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Coronary Heart Disease (CHD). Coronary Heart Disease (CHD). >58 million American have at least one form of CHD. 50% of all cardiac deaths result from CHD. Mortality From Diseases of the Heart by Race/Ethnicity (Deaths/100,000). Coronary Heart Disease.

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Coronary Heart Disease (CHD)

  • >58 million American have at least one form of CHD.

  • 50% of all cardiac deaths result from CHD



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Coronary Heart Disease

  • The major underlying cause is atherosclerosis.

  • Atherosclerosisis a slow, progressive disease which begins in childhood and takes decades to advance


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Coronary Heart Disease

  • Plaque (the build-up of lipid/cholesterol) in the artery wall forms as a response toinjuryto the endothelium in the artery wall.


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Risk Factors forCoronary Heart Disease

  • Age:

    • Male > 45 years

    • Female > 55 years or premature menopause without estrogen replacement therapy

  • Family History of premature disease

    • Male first-degree relative <55 years

    • Female first-degree relative < 65 years)


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Risk Factors forCoronary Heart Disease

  • Hypertension

    • Appears to weaken the artery wall at points of high pressure leading to injury and invasion of cholesterol.

  • Cigarette Smoking

    • #1 cause of preventable death in US

    • 1 in 5 CHD deaths attributable to smoking


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Risk Factors forCoronary Heart Disease

  • Diabetes

    • 50% of deaths related to DM is due to CHD


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Risk Factors forCoronary Heart Disease

  • Inactivity

    • Sedentary person has 2x risk for developing CHD as a person who is active.


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Risk Factors forCoronary Heart Disease

  • Obesity


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Risk Factors forCoronary Heart Disease

  • Abnormal Blood Lipids

  • LDL Cholesterol (low density lipoprotein)

  • HDL Cholesterol (high density lipoprotein)


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Cholesterol Metabolism

Liver

Diet

Cholesterol

15%

75%


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Blood Lipids and Lipoproteins

  • Some LDL-C can be oxidized and takes up by endothelial cells and macrophages in the arterial wall, which leads to the first stages of atherosclerosis.


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Blood Lipids and Lipoproteins

  • HDL-C is thought to be involved in the transport of excess cholesterol from membranes to the liver for removal from the body.


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Blood Lipids and Lipoproteins

  • HDL-C IS INCREASED:

    • Exercise, loss of weight, and moderate consumption of ETOH.

  • HDL-C is lowered:

    • Obesity, inactivity, cigarette smoking, some oral contraceptives and steroids, hypertriglyceridemia and some genetic factors.


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Cholesterol and the CHD Patient

  • Goal:

    • The goal is a LDL-C level of 100 mg/dL




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Diet Therapy of High Blood Cholesterol

  • Trans-Fatty Acids

  • Increase LDL Cholesterol and decrease HDL Cholesterol

  • Recommendations: Intakes of trans-fatty acids should be as low as possible


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Trans fatty acid content of fast-food


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Treatment for CHD

  • Physical Activity

    • prescribed by physician for patients with CHD

    • When aerobic activity is appropriate, activity that places moderate stress on the cardio-respiratory system can be included.


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Treatment for CHD

  • Weight Control

  • 5-10# weight loss


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Diet Therapy of High Blood Cholesterol

  • Soluble Fiber

  • 10-20 g/day


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Drug Treatment

  • Statins -

  • Bile Acid Sequestrants

  • Nicotinic Acid


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Dietary Issues Requiring Further Research

  • Elevated levels ofhomocysteine

  • Elevated homocysteine levels may be present in 15% of Americans.


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Steps for Lowering LDL-C in the Diet

  • Eggs:

    • <300 mg. cholesterol: < 4 yolks/wk

    • < 200 mg. Cholesterol: < 2 yolks/wk


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Guidelines for Selecting & Preparing Foods

  • Milk and Milk Products:

    • 2-3 servings/day


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Steps for Lowering LDL-C in the Diet

  • Fats, oils:

    • <6-8 tsp./day


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Steps for Lowering LDL-C in the Diet

  • Monounsaturated Fats:

  • Canola, olive and peanut oil

  • Avocado

  • Olives: black and green

  • Nuts: almonds, cashews, peanuts, pecans

  • Sesame seeds


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Steps for Lowering LDL-C in the Diet

  • Polyunsaturated Fats

  • Margarine made with corn, soybean, safflower, sesame oils

  • Tub, squeeze or stick

  • Nuts: walnuts and English

  • Salad dressings

  • Seeds: pumpkin, sunflower


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Steps for Lowering LDL-C in the Diet

  • Saturated Fat:

  • Butter, Coconut & Coconut Oil, Palm Oil

  • Cream, half and half

  • Cream cheese

  • Shortening or lard

  • Sour cream

  • Fat from animal products including milk and meats


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Steps for Lowering LDL-C in the Diet

  • Plant Sterols and Stanols:

  • Natural substances derived from wood, vegetables, vegetable oils and other plants - sitosterol and sitostanol


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Steps for Lowering LDL-C in the Diet

  • Meat, Fish and Poultry

  • Select lean meat and poultry

    • <6 oz/day for Step I diet and <5 oz/day for Step II

  • Eat fish on a weekly basis


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Steps for Lowering LDL-C in the Diet

  • Breads and Cereals:

    • 6-11 servings/day

  • Low fat crackers

  • Tortillas

  • Hot and cold cereals excepts granola or meusli


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Steps for Lowering LDL-C in the Diet

  • Vegetables:

    • 3-5 servings per day

  • Fruits

    • 2-4 servings per day

  • Use sweets and modified fat desserts in moderation


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Reading The Label

  • Extra Lean

    • <5 g total fat, 2 g saturated fat, and 95 mg cholesterol

  • Lean

    • < 10 g total fat, 4 g saturated fat and 95 mg cholesterol


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Guidelines for Selecting & Preparing Foods

  • Try reducing fat by 1/4 to 1/3 in baked products. E.g. if recipe calls for 1 cup oil, try 2/3 C.

  • In casseroles and main dishes, cut back or eliminate the fat.

  • Sauté or stir fry with very little fat or use water, wine, or broth.

  • Chill soups, gravies and stews and skim off hardened fat before serving.


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