nutrition and disorders of the heart and blood vessels

Cardiovascular disease (CVD)
• Accounts for about __% of deaths in U.S

31%

what the leading cause of death worldwide`

cardiovascular disease

most common form of CVD and what is it due to

coronary heart disease

atherosclerosis in the coronary arteries restricting blood flow

what is a myocardial infarction

heart attack

sudden reduction in coronary blood flow

what is a stroke

blocked blood supply to brain tissue

other forms of CVD other than CHD

hypertension

heart failure

peripheral artery disease

what can CHD and atherosclerosis called

myocardial infarction

stroke

what happens in atherosclerosis

the artery walls become progressively thickened due to plaque accumulation

percentages of deaths from CVD in the US

what is plaque

fat deposits. fibrous connective tissue, and a small muscle cell

what does atherosclerosis arise from

injuries that cause injury to the inner arterial wall

where does plaque often develop

at regions where arteries branch or bend due to a disruption in the blood flow in those areas

the process of atherosclerosis

the subtle damage initiates an inflammatory response that is going to attack immune cells and increase the permeability of the vessel wall

then LDLs will slip under the endothelial cells of the artery and become oxidized by local enzymes are start to accumulate

eventually the plaque will thicken and harden

consequences of atherosclerosis

plaque can rupture and promote blood clots

and they interfere with blood flow

narrow lumen of artery

blood clots can lead to enlarged thrombus (blood clot), embolism (blood clot gets stuck in a narrow artery blocking blood flow), ischemia(reduced blood flow)

obstructed blood flow in coronary arteries (angina pectoris (pain) or heart attack)

peripheral artery disease (causes pain and weakness in legs and feet bc lack of blood flow)

kidney disease or kidney failure

aneurism

what is a blood clot called

a thrombus

what is the most common cause of an aneurism

atherosclerosis

what is an aneurism

a sack like abnormal dilation of a blood vessel’s walls

if it ruptures = massive bleeding and death

causes of atherosclerosis

inflammation (direct damage to the artery wall or material penetrating the surface of the vessel)

shear stress (stress of blood flow through arteries damaging them) /hypertension

abnormal blood lipids (when LDL is high, they are taken up in susceptible regions in the artery wall where they are prone to oxidation)

cigarette smoking (nicotine are toxic to endothelial cells. also it causes induction of chronic inflammation and vasoconstriction)

diabetes mellitus (hyperglycemia leads to accumulation of advanced glycation end products - AGEs)

age and gender (risk seen in men older than 45 and women over 55. risk in women post menopause)

tell me how abnormal blood lipids cause atherosclerosis

when blood lipid levels are high

when LDL is high, they are taken up in susceptible regions in the artery wall where they are prone to oxidation.

elevated levels of VLDL influences production of other atherogenic lipoproteins, promotes inflammation

tell me abt how HDL affects atherosclerosis

HDL protective bc they remove cholesterol from circulation and they inhibit inflammation

what to remember about LDL sizes

they come in all sizes

so super small and most dense LDLs can slip into arteries and are more atherogenic than the larger

atherosclerosis steps image

what is the most common type of CVD

coronary heart disease

what is coronary heart disease also known as

coronary artery disease

what does coronary heart disease lead to

angina pectoris

heart attack

sudden death

what is coronary heart disease

impaired blood flow through the coronary arteries

symptoms of coronary heart disease

pain in chest

SOB

weakness and fatigue

nausea

vomiting

abdominal discomfort

Angina pectoris symptoms are triggered by

exertion; subside with rest

Heart attack causes severe

pain; lasts longer; occurs without exertion

when do coronary heart disease symptoms arise

several years post condition

are men or women more likely to have a heart condition?

womenr

risk factors for coronary heart disease

modified with diet is highlighted

what do AHA and ACC reccomend with risk factors?

AHA/ACC recommend an assessment for risk factors of atherosclerotic CVD every 4-6 years in individuals from ages 20-79

they developed an online calculator

clinical measures in regard to evaluating your risk for coronary heart disease

clinicians review the lipoprotein profile or blood lipid profile, which include measures of total cholesterol, LDL, and HDL, and blood triglycerides

can also use the coronary artery calcium score which is obtained from a CT scan that evaluates the level of calcium content of plaque in the coronary arteries

levels of c reactive protein (marker of inflammation) may identify people as risk for CHD

ankle brachial index - ratio of bp measurements from the ankles and arms can find the presence of CHD

examples of lab and metabolic measures for CHD risk assessment

people with high risk of CHD are suggested to modify their lifestyle… how? (main features)

blood cholesterol-lowering diet, regular physical
activity (also not smoking) , and weight reduction

Balanced diet that includes fruits, vegetables, whole grains

tell me about the types of fats and regulating CHD

s
• Saturated fat…
• Replace with monounsaturated and polyunsaturated fats (will lower LDL levels)
• (if you have high levels of LDLs) Consume <7% total kcal as saturated fat
• Polyunsaturated and monounsaturated fat
• Replacing saturated with polyunsaturated fat associated with reduced morbidity, mortality from CHD

what fatty acids are beneficial for CHD risk

not omega 6 but omega 3!

limiting total fat intake, and types of fats with CHD suggestions

Total fat
• 25% to 35% of kcal
• 30% to 35% of kcal (if you have high triglycerides so that their carb intake isn’t excessive)
• Trans fats: keep intake as low as possible (will increase inflammation)
-Read food labels carefully

influence of dietary cholesterol on CHD

• Dietary cholesterol

somewhat unclear
• <200 mg/day for high-risk individuals

What are the recommendations for eggs and CHD risk?

eggs are not linked

undetermined

depends with healthy vs high risk people

soluble fibers and CHD

can reduce LDL levels by inhibiting cholesterol and bile absorption in the small intestines

Particularly soluble fiber found in in oats, barley, legumes, fruits
• Psyllium supplements effective in lowering cholesterol levels

Plant sterols and CHD

added to various food products (e.g., margarine, orange juice)

interferes with the cholesterol creation
• Supplied in dietary supplements
• ~2 g daily will lower LDL cholesterol by up to 10%

fish and omega 3 fatty acids in regards to CHD

also known as EPA and DHA

suppresses inflammation, lowers triglyceride levels and lowers blood clotting

fish is low in saturated fat and replaces meat dishes that have saturated fat!

AHA recommends 2 or more servings (3.5 oz) of fish per week,
with an emphasis on fatty fish

alcohol in regards to CHD

Light/moderate consumption

actually favorable
• 1 drink/day for women, 2/day for men

blood pressure and preventing CHD

Blood pressure reduction
• DASH eating plan (low-sodium, healthful diet)
• Reduce sodium intake (minimally-processed foods)

(sodium increases it and potassium lowers it)

physical activity and reducing CHD

40 min/session, at least 3-4 days/week

can reverse a number of risk factors

smoking and reducing CHD

Smoking cessation
• CHD incidence drops to levels near those of nonsmokers within 3 years

weight change and reducing CHD

Weight reduction (if obese)
• goal is to lose 5-10% of initial weight over 6-12 months
• Additional loss to acceptable weight

how to motivate your patients to manage their lifestyle changes

setting reasonable goals, practical sugesstiobs

vitamin supplementation and CHD risk

Vitamin supplementation and CHD risk
• B vitamin supplements and homocysteine
• Elevated levels of homocysteine associated with increased risk for CHD
-Amino acid produced during conversion of methionine to cysteine
-B-vitamins associated with this conversion include:
-Vitamin B6, Vitamin B12 and folate (low intakes of these leads to higher blood homocysteine concentrations so some patients eat a lot of these in hopes to reduce homocysteine but it says there is not correlation)
• Will B-vitamin supplements lower homocysteine?
• Yes, but.....
• No risk reduction for heart attacks noted

Antioxidant supplements (may inhibit atherosclerosis bc stress can cause it)
• Not recommended for heart disease prevention - inconsistent results (no proof)

what is hypertriglyceridemia

elevated blood triglyceride levels

who is hypertriglyceridemia common in

Common in people with diabetes mellitus, obesity,
metabolic syndrome, genetics, etc.

what is severe hypertriglyceridemia

(triglyceride levels are >500 mg/dL)
• Fatty deposits in skin
• Acute pancreatitis

how many people does hypertriglyceridemia affect

1/3 of adults in the US

hypertriglyceridemia may coexist with

elevated LDL cholesterol

nutrition therapy to reduce hypertriglyceridemia

Control body weight
• Become physically active
• Restrict alcohol
• Limit intakes of refined carbohydrates

-Especially fructose and sucrose
• In extreme cases (i.e. triglycerides > 1000 mg/dL):
-Very low-fat diets may be necessary
-< 15% of kcal from fat
• Fish oil supplements and hypertriglyceridemia
-3-4 grams EPA and DHA (the fish) from supplements recommend (from the previous 1 gram per day)
-Caution for blood thinning

hypertriglyceridemia and HDL

hypertriglyceridemia means low HDL

individuals that cannot improve CHD risk with nutrition and lifestyle changes must

b prescribes one or more indications

nutriton can effect drugs!

Drug therapies for CHD prevention

statins

bile acid sequestrants

nicotinic acid

Anticoagulants and aspirin
• Blood pressure medications
• Nitroglycerin (vasodilator) relieves angina
• Be aware of diet-drug interactions

tell me abt statins

Statins (e.g., Lipitor or Crestor) will reduce cholesterolsynthesis in the liver
• NDI(nutrient drug interaction): Avoid grapefruit, red yeast rice

tell me about bile acid sequestrants

less effective than statins

Bile acid sequestrants (e.g., Colestid or Questran)
interfere with bile acid reabsorption in the small intestine
• NDI: May interfere with absorption of fat-soluble vitamins

tell me about nicotinic acid

Nicotinic acid (high dose niacin) lowers triglycerides;
increases HDL; reduces LDL and lipoprotein(a) levels
• Need to monitor liver enzymes, flushing in skin… bc liver enzyme elevation

drug therapies given immediately after a heart attack

Thrombolytic drugs to break up clot
• Anticoagulants or aspirin
• Painkillers
• Medications that regulate heart rhythm and reduce blood
pressure
• no food or beverages except for Sips of water or clear liquids only until condition stabilizes

treatment of heart attack once they are able to eat

Hearth healthy, sodium restriction (2000 mg/day) initially
• Small portions if tolerated - slowly regaining strength
• Cardiac rehabilitation programs
-Exercise therapy
-Instruction about heart-healthy food choices
-Help with smoking cessation
-Medication counseling

4th most common cause of death in U.S.

stroke

A leading cause of long-term disability

stroke

what is stroke

Sudden death of brain cells due to impaired blood flow to
part of brain

3 types of stroke

Types (3)
• Ischemic strokes (18%)
-Obstruction of blood flow to brain tissue
-Common cause: atherosclerosis
• Hemorrhagic strokes (13%)
-Bleeding within the brain due to rupture of blood vessels

-more deadly 33% result in death within thirty days
• Transient ischemic attacks (TAI)
-Sudden, short strokes. May predict more severe events.

what percent of strokes are ischemic?

87%

which type of stroke is most deadly

hemorrhagic stroke

more deadly 33% result in death within thirty days

stroke prevention

Recognize stroke risk factors: similar to those for heart disease
-Hypertension, elevated LDL, diabetes, smoking, physical inactivity
• Make lifestyle choices to reduce risk
• Medications
-Antiplatelet drugs (e.g., aspirin)
-Anticoagulants (e.g., warfarin [Coumadin])

neurological effects of stroke depend on

Neurological effects of stroke vary depending on area of the
brain that has been injured. May include:
• Difficulty speaking (dysphasia or aphasia)
• Difficulty swallowing (dysphagia)
• One-sided paralysis

in stroke

what is necessary to prevent brain damage?

early diagnosis and treatment

Preserve brain tissue and minimize long-term disability
• Ideally, thrombolytic drugs used within 4.5 hours after ischemic stroke

tell me about post stroke rehabilitation programs

Rehabilitation programs
• Start as soon as possible after stabilization
• Physical therapy, occupational therapy, speech and language pathology, and
kinesiotherapy

nutrition care post stroke

Focus: help patients maintain nutrition status and overall health
• Tube feedings may be needed until skills regained

definition of hypertension

Chronic elevation of blood pressure
• Primary or essential hypertension
• Cause is unknown

bp stats

what is a Primary risk factor for atherosclerosis and
cardiovascular diseases

hypertension

what is a primary cause of stroke and kidney failure

hypertension

how much of US adults does hypertension effect?

Affects about one-third of U.S. adults

an estimated __% of people with hypertension are
unaware that they have it

17%

in what race is hypertension prevalence higher?

african americans

Factors that influence blood pressure Blood
pressure depends on

Cardiac output: volume of blood pumped by the heart
• Peripheral resistance: resistance the blood encounters
in the arterioles

what is peripheral resistance affected by

diameter of arterioles and viscocity of blood

Physiological factors that influence blood pressure

Nervous system: regulates heart muscle contractions and arteriole
diameters
• Hormonal signals: may cause fluid retention or blood vessel
constriction

- Kidneys - control hormone secretion for vasoconstricion and retension of na and h2o

90-95% of hypertension cases the cause it….

znd what is this called

unknown

primary or essential hypertension

if hyperension is caused by a known physical or metabolic disorder it is called

secondary hypertension

Risk factors for hypertension

nearly 2/3ds of older individuals have hypertension

bp that is sensitive to salt?

Lifestyle Treatment of Hypertension***

weight and hypertension treatment**

Weight reduction
• Blood pressure reduced by ~1 mm Hg per kg weight loss

Dietary approaches for blood pressure reduction***

more potassium, fiber, magnesium, and calcium

drug therapies for hypertension

Combinations of two or more medications usually required
• Most treatments include diuretics
• Lower BP by reducing blood volume
• Other medications:
• Calcium channel blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin-receptor blockers

what is heart failure

Heart’s inability to pump adequate blood
• Also called congestive heart failure results in buildup fluid

what dos heart failure lead to

Fluid accumulation in extremities and lungs
• Heart enlarges (to accomdate the extra workload by eventually will wekaen!)

causes of heart failure

Various causes
• Often a consequence of chronic hypertension or CHD

Leading cause of hospitalization in patients >65 years old

heart failure

Consequences of heart failure

left sided failure

right sided failure

effects food intake and level of physcial activity

cardiac cachexia

what is left sided heart failure

Left side of heart receives fluid from lungs (rich in oxygen)
• Buildup of fluid in the lungs, i.e., pulmonary edema
• Shortness of breath; limited oxygen for activity

what is right sided heart failure

Right side of heart receives fluid from peripheral tissues
• Fluid accumulation in the lower extremities (edema), and abdomen (ascites)