CV2

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CVD: Cardiovascular disease includes any disease or condition affecting heart, blood vessels, or circulation of blood
What is the #1 killer in US?: CVD
>___ people die of CVD each day, 1 death/33 seconds: 2600
Clinical Manifestations of CVD: Coronary Heart Disease; _____; MI; Atrial fibrillation; Congestive heart failure; Renal vascular disease; peripheral vascular disease; stroke; ED; Atherosclerosis
CV Risk: All factors inclusive; risk factors have multiplicative effect on one another (2+ risk factors increase global risk)
Modifiable Risk Factors: Hypertension; dyslipidemia; diabetes; smoking; obesity; physical inactivity; microalbuminuria<60mL/min
Nonmodifiable Risk Factors: Age: men>45yrs; women>55yrs
Family history/genetic predisposition
Probability of Risk Factors: Millions of Americans have >1 risk factor for CVD
Patients with one risk factor prob have others: "clustering"; 80% who have hypertension have another risk factor
More risk factors=more CVD risk
Americans with CV Risk Factors: Diabetes=16 million
Hypertension=50 million
Dyslipidemia=59 million
Multiplicative Effect: Association of hypertension with other risk factors/dyslipidemia can have more than one effect on CV risk
MRFIT: Multiple Risk Factor Intervention Trial: combo of both hypertension and dyslipidemia can have a dramatic effect on CV mortality risk
Primary vs. Secondary: _____ prevention: reduce risk in pts w/o established CVD
_____ prevention: reduce risk in patients with established CVD
Diabetes Mellitus: Metabolic disorder; pancrease produces little or no insulin
Leading cause of CVD in US
>10 million Americans diagnosed w/ diabetes
Worldwide Diabetes epidemiology:: Number of adults w/ diabetes expected to more than double from 135 million in 95 to 300 million in 2025
Metabolic Features of Diabetes: _______ increased glucose in blood: breakdown of fat and protein; results in weight loss and weakness
Glucosuria: abnormall high concentrations of glucose in urine
Diabetes Diagnosis and Tests: Blood Tests: fasting plasma glucose (FPG) fasting 8-12 hrs
Oral glucose tolerance test (OGTT): fast for >8 hours, glucose levels measure for 2 hrs
Glycosylated hemoglobin (HbA1c)
Diabetes diagnosed when...: FPG>126 mg/dL
OGTT 2-hrs post-glucose load >200 mg/dL
Types of Diabetes: Type 1: complete lack of insulin production/common in childhood and Type 2: inadequate insulin production and insulin resistance
Type 1 Diabetes: Auto immune disease resulting in destruction of pancreatic beta cells
Absolute insulin deficiency
Treated with insulin injections or insulin pump
Represents about __% of all cases
Type 2 Diabetes: -Beta cell dysfunction and insulin resistance; relative insulin deficiency
-Onset in adulthood
-Patients may eventually need insulin for hyperglycemia control
-___ and heredity are contributing factors
-Most common form of Diabetes
Microvascular Complications: Retinopathy
Neuropathy
Nephropathy
Retinopathy: Leading cause of blindess among adults age 20-74; blurred vision; structural changes in retina, leaking/bleeding
Neuropathy: Diabetes most common cause of neuropathy in US; linked to hyperglycemia; metabolic abnormalities in nerve tissue; motor control
Nephropathy: Responsible for half of end-stage renal disease cases
Macrovascular Complications: 1. Coronary artery disease (CAD)
2. Cerebrovascular disease
3. PVD
CAD/Cardiovascular disease: Leading cause of diabetes-related deaths; MI, silent
Cerebrovascular disease: Risk of storke is 2-4 times higher among people with diabetes
Peripheral vascular Disease: Peripheral vascular disease can result in tissue death, requiring amputation; affects blood vessels that supply other areas of the body
Diabetes Treatment Options: 1. Diet/exercise
2. Diabetic pharmacologic theraphy options: insulin or oral agents
3. CV therapy options: Cholesterol-lowering agents; antihypertensives
Diabetes Treatment Goals: *Patients with diabetes have lower goals than patients w/o diabetes
*FPG (preferred method/easy): 90-130 mg/dL
Bedtime plasma glucose: 110-150 mg/dL
*OGTT (easy as well)
*HbA1c (already diag pts, shows avg blood glucose levels over 2-3 months): <7%
*Blood Pressure: <130/80
*LDL Cholesterol: <100mg/dL
Diabetes and Dyslipidemia: Cause of dyslipidemia: associated with hypertriglyceridemia and low HDL; Type 2 diabetics have a more ___ form of LDL (small, dense LDL)
Considered a CHD risk equivalent in NCEP guidelines: 2/3 of people w/ diabetes die of some form of CVD
Key Trial in Diabetes HPS Design: *HPS: heart protection study
*Double-blind trial in 20,536 adults with CV disease, arterial disease or diabetes
*Pts randomized to simvastatin 40mg/day or pacebo for 5 yrs
*Assessed long-term effect on vascular and all cause mortality
HPS Results: *About 5% treated with placebo had major vascular events during each year of study f/u
*Simvastatin significantly reduced: mortality (12.9%), nonfatal heart attacks (38%) and first strokes (25%)
CARDS: Collaboratie AtoRvastatin Diabetes Study
First study to evaluate the primary prevention of major CV events in pts w/ type 2 diabetes w/o a history of CV disease or stroke
Patients randomized to: Lipitor at 10 mg/day and Placebo
CARDS Results: *Lipitor treatment associated with 37% reduction in the incidence of major CV events
*Lipitor produced a reduction of 36% in coronary events, 31% in coronary revascularization events and 48% in stroke
Types of Obesity: Obesity is a state in which individuals have excess fat tissue mass
Adult Onset and Lifelong Obesity: Two types of obesity
Adult Onset: Affects many individuals in developed countries; normal weight in childhood; gradual weight gain 20-40 yrs old; imbalance between calories in and out
Lifelong Obesity: Childhood start; weight gain as a child; weight increase in women during/after pregnancy; often severely obese, weight>150% of ideal weight
Measuring Obesity: BMI: Widely used method: body mass index
BMI=weight (kg)/height (M2):
Normal=18.5-24.9
Overweight=>25
Obese=>30
Measuring Obesity: Fat Distribution: *Central/truncal obesity: linked with more serious complications
*Waist circumference: measures elevated risk for CHD (35" women; 40" men)
*waist to hip ration: abnormal: >.9 women; >1.0 men
Epidemiology of Obesity: *30.5% of American adults obese between 1999-2000
*300,000 deaths/year due to obesity
*Rising prevalence in kids
Cardiac Consequences: CARDIAC: *Causes increases in Blood volume and cardiac output
*Heart weight and size may increase due to continual increase of cardiac output
Obesity Consequences: DIABETES: *__% of pts with Type 2 diabetes mellitus are obese
*Insulin resistance: increases w/ weight gain and decreases with weight loss
Obesity Consequences: HYPERTENSION: *Increase peripheral resistance
*Increase cardiac output
*Increase sympathetic nervous system tone
Obesity Consequences: CAD: *Obesity linked with CAD by increasing its risk foactors, including: Hypertension; Insulin resistance; Diabetes mellitus; ____
*These are linked to central obesity
*Nurses' Health Study: increased risk for CAD in overweight women
Obesity Consequences: CHF: *Pulmonary and systemic congestion related to: ventricular dysfunction and elevations in filling pressures
*Heart failure results from marked chronic increase in cardiac work
Obesity Consequences: OTHER: Stroke; Pulmonary disease; bone, joint and cutaneous diseases
Benefits of weight loss:: *Improves exercise capacity of pts
*Improves cardiac hemodynamics
*Reduces blood pressure
Metabolic Syndrome: *Constellation of abnormalities that constitute major risk factors for CHD
*Contributing Factors: physical inactivity; central obesity; high dietary intake of carbs and saturated fat; aging; genetic factors
Metabolic Syndrome Diagnosis: According to NCEP ATP III, involves the presence of >3 of:
-Abdominal obesity >40" men, >35" women
-Elevated TG levels >150
_Low HDL Levels <40 men, <50 women
_Elevated BP >130/85
_Fasting glucose >110
Metabolic Syndrome Management: No FDA approved treatment fo rdisease
Treatment aimed at controlling risk factors:
weight control; phys activity; cholesteroal control treatments; treatment of ___; use of aspirin in pts wit CHD treatment of elevated TG and low HDL levels
Action Potential in Cardiac Muscle: Starts at SA Node, Goes to AV Node,delay,then to Bundle of Hiss, out to Perkinje Fibers, E` hits these fibers and they contract
Preload: Degree of ventricular myocardial fiber STRETCH before contraction
Contractility: The capacity of the heart muscle to CONTRACT
After load: The resistance against which the ventricles work during contraction
Stroke Volume: Amount of blood contracted by the ventricle in each contraction/amount of blood going to the body
Things that effect stroke volume: TPR, blood volume, blood viscosity, blood flow
Ejection Fraction: % of Left Ventricular volume after ejection; 50-60% of the amount of blood pumped out into the body

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