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Presented by:
Margie Latrella, Cardiac APN and
Carolyn Strimike, Cardiac APN
Heartstrong, LLC
•Increased Age (Menopause)•Heredity•Overweight/Obesity•Physical Inactivity•Smoking•Emotional Stress•Gum Disease•Inflammation•Sleep Apnea•High Blood Pressure (Pregnancy Induced)•High Cholesterol (HDL, Triglycerides)•Diabetes/Metabolic Syndrome•Depression (Broken Heart Syndrome)•Thyroid disease
Total CholesterolTotal Cholesterol < 200 < 200 LDLLDL (Bad “Lousy” Cholesterol) < 100 (Bad “Lousy” Cholesterol) < 100 HDLHDL (Good “Healthy” Cholesterol) (Good “Healthy” Cholesterol)
> 60 in women> 60 in women
>50 in men>50 in men TriglyceridesTriglycerides < 150 < 150
SystolicSystolic DiastolicDiastolic
NORMALNORMAL < 120< 120 < 80< 80
HIGH NORMALHIGH NORMAL 120-139120-139 81-8981-89
HYPERTENSION HYPERTENSION >> 140 140 >> 90 90
NCEP-ATP III definitionNCEP-ATP III definition::
Waist circumference >35” in Waist circumference >35” in women, >40” in menwomen, >40” in men
HDL <50 mg/dl in women,HDL <50 mg/dl in women, <40 mg/dl in men<40 mg/dl in men
Triglycerides Triglycerides >>150 mg/dl150 mg/dlGlucose > 100Glucose > 100Blood pressure Blood pressure >>130/85 mmHg130/85 mmHg
Atkin’s Diet (Low Carb)
Eat Protein, Fats (all fats)Eat Protein, Fats (all fats) Causes Ketosis – burns fatCauses Ketosis – burns fat Promotes Weight LossPromotes Weight Loss, Lowers TG, Improves , Lowers TG, Improves
HDL, Lowers BP (No effect LDL)HDL, Lowers BP (No effect LDL) ? Questionable Long Term Effects/Safety ?? Questionable Long Term Effects/Safety ? Increases Urinary Excretion Calcium = Increases Urinary Excretion Calcium =
Increased RiskIncreased Risk Osteoporosis, Kidney StonesOsteoporosis, Kidney Stones
Single Fatty Meal Stresses the Heart
Sausage McMuffinHash Browns(42 Grams Fat)
OR
Cereal, Skim MilkYogurtOrange Juice(1 Gram Fat)
2 Hours Later – Blood Pressure Higher After High Fat Meal
Journal of Nutrition (137) 2007
3 Hours Later – arteries unable 3 Hours Later – arteries unable dilatedilate
6 Hours Later – anti-inflammatory 6 Hours Later – anti-inflammatory properties HDL diminishedproperties HDL diminished
“Effects of ONE Saturated Fat Meal”
South Beach Diet (Low Carb)
Allows “good” carbs, Low Glycemic Index, Allows “good” carbs, Low Glycemic Index, “good” fats“good” fats
Fruits, Vegetables, Whole Grains, Lean Fruits, Vegetables, Whole Grains, Lean ProteinProtein
Decreased Metabolic SyndromeDecreased Metabolic Syndrome
Hayes, J of Nutrition 2007
Ornish Diet (Vegetarian, EXTREMELY Low Fat, High Fiber)
No Meat/Fish/NutsNo Meat/Fish/Nuts Promotes Complex Carbohydrates (70%)Promotes Complex Carbohydrates (70%) Regular Exercise/Stress ManagementRegular Exercise/Stress Management ? Reverses Heart Disease – Plaque Regression ? ? Reverses Heart Disease – Plaque Regression ?
Decreases AnginaDecreases Angina Decreases LDLDecreases LDL, Small amount weight loss, Small amount weight loss
Mediterranean Diet (Low Fat)
Small portions “high quality food”Small portions “high quality food” Fruits/Vegetables Fruits/Vegetables (7-10/day),(7-10/day), Olive oil, Nuts, Olive oil, Nuts,
Red wine, FishRed wine, Fish Exercise (Lifestyle)Exercise (Lifestyle)
Decreases LDL, BP, Blood Sugar, WeightDecreases LDL, BP, Blood Sugar, Weight Prevents re-current CV eventsPrevents re-current CV events
Mediterranean Diet
PREDIMED StudyPREDIMED Study (ongoing)(ongoing)
Lowers LDL better than “routine” low Lowers LDL better than “routine” low fat diet – Adds “good” fats (olive oil, fat diet – Adds “good” fats (olive oil, nuts)nuts)
LYON Heart StudyLYON Heart Study Secondary preventionSecondary prevention Decreased CV events 50-70%Decreased CV events 50-70%
JAMA 2004Circ (103) 2001
DASH Diet (Low Fat, Low Salt)
Fruits/Vegetables, Whole grain, Fish, Poultry, Fruits/Vegetables, Whole grain, Fish, Poultry, NutsNuts
Lowers BPLowers BP, Weight Loss, Decreases LDL, Weight Loss, Decreases LDL Lower Risk CVA/MI Lower Risk CVA/MI (Women)(Women)
Arch Intern Med (168) 2008
Dr Oz’s Diet
High Fiber, Small Frequent MealsHigh Fiber, Small Frequent Meals Low Fat, Fruits/VegetablesLow Fat, Fruits/Vegetables Exercise, LifestyleExercise, Lifestyle
Weight LossWeight Loss, Slim Waist, Slim Waist Claims: Decrease RiskClaims: Decrease Risk
Heart Disease, Diabetes ?Heart Disease, Diabetes ?
Best Life Diet
AHA Dietary Guidelines
Low FatLow Fat Fruits/Vegetables (4 to 9/day)Fruits/Vegetables (4 to 9/day) Whole Grains (6 to 8/day)Whole Grains (6 to 8/day) Fish, Poultry, Lean Meats (< 6 oz/day)Fish, Poultry, Lean Meats (< 6 oz/day) Legumes, NutsLegumes, Nuts Limit added salt/sugarLimit added salt/sugar
Lose Belly Fat with Whole Grains
Whole GrainsWhole Grains (Oatmeal, Whole wheat pasta, (Oatmeal, Whole wheat pasta, Granola)Granola)
Weight Loss (Abdominal Fat)Weight Loss (Abdominal Fat) Decreases CRPDecreases CRP Stabilizes Blood SugarStabilizes Blood Sugar Decreases Risk CVADecreases Risk CVA
““Everyone Needs at least 3 servings ofEveryone Needs at least 3 servings of
Whole Grains Every Day”Whole Grains Every Day”
www.wholegrainscouncil.orgJAMA (284) 2000
Soluble Fiber (psyllium, beans, legumes, fruits, Soluble Fiber (psyllium, beans, legumes, fruits, oats)oats) Lowers cholesterol, Controls blood sugarLowers cholesterol, Controls blood sugar
Psyllium (5 Gm TID) + Simvastatin 10 mg = Simvastatin 20 mgPsyllium (5 Gm TID) + Simvastatin 10 mg = Simvastatin 20 mg
Reduces risk CV disease, DiabetesReduces risk CV disease, Diabetes Decrease inflammation (CRP)Decrease inflammation (CRP) Weight managementWeight management
Women 25 to 30 grams/dayWomen 25 to 30 grams/day Men 30 to 35 grams/dayMen 30 to 35 grams/day
Circulation (95) 1997
“More Americans Die By the Fork than any
Other Weapon.”
www.nhlbi.nih.gov
Calorie Difference: 525 calories
1,025 calories
20 Years Ago Today
500 calories
SPAGHETTI AND MEATBALLS
www.nhlbi.nih.gov
*Based on 130-pound person
If you do aerobic dance for 1 hour and 20 minutes you will burn approximately 525 calories.*
Calories In = Calories Out
www.nhlbi.nih.gov
Chocolate chip cookie
220 calories!
20 Years Ago Today
55 calories 275 calories
www.nhlbi.nih.gov
*Based on 160-pound person
If you ride a bike for 50 minutesyou will burn approximately 220 calories.*
Calories In = Calories Out
www.nhlbi.nih.gov
COFFEE 20 Years Ago
Coffee(with whole milk and sugar)
Today
Mocha Coffee(with steamed whole milk and
mocha syrup)
45 calories 8 ounces
350 calories16 ounces
Calorie Difference: 305 calorieswww.nhlbi.nih.gov
If you walk 1 hour and 20 minutes, you will burn approximately 305 calories.*
*Based on 130-pound person
Calories In = Calories Out
www.nhlbi.nih.gov
¼ of PlateGrains, Starches
¼ of Plate Beans, Meat, Poultry or Fish
½ of PlateFruits and Vegetables
“Salt is NOT a Food” No Vitamins/NutrientsNo Vitamins/Nutrients
Most Americans consume more salt than they need
Sources of Dietary Sodium (Salt)
Food Processing At the Table During Cooking Inherent
Food Processing77%
6%
5%12%
Adding Potassium to Your Diet can Help Lower BP
Daily recommended amount Potassium Daily recommended amount Potassium
4,700 mg/day4,700 mg/day
WHO Recommendations on Sugar Intake
Added free sugars include:Added free sugars include:
Table, refined, processed, Table, refined, processed, added sucroseadded sucrose
Corn sugar(glucose), corn Corn sugar(glucose), corn syrup (high fructose)syrup (high fructose)
HoneyHoney SyrupsSyrups Sugars added to fruit juicesSugars added to fruit juices
Added free sugars do Added free sugars do NOT include:NOT include:
Fresh fruit sugars-Fresh fruit sugars-natural fructose and natural fructose and sucrosesucrose
Milk – lactoseMilk – lactose VegetablesVegetables
Limit “added free sugars” to 48 grams or 12 tsp. per day
One 12 ounce soda averages 12 teaspoons of sugar!!!
WHITE TEAGREEN TEABLACK TEA
(Not Supplements)
Polyphenols (Antioxidant)
Black Tea
Decreases LDL /TriglyceridesDecreases LDL /Triglycerides Improves endothelial functionImproves endothelial function VasodilationVasodilation Lowers blood pressureLowers blood pressure Decreases risk MI/CVA Decreases risk MI/CVA (1 - 3 cups/day)(1 - 3 cups/day)
Helps regulate blood sugarHelps regulate blood sugar
Green Tea (3 to 5 cups/day) (More Antioxidants)
Lowers Total Cholesterol/LDL/TGLowers Total Cholesterol/LDL/TG Improves HDLImproves HDL Lowers Blood PressureLowers Blood Pressure Anti-inflammatoryAnti-inflammatory Reverses Endothelial DysfunctionReverses Endothelial Dysfunction Decreases Risk MI/CVADecreases Risk MI/CVA Decreases MortalityDecreases Mortality Reduces Blood Sugar LevelsReduces Blood Sugar Levels Very Low Caffeine ConcentrationVery Low Caffeine Concentration
Int J Card (108) 2006J Nutr Bichem (18) 2007JAMA (296) 2006
Caffeinated CoffeeCaffeinated Coffee:: 1 to 3 cups decrease CV risk 1 to 3 cups decrease CV risk ( in women)( in women) S/P MI – no increased risk with espresso S/P MI – no increased risk with espresso (GISSI (GISSI
– Prev Study)– Prev Study) Increased risk HTNIncreased risk HTN Decreased FMD/Endothelial functionDecreased FMD/Endothelial function
Decaffeinated CoffeeDecaffeinated Coffee:: Increases cholesterol Increases cholesterol (ApoB)(ApoB) Overweight – Increased HDLOverweight – Increased HDL
Am J Clin Nut (83) 2006 Am J Clin Nut (86) 2007Circ (107) 2007 AHA 2005 Scient Session 2005 (abstract 3852)
Increases HDL, Lowers BPIncreases HDL, Lowers BP Decreases blood clotsDecreases blood clots Reduce risk CVA, MI, DiabetesReduce risk CVA, MI, Diabetes Decrease mortality after MIDecrease mortality after MI
Women – one drink/dayWomen – one drink/day Men – two drinks/dayMen – two drinks/day
If You Don’t Drink, Don’t StartAdverse Effects:
HTN, Alcoholic Cardiomyopathy
“Take 2 Hershey Kisses or BonBons to Lower Your Blood Pressure ??”
Potent Antioxidant/Plant Phenols/FlavonoidsPotent Antioxidant/Plant Phenols/Flavonoids
Decreases Arterial Stiffness/Dilates VesselsDecreases Arterial Stiffness/Dilates Vessels
Lowers Blood Pressure (2 to 5 mmHg) Lowers Blood Pressure (2 to 5 mmHg) Similar BP Similar BP med effectmed effect
Inhibits Platelet ActivationInhibits Platelet Activation
““Hold the Milk” – Benefits lost if Hold the Milk” – Benefits lost if drink milk with chocolate ??drink milk with chocolate ??
Arch Intern Med (167) 2007
Lowers Total Cholesterol, LDL, TriglyceridesLowers Blood Pressure
Prevents Platelet Aggregation
Garlic Dose ???Garlic Dose ??? 1 to 2 cloves raw garlic 1 to 2 cloves raw garlic
(chopped, wait 15 minutes then use, do(chopped, wait 15 minutes then use, do
not cook at high temperatures)not cook at high temperatures) 300 mg freeze dried powder 2 – 3 x’s/day, 300 mg freeze dried powder 2 – 3 x’s/day,
must be enteric coated avoid breakdown in must be enteric coated avoid breakdown in stomachstomach
7.2 grams aged extract7.2 grams aged extract
Side effects – bad breath, body odor, GI upset, Side effects – bad breath, body odor, GI upset, antiplatelet effect (D/C high doses before antiplatelet effect (D/C high doses before surgery – increases bleeding risk)surgery – increases bleeding risk)
Garlic Trials = Inconsistent Results
May have May have short-termshort-term effect on lowering effect on lowering cholesterol ???cholesterol ???
May lower BP 3 to 5% ???May lower BP 3 to 5% ??? Mild antiplatelet effectMild antiplatelet effect
Arch Intern Med. 2007;167:346-353Amer Fam Physician. July 1, 2005
Journ Agric & Food Chemistry June 2006
(Contains Tilapia, Sardines, Anchovies)
Decreases Risk SCD/MI Decreases Risk SCD/MI (re-infarction)(re-infarction)
Decreases Triglycerides Decreases Triglycerides (20-40%)(20-40%)
Decreases Growth Atherosclerotic Decreases Growth Atherosclerotic Plaque (Decreases Inflammation)Plaque (Decreases Inflammation)
Lowers Blood Pressure Lowers Blood Pressure (2-5 mmHg)(2-5 mmHg)
Prevents Platelet AggregationPrevents Platelet Aggregation Decreases Stroke RiskDecreases Stroke Risk
AHA Scientific Statement, Circulation 2002
AHA recommends AHA recommends eatingeating omega 3 fatty omega 3 fatty acids from fish and plant sourcesacids from fish and plant sources
NOTFRIED
DART Trial (Diet & Reinfarction Trial)
Secondary Prevention TrialSecondary Prevention Trial People ate 2 servings fatty fish/weekPeople ate 2 servings fatty fish/week Decreased 2 year total Decreased 2 year total && CV mortality 30% CV mortality 30%
BMJ 1998
1 ounce nuts 5 X’s/week decreases risk CV 1 ounce nuts 5 X’s/week decreases risk CV disease 25-39%disease 25-39%
Lower LDL cholesterolLower LDL cholesterol Omega 3 fatty acids Omega 3 fatty acids (Protect against arrhythmias)(Protect against arrhythmias)
Precursor nitric acid Precursor nitric acid (vasodilator)(vasodilator)
High in fiberHigh in fiber Handful = 150 caloriesHandful = 150 calories
Am J Clin Nutrition (70)1999Nutr Metab CV Dis (11) 2001
Omega 3 Intake Recommendations:
No CHDNo CHD:: Fish twice/week and oils/foods Fish twice/week and oils/foods rich alpha-linolenic acid rich alpha-linolenic acid (flaxseed, walnuts)(flaxseed, walnuts)
Patients with CHDPatients with CHD:: 1 Gm EPA+DHA 1 Gm EPA+DHA per day per day (preferably from fish: 2- 4 ounces salmon, 4-(preferably from fish: 2- 4 ounces salmon, 4-12 ounces canned tuna, 7 ounces flounder/sole)12 ounces canned tuna, 7 ounces flounder/sole)
Patients with High TriglyceridesPatients with High Triglycerides: : 2 to 4 2 to 4 Gm EPA+DHA per day Gm EPA+DHA per day (High Doses May Cause (High Doses May Cause Bleeding)Bleeding)
AHA Scientific Statement, Circulation 2002
High Fiber Content High Fiber Content (2 tablespoons 4.5 Gm Fiber, 3 Gm Omega (2 tablespoons 4.5 Gm Fiber, 3 Gm Omega
3)3)
Ligans (phytoestrogen) Ligans (phytoestrogen) (Menopausal symtpoms)(Menopausal symtpoms)
Omega 3 fatty acidsOmega 3 fatty acids
Lowers CholesterolLowers Cholesterol 9% drop Total Cholesterol, 18% drop LDL (Seeds NOT Oil)9% drop Total Cholesterol, 18% drop LDL (Seeds NOT Oil)
Reduces Platelet AggregationReduces Platelet Aggregation Reduces Inflammatory MarkersReduces Inflammatory Markers Improves Glucose ToleranceImproves Glucose Tolerance
J Clin Endo & Metab, 90 2005
Acts like HMG-CoA (Statin - Lovastatin), Contains Sterols/Isoflavones
• Reduces Total Cholesterol 15-20%, LDL 20-30%, Triglycerides 20-30%,
Increases HDL 15 to 20%
•Dose 600 mg BID = 10mg HMG-CoA reductase inhibitor daily
•Contraindications – same as Statins, DO NOT TAKE WITH STATIN,•Can cause myopathies
(2 Grams/Day Lower LDL 9 to 20%)Competes with Cholesterol for Absorption in Intestines
Vitamin E, C, Beta Carotene Vitamin E, C, Beta Carotene Negative Primary Prevention StudiesNegative Primary Prevention Studies: :
ATBC, Health Professionals F/U Study, Nurses ATBC, Health Professionals F/U Study, Nurses Health Study, Iowa Women’s Health Study, Health Study, Iowa Women’s Health Study, PPP, CARET, HPSPPP, CARET, HPS
Negative Secondary Prevention StudiesNegative Secondary Prevention Studies: : HOPE, GISSI-Prevension Trial, VEAPS, HOPE, GISSI-Prevension Trial, VEAPS, WACS, WAVE, HATSWACS, WAVE, HATS
(?May Increase Mortality?)(?May Increase Mortality?)JAMA. 2005;293:1338-1347JAMA 2007; 297:842-857 JACC 2005;46(1):184
“Get antioxidants from food, not supplements”
At this time, there is little reason to advise At this time, there is little reason to advise that individuals take antioxidant that individuals take antioxidant
supplements to reduce their risk of supplements to reduce their risk of cardiovascular disease.cardiovascular disease.
AHA Scientific Advisory08/02/2004
So far, So far, no study has shown that folic acid no study has shown that folic acid supplements reduce the risk of CADsupplements reduce the risk of CAD or that taking or that taking
these vitamins affects the development or these vitamins affects the development or recurrence of cardiovascular disease.recurrence of cardiovascular disease.
Food SourcesFood Sources::
Fortified cereals, Dark Leafy Green VegetablesFortified cereals, Dark Leafy Green Vegetables
Lowers Homocysteine Levels But May Not Lowers Homocysteine Levels But May Not Decrease Risk CV Disease ??Decrease Risk CV Disease ??
HOPE – 2 Trial Shows NO HOPE for High Dose B Complex Vitamins in Decreasing
Heart Disease Risk •Over 5,000 High Risk Patients
•No Benefit
NORVIT Trial Demonstrated Possible Harm•Over 3,700 Post MI Patients
•Decreased Homocysteine Levels BUT Increased Adverse CV Events
N Engl J Med 2006
Framingham Heart StudyFramingham Heart Study 62% Higher Risk Heart Disease events62% Higher Risk Heart Disease events
(especially in people with HTN) (especially in people with HTN)
Recommended Daily Dose Recommended Daily Dose 800 and 1,000 IU of 800 and 1,000 IU of Vitamin D3 (cholecalciferol)Vitamin D3 (cholecalciferol)
AHA recommends getting Vitamin D from food AHA recommends getting Vitamin D from food sources (milk, salmon, mackerel, sardines, fortified sources (milk, salmon, mackerel, sardines, fortified
cereals)cereals)Science Daily March 2008Am J HTN (20) 2007
(Generates ATP, Free Radical Scavenger)• Produced naturally in body ubiquinone
• Food Sources: Organ Meats, Beef, Sardines, Mackerel, Nuts
Improves QOL, Decreases Heart Failure Improves QOL, Decreases Heart Failure HospitalizationsHospitalizations (CHF patients may have lower (CHF patients may have lower CoQ10 levels?)CoQ10 levels?)
Improves myopathic pain in Statin Improves myopathic pain in Statin Treated PatientsTreated Patients (Statins may decrease CoQ10 (Statins may decrease CoQ10 production?)production?)
Take supplements with fatty meal (to Take supplements with fatty meal (to improve absorption)improve absorption)
Recommended dose 50 to 200 mg/dayRecommended dose 50 to 200 mg/day Possible interaction with CoumadinPossible interaction with Coumadin
Improves CholesterolImproves Cholesterol Lowers T.C. (9%) LDL (3%) Lowers T.C. (9%) LDL (3%)
Triglycerides (10%)Triglycerides (10%) Increases HDL (2.5%)Increases HDL (2.5%) INCONCLUSIVE STUDIESINCONCLUSIVE STUDIES
Circulation Feb 2006
Eating foods that contain soy protein instead of food high in animal fatsmay be beneficial ??
Medication & Herbal/SupplementInteractions
“Healthy living is the most powerful medicine of all.
It requires no prescription, and all of the side effects are
beneficial.”
Dr Katz, director Prev. Research Ctr, Yale
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