Coronary Heart Disease and Hypertension

1. Coronary Heart DiseaseandHypertension Chapter 19

2. CV disease is the #1 cause of death in the U.S. • We’ll look at the primary underlying disease process, atherosclerosis, and the various risk factors involved • We’ll explore ways to use nutritional approaches to reduce these risk factors and help prevent disease Coronary Heart Disease and Hypertension

3. Key Concepts • Several risk factors contribute to the development of cardiovascular disease and HTN, many of which are preventable by improved food habits and lifestyle behaviors • Other risk factors are non- modifiable such as age, gender, family hx. and race • HTN maybe classified as “essential” (primary) or secondary HTN • Early education is critical for the prevention of cardiovascular disease. Coronary Heart Disease and Hypertension

4. Coronary Heart Disease • Atherosclerosis • Acute cardiovascular disease • Chronic heart disease

6. Disease process • Fatty fibrous plaques develop into fatty streaks on inside lining of major blood vessels. • Process may begin in childhood • fatty streaks, largely composed of cholesterol • Gk. Athera = “gruel”; Sclera = “hardening” • The fatty fibrous process thickens over time, narrowing the interior part of the blood vessel  impeding or cutting off blood flow to cells beyond the blockage Atherosclerosis

7. Cells die when deprived of their normal blood supply. • The local area of dying or dead tissue is called and “infarct”. • If affected vessel is major artery supplying heart muscle, result could be myocardial infarction (heart attack). • If affected vessel is major artery supplying brain, result could be cerebrovascular accident. Atherosclerosis

11. Atherosclerotic Plaque in Artery

12. Normal Human Heart: Posterior External View

13. The major arteries and their branches serving the heart are called coronary arteries • The overall disease process is coronary heart disease • Common symptom: angina pectoris or chest pain, usually radiating down the arm Atherosclerosis

14. Elevated blood lipids associated with coronary heart disease • Triglycerides—simple fats in body or food • Cholesterol—fat-related compound produced in body; also in foods from animals • Lipoproteins—“packages” wrapped with protein that carry fat in the blood stream Relation to Fat Metabolism

15. Lipoproteins are grouped and named according to their protein, fat, and cholesterol content (e.g. density – those with higher protein content have higher density Relation to Fat Metabolism

16. 3 of these types of lipoprotein found in the liver are significant in relation to heart disease risk: • Very low-density lipoproteins (VLDL) • Carry large load of triglycerides to cells • Include approx. 12% cholesterol • Low-density lipoproteins (LDL) • Carry two thirds of total plasma cholesterol to body tissues  constantly send cholesterol to tissues  “bad cholesterol” Types of Lipoproteins

17. High-density lipoproteins (HDL) Carry less total fat and more protein Not found in foods; produced in the liver. Takes cholesterol from tissues to liver for breakdown and elimination Types of Lipoproteins

18. Sex – CVD occurs more often in men than women until menopause, at which time the relative risks are the same • Age – general risk increases with age (men > 45 years and women > 55 years) Risk Factors

19. Heredity – ethnic groups that have a higher incidence of risk factors and CVD; including “familial hypercholesterolemia” and “familial hypertryglyceridemia”. Ethnic groups include: African Americans, Hispanics, Native Americans Risk Factors

20. Elevated serum cholesterol – major risk factor especially when combined with obesity, lack of exercise, stress, smoking, and increased food intake Compounding diseases – diabetes, hypertension, metabolic syndrome Dietary fat – affects serum cholesterol Risk Factors

21. Therapeutic Lifestyle Changes approach Total energy intake = energy expenditure Total fat should not exceed 25-35% of diet Avoid trans fatty acids CHO mainly from complex CHOs National Cholesterol Education Program (NCEP) Guidelines

22. Total protein from sources other than animals should be included Total cholesterol intake < 200mg/day Exercise to expend at least 200 kcals/day National Cholesterol Education Program (NCEP) Guidelines

23. In the event that LDL cholesterol is above goal range, drug therapy may be added to diet therapy depending on the level of risk Drug Therapy

24. May be associated with MI • When CV disease progresses to the point of cutting off the blood supply to major coronary arteries, a critical vascular event – heart attack/MI- may occur. • After an infarction, enzymes and proteins are released from the damaged heart muscle = “cardiac markers” • can be measured in blood tests: CPK, • TROPONIN is heart muscle- specific Acute Cardiovascular Disease

25. Initial phase Objective: cardiac rest Immediate care includes: analgesics and supplemental oxygen All care, including diet, is directed toward ensuring that the heart rests so that the damaged heart can be restored to normal functioning Acute Cardiovascular Disease

26. Principles of diet therapy • Reduced energy intake (1200-1500 kcal) – a brief period of reduced energy intake during the first day or so after the heart attack reduces the metabolic workload on the damaged heart. • Soft food texture – easily digested to avoid excess effort in eating or the discomfort of gas formation • Controlled amount and type of fat • Mild sodium restriction (2-3 g/day) Acute Cardiovascular Disease

27. CHF and pulmonary edema The progressively weakened heart muscle is unable to maintain an adequate cardiac output to sustain normal circulation  fluid imbalance pulmonary edema. Chronic Heart Disease

28. Objective: control of pulmonary edema and resulting fluid imbalance • Mild-severe sodium restriction • Fluid restriction – often limited to 1500 ml. /day • Texture – soft foods • Small meals • Alcohol – limited or avoided Chronic Heart Disease

29. Hypertension called the “silent disease” • Essential HTN – specific cause is unknown • Secondary HTN – HTN is a symptom or side effect of another primary condition • Risk Factors: • Highly inherited disorder • Obesity worsens • Can begin in adolescent years • Made worse by physical inactivity, stress, alcohol and drug use, and salt intake. Essential Hypertension

30. Adult normal BP – 120/80 or below • Stage 1 hypertension • Focus on diet therapy, without drugs • Reduce excess weight and restrict sodium • Stage 2 hypertension • Diet therapy and drugs, as needed • Use of diuretic and potassium replacement • Stage 3 hypertension • Diet therapy and vigorous drug therapy Types of Hypertensive Blood Pressure Levels

31. Weight management—lose weight and maintain appropriate weight for height • Increase Physical activity • Sodium control • Other minerals—calcium, magnesium may be beneficial Principles of Medical Nutrition Therapy

32. DASH diet – Dietary Approaches to Stop Hypertension • 4-6 servings fruit • 4-6 “” veggie • 2-3 “” low-fat dairy • Lean meats • High-fiber grains • 14 days to lower B/P Principles of Medical Nutrition Therapy

33. Food planning and purchasing • Control energy intake; read labels • Eat fresh foods with small selection of processed foods, if any Education and Prevention Practical Food Guides

34. Food preparation • Use less salt and fat • Use seasonings instead (herbs, spices, lemon, onion, garlic, etc.) • Take time to cook • Special needs: individual adaptation of diet principles according to preferences, ethnic diets, and food habits Education and Prevention Practical Food Guides

35. Start early • Prevention begins in childhood, especially with children in high-risk families Focus on high-risk groups • Direct education to people and families with risk of heart disease and hypertension Education Principles

36. Use variety of resources • National organizations, community programs, registered dieticians Education Principles