Copyright 2017 Elsevier Inc All Rights Reserved Lesson 191 Cardiovascular Disease Cardiovascular disease CVD is the leading cause of death in the United States Several risk factors contribute to the development of coronary heart disease and hypertension many of which are preventable b ID: 780359
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Slide1
Chapter 19
Coronary Heart Disease and Hypertension
Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide2Lesson 19.1: Cardiovascular Disease
Cardiovascular disease (CVD) is the leading cause of death in the United States.Several risk factors contribute to the development of coronary heart disease and hypertension, many of which are preventable by improved diet and lifestyle behaviors.Other risk factors are nonmodifiable, such as age, gender, family history, and race.2Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide3Introduction
Coronary heart diseaseLeading cause of death in the United StatesMore than 611,000 deaths each yearSimilar in other Western developed nationsMore than 1 million live with various forms of rheumatic and congestive heart diseaseLeading cause is atherosclerosis3Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide4Atherosclerosis
Major cause of CVDFatty plaques (largely composed of cholesterol) develop on the inside lining of major blood vesselsNarrows interior part of the blood vesselIf affected vessel is major artery supplying nutrients and oxygen to heart muscle, can result in myocardial infarction (MI)Local area of dying or dead tissue is an infarct4Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide5Atherosclerosis (cont’d)
Common symptom is angina pectoris, chest pain usually radiating down the left arm, sometimes brought on by excitement or physical effortIf affected vessel is major artery supplying brain, result could be cerebrovascular accident (stroke)5Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide6Key Terms Related to Atherosclerosis
Myocardial infarctionCerebrovascular accidentCoronary heart diseaseAngina pectorisLipids6Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide7Relation to Fat Metabolism
Three lipids relevant to CVDTotal cholesterol: fat-related compound produced in body; also in foods from animalsHypercholesterolemia = high blood cholesterol levelLipoproteins: “packages” wrapped with protein that carry fat in the bloodstream for energy and metabolismDyslipidemia = abnormal lipid profileTriglycerides: simple fats in body or foodHypertriglyceridemia = high blood triglycerides levelCommonly associated with low levels of high-density lipoproteins7Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide8Types of Lipoproteins
ChylomicronsLipoprotein particles that carry absorbed dietary triglycerides to plasma and tissuesVery-low-density lipoproteins (VLDLs)Formed in the liver from endogenous fat; carry large load of triglyceridesIntermediate-density lipoproteins (IDLs)After VLDLs deposit triglycerides, IDLs remain in circulationLow-density lipoproteins (LDLs)Carry at least 2/3 of total plasma cholesterol to body tissuesHigh-density lipoproteins (HDLs)Carry less total fat and more protein than other lipoproteins8Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide9Types of Lipoproteins (cont’d)
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Slide10Cholesterol and Lipoprotein Profile
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Slide11Risk Factors
Gender: CVD more common in men until women reach menopauseAge: risk increases with age-start developing healthy diet habits early in lifeFamily historyHeredity: certain ethnic groupsFamilial hypercholesterolemiaFamilial hypertriglyceridemiaBlood cholesterol profile: high total and LDL and low HDL cholesterolCompounding conditions: type 2 diabetes, hypertension, metabolic syndrome11Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide12Dietary Recommendations to Reduce Risk
Healthy Diet ≥4.5 cups/day of fruits and vegetables≥2 servings/week of fish≥3 servings/day of whole grains<36 oz/week of sugar-sweetened beverages≤1500 mg/day of sodiumAHA recommends lowering use of partially hydrogenated vegetable oilsCopyright © 2017, Elsevier Inc. All Rights Reserved.17
Slide13Dietary Recommendations to Reduce Risk (cont’d)
Dietary guidelinesReduce certain types of fat and cholesterolMore important to consider totality of diet National Cholesterol Education Program (NCEP): reduce high blood cholesterol levelsTherapeutic Lifestyle Changes (TLC):Appropriate weightDietPhysical activityOther controllable risk factorsTLC diet has been replaced with the Lifestyle Management Guidelines, detailed on next slides 13Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide14Lifestyle Management Guidelines
Diet Emphasize vegetables, fruits, and whole grains; low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts; moderate use of polyunsaturated but should use monounsaturated food fatsLimit sodium, sweets, sugary beverages, red meats; using lemon juice to season foodAdapt to calorie requirements, personal and cultural preferences, medical nutrition therapy for other conditionsCholesterol level below 200 Exercise150 minutes/week of moderate-intensity aerobic physical activity (or 75 min/wk @ vigorous intensity)Copyright © 2017, Elsevier Inc. All Rights Reserved.19
Slide15Diet and Drug Therapy
Diet Therapy, continuedFor patients who would benefit from lower LDL:Reduce total % of calories from saturated fat. Aim for a maximum intake of 5 to 6% of calories from saturated fat.Reduce percentage of calories from trans fats.3 to 4 sessions of aerobic physical activity/week, lasting 40 minutes each, of moderate- to vigorous-intensity Drug Therapy NCEP ATP III guidelines: drug therapy initiated depending on risk factorsLifestyle Management Guidelines should be continued as adjunct therapy15Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide16Acute Cardiovascular Disease
Acute cardiovascular disease: myocardial infarctionObjective: Cardiac rest (analgesics)Principles of medical nutrition therapyGoals: promote recovery and strength, lower LDL and other known risk factors to prevent CVD progressionImmediate:Energy intake reduced to reduce load on heartSoft or easily digested foodsLong-term:Mediterranean-type diet or the DASH diet Limited sodium16Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide17Heart Failure
Congestive heart failureInability to maintain adequate cardiac output therefore leading to difficulty in breathingObjective: control of pulmonary edemaFluid shift mechanismHormonal alterations (kidneys, pituitary, adrenals)Principles of medical nutrition therapySodium restriction to 2 grams per dayFluid restrictionDietary supplementsLittle or no alcohol17Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide18Lesson 19.2: Hypertension
Hypertension (i.e., chronically elevated blood pressure) may be classified as primary or secondary hypertension.Hypertension damages the endothelium of blood vessels.Early education is critical for the prevention of cardiovascular disease.18Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide19Essential Hypertension
Incidence and nature of essential (primary) hypertension30% of American adults have high blood pressure (hypertension)Specific cause is unknownRisk factors: family history, obesity, smoking, age, ethnicity, physical inactivity, alcohol consumption, sodium intake, chronic stressAfrican Americans more susceptible to developingSecondary hypertension is the result of a known cause; symptom or side effect of another primary conditionHypertension called the “silent killer”19Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide20Hypertensive Blood Pressure Levels
Normal: systolic <120 mm Hg; diastolic <80 mm HgPrehypertension: focus on lifestyle modifications120 to 139 systolic or 80 to 89 diastolicStage 1 hypertension: diet therapy and drugs as needed140 to 159 systolic or 90 to 99 diastolic for persons age 18 to 59>150 systolic or 90 to 99 diastolic for persons 60 and olderStage 2 hypertension: diet therapy and vigorous drug therapy>160 systolic or >100 diastolic20Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide21Principles of Medical Nutrition Therapy for Hypertension
Weight management: lose excess body fat and maintain healthy weightPhysical activity: moderate to vigorous-intensity aerobic activity 3-4 times/week for average of 40 min per timeDASH diet: lower blood pressure through diet alone-review diet recommendations page 340Sodium control: limit sodium to 1500 to 2400 mg/dayDirect correlation between sodium intake and blood pressure (high sodium intake leads to high blood pressure), even in patients with resistant hypertensionAdditional lifestyle factors: limit alcohol, stop smoking, increase aerobic activity, use stress management techniques21Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide22Education and Prevention
Food planning and purchasingRead labelsEat fresh foods/fruits/vegetables with limited processed foodsFood preparationUse less salt and fat (saturated and trans)Use seasonings instead (herbs, spices, lemon, onion, garlic, etc.) can use lemon juice to season foodsLess animal products in smaller portionsPerson-centered approachPersonal desires, ethnic diets, economic restrictions, and food habits22Copyright © 2017, Elsevier Inc. All Rights Reserved.
Slide23Education Principles
Start earlyPrevention begins in childhood, especially with children in high-risk familiesFocus on high-risk groupsDirect education to people and families with risk of heart disease and hypertensionUse variety of resourcesNational organizations, community programs, registered dietitians23Copyright © 2017, Elsevier Inc. All Rights Reserved.