Module 5 - Heart Disease & Cancer *still editing*

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.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.

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, A High Triglyceride Level, A Low HDL Cholesterol Level, High Blood Pressure, High Fasting Blood Sugar* - 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. - 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.) - 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. - 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. - 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

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.

What Is 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.

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. - Recognizing and treating TIAs can reduce the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke.

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.

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.

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

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: - *Stable angina* happens during physical activity or under mental or emotional stress. - *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.

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.

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.

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

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.

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

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.

Types of Stroke

- The main types of stroke are: Ischemic stroke. Hemorrhagic stroke. Transient ischemic attack (a warning or "mini-stroke").

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.

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.)

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.

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 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