in rural areas • 8-10% in urban areas • About 30 million people were estimated to have coronary heart disease in India

5. Warning Signs of Heart Attacks • Chest discomfort, including squeezing or pain in the centre of the chest. • Discomfort and/or pain spreading to other areas of the upper body such as one or both arms, the back, neck, jaw or stomach. • Acute onset shortness of breath with or without chest discomfort.

6. Other Signs of Heart Attacks • Unexplained weakness or fatigue, anxiety or unusual nervousness, indigestion or gas-like pain, breaking out in a cold sweat, nausea, vomiting, light-headedness and collapse

7. Risk factors for CVD • Modifiable • Non-modifiable • Cigarette smoking • Hypertension • High cholesterol/low HDL • Diabetes mellitus • Physical inactivity • Obesity • Age • Sex • Post menopausal status • Family history of coronary artery disease

8. Major Risk Factors for CVD • Age (men 45 years; women 55 years) • Cigarette smoking • Hypertension (BP .140/90 mmHg or on antihypertensive medication) • Low HDL cholesterol (<40 mg/dL)t • Family history of premature CHD • CHD in male first degree relative <55 years • CHD in female first degree relative <65 years

9. HDL cholesterol ?60 mg/dL counts as a "negative" risk factor; its presence removes one risk factor from the total count. Once all risk factors have been identified, cardiovascular risk charts or calculator should be used to estimate the total risk of developing CVD over the following 10 years. A risk of <10% is mild, while >20% is high risk for CV events.

10. Prevention of CVD • In daily practice, prevention efforts are typically targeted at middle-aged or older individuals with: • Established CVD i.e. secondary prevention or • Those at high risk of developing a first cardiovascular event i.e., primary prevention.

11. Primary Prevention Recommendations • Goal is to motivate and assist high-risk individuals to lower their cardiovascular risk by: • Quitting tobacco use, or reducing the amount smoked, or not starting the habit. • Making healthy food choices; • Being physically active;Reducing body mass index (<25 kg/m2) and waist—hip ratio (< 0.8 women, <0.9 in men)

12. Lowering blood pressure (< 140/90 mmHg); • Lowering blood cholesterol (<190 mg/dl); • Lowering LDL-cholesterol (<130-160 mg/dl); • Controlling glycaemia, especially in those with impaired fasting glycaemia and impaired glucose tolerance or diabetes;

13. Prevention of AHA Guidelines for Primary Prevention of CVD and Stroke CVD • Beginning age 20: • Regularly assess family history, smoking status, diet, alcohol intake, and physical activity • BP, BMI, waist circumference, pulse assessed at last every 2 years; fasting lipid profile and glucose measured every 5 years (2 yrs if other risk factors present

14. Smoking Cessation • Increases risk by 2-3 fold • Smokers who quit reduce their excess risk by 50% in first 2-yrs. • Risk of former smokers approach that of non­smokers by 15 years • All nonsmokers should be encouraged not to start smoking. • All smokers should be strongly encouraged to quit smoking by a health professional and supported in their efforts to do so.

15. It is suggested that those who use other forms of tobacco be advised to stop. • Passive smoking should be curtailed. • Risk > 20% • Nicotine replacement therapy and/or nortriptyline or amfebutamone (bupropion) should be offered to motivated smokers who fail to quit with counselling.

16. ATP III Dietary Recommendations • NutrientRecommended Intake • Saturated fat* <7% of total calories • Polyunsaturated fat Up to 10% of total calories • Monounsaturated fat Up to 20% of total calories • Total fat 25%-35% of total calories • Carbohydrate (esp complex carbs) 50%-60% of total calories • Fiber 20-30 g/d • Protein -15% of total calories • Cholesterol <200 mg/d • *Trans fatty acids also raise LDL-C and should be kept at a low intake. • Note. Regarding total calories, balance energy intake and expenditure to maintain desirable body weight • Salt intake <5g/day, Fruit intake 200g/day, vegetables 200g/day) • AT [,MLA Treatment Panel] • Expert Panel on Detector Evelustan a. Treatment of High Blood Cholesterol ,n Adults JAMA 2001,285 2486,245,

17. Alcohol Consumption • Men who drink alcohol may consume up to 2 alcoholic beverages/day • Women no more than one/day, in part because of alcohol-related breast cancer risk. • Potential hazards: habituation to alcohol, adverse effects such as hepatotoxicity and aggravation of hypertriglyceridemia • Favorable benefit/risk ratio of other dietary practices and therapeutic interventions • Individuals should not begin to consume alcohol as a means of reducing coronary disease risk

18. Recommendation regarding exercise • All healthy adults should spend 30-45 minutes every day doing moderate to vigorous exercise, at least 5 days a week. • Sedentary individuals and those with heart problems should have graded, supervised exercise regimen. • Cycling, jogging, swimming, table tennis, badminton etc

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