Cholesterol, blood pressure, and heart disease By Melissa Bess Nutrition and Health Education Specialist University of Missouri Extension FNEP STAFF TRAINING ONLY, DO NOT USE WITH FNEP PARTICIPANTS 06/2007

Introduction About cholesterol LDL vs. HDL Triglycerides Healthy levels Common misconceptions What affects cholesterol? Why does it matter? Prevention of high cholesterol

Introduction (continued) About blood pressure Common misconceptions Controlling high blood pressure Heart disease risk factors

About cholesterol Soft, fat-like, waxy substance Bloodstream and cells Needed for cell membranes and hormones and to make vitamin D Comes from 2 sources –Body produces it (mostly genetic) in liver (1000 mg day) –Food sources (animal products – meats, poultry, fish, eggs, butter, whole milk, and cheese, not from plant sources) (100 – 500 mg day) –Foods with trans fats or saturated fats may cause the body to produce more cholesterol

About cholesterol Must be transported through blood Carriers are called lipoproteins –Low-density lipoprotein (LDL) –High-density lipoprotein (HDL) Lipoprotein = protein + fat –LDL, more fat, less protein –HDL, more protein, less fat

LDL vs. HDL LDL = “bad” Too much can clog arteries by forming plaque Atherosclerosis can cause heart attack or stroke

LDL vs. HDL HDL = “good” Tends to carry cholesterol away from arteries and back to liver May also remove excess cholesterol from plaque in arteries, slows buildup

Triglycerides Form of fat Also made in body (body fat stored as triglyceride) and from food Help transport dietary fat, metabolism Trigger liver to make more cholesterol, rising LDL and total cholesterol

Healthy Levels Total cholesterol –Optimal – under 200 mg/dL –Borderline high risk – mg/dL –High risk – 240 mg/dL and up LDL –Optimal – less than 100 mg/dL –Near/Above optimal – mg/dL –Borderline high – mg/dL –High – 160 – 189 mg/dL –Very high – 190 mg/dL Source: National Cholesterol Education Program, National Heart, Lung, and Blood Institute

Healthy Levels HDL –Low - less than 40 mg/dL –High – above 60 mg/dL (may lower risk for heart disease) –Women tend to have higher HDL due to estrogen (needs to be over 50 mg/dL) Triglycerides –Normal – less than 150 mg/dL –Borderline high – 150 – 199 mg/dL –High – above 200 mg/dL Source: National Cholesterol Education Program, National Heart, Lung, and Blood Institute

Common misconceptions Using margarine instead of butter will help lower my cholesterol Thin people don’t have to worry about high cholesterol If a label lists no cholesterol, it’s a “heart-healthy” choice Eggs – good or bad? Women don’t need to worry about cholesterol Only middle-aged people should have their cholesterol checked

What affects cholesterol? Diet –Poly and monounsaturated fats may help lower cholesterol when used in place of saturated fats, but still limit –High carbs, excessive alcohol may increase triglycerides –Soluble fiber may lower LDL, not HDL Weight Physical activity Age Gender Heredity

Why does it matter? Coronary heart disease is caused by atherosclerosis Single leading cause of death The higher LDL you have plus risk factors increases risk for heart attack –Smoking –High Blood pressure –Low HDL –Family history of early heart disease –Age

Prevention of high cholesterol Get it checked Watch fats, eat healthy Consume less than 300 mg of cholesterol a day Be active Quit smoking Some may need medication –Lipitor, Crestor, Zocor –Vytorin –Zetia

Blood pressure 1 in 3 adults has hypertension No symptoms, nearly 1/3 of those people don’t know they have it No known cause 2 forces –Blood pumps to arteries and through circulatory system –Arteries resist blood flow Arteries elastic, stretchy Heart beats times a minute

Blood pressure Systolic (top) – heart is beating Diastolic (bottom) – heart resting Normal – 120/80 mm Hg Pre-hypertensive – /80-89 mm Hg Hypertensive – 140/90 mm Hg May take several readings “White coat hypertension” Hypertension increases risk for heart disease and stroke Number 1 controllable risk factor for stroke

Blood pressure Sodium/salt –Holds excess fluid in body, heart has to work harder Potassium –Blunts effects of salt on blood pressure

Common misconceptions Symptoms of high blood pressure include nervousness, sweating, and difficulty sleeping High cholesterol = high blood pressure Everyone has high blood pressure, I don’t need to worry Women don’t need to worry about high blood pressure

Controlling hypertension Reduce fat (particularly saturated fat) Stop smoking Cut back on alcohol Be active May need medication Stress management

Heart disease risk factors Uncontrollable –Age –Male gender –Heredity (including race) – African Americans = higher blood pressure. Also higher among other races Controllable –Smoking (2-4x higher than non- smokers) –High cholesterol (high HDL can be positive risk factor) –High blood pressure

Heart disease risk factors Controllable –Physical inactivity –Obesity/overweight (especially in abdominal area) –Diabetes Other factors –Stress –Too much alcohol Moderate drinkers = less risk than non- drinkers (may increase HDL cholesterol)

Phytonutrients Soy protein may reduce risk of heart disease –Especially when replacing foods high in saturated fat Plant sterols/stanols –Found naturally in fruits/veggies, plant oils may lower LDL Omega-3 fatty acids –Two weekly servings of fish may be heart healthy Folic Acid –May lower homocysteine levels Antioxidants

Questions?? Activity time!