Modifiable Lifestyle Risk Factors

• Modifiable Lifestyle Risk Factors:

  • smoking
  • diet and nutrition
  • physical inactivity
  • obesity
  • stress
  • alcohol
  • sleep
  • pollution
  • erectile dysfunction
• Smoking/Tobacco:

  • if a patient smokes, it is out top priority to make them quit
  • the higher the amounts of cigarettes per day, the higher the risk of coronary heart disease and cerebrovascular disease
  • the duration of each time spent smoking also plays a factor as well as amount of cigarettes
• Smoking Facts:

  • smoking increases the risk of developing blood clots
  • 1 in every 2 smokers die of a tobacco related disease
  • tobacco smoke contains over 4000 chemicals, including tar, which cause cancer
  • smoking can take 10 to 15 years off your life
  • smokers are 60% more likely to die from heart disease than non smokers
• Smoking:

  • the longer the amount of time without smoking, the more benefits on your health and decreased risk of CVD, especially after 15 years, where it is equal to a non-smoker

  
• How does smoking cause CVD?

  • cigarettes contain nicotine
  • nicotine causes:
  • vascular dysfunction
  • effects on lipids metabolism
  • development of atherosclerosis
  • deregulation of cardiac autonomic function
  • insulin resistance

  
• Assessment and Measurement of Smoking Status

  • self reported
  • current smoking status
  • pack years
  • quit attempts
  • motivation to quit
  • dependence etc
  • breath carbon monoxide
  • cotinine
  • in urine or blood
  • subjective methods such as the heaviness of smoking index - measures dependence by asking how soon after waking up someone smokes, and how much someone smokes
  • can use objective measures such as a smokeometer
• Carbon Monoxide Monitor:

  • provides objective measure of someones carbon monoxide levels
  • hold breath for 15 seconds then breathe into mouthpiece
  • scores up to 6 signify a non-smoker
  • scores from 7 up to 10 signify a light smoker
  • scores 11 and higher signify a heavy smoker
  • results may not be accurate for people with inflammatory disease as due to air trapping they may already have more CO in their lungs, so the machine can confuse it for cigarette CO

  
• Pack Years

  • 20 cigarettes = 1 pack
  • number of years smoked x average number of packs smoked per day = pack years
• Diet and Anthropometrics:

  • a study showed theres 9 potentially modifiable risk factors for over 90% of the risk of an initial acute myocardial infarction
  • diet can explain 50% of those risk factors

  
• Healthy Diet Characteristics:

  • adopt a more plant and less animal based food pattern
  • saturated fatty acids should account for less than 10% of total energy intake, through replacement by PUFAs, MUFAs and carbohydrates from whole grains
  • trans unsaturated fatty acids should be minimised as far as possible, within non from processed foods
  • less than 5 grams salt intake per day
  • 30 to 45 grams of fibre per day, preferably from wholegrains
  • equal to/more than 200 g of fruit per day
  • equal to/more than 200 g of vegetables per day
• Body weight and shape:

  • theres differences in optimal BMI for white Europeans compared to Asians

  
• Physical Activity:

  • aim for minimum 150 minutes of moderate intensity or 75 minutes of vigorous intensity - based on class 1, level A studies
  • can reduce:
  • type 2 diabetes by 40%
  • cardiovascular disease by 35%
  • falls, depression by 30%
  • joint and back pain by 25%
  • cancers by 20%

  
• • Physical activity is linked with/can lead to many other CVD risk factors:
  • obesity
  • diabetes
  • high blood pressure
  • high cholesterol
  • mental health
• Physical Activity benefits pt1:

  • anti-atherosclerotic
  • improved lipids
  • decrease in blood pressure
  • decrease in adiposity
  • increase in insulin sensitivity
  • decrease in inflammation
  • psychological
  • decrease in depression
  • decrease in stress
  • increase in social support
  • anti-thrombotic
  • decrease in platelet adhesiveness
  • increase in fibrinolysis
  • decrease in fibrinogen
  • decrease in blood viscosity
• Physical Activity benefits pt2:

  • anti-ischaemic
  • decrease in myocardial o2 demand
  • increase in coronary blood flow
  • decrease in endothelial dysfunction
  • increase in endothelial progenitor cells
  • increase in circulating angiogenic cells
  • increase in nitric oxide
  • anti-arrhythmic
  • increase in vagal tone
  • increase in heart rate variability
  • decrease in adrenergic activity
• Physical Activity:

  • shouldnt be sedentary for more than 7 hours per day
  • after 9 hours, mortality rates increase
  • need to stand up after every 30 minutes
• • social risk factors:
  • family history
  • financial inequalities
  • employment
  • environmental risk factors:
  • housing
  • air pollution
• Air Pollution:

  • exposure to harmful pollutants in the air can increase plaque burden
  • this can be due to the effects of the pollutants on the cardiac electrophysiology, vascular system and homeostasis
• Assessment of psychosocial risk factors:

  • psychosocial risk factor assessment, using clinical interview or standardized questionnaires, should be considered to identify possible barriers to lifestyle change or adherence to medication in individuals at high CVD risk or with established CVD

  
• Comorbidities that can increase risk of developing CVD

  • hypertension
  • diabetes mellitus
  • chronic kidney disease
  • dyslipidaemia
  • auto-immune conditions e.g. RA
  • treated for cancer
  • influenza
  • serious mental health problems
  • periodontitis
  • HIV
  • infection
• COPD:

  • COPD is an independent risk factor for cardiovascular death, myocardial infarction and heart failure but not for risk of stroke
  • there are also strong associations between rheumatoid arthritis and increase heart disease risk of up to 50%
  • it may also apply to ankylosing spondylitis and psoriatic arthritis
  • theres some data to suggest there may be a connection between psoriasis and CVD, especially if disease is moderate to severe
  • so screening and detection in these population is especially important and treatment of modifiable risk factors
• COPD diagnosis:

  • FEV1 score
  • for every 10% decrease in FEV1, theres a 28% increase in CVD mortality and 20% increase non-fatal pulmonary events
• COPD:

  • can promote atherosclerosis as inflammatory conditions can promote vascular remodelling stiffness leading to atherosclerosis
• Erectile Dysfunction:

  • affects around 40% over the age of 40 and more than 50% of men over the age of 60 years of age
  • men with ED have a 44 to 59% higher risk for total cardiovascular events, 62% for acute myocardial infarction (AMI), 39% for stroke and 24 to 33% for all cause mortality, with a higher risk in those with severe ED
  • can be diagnosed via questionnaires
  • medication for CVD, such as beta blockers, can cause ED
• Sleep:

  • insufficient sleep linked to type 2 diabetes, cardiovascular disease, obesity and depression - recommended for at least 7 hours of sleep
  • obstructive sleep apnoea may be an important predictor of cardiovascular disease
  • notably, hypertension, stroke, coronary heart disease and cardiac arrhythmias have been found to be more common among those with disordered sleep than their peers without sleep abnormalities