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 • The major underlying cause is atherosclerosis. • Atherosclerosisis a slow, progressive disease which begins in childhood and takes decades to advance
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.
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)
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
Risk Factors forCoronary Heart Disease • Diabetes • 50% of deaths related to DM is due to CHD
Risk Factors forCoronary Heart Disease • Inactivity • Sedentary person has 2x risk for developing CHD as a person who is active.
Risk Factors forCoronary Heart Disease • Obesity
Risk Factors forCoronary Heart Disease • Abnormal Blood Lipids • LDL Cholesterol (low density lipoprotein) • HDL Cholesterol (high density lipoprotein)
Cholesterol Metabolism Liver Diet Cholesterol 15% 75%
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.
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.
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.
Cholesterol and the CHD Patient • Goal: • The goal is a LDL-C level of 100 mg/dL
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
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.
Treatment for CHD • Weight Control • 5-10# weight loss
Diet Therapy of High Blood Cholesterol • Soluble Fiber • 10-20 g/day
Drug Treatment • Statins - • Bile Acid Sequestrants • Nicotinic Acid
Dietary Issues Requiring Further Research • Elevated levels ofhomocysteine • Elevated homocysteine levels may be present in 15% of Americans.
Steps for Lowering LDL-C in the Diet • Eggs: • <300 mg. cholesterol: < 4 yolks/wk • < 200 mg. Cholesterol: < 2 yolks/wk
Guidelines for Selecting & Preparing Foods • Milk and Milk Products: • 2-3 servings/day
Steps for Lowering LDL-C in the Diet • Fats, oils: • <6-8 tsp./day
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
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
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
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
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
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
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
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
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.