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Heart Diseases & Dietary
Intervention &
Recommendations in the
Prevention of Heart Disease
By
Dr vinayak s hiremath
Postgr...
Life Style Associated diseases
●Coronary Artery disease
●Cerebrovasular disease
●Peripheral Vascular disease
●Obesity
●Hyp...
Types Of Cardiovascular Disease
• Atherosclerosis
• Coronary heart disease (CHD)
• Chest pain (angina pectoris)
• Irregula...
cardiovascular diseases are leading cause of
death -worldwide
• Coronary disease -7.2 million
• Cancer - 6.3 million
• Cer...
Anatomy of the Heart
Figure 15.4
• Can Anyone Tell Me the Difference
Between a Heart Attack and a
Stroke????????
Stroke vs Heart Attack
• Stroke—blocked blood flow to the brain
• Heart attack—blocked blood flow to the
heart
• Risk fact...
What is Heart Disease?
• A general term that covers a number of
diseases which affect the heart, including
coronary artery...
What Causes Heart Disease?
• Atherosclerosis-fatty deposits of cholesterol
• Hypertension
• Arteries—blood vessels that carry blood away
from the heart to the rest of the body
Normal Artery
What Causes Heart
Dise...
Plaque Starts to Build Up
Tear in Artery
Wall
Tear in
Artery Wall
Plaque Can Grow and
Harden and Obstruct
the Artery
Tear in Artery
Wall
Tear in
Artery Wall
Atherosclerosis
Ischemic Stroke
Heart Attack
Artherosclerosis
• Characterized by deposits of fatty substances,
cholesterol, cellular waste products, calcium,
and fibri...
Coronary Artery Disease
Occurs when the coronary arteries that supply
the heart muscle become blocked.
• Partially blocked...
Myocardial Infarction
or
Heart Attack
• Symptoms: uncomfortable pressure, fullness,
squeezing pain, pain spreading to the
...
Congestive Heart Failure
• Fits under the description of heart disease.
• Does not mean the heart has failed, simply
means...
Congestive Heart Failure
• The right side of the heart collects the blood
returning from the body and sends it to the lung...
Angina Pectoris
• Ischemia – reduction of the heart’s blood and
oxygen supply
• The more serious the oxygen deprivation th...
Arrythmias
• An irregularity in heart rhythm
• Tachycardia – racing heart in the absence of
exercise or anxiety
• Bradycar...
Congenital And Rheumatic Heart
Disease
• Congenital heart disease affects 1 out of 125
children born
• May be due to hered...
Common Blood Vessel Disorders
Figure 15.6
Unchangeable Risk Factors
• Age- the older you get, the greater the
chance.
• Sex- males have a greater rate even after
wo...
Unchangeable Risk Factors
• Personal Medical History- other diseases such
as Diabetes Mellitus can increase chances.
Changeable Risk Factors
• Hypertension
• Serum cholesterol
• Obesity
• Diabetes Mellitus
• Physical Inactivity
• Cigarette...
Cholesterol
• Everybody needs cholesterol, it serves a vital
function in the body.
• It is a component of the nerve tissue...
Types of Cholesterol
Lipoproteins- 4 main classes
• Chylomicrons
• Very low density lipoproteins (VLDL)
• Low Density Lipo...
Good vs. BAD
• LDL is known as bad cholesterol. It has a
tendency to increase risk of CHD.
• LDL’s are a major component o...
Good vs. BAD
• HDL is known as the good cholesterol.
• It helps carry some of the bad cholesterol out
of the body.
• It do...
The Facts About Fat
• Certain fats are essential for good nutrition
and health.
• Fats provide essential fatty acids which...
The Facts About Fat
• Provide the greatest energy output per gram
of any food source. ( 9 cals)
• Carry fat soluble vitami...
The Skinny on Fat
• Saturated fats- basically means the fat is
saturated with hydrogen, they are solid at
room temperature...
The Skinny on Fat
• What are polyunsaturated fats? They are
unsaturated fats which are liquid at room
temperature and in t...
The Skinny on Fat
• What are monounsaturated fats?
• They are liquid at room temperature but start
to solidify in the refr...
The Skinny on Fat
• What are trans fatty acids? They are
unsaturated fats but they tend to raise total
and bad cholesterol...
What about Omega 3?
• Type of polyunsaturated fat.
• Consistently lowers serum triglycerides and
may also have an effect o...
Associations between the percent of calories
derived from specific foods and CHD mortality in
the 20 Countries Study*
Butt...
Obesity
• People who are obese have 2 to 6 times the
risk of developing hypertension.
• Location of the body fat is signif...
Diabetes Mellitus
• At any given cholesterol level, diabetic persons
have a 2 or 3 x higher risk of atherosclerosis!
• Ins...
Physical Inactivity
• Increasing physical activity has been shown to
decrease blood pressure.
• Moderate to intense physic...
Cigarette Smoking
• Causes an increase in blood pressure
• Usually have lower levels of HDL
• Within 1 year of quitting, C...
Alcohol Consumption
• In small amounts it acts as a vasodilator-
Good! 1-2 drinks
• In large amounts it acts as a vasocons...
Women And Cardiovascular Disease
• 2003, CVD deaths
– 426,800 men
– 483,800 women
• Estrogen
– Once estrogen production st...
1. Know your numbers:
– Cholesterol (LDL=lousy, HDL=healthy)
– Triglycerides
– Blood pressure
– Blood glucose
2. Maintain ...
Do You Know?
• Your total cholesterol—under 200
– HDL—60 or higher (less than 40 milligrams
(mg)/deciliter (dL) increases ...
• Blood pressure
• Cholesterol level
• Triglyceride level
• Blood sugar level
• Risk for developing type 2 diabetes
If ove...
Body Mass Index (BMI)
Underweight <18.5
Normal Weight 18.5-24.9
Overweight 25-29.9
Obesity 30+
Step 2: Maintain a
Healthy ...
• Weight loss:
– Reduces risk for cardiovascular disease
– Lowers blood pressure
– Lowers blood sugar
– Improves lipid lev...
ACSM and AHA Recommendations:
• Do moderately intense cardio
30 minutes/day, 5 days/week
OR
• Do vigorously intense cardio...
Staying physically active can reduce your:
• Blood pressure
• Cigarette smoking
• Diabetes
• Extra body weight in the over...
The FITT formula:
• F=frequency (days/week)
• I=intensity (how hard—easy, moderate)
• T=time
• T=type
Step 3: Stay Physica...
Manage Stress
• If left unmanaged, stress can cause
emotional, psychological, and physical
problems (heart disease, high blood
pressure,...
Stress Warning Signs
• Identify the stressor first
• Avoid hassles and minor irritation, if
possible
• Try to continue doing the things that yo...
• If you do smoke, stop
• Support is available:
– 800-ACS-2345 (American Cancer Society)
– 800-QUIT-NOW (US Dept of Health...
• But I heard alcohol is good for the heart!
– Doctors do not recommend it
• Moderate drinking is defined as:
– No more th...
• One drink is equal to:
– 12 fluid ounces (fl oz) of beer or wine cooler
– 5 fl oz of wine
– 1.5 fl oz of 80-proof liquor...
Who Benefits
From Eating
Heart Healthy?
The Entire Family!
Step 7: Eat Heart
Healthy
• Learn to read food labels
Knowledge is power!
What should I look for?
Step 7: Eat Heart
Healthy (cont’d)
Start Here
Limit These
Nutrients
Get Enough
of These
Nutrients
% DV=Percent Daily Value
• Reduce your calories if you are overweight
and want to lose weight:
– Calories are the energy in food that contribute
to...
• Eat breakfast
• Keep regular mealtimes
• Look for lower-fat alternatives
• Drink enough fluids (water)
• Focus on fruits...
How can You Stop CVD?
Diet and Nutrition, there are several
guidelines listed by the American Heart
Association:
• Eat a v...
Diet and Prevention of CVD
• Choose nonfat or low-fat products.
• Use lean meats- choose chicken, fish, turkey
and lean cu...
Dietary Guidelines
• Choose fats with 2 gms or less of saturated
fats per serving such as liquid and tub
margarines, canol...
Dietary Guidelines
• Limit your intake of foods high in calories and
low in nutrition, including foods like soft
drinks an...
Step I and II Diets
• The AHA and NCEP have developed these
diets to treat high blood pressure and
hypercholesterolemia
• ...
Step I Step II
• Total fat- 30% or less
• Sat fat- 7-10%
• Poly - up to 10%
• Mono Up to 15%
• Carb 55% or more
• Pro Appr...
Exercise and CVD
• Serves several functions in preventing and
treating those at high risk.
• Reduces incidence of obesity....
other Weapons Against Heart Disease
• Techniques for diagnosing heart disease
– Electrocardiogram (ECG)
– Angiography
– Po...
Angioplasty Versus Bypass Surgery
• Angioplasty – a thin catheter is threaded
through the blocked arteries. The catheter
h...
Thrombolysis
• If victim reaches an emergency room and is
diagnosed quickly, thrombolysis can be
performed
• Thrombolysis ...
Cardiac Rehabilitation
• Every year, 1 million people survive heart
attacks
• Cardiac rehabilitation exercise training
inc...
Los Angeles VA study
• 846 men in Veterans Home, 5-8 years
• Groups randomized to diets in which 2/3 of fat
given either a...
Lyon Diet Heart study
• 302 men and women with CHD
• Treatment group randomized to low saturated
fat, high canola oil marg...
Benefits of fish oil supplementation
• In the Diet and Reinfarction Trial (DART) in
2033 men with CHD increased intake of ...
Nuts, Soy, Phytosterols, Garlic
• Nurses’ Health Study: five 1oz servings of nuts
per week associated with 40% lower risk ...
Conclusion
• Cardiovascular disease is the number one
killer.
• It is highly preventable and controllable with
diet and ex...
Heart diseases & dietary intervention & recommendations
Heart diseases & dietary intervention & recommendations
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Heart diseases & dietary intervention & recommendations

  1. 1. Heart Diseases & Dietary Intervention & Recommendations in the Prevention of Heart Disease By Dr vinayak s hiremath Postgraduate Internal Medicine MRMC,GULBARGA
  2. 2. Life Style Associated diseases ●Coronary Artery disease ●Cerebrovasular disease ●Peripheral Vascular disease ●Obesity ●Hypertension ●Diabetes ●Cancers ●Osteoporosis
  3. 3. Types Of Cardiovascular Disease • Atherosclerosis • Coronary heart disease (CHD) • Chest pain (angina pectoris) • Irregular heartbeat (arrhythmia) • Congestive heart failure (CHF) • Congenital and rheumatic heart disease • Stroke
  4. 4. cardiovascular diseases are leading cause of death -worldwide • Coronary disease -7.2 million • Cancer - 6.3 million • Cerebrovascular disease- 4.6 • Acute lower respiratory tract infections- 3.9 • Tuberculosis -3.0 • COPD (chronic obstructive pulmonary disease) 2.9 • Diarrhoea (including dysentery) -2.5 • Malaria -2.1 • AIDS- 1.5 • Hepatitis -B 1.2
  5. 5. Anatomy of the Heart Figure 15.4
  6. 6. • Can Anyone Tell Me the Difference Between a Heart Attack and a Stroke????????
  7. 7. Stroke vs Heart Attack • Stroke—blocked blood flow to the brain • Heart attack—blocked blood flow to the heart • Risk factors are the same for both
  8. 8. What is Heart Disease? • A general term that covers a number of diseases which affect the heart, including coronary artery disease, heart-failure and angina. • Heart Disease is the number one killer in the world.
  9. 9. What Causes Heart Disease? • Atherosclerosis-fatty deposits of cholesterol • Hypertension
  10. 10. • Arteries—blood vessels that carry blood away from the heart to the rest of the body Normal Artery What Causes Heart Disease/Stroke?
  11. 11. Plaque Starts to Build Up Tear in Artery Wall Tear in Artery Wall
  12. 12. Plaque Can Grow and Harden and Obstruct the Artery Tear in Artery Wall Tear in Artery Wall Atherosclerosis
  13. 13. Ischemic Stroke
  14. 14. Heart Attack
  15. 15. Artherosclerosis • Characterized by deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of the artery • Hyperlipidemia – abnormally high blood lipid level • Plaque – the buildup of deposits in the arteries
  16. 16. Coronary Artery Disease Occurs when the coronary arteries that supply the heart muscle become blocked. • Partially blocked it causes angina. • Fully blocked it causes a myocardial infarction or a heart attack!
  17. 17. Myocardial Infarction or Heart Attack • Symptoms: uncomfortable pressure, fullness, squeezing pain, pain spreading to the shoulders, neck and arms. • Chest discomfort and light headedness • Anxiety/nervousness • Paleness or pallor • Increased irregular heart rate
  18. 18. Congestive Heart Failure • Fits under the description of heart disease. • Does not mean the heart has failed, simply means the heart is not doing an efficient job. • It results from an injury or a reduction of function of the heart muscle. • Can be due to arteriosclerosis, hypertension, myocardial infarction, rheumatic fever or birth defect.
  19. 19. Congestive Heart Failure • The right side of the heart collects the blood returning from the body and sends it to the lungs. • If it is failing, the blood backs up into the veins, and there are signs of edema. • The left side of the heart receives the blood from the lungs and pumps it out into the body. If it is failing the blood is not pumped effectively.
  20. 20. Angina Pectoris • Ischemia – reduction of the heart’s blood and oxygen supply • The more serious the oxygen deprivation the more severe the pain • Nitroglycerin – drug used to relax (dilate) the veins • Beta blockers control potential overactivity of the heart muscle
  21. 21. Arrythmias • An irregularity in heart rhythm • Tachycardia – racing heart in the absence of exercise or anxiety • Bradycardia – abnormally slow heartbeat • Fibrillation – heart beat is sporadic, quivering pattern
  22. 22. Congenital And Rheumatic Heart Disease • Congenital heart disease affects 1 out of 125 children born • May be due to hereditary factors, maternal diseases, or chemical intake (alcohol) during fetal development • Rheumatic heart disease results from rheumatic fever which affects connective tissue
  23. 23. Common Blood Vessel Disorders Figure 15.6
  24. 24. Unchangeable Risk Factors • Age- the older you get, the greater the chance. • Sex- males have a greater rate even after women pass menopause. • Race- minorities have a greater chance. • Family history- if family members have had CHD, there is a greater chance.
  25. 25. Unchangeable Risk Factors • Personal Medical History- other diseases such as Diabetes Mellitus can increase chances.
  26. 26. Changeable Risk Factors • Hypertension • Serum cholesterol • Obesity • Diabetes Mellitus • Physical Inactivity • Cigarette Smoking • Alcohol Intake
  27. 27. Cholesterol • Everybody needs cholesterol, it serves a vital function in the body. • It is a component of the nerve tissue of the brain and spinal cord as well as other major organs. • Frequently measured to promote health and prevent disease. • A major component of the plaque that clogs arteries.
  28. 28. Types of Cholesterol Lipoproteins- 4 main classes • Chylomicrons • Very low density lipoproteins (VLDL) • Low Density Lipoprotein (LDL) • High Density Lipoprotein (HDL)
  29. 29. Good vs. BAD • LDL is known as bad cholesterol. It has a tendency to increase risk of CHD. • LDL’s are a major component of the atherosclerotic plaque that clogs arteries. • Levels should be <130
  30. 30. Good vs. BAD • HDL is known as the good cholesterol. • It helps carry some of the bad cholesterol out of the body. • It does not have the tendency to clog arteries. • Levels should be >35. • High levels of HDL >60 can actually negate one other risk factor.
  31. 31. The Facts About Fat • Certain fats are essential for good nutrition and health. • Fats provide essential fatty acids which the body can’t manufacture. • Act as insulators to maintain body temperature. • Improve the palatability of food and promote digestion.
  32. 32. The Facts About Fat • Provide the greatest energy output per gram of any food source. ( 9 cals) • Carry fat soluble vitamins- A,D,E, and K.
  33. 33. The Skinny on Fat • Saturated fats- basically means the fat is saturated with hydrogen, they are solid at room temperature. Examples are lard and butter. • Why are they bad for you? They increase levels of LDL , decrease HDL and increase total cholesterol.
  34. 34. The Skinny on Fat • What are polyunsaturated fats? They are unsaturated fats which are liquid at room temperature and in the refrigerator. • Why are they good for us? • They help the body get rid of newly formed cholesterol.
  35. 35. The Skinny on Fat • What are monounsaturated fats? • They are liquid at room temperature but start to solidify in the refrigerator. • Decrease total cholesterol and lower LDL levels.
  36. 36. The Skinny on Fat • What are trans fatty acids? They are unsaturated fats but they tend to raise total and bad cholesterol. • Where do you find them? • In fast-food restaurants • Commercial baked goods. Examples: doughnuts, potato chips, cupcakes.
  37. 37. What about Omega 3? • Type of polyunsaturated fat. • Consistently lowers serum triglycerides and may also have an effect on lowering blood pressure. • Found in oily fish such as salmon, tuna, and herring. • Is available as a supplement.
  38. 38. Associations between the percent of calories derived from specific foods and CHD mortality in the 20 Countries Study* Butter 0.546 All dairy products 0.619 Eggs 0.592 Meat and poultry 0.561 Sugar and syrup 0.676 Grains, fruits, and starchy -0.633 and nonstarchy vegetables Food Source Correlation Coefficient† *1973 data, all subjects. From Stamler J: Population studies. In Levy R: Nutrition, Lipids, and CHD. New York, Raven, 1979. †All coefficients are significant at the P<0.05 level.
  39. 39. Obesity • People who are obese have 2 to 6 times the risk of developing hypertension. • Location of the body fat is significant. • Pears of apples?
  40. 40. Diabetes Mellitus • At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of atherosclerosis! • Insulin is required to maintain adequate levels of lipoprotein lipase, an enzyme needed to break down bad cholesterols.
  41. 41. Physical Inactivity • Increasing physical activity has been shown to decrease blood pressure. • Moderate to intense physical activity for 30-45 minutes on most days of the week is recommended.
  42. 42. Cigarette Smoking • Causes an increase in blood pressure • Usually have lower levels of HDL • Within 1 year of quitting, CHD risk decreases, within 2 years it reaches the level of a nonsmoker.
  43. 43. Alcohol Consumption • In small amounts it acts as a vasodilator- Good! 1-2 drinks • In large amounts it acts as a vasoconstrictor- BAD! 3-4 drinks • This is a very fine line!
  44. 44. Women And Cardiovascular Disease • 2003, CVD deaths – 426,800 men – 483,800 women • Estrogen – Once estrogen production stops, risk for CVD death increases • Diagnostic and therapeutic differences – Delay in diagnosing possible heart attack – Complexity in interpreting chest pain in women – Less aggressive treatment of female heart attack victims – Smaller coronary arteries in women • Gender bias in CVD research – typically CVD research has been conducted on male subjects
  45. 45. 1. Know your numbers: – Cholesterol (LDL=lousy, HDL=healthy) – Triglycerides – Blood pressure – Blood glucose 2. Maintain a healthy weight 3. Stay physically active 4. Manage stress 5. Do not smoke 6. Do not drink alcohol excessively 7. Eat heart healthy HDL=high-density lipoprotein, LDL=low-density lipoprotein 7 Steps to a Healthier You
  46. 46. Do You Know? • Your total cholesterol—under 200 – HDL—60 or higher (less than 40 milligrams (mg)/deciliter (dL) increases risk) – LDL—under 100 mg/dL • Your triglycerides—less than 150 mg/dL • Your blood pressure—less than 120/80 • Fasting blood glucose—less than 100 mg/dL Knowledge Is Power, So Learn and Live! Step 1: Know Your Numbers
  47. 47. • Blood pressure • Cholesterol level • Triglyceride level • Blood sugar level • Risk for developing type 2 diabetes If overweight, take action to lose weight to improve your overall health and lower your: Step 2: Maintain a Healthy Weight
  48. 48. Body Mass Index (BMI) Underweight <18.5 Normal Weight 18.5-24.9 Overweight 25-29.9 Obesity 30+ Step 2: Maintain a Healthy Weight (cont’d)
  49. 49. • Weight loss: – Reduces risk for cardiovascular disease – Lowers blood pressure – Lowers blood sugar – Improves lipid levels Source: Office of Surgeon General. http://www.surgeongeneral.gov/topics/obesity/calltoaction/1_6.htm. Benefits of Weight Loss (cont’d)
  50. 50. ACSM and AHA Recommendations: • Do moderately intense cardio 30 minutes/day, 5 days/week OR • Do vigorously intense cardio 20 minutes/day, 3 days/week AND • Do 8 to 10 strength-training exercises, 8 to 12 repetitions of each exercise, twice/week ACSM=American College of Sports Medicine, AHA=American Heart Association Step 3: Stay Physically Active
  51. 51. Staying physically active can reduce your: • Blood pressure • Cigarette smoking • Diabetes • Extra body weight in the overweight/obese • Triglyceride level Step 3: Stay Physically Active (cont’d)
  52. 52. The FITT formula: • F=frequency (days/week) • I=intensity (how hard—easy, moderate) • T=time • T=type Step 3: Stay Physically Active (cont’d)
  53. 53. Manage Stress
  54. 54. • If left unmanaged, stress can cause emotional, psychological, and physical problems (heart disease, high blood pressure, chest pain, and irregular heart beat) • Stress also may cause you to overeat, exercise less, and possibly smoke more • You can think yourself into clinical depression Step 4: Manage Stress
  55. 55. Stress Warning Signs
  56. 56. • Identify the stressor first • Avoid hassles and minor irritation, if possible • Try to continue doing the things that you enjoyed before the change that caused stress occurred in your life • Learn how to manage your time efficiently • Do one thing at a time • Learn to take a break • Ask for help when you need it Tips to Reduce Stress
  57. 57. • If you do smoke, stop • Support is available: – 800-ACS-2345 (American Cancer Society) – 800-QUIT-NOW (US Dept of Health and Human Services) or http://1800quitnow.cancer.gov – 877-448-7848 (National Cancer Institute) or www.cancer.gov/cancertopics/smoking Step 5: Do Not Smoke
  58. 58. • But I heard alcohol is good for the heart! – Doctors do not recommend it • Moderate drinking is defined as: – No more than one drink/day for women – No more than two drinks/day for men • Drinking more than three drinks/day has a detrimental effect on the heart Step 6: Do Not Drink Alcohol Excessively
  59. 59. • One drink is equal to: – 12 fluid ounces (fl oz) of beer or wine cooler – 5 fl oz of wine – 1.5 fl oz of 80-proof liquor Step 6: Do Not Drink Alcohol Excessively (cont’d)
  60. 60. Who Benefits From Eating Heart Healthy?
  61. 61. The Entire Family! Step 7: Eat Heart Healthy
  62. 62. • Learn to read food labels Knowledge is power! What should I look for? Step 7: Eat Heart Healthy (cont’d)
  63. 63. Start Here Limit These Nutrients Get Enough of These Nutrients % DV=Percent Daily Value
  64. 64. • Reduce your calories if you are overweight and want to lose weight: – Calories are the energy in food that contribute to weight loss and weight gain – 1 pound of fat=3500 calories Why Reduce Calories?
  65. 65. • Eat breakfast • Keep regular mealtimes • Look for lower-fat alternatives • Drink enough fluids (water) • Focus on fruits and vegetables • Choose lean meats and skim dairy products • Limit extra sugars to 40 grams (g)/day or 10 teaspoons (tsp)/day • Eat slowly • Practice potion control Ways to Reduce Calories
  66. 66. How can You Stop CVD? Diet and Nutrition, there are several guidelines listed by the American Heart Association: • Eat a variety of fruits and vegetables every day. ( 5 servings - they are naturally low in fat and high in vitamins and minerals) • Eat a variety of grain products ( 6 a day)
  67. 67. Diet and Prevention of CVD • Choose nonfat or low-fat products. • Use lean meats- choose chicken, fish, turkey and lean cuts of beef and pork. • Switch to fat-free milk- gradually reduce the fat content of the milk you drink.
  68. 68. Dietary Guidelines • Choose fats with 2 gms or less of saturated fats per serving such as liquid and tub margarines, canola oil and olive oil. • Balance the # of calories you eat with the number of calories you use each day. • Maintain a level of physical activity that keeps you fit and matches the # of calories you eat.
  69. 69. Dietary Guidelines • Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks and candy. • Limit foods high in saturated fat, trans fat and cholesterol • Eat less than 6 gms of salt a day • Have no more than one alcoholic drink a day.
  70. 70. Step I and II Diets • The AHA and NCEP have developed these diets to treat high blood pressure and hypercholesterolemia • They are designed to lower LDL levels, while at the same time promoting good nutrition.
  71. 71. Step I Step II • Total fat- 30% or less • Sat fat- 7-10% • Poly - up to 10% • Mono Up to 15% • Carb 55% or more • Pro Approx 15% • Chol. less than 300mg • 30% or less • 7% • up to 10% • up to 15% • 55% or more • Approx 15% • less than 200 mg
  72. 72. Exercise and CVD • Serves several functions in preventing and treating those at high risk. • Reduces incidence of obesity. • Increases HDL • Lowers LDL and total cholesterol • Helps control diabetes and hypertension • Those at high risk should take part in a specially supervised program.
  73. 73. other Weapons Against Heart Disease • Techniques for diagnosing heart disease – Electrocardiogram (ECG) – Angiography – Positron emission tomography (PET) – Single positron emission color tomography (SPECT) – Radionuclide imaging – Magnetic resonance imaging (MRI) – Ultrafast CT – Digital cardiac angiography (DSA)
  74. 74. Angioplasty Versus Bypass Surgery • Angioplasty – a thin catheter is threaded through the blocked arteries. The catheter has a balloon on the tip which is inflated to flatten the fatty deposits against the wall of the artery • Coronary bypass surgery – a blood vessel is taken from another site and implanted to bypass blocked arteries and transport blood
  75. 75. Thrombolysis • If victim reaches an emergency room and is diagnosed quickly, thrombolysis can be performed • Thrombolysis involves injecting an agent such as tissue plasminogen activator (TPA) to dissolve the clot and restore some blood flow
  76. 76. Cardiac Rehabilitation • Every year, 1 million people survive heart attacks • Cardiac rehabilitation exercise training increases stamina and strength, and promotes recovery
  77. 77. Los Angeles VA study • 846 men in Veterans Home, 5-8 years • Groups randomized to diets in which 2/3 of fat given either as vegetable oil (corn, cottonseed, safflower, soybean) or animal fat • Saturated fat 11% vs. 18%, polyunsaturated fat 16% vs. 5% of calories • 31% decrease in CVD endpoints Dayton et al. Circulation 1969; 40:1.
  78. 78. Lyon Diet Heart study • 302 men and women with CHD • Treatment group randomized to low saturated fat, high canola oil margarine (5% alpha linolenic, 16% linoleic, and 48% oleic acid, also 5% trans) • 46 month follow-up • 65% lower CHD death rate in treatment group (6 vs. 19 death) de Lorgeril et al. Circulation 1999; 99:779-785.
  79. 79. Benefits of fish oil supplementation • In the Diet and Reinfarction Trial (DART) in 2033 men with CHD increased intake of fish or use of 2 fish oil caps/day reduced CHD mortality 29% over 2 years • In GISSI 11324 men and woman with CHD use of 1 gr. of n-3 PUFA decreased CVD events including mortality 15% Lancet 1989; 2;757-761, and 1999; 345:447-455.
  80. 80. Nuts, Soy, Phytosterols, Garlic • Nurses’ Health Study: five 1oz servings of nuts per week associated with 40% lower risk of CHD events • Metaanalysis of 38 trials of soy protein showed 47g intake lowered total, LDL-C, and trigs 9%, 13%, and 11% • Phytosterol-supplemented foods (e.g., stanol ester margarine) lowers LDL-C avg. 10% • Meta-analysis of garlic studies showed 9% total cholesterol reduction (1/2-1 clove daily for 6 months).
  81. 81. Conclusion • Cardiovascular disease is the number one killer. • It is highly preventable and controllable with diet and exercise.

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