Transcript Nutrition and Heart Disease

Lipids in Heart
Disease & Cancer
Module 3.5
Heart Disease - Atherosclerosis
Heart Disease
Red- diet related
• #1 cause of death in America.
• 1/3 die of atherosclerosis.
• Myocardial infarction and stroke
risk increase with atherosclerosis.
Atherosclerosis
1. A buildup of plaque occlude arterial walls arterial vessels.
– Begins as injury or inflammation
– Contain cholesterol (oxidized LDL), platelets, etc
2. Artery walls lose elasticity
3. Passage through the artery narrows
4. One leading cause of heart disease
Healthy Occluded
Lipids and Cardiovascular Disease
Hypertension
• High blood pressure.
• Leading cause of arterial
wall injury.
• Synergizes with
atherosclerosis to cause
heart disease and stroke.
http://www.precisionnutrition.com/wordpress/wpcontent/uploads/2009/09/LFTH_heartdisease_476x284.jpg
Methods to reduce Hypertension
• DASH Diet (The Dietary Approach to Stop Hypertension)
• Increase calcium, potassium and magnesium
• Low-fat, fiber-rich, moderate protein & carbohydrate
• Aerobic exercise
• Healthy Body Weight
Blood Pressure Measurements
Category
Systolic
1
Optimal
<120
Conjuncti
on
and
Diastolic2
<80
Pre-hypertension
120-139
or
80-89
Stage 1
hypertension
Stage 2
hypertension
140-159
or
90-99
≥ 160
or
≥ 100
1 Systolic
Who is Dying of Heart Disease?
25-34 years: Men at 3X rate as Women
35-44 years: Men at 2X rate as Women
45-64 years: Women catching up to men
65-75 years: Women catching up to men
75-80 years: Women = Men
BP in mm of
mercury (Hg)
2 Diastolic BP in mm of
mercury (Hg)
Over 70 million
Americans suffer from
some form of
cardiovascular disease.
What are the Risk Factors
for Heart Disease?
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Elevated serum cholesterol
Genetics
Smoking tobacco & drinking alcohol
Hypertension
Diabetes
Obesity
Sedentary lifestyle
Stress
Male gender
Consuming a low fiber & high fat diet
How can hypertension and heart disease
be prevented?
• Lifestyle changes
• Less stress, no smoking
• Healthy diet
• Healthy fats, nutritionally adequate
• SFA: Increase LDL
• PUFA: Decrease LDL & HDL
• MUFA: Decrease LDL
• Cholesterol: Can Increase LDL
• Regular aerobic exercise
• An hour a day
All positively affect blood lipid values and blood
pressure
Metabolic Syndrome
• Metabolic syndrome is a disorder
of energy utilization and storage,
diagnosed by a co-occurrence of
three out of five of the following
medical conditions:
1. abdominal (central) obesity
Waist circumference
• (apple/pear shape) >35” males >40” females
2. Elevated blood pressure ≥130/85 mm Hg
3. Elevated fasting plasma glucose: ≥110 mg/dl
4. High serum fasting Blood Triglycerides: ≥150 mg/dl
5. Low HDL levels. <50 mg/dl Males <40 mg/dl Females
Metabolic syndrome increases the risk of developing
cardiovascular disease and diabetes.
Blood Lipids
Serum Triglycerides
• Elevated levels associated w/ heart disease.
• High triglyceride levels thicken the blood
causing hypertriglyceridemia.
• Triglycerides are packaged primarily in
Chylomicrons and Very Low Density
Lipoproteins (VLDL).
• A fasting 12 hour blood test is
needed to determine an
accurate triglyceride level.
• <150mg/dl is normal.
• 450 mg/dl is like pumping
ketchup, causes arterial
damage contributing to
heart disease and stroke.
http://comps.canstockphoto.com/can-stockphoto_csp11670146.jpg
Total Cholesterol
Triglycerides + HDL +LDL
 < 200 mg/dl
Desirable/Low Risk
 200-239 mg/dl
Borderline High Risk
 ≥ 240 mg/dl
High Risk
LDL Cholesterol
• < 100 mg/dl Optimal
• 100-129 mg/dl Near optimal
• 130-159 mg/dl Borderline high
• 160-189 mg/dl High
• ≥ 190 mg/dl Very high
HDL Cholesterol
• < 40 Low (indicates risk)
• > 60 High Good!
Blood Cholesterol &
Disease Risk
Oxidation of Fat
• The double bonds of
polyunsaturated fatty acids
are targets for oxidation
(damage by oxygen
https://d39ya49a1fwv14.cloudfront.net/wpspecies).
content/uploads/2013/10/Cardiovascular-Disease.jpg
The double bond breaks
• Antioxidants prevent oxidation
reactions, react with oxygen radical with oxidation generating
lipid fragments that are
species directly, & prevent heart
very sticky.
disease
• Antioxidants vitamins:
– CH2CH = CHCH2
• vitamin E (alpha-tocopherol),
= CH2CHO + CH2CHO
• vitamin C (L-ascorbic acid),
• The sticky fragments
• beta-carotene (provitamin A)
contribute to
• Minerals with antioxidant cofactor
atherosclerotic plaque
• Zinc, Copper, & Iron
formation.
Trans Fats and Fat Hydrogenation
• Trans fatty acids levels are high in processed
foods containing partially hydrogenated oils.
Created when an unsaturated fat is hydrogenated.
• The double bonds from PUFA & MUFA are
removed by hydrogenation (adding hydrogen).
• The fatty acid becomes more saturated making
product more solid at room temperature.
http://upload.wikimedia.org/wikipedia/en
/8/87/Nyc-trans-poster.gif
o Changes shape of the double bond structure and
allows for easy “packing” of the molecule leading
to potential plaque in the arteries.
• Used in the process of making margarine.
– Stick margarine & shortening are highly
hydrogenated and partially hydrogenated
• Found in shortening, baked goods, fried foods, potato chips,
• Trans fatty acids have been implicated as risk in heart disease
o Lowers HDL cholesterol
• Manufactures required to list on food label if ≥ 0.5 grams
Homocysteine in Heart Disease
• Homocysteine is byproduct of the metabolism of the essential
amino acid methionine. It can be recycled back into methionine
or converted into the amino acid cysteine by B vitamins.
• Elevated levels of homocysteine cause arterial wall damage &
contribute to blood clots, heart attacks, and stroke. Some
research also indicates higher risks of developing dementia and
Alzheimer’s disease
• Folic acid (folate), B6 & B12 function as cofactors for the enzymes
driving the inter conversion of cysteine & methionine, thus
adequate intakes prevent hyper-homocystemia.
methionine (B12)
homocysteine
Cysteine (B6)
http://patientadvocates.com/sites/default/files/Homocysteine-Damage-Ladd-McNamara.jpg
Preventive Factors for Heart Disease
• High doses of Niacin: Increases HDL, decreases LDL.
• Statin type cholesterol lowering drugs: Reduce the
synthesis of cholesterol in the liver.
• Cholesterol absorption inhibitor drugs.
• Benecol spreads: Contain plant stanol esters that reduce
the absorption of cholesterol in the digestive tract.
• Wine: Reduces blood viscosity. Red wine and/or grape
juice increases HDL.
– Alcohol: 1 serving per day decreases risk of a cardiovascular
accident. It is an anticoagulant.
• Aerobic Activity: Increases HDL, decreases LDL.
• Soluble Fiber: Decreases LDL.
• Soy Protein: Increases HDL, decreases LDL.
Lipids in Cancer
• Cancer is the 2nd leading cause of death in Americans.
• Characterized by uncontrolled cell growth.
• Occurs through a process of initiation, promotion, and
progression.
Increased Cancer Risk by Lifestyle Practices
– Smoking tobacco, UV light, Obesity, Sedentary Lifestyle
Increased Cancer Risk by Dietary Practices
– ~ 45% of all cancer deaths are diet-related
– Low F&V, antioxidant nutrient, & fiber intake
– High total fat and PUFA, sodium intake
• P:S ≥3:1 + high fat diet = cancer risk
• P:S ≤0.33:1 (or ≤1:3) + high fat diet = heart disease risk
* P =polyunsaturated
S = saturated
Carcinogenesis
Obesity, Fat Intake and Cancer Risk
• Obese individuals often have increased levels of insulin
and insulin-like growth factor-1 (IGF-1) in their blood (a
condition known as hyperinsulinemia or insulin resistance),
which may promote the development of certain tumors.
• Fat cells produce hormones that may stimulate or inhibit cell
growth. Ex: leptin, which is more abundant in obese individuals
seems to promote cell proliferation.
– Concurrently, obesity increases leptin production but
decreased its sensitivity to inhibit hunger though
sufficient calories have been consumed and stored.
• Fat cells may also have direct and indirect effects on other
tumor growth regulators.
• Obese individuals often have chronic low-level inflammation,
which has been associated with increased cancer risk.
• High levels of fat intake have particularly indicated potential
higher risks of colon cancer due to proliferation of colon stem
cell mutations that lead to tumor formation.