This document discusses coronary heart disease (CHD), which over 58 million Americans have at least one form of. The major underlying cause of CHD is atherosclerosis, a slow, progressive disease beginning in childhood. Plaque forms in artery walls in response to endothelial injury. Risk factors include age, family history, hypertension, smoking, diabetes, inactivity, obesity, and abnormal blood lipids. Lifestyle changes like a healthy diet, physical activity, and weight control can help lower risk, as well as medications like statins for those with high LDL cholesterol.

1. Coronary Heart Disease
(CHD)

Ratheesh R.L

2. Coronary Heart Disease (CHD)
>58 million American have
at least one form of CHD.
50% of all cardiac deaths
result from CHD

4. Mortality From Diseases of the
Heart by Race/Ethnicity
(Deaths/100,000)
Age Hispanic Asian Native
Amer.
Black White
45-64 166 99 224 426 244
>65 1336 870 1128 2181 2079

5. Coronary Heart Disease
The major underlying cause is
atherosclerosis.
atherosclerosis.
Atherosclerosis
Atherosclerosis is a slow,
progressive disease which
begins in childhood and takes
decades to advance

6. Coronary Heart Disease
Plaque (the build-up of
lipid/cholesterol) in the artery
wall forms as a response to
injury
injury to the endothelium in the
artery wall.

12. Risk Factors for
Coronary Heart Disease
Age:
Male > 45 years
Female > 55 years or premature menopause
without estrogen replacement therapy
Family History of premature disease
Male first-degree relative <55 years
Female first-degree relative < 65 years)

13. Risk Factors for
Coronary Heart Disease
Hypertension
 Appears to weaken the artery wall at
points of high pressure leading to
injury and invasion of cholesterol.
Cigarette Smoking
#1 cause of preventable death in US
1 in 5 CHD deaths attributable to
smoking

14. Risk Factors for
Coronary Heart Disease
Diabetes
50% of deaths related to DM
is due to CHD

15. Risk Factors for
Coronary Heart Disease
Inactivity
Sedentary person has 2x risk
for developing CHD as a person
who is active.

16. Risk Factors for
Coronary Heart Disease
Obesity

17. Risk Factors for
Coronary Heart Disease
Abnormal Blood Lipids
 LDL Cholesterol (low density
lipoprotein)
 HDL Cholesterol (high density
lipoprotein)

18. Cholesterol
Diet Liver
Cholesterol Metabolism
15% 75%

19. Blood Lipids and Lipoproteins
Some LDL-C can be oxidized and
takes up by endothelial cells and
macrophages in the arterial wall,
which leads to the first stages of
atherosclerosis.

20. Blood Lipids and Lipoproteins
HDL-C is thought to be involved in
the transport of excess cholesterol
from membranes to the liver for
removal from the body.

21. Blood Lipids and Lipoproteins
HDL-C IS INCREASED:
Exercise, loss of weight, and
moderate consumption of ETOH.
HDL-C is lowered:
Obesity, inactivity, cigarette
smoking, some oral contraceptives
and steroids, hypertriglyceridemia
and some genetic factors.

22. Cholesterol and the CHD Patient
Goal:
The goal is a LDL-C level of
100 mg/dL

23. Blood Lipid Classification
Cholesterol:
<200 mg/dl
200-239 mg/dl
>240 mg/dl
Desirable
Borderline high-risk
High-risk
HDL Cholesterol
<40 mg/dl
>60 mgl/dl
Low
High, negates one
risk factor
LDL Cholesterol
<100 mg/dl
100 – 129 mg/dl
130-159 mg/dL
>160 mg/dl
Desirable
Above optimal
Borderline High
High Risk

24. Treatment in CHD Patients
LDL-C
Levels
Diet & Life
Habits
Drug
Therapy
<100 mg/dL Yes No
100-129
mg/dL
Yes Clinical
Judgment
>130 mg/dL Yes Yes

25. Diet Therapy of High Blood
Cholesterol
Healthy Heart Diet Therapeutic Lifestyle
Change Diet (TLC)
8-10% calories from
saturated fat
<7% calories from
saturated fat
20 - 35% calories from fat 20-35% calories
from fat
<300 mg. cholesterol <200 mg. cholesterol
5-10% of energy from
PUFA
5-10% of energy from PUFA
Up to 20% MUFA Up to 20% MUFA
Calories to maintain IBW Calories to maintain IBW

27. Diet Therapy of High Blood
Cholesterol
Trans-Fatty Acids
Increase LDL Cholesterol and
decrease HDL Cholesterol
Recommendations: Intakes of
trans-fatty acids should be as low
as possible

28. Food
Calories
Trans
Fatty
Acids
(g)
Saturated
Fatty
Acids
(g)
Hamburger (7 oz) 660 3 14
McDonalds chicken McNuggets
(9 oz)
510 3 6
Burger King chicken sandwich
(8 oz)
610 2 7
Burger King fries (6 oz King
size)
540 7 6
Starbucks cinnamon scone (5
oz)
530 3 13
Trans fatty acid content of fast-
food

29. Treatment for CHD
Physical Activity
Physical Activity
prescribed by physician for patients with
CHD
When aerobic activity is appropriate,
activity that places moderate stress on
the cardio-respiratory system can be
included.

30. Treatment for CHD
Weight Control
Weight Control
 5-10# weight loss

31. Diet Therapy of High Blood
Cholesterol
Soluble Fiber
10-20 g/day

32. Drug Treatment
Statins -
Bile Acid Sequestrants
Nicotinic Acid

33. Dietary Issues Requiring Further
Research
Elevated levels of
homocysteine
homocysteine
Elevated homocysteine levels
may be present in 15% of
Americans.

35. Steps for Lowering LDL-C in the
Diet
Eggs:
<300 mg. cholesterol: < 4
yolks/wk
< 200 mg. Cholesterol: < 2
yolks/wk

36. Guidelines for Selecting &
Preparing Foods
Milk and Milk Products:
2-3 servings/day

37. Steps for Lowering LDL-C in the
Diet
Fats, oils:
<6-8 tsp./day

38. Steps for Lowering LDL-C in the
Diet
Monounsaturated Fats:
Canola, olive and peanut oil
Avocado
Olives: black and green
Nuts: almonds, cashews, peanuts,
pecans
Sesame seeds

39. Steps for Lowering LDL-C in the
Diet
Polyunsaturated Fats
Margarine made with corn, soybean,
safflower, sesame oils
Tub, squeeze or stick
Nuts: walnuts and English
Salad dressings
Seeds: pumpkin, sunflower

40. Steps for Lowering LDL-C in the
Diet
Saturated Fat:
Butter, Coconut & Coconut Oil, Palm Oil
Cream, half and half
Cream cheese
Shortening or lard
Sour cream
Fat from animal products including milk
and meats

41. Steps for Lowering LDL-C in the
Diet
Plant Sterols and Stanols:
Natural substances derived from
wood, vegetables, vegetable oils
and other plants - sitosterol and
sitostanol

42. Steps for Lowering LDL-C in the
Diet
Meat, Fish and Poultry
Meat, Fish and Poultry
 Select lean meat and poultry
<6 oz/day for Step I diet and <5 oz/day
for Step II
Eat fish on a weekly basis

43. Steps for Lowering LDL-C in the
Diet
Breads and Cereals:
6-11 servings/day
Low fat crackers
Tortillas
Hot and cold cereals excepts granola or
meusli

44. Steps for Lowering LDL-C in the
Diet
Vegetables:
3-5 servings per day
Fruits
2-4 servings per day
Use sweets and modified fat desserts in
moderation

45. Reading The Label
Extra Lean
<5 g total fat, 2 g saturated fat, and 95 mg
cholesterol
Lean
< 10 g total fat, 4 g saturated fat and 95 mg
cholesterol

46. Guidelines for Selecting &
Preparing Foods
Try reducing fat by 1/4 to 1/3 in baked
products. E.g. if recipe calls for 1 cup oil,
try 2/3 C.
In casseroles and main dishes, cut back or
eliminate the fat.
Sauté or stir fry with very little fat or use
water, wine, or broth.
Chill soups, gravies and stews and skim off
hardened fat before serving.