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Coronary Artery Disease.ppt
 

Coronary Artery Disease.ppt

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  • One in 9 women and one in 6 men, age 45 to 64 have CHD. After age 65, one in 3 women and 1 in 8 men are afflicted.
  • Looks good on paper, but……. Differences between ethnicities
  • Per 100,000 2001
  • CHD results from a lack of blood flow to the block vessels surrounding the heart.
  • After injury, platelets adhere and release growth factors that increase the development of the lesion.
  • Related to the additional presence of other risk factors such as hyperlipidemia, hypertension and obesity
  • The magnitude of this risk is similar to high blood cholesterol and smoking.
  • LDL-C is the primary transporter of cholesterol in the blood.
  • Recent clinical trials have proven that lowering LDL-C levels sharply reduces the risk of MI, death from CHD and death from all cases
  • 4,444 patients with history of angina or MI Cholesterol levels between 213-310 mg/dL Placed on cholesterol-lowering diet and either a statin drug or placebo.
  • With statin drug
  • Total Fat 20-35% calories from fat Average of total calories consumed over a one week period. Saturated fatty acid Intake is the strongest dietary determinant of LDL-C Recommendation: 8-10% calories Help to thin blood and prevent blood platelets from clotting and sticking to artery walls. Food Sources: fatty fish, such as salmon, sardines, trout, swordfish, herring, albacore tuna, mackerel and, soy, canola and flaxseed oil. Consumption of 2 servings (~8ounces)per week of fish high in α -linolenic acid Monounsaturated fatty acids If equal amounts of MUFAs are substituted for saturated fatty acids, LDL-C decreases MUFAs do not lower HDL-C Recommended intakes: up to 20% of total calories
  • Found in prepared foods containing “partially hydrogenated vegetable oils” Some margarines, crackers, other baked goods, commercially fried foods
  • 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. brisk walking, jogging, swimming, bicycling, and tennis
  • 5-10# weight loss can double the LDL-C reduction achieved by reducing saturated fat and cholesterol in the diet.
  • Oats, legumes, pectin, psyllium and certain gums have been shown to reduce serum cholesterol when added to a reduced fat/cholesterol diet .
  • Statins - Reduces LDL-C by inhibiting a enzyme in the pathway for cholesterol synthesis. Bile Acid Sequestrants Binds with cholesterol-containing bile acids in the intestine, and promoting the conversion of cholesterol to bile acids in the liver. Nicotinic Acid - Niacin lowers LDL-C by 10-25%
  • Recent studies of 700 individuals with atherosclerosis and 800 control subjects free of overt disease showed that those with the highest levels of homocysteine had a 2x increase in vascular disease risk, similar to that of smoking. Elevated homocysteine levels may be present in 15% of Americans.
  • Several vitamins, including folic acid, vitamin B6 and B12, function are cofactors in the metabolism of methionine and homocysteine. A number of studies have shown an inverse relationship of blood homocysteine levels and plasma/serum levels of folate, B6 and B12.
  • To date there are no studies which clearly demonstrate a cause and effect relationship
  • Use 2 egg whites or an egg substitute product instead of one whole egg.
  • Use skim or 1% milk and low fat or non fat yogurt Use cheeses labeled ‘reduced fat’, ‘low fat’, ‘part-skim’ or ‘fat free’’ <3g/oz.
  • Use tub margarine Monounsaturated oils - canola, olive Polyunsaturated oils – corn, soy, safflower, sunflower
  • Plant sterols and stanols structurally resemble cholesterol. Reduce cholesterol absorption in the intestine. 2-3 grams of plant sterols or stanols have been shown to reduce LDL-C ~ 10 - 20%.
  • USDA select or choice Loin, Round and Flank cuts Remove the skin from poultry Avoid high-fat process meats Tongue, kidneys Liver, sweetbreads, heart and brains are high in cholesterol.
  • WW, rye, pumpernickel, white bread, buns, dinner roles, bagels, English muffins, pita bread.

Coronary Artery Disease.ppt Coronary Artery Disease.ppt Presentation Transcript

  • 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
    • The major underlying cause is atherosclerosis.
    • Atherosclerosis is 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 to injury to the endothelium in the artery wall.
  •  
  •  
  •  
  •  
  •  
  • Risk Factors for Coronary 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 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 Disease
    • Diabetes
      • 50% of deaths related to DM is due to CHD
  • Risk Factors for Coronary Heart Disease
    • Inactivity
      • Sedentary person has 2x risk for developing CHD as a person who is active.
  • Risk Factors for Coronary Heart Disease
    • Obesity
  • Risk Factors for Coronary Heart Disease
    • Abnormal Blood Lipids
    • LDL Cholesterol (low density lipoprotein)
    • HDL Cholesterol (high density lipoprotein)
  • Cholesterol Diet Liver Cholesterol Metabolism 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
  •  
  • Treatment in CHD Patients
  • Cholesterol and the CHD Patient
    • Scandinavian Sinvastatian Survival Study:
    • N = 4,444 patients with history of angina or MI
    • Cholesterol levels = 213-310 mg/dL
    • Treatment A:
      • Placed on cholesterol-lowering diet and
      • B: a statin drug or a placebo.
  • Cholesterol and the CHD Patient
    • Results:
      • Cholesterol Levels - total cholesterol decreased 25%, LDL decreased 35%
      • 34% decrease in major coronary events
      • 42% decrease in CHD mortality
      • 30% decrease in total mortality
      • 37% decrease in surgery for CHD
  • Diet Therapy of High Blood Cholesterol
  • Diet Therapy of High Blood Cholesterol
    • Total Fat
      • 20-35% calories from fat
      • Average of total calories consumed over a one week period.
    • Saturated fatty acid
      • Intake is the strongest dietary determinant of LDL-C
      • Recommendation: 8-10% calories
  • Diet Therapy of High Blood Cholesterol
    • Polyunsaturated fatty acids
    • Reduces LDL-C and risk of CHD when substituted for saturated fat in the diet
    • Can cause small reduction in HDL-C when present in high amounts
    • Recommendation: ~10% of energy intake
  • α - Omega-3 Fatty Acids
    • Help to thin blood and prevent blood platelets from clotting and sticking to artery walls.
    • Food Sources: fatty fish, such as salmon, sardines, trout, swordfish, herring, albacore tuna, mackerel and,
    • soy, canola and flaxseed oil.
    • Consumption of 2 servings (~8ounces)per week of fish high in α -linolenic acid
    • Monounsaturated fatty acids
    • If equal amounts of MUFAs are substituted for saturated fatty acids, LDL-C decreases
    • MUFAs do not lower HDL-C
    • Recommended intakes: up to 20% of total calories
  •  
  • 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
  • Trans fatty acid content of fast-food (Data compiled from Nutrition Action Health Letter, June 1999)         13 3 530 Starbucks cinnamon scone (5 oz) 6 7 540 Burger King fries (6 oz King size) 7 2 610 Burger King chicken sandwich (8 oz) 6 3 510 McDonalds chicken McNuggets (9 oz) 14 3 660 Hamburger (7 oz) Saturated Fatty Acids (g) Trans Fatty Acids (g) Calories Food
  • 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 of homocysteine
    • Elevated homocysteine levels may be present in 15% of Americans.
  • Dietary Issues Requiring Further Research
    • Several vitamins, including folic acid, vitamin B6 and B12, function are cofactors in the metabolism of methionine and homocysteine .
  •  
  • Dietary Issues Requiring Further Research
    • Antioxidant Vitamin Supplements - Vitamins E, C and A
    • Results of epidemiological observations suggest a relationship between increased intake of these vitamins and decreased CHD risk.
  • Dietary Issues Requiring Further Research
    • Very low-fat diets (<15 % fat)
  • 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
    • Tongue, kidneys Liver, sweetbreads, heart and brains are high in cholesterol.
  • 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
  • Reading The Label
    • Fat Free
      • less than 0.5 gm fat
    • Low Fat
      • 3 grams or less fat
    • Reduced fat
      • at least 25% less fat
    • Light
      • one-third fewer calories or 50% less fat
  • 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.
  • Risk Factors for Coronary Heart Disease
    • Triglycerides
      • Normal: < 200 mg/dl
      • Borderline: 200 - 400 mg/dl
      • High: 400 - 1000 mg/dl
      • Very High:> 1000 mg/dl
  • Risk Factors for Coronary Heart Disease
    • High Triglycerides (>200 mg/dl) and low HDL cholesterol is associated with increased risk.
    • Stronger in women than men and older adults
  • Hypertriglyceridemia
    • Factors Associated with Increased Triglycerides:
      • Diets - low fat, high refined sugar
      • Estrogens
      • Alcohol
      • Obesity
      • Untreated Diabetes, hypothyroidism, chronic renal failure and liver disease
  • Hypertriglyceridemia
    • Treatment:
      • Weight Loss
      • Low cholesterol, low saturated fat diet
      • Increased physical activity
      • Smoking cessation
      • Management of Diabetes
      • Restricted alcohol use