CVD and health

1. MNT and Cardiovascular
Diseases
By :Assoc. prof.dr. Faisal

2. Cardiovascular Diseases
 Includes heart attack, stroke
 Leading cause of death in the U.S.
 Annually, 500,000 people die of CHD
in the U.S. (1 million including strokes
and other CVD)
 Each year, 1.5 million Americans have
a heart attack

3. Cardiovascular Diseases
 Symptoms take years to develop
 Plaque build-up can begin in childhood
 Myocardial infarction (heart attack)
 Cerebrovascular accident (stroke)

4. Pathophysiology of
Atherosclerosis
 Vessel lining is injured (often at
branch points) →
 Plaque is deposited to repair injured
area →
 Plaque thickens, incorporating
cholesterol, protein, muscle cells, and
calcium (rate depends partly on level
of LDL-C in the blood) →

5. Pathophysiology of
Atherosclerosis (cont)
 Arteries harden and narrow as plaque
builds, making them less elastic →
 Increasing pressure causes further
damage →
 A clot or spasm closes the opening,
causing a heart attack

6. Heart Attack (Myocardial
Infarction)

7. Heart Attack (Myocardial
Infarction)
 When blood supply to the heart is
disrupted, the heart muscle is
damaged.
 May cause the heart to beat irregularly
or stop altogether.
 25% of people do not survive their first
heart attack.

8. Heart attack types and
diagnosis
A heart attack is also called a myocardial infarction, sometimes
simply referred to as an “MI.” A heart attack occurs when a
blockage in one or more coronary arteries reduces or stops
blood flow to the heart, which starves part of the heart muscle
of oxygen.
The blood vessel blockage might be complete or partial:
A complete blockage of a coronary artery means you suffered
heart attack – which stands for ST-elevation myocardial
infarction.
A partial blockage translates to– a non-ST-elevation myocardial
infarction.

9. Heart attack and diagnosis
- Non-invasive cardiac tests measure your heart’s
activity through ,chest x-rays, echo and
electrocardiography.
- Invasive tests: cardiac enzymes testing, and
inserting a thin hollow tube called a catheter into a
blood vessel to get an inside view.
 Treatment:-
• Thrombolysis: injecting a clot-dissolving agent to restore
blood flow in a coronary artery.
• Coronary angioplasty/coronary artery bypass graft surgery: to
improve blood supply to the heart muscle.

10. Angioplasty
The term "angioplasty" means using a balloon to stretch
open a narrowed or blocked artery.
However, most modern angioplasty procedures also
involve inserting a short wire mesh tube, called a stent,
into the artery during the procedure.
The stent is left in place permanently to allow blood to
flow more freely.

12. Symptoms of a Heart
Attack
 Intense, prolonged chest pain or
pressure
 Shortness of breath
 Sweating
 Nausea and vomiting
 Dizziness
 Weakness
 Jaw, neck and shoulder pain
 Irregular heartbeat

13. Factors that May Bring On a
Heart Attack in At-Risk Persons
 Dehydration
 Emotional stress
 Strenuous physical activity when not
physically fit
 Eating a large, high-fat meal
(increases risk of clotting)

14. Cerebrovascular Accident (CVA)
or Brain Attack

15. Brain Attack (Stroke) or
Cerebrovascular Accident

17. Symptoms of Stroke
(Brain Attack)
 Sudden numbness or weakness of the face,
arm or leg, especially on one side of the
body
 Sudden confusion, trouble speaking or
understanding
 Sudden trouble seeing in one or both eyes
 Sudden trouble walking, dizziness, loss of
balance or coordination
 Sudden severe headache

18. Blood Lipid Levels are
Related to Risk of CVD

19. Blood Lipids
(Lipoproteins)
 Lipids (fat) cannot mix with water
 Blood is high in water
 Lipids cannot travel in blood without
help
 Lipoproteins are formed to carry lipids

20. Lipoproteins combine
 Lipids (triglycerides,
cholesterol)
 Protein
 Phospholipids

21. Cholesterol biosynthesis
 Location of pathway
1.The pathway is located in the
cytosol.
2.Raw material Acetyl-CoA.
3.Most cells can make cholesterol,
but liver is most active.

23. Regulation of Cholesterol
Production

24.  Role of Fatty acids.
 High rich-cholesterol food intake.
 High fructose intake.
 Anabolic steroids.
 Hypercholesterolemia occurs in diabetes mellitus,
Hypothyroidism, Obstructive jaundice, Familial
hypercholesterolemia.
 Familial combined hyperlipidaemia.
 Hereditary factor -In familial hypercholesterolemia,
due to LDL receptor defect, LDL cholesterol uptake
is reduced.
Factors affecting serum cholesterol

25. Hypolipidemic drugs
 Statins - competitive inhibitors of HMG CoA-
reductase. Leads to an increase in LDL receptor
expression in the liver, which lowers LDL.
 Clofibrates, lower plasma TG by decreasing VLDL .
Activate lipoprotein lipase.
Probucol: increases the catabolism of LDL. It also has
antioxidant properties.
Ezetimibe: Inhibits cholesterol absorption from the
gut.

26. Low-Density Lipoproteins
(LDL-C)
 Also called “bad cholesterol)
 Contain relatively large amounts of fat,
and less protein
 Deposits cholesterol in arteries
 Thus, ↑ LDL-C is associated with ↑
CVD risk
 Serum LDL-C should be < 130 mg/dL

27. High-Density Lipoproteins
(HDL)
 Also called “good cholesterol”
 Relatively high in protein, lower in lipid
 Acts as scavenger, carrying cholesterol from
arteries to liver
– Liver packages as bile
– Excretes
 ↑ HDL-C is associated with ↓ risk of CVD
 Serum HDL-C should be >60 mg/dL
(optimal) or at least >40 in men and 50 in
women

28. Triglycerides
 The most diet-responsive blood
lipid
 Should be ≤150 mg/dL in fasting
state

29. Triglycerides
Lower blood triglycerides by:
 Not overeating
 Limiting alcohol and simple sugars
 Spreading meals throughout the day
 Including fatty fish in the diet
 Controlling diabetes if present
 Performing regular physical activity
 Not smoking

30. Total Cholesterol
 Includes HDL-C, LDL-C, and a fraction
of the triglycerides
 Total cholesterol should be ≤ 200
mg/dL
 Total cholesterol does not tell whole
story

31. Lipoprotein Summary

32. Evaluating Blood Lipids:
LDL
<100 mg/dL Optimal
100-129 Near optimal
130-159 Borderline high
160-189 High
≥190 Very high
Source: ATP-III Guidelines, NHLBI, accessed 2-2005

33. Evaluating Blood Lipids:
Total Cholesterol
<200 mg/dL Desirable
200-239 mg/dL Borderline high
≥240 mg/dL High
Source: ATP-III Guidelines, NHLBI, accessed 2-2005

34. Evaluating Blood Lipids:
HDL
< 40 mg/dL Low
≥ 60 mg/dL High
Source: ATP-III Guidelines, NHLBI, accessed 2-2005

35. Blood Pressure
 Measured in mmHg
 Systolic blood pressure: the pressure
in the arterial blood vessels associated
with the pumping of the heart.
 Diastolic blood pressure: the pressure
in the arterial blood vessels when the
heart is between beats.

36. Hypertension: Either
 Systolic blood pressure > 140 mmHg
 Diastolic blood pressure > 90 mmHg

37. Risk Factors (other than
LDL) for CVD
 Cigarette smoking
 Hypertension (BP ≥140/90 mmHg or on
anti-hypertensive tx
 Low HDL-C* (<40 mg/dL)
 Family history
 Age (men ≥45 years, women ≥55 years)
*HDL-C ≥ 60 mg/dL counts as a negative risk factor
Source: ATP-III Guidelines, NHLBI, accessed 2-2005

38. Risk Factors (other than
LDL) for CVD
 Diabetes (considered equivalent to a
history of CHD)
 Obesity
 Inactivity
Source: ATP-III Guidelines, NHLBI, accessed 2-2005

39. Screening for CVD Risk
 Everyone 20 and older should have his
cholesterol measured at least every 5
years
 Lipoprotein profile: includes TC, LDL-C
HDL-C, and TG
 At least should include TC and HDL-C
 If TC> 200 mg/dL or HDL-C< 40
mg/dL, obtain full lipid profile
Source: National Cholesterol Education Program, National Institutes of
Health, accessed 2-05

40. Total Cholesterol
 John and Marty
each have total
cholesterol levels of
200 mg/dL.
 Their health risk is
different

41. Total Cholesterol is Not
Enough
John’s Lipid Profile
 TC: 200 mg/dL
 LDL-C: 140 mg/dL
 HDL-C: 30 mg/dL
 TG: 150 mg/dL
Marty’s Lipid Profile
 TC: 200 mg/dl
 LDL-C: 95 mg/dL
 HDL-C: 75 mg/dL
 TG: 150 mg/dL

42. What Affects Cholesterol
Levels?
 Diet
 Weight
 Physical activity
 Age and gender
 Heredity
You control the first three!

43. Lowering LDLs
 See your doctor to assess for other
conditions
 Reduce dietary saturated fat, trans
fatty acids, and cholesterol
 Increase MUFA and PUFA
 Increase dietary fiber

44. Lowering Blood TG
 Is the most diet-responsive blood lipid
 Avoid overeating
 Limit alcohol
 Limit simple sugars
 Small frequent meals
 Include fish in the diet

45. Raise the HDL
 Physical activity
 At least 45 min./day, 4 days a week
 Avoid smoking
 Eat regularly
 Eat less total fat
 Moderate intake of alcohol increases
HDL

46. Therapeutic Lifestyle
Changes (TLC)
 TLC Diet
 Physical activity (30 minutes on most,
if not all, days)
 Weight management: will help
manage triglycerides, increase HDL,

47. Diet Strategies for
Reducing the Risk
 Eat less saturated fat & trans fats
 Replace with MUFA and essential fatty
acids
 Eat fish 2x a week
 Eat plenty of fruits and vegetables
 Eat more whole grains and less refined
CHO
 Eat at least 3 meals regularly

48. TLC Diet
 Low in saturated fat (<7% of calories)
and cholesterol (<200 mg/day)
 Enough calories to maintain a
desirable weight
 High in soluble fiber
 Plant stanols or sterols, if needed

49. Other Recommendations
 Fat intake can be higher as long as
saturated and trans fatty acid are
minimal
 Eat diet with plenty of fruits and
vegetables
 Cut down on red meats
 Cut down on simple sugars and
refined CHO

50. TLC: Healthy Cooking
 Bake, steam, roast, broil, stew or boil
instead of frying
 Remove poultry skin before eating
 Use a nonstick pan with cooking oil
spray or small amount of liquid
vegetable oil instead of lard, butter,
shortening, other solid fats
 Trim visible fat before you cook meats
 Chill meat and poultry broth until fat
becomes solid, remove

51. TLC: Healthy Shopping
 Choose chicken breast instead of wing
and thigh
 Select skim milk or 1 percent instead
of 2 percent or whole milk
 Buy lean cuts of meat
 Buy more vegetables, fruits and grains
 Read nutrition labels on food packages

52. TLC: Dining Out
 Choose restaurants that have lowfat
options available
 Ask that sauces, gravies, and salad
dressings be served on the side
 Control portions by asking for an
appetizer serving or sharing with a
friend

53. TLC: Dining Out
 At fast food restaurants, go for salads,
grilled (not fried or breaded) skinless
chicken sandwiches.
 Avoid regular salad dressings and fatty
sauces.

54. Omega-3 Fatty Acids
 Reduces inflammation, blood clotting
 Sources
– Fatty fish (salmon, tuna) twice a week
– Canola and soybean oil
– Flaxseed, walnuts
– Fish oil supplements (expensive and may
contain heavy metals)

55. Phytochemicals
 ↓ inflammation
 ↓ blood clotting
 Include anthocyanins (found in red and blue
fruits such as raspberries and blueberries
and vegetables) lutein (green leafy
vegetables) lycopene (tomato products),
phenolics (citrus fruits, fruit juices, cereals,
legumes, and oilseeds)

57. Nitric oxide is one of the most important molecules produced
naturally in the human body.
It serves as a critical signaling molecule in the cardiovascular
and circulatory system. Our bodies cannot function as intended
without proper circulation. This means that NO affects
absolutely every function in our bodies.
It's a vasodilator, meaning it relaxes the inner muscles of your
blood vessels, causing the vessels to widen. In this way, nitric
oxide increases blood flow. NO is made by the blood vessel’s
lining called the endothelium. Nitric oxide expands the blood
vessels, increasing blood flow and decreasing plaque growth
and blood clotting.
Nitric oxide and CVDs

58. Why is NO important in our
bodies?

59. NO is a vasodilator that helps keep arteries open and
prevents plaque buildup. Reduced NO availability is
often used as an early marker for various cardiovascular
diseases.

60. Who needs NO?
• Anyone looking to support healthy blood
pressure
• Anyone over the age of 30
• Anyone with low energy
• Diabetics
• Anyone diagnosed with vascular
dysfunction
• Men experiencing sexual dysfunction

61. CVDs and dietary supplements

63. MNT Summary

64. Prevention & therapy
 Before drug therapy – diet therapy or dietary control
for 6 months:
 Generally decrease food rich in saturated fat and increase
food rich in unsaturated fat.
 decrease saturated fat intake.
 decrease cholesterol intake.
 adjust weight (decrease high caloric intake &
increase physical activity).
 Lipid profile should be :
 Total Cholesterol = < 200 mg/dl
 Triglycerides = < 150mg/dl
 LDL = < 130 mg/dl ^ risk >160
 HDL = > 60 mg/dl ^ risk < 35
 LDL/HDL ratio < 3.0 (Best 2.5)
 160/35 = 4.5 ^ risk
 130/60 = 2.1 low risk

71. Thank you….