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. 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)

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 )
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. Coronary Heart Disease
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
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
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: mg/dL
High: ≥200 mg/dL
Nutrition & Diet Therapy (7th Edition)

13. Coronary Heart Disease
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
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. 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)

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. Blood Pressure Measurement
Desirable BP
Systolic <120 mmHg
Diastolic <80 mmHg
Prehypertension
Systolic mmHg
Diastolic mmHg
Hypertension
Systolic ≥140 mmHg
Diastolic ≥90 mmHg
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
Nutrition & Diet Therapy (7th Edition)

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

20. Nutrition & Diet Therapy (7th Edition)

21. 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 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 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 Stroke prevention Nutritional goals Stroke management
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)

25. Nutrition in Practice— 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)