• See course schedule for dates

of exams, exam content,

assignments, tutorial quizzes.
BPK • University policy on
attendance for examinable
Policy items (midterms, finals,
quizzes, in-class assignments,
Refresher labs etc.) is mandatory unless
you have a medical certificate
or a pre-scheduled SFU
varsity competition that has
been authorized.
• Emails to professor and TA’s –
extenuating circumstances or
clarification of a difficult
curriculum concept ONLY.
• All other enquiries, refer to
syllabus.

BPK 140 SFU Spring 2019 C BOTT

Chapter 4
Carmen Bott MSc. CSCS

Cardiovascular
Disease and
Diabetes
Learning Objectives
• Explain basic anatomy of CV system
• Describe stages of Atherosclerosis
• Identify Risk Factors for CVD
• Describe trend in CVD mortality
• Explain the physiology of Diabetes*
• Summarize prevention and treatment of CVD and Diabetes

BPK 140 SFU Spring 2019 C BOTT

The Cardiovascular
System
• CVD refers to diseases of the heart and blood
vessels
• Heart is a muscle, size of fist
• Blood is pumped via arteries, dividing into
capillaries before saturating the tissues
• Blood returns to the heart via veins
• RHR about 70 BPM
• MHR about 200 BPM
• Arteries that supply the blood to the heart itself are
coronary arteries
BPK 140 SFU Spring 2019 C BOTT
Cardiovascular
Disease
• CVD refers to diseases of the heart
and blood vessels
• Video: Peter’s Story
• Link:
https://www.youtube.com/watch?v=
Bv1IFRiSrg0

BPK 140 SFU Spring 2019 C BOTT

Atherosclerosis

• Disease of the arteries

• Arteries become narrowed due to
fatty deposits progessive narrowing of
'lumen', the middle of the
'tube' through which blood
accumulation of fatty deposits
• Decreases blood supply
flows

• Clots can break loose, get stuck in

smaller vessels “downstream”

BPK 140 SFU Spring 2019 C BOTT

Atherosclerosis
• When coronary arteries become narrowed =
coronary artery disease or coronary heart
disease
• Starts with a ‘lesion’ (injury) to the inner wall of
the artery
• What causes this?
• High BP & various toxins like nicotine
• Once lesion is formed, then cholesterol begins
to deposit, but is reversible in early adult life.
• However, if toxins continue, the walls can
become stiff and the artery less pliable.

BPK 140 SFU Spring 2019 C BOTT

Arteriosclerosis
• This is what atherosclerosis leads to
• “hardening of the arteries”
• Can cause a bulge to protrude inside artery
• The deficiency in blood flow it causes reduces
oxygen supply and waste removal.
• Cells that do not get oxygen DIE
• When the heart does not get enough oxygen – we
suffer a heart attack.
• In the brain it is called a stroke.

BPK 140 SFU Spring 2019 C BOTT

Prevalence
• Heart Disease and Stroke are two of the three
leading causes of death in Canada (2017)
• Prevalence – number of people with a particular
disease or condition as a portion of the total
population (as a rate)
• Prevalence increases with AGE.
• Heart disease is more common than stroke
• Both death rate and incidence in Canada have
decreased since 2001
• However, it can be asymptomatic…so prevalence
is tough to gauge!

BPK 140 SFU Spring 2019 C BOTT

Risk Factors for CVD
• The onset is ‘asymptomatic’
• Thus, prevention must be about identification and modification of risk
factors
• Scientists and doctors use Epidemiological studies for this
• “Individuals with certain characteristics were more likely to contract
and die from CVD”

BPK 140 SFU Spring 2019 C BOTT

Risk Factors for CVD

BPK 140 SFU Spring 2019 C BOTT

Unchangeable Risk
Factors
• Age – risk increases with age…repair
mechanisms become less effective as we
age
• Sex – The same for men and women
(2008)
• Heredity – parent or sibling increases
likelihood
• Ethnicity – African, Hispanic, South Asian
are higher risk than other people in
Canada. As are Indigenous people.

BPK 140 SFU Spring 2019 C BOTT

Changeable Risk
Factors
• Smoking
• Lack of Exercise
• Unhealthy eating
• High Cholesterol
• Hypertension
• High sodium intake
• Stress
• Diabetes
• Overweight
BPK 140 SFU Spring 2019 C BOTT
Let’s look at
what we can
change!

BPK 140 SFU Spring 2019 C BOTT

Tobacco Smoking
• Risk of CVD increases with number of
cigarettes smoked
• Smoke contains hazardous compounds
• Some are carcinogenic
• Others increase risk of CVD – carbon
monoxide and nicotine
• They cause lesions in artery walls and
impair body’s natural repair mechanisms
by reducing oxygen supply to the tissues.

BPK 140 SFU Spring 2019 C BOTT

Physical Inactivity

• Regular, moderate levels of activity are

beneficial
• Why? Lowers blood pressure, increases HDL
cholesterol, decreases LDL cholesterol,
reduces stress, control body weight, controls
Diabetes
• Associated with improved nutritional habits
and better sleep
• Even low intensity aerobic exercise such as
walking is associated with a decreased risk of
CVD.
BPK 140 SFU Spring 2019 C BOTT
Unhealthy Eating
Here are the problems that can contribute to CVD:
• Eating too many calories and then accumulating
excess body weight
• Eating too much fat, especially processed
saturated fats (more later)
• Not eating enough omega-3 fatty acids found in
fish
• Not eating enough fruits and vegetables – 5-10
servings a day are needed as they contain fibre
and antioxidants, both which reduce risk of CVD.
• Drinking too much Alcohol

BPK 140 SFU Spring 2019 C BOTT

 • Cholesterol is a very important molecule
• Used to make cell membranes, steroid
hormones, etc.
• Is synthesized by your body
High Blood • Only ~10% is from diet – ‘dietary cholesterol’
Cholestero • Found in animal sources

l • However, elevated blood cholesterol is a big

risk factor for CVD
• Changing the diet can help ‘some’ people.
• Statins (drugs) inhibit synthesis of cholesterol
by your body

BPK 140 SFU Spring 2019 C BOTT

 • Cholesterol is fatty, so it will not
dissolve in blood, which is watery
• So, cholesterol is carried in blood
attached to proteins called
High Blood ‘lipoproteins’
• Low-density & very-low-density
Cholestero lipoproteins (LDL & VLDL) are bad
l • High-density lipoproteins (HDL) are
good – promote reabsorption of
cholesterol
• *The higher the proportion of HDL
cholesterol, the lower the risk of CVD
(Mayo Clinic, 2012)
BPK 140 SFU Spring 2019 C BOTT
High Blood
Pressure
• The SILENT KILLER
• Do you know your Resting BP?
• Arteries are elastic and strong and carry
blood to tissues
• However, they can only handle so much
pressure, especially in the eyes and kidneys
and brain.
• High blood pressure can cause tearing and
increases the risk of CVD

BPK 140 SFU Spring 2019 C BOTT

High Blood
Pressure
• Prevalence is over 22% - that is 7.5 Million
Canadians with high BP
• Much more common among older adults
• Canada has the highest rate of
AWARENESS, TREATMENT and CONTROL
though
• Many things can influence a resting BP
reading….

BPK 140 SFU Spring 2019 C BOTT

High Blood
Pressure
• Exercise
• Anxiety
• Lack of Sleep
• Caffeine
• Food
• Drugs
• Cold
• Pain
BPK 140 SFU Spring 2019 C BOTT
Causes of
Hypertension
(Risk Factors)
• High dietary sodium intake
• Obesity
• Low dietary potassium
• Low Physical Activity

• Drugs are often prescribed to treat

hypertension – can cause side effects so
adherence can be difficult.

BPK 140 SFU Spring 2019 C BOTT

High Sodium
Diet
• Salt can be added but it can also be
part of food sources high in
preservatives
• Can you think of any?

BPK 140 SFU Spring 2019 C BOTT

Stress
• Mechanism remains elusive
• Perhaps it is the response of elevated BP
• Stress also increases blood clotting rate =
narrow arteries
• Blood cholesterol levels are known to rise
during stressful periods
• Decreased blood flow to the liver during stress
may impairs its ability to excrete cholesterol
• Stressed out people – tend to sleep less,
smoke more…
• What stresses you out?

BPK 140 SFU Spring 2019 C BOTT

Diabetes
Mellitus
• Adults with Diabetes are 2-4 times more likely
to have heart disease or stroke than adults
without (AHA, 2013)
• Heart disease and stroke are the main causes
of death and disability in people with type 2
diabetes
• Diabetes causes elevated blood glucose levels
• More in a few minutes . . .

BPK 140 SFU Spring 2019 C BOTT

Obesity and
Overweight
• Many Canadians are overweight
• Obesity – defined as being 20% or more
above one’s ideal body weight is associated
with hypertension, poor blood lipid profile
(low HDL levels) and Diabetes (AHA, 2012).
• Obesity is probably an independent risk
factor for atherosclerosis and CHD events.

How obesity is defined might be

questionable . . .

BPK 140 SFU Spring 2019 C BOTT

Thought
Question

Should a medical doctor

advise an overweight or
obese patient with CVD to
lose weight or not?

BPK 140 SFU Spring 2019 C BOTT

CVD Mortality
Rates
• Mortality rates have declined due to better
treatments and prevention efforts
• Since 1952, the CVD death rate has
declined more than 75% and nearly 40% in
the last decade!
• Why?
• Research advances in surgical procedures,
drug therapies and prevention efforts.

BPK 140 SFU Spring 2019 C BOTT

Decline in CVD -
Reasons
1. Improved health habits
• Smoking
• Fat consumption
• Exercise
2. Improved screening * & treatment
for hypertension & high
cholesterol
3. Better emergency care

BPK 140 SFU Spring 2019 C BOTT

CVD Mortality in Australia

BPK 140 SFU Spring 2019 C BOTT

CVD Mortality in U.S.A.

BPK 140 SFU Spring 2019 C BOTT

International CHD Mortality
Trends in Men: 1968-2003

BPK 140 SFU Spring 2019 C BOTT

Treatment – for
CVD
1. Emergency CPR
2. Drugs to dissolve clots such as aspirin
3. Coronary artery by-pass grafts (fig 4.7)
4. Angioplasty (fig 4.8)
5. Pacemakers
6. Drugs to reduce blood pressure,
cholesterol
7. Lifestyle change: diet, exercise,
smoking, weight, stress

BPK 140 SFU Spring 2019 C BOTT

By-Pass Grafts & Angioplasty
BPK 140 SFU Spring 2019 C BOTT
 Is CVD Really Declining?

• “Decades of decline in the incidence of heart disease may have come to an end, according to results of a
long-term autopsy study conducted at the Mayo Clinic College of Medicine in Rochester, Minnesota.”
• “In fact, coronary artery disease (CAD) rates may even be climbing among young adults.”
• 9/10 individuals >20 years have at least ONE of the following risk factors & Two in Five have 3 or more:
• Smoking
• Physically inactive
• Not enough fruit and veg
• Stress
• High blood pressure
• Diabetes

BPK 140 SFU Spring 2019 C BOTT

 The Physiology of Diabetes
• A medical condition that involves the
hormone insulin.
• Insulin is produced in the pancreas.
• Insulin helps move glucose from the
Diabetes blood into our cells.
• Type 1 Diabetes – aka Insulin-
Mellitus Dependent or Juvenile Onset – the
pancreas does not produce enough
insulin.
• Source:
https://www.precisionnutrition.com/all
-about-diabetes-mellitus

BPK 140 SFU Spring 2019 C BOTT

BPK 140 SFU Spring 2019 C BOTT
 • In Type 2 Diabetes (Insulin-
independent or Adult-onset diabetes),
the pancreas can produce insulin, but
the cells lose their sensitivity to it
• This is called insulin resistance
Diabetes • Type 2 Diabetes is strongly correlated
Mellitus with excess body weight
• Source:
https://www.precisionnutrition.com/all
-about-diabetes-mellitus

BPK 140 SFU Spring 2019 C BOTT

BPK 140 SFU Spring 2019 C BOTT
Diabetes Mellitus

• A combination of weight loss and

physical activity can cure about 80% of
cases of Type 2 Diabetes
• People with Diabetes can train,
compete in sport, and live a normal
lifespan
• However, if blood sugar is not
controlled, they are at risk for a number
of disorders:

BPK 140 SFU Spring 2019 C BOTT

Diabetes Mellitus
• Blindness
• Peripheral Neuropathy
• Sores and infections, esp in feet
• Limb amputation
• Cardiovascular Disease

BPK 140 SFU Spring 2019 C BOTT

Diabetes Prevalence
• 6th leading cause of death in 2013
• 9.3% of Canadians have Diabetes
• More prevalent among males
• More prevalent with increasing age
• But over 20% might not know they have
it
• Prevalence seems to be increasing . . .

BPK 140 SFU Spring 2019 C BOTT

Diabetes Prevalence
• Factors contributing to increasing
prevalence:
• A decline in Mortality
• More obesity
• Broader diagnostic criteria – help ID
new cases
• Growing awareness by physicians and
the public – increases detection.

BPK 140 SFU Spring 2019 C BOTT

 Diabetes Risk Factors
• Ethnicity – Indigenous, Hispanic, Asian, South
Asian or African are at increased risk
• Weight – being overweight or obese are risk
factors
• Physical activity level – inactivity increases risk
• Family History - Having a parent or sibling
increases risk – genetics and or shared
behaviors?
• Gestational Diabetes – Developing diabetes
while pregnant increases risk for later in life

BPK 140 SFU Spring 2019 C BOTT

The International Diabetes Foundation (IDF) says that
“Diabetes and obesity are the biggest public health
challenge of the 21st century.”

BPK 140 SFU Spring 2019 C BOTT

Diabetes Management

1. Insulin – regular injections or meds to control

blood sugar (Type 1)
2. Diet - Balance carbohydrate intake and
physical activity with insulin intake. Consume
14g of fiber for 1,00 kcal. Maybe
reduce/monitor protein intake
3. Weight loss (if needed)
4. Monitor BP; manage hypertension

BPK 140 SFU Spring 2019 C BOTT