Salon 2 13 kasim 14.00 15.00 serpi̇l akkuş topçu-ing

1. ACUTE CORONARY
SYNDROMES,
RİSK FACTORS AND
PREVENTİON
KOÇ UNIVERSİTY SCHOOL OF NURSING
SERPİL TOPÇU R.N., M.S.N.

2. ACUTE CORONARY
SYNDROMES
• Acute coronary syndrome (ACS) refers to a group of
conditions due to decreased blood flow in the coronary
arteries such that part of the heart muscle is unable to
function properly.

3. Coronary Artery Disease
Clinical Signs;
• Sudden death
• Heart failure
• Stable angina pectoris,
• Unstable angina pectoris,
• Myocardial infarction (MI)

4. Global Atlas On Cardiovascular Disease
Prevention And Control- 2011

5. Global Atlas On Cardiovascular Disease
Prevention And Control- 2011

6. Cardiovascular Disease
Profile Around theWorld
COUNTRIES CVD MORTALITY RATE
European Union members %40
China (1/5 of the world's
%36
population)
Latin America %31
Middle East %25-45
India (1/6 of the world
%24
population )
Africa %10 (primary stroke)
Türkiye Kalp Ve Damar Hastalıklarını Önleme ve Kontrol Programı 2010-2014

9. Cardiovascular Disease
Profile in Turkey
• Primary cause of the disability-adjusted life
year (DALY) in Turkey is cardiovascular diseases -
%19.32
• DALY results on cardiovascular disease;
o Males -%20,5
o Females -%18
Türkiye Hastalık Yükü Çalışması- UHY (DALY- 2004)

10. RISK FACTORS AND
PREVENTION

12. Türkmen E, Badır A, Ergün A ( 2012). Koroner Arter Hastalıkları Risk Faktörleri: Primer ve Sekonder Korunmada Hemşirelerin Rolü. Acıbadem
Üniversitesi Sağlık Bilimleri Dergisi. Cilt: 3 • Sayı: 4 • Ekim

13. 1- Tobacco Smoking

16. - Turkey is 3rd in Europe and 7th around the world about
smoking
- Smoking rate in;
Men % 47,9
Women % 15,2

19. Prevention of Smoking
In Turkey
• November 25 2004 “Tütün Kontrol Çerçeve
Sözleşmesi-WHO-FCTC Framework Convention on Tobacco
Control” is accepted;
- Raise awareness of the public
- Quit smoking
- Price and taxes
- Passive smoking control
- Advertising and sponsorship
- Product control and consumer education.

20. 2- Overweight and Obesity

21. • Every year 2.6 million people dies due to overweight and
obesity. It is related to CVD.
• In Turkey according to TURDEP- I (2002)results obesity
rate;
- Men - %25.3
- Women - %46.2
• TURDEP- II (2010)
• Obesity - %44 ↑
- Waist circumference - women 6cm↑,
-men 7cm↑

22. Definition of Overweight and
Obesity
Target 1: Waist circumference
Men ≥ 94 cm, w풐풎풆풏 ≥ 80 cm (do not gain weight)
Target 2: Waist circumference
Men ≥ 102 cm, women ≥ 88 cm ( advice losing weight)

23. Prevention of Overweight and Obesity
• Diet, exercise, and behaviour modifications
• Medical therapy with orlistat and/or bariatric surgery for
patients with BMI ≥35 kg/m2 or a BMI ≥35 kg/m2 in the
presence of high-risk comorbid conditions are the only
options.

24. • Saturated fatty acids to account for <10% of total energy
intake, through replacement by polyunsaturated fatty acids
• Avoid processed food,
• <5 g of salt per day
• 30–45 g of fibre per day, from wholegrain products, fruits
and vegetables
• fruits and vegetables per day 2-3 servings
• Fish at least twice a week, one of which to be oily fish.

26. 3- Physical Inactivity

27. Physical Inactivity
With 150 minutes of regular exercise per week.
- Reducing ischemic heart diseases %30
- Reducing Diabetes rate %27

28. Physical Inactivity
In Turkey;
According to the results of : “Sağlıklı Beslenelim, Kalbimizi
Koruyalım (2004)” (N:15.468) ;
Only 3,5% of people are doing regular exercise at least 3
times a week 30 minute.

29. Physical Inactivity and Obesity
Prevention- In Turkey
• Educating children about healthy food by family, teacher
and public health nursing.
• Advertisement control about fast food.
• Regulating menus of branch restaurants which are suitable
for preventing CVD
• Organizing exercise programs.
• The main responsibility belongs to health care providers.
TKD Ulusal Kalp Sağlığı Politikası Raporu

30. 4- Hypertension

31. Hypertension
• HT is the major risk factor MI, stroke, hearth and kidney
failure, vascular dieseases and blindness
• High blood pressure is responsible of the total deaths of
%13around the world.

34. • According to Turkish Hypertension Prevalence Study;
• Nearly 15 milion people have hypertension however
%40 of them are aware of high blood pressure
• Only %31of them are taking antihypertensive therapy.

35. Reduce; Systolic blood pressure 20 mmHg
Diastolic blood pressure 11 mmHg ;
• Decrease Stroke risk % 63
• CVD risk % 46
TKD Ulusal Kalp Sağlığı Politikası Raporu

36. Prevention of
Hypertension
• Weight control, increase pyhsical activity level
• Reduce alcohol intake
• Limiting salt intake
• More Vegetable and fruit
• Prefering saturated dairy products
• It is suggested to all hypertensive and high normal blood
pressure patient ( Class I, Level B).

37. Prevention of Hypertension
1. Social Practice
• Starting prenventive life style changes in childhood.
• Family and school education programs.
• Ministery of Health, Education, Sports, Agriculture and
Religion etc. Should support this cause using media.
• Writing the salt level and calorie in food ingridients.
• Decreasing salt level in all food products.

38. Prevention of
Hypertension
• People should be encourage to exercise and it should be
accessible.
• Necessary prevention should be applied to quit smoking
2- Personal Practice
• Healthy life style
• This is the main responsibiliyt of health care provider.

39. 5- Alcohol

41. • The relationship between alcohol and CVD is not
clarified yet.
• If moderate alcohol use is peep
- CVD risk factors
- Hard to control blood pressure
- Synergetic effect of cigarates.
- Obesity

42. Prevention of CVD
• Moderate alcohol use is suggested.
Women 1 cup per day (10 g alcohol),
Men 2 cups per day (20 g alcohol)

43. 6- Diabetes

45. • Diabetes was accepted by United Nations for the first time a
non-infected diesea is considered as a global health threat
(Dec, 20 2006). They also called the countries in action to
fight againts diabetes.

47. Prevention of CVD with Diabetes;
Target HbA1c <%7.0
• Statines use
• Prevent gaining execisive weigth and hypoglisemi
• BP <140/80 mmHg

48. Prevention of Diabetes
T.C. Ministry of Health Action Plan (2011-2014)
• Prevention of diabetes, to increase quality of care in
patients with diabetes and decrease complications of
diabetes and deaths.
http://www.saglik.gov.tr/HM/dosya/1-71375/h/turkiye-diyabet-onleme-ve-kontrol-programi.
pdf

49. 7- Hyperlipidemia

53. Prevention of
Hyperlipidemia
• Life style changes.
• Drug treatment.

54. 8- Social Factors
• Poverty, lack of education and unplanned urbanization
have a negative impact on cardiovascular health.
• Unfair distribution of power, money and resources
increases exposure to cardiovascular risk factors.

55. 9-Risk Factors Take Root In The Womb,
Childhood And Youth
• Undernutrition in fetal life and infancy increases an
individual’s vulnerability to CVD.
• Low birth weight is related to CVD and DM
• Healthy behaviours are learned in childhood and
continue into adulthood.
• Passive smoking exposure in childhood.

56. TÜRKİYE HASTALIK YÜKÜ
ÇALIŞMASI 2004
RİSK FAKTÖRLERİ ÖNLENEBİLİR ÖLÜM ORANLARI
Hipertansiyon %25,2
Beden Kitle İndeksi ( BKİ) %13,3
Tütün kullanımı %12,7
Hiperlipidemi %11,4
Fiziksel aktivite %10,5
Sebze meyve tüketimi %9
Ilımlı alkol %4,3

58. Nursing Roles in Prevention
Primary prevention;
Primary prevention in providing of CAD is worse than
secondary;
Because of
• Risk calculators focus on short-term risk
• Prediction difficulties (people who are at risk)

59. Nursing Roles in Prevention

61. Results of the study;
• Students were knowledgeable about cardiovascular
disease and associated risk factors,
• There were significant gaps in their knowledge; these
should be addressed through improved nursing curricula.
• While students were generally healthy, they could
improve their practice of health-promoting behaviors.

62. According to nursing case manager models in secondary
prevention;
• Proper medication use results in improvements in risk
factors, exercise toleration, blood glucose level
• CVD
• Mortality
• Coronary atherosclerosis
• Perception of healht improves

64. The EUROACTION trial studying patients with
CHD and those at high risk of CVD in 8 countries;
The approach was;
• Family centred and led to healthier lifestyle changes in
terms of diet and physical activity, improvements in
lifestyle e (diet and physical activity)
• More effective control of risk factors such as blood
pressure in both patients and their partners in the
intervention arm compared with usual care

65. CCNAP: Council on Cardiovascular Nursing and Allied
Professions
and
AHA CVD Nursing Comitte prepare a settelement about
nurses to have an active role in prevention of CVD.