Cardiovascular Disease

As historical statistics show, heart diseases are said to be the most prominent reason for death in California. It is also a major contributor to the growing of costs in the US in terms of health care. The word cardiovascular disease (CVD) implies an inclusive range of heart and blood vessel diseases and disorders, including high blood pressure, stroke, high blood cholesterol, chronic obstructive pulmonary disease, and coronary heart disease (CHD). Out of these CHD constitutes to the largest ratio of heart disease.

The death rate of cardiovascular disease, which includes all the aforementioned range, is more than the combined ratio of all the rest of the prominent causes of death, including cancer, chronic liver disease and cirrhosis, kidney disease, diabetes, and other unintentional injuries. Medical research has shown that certain populations are excessively marked by diabetes and cardiovascular disease. Around 40-45 years ago, due to a history of hardly any cardiovascular risk factors, such as hypertension, diabetes etc. , the CVD rates in American Indians were remarkably low.

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Around some past decades, however, the frequency of these risk factors has significantly escalated. Some major risk factors for CVD include smoking, high level of alcohol consumption, deficient physical activity, and hypertension. The increased rates of these risk factors, along with the rapid development of diabetes plague have led to a significant high frequency of CVD in American Indian people. (Indian Health Service, 2001) American Indians and CDV – Statistics According to the National Center for Health Statistics, in the year 2004, throughout US, about 24.

7 million adults, categorized as non-institutionalized adults, were said to be diagnosed with heart disease, while the number of deaths were reported to be 654,092 in the same year. (National Center for Health Statistics, 2006) The Strong Heart Study NHLBI reports the percentage of American Indian men having CVD to be from 1. 5 to 2. 8 percent, while women from 0. 9 to 1. 5 percent, their ages ranging from 45-74. From the age 18 and above, 11. 6 percent among the American Indians are said to have heart disease, as reported by NCHS, while 7.

6 percent are reported to have coronary heart disease. (Statistical Fact Sheet – Populations, 2003) Cardiovascular disease is actually a process, comprising of a number of factors, the continuity of which eventually lead to its incidence. Among several, a few are: high blood pressure, tobacco consumption, physical inactivity, and overweight and obesity. The following statistical data shows the percentage of American Indians carry these factors in their lifestyle behaviors and ultimately suffer from CVD. (Statistical Fact Sheet – Populations, 2003)

In the NHIS survey through the years 1999-2003, the reports stated that around 29. 7 percent of American Indians of 18 years and above were informed that they were having high blood pressure. Furthermore, in the same population, in the age 18 years and above, 37. 3 percent of men and 28. 5 percent of women were reported as cigarette smokers, while 7. 8 percent of men and 1. 2 percent of women were the ones who chewed tobacco. For American Indians only, the total tobacco consumption in the year 2003 was recorded to be 41. 8 percent.

Physical inactivity, which contributed to a major cause behind CVD, accounted for 23. 8 percent of men and 31. 8 percent of women (American Indians) reported to show absolutely no engagement in any leisure time physical activity. Moreover, the statistically adjusted percentage of American Indians of age 18 years and above showed 33. 5 percent of overweight people and 32. 9 percent that of obese. The overall statistical data has suggested that the heart disease among American Indians is relatively more than in the whole of the US population.

Also, if compared to the racial and ethnic populations in the US, American Indians are said to have a considerably higher ratio of premature death due to heart disease. (Galloway, n. d. ) Several initiatives for prevention and clinical efforts are making progress showing success likelihoods towards reduced gaps in cardiovascular health with primary and secondary prevention programs as well as improved early diagnosis and remedial intervention for more positive cardiovascular future outcomes.

In order to promote a heart-healthy life among the American Indians, the need for an aggressive, rational, sound, and systematic plan of synchronized health support, disease control measures, and risk reduction efforts is required. Care Plan Care plan for CVD means addressing the disease, which includes both the primary prevention i. e. preventing the inception of disease, and secondary prevention i. e. coping with those previously affected to trim down negative health outcomes.

In primary prevention, the basic aim is to gather the very many risk factors leading to CVD. Along with the aforementioned risks, some other risk factors include poor dietary patterns and deficient physical inactivity, tobacco use, high cholesterol, and poor nutrition leading to overweight and extreme obesity. Keeping in mind that it is also one’s lifestyle behavior and choice that leads to such careless living patterns, the health care plan should be such that it works on creating opportunities for a healthy lifestyle.

The care plan primarily focuses on an increased spreading of awareness to people, bringing their attentions to their blood pressure, fasting glucose and cholesterol levels. This also includes alerting them of ‘a healthy weight’ so that they compare their own weight with that and work to bring down or retain their existing risk level. Also, the awareness in adults aged 20 years or more should be increased so as to be knowledgeable about the early warning signs and symptoms of a stroke or heart attack.

The health care providers and nurses should be encouraged to educate adults, children, and patients in this regard. The awareness could be promoted through media campaigns as well. At primary level, furthermore, the percentage of persons should be increased who adhere to the ‘Dietary Guidelines for Americans’, in which selection of a variety of grains, fruits, and vegetables, on preference basis has been recommended, and a dietary pattern low in cholesterol and saturated fat and reasonable in total fat with salt as less as possible, has been advised.

To accomplish this particular objective, nutritional foods and healthy eating habits should be promoted in schools through classroom lessons and supporting of cafeteria environment that enhances healthy choices; in grocery stores through food guides; as well as in restaurants through heart-healthy menu displays. Moreover, the importance of an active lifestyle should be promoted through common messages used throughout media.

Children and youth should be discouraged to watch TV, use computers or play video games for more than 2 hours on a school day, and instead should be highly encouraged to participate in sports or other physical activities. Transportation should be made common either through walking, or bicycling, rollerblading, skateboarding etc. Also, children and adolescents should be discouraged from initiating tobacco use, while patients should be counseled to completely stop tobacco consumption.

The plan further includes the development of more hospitals that deliver stroke care, discharge guidelines for patients with risk modification counseling and also the required medication. Also the number of schools that promote wide-ranging health education programs should be increased. Rationale for Interventions It is imperative that clinicians be deeply cognizant of the significance of intervening to lower the risks of CVD. Where it is easy to keep a check on the patients’ cholesterol levels and blood pressures, it is challenging to intervene to affect the lifestyle choices in CVD patients.

Here, the role of diabetes, cigarette smoking, hypertension, and obesity have been well-accepted as highly contributing to the incidence of CVD, not only among American Indian but in almost all industrialized nations. (Rippe et al, 2007) Some risks can however be modified if the role of ‘lifestyle’ is emphasized, which includes a balanced diet, physical activity, and tobacco avoidance and moderation in the use of alcohol. 1. Good Nutrition The nutritional concepts should be made broader and more practicable for patients.

Awareness should be provided to patients of the simple health-related nutritional concepts. Focus should be made on a low-calorie diet and low-fat (very low saturated fat) diet, plus an increased consumption of fish that contains Omega-3 fatty acids, considered as the ‘good’ fats. Fruits and vegetables are considered as the best dietary consumption items. Patients, specially the diabetic ones, should be told how alcohol, plus simple and refined sugars drive up the natural fats in tissues (called triglycerides) in them.

The basic understanding of nutritional importance should be provided to the patients in a way that they’re able to actually value nutrition and its deep and intense effect on their health. 2. Greater Physical Activity Focusing on physical activity i. e. exercise has a significant impact in intervention of the disease. Even people with high risk or at least one coronary artery obstructed by 75% decreased their death certainty to almost half down simply by exercising, cycling a stationary bike over almost an year as compared to stent positioning.

Hence, this implies how much of a positive effect can aerobic exercise has on prevention from it’s getting severe. The patients’ physical activity scores, as they report them, duly associate with the extent of cardiovascular fitness. Patients, therefore, should be asked about their level of activity and must be provided with fitness recommendations and precise and persuasive strategies which they can add and integrate into their lives. 3. Recognizing the stumbling blocks The stumbling blocks in lifestyle interventions are not to be considered immaterial.

Patients of CVD should be provided with strong reasons and institutional assistance so that they can completely and efficiently implement the interventions that result in the reduced risk of mortality. A sensitive attitude towards the socioeconomic, cultural, and gender differences is thought to aid success in this regard. The strategies should be designed such that they target all the groups – From the occupied managers to the living rough and from physically healthy vegetarians to inactive fast food fanatics, as almost all of them may have CVD risk at any stage in life.

An example can be taken, like in the case of gender; women patients must be seriously targeted due to their being at risk and not being able to cope up with CVD once diagnosed. Typically it has been found out that women develop CVD 10 years later than men do. However they tend to last longer than men. Thus, there is a need for them to be provided with primary prevention strategies before menopause to be most effectual. Also, an effective and compelling prevention stand should be taken due to the fact that women usually consider themselves at a low CVD risk.

The standard of education in this case is also critical, requiring greater diligence from the clinicians and other concerned parties. As the mortality of CVD remains high while the obesity epidemic is still growing, there remains a lot at stake. Clinicians can neither be satisfied in terms of being optimistic, nor can they be pessimistic at times when they are attending to their patients in regards to this issue. However, they can adopt aggressive primary and secondary prevention measures as it is said to be affordable.

The guidelines put forward by the American Heart Association/American College of Cardiology for the secondary level prevention precisely draw around the persuasive suggestion and support for an aggressive plan at decreasing mortality and cost-affectivity. Bringing down the complete and comparative risk with lifestyle medicine over a period of time is pretty economical, “and many lifestyle measures affect multiple modifiable risk factors, making lifestyle medicine the perfect approach to primary and secondary prevention. ” (Greenstone, 2007) Conclusion

CVD is indeed the most deadly disease yet it has been one of the most studied and adaptable and adjustable. Clinicians and the care providers do have the tendency to affect the lives of those likely to be affected or those already affected. Among the important considerations, the most imperative is to address the epidemic of obesity and the other diseases related to that. Spreading of awareness among risk facing patients is duly critical as well as the providing of solutions to them. Also it must be made clear to the patients that the risk reduction measures that are quite adjustable do save lives.

With the care plan borne in mind, it is essential that the strategies outlined must be aggressively pursued in order to reduce the risk faced CVD patients to the maximum level. References Galloway, JM, Cardiovascular health among American Indians and Alaska Natives: successes, challenges, and potentials, Native American Cardiology Program, MEDLINE Greenstone, Leo (2007), Rationale for Intervention to Reduce Risk of Coronary Heart Disease: A General Internist’s Perspective, American Journal of Lifestyle Medicine 2007; 1; 20, SAGE Journals

Indian Health Service (2001), Heart Disease and Strokes, Retrieved June 22, 2008 from: http://info. ihs. gov/Health/Health7. pdf National Center for Health Statistics, Deaths: Preliminary Data for 2004. National Vital Statistics Reports, DHHS Pub. No. (PHS) 2006-1120, PRS 06-0130, Vol. 54, No. 19, June 2006 Rippe JM, Angelopoulos T, Zuckley L. The Rationale for intervention to reduce coronary heart disease risk, Am J Lifestyle Med. 2007; 1:1-10

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