lifestyle and chronic diseases - dr.ravi andrews
TRANSCRIPT
“I’m tired of all this nonsense about
beauty being only skin-deep.
That’s deep enough! What do you want …….. adorable kidneys ? ! ? !”
- Jean Kerr
CHRONIC / LIFESTYLE DISEASES
• Cardiovascular Disease• Cerebrovascular Disease• Diabetes• Hypertension• Cancer• Chronic Kidney Disease• Dyslipidemia• Metabolic Syndrome
IMPACT OF LIFESTYLE DISEASES
- United States Data - 2004
• 12% attributed to lack of exercise
- American Heart Ass, 2004
C a r d i o v a s c u l a r D i s e a s e - 3 6 . 3 %
C a n c e r - 6 . 5 0 %
S t r o k e - 2 2 . 7 0 %
O t h e r C a u s e s - 3 4 . 5 %
ALL DEATHS
IMPACT OF DIABETES
Diabetes increases the risk of coronary events :-• Two-fold in men• Four-fold in women
- ADA 2002, Diabetes Care 25:S71-73
DIABETES A TICKING TIME BOMBOver the next 24 hours:
2200 diabetics will be diagnosed
512 diabetics will die
66 diabetics will go blind
77 diabetics will be diagnosed with ESRD
153 – diabetes related amputations will be performed
Centre for Disease Control and Prevention. 2000
IMPACT OF KIDNEY DISEASE….
Risk of dying is 100 times more in a 20 year old with kidney disease as compared to a healthy 80 year old
-Oxford Textbook of Clinical Neph, 3rd Ed, (2005)
IMPACT OF METABOLIC SYNDROME
Metabolic Syndrome (Syndrome X) rated as equivalent to smoking in magnitude of risk for Coronary Artery Disease.
Four fold risk of Death from CAD- National Cholesterol Education Program /
Adult Treatment Panel III (NCEP / ATP III)
Major impact on CVS, CNS, CKD
Clinical Criteria for Metabolic Syndrome
3 / 5 needed – NCEP, Circ. 166:3143 – 3421, 2002
Metabolic Syndrome
Waist CircumferenceMen > 102 cm (40 inch)
Women > 88 cm (35 inch)
BP 130 / 85 mm Hg
FBS 110 mg / dl
HDL Chol. Men < 40 mg/dl Women < 50 mg/dl
Triglycerides 150 mg/dl
Pathogenesis of Metabolic Syndrome
- Bagby et al JASN 15:2775 – 91, 2004
Abdominal Fat
Obesity Physical Inactivity Genetics
Tissue Resistance to Leptin Pro – infl. Cytokines
+ +
Adiponectin FFA
FFA Breakdown
Insulin Resistance
Insulin Glucose
Abdominal Fat
Prevalence of Metabolic SyndromeLooking at various studies around the world the prevalence varies from 8% (India) to 24% (United States) in men and from 7% (France) to 46% (India) in women.
* Gogia A et al. Ind Journ of Medical Sciences. 2006; 60 (2): 72-81
0
1 0
2 0
3 0
4 0
5 0
6 0
%
M S O b e s i t y E le v a t e d T G H y p e r t e n s io n E le v a t e d P la s m aG lu c o s e
P r e v a le n c e d a t a f r o m J a ip u r & C h e n n a i
J a ip u r
C h e n n a i
Legend: Prevalence of MS 13% in Jaipur and 41% in Chennai.The prevalence of obesity was quite similar (31% versus 33%). Prevalence of elevated triglycerides (46% vs. 30%), hypertension (55% vs. 39%) and elevated fasting plasma glucose (27% vs. 5%).
Treatment of Individual Metabolic Risk factors
Weight, Activity (Lifestyle) & Metformin, TZDs
Dyslipidemia Lifestyle & Statins, Fibrates
Hyperglycemia (A1c< 7%)
Hypertension
Prothrombotic state
Proinflammatory state
Lifestyle & Insulin / OHA
Lifestyle & ACEI, ARB, BB, CCBs, diuretics
Lifestyle & ASA
Lifestyle & statins, TZDs, ACEI/ARB
Insulin resistance (Abd. Fat )
- Grundy et al, Circ. 109:433-38 (2004) - AHA
CLASSIFICATION OF BP FOR ADULTS 18 YEARS
(Mean of 2 or more seated B.P readings on each of 2 or more office visits)
NORMAL : SBP < 120 AND DBP <80 PREHYPERTENSION: SBP = 120 – 139
OR DBP = 80 – 89 STAGE 1 HYPERTENSION: SBP = 140 – 159
OR DBP = 90 - 99 STAGE 2 HYPERTENSION: SBP 160 OR
DBP 100- A.V Chobanian, et al
JNC – 7, May 2003
Benefits of lowering BP ….
10 mmHg reduction of SBP over 10 years will prevent 1 in 10 deaths!!!
Chobanian et al, JAMA,
289,No.19(2003)
Event Average Percentage Reduction
Stroke 35 – 40 %
M.I 20 – 25 %
CHF 50 %
IMPACT OF LIFE–STYLE MODIFICATIONS ON HTN ….
- JNC VII, JAMA (2003)
MODIFICATION APPROX SBP REDUCTION
Wt. Reduction 5- 20 mmHg/10Kg wt. Loss
DASH Diet 8-14 mmHgDietary Sodium Restriction
2- 8 mmHg
Physical Activity 4- 9 mmHg
Moderation of Alcohol 2- 4 mmHg
The DASH Diet: -
Salt – 6gm/day
High K+, High Ca++
Low fat, low Cholesterol Less alcohol, less coffee
(Equivalent to one Anti – HTN drug)
- National Heart,Lung and Blood Institute (USA) –2003
“To date, the only intervention to delay aging is caloric restriction by 30-40%. This has been proved conclusively in rodents but not yet in humans”
- Resnick et al, Harrison’s Principles of
Internal Medicine 16th Ed. Pp.44(2005)
EXERCISE: -30-45 MINS OF BRISK WALKING – 5 DAYS A
WEEKReduces BP
Reduces Weight
Controls Sugars
Controls Lipids, HDL
Endorphins / Enkephalins – Well Being, TCR Activation
Reduces Cardiovascular Risk
Reduces Osteoporosis
Sleep better, energises
Reduces Diet Restrictions
- JNC VI – Arch. Int.Med. 157:2413-46 (1997)
DISEASE MEDICATION
Cardiovascular Disease Anti-HTN, Digoxin,ASA, Nitrates, Interventions
Cerebrovascular Disease Anti-HTN, ASA,
Thrombolytics etc Diabetes Insulin, OHA Hypertension Anti-HTN Cancer Surgery,
Radiation, Chemotherapy
Chronic Kidney Disease Anti-HTN, Vit. D3, Calcium,PPI,
Dialysis, EPO Metabolic Syndrome OHA, Anti-HTN,
Statins
Lifestyle ModificationsUniversal applicabilityPreventiveNo adverse effectsCheap and easily availableNo bitter pills to swallowCost – effectiveNo age restrictionsFun
How soon to start ? ? ?
“Children who cycle to school are
8 % more fit than children who use
other modes of transport”
- Anderson, BMJ 334:1173(Editorial June 2007)
''Those who think they do not have time for exercise will sooner or later have to
find time for illness''.
-Edward Stanley