This Harvard Medical School Continuing Education video examines these key questions: How do lifestyle factors contribute to cardiovascular disease (CVD)? Which factors are the most important to address for lowering CVD risk?
Dr. Romit Bhattacharya, MD, reviews the development of cardiovascular disease while identifying key lifestyle factors that contribute to cardiovascular diseases such as coronary artery disease and atherosclerosis. The role of genetics is highlighted, and guidelines for reducing the risk of cardiovascular disease through lifestyle modifications are identified and discussed.
View the playlist: / playlistlist=pl9hncxfz_xykmc4hdtbyn8gpnznq…
00:00 | Introduction 00:25 | Overview of cardiovascular disease development 01:28 | Genetic risk vs lifestyle 02:32 | Lifestyle risk factors for developing CVD 03:51 | Lifestyle interventions for reducing CVD
This video was peer reviewed by Dr. Jonathan Salik, TMD, MHPEd, Instructor of Medicine, Massachusetts General Hospital; and Dr. Sugantha Sundar, MD, Assistant Professor of Anesthesia, Beth Israel Deaconess Medical Center, to validate the quality and accuracy of the content.
References: Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
Khera AV, Emdin CA, Drake I, et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med. 2016;375(24):2349-2358.
Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-229.
Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952.
Notice: At this time, the content in this video is not accredited.
Content
0 -> [MUSIC PLAYING]
2.856 ->
5.422 -> ROMIT BHATTACHARYA:
Welcome to our series
7.13 -> on the primary prevention
of coronary artery disease.
10.37 -> Today, we'll be discussing
lifestyle management.
13.01 -> Today's key takeaways are
to understand a schema
15.59 -> for the development of
cardiovascular disease
17.66 -> and how lifestyle
factors contribute
20.51 -> and to review at a high
level the contributions
23.09 -> of key lifestyle factors.
25.49 -> Cardiovascular disease
develops across the lifespan.
28.55 -> One schema we can
use to consider this
30.59 -> is the summation of
risk across key fields,
33.53 -> like genetics or inherited
risk, ambient and structural
37.13 -> exposures, such as pollution,
unhealthy food, racism
40.97 -> and inequity.
42.41 -> Lifestyle factors like diet
and exercise, sleep and stress
46.16 -> management.
47.12 -> Medical comorbidities,
such as diabetes, obesity,
50.88 -> and hypertension.
52.34 -> And behavior, that is both on
the patient side and lifestyle
55.79 -> interventions like
we've mentioned
57.26 -> and the provider
side in problems
59.3 -> like therapeutic inertia
or unconscious bias.
63.052 -> The guideline for the primary
prevention of coronary artery
65.51 -> disease is laid out in
a similar structure,
68.27 -> where, in the first step,
we're asked to assess risk.
71.09 -> In the second step,
we're asked to use
73.1 -> nonpharmacological
interventions.
74.79 -> And in the third
step, we're asked
76.46 -> to manage comorbidities,
which is one of the things
78.898 -> that we in the medical
profession are best at.
80.815 -> And in the fourth
step, we then prescribe
83.51 -> lipid-lowering and
other therapies
85.01 -> to reduce cardiovascular
risk specifically.
88.37 -> When we consider the interaction
between genetics and lifestyle,
92.66 -> we often wonder whether
our genetics are our fate.
96.11 -> When we look at a
study such as this one,
98.09 -> we find that, when we
characterize individuals'
101.33 -> genetic risk into low,
intermediate, and high risk,
105.29 -> lifestyle intervention
still stratifies risk.
108.92 -> Here, the red bars
represent those
110.93 -> with an unfavorable
lifestyle, the blue bars
113.57 -> with a favorable lifestyle.
116.33 -> The high genetic
risk individuals
118.67 -> with a unfavorable lifestyle
have the highest risk,
122.39 -> whereas the low genetic
risk individuals
124.85 -> with a favorable lifestyle
have the lowest risk
127.22 -> of incident coronary disease.
129.27 -> However, even in the
highest genetic risk group,
132.54 -> those with a favorable
lifestyle were
134.72 -> able to significantly
mitigate their risk
137.09 -> and have an essentially
equivalent risk to those
140.99 -> in the low genetic
risk category.
143.75 -> Thus, what we learn is that
even at high genetic risk,
146.39 -> a favorable lifestyle can reduce
your risk of coronary artery
149.18 -> disease to the level of
someone with low genetic risk.
152.3 -> When we consider lifestyle risk
factors for coronary artery
154.76 -> disease, we consider things
like sleep, stress, exercise,
159.26 -> obesity, healthy diet.
161.39 -> And we're beginning
to understand
163.52 -> risk factors such as
environment and neighborhood,
165.89 -> social determinants of
health, structural racism,
168.68 -> and social isolation.
170.63 -> In fact, in the
Interheart Study,
173.54 -> they looked at 52 different
countries across the world
