Coronary Heart Disease and Hypertension

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Coronary Heart DiseaseandHypertension

• Chapter 19

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Coronary Heart Disease and Hypertension

• CV disease is the 1 cause of death in the U.S.
• Well look at the primary underlying disease
  process, atherosclerosis, and the various risk
  factors involved
• Well explore ways to use nutritional approaches
  to reduce these risk factors and help prevent
  disease

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Coronary Heart Disease and Hypertension

• Key Concepts
• Several risk factors contribute to the
  development of cardiovascular disease and HTN,
  many of which are preventable by improved food
  habits and lifestyle behaviors
• Other risk factors are non- modifiable such as
  age, gender, family hx. and race
• HTN maybe classified as essential (primary) or
  secondary HTN
• Early education is critical for the prevention of
  cardiovascular disease.

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Coronary Heart Disease

• Atherosclerosis
• Acute cardiovascular disease
• Chronic heart disease

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Atherosclerosis

• Disease process
• Fatty fibrous plaques develop into fatty streaks
  on inside lining of major blood vessels.
• Process may begin in childhood
• fatty streaks, largely composed of cholesterol
• Gk. Athera gruel Sclera hardening
• The fatty fibrous process thickens over time,
  narrowing the interior part of the blood vessel ?
  impeding or cutting off blood flow to cells
  beyond the blockage

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Atherosclerosis

• Cells die when deprived of their normal blood
  supply.
• The local area of dying or dead tissue is called
  and infarct.
• If affected vessel is major artery supplying
  heart muscle, result could be myocardial
  infarction (heart attack).
• If affected vessel is major artery supplying
  brain, result could be cerebrovascular accident.

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Atherosclerotic Plaque in Artery
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Normal Human Heart Posterior External View
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Atherosclerosis

• The major arteries and their branches serving the
  heart are called coronary arteries
• The overall disease process is coronary heart
  disease
• Common symptom angina pectoris or chest pain,
  usually radiating down the arm

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Relation to Fat Metabolism

• Elevated blood lipids associated with coronary
  heart disease
• Triglyceridessimple fats in body or food
• Cholesterolfat-related compound produced in
  body also in foods from animals
• Lipoproteinspackages wrapped with protein that
  carry fat in the blood stream

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Relation to Fat Metabolism

• Lipoproteins are grouped and named according to
  their protein, fat, and cholesterol content (e.g.
  density those with higher protein content have
  higher density

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Types of Lipoproteins

• 3 of these types of lipoprotein found in the
  liver are significant in relation to heart
  disease risk
• Very low-density lipoproteins (VLDL)
• Carry large load of triglycerides to cells
• Include approx. 12 cholesterol
• Low-density lipoproteins (LDL)
• Carry two thirds of total plasma cholesterol to
  body tissues ? constantly send cholesterol to
  tissues ? bad cholesterol

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Types of Lipoproteins

• High-density lipoproteins (HDL)
• Carry less total fat and more protein
• Not found in foods produced in the liver. Takes
  cholesterol from tissues to liver for breakdown
  and elimination

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Risk Factors

• Sex CVD occurs more often in men than women
  until menopause, at which time the relative risks
  are the same
• Age general risk increases with age (men gt 45
  years and women gt 55 years)

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Risk Factors

• Heredity ethnic groups that have a higher
  incidence of risk factors and CVD including
  familial hypercholesterolemia and familial
  hypertryglyceridemia.
• Ethnic groups include African Americans,
  Hispanics, Native Americans

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Risk Factors

• Elevated serum cholesterol major risk factor
  especially when combined with obesity, lack of
  exercise, stress, smoking, and increased food
  intake
• Compounding diseases diabetes, hypertension,
  metabolic syndrome
• Dietary fat affects serum cholesterol

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National Cholesterol Education Program (NCEP)
Guidelines

• Therapeutic Lifestyle Changes approach
• Total energy intake energy expenditure
• Total fat should not exceed 25-35 of diet
• Avoid trans fatty acids
• CHO mainly from complex CHOs

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National Cholesterol Education Program (NCEP)
Guidelines

• Total protein from sources other than animals
  should be included
• Total cholesterol intake lt 200mg/day
• Exercise to expend at least 200 kcals/day

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Drug Therapy

• In the event that LDL cholesterol is above goal
  range, drug therapy may be added to diet therapy
  depending on the level of risk

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Acute Cardiovascular Disease

• May be associated with MI
• When CV disease progresses to the point of
  cutting off the blood supply to major coronary
  arteries, a critical vascular event heart
  attack/MI- may occur.
• After an infarction, enzymes and proteins are
  released from the damaged heart muscle cardiac
  markers
• can be measured in blood tests CPK,
• TROPONIN is heart muscle- specific

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Acute Cardiovascular Disease

• Initial phase Objective cardiac rest
• Immediate care includes analgesics and
  supplemental oxygen
• All care, including diet, is directed toward
  ensuring that the heart rests so that the damaged
  heart can be restored to normal functioning

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Acute Cardiovascular Disease

• Principles of diet therapy
• Reduced energy intake (1200-1500 kcal) a brief
  period of reduced energy intake during the first
  day or so after the heart attack reduces the
  metabolic workload on the damaged heart.
• Soft food texture easily digested to avoid
  excess effort in eating or the discomfort of gas
  formation
• Controlled amount and type of fat
• Mild sodium restriction (2-3 g/day)

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Chronic Heart Disease

• CHF and pulmonary edema
• The progressively weakened heart muscle is unable
  to maintain an adequate cardiac output to sustain
  normal circulation ? fluid imbalance? pulmonary
  edema.

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Chronic Heart Disease

• Objective control of pulmonary edema and
  resulting fluid imbalance
• Mild-severe sodium restriction
• Fluid restriction often limited to 1500 ml.
  /day
• Texture soft foods
• Small meals
• Alcohol limited or avoided

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Essential Hypertension

• Hypertension called the silent disease
• Essential HTN specific cause is unknown
• Secondary HTN HTN is a symptom or side effect
  of another primary condition
• Risk Factors
• Highly inherited disorder
• Obesity worsens
• Can begin in adolescent years
• Made worse by physical inactivity, stress,
  alcohol and drug use, and salt intake.

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Types of Hypertensive Blood Pressure Levels

• Adult normal BP 120/80 or below
• Stage 1 hypertension
• Focus on diet therapy, without drugs
• Reduce excess weight and restrict sodium
• Stage 2 hypertension
• Diet therapy and drugs, as needed
• Use of diuretic and potassium replacement
• Stage 3 hypertension
• Diet therapy and vigorous drug therapy

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Principles of Medical Nutrition Therapy

• Weight managementlose weight and maintain
  appropriate weight for height
• Increase Physical activity
• Sodium control
• Other mineralscalcium, magnesium may be
  beneficial

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Principles of Medical Nutrition Therapy

• DASH diet Dietary Approaches to Stop
  Hypertension
• 4-6 servings fruit
• 4-6 veggie
• 2-3 low-fat dairy
• Lean meats
• High-fiber grains
• 14 days to lower B/P

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Education and Prevention Practical Food Guides

• Food planning and purchasing
• Control energy intake read labels
• Eat fresh foods with small selection of processed
  foods, if any

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Education and Prevention Practical Food Guides

• Food preparation
• Use less salt and fat
• Use seasonings instead (herbs, spices, lemon,
  onion, garlic, etc.)
• Take time to cook
• Special needs individual adaptation of diet
  principles according to preferences, ethnic
  diets, and food habits

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Education Principles

• Start early
• Prevention begins in childhood, especially with
  children in high-risk families
• Focus on high-risk groups
• Direct education to people and families with risk
  of heart disease and hypertension

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Education Principles

• Use variety of resources
• National organizations, community programs,
  registered dieticians