Fat-Controlled, Mineral-Modified Diets for Cardiovascular Diseases

1. Fat-Controlled, Mineral-Modified Diets for Cardiovascular Diseases Chapter 22 Nutrition & Diet Therapy (7th Edition)

2. 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)

3. Nutrition & Diet Therapy (7th Edition)

4. 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 I. Atherosclerosis Nutrition & Diet Therapy (7th Edition)

5. 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)

6. 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)

7. 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)

8. Nutrition & Diet Therapy (7th Edition)

9. Nutrition & Diet Therapy (7th Edition)

10. 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)

11. 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 Coronary Heart Disease Nutrition & Diet Therapy (7th Edition)

12. 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 Triglycerides Borderline high: 150-199 mg/dL High: ≥200 mg/dL Nutrition & Diet Therapy (7th Edition)

13. Mild 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 Coronary Heart Disease Nutrition & Diet Therapy (7th Edition)

14. 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)

15. 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 Coronary Heart Disease Nutrition & Diet Therapy (7th Edition)

16. 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)

17. 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)

18. 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 Blood Pressure Measurement Nutrition & Diet Therapy (7th Edition)

19. 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 therapies Hypertension DASH Eating Plan-p. 616-618 “Dietary Approaches to Stop Hypertension” Nutrition & Diet Therapy (7th Edition)

20. Nutrition & Diet Therapy (7th Edition)

21. 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 IV. Congestive Heart Failure Cardiac Cachexia Malnutrition caused by changes in body chemistry & reduced appetite & food intake; severe weight loss & tissue wasting Nutrition & Diet Therapy (7th Edition)

22. 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)

23. 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)

24. 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 Stroke Nutrition & Diet Therapy (7th Edition)

25. 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)

26. Nutrition & Diet Therapy (7th Edition)

27. 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 Nutrition & Diet Therapy (7th Edition)