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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 chd2
Coronary Heart Disease (CHD)
  • >58 million American have at least one form of CHD.
  • 50% of all cardiac deaths result from CHD
coronary heart disease
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 disease6
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 for coronary heart disease
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 for coronary heart disease13
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 for coronary heart disease14
Risk Factors forCoronary Heart Disease
  • Diabetes
    • 50% of deaths related to DM is due to CHD
risk factors for coronary heart disease15
Risk Factors forCoronary Heart Disease
  • Inactivity
    • Sedentary person has 2x risk for developing CHD as a person who is active.
risk factors for coronary heart disease17
Risk Factors forCoronary Heart Disease
  • Abnormal Blood Lipids
  • LDL Cholesterol (low density lipoprotein)
  • HDL Cholesterol (high density lipoprotein)
slide18

Cholesterol Metabolism

Liver

Diet

Cholesterol

15%

75%

blood lipids and lipoproteins
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 lipoproteins20
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 lipoproteins21
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
Cholesterol and the CHD Patient
  • Goal:
    • The goal is a LDL-C level of 100 mg/dL
diet therapy of high blood cholesterol27
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
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 chd30
Treatment for CHD
  • Weight Control
  • 5-10# weight loss
drug treatment
Drug Treatment
  • Statins -
  • Bile Acid Sequestrants
  • Nicotinic Acid
dietary issues requiring further research
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
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
Guidelines for Selecting & Preparing Foods
  • Milk and Milk Products:
    • 2-3 servings/day
steps for lowering ldl c in the diet37
Steps for Lowering LDL-C in the Diet
  • Fats, oils:
    • <6-8 tsp./day
steps for lowering ldl c in the diet38
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 diet39
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 diet40
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 diet41
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 diet42
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 diet43
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 diet44
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
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 foods46
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.