1. Headings The Place of Nutrition in the Prevention of Cardio-Vascular Diseases Headings Y. A. Carpentier CLINICAL CASE Nutritional Support in Cardio- Vascular Diseases

2. Francois is a 39-year old traveling salesman. Over the last six months his company has been cutting its labor force and a number of his close friends have been released. As a result he feels depressed, overworked and tired from the added workload. Nutritional Support in Cardio- Vascular Diseases

3. His wife has insisted he consult the doctor, because he has recently, on occasion complained of chest pain. On one such occasion he had visited his local emergency department and had been assessed for possible cardiovascular disease. Nutritional Support in Cardio- Vascular Diseases

4. . It was concluded that the pain was not of significance in relation to heart disease. On enquiry, Francois tells, that the chest pain comes on at times of stress and although it is tight and central in nature it lasts for only 5-15 seconds. It occurs at rest and is not precipitated by physical activity. Nutritional Support in Cardio- Vascular Diseases

5. He has had no episodes of pain over the last 2 weeks. Francois tells that both his parents are alive and in their mid-seventies. However, his father had a heart attack at age 61yr. Also one uncle on his fathers side died from cardiovascular disease at age 59 yr. Nutritional Support in Cardio- Vascular Diseases

6. During the examination, it was note that Francois is overweight. He tells that he drinks rarely, but that he has smoked 10 cigarettes/ day for 20 years. He takes no regular exercise now because of pressures at work. His blood pressure was 138/88 (towards the upper limit of acceptable range).

7. At the next visit following a fasting blood sample: Thyroid, liver and renal function (biochemical) tests were normal Blood glucose: 5.5mmol/L Serum cholesterol: 7.1mmol/L (target<4.9mmol/L) LDL cholesterol: 4.7mmol/L (target <2.5mmol/L) HDL cholesterol: 0.8mmol/L (target >1.0mmol/L) Serum triglyceride: 3.5mmol/L (target<1.7mmol/L) Nutritional Support in Cardio- Vascular Diseases

8. 2. Which ONE of the following dietary changes will not lower Francois’s LDL cholesterol concentration? A. Increased soy protein consumption. B. Increased plant sterol consumption. C. Increased viscous fiber consumption. D. Increased  -3 fatty acid intake.** E. Increased  -6 fatty acid intake. Nutritional Support in Cardio- Vascular Diseases

9. 3. Which ONE of the following is the most likely to WORSEN Francois’s triglyceride concentration? A. Exercise. B. Smoking cessation. C. Monounsaturated fatty acids. D. Saturated fatty acids. E. Simple sugars (refinedarbohydrates). Nutritional Support in Cardio- Vascular Diseases

10. 4. What other recommendations will you not give ? A. Advise weight reduction. B. Suggest increased trans fatty acids as an alternate to saturated fatty acids.** C. Cut down on refined fiber- free carbohydrates. D. Allow olive oil use providing body weight does not increase. E. Allow w6 fatty acid intake (sunflower oil) Nutritional Support in Cardio- Vascular Diseases