The Role of Diet in CVD

Presented By:

Lisa Spott R.D

Clinical Nutrition – Cardiology

St. Mary’s General Hospital

A Professional Opinion

• Reliable source for health information

• Clarify media reports on various nutrition topics

• Help distinguish nutrition myth from nutrition fact

CLARITY

Workshop Goals

Answer your questions about nutrition and CVD management.

Provide useful tools and resources that can be used in the treatment of the CVD patient

Workshop Topics

Case #1 – Elevated Lipid Profile

Case #2 – Weight Loss

Case #3 – CHF

Points of interest:

• Homocysteine

• Omega-3 Fatty Acids

• DASH Diet

Where Do You Start?

Case Study • 55 year old male• PMHx: hypercholesterolemia• Family Hx: premature CVD• Ex-smoker• Exercises 30min 3x/wk• BP 115/79 mm hg• BMI - 29 • WC - 39in

Lab Values

Lab test Values

ATP III Reference Values

(primary prevention)

Total Cholesterol 7.44 < 5.2

LDL Cholesterol 4.32 <2.5

HDL Cholesterol 0.93 >1.0

Triglycerides 1.58 <1.7

Problem List

• Elevated TC

• Elevated LDL

• Low HDL

• Overweight

• Family History concerns

Diet Vs. Drugs

• Despite the wide spread use of statins and their effectiveness in reducing

cardiovascular disease, diet is still the preferred treatment option in primary prevention

The Portfolio DietDiet Components Dietary Change Approx. %

LDL

NCEP II <7% saturated fat

<200mg cholesterol/d10

Portfolio Diet:Soluble Fibre 20g/d 5

Vegetable protein 80g/d 5

Plant Sterols 2g/d 5

Almonds 30g/day 5

Cumulative Potential Effect 20-30

ATP III

Dietary Component Dietary Change Approx. %

LDL

Saturated Fatty Acids <7% kcal 8-10

Cholesterol <200mg/d 3-5

Weight Reduction Lose 10 pounds 5-8

Soluble Fibre 5-10g/d 3-5

Plant Sterols 2g/d 6-15

Cumulative Potential Effect 20-30

The Mediterranean Diet

Daily Activity

www.oldwayspt.org/

A Diet Prescription for Heart Disease

In 5 minutes or less…

Physician Nutrition Check List for Heart Health “The 5 F’s”

Fruits & Vegetables

Unsaturated Fats

Fish

Fibre

Food Portions

Fruits and Vegetables

• Current recommendations are to aim for 7-10 fruits and vegetable servings everyday

• Limit red meat to < 1 x per week• Choose a soft non-hydrogenated margarine• Choose low fat dairy products 1% M.F.or less for

milk, yogurt and cottage cheese, <20% M.F. for cheese

• Choose olive and canola oil for cooking• Snack on a ¼ cup of nuts daily

Unsaturated Fats

• Aim for 2-3 meals of fish per week• Salmon and trout are high in omega-3 fats

Fish

Fibre

• Recommendations for daily Fibre intake:

Men: 30-38 grams per day

Women: 21-27 grams per day

Soluble Fibre recommendation: 10-15grams per day• Sources include: psyllium, oatbran, oatmeal,

beans, lentils, some fruits and vegetables

• Eat frequently throughout the day so it is easier to control food portions

• Measure foods at home and become familiar with recommended portion sizes

Food Portions

In 5 minutes or less…

Fruits & Vegetables

Get a HANDle on Heart Healthy Nutrition

Fish

FibreFats

Food Portions

Get a HANDle on Food Portions

3 oz

¼ cup

1 cup&

½ cup

1 tsp

1 oz

Case Study # 2 -Weight Loss

• Patient returns to your office to review results of blood lipid profile

• In addition to elevated LDL-C patient has a BMI of 29.

Patient asks which “fad” diet you would recommend.

Discrediting Fad Diets

Diets Evidence of in

Coronary Disease

Weight LossShort term Long term

CompliancePotential

Worsening/

Side effects

VLFDOrnish

+ + + + + + + + + DM, Met

Syndrome

Low

Carb

Atkins

+/- + + + +/- + Gout, renal

disorders, hair loss, constipation,

bad breath

AHA + + + + + + + + None

Reported

DASH + + + + - - - None

Reported

Questions to ask when choosing a weight loss program…

1. Has a registered dietitian helped to design the program or is one available to talk with you?

2. Is the recommended weight loss more than 2 pounds per week?

3. Does the program provide at least 1200 Calories (5000 kilojoules) per day for women and 1500 Calories (6500 kilojoules) per day for men?

4. Does the program depend on special products, special foods, supplements or treatments?

Case Study #3– CHF

• Patient with know history of CHF comes to see you with complaints of increased ankle edema. The patient is on

maximum diuretic therapy, what else can you do for this patient to help her out of this potential crisis?

Nutrition Management of CHF

• Low Salt Diet:

2400mg sodium per day

• Fluid restriction:

1.5L fluid per day

Ask your CHF patient…

• Are you adding salt at the table or in cooking?

• Do you consume canned soups, vegetables or stews?

• Do you eat packaged frozen entrees?

• Do you eat processed cheese

and prepared meats?

• Do you eat out frequently?

Sodium and Food Labels

Using % Daily Value

% Daily Value How Much Sodium?

What does it mean?

< 5% <125mg sodium per serving

A low sodium food that can be enjoyed daily

5-10% 125-250mg sodium per serving

A food that can easily fit into a low sodium diet

11-20% 250-500mg sodium per serving

A food that can be carefully fit into a low sodium diet

>20% >500mg sodium per serving

A high sodium food that should not be consumed daily when following a low sodium diet

Fluid restriction

• Encourage the patient to track their fluid intake daily

•Remind patients that fluids include: Water, coffee, tea, milk, juice, pop, soup,

jello, nutrition supplements, alcohol, ice cream, thin fluids at room temperature

Additional Thoughts on CHFManagement…

• Multivitamin supplementation

• Thiamine supplementation

• Interpreting BMI in the CHF patient

Heart Failure Society of America

Education modules available online at

www.hfsa.org/pdf/module2.pdf

Should I be taking a vitamin B supplement?

Although two recent studies did show that the vitamins cut homocysteine levels, that did not translate into a reduction in the risk for heart attacks or strokes.

Lonn, E. et al. McMaster University. N Eng J of Med. 2006

Bonaa, K.H. et al. University or Tromso. N Eng J of Med.2006

I have heard a lot recently about Omega-3 fats…

• AHA recommends 2-3 meals of fish per week to meet omega-3 fatty acid requirements, 1000mg per day, for CVD prevention

Is an Omega-3 supplement a good idea?

• Omega-3 supplements are recommended for those who do not eat fish regularly

• Choosing a supplement:

1000mg capsule 400mg EPA

200mg DHA

600mg total

Take 1-2 times per day.

The DASH Diet• Dietary Approaches to Stop Hypertension

Grains and grain products 7-8 daily Fruits 4-5 dailyVegetables 4-5 dailyLow fat or fat free dairy 2-3 dailyMeats 2 or less dailyNuts,seeds and dry beans 4-5 x per weekFats and oils 2-3 dailySweets 5 per week

The DASH Eating Plan

Website Resource:

Download a copy of the DASH Eating Plan

www.nhlbi.nih.gov/health/public/heart/hbp/dash/

Community Services

• Referral to a private practice dietitian

• Meals on Wheels

• Cardiac Rehab

• Heart Function Clinic

• SMGH is considering a fee-for-service weightloss program…details to come