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Chapter
15
Preventing Major
Disease
Elizabeth Lytle, MPH, BSN, RN
Los Altos School District
Topics Of Focus For This Chapter
Cardiometabolic
Health
Heart Attack
Diabetes
Stroke
Hypertension
Cancer
Cholesterol
Lifestyle
Cardiometabolic Health
Approaching the connection between risk
factors, symptoms and diseases
Cardio
Heart
Blood vessels
Biochemical processes involved in
Metabolic
body functioning
Control Weight and Waist Circumference
Weight
Waist
Size
Overweight teens have high risk of
diabetes and heart disease in future
Obese men have dramatically higher risk
of dying
Subcutaneous fat and visceral fat are
dangerous
Avoid waists of:
 40 inches for men
 30 inches for women
 Potbelly with normal weight
Physical Activity Decreases Risk
All
Men
Women
Least fit are at greater risk of death
More rigorous exercise = greater
protection and longevity
30 minutes/day of moderate activity
lessens risk
Fitness more important than overweight
or obesity in cardiometabolic risk
Smoking Is The Most Significant Risk Factor
Causes over 250,000 deaths per year
 Causes peripheral arterial disease
 Active and passive smoking
 Accelerate artery clogging
 Increase risk of developing coronary
heart disease
Control Blood Sugar To Decrease Risk
Check your blood sugar to see if you are at risk
Blood Sugar
Healthy
Under 100
Prediabetes
100-125
Diabetes
Over 125
High Blood Pressure Increases Work Of Heart
Systolic
Over
Diastolic
Systolic = pressure during heart
contraction
Diastolic = pressure during heart
relaxation
Effects
Heart muscle gets strong and stiff
Accelerated development of plaque
Action
Control with diet, exercise and possibly
medication
Control Cholesterol and Triglycerides
Total Cholesterol less than 200 AND:
Desired
Numbers
 HDL over 40 mg/dL
 LDL less than 100
Low Triglycerides
Effects
Best indicator of plaque in arteries
Action
Cut back on high-fat foods
Exercise more
Cholesterol In Food
Risk Factors You Cannot Control
Family history
Race and ethnicity
Age
Metabolic Syndrome Is An Epidemic
High blood pressure
General
Effects
High insulin levels
Abnormal cholesterol levels
Abdominal obesity
Waist measurement (40 in, 35 in)
Triglycerides 150 or more
Diagnosis =
HDL less than 40 mg/dL
3 or more
Blood Pressure of 130/85 or higher
Blood Sugar 110 mg/dL or higher
Metabolic Syndrome Risk Factors
 Overweight or obese
 Age 60 or older
Physically inactive or exercise less than 3

times/week
 Parent or sibling with diabetes
Having baby over 9 pounds or gestational

diabetes
 Blood pressure 140/90 or higher
More Metabolic Syndrome Risk Factors
African American, Alaskan Native, American
 Indian, Asian American, Hispanic/Latino or
Pacific Islander
 HDL below 35 or Triglycerides above 250
Impaired fasting glucose or impaired glucose

tolerance test
 History of cardiovascular disease
 Conditions associated with insulin resistance
 Fasting blood sugar 101-125 = Prediabetes
Diabetes
Diabetes Shortens Life Expectancy
Women
8.4 years
Men
7.8 years
Normal Response To Eating
• Blood glucose
increases
• Triggers
pancreas
Insulin
Released
Blood Sugar
Decreases
• Glucose
moved into
cells
• Energy needs
met
• Excess
urinated out
Normal
Blood Sugar
Uncontrolled Diabetes
• Blood glucose
increases
• Triggers
pancreas
NO Insulin
Released
Blood Sugar
INCREASES
• Glucose
remains in
blood
• Energy needs
unmet
• Ketones
produced
Ketoacidosis
Effects Of Uncontrolled Diabetes
 Damaged blood vessels
 Blindness
 Amputation
 Kidney failure
 Heart attack and stroke
Types Of Diabetes
Type 1
Immune system attacks insulin
producing cells in pancreas
Develops often in young people,
but can appear in adults
Type 2
Pancreas does not make enough
insulin or body is resistant to its
insulin
Diabetes during pregnancy
Gestational
At risk for diabetes later in life
Decrease Risk Of Type 2 Diabetes
Exercise 30 minutes 5 days/week
If overweight, lose weight
Diet rich in complex carbohydrates
and fiber
Diet low in sodium and fat
Eat fruits and vegetables
Take medication recommended by
physician
Signs And Symptoms Of Diabetes
 Increased thirst and urination
 Flu-like symptoms
 Weight loss or gain
 Blurred vision
 Slow-healing sores or frequent infections
 Nerve damage
 Red, swollen, tender gums
Detecting Diabetes
Anyone over age 45 should be screened
for diabetes every 3 years
Random blood sugar test
Fasting blood glucose test
Glucose challenge test
Controlling Diabetes Decreases Risk
A
A1c less than 7 percent
B
Blood Pressure 115/75
C
Cholesterol LDL less than 160
Hypertension
Risks
Effects
Family history
Obesity when young
Race
Death especially for those with
diabetes, kidney disease and obesity
Lifestyle changes
Decrease sodium to 1.5 grams/day
Treatment Increase potassium to 4.7 grams/day
Exercise
Medication
Numerous Effects Of High Blood Pressure
Understanding Blood Pressure Numbers
Type of BP
Systolic
Diastolic
Prehypertension
120-139
80-89
Mild
140-159
90-99
160 +
100
Moderate-Severe
Low
Less than 90
Hypertension is any one of the values
above or a combination of values
Lipoproteins: Cholesterol And Triglycerides
Risk
None
Borderline
High
High
Total
Cholesterol
Triglycerides
Less than 200
Less than
150
200-239
150-199
240 +
200 +
Lowering Lipoproteins Decreases Risks
Include nuts, soy, oats, plant sterols
Diet
Weight management
Physical activity
Statins
Medication
Needed for about half of those with
high lipoprotein levels
Few Meet Criteria For Ideal Heart Health
Never smoked or quit more than 1 year ago
BMI less than 25
150 + moderate or 75 + vigorous minutes of
exercise/week
4 + components of healthful diet
Total cholesterol less than 200
Blood pressure below 120/80
Fasting blood sugar below 100
Heart Anatomy
Heart Anatomy
Overview Of Blood Flow Through Heart
• Blood from
body moves
into right
atrium
Right Ventricle
Contracts
• Blood moves
into right
ventricle
Right Atrium
Contracts
• Blood moves
to lungs and
then
pulmonary vein
Left Atrium
Contracts
Left Ventricle
Contracts
• Blood moves
into left
ventricle
• Blood moves
through aorta
to brain and
body
How Blood Flows Through Body
Understanding The Heart
Myocardium Heart muscle
2-layer membrane surrounding heart
Pericardium Lubricant between layers allows heart
muscle to move freely
Systole
Contraction of heart
Period between contractions when
Diastole
heart fills with blood
Smallest blood vessels in body
Capillaries Deliver oxygen via the blood and take
up waste
Cardiovascular Risk Factors
Education Low education level at higher risk
Chronic = plaque & high blood pressure
Stress
Episodic = creates unstable plaque
Acute = trigger heart attack
Depression and heart disease are linked
Depression Depressed women more likely to have
heart attack
Anger
Angry men at much higher risk
Cardiovascular Risk Factors Continued
C-Reactive protein signals inflammation
CRP
Increased CRP increases risk
Homocysteine
May influence atherosclerosis
Sudden increases in blood pressure
Illegal
Drugs
Left ventricular contraction
Irregular heart rhythms
Bacterial
Infection
Streptococcus and chlamydia
Tips For Women To Avoid Heart Disease
Abstain from smoking
BMI less than 25
Exercise 150 + moderate or 75 + vigorous
minutes each week week
Eat 4 + components of healthful
Non-HDL cholesterol less than 230
Blood pressure below 120/80
Fasting blood sugar below 100
Heart Disease Symptoms Different In Women
Pay attention to these early signs of disease
 Pain in back, between shoulders
 Sick to stomach
 Feeling scared or nervous
 Pain in belly above belly button
 New or worse headaches
More Symptoms In Women
 Tiredness, even after getting enough sleep
 Trouble breathing
 Trouble sleeping
 Ache in chest
 Chest feeling ‘heavy’ or ‘tight’
 Burning feeling in chest
 Pain or tightness in chest that spreads
Aspirin Is Recommended For Some
Aspirin may reduce heart attack risk, but
may also increase bleeding
Aspirin decreases clotting risk, but increases

bleeding risk
Must consider risk of gastrointestinal

bleeding when choosing to take aspirin
 Men 45 to 79 to reduce risk of heart attack
 Women 55-70 to reduce risk of stroke
Heart Health Conditions
Coronary Artery Disease
Arteriosclerosis – degeneration and hardening of
arterial walls
Atherosclerosis – arteriosclerosis plus plaque
deposits on walls of arteries
Heart Conditions
Angina Pectoris
Due to brief lack of oxygen to heart
Severe, suffocating chest pain
Heart Attack / Myocardial Infarction
When portion of heart does not receive oxygen
and begins to die
Cardiac Arrest
Heart stops beating
Symptoms Of A Heart Attack
30 minutes or more of chest pain that is not
relieved with rest
Chest pain radiating to shoulder, arm, neck,
back or jaw
Anxiety
Sweating or cold, clammy skin
Nausea and vomiting
Shortness of breath
Dizziness, fainting or loss of consciousness
If experiencing heart attack
symptoms, take 325 mg of
aspirin and seek immediate
medical attention
Cardiac Arrest
CPR
Cardio-pulmonary resuscitation
Combining rescue breaths with chest
compressions creates circulation
AED
Automatic External Defibrillator
Portable device available in most public
places can restart a heart that has a
lethal rhythm
Action
Control with diet, exercise and possibly
medication
Cerebrovascular Accident Explained
‘Stroke’ occurs when blood supply to
Defined
brain in blocked
Types
Ischemic – blockage of flow by cerebral
thrombus or cerebral embolism
Hemorrhagic – blood vessels rupture
Transient Ischemic Attack
TIA
Little strokes with minimal damage
Doubles risk of heart attack
Cerebrovascular Accident Risk
Women, especially during hormonal
changes
Men across the lifespan
Heart disease and diabetes
Risk Obesity and diet high in fat and sodium
Factors
Age – risk doubles every decade after 55
Race – high in blacks and Hispanics
High red blood cell count
High blood pressure
Effects Of Stroke On Brain
Cancer
Uncontrolled growth and spread of
abnormal cells
Defined
Abnormal cells divide and create
tumors
Forms
Countless and with different genetics
Action
Infiltration – Crowds out healthy cells
Metastasis – spreads through blood or
lymph to other parts of body
How Cancer Metastasizes
Cancer Risk
Affects all social, economic and educational levels
 Obesity
 Black Americans have higher mortality
 Heredity – such as BRCA gene
 Infectious Agents – Viruses
Common Cancers
Carcinoma Arises in epithelium
Sarcoma
Starts in supporting or
connective tissues of body
Leukemia
Begins in blood-forming tissues
Lymphoma Forms in lymph cells
Cancer Warning Signs
 Change in bowel or bladder habits
 Sore that doesn’t heal
 Unusual bleeding or discharge
 Thickening or lump in breast, testis or elsewhere
 Indigestion or difficulty swallowing
 Obvious change in wart or mole
 Nagging cough or hoarseness
Skin Cancer
Basal Cell Cells in top level of skin
Squamous
Cells in epidermis
Cell
Actinic
Not cancer, but 40% become
Keratoses squamous cell carcinoma
Malignant
Most lethal form of skin cancer
Melanoma
Malignant Melanoma Is Most Dangerous
Fair skin, light eyes or fair hair
Tendency to burn instead of tan
Risk Childhood sunburn or intermittent,
Factors intense sun exposure
Personal or family history
Large number of moles or atypical moles
Warning Signs Of Melanoma
A
Asymmetry
B
Border Irregularity
C
Color
D
Diameter
Every Woman Is At Risk For Breast Cancer
Increased Age
Age at first childbirth
Breast biopsies
First period before 12
Many occupations
Hormone Therapy
Obesity
Sedentary lifestyle
2 or more drinks per
day
White or African
American
Family History
Risk Increases With Age
Detecting Breast Cancer
Recommended annually for
Mammography women over 40
Best detection tool
Breast SelfExam
MRI
Monthly at home
Every 3 years by trained
practitioner
Recommended if strong family
history or Hodgkin’s Disease
Cervical and Ovarian Cancer
Risks for cervical cancer
 Sexual activity before 16
 Multiple sexual partners
 Secondhand smoke
 Genital herpes
 HPV
Risks for ovarian cancer
Family history of ovarian cancer
Infertility
Personal history of breast cancer
Obesity
Low levels of transferase
Testicular Cancer Rates Are Increasing
Men at 18-35
Risk
Undescended testicle
Chronic marijuana use
Perform monthly testicular exam
Detection One testicle larger than other
Dull ache in groin or abdomen
Treatment
Surgery to remove testicle
Radiation, chemotherapy
Colon And Colorectal Cancer
Age over 50
History of rectal cancer or polyps
Smoking
Risk
Factors
Alcohol consumption
Prolonged high consumption of red
and processed meats
High-fat or low-fiber diet
Ulcerative colitis
Detection Colonoscopy at 50
Prostate Cancer
Increasing age
Family history
Risk
Factors
Exposure to cadmium
High number of sexual partners
Frequent STIs
High-fat diet
Detection Prostate-specific antigen test
Treatment
Hormones and low-fat diet
Chemotherapy and radiation
Epilepsy
Defined
Diagnosis
Sudden attacks of violent muscle
contractions and unconsciousness
Electroencephalogram (EEG)
Recurring attacks
Treatment Anticonvulsant drugs
Asthma
Risk
Factors
African American
Inner-city
Secondhand smoke exposure
Wheezing
Symptoms
Shortness of breath
Tightness of chest
Coughing
Steps To Control Asthma
1. Get away from trigger
2. Assess severity of attack
3. Use quick reliever
4. Suppress inflammation
5. Know when to call for help
Ulcers
Defined
Open sores in lining of stomach or
duodenum
Cause Excessive acidic digestive juices
Symptom Burning pain in upper abdomen
Antibiotics (if H. pylori)
Avoiding aspirin
Treatment
Eating small, frequent meals
Taking antacids
Not smoking or drinking and avoiding
caffeine