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What causes heart disease? Two major conditions contribute Atherosclerosis it involves deposits of fatty substances cholesterol, cellular waste and calcium in the lining of an artery. It starts due to elevated levels of cholesterol, high blood pressure, and tobacco smoke.
This is a normal artery where blood can flow easily.
Once the inner wall of an artery is damaged, blood cells called platelets often clump at the injury site to try to repair the artery, leading to inflammation. Over time, fatty deposits (plaque) made of cholesterol and other cellular waste products also accumulate at the injury and harden, narrowing your arteries. The organs and tissues connected to the blocked arteries then do not receive enough blood to function properly.
Eventually, pieces of the fatty deposits may rupture and enter your bloodstream. This can cause a blood clot to form and damage your organs, such as in a heart attack. A blood clot also can travel to other parts of your body and partially or totally block blood flow to another organ.
Atherosclerosis occurs when plaque builds up inside the arteries. Arteries are the blood vessels that carry oxygen-rich blood throughout your body. Atherosclerosis can affect any artery in the body. When it occurs in the arteries that supply blood to the heart, it is called coronary artery disease.
Here is one form of a stroke where you see the buildup of atherosclerosis.
Here is a heart attack, where you also can see atherosclerosis in the coronary artery, which supplies blood to the heart.
Congestive Heart Failure affects people of all ages from children to senior citizens, there is no cure. The heart has been weakened by an underlying problem. Clogged arteries, high blood pressure, a defect or some other medical condition. It does not mean the heart has failed, simply means the heart is not doing an efficient job.
Unchangeable Risk Factors: Age, the older you get the greater the chance of heart disease. Four out of five people who die of congestive heart disease are 65 years of age or older. Sex, males have a greater rate of congestive heart disease. Race, minorities have a greater chance of heart disease. African Americans have a greater chance of high blood pressure. The risk is also higher in Mexican Americans, America Indians, native Hawaiians and Asian Americans. Also included as unchangeable risk factors is your family history and your own personal medical history.
Hypertension Serum Cholesterol: As cholesterol rises so does the risk of congestive heart disease, and obesity. It is unhealthy because excess weight puts more strain on your heart. It can raise blood pressure and blood cholesterol and lead to diabetes. Diabetes Mellitus, Physical Inactivity, and Cigarette Smoking along with Alcohol intake are the other changeable risk factors. A smoker’s risk of a heart attack is more than twice that of a non-smoker.
Cholesterol is a soft waxy substance found among the lipids in the bloodstream and in all of your body’s cells. 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. We get cholesterol from two ways. Our bodies make it and the rest comes from animal products we eat. It is frequently measured to promote health and prevent disease. Desirable levels of total cholesterol levels should be at 200 or less. 240 is considered high but it will depend on the HDL and LDL levels if at this level there is a risk to your health. It is a major component of the plaque that clogs arteries. Cholesterol and other fats can’t dissolve in the blood. They have to be transported to and from cells by special carriers called lipoproteins.
HDL or high density lipoprotein is know as the good cholesterol, it helps to bind to some of the bad cholesterol and carry it out of the body. It does not have the tendency to clog arteries. The target level is greater than 35mg/dl. High levels of >60 can actually negate one other risk factor. Studies suggest that high levels of HDL cholesterol reduce your risk of a heart attack.
The Facts About Fat – Certain fats are essential for good nutrition and health. Fats provided essential fatty acids which the body can’t manufacture, they act as insulators to maintain body temperature and they improve the palatability of food and promote digestion. Knowing which fats raise LDL cholesterol and which ones don’t is very important. Saturated fat, trans fatty acids, and dietary cholesterol raise blood cholesterol. Some studies suggest that using monounsaturated and polyunsaturated may lower cholesterol levels slightly.
Saturated fats can cause an increase in cholesterol. What is saturated fat? It is fat that is saturated with hydrogen and is a solid at room temperature. Examples are lard and butter. Saturated fats increase levels of LDL, decrease levels of HDL and increases total cholesterol. The American Heart Association recommends you limit saturated fat intake to 7-10% of your total calories.
Monounsaturated fat includes canola, olive and peanut oils and avocados.
Trans fatty acids have hydrogen added to them to give them a longer shelf life and they also tend to lower HDL levels.
The American Heart Association recommends eating fish two times per week. Mention other fish that contain Omega 3 fatting acids. Omega 3 fatty acids are available as a supplement but research is till being done to determine the supplements’ effectiveness.
People who are obese have 2 to 6 times the risk of developing hypertension even if they have no other risk factors.
About 2/3 of the people with diabetes die of some type of heart or blood vessel disease.
Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure.
Alcohol Consumption: In small amounts alcohol acts as a vasodilator, this is good and usually occurs in 1-2 drinks. In large amounts it acts as a vasoconstrictor which is bad. The range this occurs is 3-4 drinks. This is a very fine line. Other risk factors that may contribute to a higher risk of heart disease is an individual’s response to stress, sex hormones, and the loss of natural estrogen as women age.
Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood out into the arteries. A blood pressure chart is available at www.nhlbi.nih.gov/hbp/detect/categ.htm.
High blood pressure makes your heart work harder than normal and makes the arteries more prone to injuries—walls become harder and less elastic over time, which can narrow arteries and make it harder to get blood to your body’s organs. Think of it like a callus on your finger. How many of you have had a callus from pushing too hard when writing with a pencil? Over time, you develop harder skin, right? Artery walls are the same. High blood pressure, over time, causes them to become hard, and when they are hard, fatty deposits, and other things such as blood clots get stuck easier.
Note to presenter: Define BMI.
Look at the health benefits of losing just 5%-10% of your body weight!
Moderate-intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still having the ability to carry on a conversation. You may need to commit to 60 to 90 minutes of physical activity daily in order to lose weight or maintain weight loss. The 30-minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease.
You can accumulate physical activity by doing three 10-minute sessions or two 15-minute sessions.
High blood pressure: Regular aerobic activities can lower blood pressure. Cigarette smoking: Smokers who become physically active are more likely to cut down or stop smoking. Diabetes: People at their ideal weight are less likely to develop diabetes. Physical activity also may decrease insulin requirements for people with diabetes. Obesity and overweight: Regular physical activity can help people lose excess fat or stay at a reasonable weight. High levels of triglycerides: Physical activity helps reduce triglyceride levels. High triglycerides are linked to developing coronary artery disease in some people.
Physical ActivityAHA Scientific Position: Physical inactivity is a major risk factor for developing coronary artery disease. Coronary artery disease is characterized by deposits of fatty substances, cholesterol, calcium, and other substances in the inner lining of arteries that supply blood to the heart muscle. It also contributes to other risk factors, including obesity, high blood pressure, high triglycerides, a low level of HDL (“good”) cholesterol, and diabetes. Even moderately intense physical activity, such as brisk walking, is beneficial when done regularly for a total of 30 minutes or longer on most or all days.
Why is exercise or physical activity important? Regular aerobic physical activity increases your fitness level and capacity for exercise. It also plays a role in both primary and secondary prevention of cardiovascular disease. Physical inactivity is a major risk factor for heart disease and stroke, and is linked to cardiovascular mortality.
Regular physical activity can help control blood lipid abnormalities, diabetes, and obesity. Aerobic physical activity also can help reduce blood pressure.
Studies show that people who modify their behavior and start regular physical activity after a heart attack have better rates of survival and better quality of life. Healthy people, as well as many patients with cardiovascular disease, can improve their fitness and exercise performance with training.
How can physical activity help condition my body? Some activities improve flexibility, some build muscular strength, and some increase endurance. Some forms of continuous activities involve using the large muscles in your arms or legs. These are called endurance or aerobic exercises. They help the heart by making it work more efficiently during exercise and at rest. Brisk walking, jumping rope, jogging, bicycling, cross-country skiing, and dancing are examples of aerobic activities that increase endurance.
Could you imagine if this was your house? Wow, a stressful situation, right?
If you do smoke, stop.
Support is available: 1-800-ACS-2345 (The American Cancer Society), also available at: http://www.cancer.org/docroot/ESN/content/ESN_3_1X_ACS_National_Cancer_Information_Center.asp.
1-800-QUIT-NOW (US Dept of Health and Human Services), also available at: http://1800quitnow.cancer.gov/.
1-877-44U-QUIT (1-877-448-7848) (National Cancer Institute), also available at: www.cancer.gov/cancertopics/smoking.
Drinking more than three drinks a day has a direct toxic effect on the heart. Heavy drinking, particularly over time, can damage the heart and lead to high blood pressure, alcoholic cardiomyopathy (enlarged and weakened heart), congestive heart failure, and stroke. Heavy drinking puts more fat into the circulation in your body, raising your triglyceride level. That is why doctors will tell you, “If you don’t drink, don’t start.” You can find other healthier ways to reduce your risk of heart disease, such as eating right, getting regular exercise, and maintaining a healthy weight.
Heart-healthy eating is not a diet. It is a way of eating and is appropriate for anyone older than 2 years of age.
Children learn food habits when they are young. It is a good idea to start early in developing a heart-healthy lifestyle. Remember, it has taken you a lifetime to develop your eating habits, so make changes slowly. Do not expect to make a complete change overnight. Focus on one major change per month. It will lead to a heart-healthy diet low in fat and cholesterol. If you are a positive role model and make eating healthy and fun, then children can adopt a healthy lifestyle for the rest of their life.
Extra sugars do not occur naturally in foods (milk and fruit). Extra sugars are found in cereals, sweetened drinks, etc.
How can you stop cardiovascular disease? The heart healthy diet is designed to decrease sodium, saturated fat, including trans fatty acids which are all closely linked to high blood cholesterol and an increased risk of heart disease. It also encourages the increased intake of monounsaturated fat, Omega 3 fatty acids and soluble fiber which helps to lower blood cholesterol levels and reduce the risk of heart disease.
The American Heart Association and the National Cholesterol Education Program have developed these diets to treat high blood pressure and hypercholesterolemia. The main goal is to lower LDL levels to reduce the risk of cardiovascular heart disease. These guidelines help patients reduce saturated fat and cholesterol in their diets. The difference between Step 1 and 2 is that Step 1 is carried out in a medical setting. Step 1 is the starting point.
• Can Anyone Tell Me the Difference
Between a Heart Attack and a
Stroke vs Heart Attack
• Stroke—blocked blood flow to the brain
• Heart attack—blocked blood flow to the
• Risk factors are the same for both
What is Heart Disease?
• A general term that covers a number of
diseases which affect the heart, including
coronary artery disease, heart-failure and
• Heart Disease is the number one killer in the
What Causes Heart Disease?
• Atherosclerosis-fatty deposits of cholesterol
• Arteries—blood vessels that carry blood away
from the heart to the rest of the body
What Causes Heart
Plaque Starts to Build Up
Tear in Artery
Plaque Can Grow and
Harden and Obstruct
Tear in Artery
• 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
• Plaque – the buildup of deposits in the
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!
• Symptoms: uncomfortable pressure, fullness,
squeezing pain, pain spreading to the
shoulders, neck and arms.
• Chest discomfort and light headedness
• Paleness or pallor
• Increased irregular heart rate
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
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.
• Ischemia – reduction of the heart’s blood and
• The more serious the oxygen deprivation the
more severe the pain
• Nitroglycerin – drug used to relax (dilate) the
• Beta blockers control potential overactivity of
the heart muscle
• 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
Congenital And Rheumatic Heart
• Congenital heart disease affects 1 out of 125
• May be due to hereditary factors, maternal
diseases, or chemical intake (alcohol) during
• Rheumatic heart disease results from
rheumatic fever which affects connective
Unchangeable Risk Factors
• Age- the older you get, the greater the
• 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.
Unchangeable Risk Factors
• Personal Medical History- other diseases such
as Diabetes Mellitus can increase chances.
• 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
• Frequently measured to promote health and
• A major component of the plaque that clogs
Types of Cholesterol
Lipoproteins- 4 main classes
• Very low density lipoproteins (VLDL)
• Low Density Lipoprotein (LDL)
• High Density Lipoprotein (HDL)
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
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.
The Facts About Fat
• Certain fats are essential for good nutrition
• Fats provide essential fatty acids which the
body can’t manufacture.
• Act as insulators to maintain body
• Improve the palatability of food and promote
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.
The Skinny on Fat
• Saturated fats- basically means the fat is
saturated with hydrogen, they are solid at
room temperature. Examples are lard and
• Why are they bad for you? They increase
levels of LDL , decrease HDL and increase total
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
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
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.
What about Omega 3?
• Type of polyunsaturated fat.
• Consistently lowers serum triglycerides and
may also have an effect on lowering blood
• Found in oily fish such as salmon, tuna, and
• Is available as a supplement.
Associations between the percent of calories
derived from specific foods and CHD mortality in
the 20 Countries Study*
All dairy products 0.619
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.
• People who are obese have 2 to 6 times the
risk of developing hypertension.
• Location of the body fat is significant.
• Pears of apples?
• 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.
• 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
• 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
• 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!
Women And Cardiovascular Disease
• 2003, CVD deaths
– 426,800 men
– 483,800 women
– Once estrogen production stops, risk for CVD death
• 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
1. Know your numbers:
– Cholesterol (LDL=lousy, HDL=healthy)
– 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
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
Knowledge Is Power, So Learn and Live!
Step 1: Know Your Numbers
• 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
Body Mass Index (BMI)
Normal Weight 18.5-24.9
Step 2: Maintain a
Healthy Weight (cont’d)
• Weight loss:
– Reduces risk for cardiovascular disease
– Lowers blood pressure
– Lowers blood sugar
– Improves lipid levels
Source: Office of Surgeon General.
Benefits of Weight Loss
ACSM and AHA Recommendations:
• Do moderately intense cardio
30 minutes/day, 5 days/week
• Do vigorously intense cardio
20 minutes/day, 3 days/week
• Do 8 to 10 strength-training exercises,
8 to 12 repetitions of each exercise,
ACSM=American College of Sports Medicine, AHA=American Heart Association
Step 3: Stay Physically Active
Staying physically active can reduce your:
• Blood pressure
• Cigarette smoking
• Extra body weight in the overweight/obese
• Triglyceride level
Step 3: Stay Physically
• If left unmanaged, stress can cause
emotional, psychological, and physical
problems (heart disease, high blood
pressure, chest pain, and irregular heart
• Stress also may cause you to overeat,
exercise less, and possibly smoke more
• You can think yourself into clinical
Step 4: Manage Stress
• Identify the stressor first
• Avoid hassles and minor irritation, if
• 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
• 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
Step 5: Do Not Smoke
• 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
• 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
• Learn to read food labels
Knowledge is power!
What should I look for?
Step 7: Eat Heart
% 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 weight loss and weight gain
– 1 pound of fat=3500 calories
Why Reduce Calories?
• 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
How can You Stop CVD?
Diet and Nutrition, there are several
guidelines listed by the American Heart
• 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)
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.
• 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.
• 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
• Eat less than 6 gms of salt a day
• Have no more than one alcoholic drink a day.
Step I and II Diets
• The AHA and NCEP have developed these
diets to treat high blood pressure and
• They are designed to lower LDL levels, while at
the same time promoting good nutrition.
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
• up to 10%
• up to 15%
• 55% or more
• Approx 15%
• less than 200 mg
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.
other Weapons Against Heart Disease
• Techniques for diagnosing heart disease
– Electrocardiogram (ECG)
– Positron emission tomography (PET)
– Single positron emission color tomography
– Radionuclide imaging
– Magnetic resonance imaging (MRI)
– Ultrafast CT
– Digital cardiac angiography (DSA)
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
• Coronary bypass surgery – a blood vessel is
taken from another site and implanted to
bypass blocked arteries and transport blood
• If victim reaches an emergency room and is
diagnosed quickly, thrombolysis can be
• Thrombolysis involves injecting an agent such
as tissue plasminogen activator (TPA) to
dissolve the clot and restore some blood flow
• Every year, 1 million people survive heart
• Cardiac rehabilitation exercise training
increases stamina and strength, and promotes
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.
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
• 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.
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.
Nuts, Soy, Phytosterols, Garlic
• Nurses’ Health Study: five 1oz servings of nuts
per week associated with 40% lower risk of CHD
• 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
• Cardiovascular disease is the number one
• It is highly preventable and controllable with
diet and exercise.