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Noel R. Lamorena, MD

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Kar Twentyfive
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147 views

Noel R. Lamorena, MD

Uploaded by

Kar Twentyfive
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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NOEL R.

LAMORENA, MD
FACTS :
>33% OF DEATHS IN DEVELOPING
COUNTRIES ATTRIBUTABLE TO
CORONARY HEART DISEASE (CHD)

IN THE UNITED STATES 1.1 MILLION


MYOCARDIAL INFARCTIONS PER YEAR

225,000 DIE BEFORE


REACHING THE HOSPITAL
IN THE PHILIPPINE SETTING :
Leading causes of mortality ---
INFECTION
CORONARY HEART DISEASE (CHD)

USA : WORTHWHILE INTERVENTIONS


HAVE IMPROVED SURVIVAL BY 20-25%
PHILS : NOT ALL AREAS HAVE
APPROPRIATE EQUIPMENT AND KNOW
HOW TO ADDRESS CHD
PREVENTION -- ADDRESS RISK FACTORS

What is a cardiovascular risk factor ?

a characteristic or feature of an
individual (or population) that is associated
with an INCREASED risk of development of a
disease
A RISK FACTOR may be any of
the following :

Behavior –smoking
Inherited trait – family history of
CHD
Laboratory data – increased
cholesterol levels
From atherosclerosis
Formation of blood clots or plaques
that occlude blood flow through the
coronary vessels resulting in
ischemia or infarction
ATHEROSCLEROSIS BUILD UP
ATHEROSCLEROSIS BUILD UP
•Age female > 55 yo; male > 45 yo
•Hypertension
•Diabetes Mellitus
•Smoking
•High low density lipoprotein (LDL)
•Low high density lipoprotein (HDL)
•Family history of premature CHD
CIGARETTE SMOKING
•LEADING PREVENTABLE CAUSE OF
DEATH
•430,000 DEATHS/YEAR IN THE USA
40% FROM CVD (MI, STROKE)
REST – COPD, INFECTION, CANCER
CIGARETTE SMOKING

REGULAR SMOKER:
HAS 2X THE RISK OF
DEVELOPING CHD
HAS 50% CHANCE OF
DYING FROM IT
CIGARETTE SMOKING
CIGARETTE SMOKING
CIGARETTE SMOKING

CARDIOVASCULAR DISEASES RELATED TO


SMOKING :

MYOCARDIAL INFARCTION
ANEURYSMS
ISCHEMIC STROKE
PERIPHERAL ARTERIAL DISEASES
CIGARETTE SMOKING

•ACCELERATES PROGRESSION OF
ATHEROSCLEROSIS
•ENHANCES LDL OXIDATION
•REDUCES LEVELS OF HDL
•IMPAIRS ENDOTHELIUM DEPENDENT
CORONARY ARTERY VASODILATION
CIGARETTE SMOKING

•50% REDUCTION IN RISK IN THE FIRST


1-2 YEARS OF STOPPING
•AFTER 5-15 YEARS OF QUITTING, RISK
EQUALS THAT OF A NON-SMOKER
CHOLESTEROL REDUCTION
CHOLESTEROL REDUCTION

DESIRABLE LEVELS IN THE BLOOD :

TOTAL CHOLESTEROL < 200 MG/DL/5.2 MMOL/L


LDL < 130MG/DL/3.4 MMOL/L
HDL > 40 MG/DL/1.0 MMOL/L
TRIGLYCERIDES < 150MG/DL/1.7 MMOL/L
CHOLESTEROL REDUCTION

APPROACHES :

• DIET
• WEIGHT MANAGEMENT
• PHYSICAL ACTIVITY
• DRUGS – STATINS, FIBRATES
CHOLESTEROL REDUCTION

DIET :
<7% OF CALORIES FROM SATURATED FAT
<200 MG CHOLESTEROL PER DAY
55% CARBOHYDRATES
15% PROTEIN
10% POLYUNSATURATED FAT
20% MONOUNSATURATED FAT
BP CONTROL
BP CONTROL

A 7mm Hg increase in diastolic BP


BP CONTROL

TREATMENT :
•DRUG THERAPY
•CESSATION OF SMOKING
•WEIGHT REDUCTION IF NEEDED
•INCREASED PHYSICAL ACTIVITY
•LIMIT ALCOHOL AND SALT INTAKE
•LOW FAT DIET
CHD – A MAJOR COMPLICATION OF
DIABETES

DIABETES- INCREASES THE RISK OF


ATHEROSCLEROSIS

TREATMENT :
DRUGS
EXERCISE
DIET
CORRECTION OF CO MORBIDITIES
BENEFITS OF EXERCISE:

INCREASES HDL
•DECREASES LDL
•DECREASES TRIGLYCERIDES
•INCREASED INSULIN SENSITIVITY
•DECREASED RESTING BLOOD
PRESSURE
Dramatic increase in overweight and
obesity in the USA
FILIPINOS are following the western
diet-------
increase in the average weight of
Filipinos
ASSOCIATION OF OBESITY WITH CHD
IS CONFLICTING
Hypertension
Dyslipidemia
Glucose intolerance
WAIST CIRCUMFERENCE --- MEASURE
OF ABDOMINAL ADIPOSITY WHICH
INCREASES THE RISK FOR CHD
SUMMARY OF APPROACHES TO MODIFY
CHD RISK FACTORS:
•SMOKING CESSATION
•CHOLESTEROL REDUCTION
•BP CONTROL
•DM CONTROL
•INCREASED PHYSICAL ACTIVITY
•PREVENT OBESITY

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