© 2007 Thomson - Wadsworth Chapter 21 Nutrition & Disorders of the Heart & Blood Vessels

© 2007 Thomson - Wadsworth CVD Deaths in the U.S.

© 2007 Thomson - Wadsworth Athrosclerosis Artery walls become progressively thickened due to accumulation of plaque Occurs due to minimal but chronic injuries that damage the inner arterial wall

© 2007 Thomson - Wadsworth

Consequences Lumen narrows Plaque can rupture, forming a clot (thrombus) Thrombus can break free & shut off blood flow (embolism) Ischemia occurs within the tissue Coronary arteries (angina pectoris & heart attack) Brain (stroke) Aneurysm (sac- like distention of blood vessel wall)

© 2007 Thomson - Wadsworth Causes of Athrosclerosis Inflammation & infection Hypertension Smoking Diabetes mellitus Aging Elevated LDL & VLDL

© 2007 Thomson - Wadsworth Coronary Heart Disease Most common type Leading cause of death in U.S. Evaluating Risk Smoking High LDL High blood pressure Diabetes Obesity Inactivity Non-modifiable risk factors Age Male gender Family history

© 2007 Thomson - Wadsworth

Lifestyle Changes for CHD Cholesterol-lowering diet (<200 mg) Weight reduction Regular physical activity Decrease saturated fat <7% total kcalories Decrease total fat 25-35% of kcalories Decrease trans fat Increase soluble fiber Plant sterols & stanols Eat soy products Increase fish & omega-3 fatty acids Moderate alcohol

© 2007 Thomson - Wadsworth Lifestyle Changes for Hypertriglyceridemia Mild Weight reduction Physical activity Quit smoking Avoid high-CHO diet Restrict alcohol Severe Weight reduction Physical activity Very-low-fat diet: <15% of kcalories Medication

© 2007 Thomson - Wadsworth Vitamin Supplementation No conclusive research results have been obtained for vitamins being preventative for CVD Study is underway for increasing: Folate, vitamin B 6 & B 12 to decrease homocysteine levels Vitamin C and E for antioxidant effects

© 2007 Thomson - Wadsworth Drug Therapies for CHD Prevention Statins Reduce cholesterol synthesis in the liver Bile acid sequestrants Reduce cholesterol & bile absorption in small intestine Nicotinic acid Lowers triglycerides & raises HDLs Anticoagulants & aspirin Suppress blood clotting Blood pressure medications Nitroglycerin for angina

© 2007 Thomson - Wadsworth Treatment for Heart Attack Drug therapy Thrombolytics Anticoagulants Aspirin Painkillers Blood pressure medications Rhythm stabilizers No food until stable Soft foods Low sodium Low saturated fat Cardiac rehabilitation

© 2007 Thomson - Wadsworth Hypertension Affects 1/3 of adults in U.S. Factors influencing BP Cardiac output Peripheral resistance Secretion of hormones by kidneys Desirable BP < 120/80 Prehypertension /80-89 Hypertension > 140/90

© 2007 Thomson - Wadsworth

Contributing Factors Aging Genetics More prevalent in African Americans Obesity Alters kidney function & promotes fluid retention Salt sensitivity 30-50% of cases Alcohol 3-4 drinks daily Diet Fruits, vegetables, nuts, low-fat milk can lower BP Potassium, calcium, & magnesium can lower BP

© 2007 Thomson - Wadsworth Treatment of Hypertension Weight reduction Low-sodium diet Diet rich in potassium, calcium, & magnesium Regular physical activity Moderate alcohol DASH Diet - Limits: Red meats Sweets Sugar-containing beverages Saturated fat to <7% Cholesterol to 150 mg/day Drug therapy

© 2007 Thomson - Wadsworth

Congestive Heart Failure Heart’s inability to pump adequate blood Fluids build up in veins & tissues Heart enlarges 75% are 65 or older Consequences Fluid accumulation in liver, abdomen, & lower extremities Chest pain; swelling legs, ankles, feet; SOB Impaired liver & kidneys Heart failure Cardiac cachexia

© 2007 Thomson - Wadsworth

Medical Management Sodium & fluid restrictions Diuretics Small, frequent meals Vaccinations for influenza & pneumonia Adequate fiber Avoid alcohol Liquid supplements, tube feedings, parenteral support

© 2007 Thomson - Wadsworth Stroke 3 rd leading cause of death Types Ischemic Hemorrhagic Transient ischemic attacks (TIAs) Prevention Recognize risk factors Lifestyle changes Management Thrombolytic drugs Maintain nutrition status Problems Lack of coordination Difficulty swallowing