CRT 2017 Turning off The Faucet Prevention and
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CRT 2017: Turning off The Faucet Prevention and Disparities Kim Allan Williams, Sr. , M. D. , MACC, FAHA, MASNC Immediate Past President, American College of Cardiology James B. Herrick Professor and Chief, Division of Cardiology Rush University Medical Center, Chicago, IL No Disclosures
Burden of Coronary Heart Disease • • CHD: 1 of every 6 deaths = 379, 559 Americans 1 st MI: ≈620, 000 Americans Recurrent MI: ≈295, 000 Silent 1 st MI: ≈150, 000 “Every 34 seconds, 1 American has a coronary event, and approximately every 1 minute 23 seconds, an American will die of one. ” http: //circ. ahajournals. org/content/129/3/e 28. full. pdf+html
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Life Expectancy Differentials Harper S. JAMA. 2007; 297: 1224 -1232
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CDC analysis of County-Level Premature Mortality Factors that Increase mortality Factors that Reduce mortality • Smoking, obesity • HS and 4 -year college graduation rate • Greater inequality • Hispanic paradox’ • AA race • DIET No Effect Overall # of Primary Care Physicians in County
Blue Zones (Dan Buettner) Where? • • • Ikaria, Greece Okinawa, Japan Ogliastra Region, Sardinia Loma Linda, California, USA Nicoya Peninsula, Costa Rica. 9
Blue Zones (Dan Buettner) What? • Stop eating when your stomach is 80 percent full to avoid weight gain. • Eat the smallest meal of the day in the late afternoon or evening. • Eat mostly plants, especially beans. • Eat meat rarely, in small portions of 3 to 4 ounces (about once per week) 10
From: Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2 JAMA Intern Med. 2013; (): 1 -8. doi: 10. 1001/jamainternmed. 2013. 6473 Figure Legend: Date of download: 6/19/2013 Copyright © 2012 American Medical Association. All rights reserved.
From: Vegetarian Diets and Blood Pressure: A Meta-analysis JAMA Intern Med. 2014; 174(4): 577 -587. doi: 10. 1001/jamainternmed. 2013. 14547 Date of download: 8/15/2015 Copyright © 2015 American Medical Association. All rights reserved.
From: Vegetarian Diets and Blood Pressure: A Meta-analysis JAMA Intern Med. 2014; 174(4): 577 -587. doi: 10. 1001/jamainternmed. 2013. 14547 Date of download: 8/15/2015 Copyright © 2015 American Medical Association. All rights reserved.
“. . . whether BP is associated with glutamic acid intake (the predominant dietary amino acid, especially in vegetable protein) and with each of 4 other amino acids that are relatively higher in vegetable than animal protein (proline, phenylalanine, serine, and cystine). “Dietary glutamic acid may have independent BPlowering effects, which may contribute to the inverse relation of vegetable protein to BP. “ 18
Conclusions: The improvement in diastolic blood pressure was >3 -fold greater in overweight and obese adults when they consumed a whole-grain compared with a refined-grain diet. Because diastolic blood pressure predicts mortality in adults aged <50 y, increased whole-grain intake may provide a functional approach to control hypertension. This may benefit patients at risk of vascular-related morbidity and mortality. . “ 19
Hypertension Costs: 2007 • “. . . expenditure of $130. 7 billion for hypertension as a risk factor for cardiovascular diseases, and medication expenditures constitutes about half of treatment expenditures for hypertension” • Total Medicare expenditures: $433. 6 billion in 2007 • Hypertension is about 30% of total Medicare costs
Hypertension Costs: 2020 • “. . . expenditure of $287. 7 billion for hypertension as a risk factor for cardiovascular diseases, and medication expenditures constitutes about half of treatment expenditures for hypertension” • Total Medicare expenditures: $954. 6 billion in 2020 • Hypertension is about 30% of total Medicare costs • Cut this by 75%? Save over $200 B?
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Dietary Patterns
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Sugar Sweet To You, But Not For You 31
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Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults JAMA Intern Med. 2014; 174(4): 516 -524. doi: 10. 1001/jamainternmed. 2013. 13563
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Saturated Fate 38
BMJ 2016; 355: i 5796 39
Figure 1. Dose-response relationship between red meat intake and risk of all-cause mortality in the Health Professionals Follow-up Study (A) and the Nurses’ Health Study (B). The results were adjusted for age (continuous); body mass index (calculated as weight in kilograms divided by height in meters squared) category (23. 0, 23. 0 -24. 9, 25. 0 -29. 9, 30. 034. 9, or 35); alcohol consumption (0, 0. 1 -4. 9, 5. 029. 9, 30. 0 g/d in men; 0, 0. 1 -4. 9, 5. 0 -14. 9, or 15. 0 g/d in women); physical activity level (3. 0, 3. 0 -8. 9, 9. 0 -17. 9, 18. 0 -26. 9, or 27. 0 hours of metabolic equivalent tasks per week); smoking status (never, past, or current [1 -14, 15 -24, or 25 cigarettes per day]); race (white or nonwhite); menopausal status and hormone use in women (premenopausal, postmenopausal never users, postmenopausal past users, or postmenopausal current users); family history of diabetes mellitus, myocardial infarction, or cancer; history of diabetes mellitus, hypertension, or hypercholesterolemia; and intakes of total energy, whole grains, fruits, and vegetables, all in quintiles. Broken lines represent 95% CI.
“Men who consumed ≥ 75 g/d processed meat compared with those who consumed <25 g/d had a 1. 28 (95% confidence interval, 1. 10– 1. 48, P trend=0. 01) higher risk of HF incidence and 2. 43 (95% confidence interval, 1. 52– 3. 88, P trend<0. 001) higher risk of HF mortality. ” 45
Plaque Regression with Plant-Based Diet Esselstyn
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Gould et al. JAMA 1995; 274: 894 -901.
Coronary Disease? No, it’s Culinary Disease! – Reduced risk of coronary heart disease (CHD) and coronary disease mortality – 5 prospective studies reported a combined: • 24% lower risk of mortality from IHD in vegetarians • 34% reduced in lacto-ovo vegetarians • 26% reduced risk in vegans – The benefit was apparent if diet followed for at least 5 years and was greater in younger age groups
Increased Longevity Among Vegetarians – Reduced consumption of saturated fat, cholesterol, animal protein, red meat, heme iron, IGF-1, phosphorus and phosphatidyl choline; reduced production of TMAO, su. PAR – Increased consumption of beneficial dietary components, including fruit, vegetables, whole grains, legumes, and nuts, all rich in dietary fiber, antioxidants, and phytochemicals – Other healthy lifestyle choices (less sugar)
“As recommended by the IOM, individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern. ” As little as possible is, of course, zero cholesterol, which should be the goal. KAW
Three Phases of Truth "All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being selfevident. “ Arthur Schopenhauer German Philosopher (1788 -1866)
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