Chapter 15 Lecture

Preventing and Controlling Chronic Health Conditions

Inaction is Unacceptable

• Chronic diseases are largely preventable.

• Nearly 80% of heart disease, stroke, and Type 2 diabetes and 40% of all cancers are related to lifestyle choices.

• Obesity, sedentary lifestyles, and tobacco use are the major lifestyle risk factors.
The Leading Cause of Death in Women
• Today, U.S. women surpass men in the number of deaths related to heart disease
• Cardiovascular disease (CVD) includes coronary heart disease, high blood pressure, heart failure, and stroke
• CVD accounts for one in three deaths, and costs more than any other group of diseases
• The U.S. Public Health Service has set a goal to improve cardiovascular health by 20%, by 2020, but there are challenges in the way

Cardiovascular Diseases

Normal Cardiovascular Functioning

• Characteristics of the heart

The Vascular System

• Refers to the blood vessels
• Arteries carry blood away from the heart
• Veins carry blood back into the heart
• Because a women’s heart and blood vessels are typically smaller compared to men, there is more difficulty with treatments and greater chances of blockage of an artery

Types of Heart Disease

• Atherosclerosis
• Angina Pectoris
• Myocardial Infarction (MI)
• Congenital Heart Disease
• Arrhythmia
• Congestive Heart Failure (CHF)
• Endocarditis
• Mitral Valve Prolapse (MVP)

Risk Factors for Heart Disease

• Research indicates that having just one risk factor doubles chances of developing heart disease
• Factors for women can include

• • Menopause and estrogen loss
  • Birth control pills
  • High triglyceride levels
  • Excessive alcohol intake
  • Stress

Unchangeable Risk Factors

• Increasing Age
• Family Health History
• Race
• Gender

Risk Factors for Heart Disease That Can Be Modified, Treated, Controlled

• Tobacco smoking
• High blood cholesterol
• Obesity and overweight

• High blood pressure
• Physical inactivity
• Diabetes

Screening and Diagnosis

• Women often have false positive results from a traditional stress test, e.g., treadmill test
• Results are better from stress-echocardiograms

• • Non-invasive technique using a treadmill test and ultrasound pictures of the heart
  • Ultrasound pictures allow cardiologists to see the heart contractions during peak exercise

Stroke
• Blockage of vessel to the brain
• Types – Cerebral hemorrhagic and Ischemic Strokes
• Diagnosis – CAT scan, MRI
• Treatment – clot dissolving drug therapy (TPAs), carotid endarterectomy, or endovascular procedure

Risk Factors for Stroke

• Age
• Race
• Heredity
• Gender
• Experience of a previous stroke
• Blood lipid profile
• Smoking
• Hypertension
• Heart disease
• Diabetes
• High red blood cell count
• Carotid artery disease
• Transient ischemic attacks (mini-strokes)

Osteoporosis

• A bone weakening disorder which results in bone mineral loss and increases the risk of skeletal frailty and fracturing
• Manifests itself during childhood, although perceived as a geriatric disease
• Primary prevention focuses on increasing peak bone mass between the ages of 30-35 years
• The greatest bone density loss occurs in women during the first 5 years after menopause
• Nearly half of all women over the age of 50 are predicted to have a bone fracture during their lifetime related to bone loss

Protective Factors Against Osteoporosis

• Exercise

• • Weight bearing activities acts as a protective factor against bone loss, e.g., walking, weight training
  • Exercise provides the added benefit of muscle strength, tone, and balance

• Diet

• • Calcium and Vitamin D are two major nutrients needed to prevent osteoporosis
  • Peak bone mass can be increased by drinking milk during childhood and adolescence, increasing levels beyond the current RDA standards
  • Studies show that American women and girls take half the amount of calcium recommended for growth and maintenance of bone tissue

• Measuring Bone Mineral Density (BMD)

• • Multiple types of BMD tests exist, and they are painless and noninvasive
    Treatment for Osteoporosis

• There is no cure for osteoporosis; however, it can be treated and prevented
• Drug therapy include:
• Bisphosphonates (Fosamax, Actonel)
• Estrogen analogs (raloxifene)
• Anabolic drug (Forteo)

Diabetes Mellitus

• Diabetes is a chronic disorder of carbohydrate metabolism with a deficiency in insulin production or alteration in the effectiveness of insulin production
• Type 1 Diabetes: insulin dependent

• • Pancreas produces little or no insulin
  • Daily injections of insulin are needed

• Type 2 Diabetes: non-insulin dependent

• • Insulin is produced but the body is resistive in using it
  • Accounts for 90% of all diabetics
  • Linked to obesity and physical inactivity

Gestational Diabetes

• Carbohydrate intolerance during pregnancy appearing around the 24th week
• May be related to large quantities of hormones that the placenta produces
• Women who experience this will have a normal glucose level after the pregnancy
• Babies born with mothers with gestational diabetes are at more risk for certain health problems
• Women with gestational diabetes are higher risk for:
• Preeclampsia
• Urinary Tract Infections
• Ketonuria
Asthma
• Asthma is a chronic, incurable disease of the lungs

• Characterized by inflammation and temporary narrowing of the air passageways leading from the mouth and nose into the lungs

• Women and children with asthma suffer periodic episodes, or attacks, with mild to severe symptoms
• These symptoms include:
• shortness of breath
• wheezing, coughing (often occurring at night or early morning)
• chest pain
• tightness or any combination.

• In severe cases, an asthma attack can lead to the death

• Controlling asthmatic symptoms is vital for a pregnant women’s health and the health of her baby

• • This is one of the most serious medical conditions affecting pregnancy.

Types of Asthma

• There are two types

• • allergic: triggered in susceptible individuals by exposure to common air-borne pollutants
  • non-allergic: triggered by allergens but is often triggered by other factors including stress, anxiety, extreme weather changes, exercise, cold air, dry air, hyperventilation, viruses, and bronchial illnesses including colds and flu, or lung infections

• For some patients, however, asthma symptoms may disappear or lessen upon adulthood, as asthma is most often diagnosed during childhood
Epilepsy
• Chronic brain disorder characterized by recurrent seizures
• Occurs when abnormal electrical activity in the brain causes an involuntary change in body movement or function, sensation, awareness, or behavior lasting from a few seconds to a few minutes
• Seizure-preventing drugs are the most common form of treatment
• Factors to consider for people with epilepsy are:
• Psychosocial and Economic considerations
• Birth Control, Conception, and Pregnancy
Arthritis
• An inflammatory condition of the joints, characterized by swelling, pain, and/or difficulty moving which persists longer than 2 weeks
• Arthritis or chronic joint symptoms affect approximately 50 million U.S. adults in the U.S.
• Women are more likely than men to have arthritis and the prevalence of arthritis increases with age

• Treatment includes:
• Rest
• Exercise
• Heat/cold treatments
• Medication
• Surgery

Systemic Lupus Erythematosus (SLE)

• SLE is a chronic, autoimmune, rheumatic disease of the connective tissue
• Inflames the joints, muscles, and vital organs
• It is 10 times more frequent in women than in men
• Lupus is two to threetimes more common in women of color
• The cause is unknown
• There is no cure, but early treatment of symptoms is important for long-term management of the disease

Fibromyalgia

• Fibromyalgia is a common and chronic musculoskeletal syndrome characterized by widespread pain in the muscles, ligaments, and tendons, fatigue and multiple “tender points” on the body where there is increased sensitivity to touch or slight pressure
• The American College of Rheumatology (ARC) states that fibromyalgia affects 3 to 6 million Americans with 80-90 percent being women
• Fibromyalgia is generally diagnosed during middle age (between 30 to 50 years of age), but the symptoms may exist much earlier
• It does not damage the joints, muscles or internal organs and with time, many women experience improvements in their condition

Multiple Sclerosis (MS)

• Chronic debilitating disease that affects the Central Nervous System (CNS)
• MS is thought to be an autoimmune disease that causes damage to and loss of myelin (fatty white tissue that surrounds the protects nerve fibers of the CNS)
• The exact cause of MS is still unknown but believed to be triggered by the following factors:
• Genetics
• Gender
• Environment
• The onset of MS is between the ages of 20-50 years and is 2-3 times higher in women than men
• Diagnosing is very difficult and there is no cure, however, medications such as steroids can be helpful in reducing flare ups for a short term basis

Thyroid Disease

• Thyroid hormones regulate the rate of fat, protein, and glucose metabolism. They are necessary for normal growth and development, and are needed for resistance to infection.

• A malfunctioning thyroid can result in

• • A goiter (an enlargement of the thyroid)
  • Hyperthyroidism - over activity of the thyroid

• More common in women. They are at increased risk for osteoporosis.
• Graves’ disease is the primary cause of hyperthyroidism

• • Bulging eyes and goiter are symptoms
  • Hypothyroidism - under activity of the thyroid

• Hashimoto’s thyroiditis - a long-term inflammatory autoimmune condition, where the body attacks it’s own thyroid gland.
Irritable Bowel Syndrome (IBS)
• IBS interferes with the colon’s normal function.

• Symptoms include abdominal pain, bloating, cramping, constipation, and diarrhea.

• Some women can control their symptoms through diet adjustments, stress management, and prescribed medications.

• 1 out of 6 Americans have symptoms of IBS. It occurs twice as often in women.

• Treatment: medications to regulate constipation/diarrhea, antispasmodics, antidepressants, fiber supplements, and Lotronex.
Alzheimer’s Disease (AD)
• Most common form of dementia (gradual, progressive loss of brain cells that can lead to death)
• Characterized by confusion, progressive memory loss, and behavioral disturbances
• The exact cause of AD is unknown, however a genetic component seems to be implicated
• Increasing age is the leading risk factor but is not considered a normal aspect of aging
• No treatment can stop the progressive loss of brain cells but current drug treatments can help minimize the symptoms for a period of ti