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© 2007 Thomson - Wadsworth
Chapter 21
Nutrition & Disorders of the Heart & Blood
Vessels
© 2007 Thomson - Wadsworth
CVD Deaths in the U.S.
© 2007 Thomson - Wadsworth
Athrosclerosis
• Artery walls become progressively thickened due to accumulation of plaque
• Occurs due to minimal but chronic injuries that damage the inner arterial wall
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Consequences
• Lumen narrows• Plaque can
rupture, forming a clot (thrombus)
• Thrombus can break free & shut off blood flow (embolism)
• Ischemia occurs within the tissueCoronary arteries
(angina pectoris & heart attack)
Brain (stroke)
• Aneurysm (sac-like distention of blood vessel wall)
© 2007 Thomson - Wadsworth
Causes of Athrosclerosis
• Inflammation & infection
• Hypertension • Smoking
• Diabetes mellitus• Aging• Elevated LDL &
VLDL
© 2007 Thomson - Wadsworth
Coronary Heart Disease
• Most common type• Leading cause of
death in U.S.• Evaluating Risk
SmokingHigh LDLHigh blood pressureDiabetesObesity Inactivity
• Non-modifiable risk factorsAgeMale genderFamily history
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Lifestyle Changes for CHD
• Cholesterol-lowering diet (<200 mg)
• Weight reduction• Regular physical
activity• Decrease saturated
fat <7% total kcalories
• Decrease total fat 25-35% of kcalories
• Decrease trans fat• Increase soluble fiber• Plant sterols &
stanols• Eat soy products• Increase fish &
omega-3 fatty acids• Moderate alcohol
© 2007 Thomson - Wadsworth
Lifestyle Changes for Hypertriglyceridemia
• MildWeight reductionPhysical activityQuit smokingAvoid high-CHO
dietRestrict alcohol
• SevereWeight reductionPhysical activityVery-low-fat diet:
<15% of kcaloriesMedication
© 2007 Thomson - Wadsworth
Vitamin Supplementation
• No conclusive research results have been obtained for vitamins being preventative for CVD
• Study is underway for increasing:Folate, vitamin B6 & B12 to decrease
homocysteine levelsVitamin C and E for antioxidant effects
© 2007 Thomson - Wadsworth
Drug Therapies for CHD Prevention
• Statins Reduce cholesterol
synthesis in the liver
• Bile acid sequestrants Reduce cholesterol &
bile absorption in small intestine
• Nicotinic acid Lowers triglycerides &
raises HDLs
• Anticoagulants & aspirin Suppress blood
clotting
• Blood pressure medications
• Nitroglycerin for angina
© 2007 Thomson - Wadsworth
Treatment for Heart Attack
• Drug therapyThrombolyticsAnticoagulantsAspirinPainkillersBlood pressure
medicationsRhythm stabilizers
• No food until stableSoft foodsLow sodiumLow saturated fat
• Cardiac rehabilitation
© 2007 Thomson - Wadsworth
Hypertension
• Affects 1/3 of adults in U.S.
• Factors influencing BPCardiac outputPeripheral resistanceSecretion of hormones
by kidneys
• Desirable BP < 120/80
• Prehypertension 120-139/80-89
• Hypertension > 140/90
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Contributing Factors
• Aging• Genetics
More prevalent in African Americans
• ObesityAlters kidney
function & promotes fluid retention
• Salt sensitivity30-50% of cases
• Alcohol3-4 drinks daily
• DietFruits, vegetables,
nuts, low-fat milk can lower BP
Potassium, calcium, & magnesium can lower BP
© 2007 Thomson - Wadsworth
Treatment of Hypertension
• Weight reduction• Low-sodium diet• Diet rich in
potassium, calcium, & magnesium
• Regular physical activity
• Moderate alcohol
• DASH Diet - Limits: Red meatsSweetsSugar-containing
beveragesSaturated fat to <7%Cholesterol to 150
mg/day
• Drug therapy
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Congestive Heart Failure
• Heart’s inability to pump adequate blood
• Fluids build up in veins & tissues
• Heart enlarges• 75% are 65 or
older
• ConsequencesFluid accumulation in
liver, abdomen, & lower extremities
Chest pain; swelling legs, ankles, feet; SOB
Impaired liver & kidneysHeart failureCardiac cachexia
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Medical Management
• Sodium & fluid restrictions• Diuretics• Small, frequent meals• Vaccinations for influenza
& pneumonia• Adequate fiber• Avoid alcohol• Liquid supplements, tube
feedings, parenteral support
© 2007 Thomson - Wadsworth
Stroke
• 3rd leading cause of death
• Types IschemicHemorrhagicTransient ischemic
attacks (TIAs)
• PreventionRecognize risk factorsLifestyle changes
• ManagementThrombolytic drugsMaintain nutrition statusProblems
• Lack of coordination• Difficulty swallowing