Because learning changes

everything. ®

Fit & Well:

Core Concepts and Labs in Physical Fitness and
Wellness
Present by MB Ntjana

11: Cardiovascular
Health and Diabetes
© McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC.
 Looking Ahead...

After reading this chapter, you should be able

to:
• 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.

© McGraw Hill LLC 2

 Major Forms of Cardiovascular
Disease
Cardiovascular disease (CVD): a collective
term for various diseases of the heart and
blood vessels.
• Heart disease, heart attack, stroke, and angina
(chest pain).
• Blood vessel diseases, arrhythmias (heart
rhythm problems), congenital heart defects, and
other conditions.

CVD is the leading cause of death in the United

States.
• This is largely due to our way of life.

© McGraw Hill LLC 3

 Atherosclerosis
Atherosclerosis: a form of CVD in which the inner
layers of artery walls are made thick and irregular
by plaque deposits; arteries become narrowed, and
blood supply is reduced.
• It begins when the cells lining the arteries become
damaged.
• Plaque: a deposit of fatty (and other) substances on
the inner wall of an artery.
• Coronary heart disease (CHD): heart disease
caused by atherosclerosis in the arteries that supply
blood to the heart muscle; also called coronary artery
disease (C͏A͏D).
• A blockage of a coronary artery causes a heart attack.
• A blockage of a cerebral artery causes a stroke.
© McGraw Hill LLC 4
 Figure 11.1 Atherosclerosis: The Process of
Cardiovascular Disease
Access the text alternative for slide images.

© McGraw Hill LLC Source: Centers for Disease Control and Prevention. 2023. Heart Disease Facts (www.cdc.gov/heartdisease/facts.htm). 5
 Heart Disease and Heart Attacks 1

Heart attack: damage to, or death of, heart

muscle, resulting from a failure of the coronary
arteries to deliver enough blood to the heart;
also known as myocardial infarction (MI).
• Although a heart attack may come without
warning, it is usually the result of a long-term
disease process.

Angina pectoris: a condition in which the

heart muscle does not receive enough blood,
causing severe pain in the chest and often in
the arm and shoulder.

© McGraw Hill LLC 6

 Figure 11.2 Blood Supply to the Heart
Blood is supplied to the heart from the right and left coronary arteries, which branch off
the aorta. If a coronary artery becomes blocked by plaque buildup or a blood clot, a
heart attack occurs; part of the heart muscle may die due to lack of oxygen.

Access the text alternative for slide images.

© McGraw Hill LLC 7

 Heart Disease and Heart Attacks 2

A heart attack is a circulation problem; cardiac arrest is

an “electrical” problem. If the electrical impulses that
control heartbeat are disrupted, the heart may beat
too quickly, a condition known as arrhythmia.

Sudden cardiac death: a nontraumatic,

unexpected death from sudden cardiac arrest, most
often due to arrhythmia; in most instances, people
have underlying heart disease.
• Sudden cardiac death, or cardiac arrest, is most often
caused by an arrhythmia called ventricular fibrillation.
• Cardiac defibrillation, such as administered with an
automated external defibrillator (AED), can jolt the
heart into a more efficient rhythm.
© McGraw Hill LLC 8
 Heart Disease and Heart Attacks 3

Heart attack symptoms may include:

• Pain or pressure in the chest.
• Pain in the arm, neck, or jaw.
• Difficulty breathing.
• Excessive sweating.
• Nausea and vomiting.
• Loss of consciousness.

Not all heart attacks involve sharp chest pain.

• Females in particular are more likely to have
different symptoms.

© McGraw Hill LLC 9

 Heart Disease and Heart Attacks 4

Get immediate medical care if the symptoms of a

heart attack occur.

Diagnostic tools include stress tests,

electrocardiograms (ECG), angiograms, magnetic
resonance imaging (MRI), computed tomography
(CT), echocardiograms, and others.

Along with lifestyle changes, many patients are

advised to take a low-dose aspirin tablet daily.

Treatments include balloon angioplasty,

implanting coronary stents, and coronary bypass
surgery.
© McGraw Hill LLC 10
 Stroke 1

Stroke: an impeded blood supply to some part of the

brain resulting in the destruction of brain cells; also
called cerebrovascular accident (CVA).

There are two major types of strokes:

• A thrombotic stroke is caused by a blood clot in an artery
that has been narrowed or damaged by atherosclerosis.
• An embolic stroke is caused by an embolus, a wandering
blood clot that may become wedged in a cerebral artery.

A hemorrhagic stroke occurs when a blood vessel in

the brain bursts, spilling blood into the surrounding
tissue.
• It may be caused by a head injury or an aneurysm.

© McGraw Hill LLC 11

 Stroke 2

A stroke may cause paralysis, walking disability,

speech impairment, memory loss, and behavior
changes.

Many people have strokes without knowing it.

• Silent strokes leave people at a higher risk of
subsequent and more serious strokes, they
contribute to loss of mental and cognitive skills.

Some stroke victims have a transient ischemic

attack (T͏I͏A), or “ministroke,” days, weeks, or
months before they have a full-blown stroke.
• A T͏I͏A produces temporary stroke-like symptoms.
© McGraw Hill LLC 12
 Congestive Heart Failure

Congestive heart failure: a condition resulting

from the heart’s inability to pump out all the blood
that returns to it; blood backs up in the veins
leading to the heart, causing an accumulation of
fluid in various parts of the body.
• It is caused by damage due to a number of
conditions, including high blood pressure, heart
attack, atherosclerosis, viral infections, rheumatic
fever, and birth defects.
• The accumulation of fluid is called pulmonary
edema.
• Treatment includes reducing heart workload,
modifying salt intake, and using drugs to eliminate
excess fluids.
© McGraw Hill LLC 13
 Major Risk Factors That Can Be
Changed: Tobacco Smoke 1
Smoking tobacco remains the leading
preventable cause of CVD in the United States.
• People who smoke a pack a day have twice the
risk of heart attack that nonsmokers do.
• Smoking two or more packs a day triples the risk.
• People who have heart attacks are two to three
times more likely to die if they smoke.

© McGraw Hill LLC 14

 Major Risk Factors That Can Be
Changed: Tobacco Smoke 2
Smoking harms the cardiovascular system by:
• Damaging the lining of arteries.
• Reducing the level of HDL (“good” cholesterol).
• Raising the levels of triglycerides and LDL (“bad”
cholesterol).
• Increasing blood pressure and heart rate.
• Reducing the oxygen available to the body.
• Speeding the developing of fatty deposits in the
arteries.
• Causing platelets to stick together, leading to clotting.

Platelets: cell fragments in the blood that are

necessary for the formation of blood clots.
© McGraw Hill LLC 15
 Major Risk Factors That Can Be
Changed: Tobacco Smoke 3
The risk of developing heart disease increases up
to 30% among people exposed to environmental
tobacco smoke (ETS), or “secondhand smoke.”

Electronic cigarettes (or e-cigarettes) contain

nicotine, which causes addiction, may harm brain
development, affects cardiovascular function, and
could lead to continued tobacco use.

In 2022, 17% of high school and 5% of middle

school students said they vaped nicotine in the
past year.

© McGraw Hill LLC 16

 Major Risk Factors That Can Be
Changed: High Blood Pressure
Hypertension: sustained abnormally high
blood pressure.
• Hypertension occurs when too much force is
exerted against the walls of the arteries.
• It is a form of CVD in itself and is a risk factor for
other forms including heart attacks and strokes.
• Often it is referred to as a silent killer, because it
usually has no symptoms.

Experts advise anyone with elevated blood

pressure to monitor their blood pressure several
times each week.

© McGraw Hill LLC 17

 Table 11.1 Blood Pressure Classification for
Healthy Adults

SYSTOLIC DIASTOLIC
CATEGORY a
t p i r c s r e p u s (mmHg) and/or (mmHg)
Normal
b
t p i r c s r e p u s below 120 and below 80

Elevated 120–129blood pressure

A table summarizing and below 80
classification as systolic and diastolic
for 4 categories.
Stage 1 130–139 or 80–89
hypertension
c
t p i r c s r e p u s

Stage 2 140 or higher or 90 or higher

hypertension
c
t p i r c s r e p u s

a
t p i When systolic and diastolic pressures fall into different categories, the higher
r c s r e p u s

category should be used to classify blood pressure status.

b
t p i The risk of death from heart attack and stroke begins to rise when blood pressure
r c s r e p u s

is above 115/75.
c
t p i Based on the average of two or more readings taken at different physician visits.
r c s r e p u s

In people older than 50, systolic blood pressure greater than 140 mmHg is a
much more significant CVD risk factor than diastolic blood pressure.

Source: Whelton, P. K., et al. 2018. 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 71(6): e13–e115.

© McGraw Hill LLC 18

 Major Risk Factors That Can Be
Changed: Unhealthy Cholesterol
Levels 1
Adequate cholesterol is essential; excess
cholesterol can clog arteries and increase the
risk of CVD.
• Lipoproteins: protein-and-lipid substances in
blood that carry fats and cholesterol; classified by
size, density, and chemical composition.
• Low-density lipoprotein (LDL): a lipoprotein
containing a moderate amount of protein and a
large amount of cholesterol; “bad” cholesterol.
• High-density lipoprotein (HDL): a lipoprotein
containing relatively little cholesterol that helps
transport cholesterol out of the arteries; “good”
cholesterol.
© McGraw Hill LLC 19
 Figure 11.3 Travels with
Cholesterol
Access the text alternative for slide images.

© McGraw Hill LLC (photo): Asier Romero/Shutterstock 20

 Major Risk Factors That Can Be
Changed: Unhealthy Cholesterol
Levels 2
The risk of CVD increases with higher LDL levels.
• The recommended test is a fasting lipoprotein
profile.
• In general, high LDL, total cholesterol, and
triglyceride levels, combined with low HDL levels,
are associated with higher risk.

Guidelines for treatment focus on lifestyle

changes and therapy with statins, a group of
medications that lower LDL.

© McGraw Hill LLC 21

 Table 11.2 People Who Benefit from
Treatment of High Cholesterol

1. People aged 75 and under with known cardiovascular

disease, including previous heart attacks, chest pain
due to partially clogged arteries, history of invasive
treatment for clogged arteries, previous stroke, or
previous clogged arteries in the limbs.
The following content is arranged like
2. People aged 21 and over with high LDL levels, 190
a table.
mg/dl or greater.

3. People aged 40–75 with a history of diabetes, an LDL

level 70–189 mg/dl, and no known history of
cardiovascular disease.

4. People aged 40–75 without diabetes or known

*10-year cardiovascular risk is calculated using a tool available on the American Heart
cardiovascular
Association disease but with a high risk of
website (https://professional.heart.org/professional/GuidelinesStatements/
developing it over the next 10 years and
ASCVDRiskCalculator/UCM_457698_ASCVD-Risk-Calculator.jsp ). an LDL level
over 70 mg/dl.*
Source: Grundy, S. M., et al. 2019. 2018 AHA/ACC/AACVPR/AAPA/ABC/
ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. A report of
the American College of Cardiology/American Heart Association Task Force on Clinical Practice
Guidelines. Journal of the American College of Cardiology 73(24): e1082–e1143.

© McGraw Hill LLC 22

 Major Risk Factors That Can Be
Changed: Physical Inactivity
At risk for CVD, about 1 in every 3
Americans is sedentary during leisure time.
• Exercise is thought to be the closest thing to a
magic bullet against heart disease.

© McGraw Hill LLC David Buffington/Blend Images/Getty Images 23

 Major Risk Factors That Can Be
Changed: Obesity
The risk of death from CVD is two to three times
higher in people with a body mass index (BMI) in
the obese range (BMI ≥ 30) than it is in people
with a BMI in the normal range (BMI 18.5–24.9).
• For every five-unit increment of BMI, a person’s
risk of death from CHD increases by 30%.
• Fat that collects in the abdomen is more
dangerous than fat around the hips.
• Even modest weight reduction can reduce CVD
risk.

© McGraw Hill LLC 24

 Figure 11.4 Prevalence of Ideal,
Intermediate, and Poor Status for
Selected Cardiovascular Health Factors
among American Adults Aged 20 or
Over
Access the text alternative for slide images.

© McGraw Hill LLC Source: Virani, S. S., et al. 2021. Heart disease and stroke statistics—2021 update. A report from the American Heart Association. 25
 Major Risk Factors That Can Be
Changed: Diabetes
Diabetes mellitus: a disease that disrupts
normal metabolism, interfering with cells’
ability to take in glucose for energy production.

People with diabetes are at increased risk of

CVD.
• Elevated blood glucose levels can damage the
lining of arteries.
• Diabetics also often have other risk factors.
• Even those whose diabetes is under control face
an increased risk.

© McGraw Hill LLC 26

 Contributing Risk
Factors That Can Be
Changed 1
High triglyceride levels are a reliable predictor
of heart disease.
• Triglycerides are blood fats absorbed from food
and manufactured by the body.
• High triglyceride levels are a reliable predictor of
heart disease.
• Levels can be reduced through losing weight,
reducing intake of added sugars while increasing
intake of unsaturated fats, increasing physical
activity, and limiting alcohol use.

© McGraw Hill LLC 27

 Contributing Risk
Factors That Can Be
Changed 2
Insulin resistance and metabolic syndrome
greatly increase CVD risk—more so in females
than in males.
• Insulin resistance refers to a condition in which
muscles, fat, and liver become less sensitive to
the effect of insulin as people gain weight and
become less active.
• Those who have insulin resistance tend to have
several other related risk factors that are
together called metabolic syndrome.
• To reduce risk, choose a healthy dietary pattern
and get plenty of aerobic exercise.

© McGraw Hill LLC 28

 Table 11.3 Characteristics of Metabolic
Syndrome*
FACTOR CRITERIA
Large waistline 35 or more inches for females
40 or more inches for males
High triglyceride 150 mg/dl or higher
level Or taking medication to treat high
triglycerides
Low HDL level A table than
Less summarizing characteristics
50 mg/dl of
for females
metabolic syndrome notes 5 factors with
Lesscriteria
their thanin40
the mg/dl for males
corresponding
column.
Or taking medication to treat low HDL
High blood pressure 130/85 mmHg or higher (one or both
numbers)
Or taking medication to treat high blood
pressure
High
*A personfasting blood
having three 100 mg/dl
or more factors listed here oris higher
diagnosed with metabolic syndrome.

sugar Or taking medication to treat high blood

Source: Adapted from National Heart, Lung, and Blood Institute. n.d. How Is Metabolic Syndrome Diagnosed? (
sugar
www.nhlbi.nih.gov/health -topics/metabolic-syndrome).

© McGraw Hill LLC 29

 Contributing Risk
Factors That Can Be
Changed 3
Many psychological and social factors that
influence other areas of wellness are also
important risk factors for CVD.
• The cardiovascular system is affected by sudden,
acute episodes of mental stress and more chronic,
underlying emotions of anger, anxiety, and
depression.

Alcohol and drugs are another controllable risk

factor.
• Drinking too much alcohol raises blood pressure and
can increase the risk of stroke and heart failure.
• Stimulant drugs can cause serious cardiac problems.

© McGraw Hill LLC 30

 Figure 11.5 The Effects of Stress and
Emotions on the Cardiovascular System
Access the text alternative for slide images.

© McGraw Hill LLC Source: Adapted from Rozanski, A., et al. 1999. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. 31
 Major Risk Factors That Can’t Be
Changed 1
Multiple genes contribute to the development of
CVD and its risk factors.
• The risk is modifiable by lifestyle factors.
About 82% of people experiencing heart attack
symptoms are aged 65 or older.
• For people over 55, the incidence of stroke more
than doubles in each successive decade.
CVD is the leading killer of males and females,
but males are more likely to have CVD earlier in
life.
• Estrogen production may offer premenopausal
females some protection against CVD.
• By age 75, the gender gap nearly disappears.
© McGraw Hill LLC 32
 Major Risk Factors That Can’t Be
Changed 2
African Americans have much higher rates of
hypertension, heart disease, and stroke than
other groups.

American Indians and Alaska Natives have

higher rates of hypertension than non-Hispanic
whites.

Hispanic females have higher rates of angina.

Asian Americans have historically had lower

rates of CVD.

© McGraw Hill LLC 33

 Figure 11.6 Death Rates for Cardiovascular Disease
Note: Per data source, Hispanic adults can be of any race; all other groups are non-Hispanic.

Access the text alternative for slide images.

© McGraw Hill LLC Source: Xu J.Q., et al. 2021. Deaths: Final data for 2019. National Vital Statistics Reports 70(08). (DOI: 34
 Possible Risk Factors
Currently Being
Studied
In recent years, several other possible risk factors have
been identified.
Elevated blood levels of homocysteine may damage the
lining of blood vessels.
Several infectious agents, including Chlamydia
pneumoniae, cytomegalovirus, and Helicobacter pylori,
may increase risk as a result of the inflammation they
produce.
Covid-19 infection has been linked to severe
cardiovascular complications.
Gum disease has long been suspected to be linked to
CVD.
© McGraw Hill LLC 35
 Protecting Yourself
against Cardiovascular
Disease 1
Eat a heart-healthy diet.
The American Heart Association recommends
limiting saturated fat intake to 5–6% of total daily
calories.
Trans fats should be avoided.
A high-fiber diet is associated with a 40–50%
reduction in the risk of heart attack and stroke.
• Focus on whole grains, fruits, and vegetables.
To reduce blood pressure, reduce sodium intake to
no more than 2,300 mg/day while increasing
potassium intake.
Any level of drinking alcohol increases the risk of
heart disease. Excessive alcohol consumption risks
a variety of serious health problems.
© McGraw Hill LLC 36
 Protecting Yourself
against Cardiovascular
Disease 2
Exercise regularly.
• You can significantly reduce your CVD risk with a
moderate amount of physical activity.

Avoid tobacco.
• Smoking is the number-one risk factor.
• Take steps to prevent exposure to smoke.

Know and manage your blood pressure.

Know and manage your cholesterol levels.

Develop ways to handle stress and anger.

© McGraw Hill LLC 37
 Figure 11.7 Strategies for
Reducing Your Risk of
Cardiovascular Disease
Access the text alternative for slide images.

© McGraw Hill LLC (left): Jessica Peterson/Rubberball/Getty Images; (right): Vladyslav Starozhylov/Alamy Stock Photo 38
 Diabetes

Diabetes mellitus is both a major risk factor for

cardiovascular disease and a leading cause of
death among Americans.

In diabetes, the process of metabolism is

disrupted.
• The pancreas normally secretes insulin, which
stimulates cells to take up glucose (blood sugar) to
produce energy.
• Diabetes interferes, causing a buildup of glucose in
the bloodstream.

© McGraw Hill LLC 39

 Figure 11.8 Diabetes
Mellitus
Access the text alternative for slide images.

© McGraw Hill LLC (photo): webphotographeer/iStock/Getty Images 40

 Types of Diabetes 1

About 39 million Americans (over 11% of the

population) have 1 of 2 major forms of
diabetes.

About 5–10% have the more serious form,

known as type 1 diabetes, in which the body’s
immune system destroys the insulin-
producing cells in the pancreas.
• Daily doses of insulin are required.
• Type 1 diabetes usually begins in childhood or
adolescence and is not related to obesity.

© McGraw Hill LLC 41

 Types of Diabetes 2

The remaining Americans with diabetes have

type 2 diabetes.
• The condition develops slowly, and about one-fifth
of affected individuals are unaware of their
condition.
• The pancreas fails to produce enough insulin,
cells are resistant to insulin, or both.

A third type, gestational diabetes, occurs in 2–

10% of females during pregnancy.
• These females have up to a 60% chance of
developing diabetes within 10–20 years.

© McGraw Hill LLC 42

 Types of Diabetes 3

Prediabetes describes blood glucose levels that

are higher than normal but not high enough for a
diagnosis of full-blown diabetes.
• Experts warn that most people with the condition
will develop type 2 diabetes unless they adopt
preventive lifestyle measures.

Factors involved in the development of type 2

diabetes are age, obesity, physical inactivity,
family history, and lifestyle.
• Excessive body fat reduces cell sensitivity to insulin,
and insulin resistance is usually a precursor to type
2 diabetes.
• Race and ethnicity also play a role.
© McGraw Hill LLC 43
 Diabetes: Warning Signs

Be alert for these warning signs:

• Frequent urination.
• Extreme hunger or thirst.
• Unexplained weight loss.
• Extreme fatigue.
• Blurred vision.
• Frequent infections.
• Cuts and bruises that are slow to heal.
• Tingling or numbness in the hands or feet.
• Generalized itching with no rash.

© McGraw Hill LLC 44

 Diabetes: Testing and Treatment

Routine screening for diabetes is

recommended for people over the age of 45
and anyone younger who is at high risk.

There is no cure.

Diabetes can be managed successfully by

keeping blood sugar levels within safe limits
through diet, exercise, and, if necessary,
medication.
• Even a small amount of exercise and weight loss
can be beneficial.

© McGraw Hill LLC 45

 Diabetes: Prevention

It is estimated that 90% of cases of type 2

diabetes could be prevented if people adopted
healthy lifestyle behaviors:
• Regular physical activity.
• Moderate diet.
• Modest weight loss.

For people with prediabetes, lifestyle measures

are more effective than medication.

Not smoking—or quitting—can also help prevent

or delay getting type 2 diabetes and has
innumerable other benefits.
© McGraw Hill LLC 46
 Test Your Knowledge

Which females are less likely to die of:

cardiovascular disease or cancer?

On average, how much earlier does heart

disease develop in people who don’t exercise
regularly than in people who do?

Of whole grains, salmon, and bananas, which

is a good choice for promoting heart health?

© McGraw Hill LLC 47

 End of Main Content

Because learning changes

everything. ®

www.mheducation.com

© McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC.