CARDIOVASCULAR

DISEASE
LET'S GET
STARTED
 CARDIO-
VASCULAR
DISEASE

 is a class of diseases that

involve the heart or blood
vessels. Cardiovascular disease
includes coronary artery
diseases (CAD) such as angina
(chest pain) and myocardial
infarction (commonly known
as aheart attack)
 UNDERLYING MECHANISMS
vary depending on the disease in question. Coronary artery
disease, stroke, and peripheral artery disease involve
atherosclerosis. 

obesity, high
high blood
blood
pressure,
cholesterol,
smoking,
poor diet, and
diabetes
excessive
lack of
alcohol
exercise
consumption
 82%
of people who die of coronary heart disease
are 65 and older. The risk of stroke double
every decade after age 55.
CARDIOVASCULAR DISEASES
ARE THE LEADING CAUSE OF
DEATH GLOBALLY

80% 75%
 of CVD deaths in males   of CVD deaths in females 
 PREVENTION

A low-fat, high-fiber diet including whole grains

and fruit and vegetables
Tobacco cessation and avoidance of second-hand
smoke
Limit alcohol consumption to the recommended
daily limits
Lower blood pressures, if elevated
Decrease body fat if overweight or obese
Increase daily activity to 30 minutes of vigorous
exercise per day at least five times per week
(multiply by three if horizontal)
Reduce sugar consumptions
REMEMBER THE PARQ IS NECESSARY
FOR ANY EXERCISE
RECOMMENDATIONS

IF YOU SUSPECT OR THE CLIENT ADMITS TO PRE-

EXISTING HEALTH CONDITIONS GET THEM TO AGREE
TO ASKING THEIR DOCTOR BEFORE FOLLOWING
YOUR ADVICE
 THE KEY TO A HEALTHY
HEART STARTS WITH
HEALTHY EATING AND ENDS
WITH HEALTHY EXERCISE AT
A LEVEL THAT FITS THE
INDIVIDUAL
 TAKE HOME MESSAGE:

KEY CONTRIBUTORS TO HEART DISEASE: SATURATED FAT/

TRANS FATS FROM HYDROGENATED OILS PARTICULARLY IN
PASTRY FOODS, STRESS, LACK OF SLEEP, POOR DIET NUTRIENT
DENSITY - USE THE SAT FAT SHEET TO AND TOOLS TO ESTIMATE
SAT FAT CONTRIBUTION AND ADJUCT OR REMOVE BIGGEST
CONTRIBUTORS
 WHY DO SOME RESPOND TO
SAT FAT AND OTHERS DON'T?
D I F F E R E N C E S I N P E R S O N A L G E N E T I C S M E A N T H A T
D I F F E R E N T P E O P L E H A V E D I F F E R E N T
S E N S I T I V I T I E S T O S A T F A T , F A T T H A T I S F U L L Y
J O I N E D W I T H H Y D R O G E N A T O M S M A K I N G I T E A S Y
T O O X I D I S E .  

S O M E P E O P L E H A V E I S S U E S W I T H H O W S T I C K Y
T H E I R L D L P A R T I C L E S A R E ( T H E S E A R E T H E
C H O L E S T E R O L A N D F A T T R A N S P O R T E R S A W A Y
F R O M T H E L I V E R T O P E R I P H E R A L C E L L S ) .

  O T H E R S H A V E G E N E T I C D I F F E R E N C E S T H A T A L S O
A L T E R H O W S T I C K Y T H E I R H D L C H O L E S T E R O L
P A R T I C L E S A R E ( T H E G O O D C H O L E S T E R O L C A R R I E R
T H A T T R A N S P O R T S C H O L E S T E R O L A N D F A T T O T H E
L I V E R T O B E B R O K E N D O W N A N D P A S S E D O U T O F
T H E B O D Y ) T H E M O L E C U L E S R E S P O N S I B L E F O R
P I C K I N G U P A N D A T T A C H I N G T H E
C H O L E S T E R O L / F A T A R E C A L L E D A P O L I P O P R O T E I N S
 THE HEALTH THERAPIST ACADEMY

A GENETIC 
TEST COULD BE A POWERFUL
TOOL IN PERSONALISED NUTRITION SUPPORT, FOR
EXAMPLE PEOPLE WITH A HIGH SAT FAT
SENSITIVITY MIGHT NEED AS LITTLE AS 5% OF KCAL
FROM SAT FAT, WHEREAS OTHERS CAN TOLERATE
10%, IT ALSO AFFECTS CHOLESTEROL SENSITIVITY
SO CLIENTS WITH A HIGH SENSITIVITY MIGHT NEED
LESS THAN 300MG OF CHOLESTEROL A DAY,
WHEREAS THE GENERAL POPULATION IS FINE WITH
NEARER 500MG

HEART DISEASE TRAINING

 THE HEALTH THERAPIST ACADEMY

YOU CAN
1
MAKE A
DIFFERENCE
Plant stanols/sterols at 2g a day may help lower LDL/bad cholesterol.

High fibre diets at greater than 24g and preferably greater than 30g for high risk
clients/sensitive ones may also help

Omega 3 supplementation doesnt reduce heart disease risk but some evidence
points towards it limiting the chance of dying from a heart attack and having a
recurrence, but NOT stopping the first one, this could be as omega 3 fatty acids affect
how sticky blood fragments are in the blood and may ease initial clot clearance 
 THE HEALTH THERAPIST ACADEMY

AFTER CARE
2

Although GP/doctor is always the primary care resource you can give advice to
clients to support a healthier lifestyle, don't be afraid of doctors talk about what
you do, write a pitch in advance and LEARN it. You may want to consider 5g a day
of taurine supplementation in clients with previous heart disease history as this
has been shown to improve health of the heart again the doctor will need to clear
it and this should be emphasised with the client

Soy isoflavones despite initial promising results don't seem to be linked to

improvements in LDL or HDL cholesterol at meaningful amounts, positive effect
studies show only a very small improvement
 THE HEALTH THERAPIST ACADEMY

3 THE
50
RESULTS
40

30

20

10

0
2017 2018 2019 2020 2021

Remember to monitor patients results to

help with this look at measures like
cholesterol levels from the testing and blood
 THE HEALTH THERAPIST ACADEMY

BLOOD PRESSURE CONTINUED...

BLOOD PRESSURE LEVELS HAVE A

DIASTOLIC READING (THE SMALLER
ONE) WHICH REPRESENTS BLOOD
PRESSURE BETWEEN BEATS, AND A
SYSTOLIC ONE WHICH IS THE HIGHER
OF THE 2 AND REPRESENTS PRESSURE
WITH EACH BEAT OF THE HEART
BLOOD THE HEALTH THERAPIST ACADEMY

PRESSURE
 THE HEALTH THERAPIST ACADEMY

THE STORY OF
ATHLEROSCLEROSIS
Thats plaques or hard deposits that form on arteries and break off causing heart
attack or stroke (myocardial/cerebral infarction or event respectively)
THE HEALTH THERAPIST ACADEMY

First cholesterol is being transported from

the Liver to peripheral tissue as its a vital
component of cell walls and necessary for
life
Next due to an immune response from the
body to an infection e.g. cold or flu the
concentration of immune cells called
macrophages increases
Some of these mistakenly attack travelling
LDL cholesterol particles (especially the
smaller dense ones) resulting in the
deposit of fat that hardens along the lining
of the artery wall, over time this builds up
and narrows the artery increasing blood
pressure.
Eventually the plaque breaks off and
travels around the body eventually
returning to the heart and may block off
blood flow causing a heart attack, or blood
flow to the brain causing stroke
 THE HEALTH THERAPIST ACADEMY

SALT AND BLOOD

PRESSURE THE
CONTROVERSY
THERE IS A GREAT DEAL OF CONTROVERSY AROUND THE IMPACT
OF SALT ON BLOOD PRESSURE AS 3 IN 5 DON'T RESPOND TO
REDUCTIONS IN SALT, HOWEVER IT IS ARGUED THAT THE
MAJORITY OF PEOPLE WITH HIGH BLOOD PRESSURE ARE SALT
RESPONDERS.

COCHRANE REVIEWS ARE CONTRADICTORY AND POINT OUT THAT

ALTHOUGH THERE IS A BENEFIT IN SOME PEOPLE IN BLOOD
PRESSURE RESTING HEART RATE (ANOTHER PREDICTOR OF HEART
DISEASE RISK) INCREASES SLIGHTLY (ABOUT 5%) AND THIS MAY
WELL CANCEL OUT THE BENEFIT

WHAT THIS MEANS FOR YOU IS YOU CAN RECOMMEND SALT

REDUCTION AS A STRATEGY BASED ON CONSUMPTION OF
PROCESSED FOODS AND ADDING SALT AT THE TABLE, BUT
EMPHASISE THE IMPORTANCE OF SATURATED FAT TARGETS AND
INCREASING VEGETABLE AND FIBRE CONSUMPTION WHILST
LIMITING MEAT - IN PARTICULAR RED MEAT WHICH IS HIGH IN
SATURATED FAT AND CHOLESTEROL, MOST SERVING OF MEAT
CONTAIN 100MG OF CHOLESTEROL PER 100G BUT EGGS, PRAWNS
AND SHELLFISH CONTAIN 300-400MG
 THE HEALTH THERAPIST ACADEMY

WHY CHOLESTEROL?
A GOOD QUESTION THE MAJORITY OF CHOLESTEROL AROUND
2000MG IS MADE BY THE BODY FROM FAT (IN PARTICULAR
SATURATED/SAT FATS) - ONLY 500MG COMES DIRECT FROM
DIETARY CHOLESTEROL FROM ANIMAL SOURCES AND PALM AND
COCONUT OIL (PREDOMINANTLY).

WHY THEN DOES SOMEONE WITH HIGH LDL CHOLESTEROL NEED

TO LOWER DIETARY CHOLESTEROL?  

WHEREAS ITS TRUE THAT THE PRIMARY INTERVENTION SHOULD

BE SAT FAT, MANY PEOPLE WITH HIGH LDL CHOLESTEROL MAY
ALSO HAVE A GENETIC CHANGE (OR POLYMORPHISM) THAT
BREAKS OR LIMITS THE PROCESS IN THE BODY THAT REDUCES
THE AMOUNT OF CHOLESTEROL MADE IN THE BODY WHEN
DIETARY CHOLESTEROL INTAKE IS HIGH

(To get from mg/dL to mmol/L multiply by 0.02586 )

BP measurement
l Three or more readings,
separated by 1 minute

l Discard first reading and

average last two

l If large difference take further

readings.
BP measurement -cuffs
l Cuff too small or too big

l Normal cuff too small for 15% of patients

l Cuff not level with the heart

l Leaky rubber tubing or bladder*

l Faulty inflation/deflation device*

* Applies to mercury manometers only.

Cuff sizes
Type Size Suitability

Adult 12cm by 23cm for smaller arms

will cover 95%

Alternative cuff 12cm by 36cm
arms

Often too wide

Large adult 15cm by 36cm
for ‘fat’ arms
Posture
l Routine - seated
l Standing in patients with
symptoms or diabetic (diabetic
nephropathy) and the elderly
l Supine position unnecessary,
inconvenient and cuff position
often below the heart.
BP measurement - patient
l Anxiety and unfamiliarity
l Animated discussion about the
latest news
l Ambient temperature
l Full bladder!
l Postural hypotension
l Difference between arms.
Patient
l Consent is taken as read when patient rolls
up sleeve
l Explain the procedure, that it may be a little
uncomfortable and that several readings will
be taken
l Seated, relaxed, not speaking

l Tight arm clothing removed

l Arm supported (not hyper extended)
with cuff level with the heart.
Explanation to the patient
l Tell the patient their blood pressure
reading
l Write BP down – use co-operation cards
l Give relevant leaflets/booklets on life
style issues (not too many at a time)
l Reassure patient that this is a risk factor
not a disease (unless left untreated)
l Do not lose to follow-up.
‘White coat’ hypertension
l Effective method of diagnosing a rise
in blood pressure associated with
having blood pressure measured

l Maybe from anxiety

l 10-20% of subjects labelled

‘hypertensive’ may have
‘white coat’ effect.
Home monitoring
l Gives patients empowerment
l May improve medication concordance
l Device used must be validated
l Multiple day time recordings, over 7 days
(eliminating ‘white coat’ effect) with BP
taken in the morning and evening
l First 24 hour readings should be discarded
l Home measurements usually lower than
clinic readings.
Copyright The Health Therapist Academy
 PARQ INSTRUCTIONS:

Description: The Physical Activity Readiness Questionnaire (PAR-Q) is a

screening tool and consists of 7 closed-ended questions that assess an
individual’s level of physical fitness and ability to engage in physical
activity.The PAR-Q is designed to determine physical activity is appropriate
for adults who are between the ages of 15-69 and for whom physical activity
may cause harm. The PAR-Q advices the adult who is over than the age of
69, and for whom physical activity is not apart of his or her normal routine
to contact his or her fitness or health professional regarding beginning
engaging in physical activity regardless of his or her score on the PAR-Q.

Scoring/Interpretation: If the subject answers “YES” to any of the seven

questions, it is recommended that the individual consult with their doctor
prior to becoming physically active. If the subject answers “NO” to all seven
questions then he/she may gradually begin to engage in a physical activity
regimen.