Download Cardiovascular Disease

Nutrition and
Cardiovascular Disease
Cardiovascular Disease
Includes heart attack, stroke
 Leading cause of death in the U.S.
 Annually, 500,000 people die of
CHD in the U.S. (1 million
including strokes and other CVD)
 Each year, 1.5 million Americans
have a heart attack
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CVD Deaths by State
Cardiovascular Disease
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Symptoms take years to develop
Plaque build-up can begin in childhood
Myocardial infarction (heart attack)
Cerebrovascular accident (stroke)
Pathophysiology of
Atherosclerosis
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Vessel lining is injured (often at branch
points) →
Plaque is deposited to repair injured
area →
Plaque thickens, incorporating
cholesterol, protein, muscle cells, and
calcium (rate depends partly on level
of LDL-C in the blood) →
Pathophysiology of
Atherosclerosis (cont)
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Arteries harden and narrow as plaque
builds, making them less elastic →
Increasing pressure causes further
damage →
A clot or spasm closes the opening,
causing a heart attack
Heart Attack (Myocardial
Infarction)
Heart Attack (Myocardial
Infarction)
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When blood supply to the heart is
disrupted, the heart is damaged
May cause the heart to beat irregularly
or stop altogether
25% of people do not survive their
first heart attack
Symptoms of a Heart
Attack
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Intense, prolonged chest pain or
pressure
Shortness of breath
Sweating
Nausea and vomiting (especially
women)
Dizziness (especially women)
Weakness
Jaw, neck and shoulder pain
(especially women)
Irregular heartbeat
Factors that May Bring On a
Heart Attack in At-Risk Persons
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Dehydration
Emotional stress
Strenuous physical activity when not
physically fit
Waking during the night or getting up
in the morning
Eating a large, high-fat meal
(increases risk of clotting)
Cerebrovascular Accident
(CVA) or Brain Attack
Brain Attack (Stroke) or
Cerebrovascular Accident
Symptoms of Stroke
(Brain Attack)
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Sudden numbness or weakness of the face,
arm or leg, especially on one side of the
body
Sudden confusion, trouble speaking or
understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of
balance or coordination
Sudden severe headache
Blood Lipid Levels are
Related to Risk of CVD
Blood Lipids
(Lipoproteins)
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Lipids (fat) cannot mix with water
Blood is high in water
Lipids cannot travel in blood without
help
Lipoproteins are formed to carry lipids
Lipoproteins combine
Lipids (triglycerides,
cholesterol)
 Protein
 Phospholipids
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Low-Density Lipoproteins
(LDL-C)
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Also called “bad cholesterol)
Contain relatively large amounts of fat,
and less protein
Deposits cholesterol in arteries
Thus, ↑ LDL-C is associated with ↑
CVD risk
Serum LDL-C should be < 130 mg/dL
High-Density Lipoproteins
(HDL)
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Also called “good cholesterol”
Relatively high in protein, lower in lipid
Acts as scavenger, carrying cholesterol from
arteries to liver
– Liver packages as bile
– Excretes
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↑ HDL-C is associated with ↓ risk of CVD
Serum HDL-C should be >60 mg/dL
(optimal) or at least >40 in men and 50 in
women
Triglycerides
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The most diet-responsive blood
lipid
Should be ≤150 mg/dL in fasting
state
Triglycerides
Lower blood triglycerides by:
 Not overeating
 Limiting alcohol and simple sugars
 Spreading meals throughout the day
 Including fatty fish in the diet
 Controlling diabetes if present
 Performing regular physical activity
 Not smoking
Total Cholesterol
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Includes HDL-C, LDL-C, and a fraction
of the triglycerides
Total cholesterol should be ≤ 200
mg/dL
Total cholesterol does not tell whole
story
Lipoprotein Summary
Evaluating Blood Lipids:
LDL
<100 mg/dL
Optimal
100-129
Near optimal
130-159
Borderline high
160-189
High
≥190
Very high
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Evaluating Blood Lipids:
Total Cholesterol
<200 mg/dL
Desirable
200-239 mg/dL Borderline high
≥240 mg/dL
High
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Evaluating Blood Lipids:
HDL
< 40 mg/dL
Low
≥ 60 mg/dL
High
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Blood Pressure
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Measured in mmHg
Systolic blood pressure: the pressure
in the arterial blood vessels associated
with the pumping of the heart
Diastolic blood pressure: the pressure
in the arterial blood vessels when the
heart is between beats
Hypertension: Either
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Systolic blood pressure > 140 mmHg
Diastolic blood pressure > 90 mmHg
Risk Factors (other than
LDL) for CVD
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Cigarette smoking
Hypertension (BP ≥140/90 mmHg or on
anti-hypertensive tx
Low HDL-C* (<40 mg/dL)
Family history of premature CHD in first
degree relative (in male <55 years, in
female <65 years)
Age (men ≥45 years, women ≥55 years)
*HDL-C ≥ 60 mg/dL counts as a negative risk factor
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Risk Factors (other than
LDL) for CVD
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Diabetes (considered equivalent to a
history of CHD)
Obesity
Inactivity
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Screening for CVD Risk
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Everyone 20 and older should have his
cholesterol measured at least every 5
years
Lipoprotein profile: includes TC, LDL-C
HDL-C, and TG
At least should include TC and HDL-C
If TC> 200 mg/dL or HDL-C< 40
mg/dL, obtain full lipid profile
Source: National Cholesterol Education Program, National Institutes of
Health, accessed 2-05
Total Cholesterol
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John and Marty
each have total
cholesterol levels of
200 mg/dL.
Their health risk is
different
Total Cholesterol is Not
Enough
John’s Lipid Profile
 TC: 200 mg/dL
 LDL-C: 140 mg/dL
 HDL-C: 30 mg/dL
 TG: 150 mg/dL
Marty’s Lipid Profile
 TC: 200 mg/dl
 LDL-C: 95 mg/dL
 HDL-C: 75 mg/dL
 TG: 150 mg/dL
What Affects Cholesterol
Levels?
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Diet
Weight
Physical activity
Age and gender
Heredity
You control the first three!
Lowering LDLs
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See your doctor to assess for other
conditions
Reduce dietary saturated fat, trans
fatty acids, and cholesterol
Increase MUFA and PUFA
Increase dietary fiber (soluble)
Lowering Blood TG
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Is the most diet-responsive blood lipid
Avoid overeating
Limit alcohol
Limit simple sugars
Small frequent meals
Include fish in the diet
Raise the HDL
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Physical activity
At least 45 min./day, 4 days a week
Avoid smoking
Eat regularly
Eat less total fat
Moderate intake of alcohol increases
HDL
Therapeutic Lifestyle
Changes (TLC)
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TLC Diet
Physical activity (30 minutes on most,
if not all, days)
Weight management: will help
manage triglycerides, increase HDL,
Diet Strategies for
Reducing the Risk
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Eat less saturated fat & trans fats
Replace with MUFA and essential fatty
acids
Eat fish 2x a week
Eat plenty of fruits and vegetables
Eat more whole grains and less refined
CHO
Eat at least 3 meals regularly
TLC Diet
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Low in saturated fat (<7% of calories)
and cholesterol (<200 mg/day)
Enough calories to maintain a
desirable weight
High in soluble fiber
Plant stanols or sterols, if needed
Other Recommendations
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Fat intake can be higher as long as
saturated and trans fatty acid are
minimal
Eat diet with plenty of fruits and
vegetables
Cut down on red meats
Cut down on simple sugars and
refined CHO
TLC: Healthy Cooking
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Bake, steam, roast, broil, stew or boil
instead of frying
Remove poultry skin before eating
Use a nonstick pan with cooking oil
spray or small amount of liquid
vegetable oil instead of lard, butter,
shortening, other solid fats
Trim visible fat before you cook meats
Chill meat and poultry broth until fat
becomes solid, remove
TLC: Healthy Shopping
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Choose chicken breast or drumstick
instead of wing and thigh
Select skim milk or 1 percent instead
of 2 percent or whole milk
Buy lean cuts of meat such as round,
sirloin, and loin
Buy more vegetables, fruits and grains
Read nutrition labels on food packages
TLC: Dining Out
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Choose restaurants that have lowfat
options available
Ask that sauces, gravies, and salad
dressings be served on the side
Control portions by asking for an
appetizer serving or sharing with a
friend
TLC: Dining Out
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At fast food restaurants, go for salads,
grilled (not fried or breaded) skinless
chicken sandwiches, regular-sized
hamburgers, or roast beef sandwiches
Avoid regular salad dressings and fatty
sauces. Limit jumbo or deluxe burgers,
sandwiches, french fries, and other foods.
Other Dietary Interventions
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Cholestin (from Chinese red yeast) reduces
cholesterol
Plant Stanols/Sterol Esters
– Benecol and Take Control margarine
– Cholesterol-lowering effects
– Decrease absorption of cholesterol and lowers
amount returning via enterohepatic circulation.
– Liver takes up more cholesterol from the blood
Omega-3 Fatty Acids
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Reduces inflammation, blood clotting
Sources
– Fatty fish (salmon, tuna) twice a week
– Canola and soybean oil
– Flaxseed, walnuts
– Fish oil supplements (expensive and may
contain heavy metals)
Phytochemicals
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↓ inflammation
↓ blood clotting
Include anthocyanins (found in red and blue
fruits such as raspberries and blueberries
and vegetables) lutein (green leafy
vegetables) lycopene (tomato products),
phenolics (citrus fruits, fruit juices, cereals,
legumes, and oilseeds)
Drug Treatment
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Statins: (e.g. Lovastatin, Pravastatin)
lower LDL-C
Bile acid sequestrants: lower LDL-C,
can be used with statins
Nicotinic acid: lowers LDL-C and
triglycerides and raises HDL-C
Fibric acids: used mainly to lower
triglycerides and raise HDL-C
Prevention and Management of
Hypertension
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Maintain a healthy weight.
Be physically active.
Follow a healthy eating plan.
Eat foods with less sodium (salt).
Drink alcohol only in moderation.
Take prescribed drugs as directed.
NHLBI Patient Guidelines, accessed 2-05
DASH: Dietary Approaches
to Stop Hypertension
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Eat foods that are low in fat, saturated
fat, and cholesterol
Eat more fruits, vegetables, whole
grains, and lowfat dairy products
Eat more poultry, fish, nuts, and
legumes
Eat less red meat, fats, sweets, and
sugared beverages
Eat foods low in salt and sodium
NHLBI. DASH Eating Plan, revised 2003. Accessed 2-2005