Cardiovascular diseases refer to diseases of the heart and blood vessels. The document discusses several types of cardiovascular diseases including coronary heart disease, congenital heart disease, hypertension, and congestive heart failure. It outlines both modifiable risk factors like smoking, diabetes, obesity, and high blood pressure as well as non-modifiable risk factors like age, gender, and family history. The document also discusses cholesterol levels, atherosclerosis, dietary management of cardiovascular disease through reducing saturated fats, increasing antioxidants and fiber, and engaging in regular exercise.

1. Cardiovascular Diseases

2. Introduction
 Refers to class of diseases involving
heart / blood vessels
 Usually used to refer to
atherosclerosis (arterial disease)
 Studies show their progression from
adolescence, making primary prevention
efforts necessary from childhood
 Increased emphasis on prevention by
modifying risk factors

3. Heart

4. Disorders of Heart

5. Coronary heart disease
• Broadly used for all heart disorders
• It is blockage of arterial valves due to
deposition of atheromatous plaques
• Causes: Angina pectoris & heart
attacks

6. Congenital heart disease
Heart diseases caused during birth
Caused due to unavoidable genetic
defects

7. Hypertension
Blood pressure above normal levels i.e.
120/80 mm Hg
Causes of hypertension: tension,
anxiety, confusion, fatigue, headache,
obesity etc.

8. Congestive heart failure
All other heart diseases along with
congestion lead to heart stroke
Condition may result from any
structural or functional cardiac disorder
Disorder that impairs ability of heart
to pump sufficient amount of blood
throughout

9. Risk Factors

10. Non-modifiable Risk Factors
 Age: increasing age (above 45 years)
 Gender: men < 64 years more likely to
get CHD than women
 Genetic factors: Family history
 Race (or ethnicity): Asian Indians have
higher risk than any ethnic group
 Environment: risk increases with increase
in air pollution, including passive smoking

11. Modifiable Risk Factors
 Tobacco / smoking
 Insulin resistance / Diabetes mellitus
 Hypercholesterolemia: elevated
cholesterol levels & abnormal lipoprotein
levels
 Obesity, especially central / male
pattern type obesity
 High blood pressure
 Sedentary lifestyle

12.  Absence of key nutritional elements, like
omega-3 fatty acids / antioxidants
 Stress / Depression
 Kidney / hormonal diseases like
hypothyroidism & Cushing’s syndrome
Use of oral contraceptives
Men have higher rate of CVD than women.
After menopause, risk equals for both as
protective levels of hormones decline

13. Effect of Cholesterol
 Cholesterol above normal levels: risk for
CHD
 Can occur if diet is high in cholesterol /
saturated fats or because of familial
hyperlipidemia
High 240 or more
Borderline-high 200-239
Desirable Below 200
Total Cholesterol (mg/dl) in blood

14.  Men with avg blood cholesterol 260 had
3 times more heart attacks than men with
cholesterol 195
 Total cholesterol majorly includes-
 High density lipoprotein (HDL-Good
Cholesterol)
 Low density lipoprotein (LDL-Bad Cholesterol)
 Very low density lipoprotein (VLDL) &
 Triglycerides (TG)

15. HDL (mg/dl) Levels
Low Below 35
Intermediate 35-39
High 60 or more
LDL (mg/dl) Levels
High 160 or above
Borderline Below 130
Desirable Below 130
Desirable for people
with heart disease
Below 100

16. Atherosclerosis

17.  Arterial lesion characterized by
patchy thickening of intima (inner most
layer of arteries)
 Lesion comprises of fat & layers of
collagen like fibers
 Slow / progressive / degenerative
disease
 Leads to problems in smooth flow of
blood

18. Deposits / plaques
restricting blood flow
Inadequate nutrient / oxygen supply &
water removal from tissues, leading to
ischemia
Causing pain in chest, referred to as
angina pectoris which radiates down left
arm

19.  Clot in coronary artery blocking
entire blood flow to heart causes
heart attack
 Atherosclerosis is categorized as
continuum of fatty streaks,
intermediate lesions, fibrous plaques
& complicated lesions

20. Three Stages
• The fatty streak: This first stage of atherosclerosis can
sometimes be found in children as young as 10 years of
age. In this stage, a yellow streak appears along major
arteries, such as the aorta and carotid artery. This streak is
made up of smooth muscle cells, cholesterol, and
macrophages (a type of white blood cell). The fatty streak
phase alone does not cause any noticeable symptoms but
can progress into a more dangerous phase of
atherosclerosis called a fibrous plaque.

21. • Fibrous plaque: A fibrous plaque develops
within the inner layer of the vessel. This
plaque is made up of smooth muscle cells,
macrophages, and lymphocytes (a more
aggressive type of white blood cell). These
cells have cholesterol inside of them. As the
fibrous plaque grows, it begins to protrude
into the vessel where the blood is flowing.

22. • Complicated lesion: The final stage of atherosclerosis is
defined when a dangerous series of events occur. When the
fibrous plaque breaks apart, it exposes the cholesterol and
connective tissue underneath it. This event is recognized
by the body as an injury, and a team of blood clotting cells
are sent to the scene. This becomes particularly dangerous
because now the blood flow is being restricted by the
initial blockage as well as the clot that has formed. The
ruptured plaque in combination with the blood clot is
called a complicated lesion.

24. Etiology
Hyperlipidemia-excess fat in blood
specially LDL
Hypertension
Diabetes mellitus, due to abnormalities of
coagulation, platelet adhesion and
aggregation
Obesity, low physical activity, cigarette
smoking
High blood homocysteine & viral infections
of lungs causing damage to endothelium &
injury

25. Homocysteine &
Atherosclerosis
How high homocysteine might affect:
 Damage endothelial cells
 Increase platelet adhesiveness
 Adversely affect clotting factors
 Promotes smooth muscle cells
proliferation
 Enhances LDL oxidation

26. Treatment / Dietary
Management

27.  Reduction in intake of total fat (saturated and
cholesterol)
 Decreased intake of high cholesterol foods
 Saturated fatty acids (SFA): raise LDL. Energy
provided from saturated fats can be 0-10% of
total calories
 Monounsaturated fatty acids (MUFA): reduces
LDL & increases HDL
 Polyunsaturated fatty acids (PUFA): n-6 e.g.
safflower, sunflower, corn & sesame oil & n-3 in
fish oils, olive oil, rapeseed oil & mustard oil

28.  Ratio of n-6: n-3 between 5-10 is
considered healthy, can be obtained by using
mixture of two oils
 Combination of safflower, corn, sunflower
or sesame oil with equal proportions of
mustard oil or rapeseed oil is considered
healthy
 n-3 fatty acids are excellent for heart.
They reduce platelet aggregation & monocyte
adherence, modify plasma lipids & lower blood
pressure

29.  Hydrogenated fat (vanaspati): contain
trans fatty acids which raise LDL
 CHOs usually provide 60-70% of total
calories. In excess it is converted to
fat in body. Fibre gets absorbed slowly
& is beneficial for CVD
 Plant protein preferable over animal.
Eggs & lean meats in case of animal
foods

30.  Antioxidants & flavonoids: vit E, C & A
scavenge cell damaging free radicals &
act as antioxidants
 Chromium, zinc & magnesium: have
critical role in maintaining proper insulin
function. Deficiency of these minerals
increases risk for CVD

31.  Vitamin E-Soya oil, sunflower oil,
almonds, spinach, buckwheat, mint
 Vitamin C - Amla, guava, orange,
lemon, papaya, tomato, leafy
vegetables
 -Carotene - Carrot, pumpkin, mango,
tomato, papaya, orange, leafy
vegetables
 Selenium : Whole cereals, pulses,
leafy vegetables, cauliflower

32.  Whole milk & whole milk products
 Organ meat, egg yolks, cold meats
canned & sausages, ham, peanut butter
 Baked foods like cookies, patties,
pastries, cakes, samosas, etc.
All fats especially butter, margarine,
cream, coconut oil, hydrogenated fats
 Fruits with cream, butter, ice creams
or dips
Foods to be avoided

33.  Skimmed milk / toned milk & products
 Fish & poultry
 Whole wheat snacks
 Fresh fruits
 Vegetables except roots & tubers
Foods to be included

34.  Maintain ideal body weight
 Total fat intake 25-30% (visible &
invisible)
 Increase soluble fiber
 Increase antioxidants
 Restrict cholesterol, SFA, Trans FA
 Avoid alcohol
 Adequate exercise/physical activity
 Quit smoking
Protective factors

35. To sum up….
 Heart disease caused during birth is
termed as _______
 CHF is a result of ______ or ______
abnormality of heart.
 Desirable total cholesterol in blood is
_________
 High blood cholesterol is termed as
________
 Enlist the modifiable & non-modifiable
risk factors of CHD.
 How does high homocysteine levels
leads to atherosclerosis?

36. Home assignment
 Explain the progression of angina
pectoris.
 Give the progression of formation
of plaque.
 Define atherosclerosis & give its
phases.
 Explain the dietary treatment of
CHD in relation to : fat, fiber &
antioxidants
 Enlist the protective factors of
CHD.