Nutrition & Diet Therapy (7 th Edition) Fat-Controlled, Mineral-Modified Diets for Cardiovascular...

Nutrition & Diet Therapy (7th Edition)

Fat-Controlled, Mineral-Modified Diets for Cardiovascular

Diseases

Chapter 22


Cardiovascular Disease

• General term describing diseases of the heart & blood vessels

• Global issue– Accounts for approximately 37% of

deaths in U.S. & 29% worldwide– Leading cause of death in Europe– More women die from CVD than men

every year



I. Atherosclerosis

• Accumulation of fatty deposits, smooth muscle cells & fibrous connective tissue—forming plaque, on the inner walls of the arteries

• Leads to progressive thickening of arterial walls

• Eventually narrows lumen of artery, interfering with blood flow

• Affects almost any organ or tissue in the body—resulting in many consequences


Atherosclerosis• Consequences

– Thrombosis: formation of blood clot within the artery; enlarges over time, causing obstruction in blood flow

– Embolus: a portion of blood clot that breaks free & travels through circulatory system; eventually lodges in smaller vessel & interrupts blood flow, causing sudden tissue death

– Ischemia: lack of blood supply within tissues, due to obstruction of blood flow through arteries; major complication caused by atherosclerosis

– Aneurysm: abnormal enlargement or bulging of blood vessel wall; vessel weakens & is prone to rupture, causing massive bleeding & death


Atherosclerosis

• Causes– Begins to develop as early as childhood &

adolescence; progresses before onset of symptoms

– Inflammation & infection– Hypertension– Smoking– Elevated LDL & VLDL– Diabetes mellitus– Aging


II. Coronary Heart Disease

• Most common type of cardiovascular disease; leading cause of death in U.S.

• Usually caused by atherosclerosis in large & medium-sized arteries that supply heart muscle with oxygen & nutrients

• Evaluating risk– Prevention usually begins by reducing risk– Classic risk factors

• Smoking• High LDL cholesterol• High blood pressure• Diabetes

– CHD risk assessment-lipid profile at 20 yrs & every 5 yrs




Coronary Heart Disease

• Therapeutic Lifestyle Changes (TLC) for lowering CHD risk (p. 607-611)– Approach to risk reduction promoted by National

Cholesterol Education Program• Cholesterol-lowering diet• Weight reduction• Regular physical activity

– Substantial progress may be seen after 6 weeks if followed carefully

– Individuals with high risk of CHD should try to lower LDL cholesterol with at least 3-month trial of TLC before starting drug therapy

– When high LDL levels persist despite adherence to a TLC program, drug therapy may be only effective treatment



• Dietary strategies– Reduce saturated fat in

diet; control overall fat & cholesterol

– Increase carbohydrates from whole grains, legumes, fruits & vegetables

– Avoid foods with trans fatty acids

– Select foods high in soluble fiber

– Limit sodium intake to 2400 mg per day

– Consume fish & omega-3 fatty acids on regular basis

– Use alcohol in moderation

• Lifestyle choices– Increase physical activity to

at least 30 minutes of moderate intensity most days of week (4/7d.)

– Smoking cessation; limit exposure to any form of tobacco

• Weight reduction– May improve other risk

factors– General goal: prevent weight

gain, reduce body weight & maintain lower body weight

– Initial goal: lose no more than 10% of original body weight



• Lifestyle changes for hypertriglyceridemia

– Elevated blood triglycerides– Common in people with diabetes mellitus &

metabolic syndrome– Can result in serious complications (fatty

deposits in liver & pancreatitis)– Diet & lifestyle may contribute to mild

hypertriglyceridemia– Genetic factors are usually responsible for

severe cases (“high” & “very high” levels)

Blood TriglyceridesBorderline high: 150-199 mg/dL

High: ≥200 mg/dL


Coronary Heart DiseaseMild hypertriglyceridemia– Dietary & lifestyle changes

can improve– Contributing factors

• Overweight & obesity• Sedentary lifestyle• Cigarette smoking• Dietary factors (high intake of

alcohol & carbohydrate, sucrose & fructose)

– Basic treatment• Controlling body weight• Being physically active• Quitting smoking• Restricting alcohol• Avoiding high carbohydrate

intake

Severe hypertriglyceridemia– Medications usually

necessary– Weight reduction &

physical activity emphasized

– Very-low-fat diet (<15% of kcalories from fat) in extreme cases


Coronary Heart Disease• Vitamin supplementation & CHD risk-studies are

inconclusive and therefore supplementation is not recommended at this time– B vitamin supplements & homocysteine

• Homocysteine is known risk factor for CHD—direct causative relationship unknown

• Increased intakes of folate, vitamins B6 & B12 lower homocysteine levels; direct effect of these vitamins on reducing risk is not demonstrated in research studies

– Antioxidant vitamin supplements• Some studies suggest relationship of antioxidant-rich diets

(like Vit. C and E) may protect against CHD; other suggest possible harm

• Study results still inconclusive



• Drug therapies for CHD prevention– Dietary & lifestyle changes may not be

fully effective in reducing LDL goals– LDL-lowering drugs

• Statins: reduce cholesterol synthesis in liver• Bile acid sequestrants: reduce cholesterol &

bile absorption in small intestine• Niacin (nicotinic acid): reduces blood

triglycerides & increases HDL levels (when taken in high amounts)

– Anticoagulants & aspirin


Coronary Heart Disease• Treatment for heart attack (MI)

– May result from blockage of one or more coronary arteries, cutting off blood supply to heart muscle

– Medications• Thrombolytic drugs: immediately after heart attack breaks clots• Anticoagulants, aspirin• Pain medications• Medications to regulate heart rhythm & reduce blood pressure

– Dietary management• Low-sodium diet• Low saturated fat & cholesterol

– Cardiac rehabilitation programs• Exercise therapy• Smoking cessation• Stress management• Dietary instruction• Medication counseling


III. Hypertension• Affects almost 1/3 of adults in U.S.

– Especially prevalent among African Americans– Estimated 37% of people with hypertension are unaware

of problem• Primary risk factor for atherosclerosis & cardiovascular

diseases—increases risk for…– Cardiac arrhythmias (abnl muscle contractions…)– Congestive heart failure– Stroke– Kidney failure– Sudden death

• Reducing blood pressure can dramatically reduce incidence of these diseases


Blood Pressure Measurement

Systolic BP: • measurement of

pressure in arteries during contraction of heart muscle

Diastolic BP: • measurement of

pressure in arteries during resting or relaxation of heart muscle

• Desirable BP– Systolic <120 mmHg– Diastolic <80 mmHg

• Prehypertension– Systolic 120-139 mmHg– Diastolic 80-89 mmHg

• Hypertension– Systolic ≥140 mmHg– Diastolic ≥90 mmHg


Hypertension

• Contributing factors– Aging– Genetics– Obesity (60% obese)

– Salt sensitivity (30-50%)

– Alcohol– Diet

• Treatment– Lifestyle

modifications• Weight reduction• DASH eating plan• Sodium restriction• Physical activity• Moderate alcohol

consumption

– Drug therapiesDASH Eating Plan-p. 616-618

“Dietary Approaches to

Stop Hypertension”



IV. Congestive Heart Failure

• Characterized by inability of heart to pump adequate blood– Results in buildup of

fluid in veins & tissues– Can develop after

illness that impairs heart’s ability to fill with or eject blood

– Heart cannot cope with usual workload

– Develops primarily in elderly individuals

• Consequences of CHF– Fluid accumulation in liver,

abdomen & lower extremities

– Fluid buildup in lungs, causing shortness of breath & limited tolerance for activity

– Impaired function to other organs, such as liver & kidneys

– Reduced food intake

Cardiac CachexiaMalnutrition caused by changes in body chemistry & reduced appetite & food intake; severe weight loss &

tissue wasting


Congestive Heart Failure• Medical management

– Goals of treatment: to enhance the patient’s quality of life & slow disease progression

– Treatment depends on nature & severity of illness– Drug therapy

• Manage congestion & improve heart function• Diuretics to reverse or prevent fluid retention

– Nutrition therapy• Moderate sodium intake to 2000-3000 mg/day• Severe cases of CHF may need stricter sodium restriction:

to 2000 mg/day or less• Fluid restriction may be necessary• Small, frequent meals or enteral supplements may be

better tolerated if eating difficulties exist• Avoid alcohol


V. Stroke (CVA)• Third leading cause of death in U.S. (after heart

disease & cancer)• Most strokes are consequence of atherosclerosis

or hypertension, or both• Ischemic strokes (majority of incidence—about

88%) result from obstruction of blood flow to brain tissue

• Hemorrhagic stroke results from bleeding in brain tissue & resultant tissue damage

• Transient ischemic attacks (TIA): brief “strokes” (lasting 2-30 minutes)– Warning sign that more severe stroke may follow– Usually treated with aspirin & other drugs that inhibit

blood clotting


Stroke• Stroke prevention

– Risk factors are similar to CHD

– Lifestyle changes to reduce risk

– Drug therapy• Aspirin• Antiplatelet drugs• Anticoagulants

• Stroke management– Specific symptoms depend

on area of brain affected– Early diagnosis & treatment

necessary to preserve brain tissue & minimize long-term disability

– Early administration of thrombolytic drugs

• Nutritional goals– Maintain nutrition status &

overall health, despite disabilities

– Management of food intake, depending on level of disability & associated problems with food intake

– Tube feedings may be necessary until disabilities are resolved & patient regains eating/swallowing & communication skills


Nutrition in Practice—Metabolic Syndrome

• Metabolic syndrome– Group of disorders that substantially increases

risk of development of cardiovascular disease– Cluster of at least 3 of the following:

• Hyperglycemia• Obesity• Elevated blood triglycerides• Reduced HDL cholesterol levels• Hypertension

– Causes• Precise cause unknown• Close relationship between abdominal obesity &

insulin resistance may be partly responsible



Nutrition in Practice—Metabolic Syndrome

• Treatment– Primarily treated with diet & lifestyle changes—goal is to

correct abnormalities that increase CVD risk– Combination of weight loss & physical activity can

improve insulin resistance, blood pressure & blood lipid levels

– Additional strategies depend on specific symptoms– Dietary strategies

• Reduce intake of added sugars & refined grains• Increase servings of whole grains & foods high in fiber• Carbohydrate restriction may help reduce triglyceride

levels & improve hyperglycemia• Low saturated fats, trans fats & cholesterol can help reduce

LDL levels

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