# Presentation: 736143

## 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

## Slide 2

## 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

## 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

## 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

## 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** **

## 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

## Buildup of Cholesterol and Plaque in Artery Walls

## Heart Attack

## Coronary Angiogram

## Change in Cardiovascular Mortality:

**Change in Cardiovascular Mortality:**
**1979-2000**

- Source: CDC/NCHA & AHA

**Men**

**Women**

## Major Risk Factorsfor Heart Disease and Stroke

| Modifiable  | Nonmodifiable  | Emerging Risk Factors |
| --- | --- | --- |
| High blood pressure | Family history | Homocysteine |
| Abnormal cholesterol levels | Age | Elevated lipoprotein (a) levels |
| Diabetes | Gender | Clotting factors |
| Cigarette smoking |  | Markers of inflammation (CRP) |
| Obesity |  |  |
| Physical inactivity |  |  |

## 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

## US Adults With High Blood Pressure (1988-1994)

**US Adults With High Blood Pressure (1988-1994)**

- American Heart Association. *2002 Heart and Stroke Statistical Update.* 2001

## 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

## Lowest Survival Rates for Diabetic Women

- Lowest Survival Rates for Diabetic Women

|  | Death |  |  |  | Death/MI |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
|  | 0-vessel ischemia  | 1-vessel ischemia  | 2-vessel ischemia  |  | 0-vessel ischemia  | 1-vessel ischemia  | 2-vessel ischemia  |
| Diabetic men | 93.8 | 93.0 | 91.3 |  | 86.3 | 77.0 | 79.0 |
| Nondiabetic men | 99.0 | 96.5 | 95.0 |  | 93.8 | 88.0 | 85.0 |
| Diabetic women | 99.0 | 80.0* | 81.3* |  | 96.5 | 72.5* | 60.0* |
| Nondiabetic women | 98.8 | 97.5 | 97.0 |  | 95.5 | 85.0 | 77.5 |
| *P < .05. Extent of ischemia was determined by the number of vascular territories (0, 1, or 2 vessels) involved in the reversible perfusion defect. |  |  |  |  |  |  |  |

## 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

## US Adults With LDL Cholesterol of   130 mg/dL or Higher (1988-1994)

- American Heart Association. *2002 Heart and Stroke Statistical Update.* 2001

## 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

## Overweight and Obesity in US Adults

- American Heart Association. *2002 Heart and Stroke Statistical Update.* 2001

## Moderate or Vigorous Physical Activity in US Adults

- American Heart Association. *2002 Heart and Stroke Statistical Update.* 2001

## Benefits of Walking

- Manson JE et al. *NEJM*. 2002;347:716-25

## 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

## 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

## Risk Factors: Goals for Prevention

| Risk Factor | Minimal Goal | Optimal Goal |
| --- | --- | --- |
| Hypertension (mm Hg) | Systolic <140
Diastolic <90 | Systolic <120
Diastolic <80 |
| High cholesterol (mg/dL) | LDL-C 100-129
Serum TC 160-199
HDL-C 45 (men)
HDL-C 55 (women) | Primary: LDL-C 100
Secondary: HDL-C >35, TG <200 |
| Diabetes | Near-normal fasting glucose (HbA1c <7%) | Same |
| Cigarette smoking | Complete cessation | Same |

- 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

## Risk Factors: Goals for Prevention

| Risk Factor | Minimal Goal | Optimal Goal |
| --- | --- | --- |
| Hypertension (mm Hg) | Systolic <140
Diastolic <90 | Systolic <120
Diastolic <80 |
| High cholesterol (mg/dL) | LDL-C 100-129
Serum TC 160-199
HDL-C 45 (men)
HDL-C 55 (women) | Primary: LDL-C 100
Secondary: HDL-C >35, TG <200 |
| Diabetes | Near-normal fasting glucose (HbA1c <7%) | Same |
| Cigarette smoking | Complete cessation | Same |

- 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

## The Nation’s Leading Health Epidemic

**The Nation’s Leading Health Epidemic**

## 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

## 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

## Cholesterol Levels in children 2-19 years old

| Category | Total Cholesterol | LDL Cholesterol |
| --- | --- | --- |
| Acceptable | Less than 170 | Less than 110 |
| Borderline | 170-199 | 110-129 |
| High | 200 or greater | 230 or greater |

- HDL levels should be > 35 mg/dl and triglycerides should be < 150 mg/dl

## What to do as a family . . .

## 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

## 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

## 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

## 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