How To Be Healthy Without Killing Yourself B

How To Be Healthy Without Killing Yourself B Bottenberg, D. O. , FNLA, FACOI

Topics For Today • • Major Risk Factors For 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 High Risk • CHD, PAD, carotid disease, diabetes, 2+ RF (10 -year risk >20%) – LDL-C goal <100 mg/d. L Moderate Risk n 2+ RF (10 -yr risk <10%) – LDL-C goal <130 mg/d. L Moderately High Risk n 2+ RF (10 -yr risk 10– 20%) – LDL-C goal <130 mg/d. L Lower Risk n 0– 1 RF – LDL-C goal <160 mg/d. L

Ruptured Atheroma

Reduction in Major Coronary Events in Major Statin Trials Primary AF/ Tex. CAPS 6605 -27% Risk Reduction, % Trial N LDLC WOSCOPS 6595 -26% ASCOT 10, 305 -28% HPS 20, 536 -29% 4 S 4444 -36% -36† LIPID 9014 -25% -25* -27‡ -31* -38* Secondary High Risk CARE 4159 -28% -25§ -38* Major coronary events defined as: fatal or nonfatal myocardial infarction (MI), unstable angina, sudden cardiac death in AF/Tex. CAPS; nonfatal MI or coronary death in WOSCOPS, ASCOT, HPS, LIPID, CARE; coronary death, nonfatal MI, silent MI, resuscitated cardiac arrest in 4 S. * p<0. 001; †p=0. 0005; ‡p<0. 0001; §p=0. 002. La. Rosa 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.

Heart Attacks LDL. 50%% LDL. 50% %

Size Matters! Triglycerides LDL 20 mg/d. L A LDL 100 mg/d. L LDL 20 mg/d. L Triglycerides LDL 20 mg/d. L

Insulin Is Secreted To Control Sugar Insulin Glucose

As You Gain Weight, It Takes More Insulin… Insulin Glucose

And More Insulin… Insulin Glucose

Until the Pancreas Fails Insulin Glucose

80% Loss Of Pancreatic Function Glucose Insulin

Risk Factors and Defining Levels of Metabolic Syndrome Risk Factor Defining Level Abdominal obesity Waist circumference Men >102 cm (>40 in) Women >88 cm (>35 in) Triglycerides 150 mg/d. L HDL-C Men <40 mg/d. L Women <50 mg/d. L Blood pressure 130/ 85 mm Hg Fasting glucose 100 mg/d. L HDL-C = high-density lipoprotein cholesterol. Reprinted with permission from NCEP ATP III. JAMA. 2001; 285: 2486 -2497.

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 Triglyceride 5 5 10

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 DAILY REDUCES HEART DISEASE BY 45% Women’s Health Study: JAMA, 2001

3 OR MORE FRUITS AND VEGETABLES DAILY 42% FEWER STROKE DEATHS 27% LESS HEART DISEASE DEATHS 15% OVERALL LESS DEATH NHANES: AJCN. 2002

EATING FISH TWICE WEEKLY (SALMON, TROUT, HERRING, HALIBUT) 31% REDUCTION IN HEART DISEASE Nurses Heart Study: JAMA, 2002 81% REDUCTION IN SUDDEN DEATH Physician’s Health study: NEJM, 2002

LOSING 5 -7% BODY WEIGHT BY EATING BETTER 58% LESS CHANCE OF BECOMING DIABETIC Diabetes Prevention Program: NEJM, 2002

STAY FIT HIGHLY FIT MEN HAVE 50% LOWER DEATH 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