Nevada Department of Corrections

1. Nevada Department of Corrections NDOC Wellness Refresher Training

2. Heart Lung Program • What is the Heart Lung Program? • Who is Covered? • Conclusive Presumption • Predisposing Factors • Lifetime Medical Benefits • NRS Statute • Pursuant to NRS § 617.455-457, Sub. 6. Failure to correct predisposing conditions which lead to heart or lung disease when so ordered in writing by the examining physician subsequent to annual examinations excludes the employee from benefits of this section if the correction is within the ability of the employee. • New Additions to Yearly Physicals • BMI plus Waist measurement • Cholesterol • LDL – If there is a family history of heart disease – target LDL<100 • Follow up with Primary Care Physician is now included on the report of results

3. Heart Disease Risk Factors • Risk factors are those behaviors that can cause the development of heart disease • Risk factors can cause damage in the lining of the arteries – this is important in the development of plaque • The function of the coronary arteries is to supply the heart with oxygen. Built up plaque eventually ruptures followed by the formation of a blood clot leading to a blocked artery or heart attack.

4. 7 Primary Risk Factors of Heart Disease • Abnormal Blood Cholesterol • Cholesterol is a fat like substance used for bodily functions such as cell and hormone production. • Cholesterol is made in the liver and obtained from diet. The liver typically makes all the necessary cholesterol. • (HDL) High density lipoprotein is the “good” cholesterol responsible for “cleaning out” arteries. LDL or low density lipoprotein is known as the “bad” cholesterol, which is responsible for blocking arteries. LDL is a major component of plaque. • An HDL value <40 is a high risk value. An HDL of 60mg/dl or higher is considered protective against heart disease. • Genetics, diet, physical activity, body fat %, stress, age and gender are all factors that determine blood cholesterol levels.

5. Lifestyle Factors Can Affect Cholesterol Levels Factors that increase HDL cholesterol • Increase activity levels • Decrease body fat • Quit smoking • Increase monounsaturated and polyunsaturated fat intake • Reduce simple and refined carbohydrates Factors that Decrease LDL Levels • Increase activity levels • Decrease saturated fat intake • Increase fiber intake • Decrease body fat % • Practice stress management • Control diabetes

6. Foods That Fight Cholesterol • Almonds • Studies have found that eating just a quarter cup of almonds a day can lower your LDL by 4.4 percent • Oatmeal • Reduction in cholesterol are due to the high levels of soluble fiber found in oatmeal • Fish • Omega 3 fatty acids are widely considered to be the best of the “good” fats (you can also use flaxseed fish oil supplements and walnuts • Red Wine • A glass of red wine, which contains flavanols, has been shown to have anti-inflammatory properties that may help lower cholesterol and stave off heart disease. • Men – 2 drinks/day • Women – 1 drink/day

7. Foods That Feed Cholesterol • Whole Milk Dairy Products • Saturated fat, which clogs arteries and increases LDL levels, is the No. 1 cholesterol-boosting culprit. Foods like ice cream and cheese are where you’re likely to find them. • Processed Meats • Bacon, sausage, liverwurst and the like are sources of artery-clogging saturated fat. Look for lower-fat options, like bacon and sausage made from turkey and other lean protein sources • Fast Food • Even worse than saturated fats are trans fats. The main source of trans fats are partially hydrogenated oils - exactly what most fast-food restaurants are using to cook. Trans fats raise your LDL and simultaneously lower your HDL. • Tropical Oils • Palm kernel and coconut oils are two of the fattiest of oils. Use olive oil instead • Baked Goods • All baked goods—even those that are homemade—are high in saturated fats, thanks to the butter and shortening. Eat high-fat baked goods occasionally, opting more often for low-fat sweets like sorbets.

8. 7 Primary Risk Factors of Heart Disease 2. Hypertension • High blood pressure • Blood pressure (BP) is the force of blood against the walls of arteries during the contraction of the heart. Blood pressure is recorded as two numbers—the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats). • Causes • Narrowing of the arteries • Greater than normal volume of blood • Most of the time the cause is not known • High blood pressure usually cannot be cured, in most cases it can be prevented and controlled • Others at risk for developing high blood pressure are the overweight, those with a family history of high blood pressure, and those with pre-hypertension

9. 7 Primary Risk Factors of Heart Disease Preventing Hypertension • Maintain a Healthy Weight • Be Physically Active • Follow a Healthy Eating Plan • Reduce Sodium in Your Diet • Drink Alcohol in Moderation • Take Prescribed Drugs as Directed

10. 7 Primary Risk Factors of Heart Disease 3.Tobacco Use • Smoking and tobacco use in general is a major risk to an individual’s health. • Harms nearly every organ in your body • Tobacco use also increases risk for: CHD, stomach cancer, lip and throat cancer, emphysema, pancreatic cancer and chronic pulmonary disease.

11. 7 Primary Risk Factors of Heart Disease 4. Diabetes • Diabetes is a disease in which the body does not produce or properly use insulin. • Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. • The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play major roles. • Type 1 diabetes: is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the pancreas no longer makes insulin because the body's immune system has attacked and destroyed them. • Type 2 diabetes: is the most common form of diabetes. People can develop type 2 diabetes at any age -- even during childhood. In type 2 diabetes, the pancreas does not make enough insulin, and the fat, muscle, or liver cells do not use it properly.

12. 7 Primary Risk Factors of Heart Disease 5. Family History There is a strong genetic link to CHD. If you have an immediate male blood relative with a history of CHD, or bypass surgery prior to the age of 55, or a female blood relative with a history of CHD prior to the age of 65, you may be at an increased risk.

13. 7 Primary Risk Factors of Heart Disease 6. Sedentary Lifestyle • Sedentary individuals can be described as those who do not participate in meeting minimum physical activity requirement. • Low fitness has been shown to be as important a predictor of premature mortality as tobacco use, high BP, or abnormal cholesterol levels.

14. 7 Primary Risk Factors of Heart Disease 7. Obesity Currently 65% of American adults (and 15% of children) are classified as obese or overweight. These statistics have been determined by using a calculation called BMI (body mass index).

15. 7 Primary Risk Factors of Heart Disease Why Is a Healthy Weight Important? If you are overweight or obese you are at risk of developing the following diseases: • High BP • High Cholesterol • Type two Diabetes • Coronary Heart Disease • Stroke • Gallbladder Disease • Arthritis • Sleep apnea • Some cancers (breast, prostate, colon)

16. Risk Factors for Heart Disease As you review the major (and contributing) risk factors, it should be clear that with the exception of family history (genetics) all other risk factors can be controlled though lifestyle choices. In many instances; coronary heart disease is a disease of choice. It is widely accepted in the medical field that a large number of heart attacks that occur yearly could be prevented (or at the very least delayed) should individuals develop healthy lifestyles. Major risk factors are responsible for approximately 85% of all coronary events.

17. PPO/HPN/HMO Wellness Services PPO • The PPO Wellness benefit provides a $2500 (per person, per plan year) benefit to participants and their covered dependent. The services for preventive care are not subject to co-payment or deductible. Services provided include (but are not limited to): • Hypertension Screening • Tobacco Cessation programs • Stress management Programs • Weight Loss Programs (medically supervised) • Prostate screening • Well-Child Examinations • Contact Information: Health Benefit Planners 877-963-8232

18. PPO/HPN/HMO Wellness Services HPN – Health Plan of Nevada • Education is an important part of preventive health. Health Plan of Nevada provides programs dedicated to promoting lifelong wellness. The Health Education and Wellness Division offers a variety of health education classes and disease management programs. • Programs and resources include, but are not limited to: • Diabetes – The Balancing Act • The Balancing Act is designed to provide you with basic knowledge of preventive care; healthy food and activity choices; and stress management techniques • Heart Health – Blood Pressure Cholesterol and Triglycerides • This program is designed to help you keep your heart health in control by reducing your weight, exercising, eating from a balanced food plan. • Weight Management • Develop a personal plan to make positive changes in your eating and exercise habits to achieve healthy and permanent weight loss. Contact Information – 702-877-5356 or 800-7207253

19. PPO/HPN/HMO Wellness Services HMO • Preventive Services provided through Blue Advantage from HMO Nevada Plan • Services include • Physical Exams • Gynecological exams • Vision and Hearing Exams • Well Baby/Well child care

20. Resources Heart Disease Risk Assessment This tool will help you assess your risk of having a heart attack or dying from coronary heart disease in the next 10 years.  It will also check to see if you may have metabolic syndrome, a group of risk factors that greatly increase your chances of developing cardiovascular disease, including stroke and diabetes.   After you have finished using the tool, you can print a copy of your risk assessment results, risk factor summary report, metabolic syndrome assessment and action plans for those areas you need to work on in order to reduce your risk. http://www.americanheart.org/presenter.jhtml?identifier=3003499

21. Resources Health Finder • Healthfinder.gov is a Web site for consumers, developed by the U.S. Department of Health and Human Services together with other Federal agencies.  Since 1997, healthfinder.gov has been recognized as a key resource for finding the best government and nonprofit health and human services information on the Internet.  Healthfinder.gov links to carefully selected information and Web sites from over 1,500 health-related organizations.    http://www.healthfinder.gov/

22. Resources American Heart Association • The mission of the American Heart association is to build healthier lives, free of cardiovascular diseases and stroke. That single purpose drives all they do. The need for their work is beyond question and their resources are available to you! The American Heart Association contains information about specific conditions and lifestyle improvement. http://www.americanheart.org/

23. Resources Nevada Tobacco Users Helpline • The Nevada Tobacco Users' Helpline was developed to as a free resource to: 1) Provide innovative, evidenced-based, confidential and individualized treatment of nicotine dependence through telephone-based professional counseling, education, and with medication to its clients, and 2) Provide innovative, evidenced-based nicotine dependence training to healthcare providers, counselors, and community partners. • The Helpline provides a range of treatment and support programming services to meet the needs of its clients. Its program services include (not limited to): • 'Quit' Kit™ Clients are tobacco-users who receive telephone-based nicotine dependence assessment, intensive 1-year+ nicotine dependence treatment counseling, and programming support services. Treatment is free and confidential. http://www.livingtobaccofree.com/

24. Resources National Heart, Lung and Blood Institute • The National Heart, Lung, and Blood Institute (NHLBI) provides leadership for a national program in diseases of the heart, blood vessels, lung, and blood; blood resources; and sleep disorders. The Institute plans, conducts, fosters, and supports an integrated and coordinated program of basic research, clinical investigations and trials, observational studies, and demonstration and education projects. • The NHLBI provides resources to the public in areas including (but not limited to) Heart Disease, Blood Diseases, Lung Disease, Sleep Disorders, and healthy Recipe Collections. The NHLBI also provides Health Assessment Tools such as a menu planner, body mass index calculator and portion size quizzes. http://www.nhlbi.nih.gov/

25. Resources Mayo Clinic • Mayo Clinic's three main Web sites provide information and services from the world's first and largest integrated, not-for-profit group medical practice. Manage your health with information and tools that reflect the expertise of Mayo's 2,500 physicians and scientists, learn how to access medical services, and discover Mayo's medical research and education offerings. http://www.mayoclinic.com/

26. Resources State of Nevada Risk Management The state of Nevada’s Risk Management Department believes that most risks can and must be identified and effectively managed. Provided in the Heart/Lung section of the risk management website are links to risk factor reduction information, heart disease risk assessment tools, smoking cessation resources, as well as a great deal of information and resources regarding the heart lung program. http://www.risk.state.nv.us/HeartLungProgram.htm

27. Let Us Know of Your Improvements! • If you are making headway to alter some of your predisposing risk factors please don’t hesitate to contact us. Risk managements wants to know of your successes so that this documentation can be placed in your personal file to indicate that you are attempting to improve your health status. • Contact Information • Vicky Fry - Occupational Health Nurse • Email: vfry@risk.state.nv.us / Phone: (775) 687-3194 • Josh Wilson - Health/Wellness Coordinator • Email: josh.wilson@willis.com / Phone: 775-323-1656 • Jim Muth - Exercise Physiologist • Email: jmuth@kbomanmd.com / 702-383-0677