1. Coronary Heart Disease and Hypertension
Chapter 19

2. Coronary Heart Disease and Hypertension
CV disease is the #1 cause of death in the U.S.
We’ll look at the primary underlying disease process, atherosclerosis, and the various risk factors involved
We’ll explore ways to use nutritional approaches to reduce these risk factors and help prevent disease
Coronary Heart Disease and Hypertension

3. Key Concepts
Several risk factors contribute to the development of cardiovascular disease and HTN, many of which are preventable by improved food habits and lifestyle behaviors
Other risk factors are non- modifiable such as age, gender, family hx. and race
HTN maybe classified as “essential” (primary) or secondary HTN
Early education is critical for the prevention of cardiovascular disease.

4. Coronary Heart Disease
Atherosclerosis
Acute cardiovascular disease
Chronic heart disease

6. Atherosclerosis Disease process
Fatty fibrous plaques develop into fatty streaks on inside lining of major blood vessels.
Process may begin in childhood
fatty streaks, largely composed of cholesterol
Gk. Athera = “gruel”; Sclera = “hardening”
The fatty fibrous process thickens over time, narrowing the interior part of the blood vessel  impeding or cutting off blood flow to cells beyond the blockage
Atherosclerosis

7. Atherosclerosis Cells die when deprived of their normal blood supply.
The local area of dying or dead tissue is called and “infarct”.
If affected vessel is major artery supplying heart muscle, result could be myocardial infarction (heart attack).
If affected vessel is major artery supplying brain, result could be cerebrovascular accident.
Atherosclerosis

11. Atherosclerotic Plaque in Artery

12. Normal Human Heart: Posterior External View

13. The major arteries and their branches serving the heart are called coronary arteries
The overall disease process is coronary heart disease
Common symptom: angina pectoris or chest pain, usually radiating down the arm
Atherosclerosis

14. Relation to Fat Metabolism
Elevated blood lipids associated with coronary heart disease
Triglycerides—simple fats in body or food
Cholesterol—fat-related compound produced in body; also in foods from animals
Lipoproteins—“packages” wrapped with protein that carry fat in the blood stream
Relation to Fat Metabolism

15. Relation to Fat Metabolism
Lipoproteins are grouped and named according to their protein, fat, and cholesterol content (e.g. density – those with higher protein content have higher density
Relation to Fat Metabolism

16. 3 of these types of lipoprotein found in the liver are significant in relation to heart disease risk:
Very low-density lipoproteins (VLDL)
Carry large load of triglycerides to cells
Include approx. 12% cholesterol
Low-density lipoproteins (LDL)
Carry two thirds of total plasma cholesterol to body tissues  constantly send cholesterol to tissues  “bad cholesterol”
Types of Lipoproteins

17. High-density lipoproteins (HDL) Carry less total fat and more protein Not found in foods; produced in the liver. Takes cholesterol from tissues to liver for breakdown and elimination
Types of Lipoproteins

18. Sex – CVD occurs more often in men than women until menopause, at which time the relative risks are the same
Age – general risk increases with age (men > 45 years and women > 55 years)
Risk Factors

19. Heredity – ethnic groups that have a higher incidence of risk factors and CVD; including “familial hypercholesterolemia” and “familial hypertryglyceridemia”.
Ethnic groups include: African Americans, Hispanics, Native Americans
Risk Factors

20. Elevated serum cholesterol – major risk factor especially when combined with obesity, lack of exercise, stress, smoking, and increased food intake
Compounding diseases – diabetes, hypertension, metabolic syndrome
Dietary fat – affects serum cholesterol
Risk Factors

21. National Cholesterol Education Program (NCEP) Guidelines
Therapeutic Lifestyle Changes approach
Total energy intake = energy expenditure
Total fat should not exceed 25-35% of diet
Avoid trans fatty acids
CHO mainly from complex CHOs
National Cholesterol Education Program (NCEP) Guidelines

22. National Cholesterol Education Program (NCEP) Guidelines
Total protein from sources other than animals should be included
Total cholesterol intake < 200mg/day
Exercise to expend at least 200 kcals/day
National Cholesterol Education Program (NCEP) Guidelines

23. In the event that LDL cholesterol is above goal range, drug therapy may be added to diet therapy depending on the level of risk
Drug Therapy

24. Acute Cardiovascular Disease
May be associated with MI
When CV disease progresses to the point of cutting off the blood supply to major coronary arteries, a critical vascular event – heart attack/MI- may occur.
After an infarction, enzymes and proteins are released from the damaged heart muscle = “cardiac markers”
can be measured in blood tests: CPK,
TROPONIN is heart muscle- specific
Acute Cardiovascular Disease

25. Acute Cardiovascular Disease
Initial phase Objective: cardiac rest
Immediate care includes: analgesics and supplemental oxygen
All care, including diet, is directed toward ensuring that the heart rests so that the damaged heart can be restored to normal functioning
Acute Cardiovascular Disease

26. Acute Cardiovascular Disease
Principles of diet therapy
Reduced energy intake ( kcal) – a brief period of reduced energy intake during the first day or so after the heart attack reduces the metabolic workload on the damaged heart.
Soft food texture – easily digested to avoid excess effort in eating or the discomfort of gas formation
Controlled amount and type of fat
Mild sodium restriction (2-3 g/day)
Acute Cardiovascular Disease

27. CHF and pulmonary edema
The progressively
weakened heart muscle is unable to maintain an adequate cardiac output to sustain normal circulation  fluid imbalance pulmonary edema.
Chronic Heart Disease

28. Objective: control of pulmonary edema and resulting fluid imbalance
Mild-severe sodium restriction
Fluid restriction – often limited to ml. /day
Texture – soft foods
Small meals
Alcohol – limited or avoided
Chronic Heart Disease

29. Essential Hypertension
Hypertension called the “silent disease”
Essential HTN – specific cause is unknown
Secondary HTN – HTN is a symptom or side effect of another primary condition
Risk Factors:
Highly inherited disorder
Obesity worsens
Can begin in adolescent years
Made worse by physical inactivity, stress, alcohol and drug use, and salt intake.
Essential Hypertension

30. Types of Hypertensive Blood Pressure Levels
Adult normal BP – 120/80 or below
Stage 1 hypertension
Focus on diet therapy, without drugs
Reduce excess weight and restrict sodium
Stage 2 hypertension
Diet therapy and drugs, as needed
Use of diuretic and potassium replacement
Stage 3 hypertension
Diet therapy and vigorous drug therapy
Types of Hypertensive Blood Pressure Levels

31. Principles of Medical Nutrition Therapy
Weight management— lose weight and maintain appropriate weight for height
Increase Physical activity
Sodium control
Other minerals— calcium, magnesium may be beneficial
Principles of Medical Nutrition Therapy

32. Principles of Medical Nutrition Therapy
DASH diet – Dietary Approaches to Stop Hypertension
4-6 servings fruit
4-6 “” veggie
2-3 “” low-fat dairy
Lean meats
High-fiber grains
14 days to lower B/P
Principles of Medical Nutrition Therapy

33. Education and Prevention Practical Food Guides
Food planning and purchasing
Control energy intake; read labels
Eat fresh foods with small selection of processed foods, if any
Education and Prevention Practical Food Guides

34. Education and Prevention Practical Food Guides
Food preparation
Use less salt and fat
Use seasonings instead (herbs, spices, lemon, onion, garlic, etc.)
Take time to cook
Special needs: individual adaptation of diet principles according to preferences, ethnic diets, and food habits
Education and Prevention Practical Food Guides

35. Education Principles Start early
Prevention begins in childhood, especially with children in high-risk families
Focus on high-risk groups
Direct education to people and families with risk of heart disease and hypertension
Education Principles

36. Use variety of resources
National organizations, community programs, registered dieticians
Education Principles