Chapter 7 LIPIDS IN HEALTH & DISEASE Objectives Summarize the events that lead to the development of atherosclerosis Identify at least five risk factors that affect the initiation or progression of cardiovascular disease Describe the interrelationship between total cholesterol, low-density lipoproteins, high-density lipoproteins, and the risk of cardiovascular disease List the cluster of risk factors associated with metabolic syndrome Discuss the implications of and recommendations for the intake of saturated fatty acids, trans fatty acids, and unsaturated fatty acids in relation to cardiovascular disease Summarize the dietary strategies that reduce the risk of heart disease

Bogalusa Heart Study Dr. Berenson conducted study from 1978 to 1998 in rural Southern town 40% living below poverty Poverty linked to cardiovascular disease Physical and lifestyle attributes contribute to developing heart disease Heart disease begins in childhood Dr. Berenson obtained hearts (over 200 organs) from 1978 to 1998 from young people in Bogalusa from 2 to 39 years of age. It is one of the longest running heart studies, and the only biracial (black and white) heart study in the world. It has shown that heart disease begins in childhood and that there are certain risk factors that increase a person’s chance of developing problems.

Cardiovascular Disease (CVD) Leading cause of death in the United States

Development of Atherosclerosis Presence of low-density lipoproteins (LDL) and plaque

Risk Factors for Cardiovascular Disease Risk factors that cannot be modified Family history of heart disease Race Age Gender

Modifiable Risk Factors for Cardiovascular Disease Smoking Diet high in saturated and trans fats, cholesterol, sodium, and added sugar Sedentary lifestyle Obesity Diabetes Excessive alcohol consumption High blood pressure High blood lipid levels (cholesterol, LDL, and triglyceride)

Modifiable Risk Factors for Cardiovascular Disease

Lipoproteins and CVD

Metabolic Syndrome Having at least three of the following problems is diagnostic of metabolic syndrome: Excessive abdominal fat High blood pressure Elevated triglycerides in the blood Low levels of HDL Elevated blood glucose levels Metabolic syndrome is rising and raises the risk of cardiovascular disease and type 2 diabetes. It affects more than 50 million adults in the United States and approximately 25% of the adults worldwide.

Dietary Fat and CVD There is a complex relationship between dietary fat and heart disease, especially with saturated and trans fats

Heart Protective Diet Dietary Guidelines for Americans Saturated fat intake <10% of daily calories

Heart Protective Diet National Cholesterol Education Program (NCEP) Therapeutic Lifestyle Changes (TLC) program Low saturated fat (<7% of daily calories), low dietary cholesterol Eating sufficient plant sterols, stanols, and soluble fiber Weight management Physical activity The NCEP is from the National Institutes of Health and is endorsed by the American Heart Association.

Dietary Lipids and Risk Saturated fats Polyunsaturated fats Monounsaturated fats Omega-6 fatty acids Omega-3 fatty acids Ratio of omega-6 and omega-3 fatty acids Trans fats Saturated and trans fats raise cholesterol, LDL, and the risk of heart disease. Polyunsaturated fats lower cholesterol. Monounsaturated fats lower cholesterol without lowering HDL. A deficiency of omega-3 fatty acids [docosahexaenoic acid (DHA)] in the diet may increase the risk of Alzheimer’s disease and dementia. DHA and EPA will lower levels of circulating triglycerides.

Dietary Lipids and Risk Saturated and trans fats raise cholesterol, LDL, and the risk of heart disease. Polyunsaturated fats lower cholesterol. Monounsaturated fats lower cholesterol without lowering HDL. A deficiency of omega-3 fatty acids [docosahexaenoic acid (DHA)] in the diet may increase the risk of Alzheimer’s disease and dementia. DHA and EPA will lower levels of circulating triglycerides.

Dietary Strategies to Reduce the Risk of Heart Disease Consumption of plant sterols or stanols Plant-based diets Nut consumption Oily, cold-water fish Whole grain oats Moderate alcohol consumption Substituting unsaturated oils for saturated fats

Fat Intake and Health Beyond Heart Disease High-fat diet increases the risk for cancer and obesity Plant-based foods are protective Fruits, vegetables, whole grains, and fish

Summary Atherosclerosis, a thickening and hardening of the arteries along with plaque development along blood vessel walls, is a major cause of heart attack and stroke Atherosclerosis is a form of cardiovascular disease (CVD) that often begins with an injury to a vessel wall that triggers inflammation and low-density lipoprotein (LDL) cholesterol infiltration, which results in plaque accumulation Some risk factors cannot be modified, like race, age, and a family history of heart disease, but certain lifestyle choices can significantly affect the risk of CVD

Summary (Cont’d) Modifiable risk factors for CVD include smoking; a diet high in saturated and trans fats, cholesterol, sodium, and added sugar; a sedentary lifestyle; obesity; diabetes; elevated lipid levels in the blood (cholesterol, LDL, and triglycerides); excessive alcohol consumption; and high blood pressure The concentrations of various lipids in the blood correlate with the risk for atherosclerosis and CVD; a high level of blood cholesterol is a major risk factor, particularly when accompanied by high levels of LDL cholesterol and low levels of high-density lipoprotein (HDL) cholesterol Metabolic syndrome is a cluster of risk factors associated with the development of CVD and type 2 diabetes; diagnosis involves the presence of at least three of the following abnormalities: excessive abdominal fat, high blood pressure, elevated levels of triglycerides in the blood, low levels of HDL, and elevated blood glucose levels

Summary (Cont’d) Diet, including the intake of fatty acids and cholesterol, plays a critical role in the development and prevention of CVD Available evidence suggests that replacing saturated fats with monounsaturated and polyunsaturated fatty acids may be beneficial The Therapeutic Lifestyle Changes (TLC) program was created by the National Institutes of Health’s National Cholesterol Education Program and is also endorsed by the American Heart Association as a heart-healthy regimen that can lower blood cholesterol and reduce the risk of CVD