cardiovascular diseases Different diseases under CVD DIETARY MANAGEMENT

1. Prepared by :
Anjesh poudel

2. INTRODUCTION
CVD is a general term describing diseases of heart and
blood vessels.
Coronary Heart Disease is the most common form of CVD
and is caused by the atherosclerosis in the large and medium
sized arteries that supply the heart muscles with oxygen and
nutrients.
CVD remains the leading cause of death in many countries.

3. PREVALANCE
It is the no 1 killer disease worldwide which take the life of 12
million people annually.
During last 30 years large declines in developed countries -rising
health awareness and government programmes.
Alarming increase in developing countries especially Nepal and
India.

4. RISK FACTORS OF CVD
There are four categories of risk factors:
i) Risk factors for which intervention have been proven to lower CVD
risk;
* Cigarette smoking
* High fat/ cholesterol diet
* Hypertension
* Left ventricular hypertrophy
* Thrombogenic factors

5. ii) Risk factor for which intervention are likely to lower CVD risk;
* Diabetes mellitus
* Physical inactivity
* HDL cholesterol
* Triglycerides, small dense LDL
* Obesity
* Postmenopausal status
iii) Modifiable risk
* Psychological factor
* Lipoprotein
* Homocysteine
* Oxidative Stress
* No alcohol consumption

6. iv) Non modifiable risk factors
* Age
* Gender
* Family history of early onset CVD

7. DISEASES INCLUDED
 Atherosclerosis
 Hyperlipidemias
 Coronary heart disease
 Myocardial infraction
 Congestive heart failure
 Hypertension

8. ATHEROSCLEROSIS

9. DEVELOPMENT OF
ATHEROSCLEROSIS

10. HYPERLIPIDEMIA
It is a general term that denotes an elevation of one or more
lipids in the blood.
Hypercholesterolemia: is a serum cholesterol in excess of
260mg/dl.
Hypertriglyceridemia when fasting triglyceride level
exceeds 250mg/dl.
These elevated levels results in rapid & severe development
of atherosclerosis & in turn coronary disease.

11. Coronary artery disease (CAD), These are diseases
of the arteries that supply the heart muscle with blood.
Coronary heart disease (CHD), a disease of the
heart itself caused by the accumulation of atheromatous
plaques within the walls of the arteries that supply the
myocardium.

12. SYMPTOMS
* No symptoms for long period
* Severe Chest pain for short period on exertion
also known as Angina Pectoris or minor heart
attack
* Infract is localized area of necrosis result
when blood supply is inadequate. An infract oh
heart is known as Myocardial Infarction or
major heart attack-Severe chest pain, death of
heart muscle, heart failure, irregular heart
beats
* Sudden Ischaemic Death (deficient blood
supply)

14. * Heart failure , often called congestive heart failure,
is a condition in which the heart can't pump enough
blood to the body's organs and tissues.
* It doesn't mean the heart has failed and can't pump
blood at all. With this less effective pumping, vital
organs don't get enough blood
* Causing signs and symptoms as:
1. Shortness of breath
2. Fluid retention (edema) in extremities first & with
increasing failure to abdomen & chest and fatigue.

15. Role of fat in CVD
Cholesterol
Two sources of cholesterol: Food & made in your body
Too much cholesterol can deposit in the arteries in the form
of plaque and block them
Hypercholesteraemia occurs when cholesterol level exceed
240mg/dl
Cholesterol & Triglyceride are the main forms of fat carried
in blood with the help of lipoproteins.

17. LIPOPROTEINS
Lipoproteins are made up of protein & lipids.
1. Chylomicrons, carry triglyceride, monogylcerides,
glycerol & small amount of cholesterol &
phospholipids.
2. VLDL also transport triglyceride but mainly
endogenous triglyceride formed in liver. They travel
through blood vessels & circulate fat throughout the
body.

18. GOOD VS BAD CHOLESTEROL
LDL cholesterol is also known as bad cholesterol. It has
the tendency to increase the risk of heart disease.
LDL cholesterol is a major component of the plaque that
clogs arteries.
HDL cholesterol is known as the good cholesterol. This
increases with exercise.
HDL helps bad cholesterol to carry out from the arteries.

19. WAYS OF ACTION

20. LDL main carrier of cholesterol, it stuck to blood vessels.
HDL takes away cholesterol from tissues to liver for
conversion or excrete.

21. SATURATED FATS
* Saturated fats raise LDL & total cholesterol levels
* Increase the risk of CVD.
* Saturated fats are found in animal products such as butter,
cheese, whole milk, icecream, cream and fatty meats and
oils such as coconut, palm and palm kernel oil.

22. TRANS FATTY ACIDS
* Trans fats raise LDL
* Lowers HDL
* Thus are atherogenic
The sources of trans fatty acids are
* Meat & dairy products
* Hydrogenated fats: hydrogenation of vegetable oils alter
the geometric structure of PUFA from natural ‘cis’ to ‘trans’
form.

23. Dietary management
* Low calorie, low fat, low CHO, high fiber diet
* Energy: patient whose weight is normal, maintenance
level of calorie.
Loss of weight for obese people is advisable
A1000-1200 kcal diet is suitable for obese patient in
bed.
* Fats: first step is restriction of fat to not more than 20%
of total calories
* Important n-3 PUFA are a-linolenic acid, EPA & DHA
n-6 are linoleic acid & arachidonic acid
* They are also known as omega 6 & omega 3.

24. BENEFITS
* Promote esterification of cholesterol
* Reduces thrombosis
* Prevent accumulation of cholesterol in blood
* Decrease synthesis of VLDL, LDL, triglycerides
* Specially food rich in ω-3 fatty acid have cardio protective
effects
* Such as fish, specially salmon, fish oil
* Vegetable sources: flaxseed, canola oil, mustard oil, walnuts.

25. MUFA
Present in vegetable sources such as olive oil, canola,
almond oil.
Lower LDL without lowering HDL & do not raise
triglyceride levels.
Cholesterol
Cholesterol level should not exceed 300mg in diet as liver
also synthesis cholesterol.

26. * CHO: Include complex CHO in diet. About 60% of total
calorie from CHO
* Protein, vitamins & minerals, Normal allowances are
recommended, Avoid animal protein
*Sodium is restricted when there is hypertension. Usually a
restriction of Na of 1600-2300mg is satisfactory for CHD
patients. When Na is restricted other sources of iodine should
be given. It also reduces intake of vit A.

27. DIETARY GUIDELINES
Limits the intake of food high in calories and nutrition,
including foods like soft drinks, candy, junk food.
Limit foods high in saturated fats, trans fat and
cholesterol.
Eat less than 6gms of salt a day.
Have no more than 1-2 alcoholic drink a day if you are
a regular drink.

28. LIMIT/ AVOID
Foods rich in cholesterol and saturated fats.
* Egg yolk
* Fatty meat and organ meat
* Butter chicken
* Milk fat – Desi ghee, Butter, Cheese, etc
* Hidden fats like bakery biscuits, patties, cakes, pasteries.

29. Hypertension
* Hypertension is elevated blood pressure.
* Hypertension impairs the pumping action of heart & if
untreated damages heart, brain & kidneys.

30. CAUSES
Predisposing factors Other factors
* Heredity *CVD
* Stress * Renal disease
* Obesity * Tumor of brain
* Smoking * Thyroidism
* High viscosity of blood
* Narrowing of blood vessel

31. Types
* Mild hypertension: DBP is 90 to 104mm Hg.
* Moderate Hypertension: DBP is 105 to 119mm Hg.
* Severe Hypertension: DBP 120- 130mm Hg & above

32. Symptoms
* Many person have no symptoms
* Headache
* Dizziness
* Impaired vision
* Failing memory
* Shortness of breath
* GIT disturbances
* Unexplained tiredness

33. Diet management
* Low calorie, low fat, low sodium diet
* Energy : Obese patient must be reduced to normal body
weight with low calorie diet.
* Protein: normal allowance
* Fats: about 20gm vegetable oil is permitted. as they are
at risk of atherosclerosis, too much fats should be
avoided
* Sodium restriction
* Include high amount of fruit & vegetables for fiber,
potassium

34. Do not use
* Table salt or excess salt in cooking
* MSG (Monosodium glutamate)
* Baking powder
* Salt preserved foods, pickles canned foods
* Highly salted foods, potato chips
* Salted butter, cheese
* Biscuits, cakes etc
* In strict sodium restriction, choose vegetables judicly

35. THANK
YOU…..