Nutrition and Nutrition and Cardiovascular Cardiovascular DiseaseDisease

Cardiovascular DiseaseCardiovascular Disease

Includes heart attack, strokeIncludes heart attack, stroke Leading cause of death in the Leading cause of death in the

U.S.U.S. Annually, 500,000 people die of Annually, 500,000 people die of

CHD in the U.S. (1 million CHD in the U.S. (1 million including strokes and other CVD)including strokes and other CVD)

Each year, 1.5 million Americans Each year, 1.5 million Americans have a heart attack have a heart attack

CVD Deaths by StateCVD Deaths by State

Heart Attack Heart Attack (Myocardial Infarction)(Myocardial Infarction)

Heart Attack Heart Attack (Myocardial Infarction)(Myocardial Infarction) When blood supply to the heart is When blood supply to the heart is

disrupted, the heart is damageddisrupted, the heart is damaged May cause the heart to beat May cause the heart to beat

irregularly or stop altogetherirregularly or stop altogether 25% of people do not survive 25% of people do not survive

their first heart attacktheir first heart attack

Symptoms of a Heart Symptoms of a Heart AttackAttack Intense, prolonged chest pain Intense, prolonged chest pain

or pressureor pressure Shortness of breathShortness of breath SweatingSweating Nausea and vomiting Nausea and vomiting

(especially women)(especially women) Dizziness (especially women)Dizziness (especially women) WeaknessWeakness Jaw, neck and shoulder pain Jaw, neck and shoulder pain

(especially women)(especially women) Irregular heartbeatIrregular heartbeat

Cerebrovascular Cerebrovascular Accident (CVA) or Accident (CVA) or Brain AttackBrain Attack

Brain Attack (Stroke) Brain Attack (Stroke) or Cerebrovascular or Cerebrovascular Accident Accident

Symptoms of Stroke Symptoms of Stroke (Brain Attack)(Brain Attack) Sudden numbness or weakness of the Sudden numbness or weakness of the

face, arm or leg, especially on one side face, arm or leg, especially on one side of the body of the body

Sudden confusion, trouble speaking or Sudden confusion, trouble speaking or understanding understanding

Sudden trouble seeing in one or both Sudden trouble seeing in one or both eyes eyes

Sudden trouble walking, dizziness, loss Sudden trouble walking, dizziness, loss of balance or coordination of balance or coordination

Sudden severe headacheSudden severe headache

Blood Lipid Levels are Blood Lipid Levels are Related to Risk of CVDRelated to Risk of CVD

Blood Lipids Blood Lipids (Lipoproteins)(Lipoproteins) Lipids (fat) cannot mix with waterLipids (fat) cannot mix with water Blood is high in waterBlood is high in water Lipids cannot travel in blood Lipids cannot travel in blood

without helpwithout help Lipoproteins are formed to carry Lipoproteins are formed to carry

lipidslipids

Lipoproteins combineLipoproteins combine

Lipids (triglycerides, Lipids (triglycerides, cholesterol)cholesterol)

ProteinProtein PhospholipidsPhospholipids

Low-Density Low-Density Lipoproteins (LDL-C)Lipoproteins (LDL-C) Also called “bad cholesterol)Also called “bad cholesterol) Contain relatively large amounts Contain relatively large amounts

of fat, and less proteinof fat, and less protein Deposits cholesterol in arteriesDeposits cholesterol in arteries Thus, Thus, ↑ ↑ LDL-C is associated with LDL-C is associated with ↑ ↑

CVD riskCVD risk Serum LDL-C should be < 130 mg/dLSerum LDL-C should be < 130 mg/dL

High-Density High-Density Lipoproteins (HDL)Lipoproteins (HDL) Also called “good cholesterol”Also called “good cholesterol” Relatively high in protein, lower in lipidRelatively high in protein, lower in lipid Acts as scavenger, carrying cholesterol Acts as scavenger, carrying cholesterol

from arteries to liverfrom arteries to liver– Liver packages as bileLiver packages as bile– ExcretesExcretes

↑ ↑ HDL-CHDL-C is ais associated with ssociated with ↓ ↓ risk of CVDrisk of CVD Serum HDL-C should be >60 mg/dL Serum HDL-C should be >60 mg/dL

(optimal) or at least >40 in men and (optimal) or at least >40 in men and 50 in women50 in women

TriglyceridesTriglycerides

The most diet-responsive blood The most diet-responsive blood lipidlipid

Should be Should be ≤150 mg/dL in ≤150 mg/dL in fasting statefasting state

Total CholesterolTotal Cholesterol

Includes HDL-C, LDL-C, and a Includes HDL-C, LDL-C, and a fraction of the triglyceridesfraction of the triglycerides

Total cholesterol should be ≤ 200 Total cholesterol should be ≤ 200 mg/dLmg/dL

Total cholesterol does not tell Total cholesterol does not tell whole storywhole story

Lipoprotein SummaryLipoprotein Summary

Evaluating Blood Evaluating Blood Lipids: LDLLipids: LDL

<100 mg/dL<100 mg/dL OptimalOptimal

100-129100-129 Near optimalNear optimal

130-159130-159 Borderline highBorderline high

160-189160-189 HighHigh

≥≥190190 Very highVery high

Source: ATP-III Guidelines, NHLBI, accessed 2-2005

Evaluating Blood Evaluating Blood Lipids: Total Lipids: Total CholesterolCholesterol<200 mg/dL<200 mg/dL DesirableDesirable

200-239 200-239 mg/dLmg/dL

Borderline highBorderline high

≥≥240 mg/dL240 mg/dL HighHigh

Source: ATP-III Guidelines, NHLBI, accessed 2-2005

Evaluating Blood Evaluating Blood Lipids: HDLLipids: HDL

< 40 mg/dL< 40 mg/dL LowLow

≥ ≥ 60 mg/dL60 mg/dL HighHigh

Source: ATP-III Guidelines, NHLBI, accessed 2-2005

Blood PressureBlood Pressure

Measured in mmHgMeasured in mmHg Systolic blood pressure: the pressure Systolic blood pressure: the pressure

in the arterial blood vessels in the arterial blood vessels associated with the pumping of the associated with the pumping of the heartheart

Diastolic blood pressure: the pressure Diastolic blood pressure: the pressure in the arterial blood vessels when the in the arterial blood vessels when the heart is between beatsheart is between beats

Hypertension: EitherHypertension: Either

Systolic blood pressure > 140 Systolic blood pressure > 140 mmHgmmHg

Diastolic blood pressure > 90 Diastolic blood pressure > 90 mmHgmmHg

Risk Factors (other Risk Factors (other than LDL) for CVDthan LDL) for CVD Cigarette smokingCigarette smoking Hypertension (BP ≥140/90 mmHg or on Hypertension (BP ≥140/90 mmHg or on

anti-hypertensive txanti-hypertensive tx Low HDL-C* (<40 mg/dL)Low HDL-C* (<40 mg/dL) Family history of premature CHD in first Family history of premature CHD in first

degree relative (in male <55 years, in degree relative (in male <55 years, in female <65 years)female <65 years)

Age (men ≥45 years, women ≥55 years)Age (men ≥45 years, women ≥55 years)

*HDL-C ≥ 60 mg/dL counts as a negative risk *HDL-C ≥ 60 mg/dL counts as a negative risk factorfactor

Source: ATP-III Guidelines, NHLBI, accessed 2-2005

Risk Factors (other Risk Factors (other than LDL) for CVDthan LDL) for CVD Diabetes (considered equivalent Diabetes (considered equivalent

to a history of CHD)to a history of CHD) ObesityObesity InactivityInactivity

Source: ATP-III Guidelines, NHLBI, accessed 2-2005

Screening for CVD RiskScreening for CVD Risk

Everyone 20 and older should have Everyone 20 and older should have his cholesterol measured at least his cholesterol measured at least every 5 yearsevery 5 years

Lipoprotein profile: includes TC, Lipoprotein profile: includes TC, LDL-C HDL-C, and TGLDL-C HDL-C, and TG

At least should include TC and At least should include TC and HDL-CHDL-C

If TC> 200 mg/dL or HDL-C< 40 If TC> 200 mg/dL or HDL-C< 40 mg/dL, obtain full lipid profilemg/dL, obtain full lipid profile

Source: National Cholesterol Education Program, National Institutes of Health, accessed 2-05

Total CholesterolTotal Cholesterol

John and Marty John and Marty each have total each have total cholesterol levels cholesterol levels of 200 mg/dL.of 200 mg/dL.

Their health risk Their health risk is differentis different

Total Cholesterol is Total Cholesterol is Not EnoughNot Enough

John’s Lipid John’s Lipid ProfileProfile

TC: 200 mg/dLTC: 200 mg/dL LDL-C: 140 LDL-C: 140

mg/dLmg/dL HDL-C: 30 mg/dLHDL-C: 30 mg/dL TG: 150 mg/dLTG: 150 mg/dL

Marty’s Lipid Marty’s Lipid ProfileProfile

TC: 200 mg/dlTC: 200 mg/dl LDL-C: 95 mg/dLLDL-C: 95 mg/dL HDL-C: 75 mg/dLHDL-C: 75 mg/dL TG: 150 mg/dLTG: 150 mg/dL

What Affects What Affects Cholesterol Levels?Cholesterol Levels? DietDiet WeightWeight Physical activityPhysical activity Age and genderAge and gender HeredityHeredity

You control the first three!You control the first three!

Lowering LDLsLowering LDLs

See your doctor to assess for See your doctor to assess for other conditionsother conditions

Reduce dietary saturated fat, Reduce dietary saturated fat, trans fatty acids, and cholesteroltrans fatty acids, and cholesterol

Increase MUFA and PUFAIncrease MUFA and PUFA Increase dietary fiber (soluble)Increase dietary fiber (soluble)

Lowering Blood TGLowering Blood TG

Is the most diet-responsive blood Is the most diet-responsive blood lipidlipid

Avoid overeatingAvoid overeating Limit alcoholLimit alcohol Limit simple sugarsLimit simple sugars Small frequent mealsSmall frequent meals Include fish in the dietInclude fish in the diet

Raise the HDLRaise the HDL

Physical activityPhysical activity At least 45 min./day, 4 days a weekAt least 45 min./day, 4 days a week Avoid smokingAvoid smoking Eat regularly Eat regularly Eat less total fatEat less total fat Moderate intake of alcohol Moderate intake of alcohol

increases HDL increases HDL

Therapeutic Lifestyle Therapeutic Lifestyle Changes (TLC)Changes (TLC) TLC DietTLC Diet Physical activity (30 minutes on Physical activity (30 minutes on

most, if not all, days)most, if not all, days) Weight management: will help Weight management: will help

manage triglycerides, increase manage triglycerides, increase HDL, HDL,

DASH: Dietary DASH: Dietary Approaches to Stop Approaches to Stop HypertensionHypertension Eat foods that are low in fat, Eat foods that are low in fat,

saturated fat, and cholesterolsaturated fat, and cholesterol Eat more fruits, vegetables, whole Eat more fruits, vegetables, whole

grains, and lowfat dairy productsgrains, and lowfat dairy products Eat more poultry, fish, nuts, and Eat more poultry, fish, nuts, and

legumeslegumes Eat less red meat, fats, sweets, Eat less red meat, fats, sweets,

and sugared beveragesand sugared beverages Eat foods low in salt and sodiumEat foods low in salt and sodiumNHLBI. DASH Eating Plan, revised 2003. Accessed 2-2005