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Fat-Controlled, Mineral-Modified Diets for Cardiovascular Diseases. Chapter 22. Cardiovascular Disease. General term describing diseases of the heart & blood vessels Global issue Accounts for approximately 37% of deaths in U.S. & 29% worldwide Leading cause of death in Europe - PowerPoint PPT Presentation
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Nutrition & Diet Therapy (7th Edition)
Fat-Controlled, Mineral-Modified Diets for Cardiovascular
Diseases
Chapter 22
Nutrition & Diet Therapy (7th Edition)
Cardiovascular Disease
• General term describing diseases of the heart & blood vessels
• Global issue– Accounts for approximately 37% of
deaths in U.S. & 29% worldwide– Leading cause of death in Europe– More women die from CVD than men
every year
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
I. Atherosclerosis
• Accumulation of fatty deposits, smooth muscle cells & fibrous connective tissue—forming plaque, on the inner walls of the arteries
• Leads to progressive thickening of arterial walls
• Eventually narrows lumen of artery, interfering with blood flow
• Affects almost any organ or tissue in the body—resulting in many consequences
Nutrition & Diet Therapy (7th Edition)
Atherosclerosis• Consequences
– Thrombosis: formation of blood clot within the artery; enlarges over time, causing obstruction in blood flow
– Embolus: a portion of blood clot that breaks free & travels through circulatory system; eventually lodges in smaller vessel & interrupts blood flow, causing sudden tissue death
– Ischemia: lack of blood supply within tissues, due to obstruction of blood flow through arteries; major complication caused by atherosclerosis
– Aneurysm: abnormal enlargement or bulging of blood vessel wall; vessel weakens & is prone to rupture, causing massive bleeding & death
Nutrition & Diet Therapy (7th Edition)
Atherosclerosis
• Causes– Begins to develop as early as childhood &
adolescence; progresses before onset of symptoms
– Inflammation & infection– Hypertension– Smoking– Elevated LDL & VLDL– Diabetes mellitus– Aging
Nutrition & Diet Therapy (7th Edition)
II. Coronary Heart Disease
• Most common type of cardiovascular disease; leading cause of death in U.S.
• Usually caused by atherosclerosis in large & medium-sized arteries that supply heart muscle with oxygen & nutrients
• Evaluating risk– Prevention usually begins by reducing risk– Classic risk factors
• Smoking• High LDL cholesterol• High blood pressure• Diabetes
– CHD risk assessment-lipid profile at 20 yrs & every 5 yrs
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Therapeutic Lifestyle Changes (TLC) for lowering CHD risk (p. 607-611)– Approach to risk reduction promoted by National
Cholesterol Education Program• Cholesterol-lowering diet• Weight reduction• Regular physical activity
– Substantial progress may be seen after 6 weeks if followed carefully
– Individuals with high risk of CHD should try to lower LDL cholesterol with at least 3-month trial of TLC before starting drug therapy
– When high LDL levels persist despite adherence to a TLC program, drug therapy may be only effective treatment
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Dietary strategies– Reduce saturated fat in
diet; control overall fat & cholesterol
– Increase carbohydrates from whole grains, legumes, fruits & vegetables
– Avoid foods with trans fatty acids
– Select foods high in soluble fiber
– Limit sodium intake to 2400 mg per day
– Consume fish & omega-3 fatty acids on regular basis
– Use alcohol in moderation
• Lifestyle choices– Increase physical activity to
at least 30 minutes of moderate intensity most days of week (4/7d.)
– Smoking cessation; limit exposure to any form of tobacco
• Weight reduction– May improve other risk
factors– General goal: prevent weight
gain, reduce body weight & maintain lower body weight
– Initial goal: lose no more than 10% of original body weight
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Lifestyle changes for hypertriglyceridemia
– Elevated blood triglycerides– Common in people with diabetes mellitus &
metabolic syndrome– Can result in serious complications (fatty
deposits in liver & pancreatitis)– Diet & lifestyle may contribute to mild
hypertriglyceridemia– Genetic factors are usually responsible for
severe cases (“high” & “very high” levels)
Blood TriglyceridesBorderline high: 150-199 mg/dL
High: ≥200 mg/dL
Nutrition & Diet Therapy (7th Edition)
Coronary Heart DiseaseMild hypertriglyceridemia– Dietary & lifestyle changes
can improve– Contributing factors
• Overweight & obesity• Sedentary lifestyle• Cigarette smoking• Dietary factors (high intake of
alcohol & carbohydrate, sucrose & fructose)
– Basic treatment• Controlling body weight• Being physically active• Quitting smoking• Restricting alcohol• Avoiding high carbohydrate
intake
Severe hypertriglyceridemia– Medications usually
necessary– Weight reduction &
physical activity emphasized
– Very-low-fat diet (<15% of kcalories from fat) in extreme cases
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease• Vitamin supplementation & CHD risk-studies are
inconclusive and therefore supplementation is not recommended at this time– B vitamin supplements & homocysteine
• Homocysteine is known risk factor for CHD—direct causative relationship unknown
• Increased intakes of folate, vitamins B6 & B12 lower homocysteine levels; direct effect of these vitamins on reducing risk is not demonstrated in research studies
– Antioxidant vitamin supplements• Some studies suggest relationship of antioxidant-rich diets
(like Vit. C and E) may protect against CHD; other suggest possible harm
• Study results still inconclusive
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease
• Drug therapies for CHD prevention– Dietary & lifestyle changes may not be
fully effective in reducing LDL goals– LDL-lowering drugs
• Statins: reduce cholesterol synthesis in liver• Bile acid sequestrants: reduce cholesterol &
bile absorption in small intestine• Niacin (nicotinic acid): reduces blood
triglycerides & increases HDL levels (when taken in high amounts)
– Anticoagulants & aspirin
Nutrition & Diet Therapy (7th Edition)
Coronary Heart Disease• Treatment for heart attack (MI)
– May result from blockage of one or more coronary arteries, cutting off blood supply to heart muscle
– Medications• Thrombolytic drugs: immediately after heart attack breaks clots• Anticoagulants, aspirin• Pain medications• Medications to regulate heart rhythm & reduce blood pressure
– Dietary management• Low-sodium diet• Low saturated fat & cholesterol
– Cardiac rehabilitation programs• Exercise therapy• Smoking cessation• Stress management• Dietary instruction• Medication counseling
Nutrition & Diet Therapy (7th Edition)
III. Hypertension• Affects almost 1/3 of adults in U.S.
– Especially prevalent among African Americans– Estimated 37% of people with hypertension are unaware
of problem• Primary risk factor for atherosclerosis & cardiovascular
diseases—increases risk for…– Cardiac arrhythmias (abnl muscle contractions…)– Congestive heart failure– Stroke– Kidney failure– Sudden death
• Reducing blood pressure can dramatically reduce incidence of these diseases
Nutrition & Diet Therapy (7th Edition)
Blood Pressure Measurement
Systolic BP: • measurement of
pressure in arteries during contraction of heart muscle
Diastolic BP: • measurement of
pressure in arteries during resting or relaxation of heart muscle
• Desirable BP– Systolic <120 mmHg– Diastolic <80 mmHg
• Prehypertension– Systolic 120-139 mmHg– Diastolic 80-89 mmHg
• Hypertension– Systolic ≥140 mmHg– Diastolic ≥90 mmHg
Nutrition & Diet Therapy (7th Edition)
Hypertension
• Contributing factors– Aging– Genetics– Obesity (60% obese)
– Salt sensitivity (30-50%)
– Alcohol– Diet
• Treatment– Lifestyle
modifications• Weight reduction• DASH eating plan• Sodium restriction• Physical activity• Moderate alcohol
consumption
– Drug therapiesDASH Eating Plan-p. 616-618
“Dietary Approaches to
Stop Hypertension”
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
IV. Congestive Heart Failure
• Characterized by inability of heart to pump adequate blood– Results in buildup of
fluid in veins & tissues– Can develop after
illness that impairs heart’s ability to fill with or eject blood
– Heart cannot cope with usual workload
– Develops primarily in elderly individuals
• Consequences of CHF– Fluid accumulation in liver,
abdomen & lower extremities
– Fluid buildup in lungs, causing shortness of breath & limited tolerance for activity
– Impaired function to other organs, such as liver & kidneys
– Reduced food intake
Cardiac CachexiaMalnutrition caused by changes in body chemistry & reduced appetite & food intake; severe weight loss &
tissue wasting
Nutrition & Diet Therapy (7th Edition)
Congestive Heart Failure• Medical management
– Goals of treatment: to enhance the patient’s quality of life & slow disease progression
– Treatment depends on nature & severity of illness– Drug therapy
• Manage congestion & improve heart function• Diuretics to reverse or prevent fluid retention
– Nutrition therapy• Moderate sodium intake to 2000-3000 mg/day• Severe cases of CHF may need stricter sodium restriction:
to 2000 mg/day or less• Fluid restriction may be necessary• Small, frequent meals or enteral supplements may be
better tolerated if eating difficulties exist• Avoid alcohol
Nutrition & Diet Therapy (7th Edition)
V. Stroke (CVA)• Third leading cause of death in U.S. (after heart
disease & cancer)• Most strokes are consequence of atherosclerosis
or hypertension, or both• Ischemic strokes (majority of incidence—about
88%) result from obstruction of blood flow to brain tissue
• Hemorrhagic stroke results from bleeding in brain tissue & resultant tissue damage
• Transient ischemic attacks (TIA): brief “strokes” (lasting 2-30 minutes)– Warning sign that more severe stroke may follow– Usually treated with aspirin & other drugs that inhibit
blood clotting
Nutrition & Diet Therapy (7th Edition)
Stroke• Stroke prevention
– Risk factors are similar to CHD
– Lifestyle changes to reduce risk
– Drug therapy• Aspirin• Antiplatelet drugs• Anticoagulants
• Stroke management– Specific symptoms depend
on area of brain affected– Early diagnosis & treatment
necessary to preserve brain tissue & minimize long-term disability
– Early administration of thrombolytic drugs
• Nutritional goals– Maintain nutrition status &
overall health, despite disabilities
– Management of food intake, depending on level of disability & associated problems with food intake
– Tube feedings may be necessary until disabilities are resolved & patient regains eating/swallowing & communication skills
Nutrition & Diet Therapy (7th Edition)
Nutrition in Practice—Metabolic Syndrome
• Metabolic syndrome– Group of disorders that substantially increases
risk of development of cardiovascular disease– Cluster of at least 3 of the following:
• Hyperglycemia• Obesity• Elevated blood triglycerides• Reduced HDL cholesterol levels• Hypertension
– Causes• Precise cause unknown• Close relationship between abdominal obesity &
insulin resistance may be partly responsible
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
Nutrition in Practice—Metabolic Syndrome
• Treatment– Primarily treated with diet & lifestyle changes—goal is to
correct abnormalities that increase CVD risk– Combination of weight loss & physical activity can
improve insulin resistance, blood pressure & blood lipid levels
– Additional strategies depend on specific symptoms– Dietary strategies
• Reduce intake of added sugars & refined grains• Increase servings of whole grains & foods high in fiber• Carbohydrate restriction may help reduce triglyceride
levels & improve hyperglycemia• Low saturated fats, trans fats & cholesterol can help reduce
LDL levels