Coronary heart disease (CHD) occurs when plaque builds up in the coronary arteries, narrowing them and reducing blood flow to the heart. A single high-fat meal can trigger pathological changes to red blood cells and increases levels of myeloperoxidase, an enzyme associated with oxidative stress that may promote acute coronary syndrome. A case study examines a 39-year-old overweight woman with high cholesterol and blood pressure. Her nutritional assessment identifies risk factors for CHD. Her dietary recommendations focus on reducing sodium, saturated fat and refined carbs by following a DASH diet and menu plan. Controlling weight and diet can help reduce CHD risk.

1. CORONARY
HEART DISEASE
KRITIKA GUPTA

2. According to National Heart, Lung and
Blood Institute, Coronary heart disease
(CHD) is a disease in which a waxy
substance called plaque builds up inside the
coronary arteries. These arteries supply
oxygen-rich blood to your heart muscle.
When plaque builds up in the arteries, the
condition is called atherosclerosis.

3. Development of atherosclerosis
Source: National Heart Lung and Blood Institute

5. Source: American Heart Association
CONSEQUENCES
OF HIGH BLOOD
PRESSURE

6. Can a single meal initiate coronary heart disease??
The journey of a thousand pounds begin with a single burger.

7. • Promotes RBC remodeling, induces intracellular ROS and oxidative
damage to RBC membranes, and increases circulating and RBC-bound
MPO that is sufficient to promote oxidative modification of HDL.
• Monocytic cells exposed to lipid release MPO, which in turn is taken up by
coronary arteries in the presence of free fatty acids.
• Microcytes have been reported to a tendency to clump in the
microcirculation, suggesting potentially important functional consequences
with regard to blood rheology, increased RBC density, and increased
peripheral resistance
A single high-fat meal provokes pathological erythrocyte remodeling and
increases myeloperoxidase levels: implications for acute coronary syndrome
Benson et al., 2018
Laboratory Investigation

8. A single high-fat meal provokes pathological erythrocyte remodeling and
increases myeloperoxidase levels: implications for acute coronary syndrome
(b) RBCs post iso-caloric meal
(c–e) RBCs post HFM
(c) microcytosis
(d) acanthocytosis
(e) echinocytosis
(f) Foamy monocytes
(g) lipid-laden monocytes
Benson et al., 2018
Laboratory Investigation

9. Benson et al., 2018
Laboratory Investigation
Normal RBCs Erythrocytes after exposure to LDL
The real cost of eating junk food never appears on the menu.

10. MODIFY YOUR DYNAMIC RISK PROFILE
Heredity
DYNAMIC AND
MODIFIABLE
FACTORS
STATIC AND
NON
MODIFIABLE
FACTORS
Source: Ghafoornissa and Kamala
Krishnaswamy, Diet and Heart Disease,
National Institute of Nutrition, 2014

11. Recommended Intake of Fat for the patient
Type of dietary fat Recommended Intake (as % of energy intake)
Total Fat 15-30
Saturated Fat <10; 7 in high risk individuals
Total MUFA 10-12
Trans Fat <1
Total PUFA Up to 10
PUFA/SFA ratio 0.8 to 1.0
n6:n3 2.5:1 - 8:1
Cholesterol <200 mg
Source: Nutrition and Dietetics by Shubhangini A Joshi

12. Nutrition Guidelines for Prevention of Heart Diseases
Nutrient Recommended Intake
Calories For weight maintenance
Protein 10-15%
Carbohydrates 55-65%
Sugars <10%
Total fat 15-30%
Cholesterol <200 mg
Saturated Fat <10
Total PUFA Up to 8
Total Fat 15-30
PUFA/SFA ratio 0.8 to 1.0
Salt 5-7 g/d
Dietary fibre 40g/d
Source: Guidelines, WHO, 1990

14. CASE STUDY

15. PATIENT PROFILE
• Name- Seema Saini
• Age- 39 years
• Gender- Female
• Occupation- Housewife
• Physical activity- Moderate
• Medical History- She suffered from lungs allergy from past 3 years

16. NUTRITIONAL ASSESSMENT
• ANTHROPOMETRICS
Height- 157.48 cm
Weight – 72 kg
BMI- 29.03231 kg/m2 (overweight)
BMR- 1,742.56 kcal
• BIOCHEMICAL
Cholesterol level- 196 mgs %
Triglyceride level- 164 mgs %
• CLINICAL
Temperature- 98.6° F (37 ° C)
Blood pressure- 180/90 mm Hg
• DIETARY HISTORY
24-hrs recall
Breakfast- Chapatti(2) +curd + sabji
Lunch- Dal + rice
Evening- Tea + biscuit (4)
Dinner- Sabji + chapatti(2)

17. DIETARY RECOMMENDATION
FOOD ALLOWED
• DASH DIET( Dietary Approaches to
Stop Hypertension)
• Green leafy & cruciferous
vegetables & citrus fruits
• Low fat milk
• Lean meat
• Grains (7-8)
FOOD AVOIDED
• Baking powder, sodium
bicarbonate, sodium benzoate
• Cheese, peanut butter, salted
butter.
• Shell fish& dry fish.
• Biscuit , cakes, breads, pastries.
• Prepared mix, potato chips, avoid-
processed- foods, pickles, canned
foods, ketchup& sauce
Fast Food = Fast Death

18. MENU PLANING
EARLY MORNING- Tea 1 cup with 1/2 tsp sugar
BREAKFAST- Milk – 1 glass+ 2 slices toasted bread +
+1 apple
MID-MORNING- Fruit smoothie + 2 egg whites
LUNCH- 1 Cup dal+ ½ cup vegetable pulao+ 2 chapatti + curd
EVENING- 1 cup tomato soup
POST-EVENING- weak tea + Poha
DINNER- 1 Cup Dal soup + 1 cup leafy vegetable+ 2 chapatti ( no butter
applied) + cucumber salad
POST-DINNER- 1 glass milk ( without sugar)

19. CONCLUSION
By shedding of the overload ( proper height weight relationship) and
restoration of normal arterial posture.
Controlling cholesterol level, being physically active , limiting alcohol
intake , avoiding tobacco, and consuming a healthy diet with reduced
sugar and salt can help to reduce the risk of CHD.