North Carolina Supplemental Cardiovascular Disease Prevention Project: Design and Objectives

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Coronary Events and Lifestyle Choices

• 84,129 women
• Nurses' Health Study free of diagnosed
  cardiovascular disease, cancer, and diabetes 14
  years of follow-up
• 1128 major coronary events (296 deaths from
  coronary heart disease and 832 nonfatal
  infarctions)

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Low Risk Status

• Not currently smoking
• Body-mass index 25
• At least half a drink of an alcoholic beverage
  per day
• Engaged in moderate-to-vigorous physical activity
  half an hour per day
• Higher than average consumption of a diet high in
  cereal fiber
• Healthy plant oils
• Low in trans fat and glycemic load

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3 had no risk factors
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Relative risk of Coronary Events
Stampfer,NEJM, 2000
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1128 total coronary events
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82 of events were due to lifestyle related
health risks

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• Knoops, JAMA 2004
• 1500 70-90 year olds

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Four risk factors moderate alcohol consumption,
exercise, Mediterranean diet, smoking
Knoops, JAMA 20042921433
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Four risk factors moderate alcohol consumption,
exercise, Mediterranean diet, smoking
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Four risk factors moderate alcohol consumption,
exercise, Mediterranean diet, smoking
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Who else has data?

• 342,815 Multiple Risk Factor Intervention Trial
  (MRFIT)
• 10025 men and 6229 women Chicago Heart
  Association Detection Project in Industry (CHA)
• And many others

Stamler, JAMA 1999
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Low risk status

• serum cholesterol level less than lt200 mg/dL
• blood pressure less than or equal to 120/80 mm Hg
• no current cigarette smoking.

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Cardiovascular Disease Mortality
Stamler, JAMA 1999
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Percent of Selected Chronic Diseases That Are
Lifestyle Related
91
82
71
70
Stampfer, 2000 Platz, 2000 Hu, 2001
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How People Died in 2003
Cancer 24
Accidents Suicide Infections Kidney failure Lung
failure Others 40
Cardiovascular Disease 36
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How People Died in 2003
CVD
Cancer
Other
70
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A healthy lifestyle is

• The common denominator of good health
• Able to prevent most, arrest many, and even
  reverse some chronic diseases
• Extremely hard to do!

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5-a-day 1 million
Food Marketing 25 Billion
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Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel on
Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults (Adult Treatment
Panel III), 2001
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Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel on
Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults (Adult Treatment
Panel III), 2001
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Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel on
Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults (Adult Treatment
Panel III), 2001
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The Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (2003)
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The Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (2003)
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The Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure (2003)
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TLC Barriers

• Whats TLC? Ive never heard of it before.
• Belief that patients wont change, so why bother
• Its easier to take a pill
• Patients take their medications only one half the
  time

Haynes, JAMA 2002
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Premiums
Inflation
Workers Earnings
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Portion of Health Care That is Related to Health
Risk
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U.S. Health Care as a Percentage of the GDP
Today 15 of GDP
US Military uses 3.2
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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U.S. Health Care as a Percentage of the GDP
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Doctor Day, January 1, 2226
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Obesity Trends Among U.S. AdultsBRFSS, 1985
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Obesity Trends Among U.S. AdultsBRFSS, 1986
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Obesity Trends Among U.S. AdultsBRFSS, 1987
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Obesity Trends Among U.S. AdultsBRFSS, 1988
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Obesity Trends Among U.S. AdultsBRFSS, 1989
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Obesity Trends Among U.S. AdultsBRFSS, 1990
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Obesity Trends Among U.S. AdultsBRFSS, 1991
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Obesity Trends Among U.S. AdultsBRFSS, 1992
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Obesity Trends Among U.S. AdultsBRFSS, 1993
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Obesity Trends Among U.S. AdultsBRFSS, 1994
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Obesity Trends Among U.S. AdultsBRFSS, 1995
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Obesity Trends Among U.S. AdultsBRFSS, 1996
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Obesity Trends Among U.S. AdultsBRFSS, 1997
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Obesity Trends Among U.S. AdultsBRFSS, 1998
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Obesity Trends Among U.S. AdultsBRFSS, 1999
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Obesity Trends Among U.S. AdultsBRFSS, 2000
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Obesity Trends Among U.S. AdultsBRFSS, 2001
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2003
No Data lt10 1014
1519 2024 25
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Obesity Trends Among U.S. AdultsBRFSS, 2004
No Data lt10 1014
1519 2024 25
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Lifetime Risk of Diabetes for Children Born in
2000
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Venkat Narayan, JAMA 20032901884
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Life Expectancy in the U.S.
2-5 year decline in life expectancy
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• www.culpritandcure.com

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