Chronic Diseases

Heart Disease Cancer Diabetes

Cardiovascular Disease Stats

 CVD is the number one cause of death globally: more people die annually from CVD than from any other cause  An estimated 17.5 million people died from CVD in 2005, representing 30% of all global deaths  Over 80% of CVD deaths take place in low- and middle-income countries and occur almost equally in men and women  By 2015, almost 20 million people will die from CVD, mainly from heart disease and stroke.

Cancer Stats

Global burden of cancer

 Cancer is a leading cause of death worldwide. The disease accounted for 7.9 million deaths (or around 13% of all deaths worldwide) in 2007. The main types of cancer leading to overall cancer mortality each year are:  lung (1.4 million deaths/year);     stomach (866,000 deaths) liver (653,000 deaths) colon (677,000 deaths) breast (548,000 deaths).  About 72% of all cancer deaths in 2007 occurred in low- and middle income countries. Deaths from cancer worldwide are projected to continue rising, with an estimated 12 million deaths in 2030.

Diabetes Stats

 The World Health Organization (WHO) estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 2030.  In 2005, an estimated 1.1 million people died from diabetes.  Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women.  WHO projects that diabetes deaths will increase by more than 50% in the next 10 years without urgent action. Most notably, diabetes deaths are projected to increase by over 80% in upper middle income countries between 2006 and 2015.

What are cardiovascular diseases?

 CVD is a group of disorders of the heart and blood vessels and include:  Coronary heart disease – disease of the blood vessels supplying the heart muscle       Cerebrovascular disease - disease of the blood vessels supplying the brain Peripheral arterial disease – disease of blood vessels supplying the arms and legs Rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria Congenital heart disease - malformations of heart structure existing at birth. Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs. Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. o The most common reason for this is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. o Strokes can also be caused by bleeding from a blood vessel in the brain or from blood clots.

WHAT CAUSES CARDIOVASCULAR DISEASES?

 The most important causes of heart disease and stroke are unhealthy diet, physical inactivity and tobacco use. These are called 'modifiable risk factors'.  The effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity; these are called 'intermediate risk factors'.  The major modifiable risk factors are responsible for about 80% of coronary heart disease and cerebrovascular disease.  There are also a number of underlying determinants of chronic diseases, or, "the causes of the causes". These are a reflection of the major forces driving social, economic and cultural change – globalization, urbanization, and population ageing. Other determinants of CVD are poverty and stress.  Heart Disease Slides http://www.crestor.com/c/home.aspx?WT.srch=1&source=301&utm_source=google&utm_medium=cpc&utm_term=artery&utm_campaign=CRESTOR%202009 %20-%20Unbranded&gclid=CInn7eTau54CFQ4NDQod0GEPlg

What is Atherosclerosis what is coronary artery disease?

  Over time, fatty deposits called

plaque

build up within the artery walls. The artery becomes narrow. This is atherosclerosis When this occurs in the coronary arteries, heart does not get sufficient blood, the condition is called

coronary artery disease

, or

coronary heart disease

Foam Cells

Myth : fat deposits at old age! It starts from 2 years of age

Fatty Streak Intermediate Lesion Atheroma Fibrous Plaque Complicated Lesion/ Rupture From First Decade From Third Decade Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).

From Fourth Decade

Are Other organs Affected?

Stroke Peripheral Vascular Disease Coronary Heart Disease • Angina • MI (Heart Attack) • Sudden Cardiac Death

WHAT ARE COMMON SYMPTOMS OF CARDIOVASCULAR DISEASES?

 Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease.  Symptoms of a heart attack include: pain or discomfort in the center of the chest; pain or discomfort in the arms, the left shoulder, elbows, jaw, or back. In addition the person may experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a cold sweat; and becoming pale.  Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain. Symptoms that seem like menopause  The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body.  Other symptoms include sudden onset of: numbness of the face, arm, or leg, especially on one side of the body; confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; and fainting or unconsciousness.  People experiencing these symptoms should seek medical care immediately.

What Increases Risk?

You can’t help it !

  Age: Men > 45; Women > 55 Sex   Race Family History

You can !!

 High Cholesterol       Smoking High Blood Pressure Diabetes Obesity Alcohol Physical Inactivity

 

Cholesterol ( A type of fat)

Everybody needs cholesterol, it serves a vital function in the body.

It circulates in the blood.

• Too much cholesterol can deposit in the arteries in the form of plaque and block them • No symptoms till heart attack

Where does it come from ?

65%

• Two sources of cholesterol: Food & made in your body

• Food sources: All foods containing animal fat and meat products

35%

Good vs. BAD Cholesterol

    LDL cholesterol is known as bad cholesterol. It has a tendency to increase risk of heart disease LDL cholesterol is a major component of the plaque that clogs arteries HDL cholesterol is known as the good cholesterol. Higher in women, increases with exercise HDL cholesterol helps carry some of the bad cholesterol out of arteries.

Obesity

 People who are overweight (10-30 % more than their normal body weight)  Obese have 2 to 6 times the risk of developing heart disease  Pears or apples?

Physical Inactivity

Every morning my brain tells me to exercise… ….. and my body laughs at the idea

Cigarette Smoking

     Increases blood pressure Decreases HDL Damages arteries and blood cells Increases heart attacks Cigarette smoke contains more than 4,000 chemicals, and 200 of these chemicals are poisonous

Cigarette Smoking

If you think YOU are smoking the cigarette, you are mistaken… It’s the other way round !

Alcohol Consumption

     In small amounts it is beneficial: 1-2 drinks In large amounts it adds fat and calories & raises BP!

4 drinks per day. You end up with gastroenterologist instead of cardiologist This is a very fine line! Finer for women as they are at higher risk Duel-carcinogens: Alcohol & Tobacco

Preventing Heart Disease Rule #1 Look before your eat

     Eat a variety of fruits and vegetables every day. (5 servings - they are naturally low in fat and high in vitamins and minerals and anti oxidants). Eat colored vegetables and fruits Eat a variety of grain products Choose nonfat or low-fat products.

Use less fat meats- chicken, fish and lean cuts Switch to fat-free milk—toned/skimmed milk

   

Dietary Guidelines

Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks, candy, junk food Limit foods high in saturated fat, trans- fat and cholesterol Eat less than 6 gms of salt a day Have no more than1-2 alcoholic drink a day if you are a regular drinker

 HOW CAN THE BURDEN OF CARDIOVASCULAR DISEASES BE REDUCED?

At least 80% of premature deaths from heart disease and stroke could be avoided through healthy diet, regular physical activity and avoiding tobacco smoke.  Individuals can reduce their risk of CVD by engaging in regular physical activity, avoiding tobacco use and second-hand tobacco smoke, choosing a diet rich in fruit and vegetables and avoiding foods that are high in fat, sugar and salt, and maintaining a healthy body weight;  Effective and inexpensive medication is available to treat nearly all CVD  After a heart attack or stroke, the risk of a recurrence or death can be substantially lowered with a combination of drugs – statins to lower cholesterol, drugs to lower blood pressure, and aspirin;  Effective medical devices have been developed to treat CVD, such as pacemakers, prosthetic valves, and patches for closing holes in the heart;  Operations used to treat CVD include coronary artery bypass, balloon angioplasty (where a small balloon-like device is threaded through an artery to open the blockage), valve repair and replacement, heart transplantation, and artificial heart operations;

What is Cancer

  Cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumors and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis. Metastases are the major cause of death from cancer.

 Malignant tumor - A cancerous tumor that has the potential of invading nearby tissues, spreading to other organs (metastasizing) and possibly leading to the patient's death.

 Benign tumor - Although the cells in a benign tumor are not normal, a benign tumor poses no immediate threat to the patient. However, in some cases a benign tumor may undergo further changes and may become a life-threatening aggressive tumor.

Loss of Normal Growth Control

Normal cell division Cell Suicide or Apoptosis Cell damage — no repair Cancer cell division First mutation Second mutation Third mutation Fourth or later mutation Uncontrolled growth

Example of Normal Growth

Dead cells shed from outer surface Epidermis Dividing cells in basal layer Cell migration Dermis

The Beginning of Cancerous Growth

Underlying tissue

Invasion and Metastasis

1 Cancer cells invade surrounding tissues and blood vessels 2 Cancer cells are transported by the circulatory system to distant sites 3 Cancer cells reinvade and grow at new location

Why Cancer Is Potentially Dangerous

Brain Melanoma cells travel through bloodstream Liver Melanoma (initial tumor)

    What causes cancer?

Continued… Cancer arises from one single cell. The transformation from a normal cell into a tumor cell is a multistage process, typically a progression from a pre-cancerous lesion to malignant tumors. These changes are the result of the interaction between a person's genetic factors and three categories of external agents, including:    physical carcinogens, such as ultraviolet and ionizing radiation chemical carcinogens, such as asbestos, components of tobacco smoke, aflatoxin (a food contaminant) and arsenic (a drinking water contaminant) biological carcinogens, such as infections from certain viruses, bacteria or parasites.    Viruses: hepatitis B and liver cancer, Human Papilloma Virus (HPV) and cervical cancer, and human immunodeficiency virus (HIV) and Kaposi sarcoma. Bacteria: Helicobater pylori and gastric cancer. Parasites: schistosomiasis and bladder cancer. Ageing is another fundamental factor for the development of cancer. The incidence of cancer rises dramatically with age, most likely due to a buildup of risks for specific cancers that increase with age. The overall risk accumulation is combined with the tendency for cellular repair mechanisms to be less effective as a person grows older.

  More toxins in body as you age (adds up over time) Chances of mutation increase exponentially with age Tobacco use, alcohol use, low fruit and vegetable intake, and infections from hepatitis B, hepatitis C and the human papilloma viruses are leading risk factors for cancer in low- and middle-income countries. Cervical cancer, which is caused by HPV, is a leading cause of cancer death among women in low-income countries. In high-income countries, tobacco use, alcohol use, and being overweight or obese are primary causes of cancer.

What Causes Cancer?

Some viruses or bacteria Some chemicals Heredity Diet Hormones Radiation

How can the burden of cancer be reduced?

   About 30% of cancer could be prevented by modifying or avoiding key risk factors.

Key risk factors for cancer:  tobacco use  being overweight or obese   low fruit and vegetable intake physical inactivity     alcohol use sexually transmitted infections, such as HIV and HPV Urban air pollution Indoor smoke from household use of solid fuels Prevention strategies:  Increase avoidance of the risk factors listed above     vaccinate against human papilloma virus (HPV) and hepatitis B virus (HBV) infection control occupational hazards reduce exposure to sunlight Early detection:

Tobacco Use and Cancer

Some Cancer-Causing Chemicals in Tobacco Smoke

Limit Alcohol and Tobacco

Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus 40x Risk Increase 30x 20x 10x Alcoholic Drinks Consumed per Day Packs of Cigarettes Consumed per Day AND

BENEFITS OF EXERCISE: Cancer Related

       Increases gut motility: reduces exposure to carcinogens (colon) Reduces estrogen: fat and ovarian estrogen (breast) Lowers free testosterone (prostate) Reduces carcinogen in visceral fat (breast, endometrial and ovarian) Increase macrophages, killer cells (ability to regulate cytokines) (all cancers) Decrease insulin (all cancers) Improves free radical defenses-scavenger enzymes (all cancers)



Treatment of Cancer

About one-third of the cancer burden could be decreased if cases were detected and treated early. Early detection of cancer is based on the observation that treatment is more effective when cancer is detected earlier. The aim is to detect the cancer when it is localized (before metastasis). There are two components of early detection efforts:   Education to help people recognize early signs of cancer and seek prompt medical attention for symptoms, which might include: lumps, sores, persistent indigestion, persistent coughing, and bleeding from the body's orifices. Screening programs to identify early cancer or pre-cancer before signs are recognizable, including mammography for breast cancer, and cytology (a "pap smear") for cervical cancer.   Ladies – self breast exam monthly Gentlemen – self testicular exam monthly  Treatment aims to cure, prolong life and improve quality of life for patients. Some of the most common cancer types, such as breast cancer, cervical cancer and colorectal cancer, have high cure rates when detected early and treated according to best practice. Principal treatment methods are surgery, radiotherapy and chemotherapy. Fundamental for adequate treatment is an accurate diagnosis through imaging technology (ultrasound, endoscopy or radiography) and laboratory (pathology) investigations.



WHAT IS DIABETES?

Diabetes occurs when   the pancreas does not produce enough insulin when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.  Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body's systems, especially the nerves and blood vessels.

   Type 1 diabetes (insulin-dependent or childhood-onset) is characterized by a lack of insulin production. Without daily administration of insulin, Type 1 diabetes is rapidly fatal.  Symptoms include excessive excretion of urine, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 2 diabetes (non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity.  Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.  Until recently, this type of diabetes was seen only in adults but it is now also occurring in obese children. Gestational diabetes is hyperglycaemia which is first recognized during pregnancy.  Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms.

 

What is Diabetes?

A metabolic disease

A disease: body doesn’t produce or use insulin properly.

Insulin function:  Secreted from pancreas when glucose is high in blood-after eating.  Insulin activates receptor cells on liver, muscle and fat cells allow glucose into the cells-energy.

to    In liver and muscle: converts to glycogen In fat cells converts glucose to fat Insulin allows AA into cells for protein synthesis

Diabetes

    At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of heart attack or stroke A diabetic is more likely to die of a heart attack than a non-diabetic ~80% Diabetics die from heart disease Risk of sudden death from a heart attack for a diabetic is the same as that of someone who has already had a heart attack.

Normal

TYPE I

Type I: Insulin-dependent diabetes. Pancreas doesn’t produce insulin.

 beta cells destroyed CAUSE:  Autoimmune: your (T & B) antibodies destroy insulin producing beta cells  Virus  Genes (chromosome 6): sibling or parent 5-10% (10X)

1.

2.

3.

TYPE II DIABETES Non-insulin dependent diabetes:

Secretes normal (maybe high) insulin BUT….

Cells become

in.

insulin resistance

:

Receptors from fat and muscle cells are resistant to insulin-does not allow glucose

Glucose remain in the bloodstream….

Warning Signs

Risks for Diabetes II

 Genes  Overweight and Lack of exercise HOW? Theory: Fat cells produce fatty acids and secrete protein: liptin & resistin which interfere with the action of insulin

Treatment

     Insulin injections Controlled diet Exercise Weight Control http://www.diabetesnet.com/diabetes _food_diet/glycemic_index.php

 Diabetes PP slide 18-32

Obesity and Disease

     80% of type II diabetes related to obesity 70% of Cardiovascular disease related to obesity 42% breast and colon cancer diagnosed among obese individuals 30% of gall bladder surgery related to obesity 26% of obese people having high blood pressure

HOW CAN THE BURDEN OF DIABETES BE REDUCED?

  Without urgent action, diabetes-related deaths will increase by more than 50% in the next 10 years.

To help prevent type 2 diabetes and its complications, people should:  Achieve and maintain healthy body weight.  Be physically active - at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control.  Early diagnosis can be accomplished through relatively inexpensive blood testing.

    Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco cessation is also important to avoid complications.

Blood lipid control (to regulate cholesterol levels); Screening for early signs of diabetes-related kidney disease. These measures should be supported by a healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use.

DIET AND EXERCISE

Questions?

 What are the 3 chronic diseases we have concentrated on?

 Which disease is the leading cause of death in the world?

 What group of diseases are the leading causes of death in the world?

 If you go to the doctor and find out you have a tumor what kind of tumor would you be hoping for?

 Which type of diabetes is on the rise in this country and why?

Misfortunes always come in by a door that has been left open for them.

Czechoslovakian proverb