Cardiovascular diseases

1. Cardiovascular diseases & it’s prevention( presented by )KhalidClinical Pharmacist Cardiovascular

2. Cardiovascular diseases • Heart attack • Angina ( Ischemic heart disease) • Stroke • Heart failure • Abnormal heart rythms (Atrial fibrillation AF) • Heart valve disease • Congenital heart disease • Heart muscle disease ( cardiomyopathy)

3. Cardiovascular diseases facts & figures • Cardiovascular diseases the number one cause of deaths around the world • Over 17.9 million deaths around the world each year • 1.1 billion people are suffering with high blood pressure • 85% of all CVD related deaths are due to heart attack & stroke • CVD is the 26% cause of all deaths in uk • Around 7 million people live with heart & circulatory disease • 1,60,000 deaths each year in uk • 188,000 people visits uk hospitals due to heart attack ( one in three minutes) • 19 billion cost to uk economy, out of which 46% is direct healthcare cost ( WHO) ( British Hearts foundation)

4. Cardiovascular diseases risk factors Modifiable Risk factors • Physical inactivity • Tobacco & smoking • Diet • High cholesterol & bad fats • Hypertension • Obesity

5. Cardiovascular disease risk factors Non-modifiable risk factors • Family history • Diabetes • Age • Gender • Ethnicity • Socioeconomic status

6. Hypertension • 140/90 mm Hg is considered normal • High blood pressure can cause stroke, heart attack. • Consistent high blood pressure can cause heart failure • Can cause eye damage ( hypertensive retinopathy) • Can cause kidney failure ( damages nephrons) • 970 million people suffer with high blood pressure worldwide.

7. How to control Hypertension Lifestyle changes • Regular exercise, 30 minutes of brisk walk every day • Swimming, cycling, jogging, sports including tennis, basketball • Stop smoking • Less salt ( 6 gram salt, 1.25 spoonful) • Loose weight • Cut down on caffeine ( 2-3 cups ) / day • Alcohol 1-2 units / day , good for heart • Healthy eating, Mediterranean diet, DASH diet Medicines • There are medicines available to bring down blood pressure including CCB, ACE inhibitors, ARB, diuretics, Beta blockers, Alpha blockers.

8. Diet to control blood pressure Mediterranean diet • Eating plenty of starchy food, eg bread and pasta • Plenty of fruits and vegetables • Eating fish twice a week • Eating less red meat • Use vegetable and plant oil, such as olive oil Drink 6-8 glasses of fluids a day • Low fat and low sugary options DASH Diet • Fruits • Low fat or No-Fat dairy foods • Lean meats, poultry & fish • Nuts, seeds & dry beans • Fats and oils. Soft margarine, low fat mayonnaise, vegetable oil

9. Healthy Eating

10. High Cholesterol levels • Normal total cholesterol levels should be less than 5 mmol/L • In the Uk , three out of five individuals have cholesterol levels 5 mmol/L or above . • High cholesterol levels can increase the risk of heart attack & stroke, by causing restrictions of blood flow to heart & brain • High cholesterol levels also increase the risk of blood clots Typed of Cholesterol • High-density lipoprotein ( HDL) , it is good cholesterol, helps in transportation of cholesterol from cells to the liver, and it should be 1 mmol/L or higher than that . • Low-density lipoprotein (LDL) . It carries cholesterol to the cells. High levels of LDL, increase the risk of artery disease, therefore it’s also known as bad cholesterol. It should be ideally 2.6-3.3 mmol/L. The targets are strict for those who suffer with heart diseases or at higherrisk.

11. Causes of High Cholesterol • Unhealthy diet, especially, eating high levels of saturated fats , found in butter, ghee, palm oil, coconut oil. Cakes, biscuits, fatty cuts of meat, sausages, bacon, cheese, pastries, ice cream , chocolate & chocolate spreads, • No more than 30g of saturated fat a day. • Smoking, as it promotes atherosclerosis, by stopping transportation of cholesterol from fatty deposits to liver, through a chemical called acrolein. • Diabetes, as among diabetic patients bad cholesterol & triglyceride levels are high, & HDL levels are low, that promotes the risk of heart attack. • Hereditary disease, genetic disease, family history • High levels of alcohol consumption promote bad cholesterol & high triglycerides production

12. High cholesterol treatment • Healthy, balanced diet • Swapping saturated fat with for fruits, vegetables, whole grain cereals. • Give up smoking • Exercise • Medicines, that helps to reduce bad cholesterol levels, & promote the production of good cholesterol HDL. Statins, decrease the production of bad cholesterol by inhibiting an enzyme in liver. Ezetimibe. Blocks the absorption of cholesterol from food in the intestine Fibrates. Reduce the build up of cholesterol in the arteries Bile acid sequestrants

13. Medicines to prescribe for high cholesterol

14. Exercise As prescription

15. Diabetes • One in 17 people in UK had diabetes • 3.2 Million people been diagnosed with diabetes in the UK, ( 2017) • High blood glucose levels damage the blood vessels, & increase the risk of heart disease. • Diabetes cause the arteries stiff and hard, and the increase of bad cholesterol, promotes clots, and atherosclerosis. • 90% people, who been diagnosed with diabetes or overweight or obese. • Obesity is a biggest challenge in UK, 62% of adults are overweight or obese in England. • In Europe 50% people are overweight. • Ideal body weight should be 18.5kg/m2-24.9kg/m2.

16. Self Management • We hardly spend 30 minutes/ year with our GP. • Better understanding of chronic disease management is very important • Keep yourself fit, healthy, by doing regular exercise, healthy eating, moderate alcohol drink, & healthy weight control. • If there is any problem, visit nhs website or patient.co.uk • Speak to your community pharmacist to get more information • Join Local health Board programs for cardiac rehabilitation, diabetes control.

17. Thank you for listening me