ACUTE CORONARY SYNDROMES,

RİSK FACTORS AND PREVENTİON

KOÇ UNIVERSİTY SCHOOL OF NURSING

SERPİL TOPÇU R.N., M.S.N.

ACUTE CORONARY SYNDROMES

• Acute coronary syndrome (ACS) refers to a group of

conditions due to decreased blood flow in the coronary

arteries such that part of the heart muscle is unable to

function properly.

Coronary Artery DiseaseClinical Signs;

• Sudden death

• Heart failure

• Stable angina pectoris,

• Unstable angina pectoris,

• Myocardial infarction (MI)

Global Atlas On Cardiovascular Disease

Prevention And Control- 2011

Global Atlas On Cardiovascular Disease

Prevention And Control- 2011

Cardiovascular DiseaseProfile Around the World

COUNTRIES CVD MORTALITY RATE

European Union members %40

China (1/5 of the world's population)

%36

Latin America %31

Middle East %25-45

India (1/6 of the world population )

%24

Africa %10 (primary stroke)

Türkiye Kalp Ve Damar Hastalıklarını Önleme ve Kontrol Programı 2010-2014

Cardiovascular DiseaseProfile in Turkey

• Primary cause of the disability-adjusted life

year (DALY) in Turkey is cardiovascular diseases -

%19.32

• DALY results on cardiovascular disease;o Males -%20,5

o Females -%18

Türkiye Hastalık Yükü Çalışması- UHY (DALY- 2004)

RISK FACTORS AND

PREVENTION

Türkmen E, Badır A, Ergün A ( 2012). Koroner Arter Hastalıkları Risk Faktörleri: Primer ve Sekonder Korunmada Hemşirelerin Rolü. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. Cilt: 3 • Sayı: 4 • Ekim

1- Tobacco Smoking

- Turkey is 3rd in Europe and 7th around the world about

smoking

- Smoking rate in;

Men % 47,9

Women % 15,2

Prevention of SmokingIn Turkey

• November 25 2004 “Tütün Kontrol Çerçeve

Sözleşmesi-WHO-FCTC Framework Convention on Tobacco

Control” is accepted;

- Raise awareness of the public

- Quit smoking

- Price and taxes

- Passive smoking control

- Advertising and sponsorship

- Product control and consumer education.

2- Overweight and Obesity

• Every year 2.6 million people dies due to overweight and

obesity. It is related to CVD.

• In Turkey according to TURDEP- I (2002)results obesity

rate;

- Men - %25.3

- Women - %46.2

• TURDEP- II (2010)

• Obesity - %44 ↑

- Waist circumference - women 6cm↑,

-men 7cm↑

Definition of Overweight andObesity

Target 1: Waist circumference

Men ≥ 94 cm, w𝒐𝒎𝒆𝒏 ≥ 80 cm (do not gain weight)

Target 2: Waist circumference

Men ≥ 102 cm, women ≥ 88 cm ( advice losing weight)

Prevention of Overweight and Obesity

• Diet, exercise, and behaviour modifications

• Medical therapy with orlistat and/or bariatric surgery for

patients with BMI ≥35 kg/m2 or a BMI ≥35 kg/m2 in the

presence of high-risk comorbid conditions are the only

options.

• Saturated fatty acids to account for <10% of total energy

intake, through replacement by polyunsaturated fatty acids

• Avoid processed food,

• <5 g of salt per day

• 30–45 g of fibre per day, from wholegrain products, fruits

and vegetables

• fruits and vegetables per day 2-3 servings

• Fish at least twice a week, one of which to be oily fish.

3- Physical Inactivity

Physical Inactivity

With 150 minutes of regular exercise per week.

- Reducing ischemic heart diseases %30

- Reducing Diabetes rate %27

Physical InactivityIn Turkey;

According to the results of : “Sağlıklı Beslenelim, Kalbimizi

Koruyalım (2004)” (N:15.468) ;

Only 3,5% of people are doing regular exercise at least 3

times a week 30 minute.

Physical Inactivity and Obesity

Prevention- In Turkey

• Educating children about healthy food by family, teacher

and public health nursing.

• Advertisement control about fast food.

• Regulating menus of branch restaurants which are suitable

for preventing CVD

• Organizing exercise programs.

• The main responsibility belongs to health care providers.

TKD Ulusal Kalp Sağlığı Politikası Raporu

4- Hypertension

Hypertension

• HT is the major risk factor MI, stroke, hearth and kidney

failure, vascular dieseases and blindness

• High blood pressure is responsible of the total deaths of

%13around the world.

• According to Turkish Hypertension Prevalence Study;

• Nearly 15 milion people have hypertension however

%40 of them are aware of high blood pressure

• Only %31of them are taking antihypertensive therapy.

Reduce; Systolic blood pressure 20 mmHg

Diastolic blood pressure 11 mmHg ;

• Decrease Stroke risk % 63

• CVD risk % 46

TKD Ulusal Kalp Sağlığı Politikası Raporu

Prevention of Hypertension

• Weight control, increase pyhsical activity level

• Reduce alcohol intake

• Limiting salt intake

• More Vegetable and fruit

• Prefering saturated dairy products

• It is suggested to all hypertensive and high normal blood

pressure patient ( Class I, Level B).

Prevention of Hypertension1. Social Practice

• Starting prenventive life style changes in childhood.

• Family and school education programs.

• Ministery of Health, Education, Sports, Agriculture and

Religion etc. Should support this cause using media.

• Writing the salt level and calorie in food ingridients.

• Decreasing salt level in all food products.

Prevention of Hypertension

• People should be encourage to exercise and it should be

accessible.

• Necessary prevention should be applied to quit smoking

2- Personal Practice

• Healthy life style

• This is the main responsibiliyt of health care provider.

5- Alcohol

• The relationship between alcohol and CVD is not

clarified yet.

• If moderate alcohol use is peep

- CVD risk factors

- Hard to control blood pressure

- Synergetic effect of cigarates.

- Obesity

Prevention of CVD

• Moderate alcohol use is suggested.

Women 1 cup per day (10 g alcohol),

Men 2 cups per day (20 g alcohol)

6- Diabetes

• Diabetes was accepted by United Nations for the first time a

non-infected diesea is considered as a global health threat

(Dec, 20 2006). They also called the countries in action to

fight againts diabetes.

Prevention of CVD with Diabetes;

Target HbA1c <%7.0

• Statines use

• Prevent gaining execisive weigth and hypoglisemi

• BP <140/80 mmHg

Prevention of DiabetesT.C. Ministry of Health Action Plan (2011-2014)

• Prevention of diabetes, to increase quality of care in

patients with diabetes and decrease complications of

diabetes and deaths.

http://www.saglik.gov.tr/HM/dosya/1-71375/h/turkiye-diyabet-onleme-ve-kontrol-

programi.pdf

7- Hyperlipidemia

Prevention of Hyperlipidemia

• Life style changes.

• Drug treatment.

8- Social Factors

• Poverty, lack of education and unplanned urbanization

have a negative impact on cardiovascular health.

• Unfair distribution of power, money and resources

increases exposure to cardiovascular risk factors.

9-Risk Factors Take Root In The Womb,Childhood And Youth

• Undernutrition in fetal life and infancy increases an

individual’s vulnerability to CVD.

• Low birth weight is related to CVD and DM

• Healthy behaviours are learned in childhood and

continue into adulthood.

• Passive smoking exposure in childhood.

TÜRKİYE HASTALIK YÜKÜ ÇALIŞMASI 2004

RİSK FAKTÖRLERİ ÖNLENEBİLİR ÖLÜM ORANLARI

Hipertansiyon %25,2

Beden Kitle İndeksi ( BKİ) %13,3

Tütün kullanımı %12,7

Hiperlipidemi %11,4

Fiziksel aktivite %10,5

Sebze meyve tüketimi %9

Ilımlı alkol %4,3

Nursing Roles in PreventionPrimary prevention;

Primary prevention in providing of CAD is worse than

secondary;

Because of

• Risk calculators focus on short-term risk

• Prediction difficulties (people who are at risk)

Nursing Roles in Prevention

Results of the study;

• Students were knowledgeable about cardiovascular

disease and associated risk factors,

• There were significant gaps in their knowledge; these

should be addressed through improved nursing curricula.

• While students were generally healthy, they could

improve their practice of health-promoting behaviors.

According to nursing case manager models in secondary

prevention;

• Proper medication use results in improvements in risk

factors, exercise toleration, blood glucose level

• CVD

• Mortality

• Coronary atherosclerosis

• Perception of healht improves

The EUROACTION trial studying patients with

CHD and those at high risk of CVD in 8 countries;

The approach was;

• Family centred and led to healthier lifestyle changes in

terms of diet and physical activity, improvements in

lifestyle e (diet and physical activity)

• More effective control of risk factors such as blood

pressure in both patients and their partners in the

intervention arm compared with usual care

CCNAP: Council on Cardiovascular Nursing and Allied

Professions

and

AHA CVD Nursing Comitte prepare a settelement about

nurses to have an active role in prevention of CVD.