醫(yī)學(xué)授課之心臟病預(yù)防與治療heartdisease

PreventionofHeartDiseaseWhatisHeartDisease?Heart:Themosthard-workingmuscleofourbody–pumps4-5litersofbloodeveryminuteduringrestSuppliesnutrientsandoxygenrichbloodtoallbodyparts,includingitselfCoronaryarteriessurroundingtheheartkeepitnourishedwithbloodWhatisAtherosclerosis

whatiscoronaryarterydisease?Overtime,fattydepositscalledplaquebuildupwithinthearterywalls.Thearterybecomesnarrow.ThisisatherosclerosisWhenthisoccursinthecoronaryarteries,heartdoesnotgetsufficientblood,theconditioniscalledcoronaryarterydisease,orcoronaryheartdiseaseMyth:fatdepositsatoldage!Itstartsfrom2yearsofageFoamCellsFattyStreakIntermediateLesionAtheromaFibrousPlaqueComplicatedLesion/RuptureAdaptedfromPepineCJ.AmJCardio.1998;82(suppl104).FromFirstDecadeFromThirdDecadeFromFourthDecadeAreOtherorgansAffected?IschemicStrokePeripheralVascularDiseaseCoronaryHeartDiseaseAnginaMI(HeartAttack)SuddenCardiacDeathWhatarethesymptomsofCoronaryarterydisease?NosymptomsforlongperiodChestpainforshortperiodonexertionalsoknownasAnginaorminorheartattackMyocardialInfarctionormajorheartattack-Severechestpain,deathofheartmuscle,heartfailure,irregularheartbeatsSuddenDeathHowBigistheProblem?No.1killerdiseaseworldwide12MilliondeathsannuallyDuringlast30yearslargedeclinesindevelopedcountries-risinghealthawarenessandgovernmentprogrammesAlarmingincreaseindevelopingcountriesespeciallyIndiaWhyMe?GeneticpredispositionPoorhandlingoffatsandmetabolicsyndromeDiabetes,obesity,highBP,CoronaryarterydiseaseEnvironmentalinsultsUrbanizationSuddenchangeinlifestyleWhatIncreasesRisk?Youcan’thelpit!Age:

Men>45;

Women>55SexRaceFamilyHistory

Youcan!!HighCholesterolSmokingHighBloodPressureDiabetesObesityAlcoholPhysicalInactivityCholesterol(Atypeoffat)Everybodyneedscholesterol,itservesavitalfunctioninthebody.Itcirculatesintheblood.

ToomuchcholesterolcandepositinthearteriesintheformofplaqueandblockthemNosymptomstillheartattackWheredoesitcomefrom?Twosourcesofcholesterol:Food&madeinyourbodyFoodsources:Allfoodscontaininganimalfatandmeatproducts65%35%Goodvs.BADCholesterolLDLcholesterolisknownasbadcholesterol.IthasatendencytoincreaseriskofheartdiseaseLDLcholesterolisamajorcomponentoftheplaquethatclogsarteriesHDLcholesterolisknownasthegoodcholesterol.Higherinwomen,increaseswithexerciseHDLcholesterolhelpscarrysomeofthebadcholesteroloutofarteries.ObesityPeoplewhoareoverweight(10-30%morethantheirnormalbodyweight)Obesehave2to6timestheriskofdevelopingheartdiseaseNormalWaist-HipRatio<0.85forwomen;<0.95formenPearsorapples?PearsandApples

Apple-shapedpaunchstorebodyfataroundtheabdomenandchest,surroundinginternalorgansPear-shapedpaunchstorefatonthehipsandthighs,justbelowthesurfaceoftheskin.Apple-shapedareatahigherriskPhysicalInactivityEverymorningmybraintellsmetoexercise……..andmybodylaughsattheideaCigaretteSmokingIncreasesbloodpressureDecreasesHDLDamagesarteriesandbloodcellsIncreasesheartattacksCigarettesmokecontainsmorethan4,000chemicals,and200ofthesechemicalsarepoisonousCigaretteSmokingIfyouthinkYOUaresmokingthecigarette,youaremistaken…It’stheotherwayround!AlcoholConsumptionInsmallamountsitisbeneficial:1-2drinksInlargeamountsitaddsfatandcalories&raisesBP!4drinksperday.YouendupwithgastroenterologistinsteadofcardiologistThisisaveryfineline!FinerforwomenastheyareathigherriskDiabetesAtanygivencholesterollevel,diabeticpersonshavea2or3xhigherriskofheartattackorstrokeAdiabeticismorelikelytodieofaheartattackthananon-diabetic~80%DiabeticsdiefromheartdiseaseRiskofsuddendeathfromaheartattackforadiabeticisthesameasthatofsomeonewhohasalreadyhadaheartattack.Riskoperatesacrossacontinuum-noclear-cutline(BloodPressure;Cholesterol;overweight;Smoking)Theriskismultiplicativewhenmanyriskfactorsco-exist;riskfactorsoftenclustertogetherMajorityofeventsariseinindividualswithmodest

elevationsofmanyriskfactorsthanfrommarkedelevationofasingleriskfactorInteractionsofRiskFactorsMisfortunesalwayscomeinbyadoorthathasbeenleftopenforthem.WiseproverbEverydayyoumakechoicestotrytohelpprotectyourselfandyourfamily.Infact,protectingyourselfhasbecomesecondnature—youjustdoit.Butdoyouknowwhatyoucandotohelpprotectyourselffromthisnumber1causeofdeath-HeartDisease?Formycar,Iwantthebestmechanic.Butformyownbody,Ifollowhearsayandadvicefromfriends,kittyparty,localquacks….Justanyone

AnddecidefortheworstCreativestrategiesdonotwork!NeverhadatestorretestNeverbeentoDoctor!

IhatethemNevertakemedicines!MyBPisnormal,sostoppedmeds!MiraclemenandMiracleMedicines!SomanyofthemIammyowndoctor!NofeestooPreventingHeartDisease

Rule#1Lookbeforeyoureat

Eatavarietyoffruitsandvegetableseveryday.(5servings-theyarenaturallylowinfatandhighinvitaminsandmineralsandantioxidants).EatcoloredvegetablesandfruitsEatavarietyofgrainproductsChoosenonfatorlow-fatproducts.Uselessfatmeats-chicken,fishandleancutsSwitchtofat-freemilk—toned/skimmedmilkDietaryGuidelinesLimityourintakeoffoodshighincaloriesandlowinnutrition,includingfoodslikesoftdrinks,candy,junkfoodLimitfoodshighinsaturatedfat,trans-fatandcholesterolEatlessthan6gmsofsaltadayHavenomorethan1-2alcoholicdrinkadayifyouarearegulardrinkerLimit/AvoidFoodsrichinCholesterolandSaturatedfatsEggYolkFattymeat&organmeat(Liver)Butterchicken/Batterfriedfish!Milkfat–DesiGhee,Butter,Cheese,Malai,Rabri,Khurchan,Doda,IceCream,fullcreammilk,HiddenFatlikeBakerybiscuits,Patties(!),Cakes,Pastries,CookingOils:ThemysteryofPUFA/MUFASaturatedFats:IncreaseCholesterol–AvoidCoconutoil,Palmoil,gheeMonounsaturatedFats(MUFA):HearthealthyOliveoil,Groundnutoil,Canolaoil,MustardoilPolyunsaturatedFats(PUFA):HearthealthySunfloweroil,SoybeanoilOmega-3-FattyacidsFishoil:HeartHealthy

RotatetheoilsorMixtureofoilsPreventingHeartDisease

Rule#2ExerciseMaintainalevelofphysicalactivitythatkeepsyoufitandmatchesthecaloriesyoueatServesseveralfunctionsinpreventingandtreatingthoseathighriskReducesincidenceofobesityIncreasesHDLLowersLDLandtotalcholesterolHelpscontroldiabetesandhypertensionExercise,Exercise,ExerciseMortalityishalvedinretiredmenwhowalkmorethantwomileseverydayRegularexercisecanhalvetheriskofheartdisease,particularlyinmenwhowalkbrisklySomeonewhoisinactivehasasgreatariskofhavingheartdiseaseassomeonewhosmokes,hashighbloodpressureorhashighcholesterolExercisesignificantlyreducesthechancesofdiabetesandstrokeWithregularexercise,bloodpressureinthosewithhypertensionisreducedbyasmuchas20mmsHgExerciseandHeartDiseaseModeratetointensephysicalactivityfor30-45minutesonmostdaysoftheweekisrecommendedWalkingforahealthyheartComplicatedexercisemachinesorsweatingitoutinthegymnotessential

JUSTWALK!Rule#3StopSmokingNOW!Theriskofheartattackstartsdecreasingwithin24hoursofquittingsmoking,within1yearofquitting,CHDriskdecreasessignificantly,within2yearsitreachesthelevelofanonsmokerSmellandtasteimprovewithindaysWithinthreemonthsofquitting,thesmokers'coughdisappearsinmostpeopleRule#3StopSmokingNOW!TobaccoDietPhysicalActivityAlcoholCardiovascularCancersDiabetesChronicRespiratoryDiseasesOsteoporosisOralHealthMentalHealthBenefitsmuchbeyondHeartDiseaseRule#4KnowyourNumber!DesirablenumbersTotalcholesterol<200;LDL<100HDL>40triglycerides<200GetthelevelstestedroutinelyandkeepthemundercontrolTheonlythingworsethanfindingoutthatyouhaveoneoftheseconditionsis…….NOTfindingoutthatyouhaveit!!Andthat’snotyourMobileNumber!10%reductionofbloodcholesterolproduces20-30%declineinCHDdeathsBenefitsofreducingcholesterolAllAdults>20yrsmustgettested-ifnormaltestagainafter5years,ifelevated,worktowardsnormalizingthelevelswithlifestylemodificationanddrugsasneededControllingBloodPressureAdultsshouldhavetheirbloodpressurecheckedatleastonceeverytwoyears,astherearenosymptomstotellifyouhavehighbloodpressureOptimallevels:120/80mmHgIfhighModifyyourlifestyle–Diet,Weight,Exercise,SaltrestrictionAdheretotheprescribedmedicationwithoutfail,todecreasechancesofgettingheartdisease–Donotstopyourmedicineswithoutconsultingyourdoctor,evenifthebloodpressurebecomesnormalControllingBloodSugarAlladultsshouldhavetheirbloodsugarcheckedregularly,astherearenoearlysymptomsofdiabetesNormalbloodsugar:Fasting<100;postmeals<140IfhighMod