HEALTH QUESTION 1

CHAPTER 12: Cardiovascular Disease, Diabetes, and Cancer Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. Cardiovascular disease includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis. The underlying mechanisms vary depending on the disease. Coronary artery disease, stroke, and peripheral artery disease involve atherosclerosis, which is the narrowing of the inside of an artery due to the build up of plaque. This may be caused by high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol consumption, among others. High blood pressure results in 13% of CVD deaths, while tobacco results in 9%, diabetes 6%, lack of exercise 6% and obesity 5%. Rheumatic heart disease may follow untreated strep throat. It is estimated that 90% of CVD is preventable. Coronary heart disease (CHD), also commonly referred to as just heart disease, is a common term for the buildup of plaque in the heart’s arteries that could lead to heart attack. But is there a difference between coronary heart disease and coronary artery disease? The short answer is often no — health professionals frequently use the terms interchangeably. However, coronary heart disease, or CHD, is actually a result of coronary artery disease, or CAD. With coronary artery disease, plaque first grows within the walls of the coronary arteries until the blood flow to the heart’s muscle is limited. View an illustration of coronary arteries below:

Coronary Arteries

The Coronary Arteries are the blood vessels that supply blood to your heart. They branch off of the aorta at its base. The right coronary artery, the left main coronary, the left anterior descending, and the left circumflex artery, are the four major coronary arteries. Blockage of these arteries is a common cause of angina, heart disease, heart

attacks and heart failure. This restriction of the blood supply to the tissues is also called ischemia. It may be chronic, narrowing of the coronary artery over time and limiting of the blood supply to part of the muscle. Or it can be acute, resulting from a sudden rupture of a plaque and formation of a thrombus or blood clot. Anatomy of the Cardiovascular System To fully understand Cardiovascular Diseases, it may be helpful to understand the anatomy of the cardiovascular system. It includes the following:

o Heart: the pump, divided into four chambers (R/L atria, R/L ventricles) o Arteries: large vessels carrying oxygen-rich blood away from heart; have

thick, muscular wall o Arterioles: smaller arteries o Capillaries: smallest vessels where gas exchange takes place, oxygen is

delivered to tissues and carbon dioxide is carried away o Veinuoles: smallest veins, which carry carbon dioxide-rich blood, back to

heart o Veins: biggest vessels that carry carbon dioxide-rich blood back to heart;

have one-way valves to prevent gravity from pulling blood backward (away from heart)

o Atria: the collecting chambers of the heart, located on top o Ventricles: the pumping chambers of the heart, located on the bottom o Aorta: the largest vessel (artery) in the body; all arteries branch from it

The right side of the heart (right atrium and right ventricle) takes CO2-rich blood and sends it to the lungs for oxygenation. The left side of the heart (left atrium and ventricle) takes O2-rich blood and delivers it to the body. The right side is said to be responsible for pulmonary circulation; the left side is said to be responsible for systemic circulation. Because of the distances involved, pulmonary circulation is a relatively low-pressure system, while systemic circulation is a relatively high- pressure system. In fact, when we measure blood pressure we’re measuring systemic pressure. Heart Disease and Stroke Facts Heart Disease Facts • Heart disease is the leading cause of death for both men and women. • About 610,000 Americans die from heart disease each year—that’s 1 in every

4 deaths. • Coronary heart disease is the most common type of heart disease, killing about

365,000 people in 2014. • In the United States, someone has a heart attack every 42 seconds. Each

minute, someone in the United States dies from a heart disease-related event. • Heart disease is the leading cause of death for people of most racial/ethnic

groups in the United States, including African Americans, Hispanics, and whites. For Asian Americans or Pacific Islanders and American Indians or Alaska Natives, heart disease is second only to cancer.

• Heart disease costs the United States about $207 billion each year. This total includes the cost of health care services, medications, and lost productivity.

Risk Factors High blood pressure, high LDL cholesterol, and smoking are key risk factors for heart disease. About half of Americans (49%) have at least one of these three risk factors. Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:

• Diabetes • Overweight and obesity • Poor diet • Physical inactivity • Excessive alcohol use

Stroke Facts

• Stroke is the fifth leading cause of death in the United States, killing more than 130,000 Americans each year—that’s 1 of every 20 deaths.

• A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts.

• Someone in the United States has a stroke every 40 seconds. Every four minutes, someone dies of stroke.

• Every year, about 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes; 185,000 are recurrent strokes.

• Stroke is an important cause of disability. Stroke reduces mobility in more than half of stroke survivors age 65 and over.

• Stroke costs the nation $33 billion annually, including the cost of health care services, medications, and lost productivity.

• You can’t control some stroke risk factors, like heredity, age, gender, and ethnicity. Some medical conditions—including high blood pressure, high cholesterol, heart disease, diabetes, overweight or obesity, and previous stroke or transient ischemic attack (TIA)—can also raise your stroke risk. Avoiding smoking and drinking too much alcohol, eating a balanced diet, and getting exercise are all choices you can make to reduce your risk.

Common Stroke Warning Signs and Symptoms • Sudden numbness or weakness of the face, arm, or leg—especially on one

side of the body. • Sudden confusion, trouble speaking or understanding. • Sudden trouble seeing in one or both eyes. • Sudden trouble walking, dizziness, loss of balance or coordination. • Sudden severe headache with no known cause.

Coronary Artery Disease (CAD) Coronary artery disease (CAD) is the most common type of heart disease in the United States. For some people, the first sign of CAD is a heart attack. Therefore, taking steps to reduce your risk for CAD is essential. Research suggests that CAD (also referred to as coronary heart disease, abbreviated CHD) starts when certain factors damage the inner layers of the coronary arteries. These factors include: • Smoking • High levels of certain fats and cholesterol in the blood • High blood pressure • High levels of sugar in the blood due to insulin resistance or diabetes Causes of CAD

When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged. Plaque is made up of deposits of cholesterol and other substances in the artery. This progression of plaque build up is called atherosclerosis. The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle. Eventually, an area of plaque can rupture (break open). If this happens, blood cell fragments called platelets will stick to the site of the injury and may clump together to form blood clots. Blood clots narrow the coronary arteries even more and worsen angina (chest discomfort or pain) or cause a heart attack. Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way that it should. An irregular heartbeat, or arrhythmia, also can develop. Other Conditions Related to Heart Disease Coronary artery disease is the most common type of heart disease, but there are many other conditions that affect the heart: • Acute coronary syndrome is a term that includes heart attack and unstable

angina. • Angina, a symptom of coronary artery disease, is chest pain or discomfort that

occurs when the heart muscle is not getting enough blood. Angina may feel like pressure or a squeezing pain in the chest. The pain also may occur in the shoulders, arms, neck, jaw, or back. It may feel like indigestion. There are two forms of angina—stable or unstable:

o Stable angina happens during physical activity or under mental or emotional stress.

o Unstable angina is chest pain that occurs even while at rest, without apparent reason. This type of angina is a medical emergency.

• Aortic aneurysm and dissection are conditions that can affect the aorta, the major artery that carries blood from the heart to the body. An aneurysm is an enlargement in the aorta that can rupture or burst. A dissection is a tear in the aorta. Both of these conditions are medical emergencies.

• Arrhythmias are irregular or unusually fast or slow heartbeats. Arrhythmias can be serious. One example is called ventricular fibrillation. This type of arrhythmia causes an abnormal heart rhythm that leads to death unless treated right away with an electrical shock to the heart (called defibrillation). Other arrhythmias are less severe but can develop into more serious conditions, such as atrial fibrillation, which can cause a stroke.

• Atherosclerosis occurs when plaque builds up in the arteries that supply blood to the heart (called coronary arteries). Plaque is made up of cholesterol deposits. Plaque buildup causes arteries to narrow over time.

• Atrial fibrillation is a type of arrhythmia that can cause rapid, irregular beating of the heart’s upper chambers. Blood may pool and clot inside the heart, increasing the risk for heart attack and stroke.

• Cardiomyopathy occurs when the heart muscle becomes enlarged or stiff. This can lead to inadequate heart pumping (or weak heart pump) or other problems. Cardiomyopathy has many causes, including family history of the disease, prior heart attacks, uncontrolled high blood pressure, and viral or bacterial infections.

• Congenital heart defects are problems with the heart that are present at birth. They are the most common type of major birth defect. Examples include abnormal heart valves or holes in the heart’s walls that divide the heart’s chambers. Congenital heart defects range from minor to severe.

• Heart failure is often called congestive heart failure because of fluid buildup in the lungs, liver, gastrointestinal tract, and the arms and legs. Heart failure is a serious condition that occurs when the heart can’t pump enough blood to meet the body’s needs. It does not mean that the heart has stopped but that muscle is too weak to pump enough blood. The majority of heart failure cases are chronic, or long-term heart failures.

• The only cure for heart failure is a heart transplant. However, heart failure can be managed with medications or medical procedures.

• Peripheral arterial disease (PAD) occurs when the arteries that supply blood to the arms and legs (the periphery) become narrow or stiff. PAD usually results from atherosclerosis, the buildup of plaque and narrowing of the arteries. With this condition, blood flow and oxygen to the arm and leg muscles are low or even fully blocked. Signs and symptoms include leg pain, numbness, and swelling in the ankles and feet.

• Rheumatic heart disease is damage to the heart valves caused by a bacterial (streptococcal) infection called rheumatic fever.

Risk Factors for Coronary Heart Disease Coronary heart disease risk factors are conditions or habits that raise your risk of coronary heart disease (CHD) and heart attack. These risk factors also increase the chance that existing CHD will worsen. There are many known CHD risk factors. You can control some risk factors, but not others. Risk factors you can control include:

• High blood cholesterol and triglyceride levels (a type of fat found in the blood)

• High blood pressure • Diabetes and prediabetes • Overweight and obesity • Smoking • Lack of physical activity

• Unhealthy diet • Stress

The risk factors you can't control are age, gender, and family history of CHD. Many people have at least one CHD risk factor. Your risk of CHD and heart attack increases with the number of risk factors you have and their severity. Also, some risk factors put you at greater risk of CHD and heart attack than others. Examples of these risk factors include smoking and diabetes. Many risk factors for coronary heart disease start during childhood. This is even more common now because many children are overweight and don’t get enough physical activity. Researchers continue to study and learn more about CHD risk factors.

Section 12.1 Stroke

A stroke is a medical condition in which poor blood flow to the brain results in cell death. This results in part of the brain not functioning properly. The main types of stroke are: • Ischemic stroke. • Hemorrhagic stroke. • Transient ischemic attack (a warning or “mini-stroke”).

Ischemic Stroke Most strokes (85%) are ischemic strokes. If you have an ischemic stroke, the artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes. Hemorrhagic Stroke A hemorrhagic stroke occurs when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them. High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke. There are two types of hemorrhagic strokes:

• Intracerebral hemorrhage is the most common type of hemorrhagic stroke. It occurs when an artery in the brain bursts, flooding the surrounding tissue with blood.

• Subarachnoid hemorrhage is a less common type of hemorrhagic stroke. It refers to bleeding in the area between the brain and the thin tissues that cover it.

Transient Ischemic Attack (TIA) A transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is different from the major types of stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes. It is important to know that:

• A TIA is a warning sign of a future stroke. • A TIA is a medical emergency, just like a major stroke. • Strokes and TIAs require emergency care. Call 9-1-1 right away if you feel

signs of a stroke or see symptoms in someone around you. • There is no way to know in the beginning whether symptoms are from a TIA

or from a major type of stroke. • Like ischemic strokes, blood clots often cause TIAs. • More than a third of people who have a TIA end up having a major stroke

within 1 year if they don’t receive treatment, and 10%-15% will have a major stroke within 3 months of a TIA.

A health care team can usually find the cause and take steps to prevent a major stroke. Recognizing and treating TIAs can reduce the risk of a major stroke. Recognizing a Stroke – Think FAST! During a stroke, every minute counts! Fast treatment can lessen the brain damage that stroke can cause. By knowing the signs and symptoms of stroke, you can take quick action and perhaps save a life—maybe even your own. Signs of Stroke in Men and Women

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body

• Sudden confusion, trouble speaking, or difficulty understanding speech • Sudden trouble seeing in one or both eyes • Sudden trouble walking, dizziness, loss of balance, or lack of coordination

• Sudden severe headache with no known cause Call 9-1-1 right away if you or someone else has any of these symptoms. Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The stroke treatments that work best are available only if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for these if they don’t arrive at the hospital in time. If you think someone may be having a stroke, act F.A.S.T. and do the following simple test: F—Face: Ask the person to smile. Does one side of the face droop? A—Arms: Ask the person to raise both arms. Does one arm drift downward? S—Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange? T—Time: If you see any of these signs, call 9-1-1 right away. Note the time when any symptoms first appear. This information helps health care providers determine the best treatment for each person. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Section 12.2 Metabolic Syndrome

Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.

The term “metabolic” refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.

In this article, “heart disease” refers to coronary heart disease (CHD). CHD (also called coronary artery disease, abbreviated CAD) is a condition in which a waxy substance called plaque builds up inside the coronary (heart) arteries.

Plaque hardens and narrows the arteries, reducing blood flow to your heart muscle. This can lead to chest pain, a heart attack, heart damage, or even death.

Metabolic Risk Factors

The five conditions described below are metabolic risk factors. You can have any one of these risk factors by itself, but they tend to occur together. You must have at least three metabolic risk factors to be diagnosed with metabolic syndrome.

A Large Waistline

Having a large waistline means that you carry excess weight around your waist (abdominal obesity). This is also called having an “apple-shaped” figure. Your doctor will measure your waist to find out whether you have a large waistline.

A waist measurement of 35 inches or more for women or 40 inches or more for men is a metabolic risk factor. A large waistline means you’re at increased risk for heart disease and other health problems.

A High Triglyceride Level

Triglycerides are a type of fat found in the blood. A triglyceride level of 150 mg/dL or higher (or being on medicine to treat high triglycerides) is a metabolic risk factor. (The mg/dL is milligrams per deciliter—the units used to measure triglycerides, cholesterol, and blood sugar.)

A Low HDL Cholesterol Level

HDL cholesterol sometimes is called “good” cholesterol. This is because it helps remove cholesterol from your arteries.

An HDL cholesterol level of less than 50 mg/dL for women and less than 40 mg/dL for men (or being on medicine to treat low HDL cholesterol) is a metabolic risk factor.

High Blood Pressure

A blood pressure of 130/85 mmHg or higher (or being on medicine to treat high blood pressure) is a metabolic risk factor. (The mmHg is millimeters of mercury— the units used to measure blood pressure.)

If only one of your two blood pressure numbers is high, you’re still at risk for metabolic syndrome.

High Fasting Blood Sugar

A normal fasting blood sugar level is less than 100 mg/dL. A fasting blood sugar level between 100–125 mg/dL is considered prediabetes. A fasting blood sugar level of 126 mg/dL or higher is considered diabetes.

A fasting blood sugar level of 100 mg/dL or higher (or being on medicine to treat high blood sugar) is a metabolic risk factor.

About 85 percent of people who have type 2 diabetes—the most common type of diabetes—also have metabolic syndrome. These people have a much higher risk for

heart disease than the 15 percent of people who have type 2 diabetes without metabolic syndrome.

Cholesterol Management

What Is Cholesterol?

To understand high blood cholesterol, it helps to learn about cholesterol. Cholesterol is a waxy, fat-like substance that’s found in all cells of the body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs. However, cholesterol also is found in some of the foods you eat. Cholesterol travels through your bloodstream in small packages called lipoproteins. These packages are made of fat (lipid) on the inside and proteins on the outside.

Two kinds of lipoproteins carry cholesterol throughout your body: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). Having healthy levels of both types of lipoproteins is important.

LDL cholesterol sometimes is called “bad” cholesterol. A high LDL level leads to a buildup of cholesterol in your arteries. (Arteries are blood vessels that carry blood from your heart to your body.)

HDL cholesterol sometimes is called “good” cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Your liver removes the cholesterol from your body.

What Is High Blood Cholesterol?

High blood cholesterol is a condition in which you have too much cholesterol in your blood. By itself, the condition usually has no signs or symptoms. Thus, many people don’t know that their cholesterol levels are too high.

People who have high blood cholesterol have a greater chance of getting coronary heart disease, also called coronary artery disease. (In this article, the term “heart disease” refers to coronary heart disease.) The higher the level of LDL cholesterol in your blood, the GREATER your chance is of getting heart disease. The higher the level of HDL cholesterol in your blood, the LOWER your chance is of getting heart disease.

Coronary heart disease is a condition in which plaque builds up inside the coronary (heart) arteries. Plaque is made up of cholesterol, fat, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis.

What Causes High Blood Cholesterol?

Many factors can affect the cholesterol levels in your blood. You can control some factors, but not others.

Factors You Can Control

Diet

Cholesterol is found in foods that come from animal sources, such as egg yolks, meat, and cheese. Some foods have fats that raise your cholesterol level.

For example, saturated fat raises your low-density lipoprotein (LDL) cholesterol level more than anything else in your diet. Saturated fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

Trans fatty acids (trans fats) raise your LDL cholesterol and lower your high-density lipoprotein (HDL) cholesterol. Trans fats are made when hydrogen is added to vegetable oil to harden it. Trans fats are found in some fried and processed foods.

Limiting foods with cholesterol, saturated fat, and trans fats can help you control your cholesterol levels.

Physical Activity and Weight

Lack of physical activity can lead to weight gain. Being overweight tends to raise your LDL level, lower your HDL level, and increase your total cholesterol level. (Total cholesterol is a measure of the total amount of cholesterol in your blood, including LDL and HDL.) Routine physical activity can help you lose weight and lower your LDL cholesterol. Being physically active also can help you raise your HDL cholesterol level.

Factors You Can’t Control

Heredity

High blood cholesterol can run in families. An inherited condition called familial hypercholesterolemia causes very high LDL cholesterol. (“Inherited” means the condition is passed from parents to children through genes.) This condition begins at birth, and it may cause a heart attack at an early age.

Age and Sex

Starting at puberty, men often have lower levels of HDL cholesterol than women. As women and men age, their LDL cholesterol levels often rise. Before age 55, women usually have lower LDL cholesterol levels than men. However, after age 55, women can have higher LDL levels than men.

How Is High Blood Cholesterol Diagnosed?

Your doctor will diagnose high blood cholesterol by checking the cholesterol levels in your blood. A blood test called a lipoprotein panel can measure your cholesterol levels. Before the test, you’ll need to fast (not eat or drink anything but water) for 9 to 12 hours.

The lipoprotein panel will give your doctor information about your:

• Total cholesterol. Total cholesterol is a measure of the total amount of cholesterol in your blood, including low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.

• LDL cholesterol. LDL, or “bad,” cholesterol is the main source of cholesterol buildup and blockages in the arteries.

• HDL cholesterol. HDL, or “good,” cholesterol helps remove cholesterol from your arteries.

• Triglycerides (tri-GLIH-seh-rides). Triglycerides are a type of fat found in your blood. Some studies suggest that a high level of triglycerides in the blood may raise the risk of coronary heart disease, especially in women.

If it’s not possible to have a lipoprotein panel, knowing your total cholesterol and HDL cholesterol can give you a general idea about your cholesterol levels.

Testing for total and HDL cholesterol does not require fasting. If your total cholesterol is 200 mg/dL or more, or if your HDL cholesterol is less than 40 mg/dL, your doctor will likely recommend that you have a lipoprotein panel. (Cholesterol is measured as milligrams (mg) of cholesterol per deciliter (dL) of blood.)

The tables below show total, LDL, and HDL cholesterol levels and their corresponding categories. See how your cholesterol numbers compare to the numbers in the tables below.

Total Cholesterol Level Total Cholesterol Category

Less than 200 mg/dL Desirable

200–239 mg/dL Borderline high

240 mg/dL and higher High

LDL Cholesterol Level LDL Cholesterol Category

Less than 100 mg/dL Optimal

100–129 mg/dL Near optimal/above optimal

130–159 mg/dL Borderline high

160–189 mg/dL High

190 mg/dL and higher Very high

HDL Cholesterol Level HDL Cholesterol Category

Less than 40 mg/dL A major risk factor for heart disease

40–59 mg/dL The higher, the better

60 mg/dL and higher Considered protective against heart disease

Triglycerides also can raise your risk for heart disease. If your triglyceride level is borderline high (150–199 mg/dL) or high (200 mg/dL or higher), you may need treatment.

How Is High Blood Cholesterol Treated?

High blood cholesterol is treated with lifestyle changes and medicines. The main goal of treatment is to lower your low-density lipoprotein (LDL) cholesterol level enough to reduce your risk for coronary heart disease, heart attack, and other related health problems.

Your risk for heart disease and heart attack goes up as your LDL cholesterol level rises and your number of heart disease risk factors increases.

Some people are at high risk for heart attacks because they already have heart disease. Other people are at high risk for heart disease because they have diabetes or more than one heart disease risk factor.

Talk with your doctor about lowering your cholesterol and your risk for heart disease. Also, check the list to find out whether you have risk factors that affect your LDL cholesterol goal:

• Cigarette smoking • High blood pressure (140/90 mmHg or higher), or you’re on medicine to

treat high blood pressure • Low high-density lipoprotein (HDL) cholesterol (less than 40 mg/dL)

• Family history of early heart disease (heart disease in father or brother before age 55; heart disease in mother or sister before age 65)

• Age (men 45 years or older; women 55 years or older)

Lowering Cholesterol Using Therapeutic Lifestyle Changes (TLC)

TLC is a set of lifestyle changes that can help you lower your LDL cholesterol. The main parts of the TLC program are a healthy diet, weight management, and physical activity.

The TLC Diet

With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found in some meats, dairy products, chocolate, baked goods, and deep-fried and processed foods.

No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.

You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the types of fat in prepared foods can be found on the foods’ Nutrition Facts labels.

Foods high in soluble fiber also are part of the TLC diet. They help prevent the digestive tract from absorbing cholesterol. These foods include:

• Whole-grain cereals such as oatmeal and oat bran • Fruits such as apples, bananas, oranges, pears, and prunes • Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima

beans

A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

A healthy diet also includes some types of fish, such as salmon, tuna (canned or fresh), and mackerel. These fish are a good source of omega-3 fatty acids. These acids may help protect the heart from blood clots and inflammation and reduce the risk of heart attack. Try to have about two fish meals every week.

You also should try to limit the amount of sodium (salt) that you eat. This means choosing low-salt and “no added salt” foods and seasonings at the table or while cooking. The Nutrition Facts label on food packaging shows the amount of sodium in the item.

Try to limit drinks with alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.

Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.

Weight Management

If you’re overweight or obese, losing weight can help lower LDL cholesterol. Maintaining a healthy weight is especially important if you have a condition called metabolic syndrome.

Metabolic syndrome is the name for a group of risk factors that raise your risk for heart disease and other health problems, such as diabetes and stroke.

The five metabolic risk factors are a large waistline (abdominal obesity), a high triglyceride level, a low HDL cholesterol level, high blood pressure, and high blood sugar. Metabolic syndrome is diagnosed if you have at least three of these metabolic risk factors.

Physical Activity

Routine physical activity can lower LDL cholesterol and triglycerides and raise your HDL cholesterol level.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week (however, 150 minutes per week is the recommendation). The more active you are, the more you will benefit.

Cholesterol-Lowering Medicines

In addition to lifestyle changes, your doctor may prescribe medicines to help lower your cholesterol. Even with medicines, you should continue the TLC program.

Medicines can help control high blood cholesterol, but they don’t cure it.

List of Treatments for Cardiovascular Disease

• Drugs: There are a number of drugs on the market that aid in the prevention and management of all of the aforementioned conditions. They cannot replace the benefits of diet, exercise, and stress management, but should be used in conjunction.

• Angiogram: One of many diagnostic tests used to determine location and extent of coronary artery disease.

• Angioplasty: A procedure where a balloon is fed through a catheter into a coronary artery and a blockage is opened when the balloon is inflated.

• Stent: A “prop” that keeps the artery open following angioplasty. • Coronary Artery Bypass Graft: A surgical procedure in which blockages in

coronary arteries are bypassed via grafting of vessels (vein & arterial tissues can be used) around the blockage. This used to be done only “open chest” or “open heart”; modern surgical practice allows for some blockages to be bypassed via small opening in between the ribs (rather than sawing open the breast bone).

• Endarcterectomy: When the carotid artery (feeds the brain) is opened via a procedure (angioplasty &/or stent, usually).

• Valve replacements: valves separate the chambers of the heart. Sometimes those valves become compromised either mechanically or via infection and have to be replaced. Porcine of mechanical valves can be used.

• Heart transplant: When a heart has been damaged beyond repair a patient may become a candidate for a transplant; a large percentage of patients awaiting transplants never receive one.

Section 12.3 Diabetes

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any— insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells. Over time, having too much glucose in your blood can cause health problems. The most common types of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

Other types of diabetes

Less common types include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes .

How common is diabetes?

As of 2015, 30.3 million people in the United States, or 9.4 percent of the population, had diabetes. More than 1 in 4 of them didn’t know they had the disease. Diabetes affects 1 in 4 people over the age of 65. About 90-95 percent of cases in adults are type 2 diabetes.1

Risk Factors for Type 2 Diabetes

Developing type 2 diabetes depends on a combination of risk factors such as genes and lifestyle. Although some risk factors are non-modifiable such as family history, age, or ethnicity, lifestyle risk factors around eating, physical activity, and weight are modifiable. These lifestyle changes can affect ones chances of developing type 2 diabetes. Read about risk factors for type 2 diabetes below and see which ones apply to you. You are more likely to develop type 2 diabetes if you

• are overweight or obese • are age 45 or older • have a family history of diabetes • are African American, Alaska Native, American Indian, Asian American,

Hispanic/Latino, Native Hawaiian, or Pacific Islander • have high blood pressure • have a low level of HDL (“good”) cholesterol, or a high level of triglycerides • have a history of gestational diabetes or gave birth to a baby weighing 9

pounds or more • are not physically active • have a history of heart disease or stroke • have depression • have polycystic ovary syndrome , also called PCOS • have acanthosis nigricans—dark, thick, and velvety skin around your neck or

armpits

You can also take the Diabetes Risk Test to learn about your risk for type 2 diabetes.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as

• heart disease • stroke • kidney disease • eye problems • dental disease • nerve damage • foot problems

Symptoms & Causes of Diabetes

Symptoms of diabetes include

• increased thirst and urination • increased hunger • fatigue • blurred vision • numbness or tingling in the feet or hands • sores that do not heal • unexplained weight loss

Symptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly—over the course of several years—and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.

What causes type 1 diabetes?

Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as TrialNet are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease.

What causes type 2 diabetes?

Type 2 diabetes—the most common form of diabetes—is caused by several factors, including lifestyle factors and genes.

Overweight, obesity, and physical inactivity

You are more likely to develop type 2 diabetes if you are not physically active and are overweight or obese. Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a

difference. Extra belly fat is linked to insulin resistance, type 2 diabetes, and heart and blood vessel disease.

Insulin resistance

Type 2 diabetes usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well. As a result, your body needs more insulin to help glucose enter cells. At first, the pancreas makes more insulin to keep up with the added demand. Over time, the pancreas can’t make enough insulin, and blood glucose levels rise.

Genes and family history

As in type 1 diabetes, certain genes may make you more likely to develop type 2 diabetes. The disease tends to run in families and occurs more often in these racial/ethnic groups:

• African Americans • Alaska Natives • American Indians • Asian Americans • Hispanics/Latinos • Native Hawaiians • Pacific Islanders

Genes also can increase the risk of type 2 diabetes by increasing a person’s tendency to become overweight or obese.

What causes gestational diabetes?

Scientists believe gestational diabetes, a type of diabetes that develops during pregnancy, is caused by the hormonal changes of pregnancy along with genetic and lifestyle factors.

Insulin resistance

Hormones produced by the placenta contribute to insulin resistance, which occurs in all women during late pregnancy. Most pregnant women can produce enough insulin to overcome insulin resistance, but some cannot. Gestational diabetes occurs when the pancreas can’t make enough insulin.

As with type 2 diabetes, extra weight is linked to gestational diabetes. Women who are overweight or obese may already have insulin resistance when they become pregnant. Gaining too much weight during pregnancy may also be a factor.

Hormonal changes, extra weight, and family history can contribute to gestational diabetes.

Genes and family history

Having a family history of diabetes makes it more likely that a woman will develop gestational diabetes, which suggests that genes play a role. Genes may also explain why the disorder occurs more often in African Americans, American Indians, Asians, and Hispanics/Latinas.

What else can cause diabetes?

Genetic mutations , other diseases, damage to the pancreas, and certain medicines may also cause diabetes.

Diagnosing diabetes and prediabetes?

Health care professionals most often use the fasting plasma glucose (FPG) test or the A1C test to diagnose diabetes. In some cases, they may use a random plasma glucose (RPG) test. The FPG blood test measures your blood glucose level at a single point in time. For the most reliable results, it is best to have this test in the morning, after you fast for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.

The A1C test is a blood test that provides your average levels of blood glucose over the past 3 months. Other names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. You can eat and drink before this test. When it comes to using the A1C to diagnose diabetes, your doctor will consider factors such as your age and whether you have anemia or another problem with your blood.1 The A1C test is not accurate in people with anemia.

How can I lower my chances of developing type 2 diabetes?

Research such as the Diabetes Prevention Program shows that you can do a lot to reduce your chances of developing type 2 diabetes. Here are some things you can change to lower your risk:

• Lose weight and keep it off. You may be able to prevent or delay diabetes by losing 5 to 7 percent of your starting weight.1 For instance, if you weigh 200 pounds, your goal would be to lose about 10 to 14 pounds.

• Move more. Get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional about which activities are best. Start slowly to build up to your goal.

• Eat healthy foods most of the time. Eat smaller portions to reduce the amount of calories you eat each day and help you lose weight. Choosing foods with less fat is another way to reduce calories. Drink water instead of sweetened beverages.

Manage Diabetes

Although diabetes has no cure, it can be managed by taking the right steps to stay healthy. The National Institute of Health recommends make the following recommendations for managing diabetes:

• Follow a diabetes meal plan: Choose fruits and vegetables, beans, whole grains, chicken or turkey without the skin, fish, lean meats, and nonfat or low-fat milk and cheese. Drink water instead of sugar-sweetened beverages. Choose foods that are lower in calories, saturated fat, trans fat, sugar, and salt. Learn more about eating, diet, and nutrition with diabetes.

• Engage in physical activity daily: Set a goal to be more physically active. Try to work up to 30 minutes or more of physical activity on most days of the week. Brisk walking and swimming are good ways to move more.

• Take appropriate medicine: Take medicine(s) for diabetes and any other health problems, even when feeling good or having reached a healthy blood glucose, blood pressure, and cholesterol goals.

• Check your blood glucose levels: For many people with diabetes, checking their blood glucose level each day is an important way to manage their diabetes. Monitoring blood glucose levels is most important for anyone taking insulin. The results of blood glucose monitoring can help diabetes sufferers make decisions about food, physical activity, and medicines.

Table 1: Checking and recording your blood glucose levels is an important part of managing diabetes. The most common way to check a blood glucose level is at home is with a blood glucose meter. You get a drop of blood by pricking the side of your fingertip with a lancet. Then you apply the blood to a test strip. The meter will show you how much glucose is in

your blood at the moment.

Section 12.4 Cancer

What Is Cancer?

Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues.

Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors.

Cancerous tumors are malignant, which means they can spread into, or invade, nearby tissues. In addition, as these tumors grow, some cancer cells can break off and travel to distant places in the body through the blood or the lymph system and form new tumors far from the original tumor.

Unlike malignant tumors, benign tumors do not spread into, or invade, nearby tissues. Benign tumors can sometimes be quite large, however. When removed, they usually don’t grow back, whereas malignant tumors sometimes do. Unlike most benign tumors elsewhere in the body, benign brain tumors can be life threatening.

Key Cancer Terms

• Neoplasms: clusters of abnormal cells; aka “tumors.” When the neoplasms or tumors grow out and replace normal cells they are said to be “infiltrating” or “metastasizing” which means traveling to other parts of the body via the blood or lymph.

• Carcinoma: most common form; starts in the epithelium. • Sarcoma: forms in connective tissue: bones, muscles, blood vessels. • Leukemias: form in blood-forming tissues: bone marrow, lymph nodes, and

the spleen. • Lymphomas: form in the cells of the lymph system (the system that filters

out impurities and/or infection). • Conceptually, cancer is thought to develop via the turning on of genes called

“oncogenes” or genes that have gone awry. The DNA in these cells replicates at an accelerated rate. “Tumor suppressor genes”, which are present in all of us, fail to stop these cells from dividing thereby allowing a tumor to form.

• A “malignant” tumor is a cancerous tumor, whereas a “benign” tumor is not cancerous and of no imminent danger to the body.

How Cancer Arises

Cancer is caused by changes to genes that control the way our cells function, especially how they grow and divide.

Genetic changes that cause cancer can be inherited from our parents. They can also arise during a person’s lifetime as a result of errors that occur as cells divide or because of damage to DNA caused by certain environmental exposures. Cancer- causing environmental exposures include substances, such as the chemicals in tobacco smoke, and radiation, such as ultraviolet rays from the sun.

When Cancer Spreads

In metastasis, cancer cells break away from where they first formed (primary cancer), travel through the blood or lymph system, and form new tumors

(metastatic tumors) in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.

A cancer that has spread from the place where it first started to another place in the body is called metastatic cancer. The process by which cancer cells spread to other parts of the body is called metastasis.

Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer. For example, breast cancer that spreads to and forms a metastatic tumor in the lung is metastatic breast cancer, not lung cancer.

Under a microscope, metastatic cancer cells generally look the same as cells of the original cancer. Moreover, metastatic cancer cells and cells of the original cancer usually have some molecular features in common, such as the presence of specific chromosome changes.

Cancer Stages

Cancers are staged 1-3/4, depending on the cancer and the severity. When detected at stage 1, a person suffering from most types of cancer has about a 95% of surviving. The odds go down as you get to stage 3 or 4 (some cancers only have 3 stages, others 4). Doctors will often add an ‘A’ or ‘B’ to the staging as well, and this can relate to whether or not the cancer has invaded other tissues.

Tissue Changes That Are Not Cancer

Not every change in the body’s tissues is cancer. Some tissue changes may develop into cancer if they are not treated, however. Here are some examples of tissue changes that are not cancer but, in some cases, are monitored:

Hyperplasia occurs when cells within a tissue divide faster than normal and extra cells build up, or proliferate. However, the cells and the way the tissue is organized look normal under a microscope. Hyperplasia can be caused by several factors or conditions, including chronic irritation.

Dysplasia is a more serious condition than hyperplasia. In dysplasia, there is also a buildup of extra cells. But the cells look abnormal and there are changes in how the tissue is organized. In general, the more abnormal the cells and tissue look, the greater the chance that cancer will form.

Some types of dysplasia may need to be monitored or treated. An example of dysplasia is an abnormal mole (called a dysplastic nevus) that forms on the skin. A dysplastic nevus can turn into melanoma, although most do not.

Normal cells may become cancer cells. Before cancer cells form in tissues of the body, the cells go through abnormal changes called hyperplasia and dysplasia. In

hyperplasia, there is an increase in the number of cells in an organ or tissue that appear normal under a microscope. In dysplasia, the cells look abnormal under a microscope but are not cancer. Hyperplasia and dysplasia may or may not become cancer.

Types of Cancer

There are more than 100 types of cancer. Types of cancer are usually named for the organs or tissues where the cancers form. For example, lung cancer starts in cells of the lung, and brain cancer starts in cells of the brain. Cancers also may be described by the type of cell that formed them, such as an epithelial cell or a squamous cell.

Common Cancer Types

This list of common cancer types includes cancers that are diagnosed with the greatest frequency in the United States, excluding non-melanoma skin cancers:

• Bladder Cancer: The most common type of bladder cancer is transitional cell carcinoma, also called urothelial carcinoma. Smoking is a major risk factor for bladder cancer. Bladder cancer is often diagnosed at an early stage.

• Breast Cancer: Breast cancer is the second most common cancer in women after skin cancer. Mammograms can detect breast cancer early, possibly before it has spread.

• Colon and Rectal Cancer: Colorectal cancer often begins as a growth called a polyp inside the colon or rectum. Finding and removing polyps can prevent colorectal cancer.

• Endometrial Cancer: Uterine cancers can be of two types: endometrial cancer (common) and uterine sarcoma (rare). Endometrial cancer can often be cured. Uterine sarcoma is often more aggressive and harder to treat.

• Kidney Cancer: Kidney cancer can develop in adults and children. The main types of kidney cancer are renal cell cancer, transitional cell cancer, and Wilms tumor. Certain inherited conditions increase the risk of kidney cancer.

• Leukemia: Leukemia is a broad term for cancers of the blood cells. The type of leukemia depends on the type of blood cell that becomes cancer and whether it grows quickly or slowly. Leukemia occurs most often in adults older than 55, but it is also the most common cancer in children younger than 15.

• Lung Cancer: Lung cancer includes two main types: non-small cell lung cancer and small cell lung cancer. Smoking causes most lung cancers, but nonsmokers can also develop lung cancer.

• Melanoma: Skin cancer is the most common type of cancer. The main types of skin cancer are squamous cell carcinoma, basal cell carcinoma, and melanoma. Melanoma is much less common than the other types but much more likely to invade nearby tissue and spread to other parts of the body. Most deaths from skin cancer are caused by melanoma.

• Non-Hodgkin Lymphoma: Lymphoma is a broad term for cancer that begins in cells of the lymph system. The two main types are Hodgkin lymphoma and non-Hodgkin lymphoma (NHL). Hodgkin lymphoma can often be cured. The prognosis of NHL depends on the specific type.

• Pancreatic Cancer: Pancreatic cancer can develop from two kinds of cells in the pancreas: exocrine cells and neuroendocrine cells, such as islet cells. The exocrine type is more common and is usually found at an advanced stage. Pancreatic neuroendocrine tumors (islet cell tumors) are less common but have a better prognosis.

• Prostate Cancer: Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the United States. Prostate cancer usually grows very slowly, and finding and treating it before symptoms occur may not improve men's health or help them live longer.

• Thyroid Cancer: Thyroid cancer can be of four main types, which vary in their aggressiveness. Anaplastic thyroid cancer is hard to cure with current treatments, whereas papillary (the most common), follicular, and medullary thyroid cancer can usually be cured.

Cancer incidence and mortality statistics reported by the American Cancer Society and other resources were used to create the list. To qualify as a common cancer for the list, the estimated annual incidence for 2016 had to be 40,000 cases or more.

The most common type of cancer on the list is breast cancer, with more than 249,000 new cases expected in the United States in 2016. The next most common cancers are lung cancer and prostate cancer.

Because colon and rectal cancers are often referred to as “colorectal cancers,” these two cancer types are combined for the list. For 2016, the estimated number of new cases of colon cancer and rectal cancer are 95,270 and 39,220, respectively, adding to a total of 134,490 new cases of colorectal cancer.

The following table gives the estimated numbers of new cases and deaths for each common cancer type:

Cancer Type Estimated New Cases Estimated Deaths

Bladder 76,960 16,390

Breast (Female – Male) 246,660 – 2,600 40,450 – 440

Colon and Rectal (Combined) 134,490 49,190

Endometrial 60,050 10,470

Kidney (Renal Cell and Renal Pelvis) Cancer 62,700 14,240

Leukemia (All Types) 60,140 24,400

Lung (Including Bronchus) 224,390 158,080

Melanoma 76,380 10,130

Non-Hodgkin Lymphoma 72,580 20,150

Pancreatic 53,070 41,780

Prostate 180,890 26,120

Thyroid 64,300 1,980

Risk Factors for Cancer

It is usually not possible to know exactly why one person develops cancer and another doesn’t. But research has shown that certain risk factors may increase a person’s chances of developing cancer. (There are also factors that are linked to a lower risk of cancer. These are called protective factors.)

Cancer risk factors include exposure to chemicals or other substances, as well as certain behaviors. They also include things people cannot control, like age and family history. A family history of certain cancers can be a sign of a possible inherited cancer syndrome.

Most cancer risk (and protective) factors are initially identified in epidemiology studies. In these studies, scientists look at large groups of people and compare those who develop cancer with those who don’t. These studies may show that the people who develop cancer are more or less likely to behave in certain ways or to be exposed to certain substances than those who do not develop cancer.

Such studies, on their own, cannot prove that a behavior or substance causes cancer. For example, the finding could be a result of chance, or the true risk factor could be something other than the suspected risk factor. But findings of this type sometimes get attention in the media, and this can lead to wrong ideas about how cancer starts and spreads.

When many studies all point to a similar association between a potential risk factor and an increased risk of cancer, and when a possible mechanism exists that could explain how the risk factor could actually cause cancer, scientists can be more confident about the relationship between the two.

The list below includes the most studied known or suspected risk factors for cancer:

• Age • Alcohol

• Cancer-Causing Substances • Chronic Inflammation • Diet • Hormones • Immunosuppression • Infectious Agents • Obesity • Radiation • Sunlight • Tobacco

Although some of these risk factors can be avoided, others—such as growing older—cannot. Limiting your exposure to avoidable risk factors may lower your risk of developing certain cancers.

TOBACCO

Tobacco use is a leading cause of cancer and of death from cancer. People who use tobacco products or who are regularly around environmental tobacco smoke (also called secondhand smoke) have an increased risk of cancer because tobacco products and secondhand smoke have many chemicals that damage DNA.

Tobacco use causes many types of cancer, including cancer of the lung, larynx (voice box), mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia. People who use smokeless tobacco (snuff or chewing tobacco) have increased risks of cancers of the mouth, esophagus, and pancreas.

There is no safe level of tobacco use. People who use any type of tobacco product are strongly urged to quit. People who quit smoking, regardless of their age, have

substantial gains in life expectancy compared with those who continue to smoke. Also, quitting smoking at the time of a cancer diagnosis reduces the risk of death.

Scientists believe that cigarette smoking causes about 30% of all cancer deaths in the United States.

Cancer Prevention

The number of new cancer cases can be reduced and many cancer deaths can be prevented. Research shows that screening for cervical and colorectal cancers as recommended helps prevent these diseases by finding precancerous lesions so they can be treated before they become cancerous. Screening for cervical, colorectal, and breast cancers also helps find these diseases at an early stage, when treatment works best.

Vaccines (shots) also help lower cancer risk. The human papillomavirus (HPV) vaccine helps prevent most cervical cancers and several other kinds of cancer, and the hepatitis B vaccine can help lower liver cancer risk.

A person’s cancer risk can be reduced with healthy choices like avoiding tobacco, limiting alcohol use, protecting your skin from the sun and avoiding indoor tanning, eating a diet rich in fruits and vegetables, keeping a healthy weight, and being physically active.

Avoiding Tobacco

Cigarette Smoking

Lung cancer is the leading cause of cancer death, and cigarette smoking causes almost all cases. Compared to nonsmokers, current smokers are about 25 times more likely to die from lung cancer. Smoking causes about 80% to 90% of lung cancer deaths. Smoking also causes cancer of the mouth and throat, esophagus, stomach, colon, rectum, liver, pancreas, voicebox (larynx), trachea, bronchus, kidney and renal pelvis, urinary bladder, and cervix, and causes acute myeloid leukemia.

Visit smokefree.gov to learn how you can quit smoking.

Secondhand Smoke

Adults who are exposed to secondhand smoke at home or at work increase their risk of developing lung cancer by 20% to 30%. Concentrations of many cancer-causing and toxic chemicals are higher in secondhand smoke than in the smoke inhaled by smokers.

Protecting Your Skin

Skin cancer is the most common kind of cancer in the United States. Exposure to ultraviolet (UV) rays from the sun and tanning beds appears to be the most important environmental factor involved with developing skin cancer. To help prevent skin cancer while still having fun outdoors, protect yourself by seeking shade, applying sunscreen, and wearing sun-protective clothing, a hat, and sunglasses.

DETECTING MELANOMA

Melanoma is the most serious type of skin cancer. Often the first sign of melanoma is a change in the size, shape, color, or feel of a mole. Most melanomas have a black or black-blue area. Melanoma may also appear as a new mole. It may be black, abnormal, or “ugly looking.”

Thinking of “ABCDE” can help you remember what to watch for:

• Asymmetry – the shape of one half does not match the other • Border – the edges are ragged, blurred or irregular • Color – the color is uneven and may include shades of black, brown and tan • Diameter – there is a change in size, usually an increase (larger than 6

millimeters or about 1/4 inch) • Evolving – the mole has changed (in size, color, shape; it may start to itch or

bleed) over the past few weeks or months

Limiting Alcohol Intake

Drinking alcohol raises the risk of some cancers. Drinking any kind of alcohol can contribute to cancers of the mouth and throat, larynx (voice box), esophagus, colon and rectum, liver, and breast (in women). The less alcohol you drink, the lower the risk of cancer.

Studies around the world have shown that drinking alcohol regularly increases the risk of getting mouth, voice box, and throat cancers.

A large number of studies provide strong evidence that drinking alcohol is a risk factor for primary liver cancer, and more than 100 studies have found an increased risk of breast cancer with increasing alcohol intake. The link between alcohol consumption and colorectal (colon) cancer has been reported in more than 50 studies.

Keeping a Healthy Weight

Research has shown that being overweight or obese substantially raises a person’s risk of getting endometrial (uterine), breast, prostate, and colorectal cancers. Overweight is defined as a body mass index (BMI) of 25 to 29, and obesity is defined

as a BMI of 30 or higher. You can learn more about eating healthy and maintaining a healthy weight in chapters 9 and 10.

Types of Cancer Treatment

Source: National Cancer Institute - https://www.cancer.gov/about-cancer/treatment/types

There are many types of cancer treatment. The types of treatment will depend on the type of cancer and how advanced it is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.

Surgery When used to treat cancer, surgery is a procedure in which a surgeon removes cancer from your body. Learn the different ways that surgery is used against cancer and what you can expect before, during, and after surgery. Radiation Therapy Radiation therapy is a type of cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors. Learn about the types of radiation, why side effects happen, which ones you might have, and more. Chemotherapy Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells. Learn how chemotherapy works against cancer, why it causes side effects, and how it is used with other cancer treatments. Immunotherapy Immunotherapy is a type of treatment that helps your immune system fight cancer. Get information about the types of immunotherapy and what you can expect during treatment. Targeted Therapy Targeted therapy is a type of cancer treatment that targets the changes in cancer cells that help them grow, divide, and spread. Learn how targeted therapy works against cancer and about common side effects that may occur. Hormone Therapy

Hormone therapy is a treatment that slows or stops the growth of breast and prostate cancers that use hormones to grow. Learn about the types of hormone therapy and side effects that may happen. Stem Cell Transplant

Stem cell transplants are procedures that restore blood-forming stem cells in cancer patients who have had theirs destroyed by very high doses of chemotherapy or radiation therapy. Learn about the types of transplants, side effects that may occur, and how stem cell transplants are used in cancer treatment. Precision Medicine Precision medicine helps doctors select treatments that are most likely to help patients based on a genetic understanding of their disease. Learn about the role precision medicine plays in cancer treatment, including how genetic changes in a person's cancer are identified and used to select treatments. References Cancer Treatment, https://www.cancer.gov/about-cancer/treatment/types Cardiovascular Disease, https://en.wikipedia.org/wiki/Cardiovascular_disease#cite_note-WHO2011-2 Cardiovascular Disease, https://courses.lumenlearning.com/suny-monroecc- hed110/ Coronary Artery Disease, http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Cor onary-Artery-Disease---Coronary-Heart- Disease_UCM_436416_Article.jsp#.Ww7f7iOZM0o Global Atlas on Cardiovascular Disease Prevention and Control, Shanthi Mendis; Pekka Puska; Bo Norrving; World Health Organization (2011). Global Atlas on Cardiovascular Disease Prevention and Control (PDF). World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization.

pp. 3–18. ISBN 978-92-4-156437-3. Archived (PDF) from the original on 2014-08- 17. Heart Anatomy, https://watchlearnlive.heart.org/CVML_Player.php?moduleSelect=corart National Diabetes Report, [1] Centers for Disease Control and Prevention. National diabetes statistics report, 2017. Centers for Disease Control and Prevention website. www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics- report.pdf (PDF, 1.3 MB) . Updated July, 18 2017. Accessed August 1, 2017. Preventing Diabetes, https://www.niddk.nih.gov/health- information/diabetes/overview/preventing-type-2-diabetes Stroke, https://en.wikipedia.org/wiki/Stroke