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Ch11.pptxChapter 11 chronic diseases
Questions and Answers: A Guide to Fitness and Wellness 3rd Edition
1
COMING UP IN THIS CHAPTER
Identify the major types of cardiovascular disease, cancer, and diabetes
Assess your personal risk factors for these chronic diseases
Understand screening, diagnosis, and treatment options
Plan steps to reduce your risk for these diseases
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Table 11-1 Estimated Prevalence and Annual Mortality from Cardiovascular Disease, Cancer, and Diabetes
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Cardiovascular Disease
Cardiovascular disease (CVD) is a broad collection of many diseases that affect the heart (cardio) or blood vessels (vascular), or both
Deaths due to CVD have declined in the last 20 years
Still responsible for one in every three U.S. deaths
By 2030, over 40 percent of the U.S. population is projected to have some form of CVD
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What is cardiovascular disease? How many people die from it?
Q
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Types of Cardiovascular Disease
CVD is group of diseases that affects the heart and/or blood vessels
Heart attacks, strokes, coronary artery disease, hypertension, heart failure, and peripheral artery disease
Strokes are one of the most common forms of CVD
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Heart attacks and strokes affect different parts of the body, so why are they always lumped together?
Q
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Figure 11-1 Percentage breakdown of U.S. deaths from cardiovascular disease
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Types of Cardiovascular Disease
Coronary artery disease (CAD)
Usually caused by atherosclerosis
Buildup of plaque creating an occlusion
Can lead to arteriosclerosis
When atherosclerosis occurs in coronary arteries, CAD results
In artery leading to brain—stroke
In artery to a limb—peripheral artery disease
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What type of cardiovascular disease kills the most people?
Q
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Types of Cardiovascular Disease
CAD often has no symptoms as it develops
Once developed, it may reveal itself as:
Angina pectoris: chest pain as result of reduced blood supply to heart
Heart attack, or myocardial infraction (MI)
Blood supply in a coronary artery is blocked, depriving the heart of oxygen
Arrhythmia: a change in the normal pattern of the heartbeat
Cardiac arrest: sudden loss of responsiveness, pulse, and blood pressure
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Figure 11-2 Atherosclerosis and heart attack
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Types of Cardiovascular Disease
Stroke: when the blood (and oxygen) supply to a part of the brain is suddenly interrupted
Two major types:
Ischemic stroke: caused by a blocked artery
Hemorrhagic stroke: caused by a burst blood vessel
Transient ischemic attacks (TIAs)
“Mini-strokes”; caused by temporary blockage and typically do not cause lasting damage
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Is stroke caused by a blocked artery or burst artery?
Q
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Figure 11-3 Stroke
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Thrombus- a clot that forms in and occludes an artery to the brain
Embolus- a clot that forms elsewhere and travels to a cerebral artery
Cerebral hemorrhage- a blood vessel in the brain that bursts
Aneurysm- a weak spot in the blood vessel that forms a pouch that is subject to rupturing
Types of Cardiovascular Disease
Peripheral artery disease (PAD) occurs in the limbs, most commonly the legs
It may cause leg pain when walking, leg numbness or weakness, and coldness or paleness of the limb
Unless treated, it may lead to infections and amputation of the affected limb
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Can I really get CVD in my arms and legs?
Q
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Types of Cardiovascular Disease
Temporary increases in blood pressure are OK
Sustained high blood pressure (hypertension) is not OK
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If my blood pressure goes up naturally when I exercise, why is high blood pressure so bad?
More…
Q
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Types of Cardiovascular Disease
Blood pressure is the force of blood pumping against blood vessel walls
Systolic blood pressure (top number)
Force produced when the heart contracts
Diastolic blood pressure (bottom number)
Force between beats when the heart is at rest
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Types of Cardiovascular Disease
The recommended blood pressure is less than 120/80
Hypotension: low blood pressure
Less common
Systolic pressure below 90 or diastolic pressure below 60, or both
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For blood pressure, how high is too high?
Q
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Table 11-2 Blood Pressure Classification for Adults Age 18 and Older
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Types of Cardiovascular Disease
Heart attack can lead to heart failure
The heart is unable to pump a sufficient volume of blood
Often causes shortness of breath, fatigue, and fluid buildup
May compromise the ability of the kidneys to eliminate fluid
Heart failure complicated by fluid buildup is referred to as congestive heart failure
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17
Is heart failure the same as a heart attack?
Q
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Types of Cardiovascular Disease
Heart murmur refers to a variety of conditions
Most have no ill effects, and no treatment is needed
Result of inherited defects, infections, heart disease
May be related to heart valve function
Mitral valve prolapse (MVP)
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18
What can be done to eliminate a heart murmur?
Q
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Types of Cardiovascular Disease
Varicose veins are a product of improper valve function
Blood accumulation, twisting, and enlargement of affected veins
Caused by aging, hereditary, hormone changes
The best prevention is exercise and avoidance of excess weight
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19
What causes varicose veins, and how can I avoid them?
Q
Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control
You can’t reverse your familial predisposition to CVD, and some risks factors are not modifiable
Important to know family health history/ genetic predispositions
CVD that may be caused by inherited traits include certain forms of cardiomyopathy; arrhythmia; aneurysm; and Marfan’s syndrome
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Is there any way you can reverse genetically predisposed heart problems?
Q
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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control
The prevalence of CVD rises with age
This is due to the wear and tear on the heart and blood vessels
Leads to structural and functional alternations, i.e. hypertension
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21
Why does getting older make a person more likely to have CVD?
Q
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Figure 11-4 Prevalence of high blood pressure among adults age 20 and over by age and sex
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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control
Men are more likely to develop and die from CVD at a younger age
There is no clear reason for the difference
Women are more likely to die from a heart attack
On the horizon: studies that examine heart physiology and rhythms, and hormone fluctuations
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23
Why do more men have heart attacks than women?
Q
23
Figure 11-5 Incidence of cardiovascular disease among adults age 20 and over, by age and sex
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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control
Studies have found different rates of CVD and associated risk factors among different ethnic groups
The reasons are complex but include socioeconomic and biological factors
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How does ethnicity affect cardiovascular disease? What group or groups are most at risk?
More…
Q
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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control
African Americans
Higher prevalence of CVD, hypertension, and stroke
Asian Americans and Latinos
Lower prevalence of heart disease than other groups
American Indians and Alaska Natives
Highest prevalence of stroke as a group
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Cardiovascular Disease Prevention
Some CVD risk factors are modifiable
Avoid tobacco
Keep alcohol use moderate and avoid drugs
Manage stress in healthy ways
Have regular screenings
Reduce elevated blood pressure
Maintain healthy cholesterol and triglyceride levels
Control diabetes
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27
Cardiovascular Disease Prevention
Body weight and food choices are only part of what affects CVD risk
Genes, age, biological sex, and ethnicity also count
Physical activity is an important factor in reducing one’s risk
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Are people who can eat all they want and not gain weight still at risk for cardiovascular disease?
Q
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Cardiovascular Disease Prevention
Many factors must be looked at to assess CVD risk
Among the factors: age, sex, smoking and drinking habits, eating patterns
You are a sum of your risk factors
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29
If you have excellent cardiovascular fitness but CVD runs in your family, do you have a greater risk than someone with no family history of CVD?
Q
Cardiovascular Disease Prevention
The best food plan for CVD prevention is balanced and moderate
Fiber-rich foods, low-fat dairy products, and seafood
Limit excess calorie intake from added sugars, fats, and processed foods
Keep alcohol intake moderate
Limit salt intake
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What types of food should I avoid and eat to help prevent cardiovascular disease?
Q
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Cardiovascular Disease Prevention
Added weight puts stress on the heart
People with excessive body fat are more likely to develop CVD even with no other risk factors
Increased physical activity and a balanced diet are key
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31
If I’m overweight is my risk a lot higher?
Q
Cardiovascular Disease Prevention
Avoid tobacco
Smoking not only raises cancer risk but also significantly increases risk for cardiovascular disease
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Smoking causes cancer, not cardiovascular disease—right?
More…
Q
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Two issues must be addressed in order to quit smoking, the nicotine addiction and psychological dependence.
One-third of all cigarette smokers try to quit each year, but less than 10% succeed.
Cigarette smoking is responsible for one out of ever five deaths in the U.S. annually.
Cardiovascular Disease Prevention
Smoking:
Affects fatty buildup (HDL and LDL levels)
Increases heart rate
Contributes to arrhythmias
Elevates blood pressure, reduces the oxygen level in the blood, and may trigger blood clots
The body slowly begins to heal as soon as someone quits
The risk of CVD falls by 50 percent just 1 year after quitting
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Two issues must be addressed in order to quit smoking, the nicotine addiction and psychological dependence.
One-third of all cigarette smokers try to quit each year, but less than 10% succeed.
Cigarette smoking is responsible for one out of ever five deaths in the U.S. annually.
Cardiovascular Disease Prevention
Keep alcohol use moderate, and avoid drugs
No more than 2 drinks per day for men or 1 drink per day for women
The effects of alcohol use can be positive or negative
Alcohol use is associated with a small increase in HDL and reduced clot formation
Excessive drinking can lead to high blood pressure, arrhythmia, stroke, sudden cardiac death, and obesity
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Does alcohol affect cardiovascular disease? What about other drugs?
Q
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Two issues must be addressed in order to quit smoking, the nicotine addiction and psychological dependence.
One-third of all cigarette smokers try to quit each year, but less than 10% succeed.
Cigarette smoking is responsible for one out of ever five deaths in the U.S. annually.
Table 11-3 Drugs and Related Cardiovascular Disease Complications
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35
Two issues must be addressed in order to quit smoking, the nicotine addiction and psychological dependence.
One-third of all cigarette smokers try to quit each year, but less than 10% succeed.
Cigarette smoking is responsible for one out of ever five deaths in the U.S. annually.
Cardiovascular Disease Prevention
Manage stress in healthy ways
There is a likely connection between stress and cardiovascular disease
The acute stress response is associated with elevated blood pressure and heart rhythms
Over time, the hormones associated with uncontrolled stress may alter glucose and blood fat levels
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Is stress a major factor in cardiovascular disease?
Q
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Cardiovascular Disease Prevention
Have regular screenings for:
Blood pressure
Cholesterol and triglycerides
Triglycerides
Diabetes
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How often do I have to get my blood pressure and cholesterol checked?
Q
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Cardiovascular Disease Prevention
Reduce elevated blood pressure
Hypertension is a type of cardiovascular disease that is a risk factor for other types of CVD
Keeping your blood pressure in check can help prevent CVD and complications from many conditions
Eat a balanced, low-sodium diet, engage in physical activity, maintain healthy weight, limit alcohol, and avoid smoking
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38
What can I do to lower my blood pressure?
Q
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Cardiovascular Disease Prevention
The connection between the foods you eat and the fats (lipids) in your blood are complex
Cholesterol is a waxy substance that occurs naturally in all cells of the body
Low-density lipoprotein (LDL)—bad cholesterol
High-density lipoprotein (HDL)—good cholesterol
Triglycerides
High levels are closely associated with CVD
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How does the fat in the foods I eat affect my cholesterol?
Q
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Table 11-4 Cholesterol and Triglyceride Classification
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Cardiovascular Disease Prevention
People with diabetes are two to four times more likely to develop cardiovascular disease
Elevated blood glucose levels can harm cardiovascular system
Metabolic syndrome: the cluster of conditions that puts people at risk for both heart disease and type 2 diabetes
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Why does diabetes affect the heart?
Q
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Table 11-5 Metabolic Syndrome
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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease
Some forms of CVD have no visible symptoms
Testing is required
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Would I know if I had CVD?
Q
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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease
Symptoms vary depending on the type of CVD
Signs to watch out for:
Chest pain
Fatigue
Shortness of breath
Leg pain
Palpitations
Light-headedness and fainting
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Does cardiovascular disease hurt? Would it affect my everyday activities?
Q
Symptoms, Diagnosis, and Treatment of Cardiovascular Disease
Look for signs
Chest and upper body discomfort (including jaw, neck, arms, back, stomach)
Shortness of breath
Cold sweat, nausea, light-headedness
Prompt treatment is crucial
Call 911
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45
How can you tell if a person is having a heart attack or a stroke?
Q
Table 11-6 Warning Signs of Heart Attack and Stroke
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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease
Cardiopulmonary resuscitation (CPR)
Artificial blood circulation and respiration
For victims of cardiac arrest
Doesn’t usually restart the heart but can temporarily maintain circulation
Resuscitation usually requires defibrillation
AEDs
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47
When are you supposed to use CPR?
Q
Table 11-7 Tests for Diagnosing and Monitoring Cardiovascular Disease
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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease
Lifestyle changes are the first line of defense
Other treatments include:
Medications
Coronary angioplasty and the placement of a stent
Coronary bypass surgery
Pacemakers
Heart valve repair or replacement
Heart transplant
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49
What kinds of medicine and help are available?
Q
Symptoms, Diagnosis, and Treatment of Cardiovascular Disease
Many forms of CVD are treatable
It is necessary to learn to manage CVD
Prevention is best
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How likely is it that someone will survive and recover from CVD? Is there a cure for it?
Q
Cancer
Cancer is a broad category of disease, characterized by the uncontrolled growth of cells
Tumors are abnormal clumps of cells
Benign means noncancerous
Polyps
Malignant tumors are known as cancer
Metastasize: spread
Primary tumor and secondary tumors
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What is cancer? What is the difference between malignant and benign tumors?
Q
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Figure 11-6 Normal cell division versus cancer cell division
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Cancer
About 13.7 million Americans with a history of cancer are alive today
Each year:
1.66 million new diagnoses
586,000 deaths
The number of new cases occurring each year has begun to decline slightly
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How many Americans have cancer?
Q
Types of Cancer
There are hundreds of types of cancer, most falling into one of these general groupings:
Carcinoma: in the skin or tissue lining or covering
80–90% of all cases
Sarcoma: in connective or supportive tissue
Lymphoma and myeloma: in the immune system
Leukemia: in blood-forming tissues
Central nervous system cancers: in the tissues of the brain or spinal cord
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Types of Cancer
The most frequently diagnosed cancers in the U.S. are basal cell carcinoma and squamous cell carcinoma
Noninvasive and highly curable
Lung cancer is the leading cause of cancer death
Lung, liver, and pancreatic cancers have poor survival rate
Diagnosis typically doesn’t happen until advanced
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55
What is the most common type of cancer? Which type is most severe?
Q
Table 11-8 Most Frequently Diagnosed Cancers in the U. S., 2012 estimates
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Assessing Your Risk for Cancer
Cancer risk is viewed in two ways:
Lifetime risk: probability of dying from cancer in your lifetime
Relative risk: extent of the relationship between a risk factor and a specific kind of cancer
Specific risk factors: heredity/genetics; age; gender; ethnicity; exposure to cancer-causing agents
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What are my chances of getting cancer?
Q
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Assessing Your Risk for Cancer
Heredity/genetics:
All cancers involve genetic mutation (damage)
Most are random
Only 5–10% are linked to inherited mutations
In evaluating your own risk, consider:
How many family members have had a particular type of cancer
Whether any were diagnosed at a young age
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If someone in my family has cancer, am I likely to get it too?
Q
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Assessing Your Risk for Cancer
The likelihood of being diagnosed with cancer rises with age
Genetic mutations and environmental factors build up
Increased exposure/decreased ability to repair damaged cells
Testicular cancer is an exception
Although uncommon, it is more prevalent in men aged 15–34
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Is cancer common in young adults? What types of cancer should I worry about now, when I’m 20?
Q
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Assessing Your Risk for Cancer
Men are more likely to develop cancer
Half of all men will develop cancer at some point in their life; one-third of all women
Data are inconclusive as to why
Lifestyle factors
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Are men or women more likely to get cancer?
Q
Assessing Your Risk for Cancer
Cancer is more common in African Americans
Other ethnicities have lower overall cancer rates but higher rates of specific cancers
Many factors contribute
Low incomes; limited access to health care, insurance
Cultural dietary factors and preferences for early marriage and childbirth
Genetics
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What groups are most at risk for cancer?
Q
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Assessing Your Risk for Cancer
A carcinogen is any substance that causes cancer
Radiation: X-rays, radon, sunlight, and tanning beds
Certain hormones and viruses
Asbestos
Tobacco
Solvents
Pesticides
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What’s a carcinogen?
Q
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Cancer Prevention
Avoid tobacco
Pay attention to your diet, physical activity, and body weight
One-third of all cancer deaths are due to poor nutrition and physical activity and/or excess body weight
Drink alcohol in moderation
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Is there a way to keep from getting cancer?
More…
Q
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Cancer Prevention
Be aware of infectious agents
Prevent with vaccination, antibiotic treatments, and lifestyle choices
Avoid unnecessary radiation
X-rays, radioactive substances, sunlight
Be cautious with sunlight, and avoid tanning lamps and booths
UV rays can lead to melanoma
Minimize stress
Be careful about chemical exposure
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Symptoms, Diagnosis, and Treatment of Cancer
Early cancer screening is critical
Screening tests performed before any symptoms appear can help find cancer in its earliest and most treatable stage
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When am I supposed to get all those cancer tests—and does everyone really need them?
Q
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Table 11-9 Cancer Screening Guidelines for the Early Detection of Cancer in Average-Risk Asymptomatic People
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Symptoms, Diagnosis, and Treatment of Cancer
General symptoms to watch for: CAUTION
Changes in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
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What are symptoms of cancer?
Q
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Figure 11-7 ABCDEs of melanoma
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Symptoms, Diagnosis, and Treatment of Cancer
There is no single test to diagnose cancer
Possible tests include:
Biopsy
Imaging procedures
Tumor marker or lab tests
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69
What tests will a doctor do to figure out if a symptom really means cancer?
Q
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Symptoms, Diagnosis, and Treatment of Cancer
When someone is diagnosed with cancer, the type of cancer and stage of development will be identified
Stage: I–IV (stage I, early; stage IV, advanced cancer that has spread)
In situ—found only in the layer of cells where it began
Prognosis
Typically decreases as stage increases
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What does it mean when they say that someone has stage IV cancer?
Q
Figure 11-8 Stages and spread of cancer
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Symptoms, Diagnosis, and Treatment of Cancer
Chemotherapy: drugs to kill cancer cells or inhibit their growth
Radiation therapy: use of high-energy rays to kill or damage cancer cells in an attempt to keep them from growing and/or spreading
Local rather than a systemic treatment
Surgery: removal of malignant tissue
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Once someone has cancer, what’s the best way to treat it?
Q
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Diabetes
Diabetes mellitus is a metabolic disorder characterized by problems with the body’s production or use of insulin
Causes glucose to build up in the blood stream, resulting in high blood sugar, or hyperglycemia
Because cells can’t obtain sufficient glucose, body loses main source of energy
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What is diabetes?
Q
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Diabetes
Prolonged hyperglycemia can cause damage to nerves, blood vessels, and other organs
Untreated, it can lead to ketoacidosis
Long-term complications include higher rates of CVD and lower life expectancy
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What’s bad about high blood sugar?
Q
Figure 11-9 Possible complications of diabetes
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Diabetes
Hypoglycemia or low blood sugar occurs when glucose levels in the blood are low
Relatively rare
Danger is to the brain because without glucose, brain cells die
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Can blood sugar be too low?
Q
Diabetes
Diabetes is more common in older adults
The number of cases among children and teens is growing
An estimated 79 million American adults have prediabetes
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77
Who is most likely to develop diabetes?
Q
Types of Diabetes
There are three primary types of diabetes:
Type 1 diabetes: an autoimmune disease attacking and destroying the insulin-producing cells of the pancreas
Type 2 diabetes: the pancreas produces insulin, but cells don’t respond properly to the insulin
Insulin resistance
Gestational diabetes: high glucose levels during pregnancy
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Are some kinds of diabetes more dangerous than others?
Q
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Types of Diabetes
Before developing type 2 diabetes, people often develop prediabetes, impaired glucose tolerance
Higher than normal glucose, but not high enough to be classified as diabetes
Can suffer the same complications as those with diabetes
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Can you have high blood sugar without having diabetes?
Q
Figure 11-10 Normal glucose metabolism, type 1 diabetes, and type 2 diabetes
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Assessing Your Risk for Diabetes
Different types have different causes
Type I: autoimmune condition
Genetic and viral factors are suspected to be the primary trigger
The exact cause is unknown
Develops most often in children
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What causes diabetes?
More…
Q
Assessing Your Risk for Diabetes
Type II: causes unknown; risk factors include:
Age 45 or older
BMI over 25; not physically active
A family history of diabetes
High blood pressure or high cholesterol
Gestational diabetes
Blood glucose levels that are higher than normal
African American, American Indian, Asian American, Pacific Islander, or Hispanic/Latino genetic heritage
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More…
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Assessing Your Risk for Diabetes
Type II: causes unknown; risk factors include:
Polycystic ovary syndrome
Dark, thick, velvety skin around the neck or in the armpits
Blood vessel problems affecting the heart, brain, or legs
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Figure 11-11 Lifetime risk of diabetes by BMI at age 18
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Assessing Your Risk for Diabetes
A family history of diabetes is a risk factor in the disease
Positive lifestyle choices can delay or prevent the onset of diabetes
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85
If both my dad and my grandfather have diabetes, will I get it too?
Q
Assessing Your Risk for Diabetes
As a nation, we are getting fatter, and obesity is a key risk factor for type 2 diabetes
The risk is greater for those who are overweight at a young age
Lifestyle choices related to diet and exercise are key to prevention
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86
I keep hearing that more and more people are getting diabetes. Why is that?
Q
Diabetes Prevention
Eating anything in excess can cause obesity, a key risk factor
Sugar itself does not directly cause diabetes
Diabetes is related to genetics and lifestyle choices
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Does eating too much sugar cause diabetes?
Q
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Symptoms, Diagnosis, and Treatment of Diabetes
Symptoms to watch for:
Increased thirst
Increased hunger after eating
Dry mouth
Frequent urination
Unexplained weight loss or weight gain
Fatigue
Blurred or decreased vision
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88
How would I know if I had diabetes?
More…
Q
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Symptoms, Diagnosis, and Treatment of Diabetes
Symptoms to watch for:
Numbness or tingling in hands or feet
Slow-healing sores or cuts
Itching of the skin, most often around the vaginal or groin area
Frequent yeast infections
Impotency
Loss of consciousness (in rare cases)
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89
Symptoms, Diagnosis, and Treatment of Diabetes
Adults over age of 45 should be tested every 3 years
If at high risk, early and more frequent testing required
A1C test
Fasting plasma glucose test (FPG)
Oral glucose tolerance test (OGTT)
Urinalysis
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Do I need to be tested for diabetes even if I don’t have any symptoms?
Q
90
Figure 11-2 Criteria for diagnosing diabetes
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Symptoms, Diagnosis, and Treatment of Diabetes
Type 1: requires daily doses of insulin
Self-injections
Pumps
Type 2: oral medication and lifestyle strategies
Gestational: lifestyle strategies and insulin in some cases
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I have a friend who has to give herself shots. Does everyone with diabetes have to do this?
Q
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Symptoms, Diagnosis, and Treatment of Diabetes
Self-management of diabetes is crucial
Learn how to self-test glucose levels
Understand signs of diabetes complications
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What about those ads for diabetes supplies? Besides taking medication, what does someone with diabetes have to do?
Q
Putting it All Together for Chronic Disease Prevention
Get regular physical activity
Eat a balanced diet
Don’t smoke, or stop if you do
Consume alcohol only in moderation
Give your health history to your health care provider
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Table 11-10 Top Lifestyle Choices for Preventing Chronic Disease
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