Cardiovascular Diseases

FactsRisks

Prevention

Facts According to CDC• About 610,000 people die of heart disease in the United States every year–that’s 1 in

every 4 deaths.

• Coronary heart disease is the most common type of heart disease, killing over 370,000 people annually.

• Every year about 735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 210,000 happen in people who have already had a heart attack.

• Population of Washington, DC - 658,893 (2014), Montgomery County 1.017 million (2013), Fairfax County 1.131 million (2013).

Deaths Vary by Ethnicity Heart disease is the leading cause of death for people of most

ethnicities in the United States.

Race or Ethnic Group % of Deaths

African Americans 24.5

American Indians or Alaska Natives 18.0

Asians or Pacific Islanders 23.2

Hispanics 20.8

Whites 25.1

All 25.0

Leading Causes of Death 2013

• Heart disease: 611,105• Cancer: 584,881• Chronic lower respiratory diseases: 149,205• Accidents (unintentional injuries): 130,557• Stroke (cerebrovascular diseases): 128,978• Alzheimer's disease: 84,767• Diabetes: 75,578• Influenza and Pneumonia: 56,979• Nephritis, nephrotic syndrome, and nephrosis: 47,112• Intentional self-harm (suicide): 41,149

“世界卫生组织在 2015 年 1 月 19 日发表的一份报告中指出，超过 300 万中国人在 70 岁之前死于非传染性疾病的问题，心脏病在这些非传染性疾病中居于首位，其次才是肺病、脑卒中、癌症和糖尿病。另外统计数据显示，在急症死亡中，心脏病占首位，可见心脏病对人体的危害 .” ( 吴佳 )

RisksRisks that cannot be modified

Age

Gender

Family history

Genetics

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Why?

• A report from the CDC’s National Center for Health Statistics indicates that “hypertension-related deaths increased 61.8%, from 2000 to 2013.”

Definition of High Blood Pressure

Blood Pressure• In persons older than 50 years, systolic blood pressure greater than

140 mmHg is a much more important cardiovascular disease risk factor than diastolic blood pressure.

• The risk begins at 115/75 mmHg, doubles with each increment of 20/10 mmHg.

• Individuals who have normal blood pressure at age 55 have a 90 percent lifetime risk for developing hypertension.

• Individuals with a systolic blood pressure of 120–139 mmHg or adiastolic blood pressure of 80–89 mmHg are pre-hypertensive and require lifestyle modifications to prevent cardiovascular disease.

Benefits of Lowering Blood Pressure• Blood pressure treatment has been associated with reductions in

stroke incidence averaging 35–40 percent; myocardial infarction, 20–25 percent; and heart failure, more than 50 percent.

Lifestyle Modification for high Blood Pressure

• Maintain normal weight

• Diet : fruits, vegetables, low fat dairy products with reduced saturated and total fat.

• Low sodium intake, less than 2.4 gm/day (one tea spoon)

• Physical activity.

• Moderation of alcohol consumption (limit to 2 drinks for men, 1 drink for women of lighter weight persons)

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

• Total cholesterol

• Good cholesterol (high density or HDL)

• Bad cholesterol (low density or LDL)

Cholesterol

Who should consider taking cholesterol medicine?

• Individuals with cardiovascular disease

• Individuals with a bad cholesterol LDL ≥ 190 mg/dL

• Individuals 40 to 75 years of age with diabetes and a bad cholesterol LDL 70 to 189 mg/dL

• Individuals without clinical cardiovascular diseases or diabetes who are 40 to 75 years of age with a bad cholesterol LDL 70 to 189 mg/dL and a 10-year ASCVD risk of 7.5% or higher

Pooled Cohort Risk Assessment Equations

Predicts 10-year risk for a first atherosclerotic cardiovascular disease event

Gender Systolic blood pressure

Age Medication controlled BP

Race Diabetes

Total cholesterol Smoker

HDL cholesterol

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Smoking• Tobacco use increases the risk of heart disease and

heart attack. Cigarette smoking promotes atherosclerosis and increases the levels of blood clotting factors.

• Nicotine raises blood pressure, and carbon monoxide reduces the amount of oxygen that blood can carry.

• Exposure to other people's smoke can increase the risk of heart disease even for nonsmokers.

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Diabetes

• Diabetes increases a person's risk for heart disease. About three–quarters of people with diabetes die of some form of heart or blood vessel disease.

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Overweight and Obesity• Obesity is excess body fat. It is linked to higher LDL

(bad) cholesterol and triglyceride levels and to lower HDL (good) cholesterol, high blood pressure, and diabetes.

Obecity

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Diet• Several aspects of dietary patterns have been linked

to heart disease. These include diets high in saturated fats and cholesterol, which raise blood cholesterol levels and promote atherosclerosis. High salt or sodium in the diet causes raised blood pressure levels.

Center for Disease Control: More than half of food Americans buy contains more than recommended amount of salt.

Leading the News (4/3/2015)

The Washington Post (4/3, Bernstein) “To Your Health” blog reports that “more than half of” the food Americans “buy contains more than the recommended amount of salt for each serving” consumed. In the April issue of the journal Preventing Chronic Disease, researchers from the CDC found that “meat and pasta mixed dishes...were the top culprits, with better than 80 percent of each containing too much salt in the three regions of the country examined (Pacific, East North Central, and South Atlantic).” Other foods containing more than the recommended amount of salt include “pizza (better than 70 percent), soups (more than 60 percent) and cold cuts (50 to 60 percent, depending on the region).”

The ABC News (4/3, Shah) website points out that a high intake of sodium has been associated with hypertension. In order “for foods to be deemed healthy by the Food and Drug Administration, they must contain less than 600 milligrams of sodium per serving for meals or less than 480 milligrams of sodium per serving of individual food items,” an amount that is “less than a quarter teaspoon of salt.”

The Today Show Online (4/3, Fox) reports that the study authors wrote, “In all three divisions, 50 percent or more of products sold in most food categories exceeded the sodium-per-serving conditions for a ‘healthy’ food.”

The NPR (4/3, Aubrey) “The Salt” blog reports that in the study, CDC investigators “used Nielsen ScanTrack data, which captured sales of nearly 4,000 packaged food items sold in big, chain grocery stores around the country.” They then examined “regional differences in the sodium content of purchased foods” and found that “no clear pattern emerged.” In other words, everywhere across the US, sodium consumption is high.

New American Dietary Guidelines May Remove Limits on Cholesterol

• A draft of the 2015 edition of Dietary Guidelines for Americans, created by the Dietary Guidelines Advisory Committee, now states that “cholesterol is not considered a nutrient of concern for overconsumption.”

• The current U.S. guidelines call for restricting cholesterol intake to 300 milligrams daily.

• Cholesterol in: an egg - 187 mg, 145 g lobster - 212 mg

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Physical Inactivity• Physical inactivity is related to the development of

heart disease. It also can impact other risk factors, including obesity, high blood pressure, high triglycerides, a low level of HDL (good) cholesterol, and diabetes. Regular physical activity can improve risk factor levels.

Risks

Risks that can be modified

• High blood pressure• High LDL cholesterol• Smoking • Diabetes• Overweight and obesity• Poor diet• Physical inactivity• Excessive alcohol use

Excessive Alcohol Use• Excessive alcohol use leads to an increase in blood

pressure, and increases the risk for heart disease. It also increases blood levels of triglycerides which contributes to atherosclerosis.

Prevention: What You Can Do• Eat a healthy diet

• Maintain a healthy weight

• Exercise regularly

• Don't smoke

• Limit alcohol use

Treat Your Medical Conditions• Have your cholesterol checked

• Monitor your blood pressure

• Manage your diabetes

• Take your medicine

• Talk with your health care provider

The Good News• Cardiovascular mortality declined by 31% from 2000 to

2010 in the US.

• Stroke mortality declined by 3% per year in the European countries.

• The American Heart Association 2020 Impact Goals

• By 2020, improve the cardiovascular health of all Americans by 20%

• By 2020, reduce deaths from cardiovascular diseases and stroke by 20%

Cardiovascular Health Metrics

• Smoking

• Body mass index

• Physical activity

• Healthy diet score

• Total cholesterol

• Blood pressure

• Fasting plasma glucose

The Not So Good News(for Chinese in China)

• Chinese smokers consume 1/3 of the world’s production of cigarettes

• China has the largest number of people with diabetes (130 million by 2030)

• The prevalence of hypertension and dyslipidemia has increased

• Chinese cardiovascular mortality increased from 223.5/100,000 to 239.5/100,000 from 2004 to 2010

• Poor cardiovascular health metrics

Status of Cardiovascular Health in Chinese Adults (JACC Vol 65, No 10, 2015)

Yufang Bi, MD, PhD∗; Yong Jiang, PhD†; Jiang He, MD, PhD‡; Yu Xu, PhD∗; Limin Wang, PhD†; Min Xu, PhD∗; Mei Zhang, MS†; Yichong Li, MS†; Tiange Wang, PhD∗

; Meng Dai, BS∗; Jieli Lu, MD, PhD∗; Mian Li, PhD∗; Chung-Shiuan Chen, MS‡; Shenghan Lai, MD, MPH§; Weiqing Wang, MD, PhD∗; Linhong Wang, PhD†; Guang Ning, MD, PhD∗

State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, Collaborative Innovation Center of Systems Biomedicine and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China † National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China ‡ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana § Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland

Cardiovascular Health Metrics

• Smoking

• Body mass index

• Physical activity

• Healthy diet score

• Total cholesterol

• Blood pressure

• Fasting plasma glucose

Status of Cardiovascular Health in Chinese Adults (JACC Vol 65, No 10, 2015)

Ideal = 7 (black)

Intermediate = 1-6 (blue)

Poor = 0 (red)

Common Questions

• Diet

• Alcohol

• Aspirin

New American Dietary Guidelines May Remove Limits on Cholesterol

• A draft of the 2015 edition of Dietary Guidelines for Americans, created by the Dietary Guidelines Advisory Committee, now states that “cholesterol is not considered a nutrient of concern for overconsumption.”

• The current U.S. guidelines call for restricting cholesterol intake to 300 milligrams daily.

• Cholesterol in: an egg - 187 mg, 145 g lobster - 212 mg

Standard drinks in the United States• A standard drink is equal to 14.0 grams (0.6 ounces)

of pure alcohol.

• 12-ounces of beer (5% alcohol content).

• 8-ounces of malt liquor (7% alcohol content).

• 5-ounces of wine (12% alcohol content).

• 1.5-ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

What is Moderate Drinking?• 1 drink/day for women and up to 2 drinks/day for men.

• This definition is referring to the amount consumed on any single day and is not intended as an average over several days.

• It is not recommended that anyone begin drinking or drink more frequently on the basis of potential health benefits because moderate alcohol intake also is associated with increased risk of breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes.

Aspirin• Men with no history of heart disease or stroke aged

45-79 years use aspirin to prevent myocardial infarctions and that women with no history of heart disease or stroke aged 55-79 use aspirin to prevent stroke when the benefit of aspirin use outweighs the potential harm of gastrointestinal hemorrhage or other serious bleeding.

Air Pollution (PM2.5)• The World Health Organization estimated in 2005 that "... fine

particulate air pollution (PM 2.5), causes about 3% of mortality from cardiopulmonary disease, about 5% of mortality from cancer of the trachea, bronchus, and lung, …...“.

• In 2002, the European Study of Cohorts for Air Pollution Effects with 100,166 participants, followed for an average of 11.5 years. An increase in estimated annual exposure to PM 2.5 of just 5 µg/m3 was linked with a 13% increased risk of heart attacks

• The largest US study on acute health effects was published 2008 and found an association with hospital admissions for cardiovascular diseases.

Questions?