Cardiovascular health

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Cardiovascular health

• Will examine what we know re CV health and
  Coronary heart disease (CHD)
• American and Canadian info resources, mostly
  allopathic, some web-based
• Then look at integrative approaches relying on
  text chapter 18 as framework

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Cardiovascular health

• CV disease is now the major cause of death and
  disability and of rising health care costs in
  Canada
• In groups of 5, record what you know about CV
  disease / health and what you know re treatment /
  prevention allopathic less conventional or
  alternative

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CHD what is it ?

• Narrowing of coronary arteries
• Atherosclerosis vs arteriosclerosis
• Angina (lack of oxygen induced) to full blown
  heart attack
• Cholesterol, vital to hormone vitamin D
  production, bile to digest fat etc present
  everywhere
• Excess cholesterol is issue re athero etc

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CV Disease Deaths by sex, Stats Can, 1994
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Risk Factors in General

• smoking
• high blood pressure
• high cholesterol
• physical inactivity
• obesity
• diabetes

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Risk Factors and CHD

• The risk factors that you cannot  control
  include
• Age (45 years or older for men 55 years or older
  for women)
• Family history of early heart disease (father or
  brother affected before age 55 mother or sister
  affected before age 65)

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Risk Factors and CHD

• The risk factors that you can control include
• High blood cholesterol (high total cholesterol
  and high LDL ("bad") cholesterol)
• Low HDL ("good") cholesterol
• Smoking
• High blood pressure
• Diabetes -- if you have diabetes, your risk for
  developing heart disease is high, as high as a
  heart disease patient's risk for having a heart
  attack need to lower cholesterol under medical
  supervision, in much the same way as a heart
  disease patient, in order to reduce high risk of
  getting heart disease.
• Obesity/overweight
• Physical inactivity

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What makes cholesterol hi or low ?

• Your blood cholesterol level is affected not only
  by what you eat but also by how quickly your body
  makes LDL ("bad") cholesterol and disposes of it
• In fact, your body makes all the cholesterol it
  needs, and it is not necessary to take in any
  additional cholesterol from the foods you eat

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Benefits of cholesterol - lowering

• Huge risk reducer (lots of evidence) both for
  people with high cholesterol those with avg
  levels
• Studies use statins (discussed in your text) as
  cholesterol lowering drugs longitudinal studies
  in Scotland etc showed dramatic reductions in
  incidences of CHD, 20-37 reductions
• See notes re studies in Handout format
  below this slide

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What makes cholesterol hi or low ? Factors re
LDL levels

• Heredity
• What you eat
• Weight
• Physical activity/exercise
• Age and sex
• Alcohol
• Stress
• see definitions in Handout format below this
  slide

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Framingham Heart Study

• huge study, best one re mass of data on
  cholesterol reductions
• 0n web site see material below this slide
  re Framingham

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Types of Blood Pressure Medications

• Diuretics
• Beta-blockers
• ACE inhibitors
• Angiotensin antagonists
• Calcium channel blockers (CCBs)
• Alpha-blockers
• Alpha-beta-blockers
• Nervous system inhibitors
• Vasodilators
• see definitions of each below this slide

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Integrative medicine re CHD

• when applied to CV disease, preventative
  medicine in Western society is a concept most
  people accept, few people practice, and almost no
  one pays for text 409
• Most of the 200 billion annual US price tag is
  spent on the treatment of symptomatic disease
  end-organ failure

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Integrative medicine re CHD

• Reliance on therapeutic vs preventative
  strategies fosters a magic bullet mentality in
  N America
• No single strategy, medication, or intervention
  program guarantees avoidance of negative cardiac
  events

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Integrative medicine re CHD

• Huge sums of to conquer a largely behavioural
  disease thru pharmacology, surgery,
  catheterization-based interventions genetic
  engineering
• So, what are the integrative suggestions from
  your text and elsewhere ???

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Integrative CV Health

• CHD as a complex of genetic, environmental,
  cultural, and behavioural factors
• Text notes that genetic markers, that is, risk
  factors we cant control, are important (lipid
  metabolism, diabetes, hypertension), CV health /
  prevention of CHD is remarkably variable
• Non-allopathy here is predominantly diet and
  lifestyle interventions - consider these as
  primary or at least adjunctive treatments for CHD
  and CV health

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Text CV Health

• Diet goes thru studies re epidemiological
  links, avocados, Mediterranean-style diets
  (mono-unsat fats), and serial monitoring of types
  of fat intake body weight/BMI
• Exercise evidence also strong here
• Alcohol red wine vs beer vs hard liquor what
  does evidence say ?

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Text CV Health

• Dietary Supplements Herbs digoxin (also
  called digitalis, both derived from plant
  foxglove) vs angiotensin inhibitors
  plant-based diets re antioxidants and
  antiinflammatories purslane garlic and
  teas, hawthorn berries rich in flavinoids
  (anti-inflam), folic acid, Vitamin E-rich foods

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Text CV Health

• Note the crystal clear summary pp 410-411 esp
  tables 18-1, 18-2, and 18-3 what makes this
  alternative is the element of informed,
  evidence-based choice
• Also, difference betw choices in acute coronary
  syndromes vs chronic stable CHD vs at-risk
• Emphasis is on delay and avoid

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Last 3 classes

• Tuesday chronic fatigue GI system
• Thursday oncology start wrap-up
• Tuesday 11th, last class, synthesis yes,
  chapters 31 33 are required re this unit

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Evidence MC Exams

• Multiple multiples NOT when theyre logic, dont
  test knowledge
• So, no more than 8 on exam, and only if content,
  not logic-based
• of alternatives evidence 4 good ones better
  than 5th bad one so Im going to do that too