Prevention of Ischemic Heart Disease: Risk Factor Control & Lifestyle Modification

1. World Heart Day: September – 2011Scientific seminarRisk factor control and life style modification for prevention of Ischemic Heart Disease Speaker: Chairperson: Dr. R. C. Debnath Dr. M. Saiful Bari Assistant professor Associate Professor & Head Department of cardiology Department of cardiology Mymensingh Medical college Mymensingh Medical college

4. Introduction:- Every year 17.1 million lives are claimed by the global burden of cardiovascular disease, with 82% of deaths occurring in low and middle income countries. This excessive number of death is particularly saddening, since through steps such as eating a healthy diet, regular physical activity and avoiding tobacco, the majority of these death could be prevented. Continue

5. Introduction (cont…) Over 70 % of all cardiac and breathing emergencies occur in the home when a family member is present and available to help a victim.

6. Risk factors for coronary Artery disease

7. Non modifiable risk factors (Non controllable) Heredity:- if parents / First degree relatives have heart disease or sudden cardiac death in early age Gender & Age:- Men > 45 years Women > 55years After menopause incidence of CAD is equal.

8. Modifiable risk factors(controllable) Smoking Hypertension Dyslipidemia Diabetes & Pre diabetes Over weight and obesity Physical inactivity Stress and Behavior Unhealthy diet Alcohol

9. Emerging risk factors C-reactive protein (CRP) Triglycerides Lipoprotein (a) Homocystine Thrombogenic /Haemostatic factor Impaired fasting blood glucose Ankle brachial index Carotid intima- media thickness Periodontal disease

10. Smoking Smoking has a particularly large impact in the third world. Persons who consume 20 or more cigarettes daily have a two to threefold increase in total coronary heart disease. Cigarette consumption directly relates to increase rates of sudden cardiac death, PVD, IHD, Ischemic CVD Smokers have 20-30% increased risk than non-smokers.

12. Smoking (cont..)* Smoking Increases level of oxidized LDL & reduces cardioprotective HDL * These effect is produced direct effect of carbon monoxides and nicotine* Impaired endothelium dependent coronary vasodilatation * Directly dysfunction of endothelial nitric oxide biosynthesis.

13. Smoking (cont)*Chronic smoking increases level of CRP, fibrinogen and homocystine level*Chronic smoking increases platelets aggregation.*Smokers have increase prevalence of coronary stenosis

14. Hypertension: (BP Control) Individual with Systolic BP 120-139 mmHg Diastolic BP 80-89 mmHg *Pre hypertension needs life style modification Goal:- <140/90 mmHg <130/85 mmHg (Renal failure) <130/80 mmHg (DM)

15. Dyslipidemia Improve cholesterol level, one healthy adult should be:- Goal:- Total cholesterol <200 mg/dl LDL <130 mg/dl HDL above 40 mg/dl (men) HDL above 50 mg/dl (women)

16. Diabetes & pre diabetesGoal: Fasting glucose <110 mg/dl HbA1c <7% * Patient with DM have high risk for coronary artery disease. * ATP III has designated DM as CHD risk equivalent * More over, many patients, with DM type-2 present with silent MI, silent ischemia and sudden cardiac death. * So DM should be properly control, by Diet, Exercise Weight Reduction & Appropriate Drugs.

17. Over weight and obesity:BMI= (Kg/m2) * Normal: 18-24.9 * Over weight: 25-29.9 * Obese: >30 * Increase risk for HTN, DM, Dyslipidemia * Increase risk for IHD, COPD & others chronic illness * Appropriate lifestyle modification by diet, exercise, best way to control weight gain. Source: over weight and obesity article

18. Over weight and obesity:BMI= (Kg/m2)

19. Lack of physical Activity

20. Lack of physical Activity *Inactive people are nearly twice as likely to develop CHD as those who are active. *A lack of physical activity can worsen other CHD risk factors. e.g. Increased cholesterol, TG, BP, DM, Pre diabetes, overweight & obesity. * It is important for children and adult to make physical activity part of their daily routines.

21. Lack of physical Activity (cont)*Many American’s are not active enough is because of hours spent in front of TV, and computers doing work, schoolwork and leisure activities. *Some Experts advise that children and teens should reduce screen time they recommended that children age 2 and older should spend no more than 2 hours a day watching TV or using computer (except school work) *Being physically active is one of the most important way to keep your heart healthy (Source:- 2008 physical activity guideline for Americans)

22. Unhealthy Diet

23. Unhealthy Diet * An unhealthy diet can raise your risk of CHD * Foods that are high in saturated and trans fat, and cholesterol raise LDL * Saturated fats are found in some meats, dairy products, chocolate, egg yolk, full cream milk, coconut oil, deep fried and processed foods

25. Life style modification: No Big Deal ! Unfortunately most of us live an unhealthy life. By adopting and practicing certain very simple and convenient day to day life style changes, we can lead a much better and healthier life

26. No Big Deal !

27. Life style changes includes Eating a healthy diet Regular physical activity Weight control Stop smoking

28. Healthy diet Cut salt:- Reduce dietary sodium intake not more than 100 mmol per day (2.4 gm sodium or 6 gm sodium chloride) High sodium intake increases BP. Avoid sugar:-Specially refined sugar (A form of carbohydrate).

29. Healthy diet (Continued) Diet:- American Guidelines for diet to reduce CHD risk. Reduced intake saturated fat <7% Poly unsaturated fat up to 10% Monounsaturated fat up to 20% of total calories. Total fat up to 25-35% of total calories

30. Healthy diet (Continued) • Carbohydrate 50-60% of total calories • Protein 15-25% of total calories. • Inclusion of plant stanols, and sterol, (Found fruits, vegetables, nut, cereals, vegetable oil, seeds) • Inclusion of 20-30 gm per day fiber (found oats, barley, soybean, citrus fruits)

31. Healthy diet

32. Recommended food Avoid saturated fat:- Such as animal fat, Ghee, egg yolks, coconut oil, full cream milk, butter, cheese, Fatty fish and meat. Should be taken:- Plant protein: pulses (dal) Animal protein: Low fat fish, meat, egg (Except yolk.)

33. Recommended food • Unsaturated fat: Sunflower oil, olive oil, mustard oil Milk: Non fat milk, non fat curd, non fat cheese • Take more vegetable and fruits (fruits should be taken 5 times in a day) • Early dinner:-Eat an early and light dinner. Almost an hour & half before bed time. To give ample time to our stomach for proper digestion of food. It is advisable to eat by end of the evening.

34. Exercise: (Physical activity) Should be Aerobic exercise At least 30 minutes of moderate intensity of physical activity on most (preferably all) days of the week. Moderate intensity of activities (40-60% of maximum capacity) are equivalent to brisk walking (15-20 min per mile)

35. Physical activity contd.. • Out door exercise : • Brisk walking • Swimming 20 minute • Jumping rope for 15 minute • Indoor exercise: • Playing single tennis • Stair climbing • Stationary bicycle • Tread mill

36. Physical activity contd..

37. Physical activity contd..

38. Physical activity contd..

39. World Heart Day 2011 key message and theme

40. One world Cardiovascular disease causes 29% of all death, globally each year. It’s the world number one killer Global leaders have recognized the urgency to control and prevent CVD with other non communicable disease It is important that efforts to fight CVD do not rest only with policy makers and global leaders. Individuals throughout the world can also reduce the CVD burden by learning about risk factors and taking vital step to reduce their own and their family’s risk.

41. One Home This year on world heart day, the world heart federation and its members challenge you to take charge of your family's heart health. To help you, the world heart federation identified four action you and your family can take Ban smoking from your home: Stop smoking tobacco in the home to improve your own and your children heart health. Implement a new rule in your home, for every cigarette smokers.

42. One Home (continue) 2. Stock your home with healthy food options: Start the day with a piece of fruits or prepare your own lunch at home. To ensure healthy options are taken. Make sure every evening contain at least two to three servings of vegetable per persons.

43. One Home (continued) • 3. Be active: • Families should limit the amount of time spent in front of the TV to less than two hours per day. • Organize outdoor activities for the family such as cycling, walking, playing in the garden. • When possible , instead of using the car, take your bicycle or walk from home to your destination.

44. One Home (continue) 4. Know your numbers: Visit a healthcare professional who can measure your blood pressure, cholesterol, and glucose levels, together with waist circumference and body mass index (BMI) Once you know your overall CAD risk, you can develop a specific plan of action to improve your heart health.

45. One Heart World heart day was created in 2000 to inform people around the globe that heart disease & stroke are leading cause of death, clamming 17.1 million lives each year. The world heart federation together with its members, spreads the news that at least 80% premature death, from heart disease and stroke could be avoided if main risk factors, tobacco, unhealthy diet and physical inactivity are controlled.

46. WORLD HEART DAY It is a national & International awareness day

48. Take care of your heart World Heart Day World Heart Day 29 September- 2011