Chapter 15

Elizabeth Lytle, MPH, BSN, RN Los Altos School District

Preventing Major Disease

Topics Of Focus For This Chapter

Cardiometabolic Health

Heart Attack

Diabetes Stroke

Hypertension Cancer

Cholesterol Lifestyle

Cardiometabolic Health

Approaching the connection between risk factors, symptoms and diseases

CardioHeart

Blood vessels

MetabolicBiochemical processes involved in body functioning

Control Weight and Waist Circumference

Weight

Overweight teens have high risk of diabetes and heart disease in future

Obese men have dramatically higher risk of dying

Waist Size

Subcutaneous fat and visceral fat are dangerous

Avoid waists of: 40 inches for men 30 inches for women Potbelly with normal weight

Physical Activity Decreases Risk

All Least fit are at greater risk of death

MenMore rigorous exercise = greater protection and longevity

Women

30 minutes/day of moderate activity lessens risk

Fitness more important than overweight or obesity in cardiometabolic risk

Smoking Is The Most Significant Risk Factor

Causes over 250,000 deaths per year

Causes peripheral arterial disease

Active and passive smoking

Accelerate artery clogging Increase risk of developing coronary heart disease

Control Blood Sugar To Decrease Risk

Check your blood sugar to see if you are at risk

Blood Sugar

Healthy Under 100

Prediabetes 100-125

Diabetes Over 125

High Blood Pressure Increases Work Of Heart

Systolic

Over

Diastolic

Systolic = pressure during heart contraction

Diastolic = pressure during heart relaxation

EffectsHeart muscle gets strong and stiff

Accelerated development of plaque

ActionControl with diet, exercise and possibly medication

Control Cholesterol and Triglycerides

Desired Numbers

Total Cholesterol less than 200 AND: HDL over 40 mg/dL LDL less than 100

Low Triglycerides

Effects Best indicator of plaque in arteries

Action Cut back on high-fat foods

Exercise more

Cholesterol In Food

Risk Factors You Cannot Control

Family history

Race and ethnicity

Age

Metabolic Syndrome Is An Epidemic

General Effects

High blood pressure

High insulin levels

Abnormal cholesterol levels

Abdominal obesity

Diagnosis = 3 or more

Waist measurement (40 in, 35 in)

Triglycerides 150 or more

HDL less than 40 mg/dL

Blood Pressure of 130/85 or higher

Blood Sugar 110 mg/dL or higher

Metabolic Syndrome Risk Factors

Overweight or obese

Age 60 or older

Physically inactive or exercise less than 3 times/week

Parent or sibling with diabetes

Having baby over 9 pounds or gestational diabetes

Blood pressure 140/90 or higher

More Metabolic Syndrome Risk Factors

African American, Alaskan Native, American Indian, Asian American, Hispanic/Latino or Pacific Islander

HDL below 35 or Triglycerides above 250

Impaired fasting glucose or impaired glucose tolerance test

History of cardiovascular disease

Conditions associated with insulin resistance

Fasting blood sugar 101-125 = Prediabetes

Diabetes

Diabetes Shortens Life Expectancy

Men

Normal Response To Eating

Uncontrolled Diabetes

Effects Of Uncontrolled Diabetes

Damaged blood vessels

Blindness

Amputation

Kidney failure

Heart attack and stroke

Types Of Diabetes

Type 1

Immune system attacks insulin producing cells in pancreas

Develops often in young people, but can appear in adults

Type 2Pancreas does not make enough insulin or body is resistant to its insulin

GestationalDiabetes during pregnancy

At risk for diabetes later in life

Decrease Risk Of Type 2 Diabetes

Exercise 30 minutes 5 days/week

If overweight, lose weight

Diet rich in complex carbohydrates and fiber

Diet low in sodium and fat

Eat fruits and vegetables

Take medication recommended by physician

Signs And Symptoms Of Diabetes

Increased thirst and urination

Flu-like symptoms

Weight loss or gain

Blurred vision

Slow-healing sores or frequent infections

Nerve damage

Red, swollen, tender gums

Detecting Diabetes

Anyone over age 45 should be screened for diabetes every 3 years

Random blood sugar test

Fasting blood glucose test

Glucose challenge test

Controlling Diabetes Decreases Risk

A1c less than 7 percent

Blood Pressure 115/75

Cholesterol LDL less than 160

A

B

C

Hypertension

Risks

Family history

Obesity when young

Race

EffectsDeath especially for those with diabetes, kidney disease and obesity

Treatment

Lifestyle changes

Decrease sodium to 1.5 grams/day

Increase potassium to 4.7 grams/day

Exercise

Medication

Numerous Effects Of High Blood Pressure

Understanding Blood Pressure Numbers

Type of BP Systolic Diastolic

Prehypertension 120-139 80-89

Mild 140-159 90-99

Moderate-Severe 160 + 100

Low Less than 90

Hypertension is any one of the values above or a combination of values

Lipoproteins: Cholesterol And Triglycerides

RiskTotal

CholesterolTriglycerides

None Less than 200Less than

150

Borderline High

200-239 150-199

High 240 + 200 +

Lowering Lipoproteins Decreases Risks

Diet

Include nuts, soy, oats, plant sterols

Weight management

Physical activity

MedicationStatins

Needed for about half of those with high lipoprotein levels

Few Meet Criteria For Ideal Heart Health

Never smoked or quit more than 1 year ago

BMI less than 25

150 + moderate or 75 + vigorous minutes of exercise/week

4 + components of healthful diet

Total cholesterol less than 200

Blood pressure below 120/80

Fasting blood sugar below 100

Heart Anatomy

Heart Anatomy

• Blood moves through aorta to brain and body

Overview Of Blood Flow Through Heart

• Blood from body moves into right atrium

Right Atrium Contracts

• Blood moves into right ventricle

Right Ventricle Contracts

• Blood moves to lungs and then pulmonary vein

Left Atrium Contracts

• Blood moves into left ventricle

Left Ventricle Contracts

How Blood Flows Through Body

Understanding The Heart

Myocardium Heart muscle

Pericardium2-layer membrane surrounding heart

Lubricant between layers allows heart muscle to move freely

Systole Contraction of heart

DiastolePeriod between contractions when heart fills with blood

CapillariesSmallest blood vessels in body

Deliver oxygen via the blood and take up waste

Cardiovascular Risk Factors

Education Low education level at higher risk

Stress

Chronic = plaque & high blood pressure

Episodic = creates unstable plaque

Acute = trigger heart attack

DepressionDepression and heart disease are linked

Depressed women more likely to have heart attack

Anger Angry men at much higher risk

Cardiovascular Risk Factors Continued

CRPC-Reactive protein signals inflammation

Increased CRP increases risk

Homo-cysteine

May influence atherosclerosis

Illegal Drugs

Sudden increases in blood pressure

Left ventricular contraction

Irregular heart rhythms

Bacterial Infection

Streptococcus and chlamydia

Tips For Women To Avoid Heart Disease

Abstain from smoking

BMI less than 25

Exercise 150 + moderate or 75 + vigorous minutes each week week

Eat 4 + components of healthful

Non-HDL cholesterol less than 230

Blood pressure below 120/80

Fasting blood sugar below 100

Heart Disease Symptoms Different In Women

Pay attention to these early signs of disease

Pain in back, between shoulders

Sick to stomach

Feeling scared or nervous

Pain in belly above belly button

New or worse headaches

More Symptoms In Women

Tiredness, even after getting enough sleep

Trouble breathing

Trouble sleeping

Ache in chest

Chest feeling ‘heavy’ or ‘tight’

Burning feeling in chest

Pain or tightness in chest that spreads

Aspirin Is Recommended For Some

Aspirin may reduce heart attack risk, but may also increase bleeding

Aspirin decreases clotting risk, but increases bleeding risk

Must consider risk of gastrointestinal bleeding when choosing to take aspirin

Men 45 to 79 to reduce risk of heart attack

Women 55-70 to reduce risk of stroke

Heart Health Conditions

Coronary Artery DiseaseArteriosclerosis – degeneration and hardening of arterial walls

Atherosclerosis – arteriosclerosis plus plaque deposits on walls of arteries

Heart Conditions

Angina PectorisDue to brief lack of oxygen to heart

Severe, suffocating chest pain

Heart Attack / Myocardial InfarctionWhen portion of heart does not receive oxygen and begins to die

Cardiac Arrest

Heart stops beating

Symptoms Of A Heart Attack

30 minutes or more of chest pain that is not relieved with rest

Chest pain radiating to shoulder, arm, neck, back or jaw

Anxiety

Sweating or cold, clammy skin

Nausea and vomiting

Shortness of breath

Dizziness, fainting or loss of consciousness

If experiencing heart attack symptoms, take 325 mg of aspirin and seek immediate

medical attention

If experiencing heart attack symptoms, take 325 mg of aspirin and seek immediate

medical attention

Cardiac Arrest

CPRCardio-pulmonary resuscitation

Combining rescue breaths with chest compressions creates circulation

AED

Automatic External Defibrillator

Portable device available in most public places can restart a heart that has a lethal rhythm

ActionControl with diet, exercise and possibly medication

Cerebrovascular Accident Explained

Defined‘Stroke’ occurs when blood supply to brain in blocked

TypesIschemic – blockage of flow by cerebral thrombus or cerebral embolism

Hemorrhagic – blood vessels rupture

TIA

Transient Ischemic Attack

Little strokes with minimal damage

Doubles risk of heart attack

Cerebrovascular Accident Risk

Risk Factors

Women, especially during hormonal changes

Men across the lifespan

Heart disease and diabetes

Obesity and diet high in fat and sodium

Age – risk doubles every decade after 55

Race – high in blacks and Hispanics

High red blood cell count

High blood pressure

Effects Of Stroke On Brain

Cancer

Defined

Uncontrolled growth and spread of abnormal cells

Abnormal cells divide and create tumors

Forms Countless and with different genetics

Action Infiltration – Crowds out healthy cells

Metastasis – spreads through blood or lymph to other parts of body

How Cancer Metastasizes

Cancer Risk

Affects all social, economic and educational levels

Obesity

Black Americans have higher mortality

Heredity – such as BRCA gene

Infectious Agents – Viruses

Common Cancers

Carcinoma Arises in epithelium

SarcomaStarts in supporting or connective tissues of body

Leukemia Begins in blood-forming tissues

Lymphoma Forms in lymph cells

Cancer Warning Signs

Change in bowel or bladder habits

Sore that doesn’t heal

Unusual bleeding or discharge

Thickening or lump in breast, testis or elsewhere

Indigestion or difficulty swallowing

Obvious change in wart or mole

Nagging cough or hoarseness

Skin Cancer

Basal Cell Cells in top level of skin

Squamous Cell

Cells in epidermis

Actinic Keratoses

Not cancer, but 40% become squamous cell carcinoma

Malignant Melanoma

Most lethal form of skin cancer

Malignant Melanoma Is Most Dangerous

Risk Factors

Fair skin, light eyes or fair hair

Tendency to burn instead of tan

Childhood sunburn or intermittent, intense sun exposure

Personal or family history

Large number of moles or atypical moles

Warning Signs Of Melanoma

Asymmetry

Border Irregularity

Color

Diameter

A

B

C

D

Every Woman Is At Risk For Breast Cancer

Increased Age Age at first childbirth

Breast biopsies First period before 12

Many occupations Hormone Therapy

Obesity Sedentary lifestyle

2 or more drinks per day

White or African American

Family History

Risk Increases With Age

Detecting Breast Cancer

Mammography

Recommended annually for women over 40

Best detection tool

Breast Self-Exam

Monthly at home

Every 3 years by trained practitioner

MRIRecommended if strong family history or Hodgkin’s Disease

Cervical and Ovarian Cancer

Risks for cervical cancer Sexual activity before 16 Genital herpes Multiple sexual partners HPV Secondhand smoke

Risks for ovarian cancerFamily history of ovarian cancer

Infertility

Personal history of breast cancer

Obesity

Low levels of transferase

Testicular Cancer Rates Are Increasing

Risk

Men at 18-35

Undescended testicle

Chronic marijuana use

Detection

Perform monthly testicular exam

One testicle larger than other

Dull ache in groin or abdomen

TreatmentSurgery to remove testicle

Radiation, chemotherapy

Colon And Colorectal Cancer

Risk

Factors

Age over 50

History of rectal cancer or polyps

Smoking

Alcohol consumption

Prolonged high consumption of red and processed meats

High-fat or low-fiber diet

Ulcerative colitis

Detection Colonoscopy at 50

Prostate Cancer

Risk

Factors

Increasing age

Family history

Exposure to cadmium

High number of sexual partners

Frequent STIs

High-fat diet

Detection Prostate-specific antigen test

TreatmentHormones and low-fat diet

Chemotherapy and radiation

Epilepsy

DefinedSudden attacks of violent muscle contractions and unconsciousness

DiagnosisElectroencephalogram (EEG)

Recurring attacks

Treatment Anticonvulsant drugs

Asthma

Risk

Factors

African American

Inner-city

Secondhand smoke exposure

Symptoms

Wheezing

Shortness of breath

Tightness of chest

Coughing

Steps To Control Asthma

1. Get away from trigger

2. Assess severity of attack

3. Use quick reliever

4. Suppress inflammation

5. Know when to call for help

Ulcers

DefinedOpen sores in lining of stomach or duodenum

Cause Excessive acidic digestive juices

Symptom Burning pain in upper abdomen

Treatment

Antibiotics (if H. pylori)

Avoiding aspirin

Eating small, frequent meals

Taking antacids

Not smoking or drinking and avoiding caffeine