Aspects of sustainable transport mode. ( buses in scotland ) Thesis Proposal

Aspects of sustainable transport mode. ( buses in scotland ) - Thesis Proposal Example In this context, the study’s aims and objectives can be described as follows: a) What is the evidence that more use of the bus is more sustainable? B) What load factors are needed for bus to have less CO2 per passenger kilometre than the car, so buses generally achieve these? c) Which cities have made most (and least) progress in making the bus network an alternative to car use? Why? d) Does better bus provision get drivers out of cars or does bus attract people who would otherwise be car passengers? e) What are the changes to bus provision that make bus attractive enough to attract a proportion of car drivers – speed, comfort, personal security and so on, f) Are the existing schemes – in regard to the improvement of the bus network (Scotland) in terms of sustainability – satisfactory? It should be noted that the study focuses on the examination of the aspects of buses as sustainable means of transport especially in Scotland; the study’s mains and o bjectives will be addressed using the relevant literature as well as figures released by governmental and non-governmental organizations in Scotland; material will be also retrieved through relevant authorities worldwide – in order to make a comparative analysis of the measures developed in Scotland towards the increase of sustainability of buses. The views of passengers and people working in the bus network in Scotland will be also employed in order to explore all aspects of the study’s aims and objectives – as described above. Bus is an essential means of transport in Scotland; because of its importance for the local social and financial needs but also for the environment, the Scottish government has developed a framework of rules regulating the bus operation and use across the country. An indicative example is the bus network scheme developed by the city of

Capstone Checkpoint Essay Example for Free

Capstone Checkpoint Essay Looking back over the past nine weeks I must say that a large amount of valuable information has been presented to our class. The reading material, assignments, and class discussions have taught me some valuable lessons in the area of nutrition. The assignment that I learned the most from was the Week Two assignment about the digestive system. I now understand how the body uses the different types of food, the path food takes as it enters the body, and how the organs, including the salivary glands work together in the digestive process. However, my favorite part of Week Two came through the class discussions in the area of home remedies. I learned how a change in diet can prevent or help to cure digestive disorders. For example, Diverticulus can be treated at home by drinking plenty of fluid and eating fiber rich foods, such as fruits, vegetables, whole grains, etc. I enjoyed this part the most because I was forced to take medicine for an extended period of time and I really did not enjoy that experience. Therefore, learning natural ways to bring relief was truly refreshing for me.  Checkpoint from week one, three day diet analysis instructed me how to begin eating healthier. I made the necessary changes in my diet and by the time I reached the three day analysis for week six, I noticed some major changes in my eating habits. Currently I notice the different foods on my plate and the nutritional value that each has to offer. I refrain from eating meals (other than grains for breakfast like cereal or oatmeal) that does not include fruits or vegetables. Even on those days when I stop by a fast food place and grab a burger I avoid the fries, and I ask for extra pickles, lettuce, and tomato, to add more nutrients to the sandwich.

Empowerment of Women through Neighbourhood Groups

Empowerment of Women through Neighbourhood Groups Empowerment of Women through Neighbourhood Groups in Malappuram district of Kerala Haseena Jasmine C K Abstract NeighbourHood Group (NHG) popularly known as Kudumbashree Ayalkoottam, is an innovative idea undertaken by Kudumbashree mission of Kerala. Empowerment of women is essential to harness the women labour in the main stream of economic development. Empowerment of women is a holistic concept. It is multi-dimensional in its approach and covers economic, political, social/cultural, personal and family aspects. Of all these facets of women development, economic empowerment is of utmost significance in order to achieve a lasting and sustainable development of society. Micro finance is an important means for attaining women empowerment. Micro finance is the provision of thrift, credit and other financial services and products of very small amounts mainly to the poor in rural, semi-urban and urban areas for enabling them to raise their income level and improve their standard of living. It has proven to be an effective and popular measure for women empowerment. This paper examines how far the NH Gs contribute to women empowerment and also to understand the problems faced by the members of NHGs. Keywords: Microfinance, Empowerment, Neighbourhood Groups (NHGs), Kudumbashree, Poverty Eradication. Introduction Women are an integral part of every economy. Overall growth and development of a nation would be possible only when women are considered as equal partners in progress with men. Empowerment of women is essential to bring the women in the main stream of economic as well as social development, and also to bring national development. Women empowerment is multi-dimensional in its approach and covers economic, political, social, cultural and personal aspects. Micro finance is an important means for attaining women empowerment. Micro finance is the provision of thrift, credit and other financial services and products of very small amounts mainly to the poor in rural, semi-urban and urban areas for enabling them to raise their income level and improve their standard of living. It has proven to be an effective and popular measure for women empowerment. The State Poverty Eradication Mission, known as Kudumbashree is an innovative poverty eradication programme of the Government of Kerala, which is a community based, women oriented and participatory programme in every respect. Kudumbasree programme is being implemented through the local self governments in the State. The three-tier community based organisation of women includes Neighbourhood Groups (NHGs) at the grass root level, Area Development Societies (ADSs) at the local level and Community Development Societies (CDSs) at the Panchayat/ Municipality level. These organisations act as important means for empowering women. Empowerment of women is considered as an important responsibility of every government. NeighbourHood Group NeighbourHood Group (NHG) popularly known as Kudumbashree Ayalkoottam, is an innovative idea undertaken by Kudumbashree mission of Kerala, with the aim of not only to know our neighbours, but also to share all our information, views, ideas or opinions for the betterment of our group in general. This platform will also help each one of the members to showcase their talents through the annual get together. Grass root level poor women are organized through Neighbourhood Groups(NHGs) consisting of 20-40 women with 5 functional Volunteers, viz., Community Health Volunteer, Income Generation Volunteer, Infrastructure Volunteer, Secretary and President. The NHG members used to meet once in a week in one of the member’s house. The members, who meet together, discuss their problems and make joint effort to find solutions to their grievances with the support of the functional volunteers. This would bring up an interpersonal feeling among the members and would generate supportive attitude to build confidence among them. Apart from this, they practice small savings through thrift which should be used to create productive assets. Women Empowerment Empowermentrefers to increasing the economic, political, social, educational, gender, or spiritual strength of individuals and communities. Womens Empowerment educates and empowers women who are homeless with the skills and confidence necessary to get a job, create a healthy lifestyle, and regain a home for themselves and their children. Empowerment also includes encouraging, and developing the skills for, self-sufficiency, with a focus on eliminating the future need for charity or welfare in the individuals of the group. This process can be difficult to start and to implement effectively. Statement of Problem Empowerment of women is seen as one of the most important means of economic, social and cultural development as well as for reducing poverty among women. Even the Government takes considerable effort for empowering women and to improve their status in the society, still they face number of problems. We know NHGs are mainly initiated for the purpose of empowering women. But we can’t think that all NHGs are succeeded in women empowerment. And also we can’t faithfully believe that all the members of NHGs are satisfied with them. It is necessary to analyse how far the NHGs contribute to women empowerment and also to understand the problems faced by the members of NHGs. Objectives of the Study The objectives of this study as follows: To examine the role of Neighbourhood Group in women empowerment. To identify the problems and constraints faced by the members of Neighbourhood Groups. To make suggestions for the empowerment of women. Research Methodology The research design adopted for the study is descriptive. The study is based on both primary and secondary data. The primary data was collected from 100 members of NHGs through a sample survey in Malappuram district of Kerala. A structured questionnaire was used for the collection of primary data. The secondary data was collected from the journals, books, reports, websites etc. For analyzing the collected data, the mathematical and statistical tools like percentage and average have been used. Analysis and Interpretation Overall Women Empowerment through NHGs The following table shows the overall empowerment that attained by members through the NHGs. Table.1 Overall Empowerment of Members Sources: Primary Data It reveals that, majority of the Neighbourhood Group members are empowered by the scheme NHGs (Kudumbashree Ayalkoottam). 56% are highly empowered by NHGs, 24% neither highly nor poorly empowered by the NHGs and only 20% are poorly empowered by the scheme NHGs. Personal Problems The following table shows the personal problems faced by the members of NHGs. Table.2 Personal Problems Sources: Primary Data This table indicate that 43% are facing the problem of delay in getting loans, 37% are feel the family responsibility as a burden for their work, 30% are facing lack of proper guidance for smooth functioning of NHGs, 20% are facing stress and strain while working in NHGs and seven percentage in decision making. From this analysis, we can conclude that majority of the members are facing problem of delay in getting loans and proper guidance. Financial Problems The following table shows the financial problems faced by NHGs members. Table.3 Financial Problems Sources: Primary Data The table 3 reveals the financial problems faced by NHG members. Among the 30 members, 67% are facing lack of income, 50% are facing lack of finance and 30% are facing delay in getting loans from the affiliated ADS/CDS. Only three percentage face resistance from banks and other financial institutions and 10% are facing the problem of proper utilization of funds. As per the table we can say that, even they are facing large number of problems but 100% NHGs are free from overdue debts. FINDINGS OF THE STUDY The key findings of the study are summarized here. From the analysis it is clear that 90 % of the NHGs members are housewives and only three percentages are Govt. employees. Seven percentages of members are engaged in other jobs along the membership in NHGs. Around 43 % of NHGs members are working in NHGs for a period of 2-5 years, 37% are above 5 years and only 13% are working for 6-12 months. It is interested to note that 57% of members are joined in NHG for taking loans to meet personal financial needs, and 40% are joined with the expectation that they can improve their standard of living by way of increasing income. Majority of the members are entered into the field only for taking loans. The level of satisfaction that attained by NHG members reveals that 74% are satisfied, 20% are neither satisfied nor dissatisfied, but only 6% are dissatisfied. Whole of the NHGs undertaking micro finance scheme. Apart from this, 40% NHGs are engaged in self employment schemes and other schemes for the welfare of the women, children, aged people, etc. The activities include Harithashree, Scholasrship for children, Balasabha, etc. These are undertaken mainly for imparting knowledge for their members. NHGs are exclusively for the benefit of women. The analysis reveals that 100% women members of NHGs are beneficiaries of their activities. They are not only undertaken for the welfare of women, but also for the welfare of general public, aged people, Children, etc. Majority of the members (90 %) opinioned that NHGs have a crucial role in women empowerment and only three percentages are fall under the category of low empowerment. Majority of the members (87%) have improvements in their standard of living as a result of reduction in poverty through NHGs. Family support is an integral part for empowering women. Majority of members (87%) get great support from their family to participate with NHG by way of financial services (69%), motivation (54%) and participation in decision making. Majority of the members (80%) have enough time to spend with their family even they are working in NHG. Unlike men, women have dual role in her family. Hence family responsibility may be a barrier for their efficient performance in NHGs. It shows that, 50% members never felt family responsibility as a burden for them. Majority of the members (60%) spend their income as they wish. It is interested to note that, they have freedom in spending their income without permission of their husbands, fathers or any other relatives. As a member in NHG, they got a prominent role in family decisions in the matters of food items, education of their children, medical treatments of their dependents, etc. Though the respondents are become a members of NHG for increasing income, only 16% have increased income through NHGs. Average 35% members believed that they got a family improvement through NHGs. At the same time, 33% believed that there is no family improvement. Above 50% members achieve personal improvement through NHG. NHG members got social improvement than any other improvements through NHGs (62%). Majority of NHGs succeeded in imparting knowledge and skills to their members. They can also acquire personal education through NHGs and their experiences in NHGs. Majority of them acquire banking habit through NHGs. Major problems faced by NHGs are lack of co-ordination (84%), lack of income (67%) and delay in getting loans from afflicted ADS/CDS (30%). Major problems faced by NHG members are lack of income for their valuable services for the economic development. They also feel lack of proper guidance (30%), training (10%), and information (10%). The level of empowerment attained by respondents through NHGs have crucial role in economic as well as social development, because the development is possible only when the women are empowered. Empowerment of women has been achieved to a great extend, through NHGs. Majority of members are attained personal improvements (85%) than any other improvements. They have acquired decision making power (77%), mobility (67%) and equality (63%) through Ayalkoottam. 100% members are attained ability to mingle with others and 86% attained mutual help and support through Ayalkoottam. Thus there have great improvements in the women in matters of their personal skills, social involvement, decision making power, etc through NHGs. SUGGESTIONS To enhance women empowerment through NHGs, it is suggested to undertake the following measures by the NHGs. For strengthen women, NHG should strengthen their overall working. Generally the members do not get any remuneration for their service. So they are not motivated to work with enthusiasm. Therefore the Government should provide adequate remuneration to them. NHGs provide service by categorizing BPL and APL families; it is not a rational measurement. Therefore the Government should identify the right beneficiaries. The Government should provide more funds for the welfare of the women through NHG. CONCLUSION Majority of the members in NHGs are highly empowered through the micro financing and loan facilities. It is clear that women are the ultimate beneficiaries of this scheme. But they still face a number of problems in this field like lack of family support, lack of income, lack of training and coordination etc. Among all improvements attained by women as a NHG member, social improvement is the most enlightened one. References J.A.Ruby, July (2008) â€Å"Micro Finance and Women Empowerment – A Study of Kudumbashree Project in Kerala†, Mahatma Gandhi University, Kottayam. Mayoux, L. (2000) â€Å"Microfinance and empowerment of women. A review of the key issues†, social finance unit, working paper, 23.Jeneva: ILO. Padmanabhan, PG. â€Å"A study of Ayalkoottam in a participatory planning and grass roots level democracy in Kumarakom panchayats and its scope of replication†,PP.72-74. John, Jacob. (90-97) â€Å"A study on Kudumbashree Project: A poverty eradication programme in Kerala†, PP. Raghavan, V P. â€Å"Social action, gender equality and empowerment: The case study of Kudumbashree Project in Kerala†, P.17 Sharma, Puspa Raj, (2007) â€Å"Microfinance and women empowerment†, The Journal of Nepalese Business Studies. Vol.4,No.1,PP.16-27, S. Sarumathi and Dr. K. Mohan, â€Å"Role of Micro Finance in Women’s Empowerment†, Journal of Management and Science, Vol. 1, No.1, Sep 2011, ISSN: 2249-1260, pp. 1-10. Ashe, J., and L. Parrott (2002) â€Å"PACT’s Women’s empowerment program in Nepal:A savings- and literacy-led alternative to financial building†, Journal of Microfinance 4(2): 137-162. Mushumbusi Paul Kato1, Jan Kratzer2 Feb. (2013) â€Å"Empowering Women through Microfinance: Evidence from Tanzania†, ACRN Journal of Entrepreneurship Perspectives, Vol. 2, Issue 1, p. 31-59, http://www.kudumbashree.org/?q=womenempower http://shodhganga.inflibnet.ac.in/handle/10603/7097 http://www.womenempowermentinindia.com/ http://en.wikipedia.org/wiki/Empowerment http://www.kerala.gov.in/kudumbashree-state-poverty-eradication-

My Educational Goals and Philosophy Statement Essay -- Philosophy Teac

My Educational Goals and Philosophy Statement 'The most important function of education at any level is to develop the personality of the individual and the significance of his life to himself and to others' -Grayson Kirk. The teaching philosophy of progressivism focuses on developing the whole child. This philosophy not only teaches the core subject material, but it also allows the teacher to help develop the person the child is going to be. John Dewey, founder of progressivism, denounced the scholarly and classical school of curriculum. Dewey thought children should not be taught what to think but how to think through a 'continuous reconstruction of experience.' This implies that children learn best when they do hands on activities, therefore, they are learning by doing. These hands on activities will also incorporate several of the multiple intelligences. The kinesthetic learners will be able to actually do the activity, visual learners get to see the activity being performed, and auditory learners get to hear the directions and steps as the teacher explains them. As a teacher, I intend to present many different activities to the classroom. I feel that is so important to incorporate as many learning styles as possible into each lesson. From my observation in my field experiences, a student that favors one learning style will perform better when that learning style is available for an activity. Hands-on activities also allow for the students to learn by relating what they are studying to the knowledge they have previously acquired. This perspective, know as constructivism, was based mostly on research performed by Swiss psychologist Jean Piaget. Children are not just em... ...g else out there that teachers can learn. New technology, for one, is something that develops each and every day. I feel that the addition of a special education classes as a requirement will further educate and prepare future educators who will continually be in contact with the special education students. As for me, I plan to take on any opportunity to excel in my teaching profession. I want to continue on in my Bachelor?s degree with a specialization in Math and move on to get my Master?s in administration. Education is a wonderful gift that is available to everyone who wants to take part. It is not only about the books and the teaching of the basics. Education is about developing the whole child. It will be my job to develop the child as a person, not just as a student. When I begin my teaching career, I will strive to develop every aspect of the child.

Puritans, Max Weber Essay

1.Explain: Puritans wanted to purify the Church of England. Puritans were people who wanted to get rid of things that were not stated by Jesus Christ or by the Bible. They rejected decisions and traditions established by the Church (i.e. people). Examples: paintings of God and Jesus, rich ornaments and dà ©cor, hierarchy in Church, selling pardons. They also thought that the temples should be smaller and not so monumental. Puritans’ beliefs were a threat to the hierarchy and wealth of the English Church, so they were persecuted and unwelcome in there. They had to look for a place they could live the way they wanted. 2.Describe the Puritans who set sail to America in 1620. Majority of Puritans who set sail to America on Mayflower in 1620 was well-educated and belonged to upper middle class (they were rather rich). Those people couldn’t worship God according to their beliefs because their religion was a threat to the Church of England. Puritans were constantly persecuted and they left to Netherlands, and then to Virginia in Noth America. Their trip resembled Exodus to the promised land. Puritans called themselves Pilgrims, because it was a pilgrimage to the new world where they hoped to be free and to establish the Church there. 3.The literary genres Puritans practiced and did not practice. 4.Explain the notion of predestination and how Puritans shaped they lives according to it. Puritans believed that they don’t have any influence on whether they will go to heaven or to hell. They believe that God knows it before they are born and they can do nothing about it. (There is a paradox of free-will -> although one may be a good person, he/she can still go to hell.) God may change his mind, but people cannot do anything. For Puritans, the fact that someone is rich and successful means that this person may be predestined, so they work even harder and look for success, hoping that maybe this would be a sign of their predestination. 5.What biblical events did the first Puritans in America draw parallels to? Puritans considered themselves to be like pilgrims to the Promised Land, like Jews running from Egypt to Israel. As they wanted to establish a Church they considered it to be a mission. 6.How did Max Weber compare Protestants and Catholics in terms of the notions of hard work and calling? According to Max Weber, Catholics believe that the hard work is their way to salvation. People have to work hard to be good people. Protestants, on the other hand, believe that they should work hard because it is their duty, as this is God’s will and it is useful for the whole country and society. For them it a kind of vocation. Every Protestant feels the vocation to work and to worship God (Everyone has his own mission in life – there have to be poor farmers and rich lawyers – this is God’s will and it is completely normal.) In case of Catholicism, only priests feel the vocation to serve God. 7.Explain how Max Weber analyzed in his discussion of Protestant ethics the notions of work, investment, charity, waste. Work– every Puritan has a vocation to work. It is a duty and God’s will. Work is useful for the whole society; thanks to work we make our community better. â€Å"Not leisure and enjoyment, but only activity serves to increase the glory of God, according to the definite manifestations of His will† Investment  Ã¢â‚¬â€œ If someone has money and is successful in business, it means that he is in God’s favor. Money should be multiplied not wasted and spent on unimportant things as luxuries and amusement. Charity– if someone needs charity it means that he is a beggar. If someone doesn’t work – he sins and offends God, as it is a duty to work. Supporting charity means supporting offending God. WASTE – waste of time is the worst and the deadliest sin. â€Å"Not leisure and enjoyment, but only activity serves to increase the glory of God, according to the definite manifestations of His will† – only hard work praises God an d any other activity is a waste. 8.What did a Puritan sermon look like (use in particular Sinners in the Hands of an Angry God). In the 18th and 19th centuries during the Great Awakening, major sermons were made at revivals, which were especially popular in the United States. These sermons were noted for their â€Å"fire-and-brimstone† message, typified by Jonathan Edwards’s famous â€Å"Sinners in the Hands of an Angry God† speech. In these sermons the wrath of God was clearly one to be afraid of, although fear was not the message Edwards was trying to convey in his sermons, he was simply trying to tell the people that they could be forgiven for their sins. It combines vivid imagery of Hell with observations of the world and citations of scripture.

Cardiovascular Diseases

Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and Cardiovascular Diseases Cardiovascular disease Introduction Heart disease is No. 1 killer disease worldwide. It causes 12 million deaths annually. Thanks to the rising health awareness and government programmes this number significantly reduce during last 30 years. Coronary heart disease and cardiovascular disease Cardiovascular diseases are diseases of the heart (cardiac muscle ) or blood vessels (vasculature).Cardiovascular disease (CVD) means all the diseases of the heart and circulation (blood vessels disease) including coronary heart disease (angina and heart attack) and stroke, as well as coronary and periphery blood vessels disease (problems with circulation). Diseases from this group are the biggest killer in Europe and USA, but developing and non-develop countries too. The final and most tragic consequence of different types of heart disease is heart attack with tragic consequences. Heart diseases are caused by atherosclerosis, a disease of arterial blood vessels resulted from atheroma i. . plaques accumulated (forming; sticking) on artery walls which makes the blood vessels nonelastic and narrowed and leads to decreased blood flow. For the atherosclerosis doctors very often use alternative name chronic cardiovascular disease. The opposite group acute heart disease made group of diseases which are dangerous for patients lives. Acute heart diseases include conditions or illnesses which usually have a rapid onset of symptoms and may resolve within days with or without treatment.A condition or illness that is sudden or severe. On the other hand a condition or illness that arises slowly over days or weeks and may or may not resolve with treatment made a group of chronic heart disease. Both of them are caused by atheroma and the most known are next: a) Acute heart disease Heart attack is caused by lack of O2 in heart muscle cells. Very often it is caused by rupture of â€Å"hard plaques† patches which result in blood clots and partially or completely block blood flow and ca use a heart attack.When a fiber cap becomes thin, these â€Å"hard plaques† can suddenly rupture, spilling their contents, resulting in blood clots that partially or completely block blood flow and cause a heart attack http://www. authorstream. com/Presentation/nitin-35423-heart-diseases-science-technology-ppt-powerpoint/ Cholesterol glossary. http://www. mybwmc. org/library/28/000225 Stroke Stroke is death of brain cells caused by obstructed blood flow to parts of the brain. Since the level of LDL cholesterol is main cause of narrowed of blood vessels, it is necessary control it. If not treated properly, high LDL cholesterol can cause a stroke.Cholesterol glossary. http://www. mybwmc. org/library/28/000225 b) Coronary heart disease Heart disease (coronary heart disease), When the plaque build up in th conorary arteries heart does not get sufficient blood, the condition is called coronary artery disease or coronary heart disease. Atherosclerosis is a disease of arterial blood vessels in which plaques form on artery walls. This is a consequence of different substances circulating in the bloodstream (inflammatory cells, proteins, cholesterol and calcium) sticking inside the vessel walls. Plaque patches influence on narrowing blood flow in the artery. ttp://www. bodybuilding. com/fun/gastelu5. htm Peripheral artery disease (reduced blood flow in the limbs, usually the legs Coronary plaque Coronary plaque is a term which use in practice as a synonym for atheroma or atherosclerosis. Patches of atheroma are formed from substances that circulate in the bloodstream. They consist of lipid, or fat, cores covered by collagen fiber caps which are sticking to the inside of the vessel walls. Over time plaque or patch of atheroma increases making an artery narrower and the blood flow through the artery is reducing.We can see the changes in blood vessels caused by plaque in the Figure 1. Figure 1 Artery with the patches of atheroma – plaque Preventing Cardiovasc ular Diseases. Patient. co. uk. emis < www. patient. co. uk/health/Preventing-Cardiovascular-Diseases. htm> (March 13, 2013) http://medicineworld. org/blogs/heart/blog/permalinks/Jan-2006/coronary-plaque-detection-by-molecular-imaging. html> (March 13, 2013) Mature plaques typically consist of two main components: soft, lipid-rich atheromatous â€Å"gruel† and hard, collagen-rich sclerotic tissue.Lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption. Researchers have found that many people who have heart attacks do not have arteries narrowed by plaque. Many heart attacks are now known to be caused by soft or vulnerable plaques, located on an inflamed part of an artery. This plaque can burst, leading to the formation of a blood clot that can cause a heart attack. The 2009 issue of â€Å"The American Journal Pathology† edited explanation of those relatio ns discovered by Olga Ovchinnikova and er colleagues. They found that inflammation results in the formation of soft (vulnerable) plaque which is filled with different cell types that promote blood clotting. This leads to a reduction of mature collagen, resulting in thinner caps that are more likely to rupture, even in the cases when total level of plaque isn’t extremely high. The authors advocate different viewpoints about relations between the plaque level and structure, i. e. its influence on heart attack. The first group claims that described types of blockages cause only about 30 percent of heart attacks.On the other hand, some sources state that more than two-thirds of acute coronary events result from rupture of coronary plaques. However problems that plaque creates are extremely dangerous for people’s life and it is very important to prevent and monitor its appearance and changes. Graphs of vulnerable plaque and rupture of plaque which causes a heart attack is p resented below. Figure 2 Vulnerable atherosclerotic plaques. Vulnerable atherosclerotic plaques. A. Atherosclerosis in a chronic disease that leads to plaque rupture and vascular occlusion. B.Cross-section of a lethal coronary plaque rupture. Adapted from Heistad D. Unstable coronary-artery plaques. N Engl J Med. 2003. Atherosclerosis Modeling In-vitro. http://www. remedi. uzh. ch/research/disease. html Figure 3 Plaque Rupture and Heart attack http://hon. nucleusinc. com/generateexhibit. php? ID=30468&A=1027 Factors influencing plaque growth and stability Based on everything mentioned above and medical experience the conclusion about relations between heart attack and other cardiovascular disease and the level of plaque increasing are found.The higher the level of plaque the higher risk of heart disease will be. The level of plaque will increase as the result of high level of cholesterol, type LDL, so called â€Å"bad cholesterol† in blood. When the level of LDL is normal, bl ood can pass in and out of the blood vessels without problems, but if it significantly increase particles of the blood will accumulate and sooner or later provoke trigger (cause) heart attack. Other very important factors influencing plaque level increasing are high blood pressure and cigarette smoking.Both factors accelerate the plaque formation changing (damaging) artery walls and even more, helping cholesterol forming. Medical experience proved that plaque composition and vulnerability (hard or soft plaque) is more responsible for the conversion of a stable disease to a life-threatening condition than the plaque size. Except the plaque vulnerability the risk of plaque disruption is are consequence of rupture triggers (extrinsic forces). Soft plaque – lipid-rich one is more dangerous because of its instability and higher probability for rupture.Even (IAKO) Although â€Å"hard plaque† that one having higher level of calcium influence on the blood vessels walls and the ir â€Å"hardness† experience show that heart attacks are mostly caused by soft plaque disruption. Figure 4 Plaque rupture and its consequences in the form of heart diseases http://www. nature. com/nrg/journal/v7/n3/fig_tab/nrg1805_F2. html Risk factors of coronary heart disease Risk factors influencing cardiovascular disease we can group based on their stability into the three groups: a) Modifiable risk factorsIn this group hypertension is the most dangerous risk factor for heart attacks, but even more for stroke. It is forming as the result of abnormal blood lipid levels which means high total cholesterol, high levels of triglycerides and high levels of low-density lipoprotein or low levels of high-density lipoprotein (HDL). Smoking, physical inactivity, Type 2 diabetes, and a diet full with saturated fats are risk factors strongly influencing the heart disease. All of them are treatable and patients (individuals) belonging into the different types of risk customersâ€℠¢ groups should avoid practice them. b) Non-modifiable risk factorsThe factors from this group mostly are constant, like the case in gender or family history. Others are changing when time is passing, like age and lifestyle and personal habits. Older people have more chance to get heart attack and the man, especially those having â€Å"bad medical history†. Ration between man and woman are changing when women past the menopause. After that the level of risk is similar as the men’s one. As I’ve presented there is direct correlation between cardiovascular disease and condition and health of blood vessels, more precisely of developing atheroma, means level and structure of plaque in vessels.On the other development of plaque and its level is directly influenced by level of cholesterol and some other elements which are connected with individual person and his/her life and genetic predispositions. As with the other diseases everybody has some risk of developing ather oma, but some risk factors increase the risk level for several categories. Those risk factors include: fn 12 †¢Fixed risk factors – factors that person cannot change: oA strong family history which means close relatives who developed heart disease or a stroke before they were 55 (for males) or 65 (for female). Severe baldness in men at the top of the head. oAn early menopause in women. oAge. Older people have more risk to develop atheroma. oEthnic group. Medical data show that people from different ethnic group have different risk for heart diseases. †¢Treatable or partly treatable risk factors include different health problems caused basically by the same causes as the: oHypertension (high blood pressure). oHigh cholesterol blood level. oHigh triglyceride (fat) blood level. oDiabetes. oKidney diseases causing diminished kidney function. All factors from this group have to be controlled and monitor.Any kind of their complication probably will trigger more serious pr oblems such as heart attack or stroke. †¢Lifestyle risk factors that can be prevented or changed. Actually these factors PRETHODE precede to those belonging to the second group. Except the genetic factors way of life and daily habits are the more responsible for different kind of heart diseases. Those factors are: oSmoking (Smoking cigarette increase blood pressure, decrease HDL; damages arteries and blood cells and increases heart attacks. Passive smoking is also a risk factor for cardiovascular disease ) oLack of physical activity. Obesity (People who are overweight (10-30% more than their normal body weight) have 2 to 6 times the risk of developing heart disease. ) oAn unhealthy diet and eating too much salt. oExcess alcohol. Looking on those three groups one can easily conclude that people with â€Å"bad predisposition† having high fixed risk factors have to think about their lifestyle risk factors even more, in order to try to decrease the second group of factors (t reatable or partly treatable risk factors). On the other hand some of risks are more dangerous than the others; for example smoking increases risk for heart disease more than obesity.And of course combination of two or more risk factors increases significantly the level of risks; older man (or woman) who smokes, without physical activity and with bad eating habits has more chance to get some of previously explained disease than the one who have â€Å"just one of bad habits†. The more risk factors someone has the greater is the likelihood that he/she will develop cardiovascular disease, unless taking action to modify his/her risk factors and working to prevent them compromising his/her heart health.That doesn’t mean that people with â€Å"good genes† can be irresponsible and ZANEMARITI risk factors from other groups. With or without genetic predisposition modern life significantly increases a risk of heart disease for everybody. Hormones impact on lipids and othe r risk factors Different numbers of man and women died from heart attack initiated a lot of research about hormones' influence on the risk factor and heart disease development. Number of men died from the heart attack outnumbered the number of women in pre-menopause period, but in the post-menopause data show completely opposite situation.A percentage of women in post-menopause having heart disease and dying from heart attack increase dramatically and now outnumbered the men. The main reasons for those changes are connected to the level of hormones and their influence on level and structure of cholesterol and consequently on risk factors and heart disease. As mentioned before total cholesterol actually is made of two different types of cholesterol: LDL – low density lipoprotein (LDL), so called bad cholesterol and high density lipoprotein (HDL).High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol redu ces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. http://www. walgreens. com/marketing/library/careguides/careguide. jsp? docid=000225=28=High%20Cholesterol Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.But after menopause (natural or surgical) when a level of estrogen significantly decreases total cholesterol rises, low density lipoprotein (LDL) cholesterol rises, and high density lipoprotein (HDL) cholesterol does not change or decreases slightly. This is the reason why negative hormones’ effect after menopause increasing more than proportionally. Some authors argue that even influence of estrogen on LDL and HDL level is proved it is yet unclear whether increase in risk is caused, at least partially, by increased level of androgen (the other of hormones belong to steroid as estrogen too), which is characteristics of menopause too. This sexual dimorphism means a lower incidence in atherosclerotic diseases in premenopausal women, which subsequently rises in postmenopausal women to eventually equal that of men. These observations point towards estrogen and progesterone playing a lifetime protective role against CAD in women. As exogenous estrogen and estrogen plus progesterone preparations produce significant reductions in low-density lipoprotein (LDL) cholesterol levels and significant increases in high-density lipoprotein (HDL) cholesterol, this should in theory lower the risk of CAD.UKLOPITI U ONO GORE Among estrogen's positive effects on the heart are: †¢Reducing the LDL (â€Å"bad†) cholesterol in the blood. †¢Increasing the HDL (â€Å"good†) cholesterol in the blood. †¢Helping to keep blood vessels open. †¢Lowering blood pressure at night. †¢Reducing blood viscosity (how sticky the blood is), a property that may cause blood clots which could result in a heart attack o r stroke. Estrogen's effects on clotting are complicated, however, since there also is an increased risk for thromboembolism (a blood clot that blocks a vessel) in women taking estrogen. Possibly enhancing fibrinolysis, which is the body's natural process for breaking down blood clots. Read more: http://ehealthmd. com/content/what-are-benefits-hrt#ixzz2NbWR3MxY http://ehealthmd. com/content/what-are-benefits-hrt#axzz2NbW1GJJN Nutrition guidelines As presented before three different groups of risk factor exist. Some of them people can change but the other are fixed, non-changeable because they caused by genetic heritage ( ) influences. Controllable factors are connected to the lifestyle of person.Lifestyle changes can prevent or slow the development of coronary plaque and heart disease. In order to prevent a disease development one have to keep track of his/her blood pressure and cholesterol levels. Choosing a heart-healthy diet is vital in controlling weight, which helps keep blood pressure and cholesterol levels down. Foods high in cholesterol and saturated fat should be avoided, and quitting smoking is imperative. Regular exercise and an increased overall activity level contribute to heart health and help reduce stress.The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All people, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. e. 150 mins/week minimum). Currently practiced measures to prevent cardiovascular disease include: †¢A low-fat, high-fiber diet including whole grains and plenty of fresh fruit and vegetables (at least five portions a d ay)[29][30] †¢Tobacco cessation and avoidance of second-hand smoke;[29] †¢Limit alcohol consumption to the recommended daily limits;[29] consumption of 1-2 standard alcoholic drinks per day may reduce risk by 30%[31][32] However excessive alcohol intake increases the risk of cardiovascular disease. [33] †¢Lower blood pressures, if elevated, through the use of antihypertensive medications[citation needed]; †¢Decrease body fat (BMI) if overweight or obese;[34] Increase daily activity to 30 minutes of vigorous exercise per day at least five times per week;[29] †¢Decrease psychosocial stress. [35] Stress however plays a relatively minor role in hypertension. [36] Specific relaxation therapies are not supported by the evidence. [37] Routine counselling of adults to advise them to improve their diet and increase their physical activity has not been found to significantly alter behaviour, and thus is not recommended. [38] http://www. news-medical. net/health/What-i s-Cardiovascular-Disease. aspx http://www. barnesandnoble. om/w/prevent-halt-and-reverse-heart-disease-joseph-piscatella/1100260037 Primary and secondary prevention of heart disease It is necessary start with prevention from heart disease as early as possible. Changes in the number of people killed by heart attack in developed countries show that prevention and awareness about this group of disease help to http://circ. ahajournals. org/content/123/20/2274/F2. expansion. html health plans must continue to drive cardiovascular care further along the continuum toward primary prevention of cardiovascular disease (CVD).CVD risk factors should be managed not only after a coronary event has occurred, but also before the onset of such and event. Ideally, health lifestyles should be promoted with all patients so that risk factors for CVD never develop. In this way, CVD care can be moved from the inpatient setting to the outpatient setting. Sidney C. Smith Jr, MD. Focus on Cardiovascular Dise ase; A Word About the Quality of Care in Cardiovascular Disease. Director, Center for Cardiovascular Science and Medicine University of North Carolina at Chapel Hill. http://www. qualityprofiles. rg/leadership_series/cardiovascular_disease/cardiovascular_introduction. asp Key priorities for implementation Primary prevention of CVD †¢For the primary prevention of CVD in primary care, a systematic strategy should be used to identify people aged 40–74 who are likely to be at high risk †¢People should be prioritised on the basis of an estimate of their CVD risk before a full formal risk assessment. Their CVD risk should be estimated using CVD risk factors already recorded in primary care electronic medical records †¢Risk equations should be used to assess CVD risk People should be offered information about their absolute risk of CVD and about the absolute benefits and harms of an intervention over a 10-year period. This information should be in a form that: opresen ts individualised risk and benefit scenarios opresents the absolute risk of events numerically ouses appropriate diagrams and text (See www. npci. org. uk) †¢Before offering lipid modification therapy for primary prevention, all other modifiable CVD risk factors should be considered and their management optimised if possible.Baseline blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated. Assessment should include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) thyroid-stimulating hormone (TSH) if dyslipidaemia is present †¢Statin therapy is recommended as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. This level of risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available or appropriate (for example, older people, people with diabetes or people in high-risk ethnic groups) †¢Treatment for the primary prevention of CVD should be initiated with simvastatin 40 mg.If there are potential drug interactions, or simvastatin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen. Secondary prevention of CVD †¢For secondary prevention, lipid modification therapy should be offered and should not be delayed by management of modifiable risk factors. Blood tests and clinical assessment should be performed, and comorbidities and secondary causes of dyslipidaemia should be treated.Assessment sho uld include: osmoking status oalcohol consumption oblood pressure (see ‘Hypertension’, NICE clinical guideline 34) obody mass index or other measure of obesity (see ‘Obesity’, NICE clinical guideline 43) ofasting total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides (if fasting levels are not already available) ofasting blood glucose orenal function oliver function (transaminases) othyroid-stimulating hormone (TSH) if dyslipidaemia is present. Statin therapy is recommended for adults with clinical evidence of CVD †¢People with acute coronary syndrome should be treated with a higher intensity statin. Any decision to offer a higher intensity statin should take into account the patient’s informed preference, comorbidities, multiple drug therapy, and the benefits and risks of treatment †¢Treatment for the secondary prevention of CVD should be initiated with simvastatin 40 mg. If there are potential drug interactions, or simvasta tin 40 mg is contraindicated, a lower dose or alternative preparation such as pravastatin ay be chosen †¢In people taking statins for secondary prevention, consider increasing to simvastatin 80 mg or a drug of similar efficacy and acquisition cost if a total cholesterol of less than 4 mmol/litre or an LDL cholesterol of less than 2 mmol/litre is not attained. Any decision to offer a higher intensity statin should take into account informed preference, comorbidities, multiple drug therapy, and the benefit and risks of treatment http://www. eguidelines. co. uk/eguidelinesmain/guidelines/summaries/cardiovascular/nice_lipid_modification. phpHow to lower the risk of cardiovascular disease The risk of cardiovascular disease is possible to reduce following recommendation for lifestyle changing: Cessation of smoking and avoidance of second-hand smoke. Nutrition should ensure a healthy diet wiht total diet no more than 8% of saturated + trans fatty acids of total energy intake. All peop le, especially ones with high risk factors should lower alcohol consumption As the prevention physical activities are recommended – at least 30 minutes of moderate intensity physical activity per day or three days week (i. . 150 mins/week minimum). Cessation of smoking The aim of this measure is complete cessation of smoking and avoidance of second-hand smoke. Patient and their families need to stop smoking. Those who are unable to quit may need professional help in form of counselling, behavioral therapy and even pharmacological therapy. Nicotine replacement therapy (NRT) is the first line choice of medication. Nutrition The aim of this measure is to ensure a healthy diet. Total diet should have no more than 8% (of total energy intake) of saturated + trans fatty acids.All patients are advised to take approximately 1g Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA) and more than 2g Alpha Linolenic Acid (ALA) daily. Diet should have vegetables, fruits and legumes, g rain-based foods, moderate amounts of lean meats, poultry, fish and reduced fat dairy products. EPA and DHA can be obtained from oily fish and marine n-3 (fish oil) capsule supplements. Alcohol consumption All patients should be advised to lower alcohol consumption. Men should drink no more than 2 standard drinks per day and women no more than 1 standard drink per day. Physical activityThe aim of this measure is to raise physical activity and exercise to the recommended goal of at least 30 minutes of moderate intensity physical activity on most, if not all, days of the week (i. e. 150 mins/week minimum). Maintaining a healthy body weight The aim should be to achieve a waist measure of less than or equal to 94 cm in men and less than or equal to 80 cm in women. The body mass index (BMI) should be maintained at 18. 5–24. 9 kg/m2 Lowering blood cholesterol The aim of therapy should be to maintain blood cholesterol at: †¢Low density lipoprotein (LDL) at – less than 2. mmol/L †¢HDL – more than 1. 0 mmol/L †¢Triglyceride (TG) less than 1. 5 mmol/L The blood cholesterol can be maintained with the use of pharmacotherapy. Statins are commonly used lipid lowering drugs. Those with diabetes and atherosclerosis need stringent blood cholesterol control as well. Other lipid lowering drugs include fibrates like gemfibrosil, clofibrates etc, Ezetimiber and niacin. Lowering blood pressure High blood pressure is one of the important risk factors for cardiovascular disease. Those with coronary heart disease, diabetes, kidney disease or stroke need tight blood pressure control.The aim should be a blood pressure of less than 130/80 mm of Hg. Diabetes and blood sugar control Those diagnosed with diabetes need stringent blood sugar control to prevent cardiovascular damage. HbA1c levels should be maintained at less than 7%. Other drugs to lower risk of cardiovascular disease Other drugs used to lower risk of cardiovascular diseases include: †¢ Antiplatelet agents – this includes Aspirin and Clopidogrel. These drugs when given to patients with risk of heart attacks may prevent such attacks and events. †¢ACE inhibitors like Enalapril, Captopril, Lsinopril and