Chapter 21 Nutrition and Cardiovascular Diseases

Nutrition and
Cardiovascular
Diseases
2121
Copyright © 2017 Cengage Learning. All Rights Reserved.

© Cengage Learning 2017
Introduction
• Cardiovascular disease (CVD)
– Accounts for about 31% of deaths in U.S.
• How does the risk of CVD compare for men and
women?
– Leading cause of death worldwide
– Most common form: coronary heart disease
(CHD), usually due to atherosclerosis

Deaths from Cardiovascular Diseases in the
United States

Introduction (cont’d.)
• Myocardial infarction: heart attack
– Sudden reduction in coronary blood flow
• Stroke
– Blocked blood supply to brain tissue

Atherosclerosis
• Artery walls become progressively
thickened due to plaque accumulation
• Consequences of atherosclerosis
– Plaques can rupture, promoting blood clotting
– Interferes with blood flow
• Narrows the lumen of the artery
• Enlarged thrombus, embolism, ischemia
• Obstructed blood flow in coronary arteries:
angina pectoris or heart attack

Plaque Formation in Atherosclerosis

Atherosclerosis (cont’d.)
• Consequences of atherosclerosis
– Peripheral artery disease
• Can cause pain and weakness in legs and feet,
especially while walking
– Kidney disease or kidney failure
• Due to artery blockage
– Most common cause of an aneurysm

• Causes of atherosclerosis
– Shear stress/hypertension
– Abnormal blood lipids
• LDL accumulate in susceptible artery wall regions
• High VLDL influences production of other
atherogenic lipoproteins, promotes inflammation
• How does low HDL contribute to the development
of atherosclerosis?

• Causes of atherosclerosis
– Cigarette smoking
– Diabetes mellitus
– Age and gender
• Risk increases in men >45 years, women >55
years
• Risk increases for women after menopause

Coronary Heart Disease
• Coronary heart disease (CHD) or coronary
artery disease
– Most common type of CVD
– Leads to:
• Angina pectoris
• Heart attack
• Sudden death
– Most common cause: atherosclerosis

Coronary Heart Disease (cont’d.)
• Symptoms of coronary heart disease
– Pain or discomfort in chest region
• Angina pectoris symptoms are triggered by
exertion; subside with rest
• Heart attack causes severe pain; lasts longer;
occurs without exertion
– Other symptoms
• Shortness of breath, unusual weakness or fatigue,
nausea, vomiting, abdominal discomfort

• Evaluating risk for coronary heart disease
– Traditional risk factors (Table 21-1)
– AHA/ACC online risk calculator
– Clinical measures (Table 21-2)
• Blood lipid profile, detailed lipoprotein tests
• Coronary artery calcium score, C-reactive protein,
ankle-brachial index

• Evaluating risk for coronary heart disease
– Blood cholesterol levels and CHD risk
• Elevated LDL levels are directly related to
development of atherosclerosis
• Low HDL is highly predictive of CHD risk
• Lifestyle management to reduce CHD risk
– What are some therapeutic lifestyle changes
for lowering CHD risk? (Table 21-3)

Coronary Heart Disease:
Lifestyle Management (cont’d.)
• Main features: blood cholesterol-lowering
diet, regular physical activity, and weight
reduction
• Saturated fat
– Replace with monounsaturated and
polyunsaturated fats
– Consume <7% total kcal as saturated fat

• Polyunsaturated and monounsaturated fat
– Replacing saturated with polyunsaturated fat
associated with reduced morbidity, mortality
• Total fat
– 25% to 35% of kcal
– 30% to 35% of kcal with high triglycerides
• Trans fats: keep intake as low as possible
– Read food labels carefully

• Dietary cholesterol
– <200 mg/day for high-risk individuals
– What are the recommendations for eggs?
• Soluble fibers
– Psyllium supplements effective in lowering
cholesterol levels

• Plant sterols
– Added to various food products (e.g.,
margarine, orange juice)
– Supplied in dietary supplements
– ~2 g daily lower LDL cholesterol by up to 10%
• Fish and omega-3 fatty acids
– AHA recommends 2 or more servings of fish
per week, with an emphasis on fatty fish

• Alcohol
– Light/moderate consumption has favorable
effects on atherosclerosis, HDL, blood
clotting, insulin resistance, overall risk
– 1 drink/day for women, 2/day for men
• Blood pressure reduction
– DASH eating plan (low-sodium, healthful diet)

• Regular physical activity
– 40 min/session, at least 3-4 days/week
• Smoking cessation
– CHD incidence drops to levels near those of
nonsmokers within 3 years
• Weight reduction
– 5-10% of initial weight over 6-12 months
– Additional loss to acceptable weight

• Managing lifestyle changes
– Ways to motivate patients:
• Explain the reasons for each change
• Set obtainable goals
• Provide practical suggestions
– Box 21-4 offers suggestions for implementing
a heart-healthy diet

• Vitamin supplementation and CHD risk
– B vitamin supplements and homocysteine
• B vitamin supplements not currently recommended
for patients at risk for CHD
– Antioxidant supplements
• Not recommended for heart disease prevention

• Lifestyle changes for hypertriglyceridemia
– Hypertriglyceridemia: elevated blood
triglyceride levels
– Common in people with diabetes mellitus,
obesity, metabolic syndrome, etc.
– Severe hypertriglyceridemia (>500 mg/dL)
• Fatty deposits in skin
• Acute pancreatitis

Hypertriglyceridemia (cont’d.)
• Nutrition therapy for hypertriglyceridemia
– Control body weight
– Become physically active
– Restrict alcohol
– Limit intakes of refined carbohydrates

Hypertriglyceridemia (cont’d.)
• Severe hypertriglyceridemia
– Dietary and lifestyle changes
– Medications for lowering blood triglycerides
– Eliminate alcoholic beverage consumption
• Fish oil supplements and
hypertriglyceridemia
– Sometimes recommended
– Should be monitored by a physician

• Drug therapies for CHD prevention
– Statins (e.g., Lipitor or Crestor) reduce
cholesterol synthesis in the liver
– Bile acid sequestrants (e.g., Colestid or
Questran) interfere with bile acid reabsorption
in the small intestine
– Fibrates (e.g., Lopid) lower triglyceride levels
and increase HDL

• Drug therapies for CHD prevention
– Nicotinic acid lowers triglycerides; increases
HDL; reduces LDL and lipoprotein(a) levels
– Anticoagulants and aspirin
– Blood pressure medications
– Nitroglycerin relieves angina
– Be aware of diet-drug interactions (Box 21-6)

• Treatment of heart attack
– Drug therapies given immediately after a
heart attack
• Thrombolytic drugs, anticoagulants, aspirin,
painkillers, and medications that regulate heart
rhythm and reduce blood pressure
– Sips of water or clear liquids only until
condition stabilizes

• Treatment of heart attack
– Sodium restriction (2000 mg/day) initially
– Cardiac rehabilitation programs
• Exercise therapy
• Instruction about heart-healthy food choices
• Help with smoking cessation
• Medication counseling

Stroke
• 4th most common cause of death in U.S.
– A leading cause of long-term disability
• Ischemic strokes
– Obstruction of blood flow to brain tissue
• Hemorrhagic strokes
– Bleeding within the brain
• What are transient ischemic attacks?

Stroke (cont’d.)
• Stroke prevention
– Recognize stroke risk factors: similar to those
for heart disease
– Make lifestyle choices to reduce risk
– Medications
• Antiplatelet drugs (e.g., aspirin)
• Anticoagulants (e.g., warfarin [Coumadin])

Stroke (cont’d.)
• Stroke management
– Stoke effects vary depending on area of the
brain that has been injured
– Early diagnosis and treatment
• Preserve brain tissue and minimize long-term
disability
• Ideally, thrombolytic drugs used within 4.5 hours
after ischemic stroke

Stroke (cont’d.)
• Stroke management
– Rehabilitation programs
• Start as soon as possible after stabilization
• Physical therapy, occupational therapy, speech
and language pathology, and kinesiotherapy
– Nutrition care
• Focus: help patients maintain nutrition status and
overall health
• Tube feedings may be needed until skills regained

Hypertension
• Primary risk factor for atherosclerosis and
cardiovascular diseases
• Primary cause of stroke and kidney failure
• Affects about one-third of U.S. adults
– An estimated 17% of people with
hypertension are unaware that they have it

Hypertension (cont’d.)
• Factors that influence blood pressure
(Figure 21-6)
– Blood pressure depends on:
• Cardiac output: volume of blood pumped by the
heart
• Peripheral resistance: resistance the blood
encounters in the arterioles

• Factors that influence blood pressure
– Nervous system: regulates heart muscle
contractions and arteriole diameters
– Hormonal signals: may cause fluid retention
or blood vessel constriction
• Factors that contribute to hypertension
– Primary or essential hypertension
• Cause is unknown

• Factors that contribute to hypertension
– Secondary hypertension
• Caused by a known physical or metabolic disorder
– Risk factors for hypertension
• Aging, genetic factors, obesity, salt sensitivity,
alcohol, and dietary factors

• Treatment of hypertension
– Table 21-4 lists lifestyle modifications
– Weight reduction
• Blood pressure reduced by ~1 mm Hg per kg
weight loss
• Most beneficial for blood pressure control during
periods when weight is decreasing

Hypertension: Treatment (cont’d.)
• Dietary approaches for blood pressure
reduction
– DASH Eating Plan (Table 21-5)
• More fiber, potassium, magnesium, and calcium
than the typical American diet
• Limits red meat, sweets, sugar-containing
beverages, saturated fat, cholesterol
– More effective when accompanied by sodium
restriction (Box 21-11 offers tips)

Hypertension: Treatment (cont’d.)
• Drug therapies
– Combinations of two or more medications
usually required
– Most treatments include diuretics
– Other medications:
• Calcium channel blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin-receptor blockers

Heart Failure
• Heart’s inability to pump adequate blood
– Also called congestive heart failure
– Various causes
• Often a consequence of chronic hypertension or
CHD
– Leading cause of hospitalization in patients
>65 years old

Heart Failure (cont’d.)
• Consequences of heart failure
– Left-sided failure
• Buildup of fluid in the lungs, i.e., pulmonary edema
• Shortness of breath; limited oxygen for activity
– Right-sided failure
• Blood backs up in the peripheral tissues and
abdomen
• Fluid accumulation in the lower extremities, ascites

Heart Failure (cont’d.)
• Consequences of heart failure
– Affects food intake and level of physical
activity
– Cardiac cachexia: severe malnutrition
• Medical management of heart failure
– May require frequent hospitalizations
– Treatment varies according to nature and
severity of illness

Heart Failure: Medical Management
(cont’d.)
• Drug therapies for heart failure
– Diuretics reverse or prevent fluid retention
– What other medications may be prescribed?
• Nutrition therapy for heart failure
– Sodium restriction: 1500-3000 mg/day
– With fluid retention, fluid restriction: 2 L/day
– Adequate fiber intake

Heart Failure: Medical Management
(cont’d.)
• Nutrition therapy for heart failure
– Alcoholic beverage restriction
– Cardiac cachexia
• Condition cannot be reversed
• Liquid supplements, tube feedings, or parenteral
nutrition may be supportive additions to treatment

Nutrition in Practice: Helping People with
Feeding Disabilities
• Impaired eating ability
• Altered energy needs
• Feeding problems from disease symptoms
• Health professionals who help with
feeding problems
• Special equipment (Figure NP21-2)
• Social implications

Chapter 21 Nutrition and Cardiovascular Diseases

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