Chapter 9 Part II (1)

Chapter 9 - Modifiable Cardiovascular Disease Risk Factors - Part II

Overview

This chapter outlines assessment and intervention strategies related to modifiable risk factors for cardiovascular disease (CVD). These factors include:

• Tobacco use
• Dyslipidemia
• Hypertension
• Physical inactivity
• Diabetes
• Psychosocial concerns
• Obesity
• Emerging risk factors

Purpose of the Chapter

The purpose is to guide healthcare professionals through the necessary assessments and interventions to help mitigate these risk factors effectively, which can be critical in managing CVD and improving patient outcomes.

Hypertension

Prevalence of Hypertension

• Approximately 1 in 3 U.S. adults has hypertension.
• 2/3 of individuals over the age of 65 are diagnosed with hypertension.
• Hypertension is more common in men than women until age 55, after which the prevalence in women increases.
• Hypertension is reported in about 48% of participants in cardiac rehabilitation (CR) and secondary prevention (SP) programs.

Medical History Considerations

When assessing a patient's medical history, focus on the following:

• Dietary sodium intake
• Excessive alcohol consumption
• Caloric intake and diet
• Levels of physical activity

Physical Examination Protocol

Initial Assessment

• Obtain two or more blood pressure (BP) measurements, taken two minutes apart, after allowing the patient five minutes of rest while seated with uncrossed legs.
• Verify BP with the contralateral arm; use the higher value for assessment.

Comprehensive Assessment Includes:

• Eye examination
• Neck assessment
• Cardiac examination for increased heart rate, murmurs, EKG changes, etc.
• Examination of the abdominal region and extremities
• Complete neurologic assessment

Classification and Management of Blood Pressure

Lab Evaluations Recommended

• Urinalysis
• Complete blood count
• Fasting glucose (if possible)
• Potassium, calcium, creatinine, uric acid
• Lipid profile

Additional Evaluations

To rule out left ventricular hypertrophy:

• Utilize a 12-lead EKG
• Implement education programs
• Consider behavioral and pharmacologic interventions

Physical Inactivity

Current Trends

• Less than 50% of adults (47% women, 49% men) meet minimal physical activity guidelines.
• Sedentary lifestyles significantly increase the risk for CVD, with low cardiorespiratory fitness correlating to higher mortality rates.
• The risk associated with low physical activity is critical for both primary and secondary CVD prevention.

Distinction Between Physical Activity and Exercise

• Physical Activity: Refers to any bodily movement produced by skeletal muscle contraction that increases energy expenditure above the basal metabolic rate.
• Exercise: A planned, structured, and repetitive form of physical activity aimed at improving or maintaining physical fitness components.

Identification of Inactivity

• Sedentary behavior is defined as accumulating
• Increased daily sitting time contributes to a doubled risk for CVD in physically inactive individuals.

Assessment Methods for Physical Activity

Common assessment tools include:

• Self-report questionnaires
• Physical activity monitors (e.g., P.LAR, WaorLink)

Class Group Work

Develop an 8-10 minute educational session focused on physical activity for a patient named Mr. DM, covering:

1. Exercise recommendations without an exercise test and how initial exercise would differ.
2. Physical activity opportunities outside of cardiac rehabilitation and secondary prevention programs.
3. Recommendations for resistance training.
4. Flexibility training guidelines.

This structured approach aims to empower patients with knowledge and support them in leading a healthier lifestyle.