1. Lipids in Health and Disease
Jamie Pope, Steven Nizielski, and Alison McCook
NUTRITION
for a Changing World
FIRST EDITION
Chapter 7
Lipids in Health and Disease
Death in Bogalusa
© 2016 by W. H. Freeman and Company & Scientific American

2. Chapter 7
Objectives
Summarize the events that lead to the development of atherosclerosis
Identify at least five risk factors that affect the initiation or progression of cardiovascular disease
Describe the interrelationship between total cholesterol, low-density lipoproteins, high-density lipoproteins, and the risk of cardiovascular disease
List the cluster of risk factors associated with metabolic syndrome
Discuss the implications of and recommendations for the intake of saturated fatty acids, trans fatty acids, and unsaturated fatty acids in relation to cardiovascular disease
Summarize the dietary strategies that reduce the risk of heart disease

3. Bogalusa Heart Study
Dr. Berenson conducted study from 1978 to 1998 in rural Southern town
40% living below poverty
Poverty linked to cardiovascular disease
Physical and lifestyle attributes contribute to developing heart disease
Heart disease begins in childhood
Dr. Berenson obtained hearts (over 200 organs) from 1978 to 1998 from young people in Bogalusa from 2 to 39 years of age. It is one of the longest running heart studies, and the only biracial (black and white) heart study in the world. It has shown that heart disease begins in childhood and that there are certain risk factors that increase a person’s chance of developing problems.

4. Cardiovascular Disease (CVD)
Leading cause of death in the United States

5. Development of Atherosclerosis
Presence of low-density lipoproteins (LDL) and plaque

6. Risk Factors for Cardiovascular Disease
Risk factors that cannot be modified
Family history of heart disease
Race
Age
Gender

7. Modifiable Risk Factors for Cardiovascular Disease
Smoking
Diet high in saturated and trans fats, cholesterol, sodium, and added sugar
Sedentary lifestyle
Obesity
Diabetes
Excessive alcohol consumption
High blood pressure
High blood lipid levels (cholesterol, LDL, and triglyceride)

8. Modifiable Risk Factors for Cardiovascular Disease

9. Lipoproteins and CVD

10. Metabolic Syndrome
Having at least three of the following problems is diagnostic of metabolic syndrome:
Excessive abdominal fat
High blood pressure
Elevated triglycerides in the blood
Low levels of HDL
Elevated blood glucose levels
Metabolic syndrome is rising and raises the risk of cardiovascular disease and type 2 diabetes. It affects more than 50 million adults in the United States and approximately 25% of the adults worldwide.

11. Dietary Fat and CVD
There is a complex relationship between dietary fat and heart disease, especially with saturated and trans fats

12. Heart Protective Diet Dietary Guidelines for Americans
Saturated fat intake <10% of daily calories

13. Heart Protective Diet National Cholesterol Education Program (NCEP)
Therapeutic Lifestyle Changes (TLC) program
Low saturated fat (<7% of daily calories), low dietary cholesterol
Eating sufficient plant sterols, stanols, and soluble fiber
Weight management
Physical activity
The NCEP is from the National Institutes of Health and is endorsed by the American Heart Association.

14. Dietary Lipids and Risk
Saturated fats
Polyunsaturated fats
Monounsaturated fats
Omega-6 fatty acids
Omega-3 fatty acids
Ratio of omega-6 and omega-3 fatty acids
Trans fats
Saturated and trans fats raise cholesterol, LDL, and the risk of heart disease. Polyunsaturated fats lower cholesterol. Monounsaturated fats lower cholesterol without lowering HDL. A deficiency of omega-3 fatty acids [docosahexaenoic acid (DHA)] in the diet may increase the risk of Alzheimer’s disease and dementia. DHA and EPA will lower levels of circulating triglycerides.

15. Dietary Lipids and Risk
Saturated and trans fats raise cholesterol, LDL, and the risk of heart disease. Polyunsaturated fats lower cholesterol. Monounsaturated fats lower cholesterol without lowering HDL. A deficiency of omega-3 fatty acids [docosahexaenoic acid (DHA)] in the diet may increase the risk of Alzheimer’s disease and dementia. DHA and EPA will lower levels of circulating triglycerides.

16. Dietary Strategies to Reduce the Risk of Heart Disease
Consumption of plant sterols or stanols
Plant-based diets
Nut consumption
Oily, cold-water fish
Whole grain oats
Moderate alcohol consumption
Substituting unsaturated oils for saturated fats

17. Fat Intake and Health Beyond Heart Disease
High-fat diet increases the risk for cancer and obesity
Plant-based foods are protective
Fruits, vegetables, whole grains, and fish

18. Summary
Atherosclerosis, a thickening and hardening of the arteries along with plaque development along blood vessel walls, is a major cause of heart attack and stroke
Atherosclerosis is a form of cardiovascular disease (CVD) that often begins with an injury to a vessel wall that triggers inflammation and low-density lipoprotein (LDL) cholesterol infiltration, which results in plaque accumulation
Some risk factors cannot be modified, like race, age, and a family history of heart disease, but certain lifestyle choices can significantly affect the risk of CVD

19. Summary (Cont’d)
Modifiable risk factors for CVD include smoking; a diet high in saturated and trans fats, cholesterol, sodium, and added sugar; a sedentary lifestyle; obesity; diabetes; elevated lipid levels in the blood (cholesterol, LDL, and triglycerides); excessive alcohol consumption; and high blood pressure
The concentrations of various lipids in the blood correlate with the risk for atherosclerosis and CVD; a high level of blood cholesterol is a major risk factor, particularly when accompanied by high levels of LDL cholesterol and low levels of high-density lipoprotein (HDL) cholesterol
Metabolic syndrome is a cluster of risk factors associated with the development of CVD and type 2 diabetes; diagnosis involves the presence of at least three of the following abnormalities: excessive abdominal fat, high blood pressure, elevated levels of triglycerides in the blood, low levels of HDL, and elevated blood glucose levels

20. Summary (Cont’d)
Diet, including the intake of fatty acids and cholesterol, plays a critical role in the development and prevention of CVD
Available evidence suggests that replacing saturated fats with monounsaturated and polyunsaturated fatty acids may be beneficial
The Therapeutic Lifestyle Changes (TLC) program was created by the National Institutes of Health’s National Cholesterol Education Program and is also endorsed by the American Heart Association as a heart-healthy regimen that can lower blood cholesterol and reduce the risk of CVD