Lecture 13 - Heart disease, hypertension, stroke and diabetes Flashcards
what is Cardiovascular Disease (CVD)
CVD = disease anywhere within the cardiovascular system (i.e. the heart blood vessels, and veins)
what are the different types of CVD
Coronary Heart Disease
Atherosclerosis in Coronary Arteries
Coronary Heart Disease: What is it?
General term referring to illnesses caused by atherosclerosis
ì narrows or blocks the coronary arteries (vessels that supply heart with blood)
what can Heart Disease lead to
ì Angina pectoris ì Heart attack
Stroke
explain the CHD: Role of Stress
Exposure to chronic stress
In the worry and strain of modern life arterial degeneration is not
only very common, but develops often at a relatively early age. For this I believe that the high pressure at which men live, and the habits of working the machine to its maximum capacity, are responsible, rather than excesses in eating or drinking. Sir William Osler, 1901
Anger, particularly cynical hostility, is most related to CHD
Atherosclerosis and Stress: Possible Mechanism 1
Cardiovascular Reactivity to Stress
• Responsiveness of the cardiovascular system to stress
• Differs between people
• Stronger stress reactions –> contribute to inflammatory
processes leading to atherosclerosis
Atherosclerosis and Stress - Possible Mechanism 2:
The Role of Systolic BP Reactivity
Atherosclerosis and Stress: Possible Mechanism 3
Personality: Hostility, in particular cynical hostility, most related to higher inflammation in the arteries and thus CHD
• Higher levels of pro-inflammatory cytokines
CHD: Associations
Negative Emotions ì Strong associations between ì Depression and heart attack ì Hopelessness and heart attack ì Anxiety and sudden cardiac death
Assumed to be due to direct and indirect effects.
Other (Related) Risk Factors for CHD
ì Cigarette smoking
ì Diabetes
ì Hypertension
ì Obesity
ì Physical inactivity
ì Metabolic syndrome
Obesity centered around the waist, high levels of triglycerides and low levels of HDL cholesterol. and difficulty metabolizing blood sugarHigh Blood Pressure: Behavioural Influences
Sodium consumption • Increases water retention and blood volume • Sodium reactivity • Stress • Obesity
what is Nocturnal Dipping
blood pressure lowers at night
why is lack of nocturnal BP dipping an issue
higher cardiovascular mortality
Non-dipper:
• BP drops less than 10% at night
Correlates with sleep quality, age, stress
what is the Treatment of Hypertension
Serious Hypertension: Medications
• Reduce blood volume (Diuretics)
• Reduce sympathetic activity (cardiac output)
• Beta-blocking agents are used in cardiac rehabilitation to
resist the effects of sympathetic nervous system stimulation
Meditation
what happens if poor adherence for hypertension
• Long term treatment (life-long) • Few symptoms
Treating/Healing Coronary Artery Disease: Lifestyle vs. Stents
Lifestyle changes: whole foods, plant-based diet, smoking cessation, moderate exercise, stress management (yoga, meditation), psychosocial support
Shows that partial reversal is possible through lifestyle change
what is a Stroke
ì Blood flow to localized areas in brain interrupted
ì Cerebral hemorrhage
ì Transient ischemic attacks
what are Transient ischemic attacks
Small strokes that produce temporary weakness, clumsiness, or loss of feeling in one side or limb
Risk Factors for Stroke
Overlap heavily with those for heart disease
Some factors are hereditary, others result from lifestyle, and still others come from unknown causes
Risk factors include: ì High blood pressure
ì Heart disease
ì Cigarette smoking
ì High red blood cell count ì Transient ischemic attacks ì Psychological distress
what is the correlation between Stroke and Depression
Depression is highly prevalent among stroke patients
Predictors of depression in such individuals include:
ì Overprotection by a caregiver
ì Site and severity of the stroke
ì Poor relationship with a caregiver
ì A caregiver with a negative viewpoint on the caregiving situation
what are the forms of Cardiac Rehabilitation
ì Physical
ì Psychological ì Social
ì Vocational
is exercise a good treatment for cardiac issues
Exercise
ì 50% drop-out rate within first 6 months
explain the Cardiovascular Disease and Psychological Distress
n Anxiety and fear of future attacks n Leads to cardiac invalidism
n Depression extremely common
how many canadians how diabetes
over 1.1 million
what is diabetes
pancreas produces none or too little insulin
what is a risk factor for diabetes
Overweight/Obesity as Risk Factor
what is type I diabetes
Type I (insulin dependent): little to no insulin produced; ~10% of cases – insulin-dependent
what is type II diabetes
Type II: insulin insufficiently produced or used,
~90% of cases
ì Generally develops relatively late in life (after age 40), but is becoming more common in children and adolescents
what is Gestational Diabetes:
Temporary condition, affects 2% to 4% of pregnant women
Diabetes: Warning Signs
ì Very frequent urination ì Excessive thirst ì Often hungry, even after eating ì Unexplained large weight loss ì Chronically tired ì Occasional blurry vision ì Wounds heal very slowly ì Tingling or numbness in your feet
explain how Stress Negatively Affects Diabetes
Stress has been implicated in:
ì Problems in glucose metabolism
ì Disruption of the performance of preventative health behaviours related to diabetes self- management
ì Adverse effects on adherence to diabetic treatment regimens and diet
ì The aggravation of both Type I and Type II diabetes after diagnosis
explain Diabetes: Medical Treatment
ì Complex self-management regimen
ì 1/3 of deaths can be prevented through proper self-management
what are the Adherence Issues in Diabetes
ì 80% of patients administer insulin in an unhygienic manner.
ì 58% administer the wrong dose of insulin.
ì 77% test or interpret the glucose levels incorrectly.
ì 75% do not eat the prescribed foods.
ì 75% do not eat with sufficient regularity
what are some Diabetes: Interventions to Improve Adherence
Interventions include: ì Helping in self-injections ì Training in monitoring blood sugar levels ì Increasing self-efficacy ì Mobilizing social support ì Stress-management programs ì weight control
Any intervention that focuses on improving a sense of self-efficacy and the ability to independently regulate one’s behaviour best predicts adherence with a diabetic treatment regimen in patients with diabetes
For adolescents (type 1 diabetes), the best outcomes are found among those whose parents are actively involved in tasks such as monitoring glucose levels
is diabetes reversal possible
yes, type II with weight management
