Coronary Heart DiseaseCoronary Heart Diseaseandand

HypertensionHypertensionChapter 19

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Coronary Heart Disease and Coronary Heart Disease and HypertensionHypertension

CV disease is the #1 cause of death in the U.S.

We’ll look at the primary underlying disease process, atherosclerosis, and the various risk factors involved

We’ll explore ways to use nutritional approaches to reduce these risk factors and help prevent disease

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Coronary Heart Disease and Coronary Heart Disease and HypertensionHypertension

Key Concepts◦Several risk factors contribute to the

development of cardiovascular disease and HTN, many of which are preventable by improved food habits and lifestyle behaviors

◦Other risk factors are non- modifiable such as age, gender, family hx. and race

◦HTN maybe classified as “essential” (primary) or secondary HTN

◦Early education is critical for the prevention of cardiovascular disease.

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Coronary Heart DiseaseCoronary Heart Disease

AtherosclerosisAcute cardiovascular

diseaseChronic heart disease

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AtherosclerosisAtherosclerosis

Disease process◦Fatty fibrous plaques develop into fatty streaks

on inside lining of major blood vessels. Process may begin in childhood fatty streaks, largely composed of cholesterol

◦Gk. Athera = “gruel”; Sclera = “hardening”◦The fatty fibrous process thickens over time,

narrowing the interior part of the blood vessel impeding or cutting off blood flow to cells beyond the blockage

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AtherosclerosisAtherosclerosis

◦Cells die when deprived of their normal blood supply.

◦The local area of dying or dead tissue is called and “infarct”.

◦If affected vessel is major artery supplying heart muscle, result could be myocardial infarction (heart attack).

◦If affected vessel is major artery supplying brain, result could be cerebrovascular accident.

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Atherosclerotic Plaque Atherosclerotic Plaque in Arteryin Artery

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Normal Human Heart: Posterior Normal Human Heart: Posterior External ViewExternal View

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AtherosclerosisAtherosclerosis

The major arteries and their branches serving the heart are called coronary arteries

The overall disease process is coronary heart disease

Common symptom: angina pectoris or chest pain, usually radiating down the arm

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Relation to Fat MetabolismRelation to Fat Metabolism

Elevated blood lipids associated with coronary heart disease◦Triglycerides—simple fats in body or food

◦Cholesterol—fat-related compound produced in body; also in foods from animals

◦Lipoproteins—“packages” wrapped with protein that carry fat in the blood stream

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Relation to Fat MetabolismRelation to Fat Metabolism

Lipoproteins are grouped and named according to their protein, fat, and cholesterol content (e.g. density – those with higher protein content have higher density

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Types of LipoproteinsTypes of Lipoproteins

3 of these types of lipoprotein found in the liver are significant in relation to heart disease risk:

Very low-density lipoproteins (VLDL)◦Carry large load of triglycerides to cells◦Include approx. 12% cholesterol

Low-density lipoproteins (LDL)◦Carry two thirds of total plasma cholesterol to body tissues constantly send cholesterol to tissues “bad cholesterol”

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Types of LipoproteinsTypes of Lipoproteins

High-density lipoproteins (HDL)

Carry less total fat and more protein

Not found in foods; produced in the liver. Takes cholesterol from tissues to liver for breakdown and elimination

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Risk FactorsRisk Factors

Sex – CVD occurs more often in men than women until menopause, at which time the relative risks are the same

Age – general risk increases with age (men > 45 years and women > 55 years)

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Risk FactorsRisk Factors

Heredity – ethnic groups that have a higher incidence of risk factors and CVD; including “familial hypercholesterolemia” and “familial hypertryglyceridemia”.

Ethnic groups include: African Americans, Hispanics, Native Americans

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Risk FactorsRisk Factors

Elevated serum cholesterol – major risk factor especially when combined with obesity, lack of exercise, stress, smoking, and increased food intake

Compounding diseases – diabetes, hypertension, metabolic syndrome

Dietary fat – affects serum cholesterol

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National Cholesterol Education National Cholesterol Education Program (NCEP) GuidelinesProgram (NCEP) Guidelines

Therapeutic Lifestyle Changes approach

Total energy intake = energy expenditure

Total fat should not exceed 25-35% of diet

Avoid trans fatty acidsCHO mainly from complex CHOs

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National Cholesterol Education National Cholesterol Education Program (NCEP) GuidelinesProgram (NCEP) Guidelines

Total protein from sources other than animals should be included

Total cholesterol intake < 200mg/day

Exercise to expend at least 200 kcals/day

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Drug TherapyDrug Therapy

In the event that LDL cholesterol is above goal range, drug therapy may be added to diet therapy depending on the level of risk

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Acute Cardiovascular DiseaseAcute Cardiovascular Disease

May be associated with MI◦When CV disease progresses to the point of cutting off the blood supply to major coronary arteries, a critical vascular event – heart attack/MI- may occur.

After an infarction, enzymes and proteins are released from the damaged heart muscle = “cardiac markers”◦ can be measured in blood tests: CPK, ◦TROPONIN is heart muscle- specific

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Acute Cardiovascular DiseaseAcute Cardiovascular Disease

Initial phase Objective: cardiac restImmediate care includes: analgesics and supplemental oxygen

All care, including diet, is directed toward ensuring that the heart rests so that the damaged heart can be restored to normal functioning

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Acute Cardiovascular DiseaseAcute Cardiovascular Disease

Principles of diet therapy◦Reduced energy intake (1200-1500 kcal) – a

brief period of reduced energy intake during the first day or so after the heart attack reduces the metabolic workload on the damaged heart.

◦Soft food texture – easily digested to avoid excess effort in eating or the discomfort of gas formation

◦Controlled amount and type of fat◦Mild sodium restriction (2-3 g/day)

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Chronic Heart DiseaseChronic Heart Disease

CHF and pulmonary edema

The progressively weakened heart muscle is unable to maintain an adequate cardiac output to sustain normal circulation fluid imbalance pulmonary edema.

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Chronic Heart DiseaseChronic Heart Disease

Objective: control of pulmonary edema and resulting fluid imbalance◦Mild-severe sodium

restriction◦Fluid restriction – often

limited to 1500 ml. /day

◦Texture – soft foods◦Small meals◦Alcohol – limited or

avoided

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Essential HypertensionEssential Hypertension

Hypertension called the “silent disease”Essential HTN – specific cause is unknownSecondary HTN – HTN is a symptom or

side effect of another primary conditionRisk Factors:Highly inherited disorderObesity worsensCan begin in adolescent yearsMade worse by physical inactivity, stress,

alcohol and drug use, and salt intake.

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Types of Hypertensive Blood Pressure LevelsTypes of Hypertensive Blood Pressure Levels

Adult normal BP – 120/80 or belowStage 1 hypertension

◦Focus on diet therapy, without drugs◦Reduce excess weight and restrict sodium

Stage 2 hypertension◦Diet therapy and drugs, as needed◦Use of diuretic and potassium replacement

Stage 3 hypertension◦Diet therapy and vigorous drug therapy

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Principles of Medical Nutrition TherapyPrinciples of Medical Nutrition Therapy

Weight management—lose weight and maintain appropriate weight for height

Increase Physical activity

Sodium controlOther minerals—

calcium, magnesium may be beneficial

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Principles of Medical Nutrition TherapyPrinciples of Medical Nutrition Therapy

DASH diet – Dietary Approaches to Stop Hypertension

4-6 servings fruit4-6 “” veggie2-3 “” low-fat dairyLean meatsHigh-fiber grains14 days to lower

B/P

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Education and Prevention Practical Food GuidesEducation and Prevention Practical Food Guides

Food planning and purchasing◦Control energy intake; read labels

◦Eat fresh foods with small selection of processed foods, if any

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Education and Prevention Practical Food GuidesEducation and Prevention Practical Food Guides

Food preparation◦Use less salt and fat◦Use seasonings

instead (herbs, spices, lemon, onion, garlic, etc.)

◦Take time to cookSpecial needs:

individual adaptation of diet principles according to preferences, ethnic diets, and food habits

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Education PrinciplesEducation Principles

Start earlyPrevention begins in

childhood, especially with children in high-risk families

Focus on high-risk groups

Direct education to people and families with risk of heart disease and hypertension

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Education PrinciplesEducation Principles

Use variety of resources◦National organizations, community programs, registered dieticians

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