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Coronary Heart Disease and Hypertension

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Title: Coronary Heart Disease and Hypertension


1
Coronary Heart DiseaseandHypertension
  • Chapter 19

2
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

3
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.

4
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

7
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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11
Atherosclerotic Plaque in Artery
12
Normal Human Heart Posterior External View
13
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

14
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

15
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

16
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

17
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

18
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)

19
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

20
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

21
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

22
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

23
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

24
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

25
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

26
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)

27
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.

28
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

29
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.

30
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

31
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

32
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

33
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

34
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

35
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

36
Education Principles
  • Use variety of resources
  • National organizations, community programs,
    registered dieticians
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