Ch_11_CardiovascularHealth and Diabetes_LJH_FALL2023.pptx

CHAPTER 11 CARDIOVASC ULAR HEALTH AND DIABETES © 2019 McGraw-Hill Education Ltd LEARNING OBJECTIVES Summarize the major forms of cardiovascular disease and how they develop. Describe the risk factors associated with cardiovascular disease. List the steps you can take to protect yourself against c...

CHAPTER 11 CARDIOVASC ULAR HEALTH AND DIABETES © 2019 McGraw-Hill Education Ltd LEARNING OBJECTIVES Summarize the major forms of cardiovascular disease and how they develop. Describe the risk factors associated with cardiovascular disease. List the steps you can take to protect yourself against cardiovascular disease. Describe types, risk factors, and prevention strategies for diabetes 2 Ltd © 2019 McGraw-Hill Education MAJOR FORMS OF CARDIOVASCULAR DISEASE Atherosclerosis Heart Disease & Heart Attacks Stroke Congestive Heart Failure Hypertension 3 Ltd © 2019 McGraw-Hill Education CARDIOVASCULAR DISEASE – Some Statistics Second leading cause of death in Canada 90% of Canadian have at least one risk factor for hearth disease or stroke 4 Ltd © 2019 McGraw-Hill Education Atherosclerosis • is a CVD in which the inner layers of the artery walls are made thick & irregular by deposits of a fatty substance called plaque. is a slow, progressive hardening & narrowing of the arteries by plaques (deposits of fat, cholesterol, and other substances). 5 Ltd © 2019 McGraw-Hill Education Atherosclerosis The Stages of Plaque Development © 2019 McGraw-Hill Education Ltd Atherosclerosis The Stages of Plaque Development 7 Ltd © 2019 McGraw-Hill Education Main Risk Factors for Atherosclerosis Cigarette smoking Physical inactivity High concentration of cholesterol in the blood High blood pressure Diabetes mellitus 8 Ltd © 2019 McGraw-Hill Education Atherosclerosis - summary Coronary arteries -> coronary heart disease Blockage in the coronary arteries: heart attack Blockage in the cerebral arteries: stroke 9 Ltd © 2019 McGraw-Hill Education Health Consequences of Atherosclerosis Coronary Heart Disease (CHD) • also called coronary artery disease (CAD). • coronary arteries are particularly susceptible to plaque buildup. Angina Pectoris • a lack of blood supply to the heart that results in chest pain. • is a signal that the heart is not receiving its requirement of oxygen. • is felt as an extreme tightness in the chest & heavy pressure behind the breastbone or in the shoulder, neck, arm, hand, or back Heart Attack • also called myocardial infarction (MI). • caused by the blockage of a coronary artery. Stroke • also called cerebrovascular accident (CVA). • caused by the blockage of a cerebral artery or a ruptured blood vessel. Decreased supply of blood & oxygen to other organs & tissues in the body. 10 Ltd © 2019 McGraw-Hill Education Heart Disease & Heart Attacks FIGURE 11.2 11 Ltd © 2019 McGraw-Hill Education Heart Disease & Heart Attacks Coronary Thrombosis • is a heart attack caused by a blood clot in one of the coronary arteries supplying blood to the heart. Angina Pectoris • is a signal that the heart is not receiving its requirement of oxygen. • is felt as an extreme tightness in the chest & heavy pressure behind the breastbone or in the shoulder, neck, arm, hand, or Arrhythmia back. • is an irregularity in the force or rhythm of the heartbeat. • the heart may beat too quickly, too slowly, or in an irregular fashion. Sudden Cardiac Death • also called cardiac arrest. • is most often caused by an arrhythmia called ventricular fibrillation. 12 Ltd © 2019 McGraw-Hill Education Most Common Signs & Symptoms of a Heart Attack Chest discomfort: • • • • • in the centre or left side of the chest. usually lasts for more than a few minutes or goes away & comes back. can feel like pressure, squeezing, fullness, or pain. can also feel like heartburn or indigestion. can be mild or severe. Upper body discomfort in: • one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach. Shortness of breath: • may be the only symptom or it may occur before or along with chest pain or discomfort. • can occur at rest or during the performance of mild physical activity. Other possible signs & symptoms: • Breaking out in a cold sweat, lightheadedness, or sudden dizziness, or a change in the pattern of usual symptoms. 13 Ltd © 2019 McGraw-Hill Education Signs & Symptoms of a Heart Attack Not all heart attacks involve sharp chest pain. Women are more likely to have different signs & symptoms such as: • • • • • • • • Shortness of breath Weakness Unusual fatigue Cold sweat Dizziness Nausea Vomiting Pain in the back, shoulders, and jaw. 14 Ltd © 2019 McGraw-Hill Education Diagnosis of Heart Disease Exercise Stress Test + Electrocardiogram (ECG) • Running on a treadmill or pedaling on a stationary cycle. Magnetic resonance imaging (MRI) Electron beam computed tomography (EBC) Echocardiograms Angiograms 15 Ltd © 2019 McGraw-Hill Education Magnetic resonance imaging (MRI) Electron beam computed tomography (EBC) Echocardiogr am Angiogra m © 2019 McGraw-Hill Education Ltd Treatment of Heart Disease Low-fat diet Regular exercise Smoking cessation Take aspirin daily: • 81 mg to reduce clotting & inflammation. Prescription drugs Balloon angioplasty Implantation of coronary stents Coronary bypass surgery 17 Ltd © 2019 McGraw-Hill Education Treatment of Heart Disease © 2019 McGraw-Hill Education Ltd Stroke Occurs when the blood supply to the brain is cut off. Can cause permanent disability or be fatal. May cause: • • • • • Paralysis, Walking disability, Speech impairment, Memory loss, and Changes in behaviour. 19 Ltd © 2019 McGraw-Hill Education Stroke Major Types of Stroke Ischemic Stroke • caused by a blockage in a blood vessel • Thrombotic Stroke • caused by a blood clot that forms in a cerebral or carotid artery that has been narrowed or damaged by atherosclerosis. • Embolic Stroke • caused by an embolus, a wandering blood clot that is carried in the bloodstream & may become wedged in a cerebral artery. Hemorrhagic Stroke • occurs when a blood vessel in the brain bursts, spilling blood into the surrounding tissue. • Intracerebral Hemorrhage • a blood vessel ruptures within the brain. • Subarachnoid Hemorrhage • a blood vessel on the brain’s surface ruptures & bleeds into the space between the brain and the skull 20 Ltd © 2019 McGraw-Hill Education Types of Stroke 21 Ltd © 2019 McGraw-Hill Education Signs & Symptoms of a Stroke Sudden numbness or weakness in the face, arm, or leg, especially on 1 side of the body, even if temporary. Sudden confusion, trouble speaking or understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance or coordination. Sudden severe headache with no known cause. 22 Ltd © 2019 McGraw-Hill Education Effective Treatment of Stroke Prompt recognition of signs & symptoms of stroke. Correct diagnosis of the type of stroke. Use of clot-dissolving & antihypertensive drugs: • Health Canada has approved the use of the clotbusting drug called tPA to be used within 3 hours from the time symptoms begin. • Emerging science shows that tPA could be effective up to 4.5 hours afterwards. 23 Ltd © 2019 McGraw-Hill Education Silent Strokes are silent cerebral infarcts. do not cause any noticeable symptoms while they are occurring. leave their victims at a higher risk for subsequent & more serious strokes later in life. contribute to loss of mental & cognitive skills. 24 Ltd © 2019 McGraw-Hill Education Transient Ischemic Attack (TIA) has the same signs & symptoms as a stroke. symptoms usually last last less than 1 to 2 hours, but may last up to 24 hours. may occur once or more often in a person’s lifetime. can be a warning sign for future strokes. 25 Ltd © 2019 McGraw-Hill Education Congestive Heart Failure a condition resulting in the heart’s inability to pump out all of the blood that returns to it because the heart cannot maintain its regular pumping rate & force. as a consequence, fluids begin to back up in the body resulting in edema, usually in the legs & ankles, & sometimes in other parts of the body such as the lungs (pulmonary edema). Edema occurs when tiny blood vessels in your body, called capillaries, leak fluid. The fluid builds up in surrounding tissues, leading to swelling. 26 Ltd © 2019 McGraw-Hill Education Congestive Heart Failure Factors that can Damage the Heart’s Pumping Mechanism High blood pressure Heart attack Atherosclerosis Viral infections Rheumatic fever • A disease, mainly of children, characterized by fever, inflammation, & pain in the joints. • Often damages the heart muscle resulting in rheumatic heart disease. • Birth defects • • • • • Treatment • Reducing the workload on the heart • Modifying salt intake • Using drugs that help the body eliminate excess fluid 27 Ltd © 2019 McGraw-Hill Education Signs & Symptoms of Cardiac Arrest Sudden Cardiac Arrest (SCA) • Strikes immediately & without warning. • Heart suddenly & unexpectedly stops beating. • Signs & Symptoms • Usually, the 1st sign of SCA is fainting (loss of consciousness). • Sudden loss of responsiveness • Stops breathing. • Some people may experience a racing heart beat, dizziness, or lightheadedness before fainting. Within an hour before SCA some people experience • chest pain, shortness of breath, nausea, or vomiting. What to do if SCA occurs? • Call 911 and begin cardiopulmonary resuscitation (CPR) immediately. • An automated external defibrillator (AED) should be used if it is available and someone nearby knows how to use it. 28 Ltd © 2019 McGraw-Hill Education RISK FACTORS FOR CARDIOVASCULAR DISEASE Major CVD Risk Factors That Can Be Altered Major CVD Risk Factors That Can’t Be Altered Possible CVD Risk Factors Currently Being Studied Chapter 10, L02 29 Ltd © 2019 McGraw-Hill Education Major CVD Risk Factors That Can Be Altered The Canadian Heart Health Initiative and the Heart and Stroke Foundation of Canada have identified 10 controllable risk factors for CVD: Lifestyle-Related Controllable Risk Factors • • • • • • Tobacco Use Unhealthy Diet Physical Inactivity Unhealthy Weight Drug and Alcohol Abuse Stress Health Conditions Controllable Risk Factors: • • • • High Blood Pressure High Cholesterol Diabetes Atrial Fibrillation Chapter 10 30 Ltd © 2019 McGraw-Hill Education Tobacco Use The risk of developing CVD • increases with the length & intensity of exposure to cigarette smoke. Smokers • 2 to 4 times more likely to develop CVD than non-smokers. • have a 70% greater chance of dying from CVD than nonsmokers. Women smokers • triple their risk of dying from CVD. • 5 times more likely to die from a stroke than women nonsmokers. Non-smokers • have a higher risk of developing CVD because environmental tobacco smoke (ETS), also called second-hand smoke, in high concentrations has been linked to the development of CVD. 31 Ltd © 2019 McGraw-Hill Education Tobacco Use Ways in which Smoking Damages the CV System Damages the linings of arteries. Reduces the concentration of HDL cholesterol in the blood. Raises the concentration of LDL cholesterol in the blood. Raises the concentration of triglycerides in the blood. Nicotine increases blood pressure & heart rate. Carbon monoxide displaces oxygen in the blood. Causes platelets to stick together in the blood, leading to clotting. Speeds the development of fatty deposits in the arteries. 32 Ltd © 2019 McGraw-Hill Education Physical Inactivity Almost 60% of Canadians are so sedentary that they are at high risk for developing CVD. Exercise is thought to be the closest thing we have to a “magic bullet” against heart disease. Exercise lowers CVD risk by helping: • • • • • • Decrease blood pressure. Increase HDL concentration. Maintain desirable weight. Improve the condition of the blood vessels. Prevent type 2 diabetes. Control diabetes. 33 Ltd © 2019 McGraw-Hill Education Unhealthy Weight The risk of death from CVD is 2 to 3 times higher in people with obesity (BMI ≥ 30 kg/m2) than it is in lean people (BMI = 18.5 to 24.9 kg/m2). For every 5-unit increment of BMI, a person’s risk of death from coronary heart disease increases by 30%. Excess Weight • increases the strain on the heart by contributing to high BP and high cholesterol. • can lead to type 2 diabetes. Abdominal Obesity • is significantly associated with narrowing of the coronary arteries, even in young adults in their twenties. 34 Ltd © 2019 McGraw-Hill Education Drug and Alcohol Abuse Stimulant Drugs and Associated Stimulants • cause serious cardiac problems such as heart attack, stroke, and sudden cardiac death: • Cocaine • Methamphetamines • Ecstasy (MDMA) Injection Drug Use • can cause heart infections that can significantly increase the risk for stroke. Excessive Use of Alcohol • increases the risk for heart disease & stroke. 35 Ltd © 2019 McGraw-Hill Education High Blood Pressure although a CVD, is a risk factor for many forms of CVD, including: • heart attacks & strokes. is often called a “silent killer” because it usually has no symptoms. results from either • an increased output of blood by the heart or, most often, • an increased resistance to blood flow in the arteries: • constriction of smooth muscles surrounding the arteries, or by • atherosclerosis. is measured with a • stethoscope & a sphygmomanometer. 36 Ltd © 2019 McGraw-Hill Education 2017 Updated Blood Pressure Classification for Adults BP Classification Normal Systolic BP (mm Hg) Diastolic BP (mm Hg) < 120 and < 80 Elevated 120-129 and < 80 Stage 1 Hypertension 130-139 or 80-89 Stage 2 Hypertension ≥ 140 or ≥ 90 Hypertensive Crisis > 180 and/or > 120 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology May 2018, 71 (19) e127-e248; DOI: 10.1016/j.jacc.2017.11.006. 37 Ltd © 2019 McGraw-Hill Education High Blood Pressure Increases the risk of: • • • • • Heart attack Congestive heart failure Stroke Kidney failure Blindness Heart & Stroke Foundation of Canada • reports that hypertension is the most important controllable risk factor for stroke. Recent Research • indicates that the risk of death from heart attack or stroke begins to rise when blood pressure is above 115 mmHg / 75 mmHg. 38 Chapter 10 © 2019 McGraw-Hill Education Ltd High Blood Pressure Lifestyle changes recommended for individuals with prehypertension & hypertension: Weight reduction Regular physical activity A healthy diet • DASH Diet • Fruits • Vegetables • Whole grains • Foods rich in potassium, calcium & fibre • Diets rich in potassium & calcium may be helpful in preventing & treating hypertension. • Foods low in sodium Moderate consumption of alcohol. 39 Ltd © 2019 McGraw-Hill Education High Blood Pressure Many people are “saltsensitive:” • BP will decrease significantly when salt intake is restricted. Health Canada Guidelines: • Adequate Intake (AI) for Sodium • 1500 mg/day = about 2/3 of a teaspoon of salt. • Tolerable Upper Intake Level (UL) for Sodium • 2300 mg/day = about 1 teaspoon of 40 Ltd © 2019 McGraw-Hill Education Unhealthy Cholesterol Levels Cholesterol • is a fatty, waxlike substance that circulates through the bloodstream. • is an important component of: • Cell membranes, • Sex hormones, • Vitamin D, • The fluid that coats the lungs, • The protective sheaths around nerves. Excess cholesterol • can clog arteries. • increase the risk of CVD. 41 Ltd © 2019 McGraw-Hill Education Sources of Cholesterol Cholesterol is obtained by our bodies in 2 ways: Liver • About 80% of the body’s total cholesterol is manufactured in the liver. • A diet high in saturated & trans fatty acids increases the liver’s production of cholesterol. Food • About 20% comes from dietary sources of animal origin. • Cholesterol only comes from animal sources. Chapter 10 42 Ltd © 2019 McGraw-Hill Education What are lipoproteins? Lipoproteins • are carriers or transporters of lipids (cholesterol, triglycerides, & phospholipids) in the human body. • are composed of different proportions of cholesterol, triglycerides, phospholipids, & protein. • exist in a variety of forms: • Chylomicrons • Very-Low-Density Lipoproteins (VLDLs) • Low-Density Lipoproteins (LDLs) • High-Density Lipoproteins © 2019 McGraw-Hill Education Ltd Chapter 10 (HDLs). 43 The Structure of a Lipoprotein 44 Ltd © 2019 McGraw-Hill Education What are the functions of the lipoproteins? Chylomicrons • are lipoproteins synthesized in the small intestine after the consumption of a meal. • transport dietary (exogenous) lipids from the small intestine into the blood to various tissues of the body such as adipose, muscle, & liverLipoproteins tissues. Very-Low-Density (VLDLs) • are lipoproteins synthesized in the liver that transport body (endogenous) lipids to various tissues of the body. 45 Ltd © 2019 McGraw-Hill Education What are the functions of the lipoproteins? Low-Density Lipoproteins (LDLs) • are formed through the breakdown of VLDLs in the blood. • transport cholesterol from the liver to the organs & tissues that require it. • are known as “bad” cholesterol because an amount beyond the body’s needs is deposited in the walls of blood vessels such as arteries & may be oxidized by free radicals resulting in inflammation & damage of the artery walls.Lipoproteins (HDLs) High-Density • are formed mainly by the liver. • transport cholesterol from the body’s tissues back to the liver for recycling or excretion, & as a result, they are known as “good” cholesterol. 46 Ltd © 2019 McGraw-Hill Education Travels with Cholesterol FIGURE 11.3 47 Ltd © 2019 McGraw-Hill Education Cholesterol & Triglyceride Guidelines Classification Concentration (mmol/L) Total Cholesterol Desirable < 5.2 Borderline High 5.2 < 6.2 High ≥ 6.2 LDL (Bad) Cholesterol Optimal < 2.6 Near Optimal/Above Optimal 2.6 < 3.4 Borderline High 3.4 < 4.2 High 4.2 < 5.0 Very High ≥ 5.0 48 Ltd © 2019 McGraw-Hill Education Cholesterol & Triglyceride Guidelines Classification Concentration (mmol/L) HDL (Good) Cholesterol Low (Undesirable) < 1.0 Normal 1.0 < 1.6 High (Desirable) ≥ 1.6 Triglycerides Normal < 1.7 Borderline High 1.7 < 2.3 High 2.3 < 5.7 Very High ≥ 5.7 From National Cholesterol Education Program. The 3rd Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, & Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), 2002. NIH Publication No. 02- 5215. 49 Ltd © 2019 McGraw-Hill Education High Risk for CVD In general, a high risk for CVD is associated with: a high total cholesterol blood concentration, a high LDL blood concentration, a high triglyceride blood concentration, & a low HDL blood concentration. 50 Ltd © 2019 McGraw-Hill Education Improving Cholesterol Levels Primary Goal: • Reduce LDL to healthy levels by: • Choosing unsaturated fats instead of saturated & trans fats, • Increasing soluble fibre intake, • Eating more fruits, vegetables, & whole grains, • Consume food products containing plant stanols & plant sterols, • Consume soy protein, • Exercising regularly. Supplemental Goal: • Raise HDL levels by: • Exercising regularly, • Losing weight, if overweight, • Quitting smoking, & • Altering the amount & type of dietary fat consumed. Chapter 10 51 Ltd © 2019 McGraw-Hill Education Diabetes Mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in: • insulin secretion, and/or • insulin action (or proper use of insulin). is a major endocrine disorder. increases the risk for CVD, • partly because elevated blood glucose levels can damage the lining of arteries, making them more vulnerable to atherosclerosis. 52 Ltd © 2019 McGraw-Hill Education Atrial Fibrillation is a type of irregular heart rhythm (arrhythmia). is the most common arrhythmia, affecting approximately 200,000 Canadians. risk increases with age. main complications are stroke and heart failure. affects the atria, the top 2 chambers of the heart. can cause your heart to beat very quickly, sometimes more than 150 beats per minute, a faster than normal heartbeat is known as tachycardia. is estimated to cause one-fourth of all strokes after age 40. • Source: https://www.heartandstroke.ca/heart/conditions/atrialfibrillation 53 Ltd © 2019 McGraw-Hill Education Major CVD Risk Factors That Can’t Be Altered Heredity (Family History) Aging Being Male Ethnicity Inflammation 54 Ltd © 2019 McGraw-Hill Education Major CVD Risk Factors That Can’t Be Altered Heredity (Family History) • Having an unfavorable set of genes: • increases a person’s risk to develop CVD, • does not guarantee the development of CVD. • risk is modifiable by lifestyle factors such as smoking, exercise, & diet. • suggests a person will have to work harder than other people to prevent the disease by controlling risk factors for CVD that can be altered. Aging • After age 65, • the risk of heart attack increases dramatically. • For people over 55, • the incidence of stroke increases by about 30% in each successive decade. 55 Ltd © 2019 McGraw-Hill Education Major CVD Risk Factors That Can’t Be Altered For Male • CVD • is the leading killer of both men & women in Canada. • kills about the same number of women as it does Formen. women • CVD typically does not develop until after age 50 because prior to menopause the hormone estrogen plays a protective role by improving blood lipid concentrations & reducing other CVD risk factors. • recent research suggests that the number of CVD deaths in women aged 35 to 45 years may be © 2019 McGraw-Hill Education Ltd increasing. 56 Major CVD Risk Factors That Can’t Be Altered Ethnicity Death rates from heart disease vary among ethnic groups in Canada. First Nations & Inuit have a higher rate of CVD than the Canadian population as a whole. As immigrant groups begin to adopt more unhealthy lifestyle habits, their risk for CVD increases. 57 Ltd © 2019 McGraw-Hill Education Major CVD Risk Factors That Can’t Be Altered Inflammation • plays a key role in the development of CVD. • is produced when an artery is injured by hypertension, smoking, high levels of total & LDL cholesterol, or other factors. • can be measured by conducting a blood test for Creactive protein (CRP): • A high blood concentration of CRP indicates a substantially elevated risk of heart attack & stroke. • CRP may also be harmful to the coronary arteries. Gum Disease • involves another type of inflammation that may moderately influence the progress of coronary heart disease (CHD). 58 Ltd © 2019 McGraw-Hill Education Possible CVD Risk Factors Currently Being Studied Elevated homocysteine Severe vitamin D deficiency Infectious Agents Elevated fibrinogen coronavirus Chapter 10 59 Ltd © 2019 McGraw-Hill Education Possible CVD Risk Factors Currently Being Studied Homocysteine • is an amino acid that may damage the lining of blood vessels. • levels that are elevated are associated with an increased risk of CVD. • levels are generally higher in men than in women. • levels are high in individuals with diets low in folic acid, vitamin B12, & vitamin B6. • levels can be lowered by consuming foods such as fruits, vegetables, & grains and/or by taking supplements that contain • folate/folic acid, vitamin B12, & vitamin B6Education . © 2019 McGraw-Hill Ltd 60 Possible CVD Risk Factors Currently Being Studied Severe Vitamin D Deficiency • associated with heart dysfunction. Infectious Agents • Chlamydia pneumoniae • Cytomegalovirus • Helicobacter pylori Gum Disease • Gingivitis, the beginning stages of gum disease, causes gums to become inflamed & to bleed easily. • is a potential risk factor for CVD. Fibrinogen • is a protein involved with blood clotting. • at higher levels, is believed to be another marker for a higher risk to develop CVD. 61 Ltd © 2019 McGraw-Hill Education PROTECTING YOURSELF AGAINST CARDIOVASCULAR DISEASE Eat a Heart-Healthy Diet Exercise Regularly Avoid Tobacco Know & Manage Your Blood Pressure Know & Manage Your Cholesterol Levels Develop Ways to Handle Stress & Anger Know Your Risk Factors 62 Ltd © 2019 McGraw-Hill Education Eat Heart Healthy Decreased Fat & Cholesterol Intake Increased Fibre Intake Decreased Sodium Intake & Increased Potassium Intake Moderate Alcohol Use DASH 63 Ltd © 2019 McGraw-Hill Education Decreased Fat & Cholesterol Intake Health Canada Recommendations All Canadians • Total Fat Intake • Not > 30% of total daily calories. • Saturated Fat Intake • Not more than 1/3 of the recommended total fat consumption • 1/3 of 30% = 10% of total daily calories. People with Heart Disease or High LDL Levels • Total Fat Intake • 25-35% of total daily calories. • Saturated Fat Intake • < 7% of total daily calories. 64 Ltd © 2019 McGraw-Hill Education Increased Fibre Intake Soluble fibre • traps the bile acids the liver needs to manufacture cholesterol & carries them to the large intestine, where they are excreted. A high-fibre diet • is associated with a 40-50% reduction in the risk of heart attack & stroke. Daily Dietary Fibre Recommendation • 25 to 38 g. Good Sources of Fibre • • • • Oatmeal Some breakfast cereals Barley Legumes, & most fruits & vegetables 65 Ltd © 2019 McGraw-Hill Education Decreased Sodium Intake & Increased Potassium Intake Recommended Limits for Sodium Intake Healthy Adult Males & Females • Tolerable Upper Intake Level = 2300 mg/day Hypertension, Middle-Aged & Older Adults, & Some Ethnic Groups • 1500 mg/day Recommended Limit for Potassium Intake Healthy Adult Males & Females • Adequate Intake = 4700 mg/day 66 Ltd © 2019 McGraw-Hill Education Moderate Alcohol Use Moderate alcohol consumption: Men • Not more than 2 drinks/day. Women • Not more than 1 drink/day. • may increase HDL cholesterol. • may reduce stroke risk. Excessive alcohol consumption increases the risk of: • • • • • • Hypertension Stroke Some cancers Liver disease Alcohol dependence Injuries 67 Ltd © 2019 McGraw-Hill Education DASH It is a dietary plan that was part of a study called Dietary Approaches to Stop Hypertension. diet plan incorporates the following: • • • • • • • • 7-8 servings/day of grains & grain products, 4-5 servings/day of vegetables, 4-5 servings/day of fruits, 2-3 servings/day of low-fat or nonfat dairy products, 2 or fewer servings/day of meats, poultry, & fish, 4-5 servings/wk of nuts, seeds, & legumes, 2-3 servings/day of added fats, oils, & salad dressings, 5 servings/wk of snacks & sweets. 68 Ltd © 2019 McGraw-Hill Education Exercise Regularly A moderate amount of physical activity • can significantly reduce your risk of CVD A formal exercise program • can provide even greater benefits. 69 Ltd © 2019 McGraw-Hill Education Avoid Tobacco Smoking • is the number-one risk factor for CVD that you can control. Quitting smoking • will significantly reduce your CVD risk. Studies show that smoking • may permanently increase the rate of plaque formation in arteries. 70 Ltd © 2019 McGraw-Hill Education Know & Manage Your Blood Pressure If you have no CVD risk factors, • Have your BP measured at least once every 2 years. If you have CVD risk factors, • have your BP measured yearly. If your blood pressure is high, • follow your physician’s advice on how to lower it. 71 Ltd © 2019 McGraw-Hill Education Know & Manage Your Cholesterol Levels Everyone 20 years of age • should have a lipoprotein profile at least once every 5 years. • measure total cholesterol, LDL cholesterol, HDL cholesterol, & triglyceride levels. Your LDL goal depends on the number of major risk factors for CVD that you have: • • • • • • Cigarette smoking, High blood pressure, Low HDL cholesterol, Family history of heart disease, Age > 45 years for men, & Age > 55 years for women. 72 Ltd © 2019 McGraw-Hill Education Develop Ways to Handle Stress & Anger To reduce the psychological & social risk factors for CVD, • develop effective strategies for handling the stress in your life. 73 Ltd © 2019 McGraw-Hill Education Know Your Risk Factors Know your CVD risk factors. Follow your physician’s advice for • Testing, • Lifestyle changes, & • Any drug treatments. 74 Ltd © 2019 McGraw-Hill Education Types of Diabetes Mellitus • Type 1 Diabetes Mellitus • Insulin-Dependent Diabetes Mellitus (IDDM) • Juvenile-Onset Diabetes Type 2 Diabetes Mellitus • Non-Insulin-Dependent Diabetes Mellitus (NIDDM) • Adult-Onset Diabetes Gestational Diabetes • develops in 2-5% of all pregnancies but disappears when a pregnancy is over. Other Specific Types of Diabetes that result from: • Specific Genetic Syndromes, Surgery, Drugs, • Malnutrition, Infections, Other illnesses. 75 Ltd © 2019 McGraw-Hill Education Characteristics of Type 1 & Type 2 Diabetes Characteristics Type 1 Type 2 Usually < 30 Usually > 40 Proportion of All Diabetics 5-10% 90-95% Appearance of Symptoms Acute or subacute Slow Frequent Rare Obesity at Onset Uncommon Common B-Cells Decreased Variable Insulin Decreased or none Variable Age at Onset (years) Metabolic Ketoacidosis 76 Ltd © 2019 McGraw-Hill Education 77 Ltd © 2019 McGraw-Hill Education Health Consequences Kidney failure Nerve damage Circulation problems Retinal damage Blindness Heart attack Stroke Hypertensi on Ethnicity is also a factor involved in the development of type 2 Major Factors Involved in the Development of Type 2 Diabetes Diabetes & Excess Body Fat Aboriginal, Hispanic, Asian, South Asian, or African descent. Age Obesity Physical Inactivity Family History Lifestyle Chapter 6 78 Ltd © 2019 McGraw-Hill Education Diabetes & Excess Body Fat Frequent urination Blurred vision SIGNS & SYMPTOMS Extreme hunger or thirst Unexplained weight loss Testing of Diabetes Mellitus Fasting Blood Glucose Test Diabetes: ≥ 7 mmol/L. Prediabetes: 5.6 to < 7.0 mmol/L. Glucose Test Uses a set dose of glucose Tingling or numbness in the hands or feet Extreme fatigue Frequent infections Cuts & bruises that are slow to heal Generalized itching with no rash 79 Ltd © 2019 McGraw-Hill Education Diabetes Classification Fasting Blood Glucose Test Category Normal [Glucose] (mmol/L) < 5.6 Impaired 5.6 and < 7.0 Diabetes ≥ 7.0 Source: The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 26 (Suppl. 1): S5-S20, 2003. 80 Ltd © 2019 McGraw-Hill Education Diabetes Mellitus Individuals with diabetes have the following risk factors that increase their risk for CVD: • • • • • • • Elevated blood glucose levels, Atherosclerosis, Hypertension, Obesity, Unhealthy cholesterol levels, Unhealthy triglyceride levels, & Platelet & blood coagulation abnormalities. Individuals with pre-diabetes & controlled diabetes • face an increased risk of CVD. 81 Ltd © 2019 McGraw-Hill Education Diabetes & Excess Body Fat Treatment No cure Managed through diet, exercise, and, if necessary, medication. Majority of people with type 2 diabetes are living with overweight when diagnosed (55% are living with obesity) Prevention Regular physical activity Moderate diet Composition of the diet Modest weight loss Routine screening for individuals over 45 years of age and anyone younger who is at high risk, including individuals that are living with obesity. 82 Ltd © 2019 McGraw-Hill Education