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Chapter 21 Nutrition & Disorders of the Heart & Blood Vessels © 2007 Thomson - Wadsworth CVD Deaths in the U.S. © 2007 Thomson - Wadsworth Athrosclerosis • Artery walls become progressively thickened due to accumulation of plaque • Occurs due to minimal but chronic injuries that damage the inner arterial wall © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Consequences • Lumen narrows • Plaque can rupture, forming a clot (thrombus) • Thrombus can break free & shut off blood flow (embolism) • Ischemia occurs within the tissue Coronary arteries (angina pectoris & heart attack) Brain (stroke) • Aneurysm (saclike distention of blood vessel wall) © 2007 Thomson - Wadsworth Causes of Athrosclerosis • Inflammation & infection • Hypertension • Smoking • Diabetes mellitus • Aging • Elevated LDL & VLDL © 2007 Thomson - Wadsworth Coronary Heart Disease • Most common type • Leading cause of death in U.S. • Evaluating Risk Smoking High LDL High blood pressure Diabetes Obesity Inactivity • Non-modifiable risk factors Age Male gender Family history © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Lifestyle Changes for CHD • Cholesterol-lowering diet (<200 mg) • Weight reduction • Regular physical activity • Decrease saturated fat <7% total kcalories • Decrease total fat 25-35% of kcalories • Decrease trans fat • Increase soluble fiber • Plant sterols & stanols • Eat soy products • Increase fish & omega-3 fatty acids • Moderate alcohol © 2007 Thomson - Wadsworth Lifestyle Changes for Hypertriglyceridemia • Mild • Severe Weight reduction Physical activity Quit smoking Avoid high-CHO diet Restrict alcohol Weight reduction Physical activity Very-low-fat diet: <15% of kcalories Medication © 2007 Thomson - Wadsworth Vitamin Supplementation • No conclusive research results have been obtained for vitamins being preventative for CVD • Study is underway for increasing: Folate, vitamin B6 & B12 to decrease homocysteine levels Vitamin C and E for antioxidant effects © 2007 Thomson - Wadsworth Drug Therapies for CHD Prevention • Statins Reduce cholesterol synthesis in the liver • Bile acid sequestrants Reduce cholesterol & bile absorption in small intestine • Nicotinic acid • Anticoagulants & aspirin Suppress blood clotting • Blood pressure medications • Nitroglycerin for angina Lowers triglycerides & raises HDLs © 2007 Thomson - Wadsworth Treatment for Heart Attack • Drug therapy Thrombolytics Anticoagulants Aspirin Painkillers Blood pressure medications Rhythm stabilizers • No food until stable Soft foods Low sodium Low saturated fat • Cardiac rehabilitation © 2007 Thomson - Wadsworth Hypertension • Desirable BP • Affects 1/3 of adults < 120/80 in U.S. • Prehypertension • Factors influencing BP Cardiac output Peripheral resistance Secretion of hormones by kidneys 120-139/80-89 • Hypertension > 140/90 © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Contributing Factors • Salt sensitivity • Aging • Genetics 30-50% of cases More prevalent in African Americans • Obesity Alters kidney function & promotes fluid retention • Alcohol 3-4 drinks daily • Diet Fruits, vegetables, nuts, low-fat milk can lower BP Potassium, calcium, & magnesium can lower BP © 2007 Thomson - Wadsworth Treatment of Hypertension • Weight reduction • Low-sodium diet • Diet rich in potassium, calcium, & magnesium • Regular physical activity • Moderate alcohol • DASH Diet - Limits: Red meats Sweets Sugar-containing beverages Saturated fat to <7% Cholesterol to 150 mg/day • Drug therapy © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Congestive Heart Failure • Heart’s inability to • Consequences pump adequate Fluid accumulation in liver, abdomen, & lower blood extremities • Fluids build up in Chest pain; swelling veins & tissues legs, ankles, feet; SOB • Heart enlarges Impaired liver & kidneys • 75% are 65 or Heart failure older Cardiac cachexia © 2007 Thomson - Wadsworth © 2007 Thomson - Wadsworth Medical Management • • • • Sodium & fluid restrictions Diuretics Small, frequent meals Vaccinations for influenza & pneumonia • Adequate fiber • Avoid alcohol • Liquid supplements, tube feedings, parenteral support © 2007 Thomson - Wadsworth Stroke • 3rd leading cause of death • Types • Prevention Recognize risk factors Lifestyle changes Ischemic • Management Hemorrhagic Thrombolytic drugs Transient ischemic Maintain nutrition status attacks (TIAs) Problems • Lack of coordination • Difficulty swallowing © 2007 Thomson - Wadsworth
