Coronary Heart Disease

and Obesity

By Sheila Mulhern

Coronary Heart Disease & Obesity Topic Outline

• Many studies show the similar risk factors and correlations between CHD and obesity.

• Identify coronary heart disease and obesity conditions and complications.

• Compare data reports from the Center of Disease Control on US reports for most and least obese states with heart disease mortality rates.

• Examine study on lifestyle and dietary risk factors that contribute to the preventable areas of heart disease and obesity.

• Identify economic costs of heart disease and obesity, types of treatments available and the proper diet options.

• Organizations dedicated to heart disease and obesity awareness.

What is Coronary Heart Disease (CHD)?

• Condition where major blood vessels that transport blood, oxygen and nutrients become damaged and diseased.

• Also called Coronary Artery Disease (CAD).

• Builds up over time and can often be undetectable for a long period of time.

*Information courtesy of MayoHealth Clinic http://www.mayoclinic.com/health/coronary-artery-disease/DS00064

What is Coronary Heart Disease (CHD)?

• Plaque deposits build on the walls of blood vessels and cause thinning of artery walls, slowing blood flow.

• Narrowing of artery walls can lead to heart conditions of chest pain (angina), heart arrhythmia, heart failure or heart attack.

CHD Risk Factors

• High blood cholesterol levels: causes plaque formation from– High levels LDL: low-density lipoproteins (bad

cholesterol)– Low levels HDL: high-density lipoproteins

(good cholesterol)

• Diabetes: related to CHD in similar risks of obesity and high blood pressure,

• Obesity: higher BMI rates increase risk.

• Age, Gender, Family history, Smoking , Poor diet, Physical activity, High stress, Poor hygiene.

• High blood pressure: can harden and thicken artery valves, which narrows blood vessels.

Further Complications from CHD

• Aneurysm: – Bulge or burst in artery

• Peripheral artery disease: – Extremities (usually legs) don’t receive enough blood flow

• Sudden cardiac arrest – Sudden loss of heart, breathing and consciousness

• Heart attack– Blood clot blocks flow of blood from the coronary artery to the heart

• Stroke– Blood narrowed or blocked and can’t reach the brain

CDC Facts on Heart Disease• Heart Disease is the #1 cause of death in the

U.S. at 26.5%– Followed by Cancer (22.8%), Stroke (5.9%), Chronic

Lung Diseases (5.3%), Accidents (4.7%) and Alzheimer’s Disease (2.9%)

• Number of U.S. deaths from heart disease in 2007: 616,067

• Estimated new coronary attacks for Americans in 2009: 785,000

• Estimated recurring attack in 2009: 470,000

Obesity Overview

• Having a BMI (body mass index) of 30 or higher.

• Causes: inactivity, unhealthy diet, pregnancy, lack of sleep, certain medication, medical problems.

• Risk factors: genetics, family history, age, smoking, socioeconomic conditions.

Obesity Complications

• Cancer• Heart disease• Depression• High blood pressure• Metabolic syndrome• Stroke• Sleep apnea• Diabetes• Gallbladder or Liver disease• Osteoarthritis• Disability, quality of life

issues

Obesity Statistics

• More than two-thirds (68%) of American adults are either overweight or obese.

• Average national BMI: men (26.6), women (26.5) (Healthy 18.5-24.9).• Rates across the country have been consistently increasing.• How do obesity rates compare with heart disease mortality rates?

Center for Disease Control: Most Obese States & Heart Disease

CDC Obesity Ranking

State Obesity % CHD Mortality

Rate (ave annual deaths per 100,000)

1 Mississippi 34.4 597

2 Louisiana 33.0 511

3 Tennessee 32.3 513

4 Kentucky 31.5 524

5 Oklahoma 31.4 552

National Average

USA 428

Center for Disease Control: Least Obese States & Heart Disease

CDC Obesity Ranking

State Obesity % CHD Mortality Rate (ave annual deaths per 100,000)

51 Colorado 18.6 308

50 Washington, DC

19.7 547

49 Connecticut 20.6 388

48 Massachusetts 21.4 375

47 Hawaii 22.3 321

National Average USA 428

PLoS Medicine Study: Preventable Causes of Death in the United States

• Compared dietary, lifestyle and metabolic risk factors in preventable diseases.

• Used data from national health surveys and mortality statistics from the National Center for Health Services.

• Conclusions– Smoking and high blood pressure, which each have effective

treatments are responsible for the largest number of deaths in the U.S.

– Additional preventable lifestyle and dietary risk factors for chronic diseases also contribute to a large number of deaths in the U.S.

PLoS Medicine Study: Comparing Risk Factors with Disease Outcome, 2009

Metabolic Risk Factor

Exposure Metric Disease Outcomes

High blood glucose Level of fasting plasma glucose

Heart disease, stroke, renal failure, colorectal, breast and pancreatic cancers

High LDL cholesterol

Level of LDL cholesterol

Heart disease, stroke, additional select cardiovascular diseases

High blood pressure

Level of systolic blood pressure

Heart disease, stroke, hypertension, renal failure, additional cardiovascular diseases

Overweight-Obesity

BMI (high) Heart disease, stroke, hypertension, diabetes, gallbladder, colon, kidney, postmenopausal breast cancer

PLoS Medicine Study: Comparing Risk Factors with Disease Outcome, 2009

Metabolic Risk Factor

Exposure Metric Disease Outcomes

High trans fatty acids

% of total calories from dietary trans fatty acids

Heart disease

High salt diet Level of dietary sodium adjusted for total calories

Heart disease, stroke

Low fruit & vegetable intake

Dietary fruit/vegetable intake adjusted for total calories

Heart disease, stroke, colorectal, stomach, lung, mouth cancers

Physical inactivity Measured in 4 categories: inactive, low-active, moderate, high activity

Heart disease, stroke, breast and colon cancers, diabetes

Treatments and Drugs for Heart Disease and Obesity

• Lifestyle changes – increase physical activity and exercise, improve diet, reduce caloric intake, decrease stress levels, don’t smoke, limit alcohol intake, behavior change

• Medications – can lower blood pressure, blood thinners, cholesterol-lowering medications (Crestor, Lipitor), weight loss (Xenical, Alli)

• Medical procedures or surgery– Heart disease: angioplasty (inserting stents), bypass

surgery, open heart surgery, heart transplant– Obesity: gastric bypass, lap band (BMI of 35 to 39.9)

The Medical Costs of CHD and Obesity• Table 1 – Estimated Annual Excess Healthcare Costs of Chronic

Conditions and Total Cost of Normal Weight Individuals: United States, 2020-2050. Combined Results of Men and Women.

– National Health and Nutrition Examination Survey – shows overweight adolescents likely to become overweight.

– Calculates potential, additional costs per year, per person.

– Estimates for direct (healthcare) and indirect (sick and disability leave).

– Economic costs, health and productivity factors all influenced.

Age, y Obesity, $ Diabetes, $ CHD, $ Total Cost Normal Weight, $

35-44 438 7,380 24,408 7,411

45-54 426 9,828 31,893 9,949

55-64 430 9,828 32,994 14,705

65-74 430 18,458 26,840 20,603•Data from American Journal of Public Health – Forecasting the Future Economic Burden of Current Adolescent Overweight: An Estimate of Coronary Heart Disease Policy Model. 2009.

Recipe for a Heart-Healthy Diet

Recommended Diet– Fruits, vegetables – low in

calories but high in dietary fiber which is good for a healthy heart

– Select whole grains and low sodium (DASH Diet) to regulate blood pressure

– Low-fat milk, nuts, poultry, fish– Diets high in vitamins A, C and E– Control portion sizes– Plan menus ahead

Avoid– Burger, fries, butter, red meat,

food high in unhealthy fats and cholesterol

– Reduce salt intake (less than a teaspoon a day

Organizations Dedicated to Heart Disease Awareness

• February is dedicated to Heart Disease awareness

• National Heart, Lung and Blood Institute (NIH)– The Heart Truth® Champions Program

• American Heart Association– Go Red For Women

• Children’s Heart Foundation– CHDs affect approximately one out of every 100 births, or more

than 35,000 babies each year

– CHDs are the #1 birth defect in the world

Organizations Dedicated to Obesity and Health

• Shape Up America– Educate the public and promote the

importance of physical fitness and healthy eating

• Get America Fit Foundation– Dedicated to breaking obesity cycle and

providing fitness opportunities and equipment to underprivileged

• Healthy People 2010, 2020– National health initiative under the U.S.

Dept. of Health and Human Services to identify health objectives and how to eliminate them