heart diseases and dietary intervention and recomendations in prevention of heart diseases

1. Heart Diseases & Dietary
Intervention &
Recommendations in the
Prevention of Heart Disease
By
Dr vinayak s hiremath
Postgraduate Internal Medicine
MRMC,GULBARGA

2. Life Style Associated diseases
●Coronary Artery disease
●Cerebrovasular disease
●Peripheral Vascular disease
●Obesity
●Hypertension
●Diabetes
●Cancers
●Osteoporosis

3. Types Of Cardiovascular Disease
• Atherosclerosis
• Coronary heart disease (CHD)
• Chest pain (angina pectoris)
• Irregular heartbeat (arrhythmia)
• Congestive heart failure (CHF)
• Congenital and rheumatic heart disease
• Stroke

4. cardiovascular diseases are leading cause of
death -worldwide
• Coronary disease -7.2 million
• Cancer - 6.3 million
• Cerebrovascular disease- 4.6
• Acute lower respiratory tract infections- 3.9
• Tuberculosis -3.0
• COPD (chronic obstructive pulmonary disease) 2.9
• Diarrhoea (including dysentery) -2.5
• Malaria -2.1
• AIDS- 1.5
• Hepatitis -B 1.2

6. Anatomy of the Heart
Figure 15.4

7. • Can Anyone Tell Me the Difference
Between a Heart Attack and a
Stroke????????

8. Stroke vs Heart Attack
• Stroke—blocked blood flow to the brain
• Heart attack—blocked blood flow to the
heart
• Risk factors are the same for both

9. What is Heart Disease?
• A general term that covers a number of
diseases which affect the heart, including
coronary artery disease, heart-failure and
angina.
• Heart Disease is the number one killer in the
world.

10. What Causes Heart Disease?
• Atherosclerosis-fatty deposits of cholesterol
• Hypertension

11. • Arteries—blood vessels that carry blood away
from the heart to the rest of the body
Normal Artery
What Causes Heart
Disease/Stroke?

12. Plaque Starts to Build Up
Tear in Artery
Wall
Tear in
Artery Wall

13. Plaque Can Grow and
Harden and Obstruct
the Artery
Tear in Artery
Wall
Tear in
Artery Wall
Atherosclerosis

14. Ischemic Stroke

15. Heart Attack

16. Artherosclerosis
• Characterized by deposits of fatty substances,
cholesterol, cellular waste products, calcium,
and fibrin in the inner lining of the artery
• Hyperlipidemia – abnormally high blood lipid
level
• Plaque – the buildup of deposits in the
arteries

17. Coronary Artery Disease
Occurs when the coronary arteries that supply
the heart muscle become blocked.
• Partially blocked it causes angina.
• Fully blocked it causes a myocardial infarction
or a heart attack!

18. Myocardial Infarction
or
Heart Attack
• Symptoms: uncomfortable pressure, fullness,
squeezing pain, pain spreading to the
shoulders, neck and arms.
• Chest discomfort and light headedness
• Anxiety/nervousness
• Paleness or pallor
• Increased irregular heart rate

19. Congestive Heart Failure
• Fits under the description of heart disease.
• Does not mean the heart has failed, simply
means the heart is not doing an efficient job.
• It results from an injury or a reduction of
function of the heart muscle.
• Can be due to arteriosclerosis, hypertension,
myocardial infarction, rheumatic fever or birth
defect.

20. Congestive Heart Failure
• The right side of the heart collects the blood
returning from the body and sends it to the lungs.
• If it is failing, the blood backs up into the veins, and
there are signs of edema.
• The left side of the heart receives the blood from the
lungs and pumps it out into the body. If it is failing
the blood is not pumped effectively.

21. Angina Pectoris
• Ischemia – reduction of the heart’s blood and
oxygen supply
• The more serious the oxygen deprivation the
more severe the pain
• Nitroglycerin – drug used to relax (dilate) the
veins
• Beta blockers control potential overactivity of
the heart muscle

22. Arrythmias
• An irregularity in heart rhythm
• Tachycardia – racing heart in the absence of
exercise or anxiety
• Bradycardia – abnormally slow heartbeat
• Fibrillation – heart beat is sporadic, quivering
pattern

23. Congenital And Rheumatic Heart
Disease
• Congenital heart disease affects 1 out of 125
children born
• May be due to hereditary factors, maternal
diseases, or chemical intake (alcohol) during
fetal development
• Rheumatic heart disease results from
rheumatic fever which affects connective
tissue

24. Common Blood Vessel Disorders
Figure 15.6

25. Unchangeable Risk Factors
• Age- the older you get, the greater the
chance.
• Sex- males have a greater rate even after
women pass menopause.
• Race- minorities have a greater chance.
• Family history- if family members have had
CHD, there is a greater chance.

26. Unchangeable Risk Factors
• Personal Medical History- other diseases such
as Diabetes Mellitus can increase chances.

27. Changeable Risk Factors
• Hypertension
• Serum cholesterol
• Obesity
• Diabetes Mellitus
• Physical Inactivity
• Cigarette Smoking
• Alcohol Intake

28. Cholesterol
• Everybody needs cholesterol, it serves a vital
function in the body.
• It is a component of the nerve tissue of the
brain and spinal cord as well as other major
organs.
• Frequently measured to promote health and
prevent disease.
• A major component of the plaque that clogs
arteries.

29. Types of Cholesterol
Lipoproteins- 4 main classes
• Chylomicrons
• Very low density lipoproteins (VLDL)
• Low Density Lipoprotein (LDL)
• High Density Lipoprotein (HDL)

30. Good vs. BAD
• LDL is known as bad cholesterol. It has a
tendency to increase risk of CHD.
• LDL’s are a major component of the
atherosclerotic plaque that clogs arteries.
• Levels should be <130

31. Good vs. BAD
• HDL is known as the good cholesterol.
• It helps carry some of the bad cholesterol out
of the body.
• It does not have the tendency to clog arteries.
• Levels should be >35.
• High levels of HDL >60 can actually negate one
other risk factor.

32. The Facts About Fat
• Certain fats are essential for good nutrition
and health.
• Fats provide essential fatty acids which the
body can’t manufacture.
• Act as insulators to maintain body
temperature.
• Improve the palatability of food and promote
digestion.

33. The Facts About Fat
• Provide the greatest energy output per gram
of any food source. ( 9 cals)
• Carry fat soluble vitamins- A,D,E, and K.

34. The Skinny on Fat
• Saturated fats- basically means the fat is
saturated with hydrogen, they are solid at
room temperature. Examples are lard and
butter.
• Why are they bad for you? They increase
levels of LDL , decrease HDL and increase total
cholesterol.

35. The Skinny on Fat
• What are polyunsaturated fats? They are
unsaturated fats which are liquid at room
temperature and in the refrigerator.
• Why are they good for us?
• They help the body get rid of newly formed
cholesterol.

36. The Skinny on Fat
• What are monounsaturated fats?
• They are liquid at room temperature but start
to solidify in the refrigerator.
• Decrease total cholesterol and lower LDL
levels.

37. The Skinny on Fat
• What are trans fatty acids? They are
unsaturated fats but they tend to raise total
and bad cholesterol.
• Where do you find them?
• In fast-food restaurants
• Commercial baked goods. Examples:
doughnuts, potato chips, cupcakes.

38. What about Omega 3?
• Type of polyunsaturated fat.
• Consistently lowers serum triglycerides and
may also have an effect on lowering blood
pressure.
• Found in oily fish such as salmon, tuna, and
herring.
• Is available as a supplement.

39. Associations between the percent of calories
derived from specific foods and CHD mortality in
the 20 Countries Study*
Butter 0.546
All dairy products 0.619
Eggs 0.592
Meat and poultry 0.561
Sugar and syrup 0.676
Grains, fruits, and starchy -0.633
and nonstarchy vegetables
Food Source Correlation Coefficient†
*1973 data, all subjects. From Stamler J: Population studies.
In Levy R: Nutrition, Lipids, and CHD. New York, Raven, 1979.
†All coefficients are significant at the P<0.05 level.

40. Obesity
• People who are obese have 2 to 6 times the
risk of developing hypertension.
• Location of the body fat is significant.
• Pears of apples?

41. Diabetes Mellitus
• At any given cholesterol level, diabetic persons
have a 2 or 3 x higher risk of atherosclerosis!
• Insulin is required to maintain adequate levels
of lipoprotein lipase, an enzyme needed to
break down bad cholesterols.

42. Physical Inactivity
• Increasing physical activity has been shown to
decrease blood pressure.
• Moderate to intense physical activity for 30-45
minutes on most days of the week is
recommended.

43. Cigarette Smoking
• Causes an increase in blood pressure
• Usually have lower levels of HDL
• Within 1 year of quitting, CHD risk decreases,
within 2 years it reaches the level of a
nonsmoker.

44. Alcohol Consumption
• In small amounts it acts as a vasodilator-
Good! 1-2 drinks
• In large amounts it acts as a vasoconstrictor-
BAD! 3-4 drinks
• This is a very fine line!

45. Women And Cardiovascular Disease
• 2003, CVD deaths
– 426,800 men
– 483,800 women
• Estrogen
– Once estrogen production stops, risk for CVD death
increases
• Diagnostic and therapeutic differences
– Delay in diagnosing possible heart attack
– Complexity in interpreting chest pain in women
– Less aggressive treatment of female heart attack victims
– Smaller coronary arteries in women
• Gender bias in CVD research – typically CVD research has
been conducted on male subjects

46. 1. Know your numbers:
– Cholesterol (LDL=lousy, HDL=healthy)
– Triglycerides
– Blood pressure
– Blood glucose
2. Maintain a healthy weight
3. Stay physically active
4. Manage stress
5. Do not smoke
6. Do not drink alcohol excessively
7. Eat heart healthy
HDL=high-density lipoprotein, LDL=low-density lipoprotein
7 Steps to a Healthier You

47. Do You Know?
• Your total cholesterol—under 200
– HDL—60 or higher (less than 40 milligrams
(mg)/deciliter (dL) increases risk)
– LDL—under 100 mg/dL
• Your triglycerides—less than 150 mg/dL
• Your blood pressure—less than 120/80
• Fasting blood glucose—less than
100 mg/dL
Knowledge Is Power, So Learn and Live!
Step 1: Know Your Numbers

48. • Blood pressure
• Cholesterol level
• Triglyceride level
• Blood sugar level
• Risk for developing type 2 diabetes
If overweight, take action to lose
weight to improve your overall health
and lower your:
Step 2: Maintain a Healthy
Weight

49. Body Mass Index (BMI)
Underweight <18.5
Normal Weight 18.5-24.9
Overweight 25-29.9
Obesity 30+
Step 2: Maintain a
Healthy Weight (cont’d)

50. • Weight loss:
– Reduces risk for cardiovascular disease
– Lowers blood pressure
– Lowers blood sugar
– Improves lipid levels
Source: Office of Surgeon General.
http://www.surgeongeneral.gov/topics/obesity/calltoaction/1_6.htm.
Benefits of Weight Loss
(cont’d)

51. ACSM and AHA Recommendations:
• Do moderately intense cardio
30 minutes/day, 5 days/week
OR
• Do vigorously intense cardio
20 minutes/day, 3 days/week
AND
• Do 8 to 10 strength-training exercises,
8 to 12 repetitions of each exercise,
twice/week
ACSM=American College of Sports Medicine, AHA=American Heart Association
Step 3: Stay Physically Active

52. Staying physically active can reduce your:
• Blood pressure
• Cigarette smoking
• Diabetes
• Extra body weight in the overweight/obese
• Triglyceride level
Step 3: Stay Physically
Active (cont’d)

53. The FITT formula:
• F=frequency (days/week)
• I=intensity (how hard—easy, moderate)
• T=time
• T=type
Step 3: Stay Physically
Active (cont’d)

54. Manage Stress

55. • If left unmanaged, stress can cause
emotional, psychological, and physical
problems (heart disease, high blood
pressure, chest pain, and irregular heart
beat)
• Stress also may cause you to overeat,
exercise less, and possibly smoke more
• You can think yourself into clinical
depression
Step 4: Manage Stress

56. Stress Warning Signs

57. • Identify the stressor first
• Avoid hassles and minor irritation, if
possible
• Try to continue doing the things that you
enjoyed before the change that caused
stress occurred in your life
• Learn how to manage your time efficiently
• Do one thing at a time
• Learn to take a break
• Ask for help when you need it
Tips to Reduce Stress

58. • If you do smoke, stop
• Support is available:
– 800-ACS-2345 (American Cancer Society)
– 800-QUIT-NOW (US Dept of Health and Human
Services) or http://1800quitnow.cancer.gov
– 877-448-7848 (National Cancer Institute) or
www.cancer.gov/cancertopics/smoking
Step 5: Do Not Smoke

59. • But I heard alcohol is good for the heart!
– Doctors do not recommend it
• Moderate drinking is defined as:
– No more than one drink/day for women
– No more than two drinks/day for men
• Drinking more than three drinks/day has a
detrimental effect on the heart
Step 6: Do Not Drink
Alcohol Excessively

60. • One drink is equal to:
– 12 fluid ounces (fl oz) of beer or wine cooler
– 5 fl oz of wine
– 1.5 fl oz of 80-proof liquor
Step 6: Do Not Drink
Alcohol Excessively
(cont’d)

61. Who Benefits
From Eating
Heart Healthy?

62. The Entire Family!
Step 7: Eat Heart
Healthy

63. • Learn to read food labels
Knowledge is power!
What should I look for?
Step 7: Eat Heart
Healthy (cont’d)

64. Start Here
Limit These
Nutrients
Get Enough
of These
Nutrients
% DV=Percent Daily Value

65. • Reduce your calories if you are overweight
and want to lose weight:
– Calories are the energy in food that contribute
to weight loss and weight gain
– 1 pound of fat=3500 calories
Why Reduce Calories?

66. • Eat breakfast
• Keep regular mealtimes
• Look for lower-fat alternatives
• Drink enough fluids (water)
• Focus on fruits and vegetables
• Choose lean meats and skim dairy products
• Limit extra sugars to 40 grams (g)/day or
10 teaspoons (tsp)/day
• Eat slowly
• Practice potion control
Ways to Reduce Calories

67. How can You Stop CVD?
Diet and Nutrition, there are several
guidelines listed by the American Heart
Association:
• Eat a variety of fruits and vegetables every
day. ( 5 servings - they are naturally low in fat
and high in vitamins and minerals)
• Eat a variety of grain products ( 6 a day)

68. Diet and Prevention of CVD
• Choose nonfat or low-fat products.
• Use lean meats- choose chicken, fish, turkey
and lean cuts of beef and pork.
• Switch to fat-free milk- gradually reduce the
fat content of the milk you drink.

69. Dietary Guidelines
• Choose fats with 2 gms or less of saturated
fats per serving such as liquid and tub
margarines, canola oil and olive oil.
• Balance the # of calories you eat with the
number of calories you use each day.
• Maintain a level of physical activity that keeps
you fit and matches the # of calories you eat.

70. Dietary Guidelines
• Limit your intake of foods high in calories and
low in nutrition, including foods like soft
drinks and candy.
• Limit foods high in saturated fat, trans fat and
cholesterol
• Eat less than 6 gms of salt a day
• Have no more than one alcoholic drink a day.

71. Step I and II Diets
• The AHA and NCEP have developed these
diets to treat high blood pressure and
hypercholesterolemia
• They are designed to lower LDL levels, while at
the same time promoting good nutrition.

72. Step I Step II
• Total fat- 30% or less
• Sat fat- 7-10%
• Poly - up to 10%
• Mono Up to 15%
• Carb 55% or more
• Pro Approx 15%
• Chol. less than 300mg
• 30% or less
• 7%
• up to 10%
• up to 15%
• 55% or more
• Approx 15%
• less than 200 mg

73. Exercise and CVD
• Serves several functions in preventing and
treating those at high risk.
• Reduces incidence of obesity.
• Increases HDL
• Lowers LDL and total cholesterol
• Helps control diabetes and hypertension
• Those at high risk should take part in a
specially supervised program.

74. other Weapons Against Heart Disease
• Techniques for diagnosing heart disease
– Electrocardiogram (ECG)
– Angiography
– Positron emission tomography (PET)
– Single positron emission color tomography
(SPECT)
– Radionuclide imaging
– Magnetic resonance imaging (MRI)
– Ultrafast CT
– Digital cardiac angiography (DSA)

75. Angioplasty Versus Bypass Surgery
• Angioplasty – a thin catheter is threaded
through the blocked arteries. The catheter
has a balloon on the tip which is inflated to
flatten the fatty deposits against the wall of
the artery
• Coronary bypass surgery – a blood vessel is
taken from another site and implanted to
bypass blocked arteries and transport blood

76. Thrombolysis
• If victim reaches an emergency room and is
diagnosed quickly, thrombolysis can be
performed
• Thrombolysis involves injecting an agent such
as tissue plasminogen activator (TPA) to
dissolve the clot and restore some blood flow

77. Cardiac Rehabilitation
• Every year, 1 million people survive heart
attacks
• Cardiac rehabilitation exercise training
increases stamina and strength, and promotes
recovery

78. Los Angeles VA study
• 846 men in Veterans Home, 5-8 years
• Groups randomized to diets in which 2/3 of fat
given either as vegetable oil (corn, cottonseed,
safflower, soybean) or animal fat
• Saturated fat 11% vs. 18%, polyunsaturated fat
16% vs. 5% of calories
• 31% decrease in CVD endpoints
Dayton et al. Circulation 1969; 40:1.

79. Lyon Diet Heart study
• 302 men and women with CHD
• Treatment group randomized to low saturated
fat, high canola oil margarine (5% alpha
linolenic, 16% linoleic, and 48% oleic acid, also
5% trans)
• 46 month follow-up
• 65% lower CHD death rate in treatment group
(6 vs. 19 death)
de Lorgeril et al. Circulation 1999; 99:779-785.

80. Benefits of fish oil supplementation
• In the Diet and Reinfarction Trial (DART) in
2033 men with CHD increased intake of fish or
use of 2 fish oil caps/day reduced CHD
mortality 29% over 2 years
• In GISSI 11324 men and woman with CHD use
of 1 gr. of n-3 PUFA decreased CVD events
including mortality 15%
Lancet 1989; 2;757-761, and 1999; 345:447-455.

81. Nuts, Soy, Phytosterols, Garlic
• Nurses’ Health Study: five 1oz servings of nuts
per week associated with 40% lower risk of CHD
events
• Metaanalysis of 38 trials of soy protein showed
47g intake lowered total, LDL-C, and trigs 9%,
13%, and 11%
• Phytosterol-supplemented foods (e.g., stanol
ester margarine) lowers LDL-C avg. 10%
• Meta-analysis of garlic studies showed 9% total
cholesterol reduction (1/2-1 clove daily for 6
months).

82. Conclusion
• Cardiovascular disease is the number one
killer.
• It is highly preventable and controllable with
diet and exercise.