samer kanaan, m.d. healthy hearts, healthy lungs: living longer and living better

Samer Kanaan, M.D.

Healthy Hearts, Healthy Lungs: Living Longer and Living Better

GoalsUnderstand the Societal impact of Smoking

Understand the Societal impact of Heart Disease

Review Americas Obesity Problem and focus on Nutrition

How to have a Healthy Heart with focus on Exercise

Smoking

SmokingSmoking FactsSmoking is the most important preventable cause of morbidity and premature mortality Worldwide

438,000 Americans die each year from smoking related diseasesSmoking is responsible for more than one in five US deathsAbout of all regular smokers will die from the addictionSmoking costs the United States $193 billion in 2004

Cigarette smoke contains over 4800 chemicals, of which 69 are known to cause cancer

Smoking is directly responsible for 90% of the 161,000 Lung Cancer deathsSmoking is directly responsible for 80-90% of the 127,000 COPD deathsSmoking is major risk factor for Coronary artery disease, stroke, and lower respiratory infections

SmokingSmoking Facts

Smoking reduces the normal life expectancy by an average of 13-15 years

8.6 million Americans have a smoking related illness

This means that for every 1 American who dies from smoking related disease, there are 20 more people who suffer from a smoking related disease

List of diseases caused by smokingCOPDCoronary Artery Disease60 % Higher Risk of dying from heart attack in smokers over 65 than non smokersStrokeMen over 65 who smoke are twice as likely to die from stroke than non smokersWomen over 65 who smoke are 1 times as likely to die from stroke than non smokersAAAAcute Myeloid LeukemiaCataracts 2-3 times the risk higher in smokersPneumoniaPeriodontitisBladder cancerEsophageal cancerLaryngeal cancerLung cancerOral cancerThroat cancerCervical cancerKidney cancerStomach cancerPancreatic cancerInfertilityPeptic Ulcer DiseaseSlow wound healingDementia / AlzheimersSmokers have far greater chance of developing dementia than nonsmokers

SmokingWorldwide

Tobacco is leading cause of preventable death worldwideTobacco kills more than HIV/AIDS, Tuberculosis, and Malaria COMBINED

Tobacco responsible for 5 million deaths each year and will increase to 8 million / year in 2030

Tobacco was responsible for 100 million deaths in the 20th CenturyWith current usage, tobacco could kill 1 billion people in the 21st Century

48% Men versus 10% Women smoke China: 63% Men versus 3.8% Women 300 million people smoke in China which is more than the entire US population

SmokingSmoking Facts45.3 million Americans (20.6 % of adults) were current smokers in 200645.7 million Americans were former smokers in 2006

Prevalence of smoking decreased 40% between 1965 and 1990, but has been UNCHANGED sinceMales 23.6%Females 17.8%American Indians/ Alaskan Natives 32.2%Whites 21.8%Blacks 22.6%Hispanics 15.1%Asians 10.3%

High school students smoking trend is alarming: data from 2004 Hispanics 26.2%African Americans 17.1%Whites 31.5%

2007

20% high schoolstudents weresmokers

6% middle school students were smokers

SmokingSmoking Facts

2005: Advertising by the 5 major tobacco companies totaled $13.1 billion $35 million / day

90% of adults who smoke start by the age of 2150% became regular smokers by the age of 18

Average youth in the US is annually exposed to 559 tobacco ads617 tobacco ads for every adult female892 tobacco ads for every adult African American

Smoking

Smoking in Pregnancy

Smoking accounts for 20-30% of low birth weight14% of preterm deliveries10% of all infant deaths10.7% of women smoked during pregnancy in 2005 (down 45% from 1990)Neonatal health-care costs attributed to maternal smoking is $366 million per year

Mothers who smoke can pass nicotine to their children through breast milk

Second Hand Smoke

Described by the EPA as a known human Group A carcinogen

Contains more than 250 toxic or cancer causing chemicals, including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide

Current Surgeon General report concluded that there is NO risk free level of exposure to secondhand smoke

Second hand smoke even in short exposures can cause platelets to become stickier, damage blood vessel lining, decrease coronary flow velocity, and reduce heart rate variability all of these can increase the risk of a heart attack

3,400 lung cancer deaths / year46,000 heart disease deaths / year

SmokingSmoking by Parents

Exacerbation of asthma 400,000 1,000,000 asthma episodes per year

Increased frequency of colds and ear infection 790,000 ear infections per year

Increased risk of respiratory infections 150,000 - 300,000 lower respiratory infections per year

Increased frequency of Sudden Infant Death Syndrome 430 cases per year

21 million or 35% of children live with smokers on a regular basis

SmokingCigar smoking5.8% or 12.8 million Americans were current cigar smokers in 200510.1% or 10.6 million of men1.7% or 2 million of women2007: 13.6% high school students(19.4% of boys and 7.6% of girls)2004: 5.3% of middle school students

Cigars contain the same addictive and carcinogenic compounds as cigarettesA single large cigar can contain as much tobacco as an entire pack of cigarettes

Cigar smoking causesLung CancerOral Cavity CancerLarynx CancerEsophageal CancerPancreatic CancerCOPD

What to do about Smoking

WHO proven policies for effective tobacco control

Raising taxes and prices Price of cigarettes has very significant effect on youth smoking every 10% increase in price decreased youth consumption by 7%

Banning advertising, promotion and sponsorship Protecting people from secondhand smoke Warning everyone about the dangers of tobacco Offering help to people who want to quit Carefully monitoring the epidemic and prevention policies

SmokingSmoking Cessation

Quitting often requires multiple attempts

Cutting down on cigarettes but not quitting DOES NOT reduce mortality risks from tobacco related illnesses

Only 5% long term success with quitting cold turkey

Counseling and medication in combination is more effective than either one alone

There are 7 FDA approved medications to aid in quitting smoking

SmokingBenefits

20 minutes after last cigarette: blood pressure decreases; pulse rate drops; and body temperature increases

8 hours after quitting: carbon monoxide level in blood drops to normal; oxygen level in blood increases to normal

24 hours after quitting: chance of a heart attack decreases

48 hours after quitting: nerve endings start regrowing; ability to smell and taste is enhanced

2 weeks to 3 months after quitting: circulation improves; walking becomes easier; lung function increases

1 to 9 months after quitting: coughing, sinus congestion, fatigue, shortness of breath decreases

SmokingBenefits

1 year after quitting: excess risk of coronary heart disease is decreased to half that of a smoker

5 to 15 years after quitting: stroke risk is reduced to that of people who have never smoked

10 years after quitting: risk of lung cancer drops to as little as one-half that of continuing smokersrisk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreasesrisk of ulcer decreases

15 years after quitting: risk of coronary heart disease is now similar to that of people who have never smokedrisk of death returns to nearly the level of people who have never smoked

SmokingLife Expectancy Benefit

Quit at age 35 years Increase in life expectancy versus those who conitnue to smoke:6.9 to 8.5 years for men6.1 to 7.7 years for women

Quit at age 45 years Increase in life expectancy versus those who conitnue to smoke:5.6 to 7.1 years for men5.6 to 7.2 years for women

Quit at age 55 yearsIncrease in life expectancy versus those who conitnue to smoke:3.4 to 4.8 years for men4.2 to 5.6 years for women

Quit at age 65 yearsIncrease in life expectancy versus those who conitnue to smoke:1.4 to 2.0 years for men2.7 to 3.7 years for women

Heart Disease

PrevalenceIncidence

Estimated 80 million Americans have one or more type of Cardiovascular Disease 1 in 3 American Adults

Mortality

Cardiovascular Disease accounts for 35.3% of all deaths in 2005, or one of every 2.8 deaths in the United States.

2,400 Americans die of CVD each day one death every 37 seconds

In every year since 1900 except 1918, CVD accounted for more deaths than any other cause.

Cardiovascular Disease claims more lives each year than Cancer, Chronic Lower Respiratory Diseases, Accidents, and Diabetes Mellitus COMBINED!

Risk Factors

Risk FactorsHealthy Lifestyle Characteristics

Non Smoking76.0 %

Healthy Weight40.1 %

Five Fruits & Vegetables per day23.3 %

Regular Physical Activity22.2 %

All 4 Above 3.0 %

Risk FactorsFamily HistoryCardiovascular disease in parent or sibling associated with two-fold increase risk of Cardiovascular disease, independent of other risk factors

Optimal Risk Factor Profile7900 men and womenBlood pressure below 120/80 mm HgTotal cholesterol below 180 mg/dLNon smokerNo diabetesMedian life expectancy was 10 or more years longer than those with 2 or more major risk factors

Diet and ActivityPeople age 70-90 eating Mediterrean-style diet and Greater physical activity 65-73% lower rate of mortalityincluding Cardiovascular disease and Cancer

Estimated 10-Year CVD risk in 50-54-year-old adults according to levels of various risk factors (Framingham Heart Study). Source: DAgostino et al., Circulation. 2008;117:743-753. A B C DAge50-54 50-54 50-54 50-54HDL Cholesterol, mg/dL45-49 45-49 35-44 35-44Total Cholesterol (mg/dL) 160-199 200-239 200-239 200-239Systolic BP mm/Hg, no treat. 120-129 130-139 130-139 130-139 Smoker No No No YesDiabetes No No Yes Yes

Chart1

7.94.5

11.27.3

21.615.9

3024.8

Men

Women

Estimated 10-Year Rate%

30+

Sheet1

Estimated 10-Year CVD Risk in 50-54 Year-Old Adults

According to Levels of Various Risk Factors

Framingham Heart Study

Note - add + to male 30!!

ABCD

Age50-5450-5450-5450-54

HDL Cholesterol, mg/dL45-4945-4935-3435-34

Total Cholesterol, mg/dL160-199200-239200-239200-239

Systolic BP mm/Hg, no treatment120-29130-139130-139130-139

SmokerNoNoNoYes

DiabetesNoNoYesTes

Source:D'Agostino, RB, Ramachandran SV, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General Cardiovascular Risk Profile for use in Primary

Care: The Framingham Study. Circulation. 2008;117:743-753.

Sheet1

7.94.5

11.27.3

21.615.9

3024.8

Men

Women

Estimated 10-Year Rate%

Sheet2

Sheet3

Nutrition

Americas Obesity Problem

Overweight and ObesityAdultsOverweight (BMI > 25)Obesity (BMI > 30)

145 million Americans are Overweight or Obese 66.7% of the Adult Population71 million Overweight74 million Obese

1999 to 2003Overweight 1.8%Obesity 3.8%Extreme Obesity (BMI >40) 1.2%

CostBetween $92 - $117 billion annually (2002)

WorldwideBy 2015,number of overweight people will be 2.3 billion and obese people will number 700 million

Age-adjusted prevalence of obesity in Adults ages 20-74 by sex and survey. (NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004). Source: Health, United States, 2007. NCHS.

Chart3

10.712.212.820.630.2

15.716.817.12634

1960-62

1971-74

1976-80

1988-94

2001-2004

Percent of Population

Sheet1

HF PREVALENCECHD MortalityCVD MortalityTotal Mortality

MenWomenNo MetS or DM2.65.314.4

20-390.30.2MetS w/o DM4.37.817.1

40-592.01.5MetS w/DM4.88.621.1

60-797.25.2DM only6.311.526.1

80+11.612.4Prior CVD10.916.730.0

Prior CVD and DM17.028.144.1

Chart 7A: Prevalence of heart failure by sex and ageChart 10A: Total mortality rates in U.S. adults, ages 3075, with metabolic syndrome (MetS), with and without diabetes mellitus (DM) and pre-existing CVD

NHANES: 199904NHANES II 197680 Follow-Up Study*

Source : NCHS and NHLBI.Source: Malik et al.(10) *Average of 13 years of follow-up.

Chart 7B: Hospital discharges for heart failure by sex

United States: 19702004

Note: Hospital discharges include those inpatients discharged alive, dead or status unknown. Source: NHDS, NCHS and personal communication with NHLBI.

Hospital Discharges for HF

CHF Discharges

-----------In thousands------

MalesFemales

708074

7986

98102

107111

121113

75122131

123143

143152

157173

174203

80176224

182240

195243

208255

228303

85247310

274308

269336

277357

304339

90315386

360405

373449

394481

390484

95378494

377493

431526

438540

430532

00418581

444551

441529

471566

04524575

Chart 7C. Incidence of heart failure* by age and sex

FHS 19802003

* - HF based on physician review of medical records and strict diagnostic criteria.

Source: NHLBI.(10)

7010

7522

8057

85719

902,107

952,363

002,199

052,125

Chart 13A: Trends in heart transplants

UNOS: 19702005

Source: United Network for Organ Sharing (UNOS), scientific registry data.

est. cv oper. & proc

u.s. 1979-03 (000)

CatheterizationsOpen-HeartBypassPTCACarotid EndarterectomyPacemakers

`NH WhitesNH BlacksHispanics792991721145442

Males24.914.024.8803501971375544

Females27.011.919.28569030823010740

9010465013922666897

Chart 9A: Prevalence of high school students in grades 912 reporting current cigarette use951137722573419132136

by sex and race/ethnicity001318686519561124152

YRBS: 2005011314690516571128177

021463709515657134199

04129764642766498170

Chart 13B: Trends in cardiovascular inpatient operations and procedures

United States: 19792004

Source: MMWR.4 NH indicates non-Hispanic.

MenWomen

NH White24.120.4

NH Black23.920.2

Hispanic18.915

Asian17.811.3Source: NHDS. NCHS and NHLBI. Note: In-hospital procedures only.

American Indian or Alaska Native37.333.4

Chart 9B: Prevalence of current smoking for Americans age 18 and older by race/ethnicity and sexEST. COST OF CV DISEASES 2007

NHIS: 2004Coronary Heart Disease142.5

Stroke57.9

Hypertensive Disease63.5

Heart Failure29.6

Chart 14A: Estimated direct and indirect costs (in billions of dollars) of major cardiovascular diseases and stroke

United States: 2007

Source: MMWR.1 NH indicates non-Hispanic.

1988-941999-022003-04

NH White206204202

NH Black204199197

Mexican American205202201Source: NHLBI

Chart 9C: Trends in mean total serum cholesterol among adults by race, sex and survey

NHANES: 198894, 199902 and 200304

Source: NCHS and NHLBI.

Note: Needs split scale.

1976-801988-941999-022003-04

White Males163163155156

Black Males171165166161

White Females170166163164

Black Females172174168161

Chart 9D: Trends in mean total serum cholesterol among adolescents ages 1217 by race, sex and survey

NHANES:1976-80,1988-94, 1999-02 and 2003-04


Note: Needs split scale.

MenWomen

Total Population32.032.0

NH Whites32.034.0

NH Blacks32.030.0

Mexican Americans39.031.0

Chart 9E: Age-adjusted prevalence of Americans age 20 and older with

LDL cholesterol of 130 mg/dL or higher by race/ethnicity and sex

NHANES: 200304


MenWomen

Total259

NH Whites269

NH Blacks167

Mexican Americans2813

Chart 9F: Age-adjusted prevalence of Americans age 20 and older with

HDL cholesterol under 40 mg/dL by race/ethnicity and sex

NHANES: 200304


NH WhiteNH BlackHispanic

Male46.938.239

Female30.221.326.5

Chart 9G: Prevalence of students in grades 912 who met currently recommended

levels of physical activity during the past 7 days by race/ethnicity and sex

YRBS: 2005

Note: Currently recommended levels is defined as activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on 5 or more of the 7 days preceding the survey. Source: MMWR.1

Source:YRBS (4)

19942004

NH White Male26.418.4

NH Black Male34.227.0

Hispanic Male37.532.5

Asian/Pacific Islander Male25.020.4

Am. Indian/Alaska Native Male34.423.8

NH White Female28.321.6

NH Black Female45.733.9

Hispanic Female44.839.6

Asian/Pacific Islander Female31.524.0

Am. Indian/Alaska Native Female36.331.8

Chart 9H: Prevalence of leisure-time physical inactivity among adults age 18 and older by race/ethnicity and sex

BRFSS: 1994 and 2004

Source: MMWR.(11) NH indicates non-Hispanic.

MalesFemales

NH Whites15.28.2

NH Blacks15.916.1

Hispanics21.312.1

Chart 9i: Prevalence of overweight among students in grades 912 by sex and race/ethnicity

YRBS: 2005

Source: BMI 95th percentile or higher by age and sex of the CDC 2000 growth chart. MMWR.(2) NH indicates non-Hispanic.

MenWomen

65-749.24.7

75-8422.314.8

85-9443.030.7

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0

Chart 9J: Age-adjusted prevalence of obesity in Americans ages 2074 by sex and survey

NHES 196062; NHANES: 197174, 197680, 198894 and 200104

Note: Obesity is defined as a BMI of 30.0 or higher. Source: Health, United States, 2006; Unpublished data, NCHS.

6-1112-19

1971-744.33.6

1976-806.66.4

1988-9411.611.0

2001-200418.716.3

Chart 9K: Trends in the prevalence of overweight among U.S. children and adolescents by age and survey

NHANES: 197174, 197680; 198894 and 200104

Source: Health, United States, 2006. Unpublished data. NCHS.

NH WhitesNH BlacksMexican Americans

Men69.89.9

Women4.512.211

Chart 9L: Prevalence of physician-diagnosed diabetes in Americans age 20 and older by race/ethnicity and sex

NHANES: 19992004

NCHS and NHLBI


Less than high school7.512.010.1

High school5.69.76.0

More than high school4.29.89.8

Chart 9M. Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Americans Age 18+

by Education, Race/Ethnicity and Years of Education

NHANES: 1999-2004


Sheet1

10.712.212.820.630.2

15.716.817.12634

1960-62

1971-74

1976-80

1988-94

2001-2004


Sheet2

4.36.611.618.7

3.66.41116.3

1971-74

1976-80

1988-94

2001-2004


Sheet3

185.303214.49

190.125240.37

194.834252.488

207.11257.35

221.391275.644

236.69317.084

258.645326.377

287.202327.978

281.616347.436

288.585374.508

312.253351.142

324.63397.288

369.68417.005

383.856455.757

403.565490.614

395.02491.788

383.917496.515

381.013496.109

436.463530.027

442.23547.189

433.785540.992

421.896585.791

446.166553.626

442.772530.311

495.774597.144

524575

Male

Female

Years

Discharges in Thousands

299172114795442

350197137805544

6903082308510740

10465013922666897

1137722573419132136

1318686519561124152

129764642766498170

Catheterizations

Open-Heart

Bypass

PCI

Carotid Endarterectomy

Pacemakers

Years

Procedures in Thousands

24.927

1411.9

24.819.2

Males

Females


24.123.918.917.837.3

20.420.21511.333.4

NH White

NH Black

Hispanic

Asian

American Indian or Alaska Native


46.938.239

30.221.326.5

NH White

NH Black

Hispanic

Sex and Race/Ethnicity


151.6

62.7

66.4

33.2

Billions of Dollars

0.30.2

21.5

7.25.2

11.612.4

Men

Women


206204202

204199197

205202201

1988-94

1999-02

2003-04

Mean Serum Total Cholesterol

2.64.34.86.310.917

5.37.88.611.516.728.1

14.417.121.126.13044.1

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM

Deaths/1,000 Person Years

MBD000B3E50.xls

Chart3

15.215.921.3

8.216.112.1

NH Whites

NH Blacks

Hispanics


OVERWT

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0

Age-Adjusted Prevalence of Obesity* in Americans Ages 20-74 by Sex and Survey

NHES and NHANES: 1960--62, 1971--74, 1976--80, 1988--94 and 1999-2002

Source:Health US, 2004.

Obesity is defined as BMI of 30 plus.

&A

Page &P

OVERWT

1960-62

1971-74

1976-80

1988-94

2001-2004


cholchild

Estimated Percentage of Children With Serum Cholesterol of 170 mg/dl or More, United States

WhiteBlack

Males 0-9 Years2940

Females 0-9 Years3350

Males 10-19 Years2534


Estimated Percentage of Children With Serum Cholesterol of 170 mg/dL

or More, United States

Trends in Mean Total Blood Cholesterol Among Adolescents Ages 12-17 by Sex and Race and Survey

NHES:1966-70; NHANES:1971-74 and 1988-94

1966-701971-741988-94


Black Males171165166`



`

cholchild

&A

Page &P

White

Black


diabetes

1966-70

1971-74

1988-94

Mean Total Blood Cholesterol

Strokerace


Men6.210.310.4

Women4.712.611.3

Age-Adjusted Prevalence of Physician-Diagnosed Diabetes in Americans Age 20 and Older by Sex and Race/Ethnicity

NHANES: 1999-2002

WhitesBlacksMexican Americans

122.95.46.4

Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Women Ages 25-64

by Education and Race/Ethnicity

NHANES III: 1988-94

&A

Page &P

Strokerace

NH Whites

NH Blacks

Mexican Americans


Hdl&Ldl

Whites

Blacks

Mexican Americans

Years of Education


smokhschool

Relative Risk of Deaths due to StrokeCompared to Non-Hispanic Whites, by Race/Ethnicity and Age Groups, U.S., 1997

Non-Hispanic BlacksAmerican Indians/ Alaska NativesAsian/Pacific IslandersHispanics

35-444.01.91.31.3

45-543.91.31.31.3

55-643.01.51.41.2

65-741.90.91.10.9

75-841.20.81.00.6

85+0.90.40.70.5

Risk for Stroke Mortality Among Racial/Ethnic Groups Compared With Non-Hispanic Whites,

by Age Groups

United States: 1997

smokhschool

35-44

45-54

55-64

65-74

75-84

85+

Race/Ethnicity

Relative Risk

Metsyndr.

Estiamted % of Americans Age 20 and Over with High-Risk LDL-Cholesterol of 130 mg/dL or More by Race and Sex

MenWomen


NH Whites43.836.9

NH Blacks36.034.5


Age-Adjusted Prevalence of Americans Age 20 and Older With

LDL-Cholesterol of 130 mg/dL or Higher by Race/Ethnicity and Sex

United States:1999-2002

MenWomen

Total33.612.6

NH Whites34.512.4

NH Blacks22.711.3


Estimated Age-Adjusted (2000) Prevalence of Adults Age 20 and Over With

HDL-Cholesterol Under 40 mg/dL by Race and Sex

United States: NHANES 1999-2002

Metsyndr.

Men

Women


PhysicAct.

Men

Women


smokmf

`NH WhitesNH BlacksHispanics

Males24.914.024.8

Females27.011.919.2

Prevalence of High School Students in Grades 9-12 Reporting Current Cigarette Use

Within the last 30 days by Race/Ethnicity and Sex

YRBS: 2005

&A

Page &P

smokmf

Males

Females


NHANESrf

CHD MortalityCVD MortalityTotal Mortality

No MetS or DM2.65.314.4

MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0


Total Mortality Rates in US Adults Age 30-75, with Metabolic Syndrome, With and Without Diabetes and Pre-Existing CVD

NHANES1976-80 Follow-Up Study

NHANESrf

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


oweight hs

% of high school students who participated in vigorous or moderate physical physical activity in past 7 days

NH WhiteNH BlackHispanicBMI

Overweight and ObesityYouthOverweight (BMI > 25)Obesity (BMI > 30)

23 million children & adolescents are Overweight or Obese 31.9% of the Population11 million Overweight12 million Obese

1971-1974 to 2003-2006Overweight from 4.0% to 17.0% (ages 6-11)Overweight from 6.1% to 17.6% (ages 12-19)

WorldwideIn 2005,number of overweight children under the age of 5 was 20 million

Trends in prevalence of overweight among U.S. children and adolescents by age and survey. (NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004). Source: Health, United States, 2007. NCHS.

Chart1

46.511.317.5

6.1510.517

1971-74

1976-80

1988-94

2001-2004


OVERWT

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0

Age-Adjusted Prevalence of Obesity* in Adults Ages 20-74 by Sex and Survey


Source:Health US, 2004.


&A

Page &P

OVERWT

00000

00000

1960-62

1971-74

1976-80

1988-94

2001-2004


cholchild

Estimated Percentage of Children With Serum Cholesterol of 170 mg/dl or More, United States

WhiteBlack

Males 0-9 Years2940


Males 10-19 Years2534


Estimated Percentage of Children With Serum Cholesterol of 170 mg/dL

or More, United States


NHANES:1976-80,1988-94, 1999-02 and 2003-04

1976-801988-941999-022003-04


Black Males171165166161`



`

cholchild

00

00

00

00

&A

Page &P

White

Black


diabetes

0000

0000

0000

0000

1976-80

1988-94

1999-02

2003-04


Strokerace


Men6.710.711.0

Women5.613.210.9

Age-Adjusted Prevalence of Physician-Diagnosed Diabetes in Adults Age 20 and Older by Sex and Race/Ethnicity

NHANES: 1999-2004

WhitesBlacksMexican Americans

122.95.46.4

Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Women Ages 25-64

by Education and Race/Ethnicity

NHANES III: 1988-94

OLD

Winkleby et al.





Prevalence of Non-Insulin-Dependent (Type 2) Diabetes in Americans Age 18+


NHANES: 1999-2004

`

NCHS and NHLBI.

&A

Page &P

Strokerace

000

000

NH Whites

NH Blacks

Mexican Americans


Hdl&Ldl

000

000

000

000

Whites

Blacks

Mexican Americans

Years of Education


smokhschool

000

000

000

Less than high school

High school

More than high school


Metsyndr.

Relative Risk of Deaths due to StrokeCompared to Non-Hispanic Whites, by Race/Ethnicity and Age Groups, U.S., 1997

Non-Hispanic BlacksAmerican Indians/ Alaska NativesAsian/Pacific IslandersHispanics

35-444.01.91.31.3

45-543.91.31.31.3

55-643.01.51.41.2

65-741.90.91.10.9

75-841.20.81.00.6

85+0.90.40.70.5

Risk for Stroke Mortality Among Racial/Ethnic Groups Compared With Non-Hispanic Whites,

by Age Groups

United States: 1997

Metsyndr.

000000

000000

000000

000000

35-44

45-54

55-64

65-74

75-84

85+

Race/Ethnicity

Relative Risk

PhysicAct.


MenWomen


NH Whites32.034.0

NH Blacks32.030.0




United States: 2003-04

MenWomen

Total259

NH Whites269

NH Blacks167





PhysicAct.

00

00

00

00

Men

Women


smokmf

00

00

00

00

Men

Women


NHANESrf


Males24.914.024.8

Females27.011.919.2



YRBS: 2005

&A

Page &P

NHANESrf

00

00

00

Males

Females


oweight hs



MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0




oweight hs

000000

000000

000000

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


RFNHANES

% of high school students who participated in vigorous or moderate physical physical activity in past 7 days

NH WhiteNH BlackHispanicBMI

Prevalence of overweight among students in grades 9-12 by race/ethnicity and sex (YRBS: 2007). Source: MMWR. 2008 57: No. SS-4. BMI 95th percentile or higher by age and sex of the CDC 2000 growth chart. NH non-Hispanic.

Chart13

15.716.618.3

12.821.417.9

NH Whites

NH Blacks

Hispanics


OVERWT

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0



Source:Health US, 2007


&A

Page &P

OVERWT

1960-62

1971-74

1976-80

1988-94

2001-2004


cholchild


NHANES:1976-80,1988-94, 1999-02, 2003-04 and 2005-06

1976-801988-941999-022003-042005-06

White Males163163155156151

Black Males171165166161161



Mex. Am. Males157158

Mex. Am. Females158161

cholchild

2940

3350

2534

2941

&A

Page &P

White

Black


diabetes

1976-80

1988-94

1999-02

2003-04

2005-06


Hdl&Ldl


Men5.814.911.3

Women6.113.114.2


NHANES: 2005-2006





Prevalence of Physician Diagnosed Type 2 Diabetes in Americans Age 18+


NHANES: 2005-2006

`

NCHS and NHLBI.

MaleFemale

Physician diagnosed 1988-945.45.4

Undiagnosed 1988-943.42.5



Trends in Diabetes Prevalence in Adults Age 20 and Older, By Sex

NHANES: 1988-94 and 2005-2006


&A

Page &P

Hdl&Ldl

000

000

NH Whites

NH Blacks

Mexican Americans


smokhschool

000

000

000


High school



Metsyndr.

00

00

00

00

Male

Female


PhysicAct.


MenWomen


NH Whites32.034.0

NH Blacks32.030.0





MenWomen

Total259

NH Whites269

NH Blacks167





PhysicAct.

00

00

00

00

Men

Women


smokmf

00

00

00

00

Men

Women


NHANESrf


Males23.814.918.7

Females22.58.414.6



YRBS: 2007

&A

Page &P

NHANESrf

Males

Females


oweightchild



MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0




oweightchild

000000

000000

000000

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


RFNHANES


Male46.141.338.6

Female27.921.021.9

Prevalence of Students in Grades 9-12 Who Met Currently Recommended Levels of

Physical Activity During the Past 7 Days by Race/Ethnicity and Sex

YRBS: 2007Centers for disease control and Prevention. Youth risk Behavior Surveillance - United States, 2007. MMWR 2008;57(ss#4)

Men '01Women '01Men '05Women '05

NH White50.646.052.349.6

NH Black40.331.445.336.1

Hispanic42.036.341.940.5

Other race43.141.245.746.6

Prevalence of Leisure-Time Physical Activity Among Adults Age 18+ by Race/Ethnicity, and Sex

BRFSS: 2001, 2005

MMWR, vol.56, no.46, 11/23/07.


Male16.721.818.8

Female28.242.135.2

Prevalence of Students in Grades 9-12 Who Did Not Meet Currently Recommended Levels of

Moderate-to-Vigorous Physical Activity During the Past 7 Days by Race/Ethnicity and Sex

YRBS: 2007"Currently recommended levels" are defined as activity that increases heart rates and made them breathe hard some of the time for a total of >60 or more minutes/day on >5 or more out of 7 days predeeding the survey.

6-1112-1516-19

Male48.911.910.020-2930-3940-4950-5960-6970+

Female34.73.45.4Male10.39.99.37.16.53.5

Female7.46.56.65.75.82.2

Prevalence of Children Ages 6-19 Who Attained sufficient MVPA to Meet Public Health Recommendations of >60 or More

Minutes/Day on >5 or more of 7 Days by Sex and AgeMean Minutes/Day of MVPA in Bouts of 10+ Minutes by Sex and Age

NHANES 2003-2004

Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical Activity in the United States Measured by Accerometer. MSSE 2008; 40: 181-188.


&A

Page &P

RFNHANES

NH White

NH Black

Hispanic


choladults

Men '01

Women '01

Men '05

Women '05


Hispanicrisk

NH White

NH Black

Hispanic


CHDlowrisk

6-11

12-15

16-19


SubclinicalDLJ

20-29

30-39

40-49

50-59

60-69

70+

Mean Minutes/Day

Subclinical

1212

Under 89-111213-1516 and UpWhites76.644.218.2Whites60.649.120.1

Men27.739.731.526.611.5Blacks26.724.116.4Blacks34.314.112.8

Women16.734.324.122.811.2Mexican Americans34.317.317.5Mexican Americans12.219.510.3

Prevalence of Current Smoking for Men Ages 18-24 by Education and Race/EthnicityPrevalence of Current Smoking for Women Ages 18-24 by Education and Race/Ethnicity

Current Cigarette Smoking for Adults Age 18 and Over by Education and SexUnited States: 1988-94United States: 1988-94

United States: 1998

Non-Hispanic White MenNon-Hispanic White WomenNon-Hispanic Black MenNon-Hispanic Black WomenHispanic MenHispanic WomenMenWomen

Nutrition

Average consumption: Whole Grains Vegetables Fruits Meat Adults0.5-0.7 to 2.0 1.2 to 2.1 1.1 to 1.81.5 to 3.7(rec: 6 8) (rec: 4 5) (rec: 4 5)

Children0.4 to 0.5 0.8 to 0.9 0.8 to 0.92.1 to 3.4(rec: 6) (rec: 3 4) (rec: 4) servings per day servings per day servings per day servings per week

Sugar Sweetened Beverages: Adults 6 18 servings (8 ounces) per weekChildren 8 23 servings per weekSweets and Bakery Desserts: Adults 4 8 servings per dayChildren 9 10 servings per week (rec: less than 5 per week) (rec: 0 per week)

Figure 16-1. Age-Adjusted Trends in Macronutrients and Total Calories Consumed by U.S. Adults (20-74 years), 1971-2004.Source: National Center for Health Statistics. Health, United States 2007, With Chartbook on Trends in the Health of Americans. Hyattsville, Md: National Center for Health Statistics; 2007 Men Women

Figure 16-3. Total U.S. Food Expenditures Away from Home and At Home, 1977 and 2007. Source: United States Department of Agriculture Economic Research Service

RecommendationsChoose lean meats and poultryPrepare without added saturated or trans fatRemove visible fat from meat and skin from poultryChoose white meat when eating poultryGrill, bake or broil meats and poultry

Select fat-free, 1 percent fat, and low-fat dairy products

Reduce trans fatCut back on foods containing partially hydrogenated vegetable oilsLimit cakes, cookies, crackers, pastries, pies, muffins, doughnuts, and French fries

Eat less than 300 milligrams of cholesterol each day200mg per egg yolk, Shellfish 50-100mg per cup, 30mg per cup whole milk

Cut back on beverages and foods with added sugars

Eat less than 2,300 milligrams of sodium per day

Drink in moderationone drink per day for womentwo drinks per day for men

Lipid GoalsTotal Cholesterol 40 at leastEliminate Saturated FatUse Unsaturated Fat insteadReduce alcohol consumptionIncrease exercise

Lipid Goals

LDL Cholesterol

Trans FatHydrogenated

Saturated FatAnimal FatPalm oil / Palm kernel oilCoconut oil

Monounsaturated Fat(may decrease LDL)(may maintain HDL)

Olive oilPeanut oilCanola oilAvocado, Nuts, Seed

Polyunsaturated Fat(may decrease LDL and HDL)

Safflower oilSunflower oilCorn oilSoybean oilOmega 3 and Omega 6

Exercise

Recommendations

Physical InactivityAdults2007 Prevalence of regular physical activity is 30.8%Males 33.9%Females 28.9%66.3% of Women report NEVER engaging in vigorous physical activity56.0% of Men report NEVER engaging in vigorous physical activity

Physical Inactivity

Youth61.5% of children ages 9-13 DO NOT participate in any organized physical activity during non-school hours

22.6% DO NOT engage in any free-time physical activity

Girls by the age of 16 or 17:31% white girls and 56% of black girls have NO habitual leisure-time activity

Students grades 9-12:24.9% spent 3 or more hours per day using computers outside of school

35.4% spent 3 or more hours per day watching TV

*Note: Currently recommended levels is defined as activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on 5 or more of the 7 days preceding the survey. Prevalence of students in grades 9-12 who met currently recommended levels of physical activity during the past 7 days by race/ ethnicity and sex (YRBS: 2007). Source: MMWR. 2008;57:No. SS-4. NH non-Hispanic.

Chart9

46.141.338.6

27.92121.9

NH White

NH Black

Hispanic


OVERWT

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0





&A

Page &P

OVERWT

1960-62

1971-74

1976-80

1988-94

2001-2004


cholchild


NHANES:1976-80,1988-94, 1999-02, 2003-04 and 2005-06

1976-801988-941999-022003-042005-06

White Males163163155156151

Black Males171165166161161





cholchild

11

&A

Page &P

#REF!

#REF!


diabetes

1976-80

1988-94

1999-02

2003-04

2005-06


Hdl&Ldl


Men5.814.911.3

Women6.113.114.2


NHANES: 2005-2006







NHANES: 2005-2006

`

NCHS and NHLBI.

MaleFemale






NHANES: 1988-94 and 2005-2006


&A

Page &P

Hdl&Ldl

NH Whites

NH Blacks

Mexican Americans


smokhschool


High school



Metsyndr.

Male

Female


PhysicAct.


MenWomen


NH Whites32.034.0

NH Blacks32.030.0





MenWomen

Total259

NH Whites269

NH Blacks167





PhysicAct.

Men

Women


smokmf

Men

Women


NHANESrf


Males23.814.918.7

Females22.58.414.6



YRBS: 2007

&A

Page &P

NHANESrf

Males

Females


oweightchild



MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0




oweightchild

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


RFNHANES


Male46.141.338.6

Female27.921.021.9





NH White50.646.052.349.6

NH Black40.331.445.336.1

Hispanic42.036.341.940.5

Other race43.141.245.746.6


BRFSS: 2001, 2005

MMWR, vol.56, no.46, 11/23/07.


Male16.721.818.8

Female28.242.135.2




6-1112-1516-19

Male48.911.910.020-2930-3940-4950-5960-6970+

Female34.73.45.4Male10.39.99.37.16.53.5

Female7.46.56.65.75.82.2



NHANES 2003-2004



&A

Page &P

RFNHANES

NH White

NH Black

Hispanic


choladults

Men '01

Women '01

Men '05

Women '05


Hispanicrisk

NH White

NH Black

Hispanic


CHDlowrisk

6-11

12-15

16-19


SubclinicalDLJ

20-29

30-39

40-49

50-59

60-69

70+

Mean Minutes/Day

Subclinical

1212






United States: 1998


*Prevalence of children ages 6-19 who attained sufficient moderate-to-vigorous physical activity to meet public health recommendations of >60 minutes/day on >5 of 7 days by sex and age. (NHANES: 2003-04). Source: MSSE 2008;40:181-8.

Chart12

48.911.910

34.73.45.4

6-11

12-15

16-19


OVERWT

1960-621971-741976-801988-942001-2004

Men10.712.212.820.630.2

Women15.716.817.126.034.0





&A

Page &P

OVERWT

1960-62

1971-74

1976-80

1988-94

2001-2004


cholchild


NHANES:1976-80,1988-94, 1999-02, 2003-04 and 2005-06

1976-801988-941999-022003-042005-06

White Males163163155156151

Black Males171165166161161





cholchild

11

&A

Page &P

#REF!

#REF!


diabetes

1976-80

1988-94

1999-02

2003-04

2005-06


Hdl&Ldl


Men5.814.911.3

Women6.113.114.2


NHANES: 2005-2006







NHANES: 2005-2006

`

NCHS and NHLBI.

MaleFemale






NHANES: 1988-94 and 2005-2006


&A

Page &P

Hdl&Ldl

NH Whites

NH Blacks

Mexican Americans


smokhschool


High school



Metsyndr.

Male

Female


PhysicAct.


MenWomen


NH Whites32.034.0

NH Blacks32.030.0





MenWomen

Total259

NH Whites269

NH Blacks167





PhysicAct.

Men

Women


smokmf

Men

Women


NHANESrf


Males23.814.918.7

Females22.58.414.6



YRBS: 2007

&A

Page &P

NHANESrf

Males

Females


oweightchild



MetS w/o DM4.37.817.1

MetS w/DM4.88.621.1

DM only6.311.526.1

Prior CVD10.916.730.0




oweightchild

No MetS or DM

MetS w/o DM

MetS w/DM

DM only

Prior CVD

Prior CVD and DM


RFNHANES


Male46.141.338.6

Female27.921.021.9





NH White50.646.052.349.6

NH Black40.331.445.336.1

Hispanic42.036.341.940.5

Other race43.141.245.746.6


BRFSS: 2001, 2005

MMWR, vol.56, no.46, 11/23/07.


Male16.721.818.8

Female28.242.135.2




6-1112-1516-19

Male48.911.910.020-2930-3940-4950-5960-6970+

Female34.73.45.4Male10.39.99.37.16.53.5

Female7.46.56.65.75.82.2



NHANES 2003-2004



&A

Page &P

RFNHANES

NH White

NH Black

Hispanic


choladults

Men '01

Women '01

Men '05

Women '05


Hispanicrisk

NH White

NH Black

Hispanic


CHDlowrisk

6-11

12-15

16-19


SubclinicalDLJ

20-29

30-39

40-49

50-59

60-69

70+

Mean Minutes/Day

Subclinical

1212






United States: 1998


SummarySmoking is the most important preventable cause of morbidity and premature mortality Worldwide

Smoking reduces the normal life expectancy by an average of 13-15 years

20% high school students were smokers

6% middle school students were smokers

2,400 Americans die of Cardiovascular disease each day one death every 37 seconds

Summary145 million Americans are Overweight or Obese 66.7% of the Adult Population

23 million children & adolescents are Overweight or Obese 31.9% of the Population

66.3% of Women report NEVER engaging in vigorous physical activity

56.0% of Men report NEVER engaging in vigorous physical activity

61.5% of children ages 9-13 DO NOT participate in any organized physical activity during non-school hours

Take Home MessageDO NOT SMOKE

Eat a Heart Healthy Diet

Eat and Drink in Moderation

Be ACTIVE for you, for your heart, and for your children!

*********************************************sometimes we think of heart conditions our own area of interestmolecular biology and pathophysiologyother aspects fuzzy

goal: replace black box with information

four components

wont discuss valvular conditions***************

samer kanaan, m.d. healthy hearts, healthy lungs: living longer and living better

Documents

smoking related illnessthis

current smokers

regular smokers

prevalence of smoking

cigarette smoke

women smoke china

rican americans

higher risk