Heart Disease 2009: It’s now becoming a family affair

1. Heart Disease 2009: It’s now becoming a family affair Jean M. Cacciabaudo, MD, FACC Medical Director, Nuclear Cardiology South Bay Cardiovascular Associates West Islip, NY

3. Cardiovascular Disease • The leading cause of death in America • 1.1 million Americans will have a first or recurrent coronary attack annually • 515,000 will die – 250,000 before reaching a hospital • 7.6 million Americans over age 20 have survived a heart attack • 6.6 million Americans have angina pectoris

4. Cerebrovascular Disease • 700,000 Americans suffer a new or recurrent stroke annually • 4.7 million stroke survivors are alive , many of them with permanent stroke related disabilities • Women account for more that 6 in 10 stroke related deaths

5. The Local Statistics on Long Island • 8,600 Long Island residents will die from heart disease each year • More then 1,000 Long Island residents will die from a stroke each year • 5,600 women die each year from a heart attack or stroke each year

6. Heart Attack Warning Signs • Uncomfortable pressure, squeezing, fullness or pain in the center of the chest that lasts more than a few minutes or goes away and comes back • Pain or discomfort in one or both arms, the back, neck, jaw or stomach • Shortness of breath with, or before, chest discomfort • Other signs: breaking out in cold sweat, nausea or lightheadedness

7. Stroke and TIA Warning Signs • 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

8. Buildup of Cholesterol and Plaque in Artery Walls

9. Heart Attack

10. Coronary Angiogram

11. Change in Cardiovascular Mortality: 1979-2000 Women Men Source: CDC/NCHA & AHA

12. Major Risk Factorsfor Heart Disease and Stroke

13. High Blood Pressure • Of all people with high blood pressure, 32 percent are unaware of it • 27 percent of those with high blood pressure are on medication • 26 percent of those on medication are not under control • 15 percent with hypertension are not treated

14. US Adults With High Blood Pressure (1988-1994) American Heart Association. 2002 Heart and Stroke Statistical Update. 2001

15. Diabetes Mellitus • 65% of diabetics die from heart disease or stroke • Diabetes increases CAD risk 3-fold to 7-fold in women vs 2-fold to 3-fold in men • Diabetes doubles the risk of second heart attack in women but not in men • 75% of diabetics die from some form of heart or blood vessel disease American Heart Association Centers for Disease Control and Prevention Manson JE, et al. Prevention of Myocardial Infarction. 1996

16. Lowest Survival Rates for Diabetic Women Giri S, et al. Circulation. 2002

17. High Cholesterol Levels • 42 million American adults have cholesterol levels of 240 mg/dL or higher • Total cholesterol should be below 200 mg/dL • Levels greater than 240 mg/dL are a major risk for heart disease and stroke • LDL levels greater than 130 mg/dL are a major risk

18. US Adults With LDL Cholesterol of 130 mg/dL or Higher (1988-1994) American Heart Association. 2002 Heart and Stroke Statistical Update. 2001

19. Clinical Identification of the Metabolic Syndrome • Abdominal obesity • Men >102 cm (>40 in) • Women >88 cm (>35 in) • Triglycerides (TG) >150 mg/dL • HDL cholesterol • Women <50 mg/dL • Men <40 mg/dL • Blood pressure >130/>85 mm Hg • Fasting glucose >110 mg/dL National Heart, Lung, and Blood Institute

20. Overweight and Obesity in US Adults American Heart Association. 2002 Heart and Stroke Statistical Update. 2001

21. Men Women Moderate or Vigorous Physical Activity in US Adults American Heart Association. 2002 Heart and Stroke Statistical Update. 2001

22. Benefits of Walking Manson JE et al. NEJM. 2002;347:716-25

23. Tobacco Smoke • 26 million men and 23 million women smoke cigarettes (this is 23% of the adult US population) • Each day more that 6,000 individuals under age 18 try a cigarette, and each day more than 3,000 become smokers

24. Sleep Apnea • 10% of the population with undiagnosed sleep apnea • Hypertension: pts with normal BP will develop HTN within four years • Higher sympathetic nervous system activity: higher SNS activity causes blood vessel constriction and increased heart rates • Increased stroke risk: 1,475 pts with moderate to severe sleep apnea were 3-4X more likely to have a stroke over four years

25. Risk Factors: Goals for Prevention Grundy SM, et al. Circulation. 1999. American Heart Association Consensus Panel. Circulation. 1995; The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee. Arch Intern Med. 1997

26. Risk Factors: Goals for Prevention Grundy SM, et al. Circulation. 1999. American Heart Association Consensus Panel. Circulation. 1995; The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the National High Blood Pressure Education Program Coordinating Committee. Arch Intern Med. 1997

27. The Nation’s Leading Health Epidemic

28. Childhood Obesity • 11 million kids in the US are overweight • 13 million children are at risk for becoming overweight • Diseases that are usually seen in adults – high blood pressure, type-2 diabetes and high cholesterol levels – are now being seen in children • Most obese children already have one major risk factor for cardiovascular disease

29. Childhood Obesity • Dietary Issues In 2003, 23.6% of high school males and 20.3% of high school females eat five or more servings of fruits and vegetable daily • Physical Activty Issues A survey in 2000 showed 8% of elementary schools, 6.4% of middle/junior high schools and 5.8% of senior high schools provide daily physical education

30. Cholesterol Levels in children 2-19 years old HDL levels should be > 35 mg/dl and triglycerides should be < 150 mg/dl

31. What to do as a family . . .

32. Reducing Cholesterol Buildup in Arteries as a Family • Cigarette smoking should be discouraged • Regular aerobic exercise that lasts at least 30-60 minutes most days of the week should be embraced • High blood pressure should be identified and treated • Obesity should be reduced and avoided • Diabetes should be diagnosed and treated • Everyone over 2 should eat five servings of fruits and vegetables daily and eat foods low in satruated fat

33. Navigating Fast Food • Don’t supersize • Skip the sides or order fruit cup or side salad • Avoid double meat or bacon – a serving size of meat is a deck of cards • Try grilled chicken • Eat your sandwich open faced • Drink water or low fat milk – Soda is loaded with sugars

34. Becoming Active • Become a role model for your family – if you’re not active, your family won’t be • Limit TV, video and computer time • Don’t reward children with food • Be supportive and choose activities your family and children enjoy • Make dinnertime family time and get the children involved with planning and preparing dinner

35. Keys to Success • Become involved and advocate for our healthier children. Insist on good food choices at school and make sure your healthcare provider is monitoring your children’s BMI, blood pressure and cholesterol • Be proactive for your own health – know your numbers and ask your healthcare provider what they think about your cardiovascular risk