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• Chronic Disease


  Diseases of long duration and slow progression
• Chronic diseases are the leading cause of mortality globally: 70% of deaths
• 40 million deaths from chronic diseases per year (31M in low/middle income countries), 15 million <70 years of age; >80% of premature deaths were in low/middle-income countries
• 4 Major Chronic Diseases

  • Cardiovascular diseases (17.7M)
  • Cancers (8.8M)
  • Chronic respiratory diseases (3.9M)
  • Diabetes (1.6M)
• Primary Risk Factors for Chronic Diseases

  • Smoking
  • Physical inactivity
  • Obesity
  • Unhealthy diet
  • High blood pressure
  • High cholesterol
  • High blood glucose
• These risk factors are the leading risk factors globally (% of deaths): High blood pressure (19%), tobacco (10%), elevated blood glucose (6%), physical inactivity (6%), obesity (5%)
• 9/10 Canadians have ≥1 risk factor: Smoking, Physical inactivity, < recommended daily Vegetables/Fruit, Stress, Overweight/Obesity, High Blood Pressure, Diabetes
• 2/5 Canadians have ≥3 risk factors
• Cardiovascular Disease (CVD)


  Collective term for diseases of heart & blood vessels
• 1.6 million Canadians have heart disease or are living with the effects of a stroke
• Cardiovascular disease affects 120,000 Canadians annually; heart disease & stroke are the leading cause of death
• Cardiovascular disease costs >$22 billion in direct ($7.6B) & indirect ($14.6B) health costs in Canada
• Cardiovascular Disease Costs in Canada

  • Hospital care ($4B)
  • Drug costs ($2.1B)
  • Physician care ($1.5B)
  • Premature death ($9.3B)
  • Long-term disability ($4.2B)
  • Short-term disability ($1.2B)
• Cardiovascular System


  The system that circulates blood through the body: the heart + blood vessels
• How the Heart Works

  1. Waste-carrying, O2-poor blood enters right atrium

  2. Flows into right ventricle, pumped through pulmonary arteries to lungs

  3. Picks up O2, discards CO2, flows through pulmonary veins into left atrium

  4. Flows into left ventricle, pumped through aorta into rest of body's blood vessels
• Blood Pressure


  Force exerted by the blood on the walls of the blood vessels, created by the pumping heart
• Systole


  When the heart contracts (beats)
• Diastole


  When the heart relaxes between beats
• Normal Blood Pressure


  120/80 mmHg
• Atherosclerosis


  • Thickening & hardening of arteries, narrowed by deposits of fat, cholesterol, other substances
  • Endothelial cell damage by smoking, high BP, high insulin or glucose, LDL particle deposit
  • Fatty plaques accumulate/grow on artery walls, loss of elasticity, restricted blood flow
  • Vulnerable to blockage by blood clots
• Coronary Artery Disease (CAD)

  Most common form of heart disease, caused by atherosclerosis
• Angina


  Partial blockage of coronary artery
• Myocardial Infarction (MI)


  Complete blockage of coronary artery, causing damage or death of heart muscle (myocardium)
• In Canada, 70,000 heart attacks occur per year = 1 every 7 minutes
• Sudden Cardiac Death


  Cardiac arrest resulting from arrhythmia, often cause of death in fatal MI
• Heart Attack Symptoms


  • Chest pain or pressure 66%
  • Arm, neck, shoulder, back or jaw pain
  • Difficulty breathing, shortness of breath
  • Excessive sweating; cool, clammy skin
  • Nausea & vomiting
  • Loss of consciousness
  • Fear, anxiety, denial
• Stroke (Cerebrovascular Disease)


  "Brain attack" - 2 million brain cells die per minute; brain ages 3.5 years each hour
• Ischemic Stroke


  Blood clot forms in a cerebral artery, or blood clot carried in the blood stream that becomes wedged in cerebral artery
• Hemorrhagic Stroke


  Blood vessel in brain bursts, spilling blood into surrounding tissue
• Stroke death rates in Canada have declined dramatically
• Stroke survivors usually have long lasting disability</b>
• Stroke Symptoms


  • Sudden numbness/weakness of face, arm, leg usually 1 side of body
  • Sudden confusion, trouble speaking, understanding
  • Sudden trouble seeing in 1 or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache, no known cause
• Peripheral Arterial Disease (PAD)

  Atherosclerosis in leg or arm arteries
• Claudication


  Aching or fatigue in leg with exertion
• Rest Pain


  More severe stage of PAD, artery significantly narrowed or completely blocked
• About 800,000 Canadians have PAD
• Congestive Heart Failure


  Caused by hypertension, atherosclerosis, CHD, MI, diabetes; Damage to heart's pumping mechanism, fluids back up, seep through capillary walls
• 400,000 Canadians per year develop Congestive Heart Failure
• Congestive Heart Failure can be controlled & treated
• Smoking


  • 15% of CVD deaths
  • 30% of smoking related deaths are due to CVD
  • 1 pack/d = 2x risk of MI; 2+ packs/d = 3x risk of MI
  • Smokers 2-3x more likely to die from MI vs. non-smokers
  • 2x risk of stroke