Listen to your heart: Good Cardiovascular Health for Life

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1 Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular Center, La Jolla, CA 1

2 Financial Disclosures: None

3 UC San Diego Health System Sulpizio Cardiovascular Center 3 San Diego s First Comprehensive Cardiovascular Center 42 nd in America by U.S. News & World Report Top 10 Most Beautiful Hospitals in America

4 UC San Diego Health System Objectives & Take Home Points Epidemiology and Significance of Cardiovascular Diseases Causes of CV Diseases Medical Treatments Invasive Therapies Preventive Measures Listen to Your Heart 4

5 Major Causes of Deaths in the U.S , ,000 Deaths 700, , , , , , ,000 Alzheimer CLRD Cancer All Other CVD Stroke Heart Disease 0 All Ages < Source: AHA Heart Disease and Stroke Statistics 2013 Update.

6 Approximately 80 million Americans suffer from Cardiovascular Diseases (CHD, HF, HTN, Stroke, PAD) Close to 50% of CV deaths occur from Coronary Heart Disease 6 Source: ACC/AHA Heart and Stroke Statistics, From MMWR, 2008;57:

7 7 Source: AHA Heart Disease and Stroke Statistics 2013 Update.

8 8

9 Progression of Atherosclerosis 9

10 Cardiovascular Risk Factors: Tobacco Smoking Family History of Early CAD Dyslipidemia (High cholesterol) Diabetes Mellitus Hypertension (High blood pressure) Advanced Age (> 65 years) Metabolic Syndrome 10

11 Diabetes <4% 4%-4.9% 5%-5.9% 6% Obesity (BMI 30 kg/m 2 ) 11 10%-14% 15%-19% 20%-24% 25% Source:

12 Smoking Trends for men and women 12

13 Coronary Artery Disease Heart Attack Death 13

14 14 Cardiac Evaluation: Listen to your Heart Chest pain or pressure Shortness of breath or Fatigue Palpitations History and Physical Exam EKG Stress Testing Exercise Treadmill Pharmacologic Stress Test Dobutamine Echo Nuclear Imaging Dobutamine MRI Cardiac CT Angiogram

15 Coronary Artery Disease & Cardiac CT Angiogram 15

16 Coronary Angiography: Definitive Evaluation of CAD 16

17 Coronary Artery Bypass Graft Surgery Traditional Approach 17

18 Peripheral Arterial Disease: 18

19 Peripheral Arterial Disease: Before Revascularization After 19 Images provided by Dr. Mitul Patel and UCSD and Health System

20 Carotid Arterial Disease - Revascularization Before After 20 Images provided by Dr. Mitul Patel and UCSD and Health System

21 Normal Aortic Stenosis Severe Aortic Stenosis 21

22 Severe Aortic Stenosis Traditional Approach 22

23 Severe Aortic Stenosis Percutaneous Approach Transcatheter Aortic Valve Replacement - TAVR 23 Images by Dr. Mahmud and Dr. Patel at UCSD Division of Cardiovascular Medicine, 2013.

24 Severe Aortic Stenosis Before TAVR After TAVR 24

25 Prevention of CAD, PAD and Valvular Disease Targeting Cardiac Risk Factors: Tobacco Smoking Family History of Early CAD Dyslipidemia Diabetes Mellitus Hypertension Advance Age Metabolic Syndrome 25

26 Improving Cardiovascular Health Brisk walking for 30 minutes per day Intermittent periods of activity, 10 min intervals for a total of 30 minutes per day Exercise routine 5 to 7 times per week Additional health benefits from more vigorous activity 26 Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.

27 Effect of Exercise on Survival 27 Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.

28 Cardiac Rehabilitation after MI, CABG, Valve surgery or CHF Mortality Benefits 17% reduction in recurrent Heart Attacks 15% overall mortality reduction Morbidity Benefits 31% reduction in hospital readmissions 63% reduction in depression Clark AM, et al. Meta-analysis; secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005;143: Milani 28 RV, et al. Impact of cardiac rehabilitation on depression and its associated mortality. The American Journal of Medicine (2007);120,

29 Summary Non-Invasive Strategies Improvement in Cardiovascular Health via: Healthy cardiac diet Smoking cessation Diabetes and BP control Lipid lowering strategies Exercise and weight loss Invasive Strategies Percutaneous Interventions PCI and TAVR Traditional Coronary Bypass Graft Surgery 29

30 Thank You! Any Questions? 30

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