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Beating the Odds of Heart Disease 2015
Catey Carter, BSN, RN
Research Manager Century Study
The Weatherhead P.E.T. Center for
Preventing and Reversing Atherosclerosis
K. Lance Gould, MD Director
NO FINANCIAL CONFLICT OF INTEREST
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Objectives
• Show the prevalence of coronary artery disease in the United States
• Describe basic physiology of heart disease
• Discuss cardiac risk factors
• Discuss what we are doing at the Weatherhead P.E.T Center to detect, prevent, stabilize and reverse CAD
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The Heart – 4” diameter, 6” long
• Over 80 year lifespan, the heart:
– Contracts 3.4 billion times
– Pumps 61 million gallons of blood
– Pumps its own blood supply-coronary flow
– Never rests, adapts to extreme demands
– Replaces its components (protein) every month
– Associated with coronation, strength, love, generosity, courage, stamina
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The Heart Pumping Volume
• Over 80 year lifespan of the heart:
– Pumps 60 million gallons of blood
– Equals 8,020,000 cubic feet of blood
– Could fill container 10” deep, 100” wide, 8020’long (1.52 miles)
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Cardiovascular Disease in U.S. facts
• 36% of all deaths (1 every 2.8)
• 1 Heart attack every 25 seconds
• 1 death every 36 seconds
• Only 18% of coronary attacks are preceded by long-standing angina
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Source: NCHS and NHLBI.
These data include coronary heart disease, heart failure, stroke and hypertension.
Prevalence of CVD in adults by age and sex (NHANES: 2005-2006)
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A Total CVD
B Cancer
C Accidents
D Chronic Lower Respiratory Diseases
E Diabetes Mellitus
F Alzheimer’s Disease
CVD and other major causes of death for all men and women (United States)
Cardiovascular
Cancer
Cardiovascular
Cancer
Source: NCHS.
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International comparison of spending on health, 1980–2005
* PPP=Purchasing Power Parity. Data: OECD Health Data 2007, Version 10/2007.
Average spending on health
per capita ($US PPP*)
Total expenditures on health
as percent of GDP
8 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008
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High expectations
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Life Expectancy vs. Rate CV Death per 100,000 pop.
• Japan 82.7 • Australia 81.4 • Italy 81.3 • France 80.9 • Spain 80.5 • Canada 80.5
• UK 77.7 • Germany 77.4 • Ireland 76.8
• Poland 73.2 • Bulgaria 70.9 • Romania 69.9 • Russia 67.2
• United States 77.1
• Japan 170 • Australia 196 • Italy 218 • Spain 205 • France 183 • Canada 212
• UK 301 • Germany 270 • Ireland 337
• Poland 557 • Bulgaria 916 • Romania 770 • Russia 1167
• United States 289
Source: WHO/NCHS and NHLBI Revised 2010
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Lifestyle, serum cholesterol and mortality
Kato H et al. American Journal of Epidemiology
(1973) 97:372-85
Comparison of cholesterol levels and coronary heart disease (CHD)
rates in Japanese living in Japan, Hawaii and San Francisco
JAPAN HAWAII SAN FRANCISCO
Serum cholesterol (mg/dL) 181 218 228
CHD rate (per 1,000) 25.4 34.7 44.6
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• Detection: non-invasive test
• Coronary Angiogram
• Revascularization therapy
How we fight coronary artery disease
Standard treatment: The Cascade
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Coronary angioplasty and stents (PCI)
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Bypass (open heart surgery)
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Why it does not work
“The Good Physician treats the disease; The Great Physician treats the patient who has the disease.”
-William Osler
1849-1919
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Why PCI/CAB do not prevent most heart attacks
or death
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Why we do it
“My Doctor gave me six months to live,
but when I could not pay the bill,
he gave me six months more!” -Walter Matthau
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Current evidence
• Intensive LDL lowering with statin therapy may induce plaque regression and further decrease CV events when compared with standard goals
• Can we do better?
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Looking for the “silver bullet”?
• Current pills
• New pills
• Drugs to New targets
• New ways of delivering drugs
• Costs…
• Benefits…
• Are we missing anything?
• Do we need a different approach?
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Lifestyle
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Bad family history?
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May not always be easy….
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PHYSICAL ACTIVITY AND CARDIOVASCULAR DEATH
…but it is worthwhile…
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Regular Exercise
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25
Houston Rodeo 3/2011
The Standard American Diet SAD
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TEXAS 12/2012
THE “ULTIMATE” or….
…. “THE LAST” STATE FAIR EXPERIENCE?
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KL Gould, Coronary Artery Stenosis and Reversing Heart Disease. 2nd edition (1999)
Types of cholesterol lowering
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Healthy Diet
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REWARD Prevention and
Regression
SCIENTIFIC EVIDENCE 2003-2009
Quality Research Brings National &
International Recognition
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Plaque stabilization and regression to prevent most heart attacks or death
GOAL
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Positron Emission Tomography: An accurate diagnostic and powerful motivational tool
ORIENTATION OF HEART
AND CORONARY
ARTERIES ON PET SCAN
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P.E.T. Imaging of the heart: Red = normal blood flow
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Imaging progression or regression of CAD by PET
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409 patients - Sdringola et al. J Am Coll Cardiol 2003;41:263
PATIENTS AT THE CENTER OF HEALTH CARE
A Randomized Trial Of Integrated CAD Management By:
I. P.E.T. Imaging of the Heart
II. Medications To Goals
III. Healthy Lifestyle
Weatherhead Center for
Preventing and Reversing Atherosclerosis
University of Texas Medical School
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•Target: 1300 participants
•Randomization:
Optimal standard of care or
Comprehensive risk factor management
•Follow-up: 5 years
•All participants: consult with study team every visit
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•Risk factor assessment and consultation
•Electrocardiogram and exercise stress test
•3 blood tests for cholesterol, liver and kidney function (hsCRP)
•P.E.T. scan studies of the heart blood flow
•Diet evaluations and consultations
•Exercise consultation and risk factor modification with MD
•A service in addition to, NOT as an alternative to your MD optimal
medical care
All Century Patients will Receive:
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•Can you participate in the study?
Study Entry Criteria
Documented Coronary Artery
Disease by
• Previous Heart Attack
• Angioplasty, Stent or
Bypass surgery
• History of Abnormal stress
test
Suspected or at Risk for Coronary
Artery Disease
•Diabetes and/or
•Multiple other CAD risk factors
with or without chest pain
symptoms
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•Age >50
•Family history of CAD
•High total or LDL cholesterol
•High blood pressure
•Low HDL cholesterol
•Diabetes
•Cigarette smoking
•Coronary Calcification
Traditional Risk Factors for CAD
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The final “take home” message for atherosclerosis prevention 2015
• A disease that YOU DO NOT HAVE TO HAVE
• Do not wait for symptoms or an abnormal stress test
• Do not expect others “to do it” for you
• We have to treat the patient who has the disease, not just the stenosis
• The “silver bullet” to win the battle against the #1 killer in U.S. is in risk factor modification by informed,
supported and motivated people!
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Can intensive lifestyle changes prevent cardiovascular events and be
cost-effective?
“In a sense, this study is mainstream, but in another sense, it’s also 10
years ahead of its time. But it’s time 10 years from now becomes today!”
-KL Gould, MD
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Diabetic Guidelines