Nutrition and Cardiovascular Disease

1. Nutrition and Cardiovascular Disease

2. Cardiovascular Disease • Includes heart attack, stroke • Leading cause of death in the U.S. • Annually, 500,000 people die of CHD in the U.S. (1 million including strokes and other CVD) • Each year, 1.5 million Americans have a heart attack

3. CVD Deaths by State

4. Heart Attack (Myocardial Infarction)

5. Heart Attack (Myocardial Infarction) • When blood supply to the heart is disrupted, the heart is damaged • May cause the heart to beat irregularly or stop altogether • 25% of people do not survive their first heart attack

6. Symptoms of a Heart Attack • Intense, prolonged chest pain or pressure • Shortness of breath • Sweating • Nausea and vomiting (especially women) • Dizziness (especially women) • Weakness • Jaw, neck and shoulder pain (especially women) • Irregular heartbeat

7. Cerebrovascular Accident (CVA) or Brain Attack

8. Brain Attack (Stroke) or Cerebrovascular Accident

9. Symptoms of Stroke (Brain Attack) • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body • Sudden confusion, trouble speaking or understanding • Sudden trouble seeing in one or both eyes • Sudden trouble walking, dizziness, loss of balance or coordination • Sudden severe headache

10. Blood Lipid Levels are Related to Risk of CVD

11. Blood Lipids (Lipoproteins) • Lipids (fat) cannot mix with water • Blood is high in water • Lipids cannot travel in blood without help • Lipoproteins are formed to carry lipids

12. Lipoproteins combine • Lipids (triglycerides, cholesterol) • Protein • Phospholipids

13. Low-Density Lipoproteins (LDL-C) • Also called “bad cholesterol) • Contain relatively large amounts of fat, and less protein • Deposits cholesterol in arteries • Thus, ↑ LDL-C is associated with ↑ CVD risk • Serum LDL-C should be < 130 mg/dL

14. High-Density Lipoproteins (HDL) • Also called “good cholesterol” • Relatively high in protein, lower in lipid • Acts as scavenger, carrying cholesterol from arteries to liver • Liver packages as bile • Excretes • ↑ HDL-Cis associated with ↓ risk of CVD • Serum HDL-C should be >60 mg/dL (optimal) or at least >40 in men and 50 in women

15. Triglycerides • The most diet-responsive blood lipid • Should be ≤150 mg/dL in fasting state

16. Total Cholesterol • Includes HDL-C, LDL-C, and a fraction of the triglycerides • Total cholesterol should be ≤ 200 mg/dL • Total cholesterol does not tell whole story

17. Lipoprotein Summary

18. Evaluating Blood Lipids: LDL Source: ATP-III Guidelines, NHLBI, accessed 2-2005

19. Evaluating Blood Lipids: Total Cholesterol Source: ATP-III Guidelines, NHLBI, accessed 2-2005

20. Evaluating Blood Lipids: HDL Source: ATP-III Guidelines, NHLBI, accessed 2-2005

21. Blood Pressure • Measured in mmHg • Systolic blood pressure: the pressure in the arterial blood vessels associated with the pumping of the heart • Diastolic blood pressure: the pressure in the arterial blood vessels when the heart is between beats

22. Hypertension: Either • Systolic blood pressure > 140 mmHg • Diastolic blood pressure > 90 mmHg

23. Risk Factors (other than LDL) for CVD • Cigarette smoking • Hypertension (BP ≥140/90 mmHg or on anti-hypertensive tx • Low HDL-C* (<40 mg/dL) • Family history of premature CHD in first degree relative (in male <55 years, in female <65 years) • Age (men ≥45 years, women ≥55 years) *HDL-C ≥ 60 mg/dL counts as a negative risk factor Source: ATP-III Guidelines, NHLBI, accessed 2-2005

24. Risk Factors (other than LDL) for CVD • Diabetes (considered equivalent to a history of CHD) • Obesity • Inactivity Source: ATP-III Guidelines, NHLBI, accessed 2-2005

25. Screening for CVD Risk • Everyone 20 and older should have his cholesterol measured at least every 5 years • Lipoprotein profile: includes TC, LDL-C HDL-C, and TG • At least should include TC and HDL-C • If TC> 200 mg/dL or HDL-C< 40 mg/dL, obtain full lipid profile Source: National Cholesterol Education Program, National Institutes of Health, accessed 2-05

26. Total Cholesterol • John and Marty each have total cholesterol levels of 200 mg/dL. • Their health risk is different

27. John’s Lipid Profile TC: 200 mg/dL LDL-C: 140 mg/dL HDL-C: 30 mg/dL TG: 150 mg/dL Marty’s Lipid Profile TC: 200 mg/dl LDL-C: 95 mg/dL HDL-C: 75 mg/dL TG: 150 mg/dL Total Cholesterol is Not Enough

28. What Affects Cholesterol Levels? • Diet • Weight • Physical activity • Age and gender • Heredity You control the first three!

29. Lowering LDLs • See your doctor to assess for other conditions • Reduce dietary saturated fat, trans fatty acids, and cholesterol • Increase MUFA and PUFA • Increase dietary fiber (soluble)

30. Lowering Blood TG • Is the most diet-responsive blood lipid • Avoid overeating • Limit alcohol • Limit simple sugars • Small frequent meals • Include fish in the diet

31. Raise the HDL • Physical activity • At least 45 min./day, 4 days a week • Avoid smoking • Eat regularly • Eat less total fat • Moderate intake of alcohol increases HDL

32. Therapeutic Lifestyle Changes (TLC) • TLC Diet • Physical activity (30 minutes on most, if not all, days) • Weight management: will help manage triglycerides, increase HDL,

33. DASH: Dietary Approaches to Stop Hypertension • Eat foods that are low in fat, saturated fat, and cholesterol • Eat more fruits, vegetables, whole grains, and lowfat dairy products • Eat more poultry, fish, nuts, and legumes • Eat less red meat, fats, sweets, and sugared beverages • Eat foods low in salt and sodium NHLBI. DASH Eating Plan, revised 2003. Accessed 2-2005