Transcript Lecture 7a powerpoint

Midterm - 2 November 2015
•In class
•60 minutes
•Start 8:45 am sharp
•55 multiple choice questions –1 point each
1 short answer-10 points
•from lecture 1a until end of lecture 6b
inclusive
1
Atherosclerosis and Diet
Chapter 20
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), hypertension,
brain (cerebrovascular accident aka stroke), or
legs (peripheral arterial disease)-ultimately
congestive heart failure may arise as the result
of a myocardial infarction
– Can also cause a ballooning out of blood vessel
walls (aneurysm)
Cardiovascular Disease (CVD)
• Much of the CVD seen today is the result of the “we
sit down and we chow down” attitude of far too
many people as illustrated…
Cardiovascular Heart Disease (CHD)
• The blood players in the atherosclerotic process:
- elevated plasma low density lipoprotein cholesterol
(LDL-c or bad cholesterol)-LDL deposits fat on artery
walls and this clogs arteries -such clogging reduces or
stops blood flow and hence oxygen and nutrient delivery
- fat deposits on wall of artery are called plaque
- low plasma high density lipoprotein cholesterol
(HDL-c or good cholesterol)- HDL cleans arteries of fat
- elevated plasma cholesterol (elevates LDL-c)
- elevated plasma cholesterol:HDL-c ratio-more cholesterol
influx than efflux as most of the cholesterol is carried on
the LDL
- elevated plasma triglycerides elevates small dense
LDL (sd LDL is very aggressive in clogging
arteries with fat)
Cardiovascular Heart Disease (CHD)
• The blood players in the atherosclerotic process continued:
-elevated post-prandial triglycerides (chylomicrontriglycerides)
-elevated VLDL-cholesterol (contributes to cholesterol
influx into the artery wall)
-hypertension-damages arterial endothelium which
leads to lipid infiltration
-plaque rupture leading to platelet aggregation in
turn leading to thrombus and embolus
formation- decreased bleeding time involved
here
-elevated lipoprotein (a) levels-contributes lipid to
the artery wall and may contribute to
elevated platelet aggregation
Cardiovascular Heart Disease (CHD)
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Atherosclerosis
• 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.
Coronary Atherosclerotic 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
Major Modifiable Risk Factors for CHD
• All of blood parameters above though
generally Lp (a) is tougher to lower
(due to tight genetic regulation)
• Obesity, especially abdominal obesity
• Physical inactivity
• Cigarette smoking
• An atherogenic (meaning likely to cause
atherosclerosis) diet
Coronary Heart Disease (CHD)—(cont.)
• Cigarette smoking
– Contributes to the development of atherosclerosis,
increases heart rate, narrows arteries, increases
blood pressure, lowers HDL, and promotes clot
formation
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.
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.
– Diet and physical activity are important to
prevent and manage MetS
Coronary Heart Disease (CHD)—(cont.)
• Metabolic syndrome (MetS)
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.
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.
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.
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.
– Recommendation- 2 servings (approximately 8 oz.) of
fatty fish per week, prepared in ways that do not add
saturated or trans fats.
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.
– Recommendation- total fat provide 25% to 35%
of total calories.
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
– Limit trans fat intake of less than 1% of
total calories.
Heart Healthy Diet and Lifestyle—(cont.)
• Cholesterol
– Dietary cholesterol raises LDL levels,
especially in people who are lean though the
contribution of dietary cholesterol to total
and cholesterol levels is small.
– 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. Added sugars in
sufficient amounts can contribute to proatherosclerotic lipid and lipoprotein profile
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.
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.
Heart Healthy Diet and Lifestyle—(cont.)
• Other dietary components that influence CVD risk
– Fish oil supplements (lowers plasma triglycerides and
platelet reactivity) and plant sterols/stanols (lower
plasma cholesterol and LDL-c) are additional options
that may be used in the treatment of heart disease.
– Fish oil supplements
o recommendation 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.
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?
– Yes for all but a few patients
Hypertension—(cont.) The DASH eating plan
DASH Food Groups
DASH Daily Servings
(except as noted)
DASH Serving Sizes
Vegetables
4-5
250 mL (1 cup) raw leafy vegetables
125 mL (½ cup) cooked vegetables
170 ml (6 oz) juice
Fruit
4-5
1 medium piece of fruit
63 mL (¼ cup) dried fruit
125 mL (½ cup) fresh, frozen or canned fruit
Grains
(mainly whole grains)
7-8
1 slice bread
250 mL (1 cup) ready to eat cereal
125 mL (½ cup) cooked rice, pasta or cereal
Low Fat or No-Fat Dairy Foods
2-3
250 mL (1 cup) milk
250 ml (1 cup) yogurt
50 g (1½ oz) cheese
Lean meats, poultry and fish
2 or less
3 ounces cooked lean meats, skinless poultry,
or fish
Nuts, seeds and dry beans
4-5 per week
1/3 cup (1.5 oz.) nuts
30 mL (2 tbsp) peanut butter
2 tbsp (1/2 oz.) seeds
1/2 cup cooked dry beans or peas
Fats and Oils
2-3
5 ml (1 tsp) soft margarine
15mL (1 tbsp) low-fat mayonnaise
30 mL (2 tbsp) light salad dressing
5 ml (1 tsp) vegetable oil
TLC diet
•
Component
TLC Diet
•
Total fat
25-35% of total calories*
•
Saturated fat
<7% total calories
•
Polyunsaturated fat
Up to 10% of total calories
•
Monounsaturated fat
Up to 20% of total calories
•
Trans fat
•
Carbohydrate** 50-60% of total calories
•
Dietary fiber
20-30 grams per day
•
Protein
15-25% of total calories
•
Cholesterol
<200 mg/day
•
Sodium
<2,300 mg/day
•
Dietary options
•
Plant sterols/stanols Add up to 2 grams per day
•
Soluble fiber
•
Fish (fatty fish) Include in weekly eating plan
•
* allows an increase of total fat to 35% of total calories and a reduction of carbohydrate to
50% in persons with metabolic syndrome and/or at risk for type 2 diabetes. **
Carbohydrate should derive predominantly from foods rich in complex carbohydrates
including grains (especially whole grains) and fruits and vegetables.
Lower intake
Increase 5-10 grams per day
Mediterranean diet
• Key components of the Mediterranean diet
• The Mediterranean diet emphasizes:
• Eating primarily plant-based foods, such as fruits and vegetables,
whole grains, legumes and nuts
• Replacing butter with healthy fats, such as olive oil
• Using herbs and spices instead of salt to flavor foods
• Limiting red meat to no more than a few times a month
• Eating fish and poultry at least twice a week
• Drinking red wine in moderation (optional)
• The diet also recognizes the importance of being physically active,
and enjoying meals with family and friends.
Mediterranean diet
• Key components of the Mediterranean diet
• Focus on fruits, vegetables, nuts and grains
• The Mediterranean diet traditionally includes fruits, vegetables
and grains. For example, residents of Greece average six or
more servings a day of antioxidant-rich fruits and vegetables.
• Grains in the Mediterranean region are typically whole grain
and usually contain very few unhealthy trans fats, and bread is
an important part of the diet. However, throughout the
Mediterranean region, bread is eaten plain or dipped in olive oil
— not eaten with butter or margarine, which contains
saturated or trans fats.
• Nuts are another part of a healthy Mediterranean diet. Nuts are
high in fat, but most of the fat is healthy. Because nuts are
high in calories, they should not be eaten in large amounts —
generally no more than a handful a day. For the best nutrition,
avoid candied or honey-roasted and heavily salted nuts.
Mediterranean diet
• The focus of the Mediterranean diet isn't on limiting total fat
consumption, but rather on choosing healthier types of fat. The
Mediterranean diet discourages saturated fats and
hydrogenated oils (trans fats), both of which contribute to
heart disease.
• The Mediterranean diet features olive oil as the primary source
of fat. Olive oil is mainly monounsaturated fat — a type of fat
that can help reduce low-density lipoprotein (LDL) cholesterol
levels when used in place of saturated or trans fats. "Extravirgin" and "virgin" olive oils (the least processed forms) also
contain the highest levels of protective plant compounds that
provide antioxidant effects.
• Canola oil and some nuts contain the beneficial linolenic acid (a
type of omega-3 fatty acid) in addition to healthy unsaturated
fat. Omega-3 fatty acids lower triglycerides, decrease blood
clotting, and are associated with decreased incidence of sudden
heart attacks, improve the health of your blood vessels, and
help moderate blood pressure. Fatty fish — such as mackerel,
lake trout, herring, sardines, albacore tuna and salmon — are
rich sources of omega-3 fatty acids. Fish is eaten on a regular
basis in the Mediterranean diet.
What is in these good diets that helps
with reducing atherosclerosis?