1. NUTRITION AND CARDIOVASCULAR DISEASE

2. Blood Lipid Levels are Related to Risk of CVD

3. Blood Lipids (Lipoproteins)  Lipids (fat) cannot mix with water  Blood is high in water  Lipids cannot travel in blood without help  Lipoproteins are formed to carry lipids

4. Lipoproteins combine  Lipids (triglycerides, cholesterol)  Protein  Phospholipids

5. Low-Density Lipoproteins (LDL-C)  Also called “bad cholesterol)  Contain relatively large amounts of fat, and less protein  Deposits cholesterol in arteries  Thus, ↑ LDL-C is associated with ↑ CVD risk  Serum LDL-C should be < 130 mg/dL

6. High-Density Lipoproteins (HDL)  Also called “good cholesterol”  Relatively high in protein, lower in lipid  Acts as scavenger, carrying cholesterol from arteries to liver  Liver packages as bile  Excretes  ↑ HDL-C is associated with ↓ risk of CVD  Serum HDL-C should be >60 mg/dL (optimal) or at least >40 in men and 50 in women

7. Triglycerides  The most diet-responsive blood lipid  Should be ≤150 mg/dL in fasting state

8. Triglycerides Lower blood triglycerides by:  Not overeating  Limiting alcohol and simple sugars  Spreading meals throughout the day  Including fatty fish in the diet  Controlling diabetes if present  Performing regular physical activity  Not smoking

9. Total Cholesterol  Includes HDL-C, LDL-C, and a fraction of the triglycerides  Total cholesterol should be ≤ 200 mg/dL  Total cholesterol does not tell whole story

10. Lipoprotein Summary

11. Evaluating Blood Lipids: LDL <100 mg/dL Optimal 100-129 Near optimal 130-159 Borderline high 160-189High ≥190 Very high Source: ATP-III Guidelines, NHLBI, accessed 2-2005

12. Evaluating Blood Lipids: Total Cholesterol <200 mg/dL Desirable 200-239 mg/dL Borderline high ≥240 mg/dL High Source: ATP-III Guidelines, NHLBI, accessed 2-2005

13. Evaluating Blood Lipids: HDL < 40 mg/dL Low ≥ 60 mg/dL High Source: ATP-III Guidelines, NHLBI, accessed 2-2005

14. Risk Factors (other than LDL) for CVD  Cigarette smoking  Hypertension (BP ≥140/90 mmHg or on anti- hypertensive tx  Low HDL-C* (<40 mg/dL)  Family history of premature CHD in first degree relative (in male <55 years, in female <65 years)  Age (men ≥45 years, women ≥55 years) *HDL-C ≥ 60 mg/dL counts as a negative risk factor Source: ATP-III Guidelines, NHLBI, accessed 2-2005

15. Risk Factors (other than LDL) for CVD  Diabetes (considered equivalent to a history of CHD)  Obesity  Inactivity Source: ATP-III Guidelines, NHLBI, accessed 2-2005

16. Screening for CVD Risk  Everyone 20 and older should have his cholesterol measured at least every 5 years  Lipoprotein profile: includes TC, LDL-C HDL-C, and TG  At least should include TC and HDL-C  If TC> 200 mg/dL or HDL-C< 40 mg/dL, obtain full lipid profile Source: National Cholesterol Education Program, National Institutes of Health, accessed 2-05

17. Total Cholesterol  John and Marty each have total cholesterol levels of 200 mg/dL.  Their health risk is different

18. Total Cholesterol is Not Enough John’s Lipid Profile  TC: 200 mg/dL  LDL-C: 140 mg/dL  HDL-C: 30 mg/dL  TG: 150 mg/dL Marty’s Lipid Profile  TC: 200 mg/dl  LDL-C: 95 mg/dL  HDL-C: 75 mg/dL  TG: 150 mg/dL

19. What Affects Cholesterol Levels?  Diet  Weight  Physical activity  Age and gender  Heredity You control the first three!

20. Lowering LDLs  See your doctor to assess for other conditions  Reduce dietary saturated fat, trans fatty acids, and cholesterol  Increase MUFA and PUFA  Increase dietary fiber (soluble)

21. Lowering Blood TG  Is the most diet-responsive blood lipid  Avoid overeating  Limit alcohol  Limit simple sugars  Small frequent meals  Include fish in the diet

22. Raise the HDL  Physical activity  At least 45 min./day, 4 days a week  Avoid smoking  Eat regularly  Eat less total fat  Moderate intake of alcohol increases HDL

23. Therapeutic Lifestyle Changes (TLC)  TLC Diet  Physical activity (30 minutes on most, if not all, days)  Weight management: will help manage triglycerides, increase HDL,

24. Diet Strategies for Reducing the Risk  Eat less saturated fat & trans fats  Replace with MUFA and essential fatty acids  Eat fish 2x a week  Eat plenty of fruits and vegetables  Eat more whole grains and less refined CHO  Eat at least 3 meals regularly

25. TLC Diet  Low in saturated fat (<7% of calories) and cholesterol (<200 mg/day)  Enough calories to maintain a desirable weight  High in soluble fiber  Plant stanols or sterols, if needed

26. Other Recommendations  Fat intake can be higher as long as saturated and trans fatty acid are minimal  Eat diet with plenty of fruits and vegetables  Cut down on red meats  Cut down on simple sugars and refined CHO

27. TLC: Healthy Cooking  Bake, steam, roast, broil, stew or boil instead of frying  Use a nonstick pan with cooking oil spray or small amount of liquid vegetable oil instead of lard, butter, shortening, other solid fats  Chill meat and poultry broth until fat becomes solid, remove

28. TLC: Dining Out  Choose restaurants that have lowfat options available  Ask that sauces, gravies, and salad dressings be served on the side  Control portions by asking for an appetizer serving or sharing with a friend

29. TLC: Dining Out  At fast food restaurants, go for salads, grilled (not fried or breaded) skinless chicken sandwiches  Avoid regular salad dressings and fatty sauces. Limit jumbo or deluxe burgers, sandwiches, french fries, and other foods.

30. Eating food with anticoagulant properties is a good way to supplement your medication for stroke patients. What are Anticoagulants? Anticoagulants are agents or substances used to prevent or reduce the formation of or ability of blood to clot.

31. Fruits are good sources of anticoagulants. Drinking fruit juices is a convenient way to meet this daily requirement as these are concentrated

32. GRAPES, APPLES, PINEAPPLES, & SPICES: GREAT ANTICOAGULANTS

33. Grapes contain phytonutrients called flavonoids that reduce platelet clumping and harmful blood clots. Grapes also have a flavonoid-type compound called resveratrol, which is more common in grape wine.

34. Apples also contain phytonutrients like those found in grapes

35. Pineapples are well-known as great sources of fiber, which acts like a broom in removing toxins in the blood and bad cholesterol. This is often the reason why it is recommended to people with high blood pressure.

36. Besides being a great fiber resource, pineapples also have enzymes called bromelain, which is a natural anticoagulant. Bromelain works by breaking down fibrin, the protein substance in blood that causes clotting.

37. Besides fruits and vegetables, nature has other anticoagulants in the form of herbs and spices. Ginger, for one, helps make blood platelets less sticky. If you don't like eating meals with ginger, your other options are curry powder, cayenne powder, paprika, thyme, cinnamon, dill, oregano, turmeric, licorice, and peppermint.

38. There are many reasons why you need to incorporate fruits and vegetables into your diet. Enjoying natural anticoagulants together with your medication to avoid another stroke is one of them

39. Wish you all Good Health..!