food and your heart lecture 22 april 13, 2015 dr. quadro

Food and Your Heart

Lecture 22April 13, 2015

Dr. Quadro

Department of Food Science

Lecture 22 – April 13, 2015



Leading Causes of Death in the U.S.



Deaths attributable to cardiovascular disease (United States: 1900–2009).

Go A S et al. Circulation 2013;127:e6-e245

Copyright © American Heart Association



Cardiovascular disease mortality trends for males and females (United States: 1979–2009).





US age-standardized death rates* from cardiovascular diseases, 2000-2009. *Directly standardized to the age distribution of the 2000 US standard population





Risk Factors of Cardiovascular Disease

NOT modifiable

• Increasing age >83% who die are >65

• MALE (gender)

• Heredity (including Race) Family History Children w/ parents with CVD African Americans > Caucasian

Modifiable• Tobacco smoke• High blood cholesterol • High blood pressure • Obesity and overweight • Physical inactivity

DECREASE risk for heart attack

DECREASE risk of stroke

Healthy Food Habits



Leading Causes of Cardiovascular Disease

1. AtherosclerosisNarrowing of the arteries due to build-up of

cholesterol-containing plaquecholesterol-containing plaque in the arterial wall

2. HypertensionHigh blood pressure



1. AtherosclerosisNarrowing of the arteries due to build-up of

cholesterol-containing plaque in the arteries

Much more than simple accumulation of lipids within the artery wall… it is a complex

inflammatory response to tissue damage



Atherosclerosis

Initiating step: injury or inflammation in the arterial wall caused by high blood pressure, high blood cholesterol, cigarette smoke, genetic factors, etc.



Atherosclerosis

LDL-Cholesterol damages the arteries in its oxidized form. o-LDL deposited in the arteries attracts macrophages which ingest o-LDL and become Foam cells. These cells localize underneath the arterial wall and reduce their lumen.



3 major atherogenic mechanisms

• Dyslipidemia• Endothelial

dysfunction• Inflammation



How cholesterol is transported in the blood



LDL, the “bad”

HDL, the “good”

PREVENTION



National Cholesterol Education Program adult panel of CVD risk

Total cholesterol (mg/dl)

LDL cholesterol (mg/dl)

Desirable <200 <130

Borderline high 200-239 130-159

High >240 >160



Consequences of Atherosclerosis

• Blood clots (platelets action) thrombosis (restriction or closure of a blood vessel)

affecting heart, brain, etc.

• High blood pressure heart attack and stroke



CVD primary prevention~ statin therapyMaycock A, Muhlestein CA et al. 2002. J Am Coll Cardiol 40(10): 1777.

“Statin therapy is associated with reduced mortality across all age groups of individuals with significant coronary disease, including very elderly patients.”

• Mortality was decreased among statin users vs non-users in all age groups

Thavendiranathan P. Bagai A, et al. 2006. Arch Intern Med. 166(21):2307.

Primary Prevention of Cardiovascular Diseases With Statin Therapy: A Meta-analysis of Randomized Controlled Trials.

Adapted from “Nutrition Medicine in CVD – Dr. Sydney-Smith, RMIT University, Melbourne



What are statins?• drugs that inhibit cholesterol synthesis by blocking action of the enzyme

HMG-CoA reductase. This enzyme catalyzes the conversion of HMG-CoA to mevalonate which is a required building block for cholesterol biosynthesis. Thus, statins interfere with cholesterol production by acting as a reversible competitive inhibitor for HMG-CoA, which binds to the HMG-CoA reductase.

• Lovastatin is the first specific inhibitor of HMG CoA reductase to receive approval for the treatment of hypercholesterolemia.

• Lovastatin is a naturally occurring drug found in food such as oyster mushrooms and red yeast rice.



Omega-3-FAs & Statins

Nambi, V. and C. M. Ballantyne (2006). "Combination therapy with statins and omega-3 fatty acids. Am J Cardiol 2006:98: 341-381.

• Statin + omega-3FAs consistently shown to be: effective, safe, and well-tolerated treatment provide additional lipid improvement without requiring

additional laboratory tests do not increase risk for adverse muscle or liver effects.

• Patients with recent myocardial infarction may also benefit from this combination.




Statin & Niacin

Chapman, M. J., G. Assmann, et al. (2004). "Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid a position paper developed by the European Consensus Panel on HDL-C." Current Medical Research and Opinion 20: 1253.

Nicotinic acid is a more potent agent than fibrates for raising HDL-C, by up to 29% at recommended doses. It also substantially reduces triglycerides and LDL-C, and promotes a shift from small, dense LDL to larger, more buoyant LDL

particles. • nicotinic acid with a statin will produce a greater reduction in cardiovascular

risk in patients with diabetes and metabolic syndrome than statin monotherapy alone.

• Nicotinic acid is safe for use in patients with diabetes, with no evidence of clinically relevant deterioration in glycaemic control at recommended doses (≤ 2g/day).




Red Yeast Rice ~ A Natural Statin

Journoud, M. and P. J. H. Jones (2004). "Red yeast rice: a new hypolipidemic drug.“ Life Sciences 74(22): 2675.

“Evidence shows that fermented red yeast rice:

lowers cholesterol levels moderately compared to other statin drugs,

~but with~

the added advantage of causing less adverse effects.

A review of the body of evidence surrounding the

properties of red yeast rice underscores its potentialas a new alternative to lipid level control.”




Background: What is Blood Pressure?

• The force of blood against the wall of the arteries Systolic: as the heart contracts Diastolic: as the heart relaxes

• Written as:

systolic

diastolic

Normal

< 130< 85

Exact cause of High Blood Pressure

not known

HIGH: Stage 1

140-159 90-99

HIGH: Stage 2

> 160> 100



Why is Hypertension is an important issue?

• Makes the heart work too hard• Makes the walls of arteries hard



2. Hypertension

• High blood pressureA consistent blood pressure of 140/90 mmHg

• Increases risk of heart disease, renal disease, and stroke

• 1 out of 4 Americans has hypertension• No warning signs or symptoms



Hypertension effects on the body

• Risk factor for stroke

• Weakens blood vessels causing bleeding in the brain

HEART

• Narrow and thickened the blood vessels causes waste to accumulate in the blood, can result in kidney damage

• Rupture of blood vessel in the eye

• Can result in blurred vision or even blindness

• Major risk factor for heart attack

• #1 one risk factor for congestive heart failure

BRAIN EYE KIDNEY



Who can develop High Blood Pressure?

Anyone, but it is more common in:• Race: African Americans

get it earlier and more often then Caucasians

• Age As we get older. 60% of Americans over the age of 60 have hypertension

• Overweight• Family history



Incidence of heart attack or fatal coronary heart disease by age, sex, and race (Atherosclerosis Risk in Communities Surveillance: 2004–2009*).





Less Sodium

• The current recommendation (safe upper limit) is to consume less than 2300 mg of sodium/day

• 5 grams of sodium = 1 teaspoon of salt• All our bodies actually need is 500 mg.

Americans consume on the average 4000 to 6000 mg of sodium a day.

• For a person with high blood pressure the doctor my recommend less then 1500 mg sodium diet



LESS Sodium: Tips

• Buy fresh, plain frozen or canned “no added salt” vegetables

• Use fresh poultry, lean meat, and fish• Use herbs, spices, and salt-free seasonings at

the table and while cooking• Choose foods low in salt• Rinse canned foods to reduce sodium



More Potassium

• The amount of potassium in the diet is also important. Potassium works with sodium to regulate the body’s water balance. Research has shown that the more potassium and less sodium a person has in his/her diet, the greater the likelihood that the person will maintain normal blood pressure. Potassium rich foods should be eaten everyday.



Foods rich in potassium

• Bananas• White mushrooms• Avocados• Fish (salmon)• Plain yogurt• Acorn squash• Dried apricots• White skin potatos• Spinach, chard, kale• White beans, Lima beans



Other minerals

Magnesium & Potassium: • improve myocardial metabolism ~and~ inhibits arrhythmia

~and~ lowers blood pressure

Calcium: essential for myocardial contraction ~and~ assists in regulating blood pressure




DASH (Dietary Approaches to Stop Hypertension) diet

Based on a 11 week trial

Emphasize fruits, vegetables, low-fat dairy food, low sodium



DASH diet

http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf



Other Options - Pharmaceuticals

If lifestyle modification is not working, blood pressure medication may be needed, there are several types:

• Diuretics work on the kidney to remove excess water and fluid

from body to lower blood pressure

• Beta blockers reduce impulses to the heart and blood vessels



• ACE (angiotensis-converting enzyme) inhibitors- relax blood vessels allowing blood to flow freely

• Angiotensin antagonists- same as ACE inhibitors• Calcium Channel Blockers- causes the blood

vessel to relax and widen• Alpha Blocker- blocks impulse to the heart

causing blood to flow more freely

Other Options – Pharmaceuticals (cont.)



• Alpha-beta blockers- same as beta blockers, also slow the heart down

• Nervous system inhibitors- slow nerve impulses to the heart

• Vasodilators- widening of blood vessel, allowing blood to flow more freely

Other Options – Pharmaceuticals (cont.)


Lecture 22 – April 13, 2015 43

What is the optimal diet?

Maintain low-moderate Glycemic Index and Glycemic Load ~

Optimise Antioxidant & fibre intake ~ fruit & vegetables Increase Essential Fatty Acid intake & omega-3/omega-6

balance ~ Maintain protein intake ~ fish, nuts/seeds, lean meat,

cheese, legumes & wholegrains Reduce saturated fat & trans-fat intake ~ Reduce calorie intake ~ 20-30% reduction promotes

antiaging effect




Eating for a Healthy Heart

• Lower your chances of getting heart disease• Choose foods carefully, eat:

less fat less sodium fewer calories more fiber



The Heart Healthy Diet is designed to:

Decrease

• BAD Fats Saturated fat Trans fats

• Sodium

Increase

• Monounsaturated fat

• Omega 3 fatty acids

• Soluble fiber

Keep blood cholesterol low

Keep blood pressure in check



Less Fat:Dietary Guidelines for Fat

• Limit TOTAL fat intake to less than 25–35% • Limit Saturated fat intake < 7 % • Limit trans fat intake to < 1 % • Remaining fat should come from sources of

monounsaturated and polyunsaturated fats such as nuts, seeds, fish and vegetable oils

• Limit cholesterol intake to < 300 mg per day If you have coronary heart disease or your LDL

cholesterol level is 100 mg/dL or greater, limit your cholesterol intake to less than 200 milligrams a day



Maintain Healthy Weight

• Blood pressure rises as weight increases• Obesity is also a risk factor for heart disease• Even a 10% weight loss can reduce blood

pressure



Be Physically Active

• Helps lower blood pressure and lose/ maintain weight

• 30 minutes of moderate level activity every day. Can even break it up into 10 minute sessions

• Use stairs instead of elevator, get off bus 2 stops early, park your car at the far end of the lot and walk!



Limit Alcohol Intake

Alcohol raises blood pressure and can harm liver, brain, and heart

• What counts as an alcoholic drink?12 oz beer 100 calories

5 oz of wine 150 calories

1.5 oz of 80 proof whiskey 100 calories



Quit Smoking

• Injures blood vessel walls

• Speeds up process of hardening of the arteries



http://www.heart.org/presenter.jhtml?identifier=4973



Heart Health Claims

1. Dietary Saturated Fat and Cholesterol and Risk of Coronary Heart Disease

2. Sodium and Hypertension

3. Soluble Fiber from Certain Foods and Risk of Coronary Heart Disease

4. Soy Protein and Risk of Coronary Heart Disease

5. Stanols/Sterols and Risk of Coronary Heart Disease



Foods and Heart Health

Health Claims • Low Sodium foods • Oats • Plant sterol and stanol esters



Leading a Healthy Lifestyle

1. Follow a healthy eating pattern

2. Maintain a healthy weight

3. Be Physically Active

4. Limit Alcohol

5. Quit Smoking

food and your heart lecture 22 april 13, 2015 dr. quadro

Documents

blood slide

heart lecture

quadro slide

plaque cholesterol

tissue damage slide

good prevention slide

buildup of cholesterol

arterial wall