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
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Financial Disclosures: None
UC San Diego Health System
Sulpizio Cardiovascular Center
 San Diego’s First Comprehensive Cardiovascular Center
 42nd in America by U.S. News & World Report
 Top 10 – Most Beautiful Hospitals in America
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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
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UCSD Sulpizio Cardiovascular Center
Major Causes of Deaths in the U.S. 2009
900,000
800,000
700,000
Alzheimer
600,000
CLRD
Deaths 500,000
Cancer
400,000
All Other CVD
300,000
Stroke
200,000
Heart Disease
100,000
0
All Ages
5
<85
85+
Source: AHA Heart Disease and Stroke Statistics – 2013 Update.
UCSD Sulpizio Cardiovascular Center
Approximately 80 million Americans suffer from Cardiovascular
Diseases (CHD, HF, HTN, Stroke, PAD)
Close to 50% of CV deaths occur from Coronary Heart Disease
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Source: ACC/AHA Heart and Stroke Statistics, 2012. From MMWR, 2008;57:1221-26.
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Source: AHA Heart Disease and Stroke Statistics – 2013 Update.
UCSD Sulpizio Cardiovascular Center
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UCSD Sulpizio Cardiovascular Center
Progression of Atherosclerosis
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UCSD Sulpizio Cardiovascular Center
Cardiovascular Risk Factors:
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Tobacco Smoking
Family History of Early CAD
Dyslipidemia (High cholesterol)
Diabetes Mellitus
Hypertension (High blood pressure)
Advanced Age (> 65 years)
Metabolic Syndrome
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2004
1994
Diabetes
<4%
4%-4.9%
5%-5.9%
≥6%
Obesity
(BMI ≥30 kg/m2)
10%-14%
15%-19%
20%-24%
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Source: www.cdc.gov
≥25%
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Smoking Trends for men and women
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UCSD Sulpizio Cardiovascular Center
Coronary
Artery Disease
Heart Attack
Death
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UCSD Sulpizio Cardiovascular Center
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
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Coronary Artery Disease & Cardiac CT Angiogram
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UCSD Sulpizio Cardiovascular Center
Coronary Angiography: Definitive Evaluation of CAD
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UCSD Sulpizio Cardiovascular Center
Coronary Artery Bypass Graft Surgery –
Traditional Approach
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UCSD Sulpizio Cardiovascular Center
Peripheral Arterial Disease:
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Peripheral Arterial Disease:
Before Revascularization
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Images provided by Dr. Mitul Patel and UCSD and Health System
After
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Carotid Arterial Disease - Revascularization
Before
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Images provided by Dr. Mitul Patel and UCSD and Health System
After
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Aortic Stenosis
Normal
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Severe Aortic Stenosis
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Severe Aortic Stenosis – Traditional Approach
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Severe Aortic Stenosis – Percutaneous Approach
Transcatheter Aortic Valve Replacement - TAVR
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Images by Dr. Mahmud and Dr. Patel at UCSD Division of Cardiovascular Medicine, 2013.
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Severe Aortic Stenosis
Before TAVR
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After TAVR
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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
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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
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Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.
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Effect of Exercise on Survival
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Source: Myers, J. Exercise and Cardiovascular Health. Circulation. 2003;107:e2-e5.
UCSD Sulpizio Cardiovascular Center
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;143:659-72.
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2Milani
RV, et al. Impact of cardiac rehabilitation on depression and its associated mortality. The American
Journal of Medicine (2007);120,799-906
UCSD Sulpizio Cardiovascular Center
Summary
Non-Invasive Strategies
 Improvement in Cardiovascular Health via:
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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
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Thank You!
Any Questions ?
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