nutrition and cardiovascular disease
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Nutrition and Cardiovascular Disease. Cardiovascular Disease. Includes heart attack, stroke Leading cause of death in the U.S. Annually, 500,000 people die of CHD in the U.S. (1 million including strokes and other CVD) Each year, 1.5 million Americans have a heart attack. CVD Deaths by State. - PowerPoint PPT PresentationTRANSCRIPT
Nutrition and Nutrition and Cardiovascular Cardiovascular DiseaseDisease
Cardiovascular DiseaseCardiovascular Disease
Includes heart attack, strokeIncludes heart attack, stroke Leading cause of death in the Leading cause of death in the
U.S.U.S. Annually, 500,000 people die of Annually, 500,000 people die of
CHD in the U.S. (1 million CHD in the U.S. (1 million including strokes and other CVD)including strokes and other CVD)
Each year, 1.5 million Americans Each year, 1.5 million Americans have a heart attack have a heart attack
CVD Deaths by StateCVD Deaths by State
Heart Attack Heart Attack (Myocardial Infarction)(Myocardial Infarction)
Heart Attack Heart Attack (Myocardial Infarction)(Myocardial Infarction) When blood supply to the heart is When blood supply to the heart is
disrupted, the heart is damageddisrupted, the heart is damaged May cause the heart to beat May cause the heart to beat
irregularly or stop altogetherirregularly or stop altogether 25% of people do not survive 25% of people do not survive
their first heart attacktheir first heart attack
Symptoms of a Heart Symptoms of a Heart AttackAttack Intense, prolonged chest pain Intense, prolonged chest pain
or pressureor pressure Shortness of breathShortness of breath SweatingSweating Nausea and vomiting Nausea and vomiting
(especially women)(especially women) Dizziness (especially women)Dizziness (especially women) WeaknessWeakness Jaw, neck and shoulder pain Jaw, neck and shoulder pain
(especially women)(especially women) Irregular heartbeatIrregular heartbeat
Cerebrovascular Cerebrovascular Accident (CVA) or Accident (CVA) or Brain AttackBrain Attack
Brain Attack (Stroke) Brain Attack (Stroke) or Cerebrovascular or Cerebrovascular Accident Accident
Symptoms of Stroke Symptoms of Stroke (Brain Attack)(Brain Attack) Sudden numbness or weakness of the Sudden numbness or weakness of the
face, arm or leg, especially on one side face, arm or leg, especially on one side of the body of the body
Sudden confusion, trouble speaking or Sudden confusion, trouble speaking or understanding understanding
Sudden trouble seeing in one or both Sudden trouble seeing in one or both eyes eyes
Sudden trouble walking, dizziness, loss Sudden trouble walking, dizziness, loss of balance or coordination of balance or coordination
Sudden severe headacheSudden severe headache
Blood Lipid Levels are Blood Lipid Levels are Related to Risk of CVDRelated to Risk of CVD
Blood Lipids Blood Lipids (Lipoproteins)(Lipoproteins) Lipids (fat) cannot mix with waterLipids (fat) cannot mix with water Blood is high in waterBlood is high in water Lipids cannot travel in blood Lipids cannot travel in blood
without helpwithout help Lipoproteins are formed to carry Lipoproteins are formed to carry
lipidslipids
Lipoproteins combineLipoproteins combine
Lipids (triglycerides, Lipids (triglycerides, cholesterol)cholesterol)
ProteinProtein PhospholipidsPhospholipids
Low-Density Low-Density Lipoproteins (LDL-C)Lipoproteins (LDL-C) Also called “bad cholesterol)Also called “bad cholesterol) Contain relatively large amounts Contain relatively large amounts
of fat, and less proteinof fat, and less protein Deposits cholesterol in arteriesDeposits cholesterol in arteries Thus, Thus, ↑ ↑ LDL-C is associated with LDL-C is associated with ↑ ↑
CVD riskCVD risk Serum LDL-C should be < 130 mg/dLSerum LDL-C should be < 130 mg/dL
High-Density High-Density Lipoproteins (HDL)Lipoproteins (HDL) Also called “good cholesterol”Also called “good cholesterol” Relatively high in protein, lower in lipidRelatively high in protein, lower in lipid Acts as scavenger, carrying cholesterol Acts as scavenger, carrying cholesterol
from arteries to liverfrom arteries to liver– Liver packages as bileLiver packages as bile– ExcretesExcretes
↑ ↑ HDL-CHDL-C is ais associated with ssociated with ↓ ↓ risk of CVDrisk of CVD Serum HDL-C should be >60 mg/dL Serum HDL-C should be >60 mg/dL
(optimal) or at least >40 in men and (optimal) or at least >40 in men and 50 in women50 in women
TriglyceridesTriglycerides
The most diet-responsive blood The most diet-responsive blood lipidlipid
Should be Should be ≤150 mg/dL in ≤150 mg/dL in fasting statefasting state
Total CholesterolTotal Cholesterol
Includes HDL-C, LDL-C, and a Includes HDL-C, LDL-C, and a fraction of the triglyceridesfraction of the triglycerides
Total cholesterol should be ≤ 200 Total cholesterol should be ≤ 200 mg/dLmg/dL
Total cholesterol does not tell Total cholesterol does not tell whole storywhole story
Lipoprotein SummaryLipoprotein Summary
Evaluating Blood Evaluating Blood Lipids: LDLLipids: LDL
<100 mg/dL<100 mg/dL OptimalOptimal
100-129100-129 Near optimalNear optimal
130-159130-159 Borderline highBorderline high
160-189160-189 HighHigh
≥≥190190 Very highVery high
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Evaluating Blood Evaluating Blood Lipids: Total Lipids: Total CholesterolCholesterol<200 mg/dL<200 mg/dL DesirableDesirable
200-239 200-239 mg/dLmg/dL
Borderline highBorderline high
≥≥240 mg/dL240 mg/dL HighHigh
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Evaluating Blood Evaluating Blood Lipids: HDLLipids: HDL
< 40 mg/dL< 40 mg/dL LowLow
≥ ≥ 60 mg/dL60 mg/dL HighHigh
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Blood PressureBlood Pressure
Measured in mmHgMeasured in mmHg Systolic blood pressure: the pressure Systolic blood pressure: the pressure
in the arterial blood vessels in the arterial blood vessels associated with the pumping of the associated with the pumping of the heartheart
Diastolic blood pressure: the pressure Diastolic blood pressure: the pressure in the arterial blood vessels when the in the arterial blood vessels when the heart is between beatsheart is between beats
Hypertension: EitherHypertension: Either
Systolic blood pressure > 140 Systolic blood pressure > 140 mmHgmmHg
Diastolic blood pressure > 90 Diastolic blood pressure > 90 mmHgmmHg
Risk Factors (other Risk Factors (other than LDL) for CVDthan LDL) for CVD Cigarette smokingCigarette smoking Hypertension (BP ≥140/90 mmHg or on Hypertension (BP ≥140/90 mmHg or on
anti-hypertensive txanti-hypertensive tx Low HDL-C* (<40 mg/dL)Low HDL-C* (<40 mg/dL) Family history of premature CHD in first Family history of premature CHD in first
degree relative (in male <55 years, in degree relative (in male <55 years, in female <65 years)female <65 years)
Age (men ≥45 years, women ≥55 years)Age (men ≥45 years, women ≥55 years)
*HDL-C ≥ 60 mg/dL counts as a negative risk *HDL-C ≥ 60 mg/dL counts as a negative risk factorfactor
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Risk Factors (other Risk Factors (other than LDL) for CVDthan LDL) for CVD Diabetes (considered equivalent Diabetes (considered equivalent
to a history of CHD)to a history of CHD) ObesityObesity InactivityInactivity
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Screening for CVD RiskScreening for CVD Risk
Everyone 20 and older should have Everyone 20 and older should have his cholesterol measured at least his cholesterol measured at least every 5 yearsevery 5 years
Lipoprotein profile: includes TC, Lipoprotein profile: includes TC, LDL-C HDL-C, and TGLDL-C HDL-C, and TG
At least should include TC and At least should include TC and HDL-CHDL-C
If TC> 200 mg/dL or HDL-C< 40 If TC> 200 mg/dL or HDL-C< 40 mg/dL, obtain full lipid profilemg/dL, obtain full lipid profile
Source: National Cholesterol Education Program, National Institutes of Health, accessed 2-05
Total CholesterolTotal Cholesterol
John and Marty John and Marty each have total each have total cholesterol levels cholesterol levels of 200 mg/dL.of 200 mg/dL.
Their health risk Their health risk is differentis different
Total Cholesterol is Total Cholesterol is Not EnoughNot Enough
John’s Lipid John’s Lipid ProfileProfile
TC: 200 mg/dLTC: 200 mg/dL LDL-C: 140 LDL-C: 140
mg/dLmg/dL HDL-C: 30 mg/dLHDL-C: 30 mg/dL TG: 150 mg/dLTG: 150 mg/dL
Marty’s Lipid Marty’s Lipid ProfileProfile
TC: 200 mg/dlTC: 200 mg/dl LDL-C: 95 mg/dLLDL-C: 95 mg/dL HDL-C: 75 mg/dLHDL-C: 75 mg/dL TG: 150 mg/dLTG: 150 mg/dL
What Affects What Affects Cholesterol Levels?Cholesterol Levels? DietDiet WeightWeight Physical activityPhysical activity Age and genderAge and gender HeredityHeredity
You control the first three!You control the first three!
Lowering LDLsLowering LDLs
See your doctor to assess for See your doctor to assess for other conditionsother conditions
Reduce dietary saturated fat, Reduce dietary saturated fat, trans fatty acids, and cholesteroltrans fatty acids, and cholesterol
Increase MUFA and PUFAIncrease MUFA and PUFA Increase dietary fiber (soluble)Increase dietary fiber (soluble)
Lowering Blood TGLowering Blood TG
Is the most diet-responsive blood Is the most diet-responsive blood lipidlipid
Avoid overeatingAvoid overeating Limit alcoholLimit alcohol Limit simple sugarsLimit simple sugars Small frequent mealsSmall frequent meals Include fish in the dietInclude fish in the diet
Raise the HDLRaise the HDL
Physical activityPhysical activity At least 45 min./day, 4 days a weekAt least 45 min./day, 4 days a week Avoid smokingAvoid smoking Eat regularly Eat regularly Eat less total fatEat less total fat Moderate intake of alcohol Moderate intake of alcohol
increases HDL increases HDL
Therapeutic Lifestyle Therapeutic Lifestyle Changes (TLC)Changes (TLC) TLC DietTLC Diet Physical activity (30 minutes on Physical activity (30 minutes on
most, if not all, days)most, if not all, days) Weight management: will help Weight management: will help
manage triglycerides, increase manage triglycerides, increase HDL, HDL,
DASH: Dietary DASH: Dietary Approaches to Stop Approaches to Stop HypertensionHypertension Eat foods that are low in fat, Eat foods that are low in fat,
saturated fat, and cholesterolsaturated fat, and cholesterol Eat more fruits, vegetables, whole Eat more fruits, vegetables, whole
grains, and lowfat dairy productsgrains, and lowfat dairy products Eat more poultry, fish, nuts, and Eat more poultry, fish, nuts, and
legumeslegumes Eat less red meat, fats, sweets, Eat less red meat, fats, sweets,
and sugared beveragesand sugared beverages Eat foods low in salt and sodiumEat foods low in salt and sodiumNHLBI. DASH Eating Plan, revised 2003. Accessed 2-2005