Aging and Cardiovascular Problems

Chapter 8

Introduction

• Cardiovascular disease (CVD)– Disease of the blood vessels of the heart

• Heart failure– The end stage of CVD

• Atherosclerosis/arteriosclerosis– Accumulation of fatty materials that line the blood

vessels• Atherosclerotic cardiovascular disease

– Leading cause of death in the U.S.

Nutrition Epidemiologyof Heart Disease

Recommended Foods to Maintain Healthy Heart (from Table 8-2)

• Swiss chard• Herbs• Nonfat/low-fat yogurt• Extra-virgin olive oil• Almonds• Salt• Carrots• Barley

• Cayenne chili• Broccoli• Pork, lean• Oranges• Salmon• Black beans• Dried cherries

Research on Heart DiseasePrevention Through Diet

• 2007 American Heart Association Guidelines– Manage blood pressure– Stop smoking– Lose weight– Reduce saturated fat intake– Increase omega-3 fatty acid intake– Do not take hormone replacement for prevention

of heart disease

Research on Heart DiseasePrevention Through Diet

• 2007 American Heart Association Guidelines (cont.)– Do not use antioxidant supplements for

prevention of heart disease– Do not use folic acid for prevention of heart

disease– Consider routine low-dose aspirin in women 65

and older (325 mg/day)– Consider lowering LDL-c to less than 70 mg/dL

Research on Heart DiseasePrevention Through Diet

• Flavonoids and Cardiovascular disease– Inverse relationship between food rich in

flavonoids and CVD and mortality

Risk Factors for Cardiovascular Disease

Risk Factors for Cardiovascular Disease

• Heart disease is leading cause of death for women– Greater incidence of ischemic heart disease– Coronary artery disease– Hypertension in older women

Risk Factors for Cardiovascular Disease

• National programs to help inspire women to take action to reduce their risk for heart disease

National Institute on Aging/National Institutes of Health, 2008

Hypertension

• Prevalence in older adults in U.S.– 50% to 70%

• Major risk factor for– Stroke– Coronary artery disease– Heart attack– Heart failure

Hypertension

• Diastolic hypertension– Occurs most often in those middle-aged and older – The second number in blood pressure reading

• 130/90 mm Hg

• Systolic hypertension– Most common in older adults– The first number in blood pressure reading

• 140/70 mm Hg

Hypertension

National Institute on Aging/National Institutes of Health, 2008

Hypertension• Prehypertension

– More likely to • Have above normal cholesterol levels• Be overweight or obese• Have diabetes

• Gender and Ethnic Factors for Hypertension– Varies with age

Hypertension

• Dietary Factors and Hypertension– Reducing sodium intake lowered BP in

hypertensive subjects– DASH (Dietary Approaches to Stop Hypertension)

Diet– Low potassium stores and ratio of potassium to

sodium may cause hypertension– Protein recommendations– Whole-grain intake associated with reduced risk

of hypertension

Tobacco

• Smokers are two to four times more likely to develop coronary heart disease than nonsmokers

Exercise

• Physical activity declines with age

© Gualberto Becerra/ShutterStock, Inc.

Dyslipidemias

• Reduce cholesterol levels• Dyslipidemias lead to atherosclerosis

– Increase risk of MI and stroke

Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2007, p. 405. Reproduced with permission.

Dyslipidemias

Cholesterol

• Cholesterol-lowering diet is initial therapy for dyslipidemias– Cholesterol under 160 is marker for malnutrition

Low Density Lipoprotein

• The “bad” cholesterol• Improve serum levels with diet or medications

Low Density Lipoproteins

High Density Lipoprotein

• The “good” cholesterol• Improve serum levels with lifestyle changes

and diet– Red wine– Polyphenols (berries)– Mono and polyunsaturated fat– Stop smoking– Exercise– Lose weight if needed

Triglycerides

• Chemical form of fat that exists in food and in blood plasma

• Forms blood plasma lipids• Hypertriglyceridemia is linked to heart disease

– Management: weight loss, cutting calories, reducing saturated fat, reducing alcohol consumption, eating low fat dairy products, eating high omega 3 fatty acid foods, medications

Other Cardiovascular Diseases

• Arrhythmias– Irregular heartbeats– Atrial fibrillation

• Thrombi may form and cause a stroke• Many causes• Treatment with medications

–Warfarin interacts adversely with many medications and foods

Other Cardiovascular Diseases

• Peripheral Arterial Disease (PAD)– Atherosclerosis– Risk factors and management same as for CAD

National Institute of Aging, National Heart, Blood and Lung Institute, 2008.

Other Cardiovascular Diseases

• Myocardial Infarction

Other Cardiovascular Diseases

• Myocardial Infarction– Caused by the sudden rupture or erosion of

plaque in blood vessel lining– Heart is deprived of oxygen-rich blood– Management: urgent care

Other Cardiovascular Diseases

• Heart Failure (HF)– End stage of cardiac disease– Heart is unable to deliver a sufficient blood supply

to meet the body’s needs– Systolic or diastolic dysfunction– “Left-sided failure” or “Right-sided failure”– Risk factors and predictors among women with

CHD include diabetes

Other Cardiovascular Diseases

• Heart Failure– Assessment

• Signs and symptoms of heart failure (table 8-10)

Other Cardiovascular Diseases

• Heart Failure– Management

• Weekly weight–Assessing fluid-volume overload

• Medication• Sodium management• Stop or limit alcohol intake• Measure serum potassium and magnesium

Other Cardiovascular Diseases

• Anorexia of Cardiac Disease– Weight loss in late-stage heart failure– Some medications used to manage heart disease

suppress appetite– Preserve the pleasure of eating and quality of life

Conclusion

• Good nutrition is vital– Can prevent heart disease to a great extent– Every adult with CV problems should have a

dietary evaluation by a health professional