How To Be Healthy Without Killing Yourself

B Bottenberg, D.O., FNLA, FACOI

Topics For Today

• Major Risk Factors For Disease• Disease Prevention• Diet and Exercise• Think About The Big Picture

Cardiovascular Disease

• Cardiovascular Disease Remains the Biggest Killer of Adult Americans

• 500,000 Deaths Annually• One Third of Cardiovascular Deaths Are In • Those Under 55 Years of Age• Accounts For More Deaths Than All Cancers

Combined

Major Cardiovascular Risk Factors

• Age/Gender : >= 45 male, >= 55 female• HDL < 40 mg/dl (male) HDL < 50 mg/d

(female)• HTN or on Tx• Tobacco use• Family History premature events in first

degree relative (male < 55) (female < 65)• If >1 Risk Factor Then Perform Framingham

Risk Scoring

ATP III Risk Categories

• CHD, PAD, carotid disease, diabetes, 2+ RF (10-year risk >20%)– LDL-C goal

<100 mg/dL

High Risk Moderately High Risk

Moderate Risk Lower Risk

2+ RF (10-yr risk 10–20%)– LDL-C goal

<130 mg/dL

2+ RF (10-yr risk <10%)– LDL-C goal

<130 mg/dL

0–1 RF – LDL-C goal

<160 mg/dL

Ruptured Atheroma

-40

-20

0

Reduction in Major Coronary Events in Major Statin Trials

SecondaryPrimary

* p<0.001; †p=0.0005; ‡p<0.0001; §p=0.002.LaRosa J et al. JAMA. 1999;282:2340-2346; HPS Collaborative Group. Lancet. 2002;360:7-22; Sever PS et al. Lancet. 2003;361:1149-1158.

-38* -38*

High Risk

4S 4444 -36%

AF/TexCAPS

6605 -27%

LIPID 9014 -25%

CARE4159 -28%

WOSCOPS 6595 -26%

Trial N

LDL-C

-25* -25§

-31*-27‡

HPS20,536 -29%

Risk

Red

uctio

n, %

ASCOT 10,305 -28%

-36†

Major coronary events defined as: fatal or nonfatal myocardial infarction (MI), unstable angina, sudden cardiac death in AF/TexCAPS; nonfatal MI or coronary death in WOSCOPS, ASCOT, HPS, LIPID, CARE; coronary death, nonfatal MI, silent MI, resuscitated cardiac arrest in 4S.

Heart Attacks

50%% 50%%

LDL. LDL.

LDL20mg/dL

Size Matters!

LDL100mg/dL

LDL20mg/dL

LDL20mg/dL

LDL20mg/dL

Triglycerides

Triglycerides

ALDL

20mg/dL

Insulin Is Secreted To Control Sugar

Insulin

Glucose

Insulin

Glucose

As You Gain Weight, It Takes More Insulin…

Insulin

Insulin

Glucose

And More Insulin…

Insulin

Insulin

Glucose

Until the Pancreas Fails

Insulin

Insulin

Glucose

80% Loss Of Pancreatic Function

Insulin

Insulin

Glucose

Risk Factor Defining LevelAbdominal obesity Waist circumference

Men >102 cm (>40 in)Women >88 cm (>35 in)

Triglycerides 150 mg/dLHDL-CMen <40 mg/dL

Women <50 mg/dLBlood pressure 130/85 mm HgFasting glucose 100 mg/dL

Reprinted with permission from NCEP ATP III. JAMA. 2001;285:2486-2497.

Risk Factors and Defining Levels of Metabolic Syndrome

HDL-C = high-density lipoprotein cholesterol.

RISK FACTORS FOR ALZHEIMERS

• Hypertension• Large Waist• Low HDL• High Triglycerides• Borderline High Blood Sugar

(Neurology: Feb. 2011. Vol 76. 518-525)

Obesity in the United States

• Adults… 1 in 3• Children… 1 in 4

(Source: CDC 2010)

Diabetes in the United States

• Diabetes… 1 in 10 !• Prediabetes… 1 in 3 !

(Source: CDC 2011)

OVEREATING vs. “BUNCH EATING”

• YOUR BODY BURNS FUEL• YOUR TANK ONLY HOLDS SO MUCH• NO MORE “BUNCH” EATING• “BUT DOC, I’M NOT HUNGRY”

We “Bunch” Eat

5 510

Triglyceride

Adipose Cells Getting Plump

Triglyceride

Adipose Cells Hypertrophy

So… How To Eat?

• 1500 – 2000 Calories Per Day• 500 – 600 Calories Per Meal• 3 Servings Per Meal• 1 Protein 15-25 gms. Per Meal (7 gms. / 20 lbs.) • 2 Healthy Carbohydrates (colored,crunchy,fruit,grains)

• Fat Fills In…(MUFA, PUFA)

Exercise

• Good For Mood• Great For Bones• Excellent For Circulation• Reduces Insulin Resistance (Diabetes)• Reduces Vascular Disease Problems• Fit People Have 50% Less Mortality !• Probably Doesn’t Affect Your Weight

Exercise

• 30 Minutes- 5 Times Per Week• 2 ½ Hours Per Week• Moderate Intensity Walking… Easy Biking… Light Swimming… Gardening… Housework… Softball… Golf…

• Heavier Intensity Counts Double

Drugs To Reduce Heart Disease

• Aspirin Reduces Heart Attacks By 18% • Niacin Reduces Heart Attacks By 25%• Statins Reduces Heart Attacks By 40%

WALKING TWO MILES DAILYREDUCES HEART DISEASE

BY 45%

Women’s Health Study: JAMA, 2001

3 OR MORE FRUITS AND VEGETABLES DAILY

42% FEWER STROKE DEATHS27% LESS HEART DISEASE DEATHS

15% OVERALL LESS DEATHNHANES: AJCN. 2002

EATING FISH TWICE WEEKLY (SALMON, TROUT, HERRING, HALIBUT)

31% REDUCTION IN HEART DISEASENurses Heart Study: JAMA, 2002

81% REDUCTION IN SUDDEN DEATHPhysician’s Health study: NEJM, 2002

LOSING 5-7% BODY WEIGHT BY EATING BETTER

58% LESS CHANCE OF BECOMING DIABETICDiabetes Prevention Program: NEJM, 2002

STAY FIT

HIGHLY FIT MEN HAVE 50% LOWERDEATH RATES THAN LOWER FIT MEN

Circulation: 2008

ADDRESS LIFE

Preventing Disease• Get a Flu Shot Annually (for the rest of us)• Pneumovax Every 10 Years• Zostavax (Shingles)• 1-2 Alcoholic Beverages Daily (not more)• Colonoscopy at Age 50 *• Stop Smoking (are you kidding me?)• Check Blood Pressure, Glucose and Cholesterol• Annual Physicals, Pap, Mammograms, DEXA• Eat Better, Move Around Some, Lose Weight