Transcript Heart Healthy Diet and Lifestyle—(cont.)

Nutrition for Patients with
Cardiovascular Disorders
Chapter 20
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Cardiovascular Disease (CVD)
• An umbrella term for diseases that affect the heart
and blood vessels
• Atherosclerotic CVD is caused by atherosclerosis.
– A progressive narrowing and hardening of blood
vessels that may lead to blocked blood flow to
the heart (myocardial infarction), brain
(cerebrovascular accident), or legs (peripheral
arterial disease)
– Can also cause a ballooning out of blood vessel
walls (aneurysm)
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Hypertension
• A symptom, not a disease
• Arbitrarily defined as sustained elevated blood
pressure greater than or equal to 140/90
mmHg
• A major risk factor for heart disease, stroke,
kidney failure, and peripheral arterial disease
• One of the most common chronic conditions in
the United States
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Hypertension—(cont.)
• Compared to nonblacks, blacks
– Have a higher prevalence of hypertension
– Develop hypertension earlier in life
– Have higher risks of hypertension-related
complications such as
o Especially stroke
o Kidney failure
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Hypertension—(cont.)
• Dietary factors play a prominent role in blood
pressure regulation.
• Normotensive or prehypertensive
– Dietary changes have the potential to reduce
blood pressure and prevent hypertension
and its complications.
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Hypertension—(cont.)
• Stage 1 hypertension
– Diet is the initial treatment before drug
therapy is introduced and may eliminate the
need for medication.
• For those who have hypertension who are
treated with medication
– Diet can lower blood pressure and reduce the
dose of medication needed.
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Hypertension—(cont.)
• The DASH Diet
– DASH = Dietary Approaches to Stop
Hypertension
– Multicenter feeding study
– Eating whole “real” foods rather than
individual nutrients
– Significantly lowers both systolic and diastolic
blood pressures as well as cholesterol
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Hypertension—(cont.)
• The DASH Diet—(cont.)
– DASH-sodium
o Lowering sodium lowers blood pressure.
o Greatest reduction in blood pressure
occurred at 1500 mg of sodium.
o Greatest blood pressure reductions
occurred in blacks; middle-aged and older
people; and in people with hypertension,
diabetes, or chronic kidney disease.
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Hypertension—(cont.)
• Weight loss
– Observational and clinical studies consistently
show
o Weight is directly related to blood pressure.
o Weight loss lowers blood pressure, even if
healthy weight is not attained.
– The greater the weight loss, the greater the
reduction in blood pressure.
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Hypertension—(cont.)
• Weight loss—(cont.)
– Achieving a healthy weight (BMI <25) is an
effective intervention to prevent and treat
hypertension.
– Preventing weight gain is critical.
• Potassium
– Potassium intake increases, blood pressure
decreases.
– Recommended that people consume 4.7 g
potassium per day
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Hypertension—(cont.)
• Alcohol
– Observational studies and clinical trials
o Show a direct, dose-dependent
relationship between alcohol and blood
pressure
o Alcohol intake should be limited to 2
drinks or less per day in men and 1
drink or less per day for women.
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Question
• Is the following statement true or false?
In stage 1 hypertension, diet is the first
treatment before medicine is given.
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Answer
True.
Rationale: In people with stage 1 hypertension,
diet is the initial treatment before drug therapy
is introduced and may eliminate the need for
medication.
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Atherosclerosis
• “Hardening of the arteries”
• Underlying cause of the most common
cardiovascular diseases (CVD)
• Progressive process
• Complications depend on the size, stability, and
location of the plaque.
• Diet has a significant effect on the progression
of atherosclerosis and CVD.
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Coronary Heart Disease (CHD)
• Usually caused by atherosclerosis in the largeand medium-sized coronary arteries
• Risk factors
– Cannot be modified
o Genetics
o Gender
o Advancing age
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Major Modifiable Risk Factors for CHD
• High blood LDL cholesterol
• Low blood HDL cholesterol
• High blood pressure
• Obesity, especially abdominal obesity
• Physical inactivity
• Cigarette smoking
• An atherogenic (meaning likely to cause
atherosclerosis) diet
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Coronary Heart Disease (CHD)—(cont.)
• High blood cholesterol levels
– Transported through watery blood in
lipoprotein molecules
– LDL and HDL impact risk of heart disease.
– As the level of LDL increases, so does the risk
of developing cardiovascular disease (CVD).
– LDL goals are determined by the number of
major independent risk factors an individual
has.
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Coronary Heart Disease (CHD)—(cont.)
• High blood cholesterol levels—(cont.)
– Diet and lifestyle changes are appropriate for all
people.
– Levels of HDL, the “good cholesterol,” are
inversely correlated to CHD risk.
• Cigarette smoking
– Contributes to the development of atherosclerosis,
increases heart rate, narrows arteries, increases
blood pressure, lowers HDL, and promotes clot
formation
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Coronary Heart Disease (CHD)—(cont.)
• Cigarette smoking—(cont’d)
– People who smoke have a 2 to 4 times
greater risk of CHD than nonsmokers.
– People who smoke have approximately
double the risk of stroke as nonsmokers.
– People who smoke are 10 times more likely
to develop peripheral arterial disease.
– Smoking causes abdominal aneurysm.
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Coronary Heart Disease (CHD)—(cont.)
• Metabolic syndrome (MetS)
– Cluster of metabolic abnormalities that
appear to promote a relatively high longterm risk for both atherosclerotic CVD and
type 2 diabetes
– Primary objective of controlling MetS is to
reduce the risk for atherosclerotic CVD.
– Goals include smoking cessation, losing
weight, and controlling blood pressure and
glucose levels.
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Question
• Atherosclerosis, or “hardening of the arteries,”
is a progressive process that begins early in
life. What do complications depend on?
a. How progressed the disease process is
b. How compliant the patient is with the
treatment
c. Size, stability, and location of the plaque
d. The patient’s genetics, gender, and age
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Answer
c. Size, stability, and location of the plaque
Rationale: Complications depend on the size,
stability, and location of the plaque.
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Heart Healthy Diet and Lifestyle
• Balanced, varied, and nutritionally adequate
eating plan
• Part of a healthy lifestyle that includes
– Regular physical activity
– The avoidance of tobacco products
• With few exceptions, recommendations to lower
the risk of CHD are the same as the ones made
to lower the blood pressure.
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Heart Healthy Diet and Lifestyle—(cont.)
• Calories, activity, and weight
– Attaining and maintaining healthy weight to
reduce the risk of CVD
– A decrease in calorie intake and an increase
in physical activity are recommended to
promote weight loss.
– A physically active lifestyle with minimal
sedentary activities is appropriate for all
people regardless of their weight status.
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Heart-Healthy Diet and Lifestyle—(cont.)
• Fruit and vegetables
– In short-term, randomized trials
o Diets rich in fruits and vegetables have been
shown to lower blood pressure and improve other
CVD risk factors.
– In long-term, observational studies
o People who have a high intake of fruits and
vegetables are at lower risk of developing CVD,
especially stroke.
– Preparation methods should preserve the fiber and
nutrient content without adding saturated fat, trans
fat, sugar, or salt.
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Heart Healthy Diet and Lifestyle—(cont.)
• Whole grains
– Diets high in whole-grain products are associated with
decreased risk of CVD.
– Both soluble and insoluble fiber are associated with
decreased risk of CVD.
• Fatty fish
– Increased intake of omega-3 fatty acids reduces risk
of CVD.
– AHA recommends 2 servings (approximately 8 oz.) of
fatty fish per week, prepared in ways that do not add
saturated or trans fats.
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Heart Healthy Diet and Lifestyle—(cont.)
• Saturated fat
– Increases LDL and total cholesterol levels
– Choosing lean meats and trimming away visible
fat lowers saturated fat intake.
– Portion sizes are limited to 6 oz. or less per day.
– Monounsaturated and polyunsaturated fats are
inversely related to CHD.
– The American Heart Association recommends
total fat provide 25% to 35% of total calories.
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Heart Healthy Diet and Lifestyle—(cont.)
• Trans fat
– Increases LDL and total cholesterol levels,
the ratio of LDL to HDL cholesterol, and the
risk of CHD
– Found in partially hydrogenated fats
– AHA recommends a trans fat intake of less
than 1% of total calories.
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Heart Healthy Diet and Lifestyle—(cont.)
• Cholesterol
– Dietary cholesterol raises LDL levels,
especially in people who are lean.
– Found only in foods originating from animals
• Added sugars
– The purpose of limiting the intake of
beverages and foods with added sugars is to
lower calorie intake and help ensure
nutritional adequacy.
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Heart Healthy Diet and Lifestyle—(cont.)
• Sodium
– As the intake of salt increases, so does blood
pressure.
– High blood pressure is a major risk factor for
CVD.
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Heart Healthy Diet and Lifestyle—(cont.)
• Alcohol
– Moderate alcohol consumption from any
source—beer, wine, or distilled liquor—is
associated with a reduced risk of CVD.
– Alcohol can be addictive, and high intakes
are associated with high triglyceride levels,
hypertension, liver damage, physical abuse,
vehicular and work accidents, and increased
risk of breast cancer.
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Heart Healthy Diet and Lifestyle—(cont.)
• Other dietary components that influence CVD risk
– Fish oil supplements and plant sterols/stanols are
additional options that may be used in the treatment
of heart disease.
– Fish oil supplements
o AHA recommends approximately 1 g of EPA + DHA
per day for people with documented CHD.
o In most cases, 1 capsule per day of a 1-g fish oil
supplement contains 200 to 800 mg of total n-3,
enough to meet the recommendations of about
1500 to 2000 mg/week to prevent CHD.
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Heart Healthy Diet and Lifestyle—(cont.)
• Other dietary components that influence
CVD risk—(cont.)
– Plant stanols/sterols
o Can be used as a therapeutic option to
help lower LDL levels by up to 15%
o Maximum benefits occur when intake is
about 2 g per day; must be taken daily
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Heart Healthy Diet and Lifestyle—(cont.)
• Putting recommendations into practice
– DASH-sodium diet and the Therapeutic Lifestyle
Changes (TLC) diet
– “Mediterranean” diet
• Is a “heart healthy” diet and lifestyle for
everyone?
– There are few patients for which this “diet” and
the recommendations to lose weight, if
overweight, and exercise are inappropriate.
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Heart Failure (HF)
• Major and growing public health problem in the United
States
• Most common Medicare diagnosis-related group
• Syndrome characterized by specific symptoms
– Shortness of breath
– Fatigue
– Edema
• CHD, hypertension, and diabetes are prevalent causes;
arrhythmias and valve disorders may also cause HF.
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Heart Failure (HF)—(cont.)
• Nutrition therapy
– For people at risk of HF, the goals of therapy
are to control underlying risks.
– DASH-sodium diet is appropriate for people
with CHD or hypertension.
– Regular exercise and smoking cessation are
encouraged.
– Alcohol is discouraged.
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Heart Failure (HF)—(cont.)
• Nutrition therapy—(cont.)
– Stage C heart failure is defined as structural heart
disease with prior or current symptoms of HF.
o Sodium is limited to 2 g of sodium/day or less.
o A fluid restriction of 1.5 L/day for patients with
hyponatremia
o A low-calorie diet for patients who are overweight
o Small, frequent meals
o Soft, easy-to-chew foods for patients with fatigue
o Increased potassium intake for patients who are
taking thiazide (potassium-wasting) diuretics or
digitalis
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Heart Failure (HF)—(cont.)
• Nutrition therapy—(cont.)
– Cardiac cachexia
o Need a high-calorie, high-protein, highnutrient diet while maintaining a lowsodium diet
o Caloric and nutrient density are
important.
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