Nutrition & Heart Disease

Key Concepts and Facts

Heart disease is leading cause of death

Dietary and lifestyle factors are important

Diets that provide some “healthy fats” decrease heart disease risk more than low fat, high carbohydrate diets

Lowering high blood cholesterol levels reduces risk of heart disease

Heart disease is the leading cause of death for both men and women.

About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.

Fig. 19-2, p. 3

Average age of first heart attack is 64.7 years for men and 72.2 years for women.

Risk of Cardiovascular Disease

Fig. 19-6, p. 4

Fig. 19-3a, p. 3

Atherosclerosis

Fig. 19-3b, p. 3

Fig. 19-4, p. 4

CAN THESE BE

SYMPTOMS OF RISK OF HEART

DISEASE?

Xanthomas– fat deposits

Total Cholesterol: Not the whole story

Harvard Health News

Fig. 19-8, p. 6

FOCUS ON BLOOD LIPIDSHDL helps remove cholesterol from the bloodHDL carries cholesterol to the liver for excretion

High HDL (> 50 mgm/dl for women, >40 in men)

protects against CVD

LDL cholesterol incorporated into plaque

Higher the LDL level, more likely atherosclerosis will develop and progress to heart disease

Triglycerides and CVD Risk High levels increase heart disease riskElevated triglycerides are one symptom of metabolic syndromeAlso low HDL cholesterolElevated fasting glucoseAbdominal obesityHigh blood pressure, low HDL

People with metabolic syndrome are at particularly high risk for heart disease

Other Factors: Folate and Homocysteine

High blood levels of homocysteine, an amino acid, increase plaque formation

Folate is required to convert the amino acid homocysteine to methionine, reducing homocysteine in the blood.

Harvard Health NewsThere is some evidence that B vitamins, including folic acid, B6, and B12, may help lower blood levels of a substance called homocysteine

The risk of heart attack or death from heart disease was nearly halved among women who consumed the most folic acid and B6 from diet and supplements compared with those who consumed the least.

Folate, B6 and B12

One meta-analysis showed that consumption of 400 mgm folic acid in fortified foods or supplements reduced homocysteine by 25%

When folic acid was combined with vitamin B12, homocysteine levels sank another 7%

Since 1998 refined grain products like bread, crackers, pasta, and rice have been fortified with folic acid.

Oxidation and Chronic Inflammation

Oxidation causes damage to endothelium (cells lining arteries)

Inflammation increases plaque formation

Table 19-1Foods that reduce oxidation and chronic inflammation

Fish, seafood

Nuts

Tea, coffee

Most fruits and vegetables

Wine

Whole grains, high-fiber foods

Vegetable oils

Textbook correction: p. 19-7 line 20: change to “other components of foods that reduce oxidation…”

DHA and EPA

Fatty fish from cold waters are sources of DHA and EPA

Omega-3 fatty acids protect against heart disease by: decreasing blood clotting decreasing blocked arteries decreasing plaque build-up decreasing blood pressure decreasing blood triglyceride levels

NutsNut consumption decreases risk of CVD

Nuts have good fats that lower LDL

1 oz of nuts a day decreases LDL

1 oz has ~200 calories FDA approved “heart healthy” claim for nuts and products made from them

A recent detailed analysis of 84 of the best studies looking at the alcohol and heart connection included more than two million men and women followed for an average of 11 years. Compared to people who didn’t drink alcohol, those who were moderate drinkers had a29% lower risk of being diagnosed with coronary artery disease25% lower risk of dying from a heart attack25% lower risk of dying from any heart or blood vessel disease13% lower risk of dying from any cause (this included cancer deaths, too)

Special Spreads

Spreads with plant stanols lower blood cholesterol levels by blocking cholesterol absorptionDaily consumption of two tbsp of spread with plant stanols or sterols causes 10% drop in cholesterol level and 14% decline in LDL concentrationBlood levels of HDL are not affectedSpreads are one more tool for lowering high blood cholesterol levels

Fruits, Veggies, Whole Grains….Fiber !

High intake of dietary fiber has been linked to a lower risk of heart disease in a number of large studies that followed people for many years. (Harvard Studies)

Study of over 40,000 male health professionals, a high total dietary fiber intake was linked to a 40 percent lower risk of coronary heart disease.

A related Harvard study of female nurses produced similar findings.

When Blood Lipids Are High

Total cholesterol is sum of the levels of LDL-, HDL-, and VLDL-cholesterol

Dietary recommendations: specific types of fat and foods that lower levels of LDL and triglycerides, and raise levels of HDL adequate intake of folate, and vitamins B6 and B12 are recommended to decrease elevated homocysteine levels

Fig. 19-9, p. 9

Reduce LDL Limit saturated fat intake to less than 7% of total caloriesExclude processed foods that contain trans fatsIncrease monounsaturated fats, not polyunsaturated fatsIncrease whole grain products, fiber, vegetables, fruits, soy protein foods, and plant stanols that lower LDL without decreasing HDL levels

Increase HDL Levelsvigorous exerciseeliminate trans fatsweight losssoy and nuts in the dietmoderate alcohol Harvard Health

If Blood Lipids are still too high

Cholesterol-lowering drugs if blood lipid changes achieved by diet and lifestyle improvements are insufficient

Statins

Statins (Lipitor, Zocor, and Mevacor) markedly reduce cholesterol production in the liverUse related to a 30% drop in LDL levels and a 30-40% reduction in heart attack and stroke in both women and menStatins improve blood lipids levels more when combined with dietary and lifestyle changes than when used alone

Statins

Side effects such as muscle pain and weakness, liver disease, and kidney failureExpenseCost and side effects have prompted alternatives like extreme cholesterol-lowering dietsTherapeutic diets can lower LDL and keep statin dose as low as possible

Diet, Lifestyle & CVD

Many factors in heart diseasePrevention & Treatment need to be broadInclude

heart-healthy diet or therapeutic diet reduction of high blood pressurebody weightdrugssmoking cessation

Goals: improved overall health and blood lipid profiles

Fig. 19-10, p. 10

The Future

Prevention and treatment of heart disease has changed in recent years and will continue to evolve

Concerns about the cost of cholesterol lowering drugs and side effects, and availability of low-cost preventive and treatment will affect these changes

Diet and lifestyle modification, changes in food supply, & increased consumer involvement in risk reduction may lead to decline in heart disease

An end to obesity and physical inactivity would also serve our hearts well