NHHC chapter 21 ppt

Nutrition for Health and Health Care, 5th Edition DeBruyne ■ Pinna © Cengage Learning 2014

Nutrition and Disordersof the Heart andBlood Vessels

Chapter 21


Introduction

• Cardiovascular disease (CDV)– Accounts for about 33 percent of deaths in

U.S.• How does the risk of CDV compare for men and

women?– Leading cause of death worldwide– Most common form

• Coronary heart disease (CHD): due to atherosclerosis



Introduction (cont’d.)

• Cardiovascular disease (CDV)– Myocardial infarction: heart attack

• Sudden reduction in coronary blood flow– Stroke

• Blocked blood supply to brain tissue


Atherosclerosis

• Artery walls become progressively thickened: plaque accumulation

• Consequences of atherosclerosis– Promotes thrombosis– Interferes with blood flow

• Narrowing the lumen of the artery, enlarged thrombus, embolism, and ischemia

• Obstructed blood flow in coronary arteries:angina pectoris or heart attack



Atherosclerosis (cont’d.)

• Consequences of atherosclerosis– Intermittent claudication

• Fatigue and pain while walking– Kidney disease or acute kidney injury

• Due to artery blockage– Most common cause of an aneurysm



• Causes of atherosclerosis– Shear stress: intensified by hypertension– Abnormal blood lipids

• LDLs accumulate in susceptible artery wall regions• High VLDL: promotes atherogenic responses in

immune cells and endothelial cells• How does low HDL contribute to the development

of atherosclerosis?



• Causes of atherosclerosis– Cigarette smoking– Diabetes mellitus– Advancing age– Gender

• Risk increases for women after menopause


Coronary Heart Disease

• Coronary heart disease (CHD): coronary artery disease– Most common type of CVD– Leads to:

• Angina pectoris• Heart attack• Sudden death

– Most common cause: atherosclerosis


Coronary Heart Disease (cont’d.)

• Symptoms of coronary heart disease– Pain or discomfort in chest region

• Angina pectoris: symptoms triggered by exertion; subside with rest

• Heart attack: severe pain; lasts longer; occurs without exertion

– Other• Shortness of breath, unusual weakness or fatigue,

lightheadedness or dizziness, nausea, etc.



• Evaluating risk for coronary heart disease– Classic risk factors

• Smoking, high LDL cholesterol, hypertension, and diabetes

– “How To” Assess a Person’s Risk of Heart Disease

– Laboratory Measures for CHD Risk Assessment (Table 21-2)




• Blood cholesterol levels and CHD risk– Elevated LDL levels: directly related to

development of atherosclerosis– Low HDL: highly predictive of CHD risk

• What are some therapeutic lifestyle changes (TLC) for lowering CHD risk? (Table 21-3)



• Main features of the TLC plan– Blood cholesterol lowering diet, regular

physical activity, and weight reduction– Saturated fat

• Replace with monounsaturated and polyunsaturated fats

• Consume less than seven percent total kcalories as saturated fat



• Main features of the TLC plan– Polyunsaturated and monounsaturated fat

• Limit polyunsaturated fat to 10 percent of total kcalories

• Consume up to 20 percent of kcalories from monounsaturated fat

– Total fat• 25 to 35 percent of kcalories



• Main features of the TLC plan– Trans fat: keep intake as low as possible

• Read food labels carefully– Dietary cholesterol

• Cholesterol intake: less than 200 mg/day• What are the recommendations for eggs?

– Soluble fiber• Dietary supplements: effective in lowering

cholesterol levels



• Main features of the TLC plan– Plant sterols and stanols

• Added to various food products, e.g., margarine and orange juice; supplied in dietary supplements

• About 2 grams of plant sterols daily: lower LDL cholesterol by up to 10 percent

– Sodium and potassium intakes• DASH Eating Plan: reduces blood pressure



• Main features of the TLC plan– Fish and omega-3 fatty acids

• American Heart Association recommendations: consume two or more servings of fish per week, with an emphasis on fatty fish

– Alcohol• Women: limit to one drink daily• Men: limit to two drinks daily



• Main features of the TLC plan– Regular physical activity

• Minimum: 150 min/week of moderate-intensity activity or 75 min/week of vigorous activity

– Smoking cessation• CHD incidence drops to levels near those of

nonsmokers within three years– Weight reduction

• After adopting dietary measures to lower LDL first



• Main features of the TLC plan– Successful adherence to lifestyle changes

• Ways to motivate patients: explain the reasons for each change, set obtainable goals, and provide practical suggestions

• “How To” Implement a Heart-Healthy Diet



• Hypertriglyceridemia– Elevated blood triglycerides– Common in people with diabetes mellitus,

obesity, metabolic syndrome, etc.– Basic treatments: control body weight,

become physically active, restrict alcohol, and limit intakes of refined carbohydrates



• Other lifestyle changes for hypertriglyceridemia– Severe hypertriglyceridemia

• Dietary and lifestyle changes• Medications for lowering blood triglycerides• Eliminate alcoholic beverage consumption

– Fish oil supplements and hypertriglyceridemia• Sometimes recommended• Should be monitored by a physician



• Vitamin supplementation and CHD risk– B vitamin supplements and homocysteine

• B vitamin supplements: not currently recommended for patients at risk for CHD

– Antioxidant supplements• Not recommended for heart disease prevention



• Drug therapies for CHD prevention– Statins (e.g., Lipitor or Zocor): reduce

cholesterol synthesis in the liver– Bile acid sequestrants (e.g., Colestid or

Questran): interfere with bile acid reabsorption in the small intestine

– Fibrates (e.g., Lopid): lower triglyceride levels and increase HDL



• Drug therapies for CHD prevention– Nicotinic acid:

• Lowers triglyceride levels; increases HDL; reduces LDL and lipoprotein(a) levels

– Anticoagulants and aspirin– Blood pressure medications– Nitroglycerin: relieves angina– Be aware of diet-drug interactions (listed in

text)



• Treatment of heart attack– Drug therapies given immediately after a

heart attack• Thrombolytic drugs, anticoagulants, aspirin,

painkillers, and medications that regulate heart rhythm and reduce blood pressure

– Sips of water or clear liquids, until condition stabilizes



• Treatment of heart attack– Sodium restriction initially: limit fluid retention– Cardiac rehabilitation programs

• Include exercise therapy, instruction about heart-healthy food choices, help with smoking cessation, and medication counseling


Stroke

• United States: fourth most common cause of death– Leading cause of long-term disability in adults

• Ischemic strokes– Obstruction of blood flow to brain tissue

• Hemorrhagic strokes– Bleeding within the brain

• What are transient ischemic attacks?


Stroke (cont’d.)

• Stroke prevention– Recognize stroke risk factors: similar to those

for heart disease– Make lifestyle choices to reduce risk– Medications

• Aspirin or anticoagulants, e.g., warfarin (Coumadin)


Stroke (cont’d.)

• Stroke management– Stoke effects vary: depends on area of the

brain that has been injured– Early diagnosis and treatment

• Preserves brain tissue and minimizes long-term disability


Stroke (cont’d.)

• Stroke management– Rehabilitation programs

• Start as soon as possible after stabilization• Physical therapy, occupational therapy, speech

and language pathology, and kinesiotherapy– Nutrition care

• Help patients maintain nutrition status and overall health

• Tube feedings may be needed until skills regained


Hypertension

• United States: affects about one-third of adults– An estimated 22 percent of people with

hypertension: unaware that they have it• Primary risk factor for atherosclerosis and

cardiovascular diseases• Primary cause of stroke and kidney failure


Hypertension (cont’d.)

• Factors that influence blood pressure (Figure 21-3)– Blood pressure depends on:

• Cardiac output: volume of blood pumped by the heart

• Peripheral resistance: resistance the blood encounters in the arterioles



• Factors that influence blood pressure– Influenced by:

• Nervous system: regulates heart muscle contractions and arteriole diameters

• Hormonal signals: may cause fluid retention or blood vessel constriction

• Factors that contribute to hypertension– Primary or essential hypertension

• Cause is unknown



• Factors that contribute to hypertension– Secondary hypertension

• Caused by a known physical or metabolic disorder– Risk factors for hypertension

• Aging, genetic factors, obesity, salt sensitivity, alcohol, and dietary factors



• Treatment of hypertension– Goal of treatment: reduce blood pressure to

• <140/<90 mm Hg• <130/<80 mmHg, for people with diagnosed CHD,

diabetes, or kidney disease– Lifestyle modifications and medications (Table

21-4)



• Treatment of hypertension– Weight reduction

• Most beneficial for blood pressure control during periods of weight loss and weight maintenance

– Dietary approaches • DASH Eating Plan (Table 21-5): higher fiber,

potassium, magnesium, and calcium than the typical American diet; limits red meat, sweets, saturated fat, etc.



• “How To” Reduce Sodium Intake• Drug therapies for reducing blood

pressure– Combinations of two or more medications

usually required• Most treatments include diuretics• Other medications: angiotensin-converting enzyme

(ACE) inhibitors, beta-blockers, and calcium channel blockers


Heart Failure

• Heart’s inability to pump adequate blood– Also called congestive heart failure– Majority of cases: occur in individuals 65

years or older


Heart Failure

• Consequences of heart failure– Right side failure

• Blood backs up in the peripheral tissues and abdominal organs

• Fluid accumulation in the lower extremities and in the liver and abdomen

– Left side failure• Buildup of fluid in the lungs, i.e., pulmonary edema• Shortness of breath; limited oxygen for activity


Heart Failure

• Consequences of heart failure– Affects food intake and level of physical

activity– Cardiac cachexia: severe malnutrition

• Medical management of heart failure– May require frequent hospitalizations– Treatment varies according to nature and

severity of illness


Heart Failure

• Medical management of heart failure– Drug therapies for heart failure

• Diuretics: reverse or prevent fluid retention• What other medications may be prescribed?

– Nutrition therapy for heart failure• Sodium restriction of 2000 milligrams or less daily

– Other dietary recommendations• Adequate fiber intake; restrict or avoid alcohol;

daily multivitamin-mineral supplementation


Heart Failure

• Medical management of heart failure– Cardiac cachexia

• Condition cannot be reversed• Liquid supplements, tube feedings, or parenteral

nutrition: supportive additions to treatment

Education

NHHC chapter 21 ppt