1. Lipids in Heart Disease & Cancer Module 3.5

2. Heart Disease - Atherosclerosis
Red- diet related
Heart Disease
#1 cause of death in America.
1/3 die of atherosclerosis.
Myocardial infarction and stroke risk increase with atherosclerosis.
Atherosclerosis
A buildup of plaque occlude arterial walls arterial vessels.
Begins as injury or inflammation
Contain cholesterol (oxidized LDL), platelets, etc
Artery walls lose elasticity
Passage through the artery narrows
One leading cause of heart disease
Healthy Occluded

3. Lipids and Cardiovascular Disease3

4. Hypertension High blood pressure.
Leading cause of arterial wall injury.
Synergizes with atherosclerosis to cause heart disease and stroke.
Methods to reduce Hypertension
DASH Diet (The Dietary Approach to Stop Hypertension)
Increase calcium, potassium and magnesium
Low-fat, fiber-rich, moderate protein & carbohydrate
Aerobic exercise
Healthy Body Weight

5. Blood Pressure Measurements
Category
Systolic1
Conjunction
Diastolic2
Optimal
<120
and
<80
Pre-hypertension or
80-89
Stage 1 hypertension
90-99
Stage 2 hypertension
≥ 160
≥ 100
1 Systolic BP in mm of mercury (Hg)
2 Diastolic BP in mm of mercury (Hg)
Who is Dying of Heart Disease?
25-34 years: Men at 3X rate as Women
35-44 years: Men at 2X rate as Women
45-64 years: Women catching up to men
65-75 years: Women catching up to men
75-80 years: Women = Men
Over 70 million Americans suffer from some form of cardiovascular disease.

6. What are the Risk Factors for Heart Disease?
Elevated serum cholesterol
Genetics
Smoking tobacco & drinking alcohol
Hypertension
Diabetes
Obesity
Sedentary lifestyle
Stress
Male gender
Consuming a low fiber & high fat diet

7. How can hypertension and heart disease be prevented?
Lifestyle changes
Less stress, no smoking
Healthy diet
Healthy fats, nutritionally adequate
SFA: Increase LDL
PUFA: Decrease LDL & HDL
MUFA: Decrease LDL
Cholesterol: Can Increase LDL
Regular aerobic exercise
An hour a day
All positively affect blood lipid values and blood pressure

8. Metabolic Syndrome
Metabolic syndrome is a disorder of energy utilization and storage, diagnosed by a co-occurrence of three out of five of the following medical conditions:
abdominal (central) obesity Waist circumference
(apple/pear shape)
>35” males >40” females
Elevated blood pressure ≥130/85 mm Hg
Elevated fasting plasma glucose: ≥110 mg/dl
High serum fasting Blood Triglycerides: ≥150 mg/dl
Low HDL levels. <50 mg/dl Males <40 mg/dl Females
Metabolic syndrome increases the risk of developing cardiovascular disease and diabetes.

9. Blood Lipids Serum Triglycerides
Elevated levels associated w/ heart disease.
High triglyceride levels thicken the blood causing hypertriglyceridemia.
Triglycerides are packaged primarily in Chylomicrons and Very Low Density Lipoproteins (VLDL).
A fasting 12 hour blood test is needed to determine an accurate triglyceride level.
<150mg/dl is normal.
450 mg/dl is like pumping ketchup, causes arterial damage contributing to heart disease and stroke.

10. Blood Cholesterol & Disease Risk
Total Cholesterol
Triglycerides + HDL +LDL
< 200 mg/dl
Desirable/Low Risk
mg/dl
Borderline High Risk
≥ 240 mg/dl
High Risk
Blood Cholesterol & Disease Risk
LDL Cholesterol
< 100 mg/dl Optimal
mg/dl Near optimal
mg/dl Borderline high
mg/dl High
≥ 190 mg/dl Very high
HDL Cholesterol
< 40 Low (indicates risk)
> 60 High Good!

11. The sticky fragments contribute to atherosclerotic plaque formation.
Oxidation of Fat
The double bonds of polyunsaturated fatty acids are targets for oxidation (damage by oxygen species).
The double bond breaks with oxidation generating lipid fragments that are very sticky.
CH2CH = CHCH = CH2CHO + CH2CHO
The sticky fragments contribute to atherosclerotic plaque formation.
Antioxidants prevent oxidation reactions, react with oxygen radical species directly, & prevent heart disease
Antioxidants vitamins:
vitamin E (alpha-tocopherol),
vitamin C (L-ascorbic acid),
beta-carotene (provitamin A)
Minerals with antioxidant cofactor
Zinc, Copper, & Iron

12. Trans Fats and Fat Hydrogenation
Trans fatty acids levels are high in processed foods containing partially hydrogenated oils. Created when an unsaturated fat is hydrogenated.
The double bonds from PUFA & MUFA are removed by hydrogenation (adding hydrogen).
The fatty acid becomes more saturated making product more solid at room temperature.
Changes shape of the double bond structure and allows for easy “packing” of the molecule leading to potential plaque in the arteries.
Used in the process of making margarine.
Stick margarine & shortening are highly hydrogenated and partially hydrogenated
Found in shortening, baked goods, fried foods, potato chips,
Trans fatty acids have been implicated as risk in heart disease
Lowers HDL cholesterol
Manufactures required to list on food label if ≥ 0.5 grams

13. Homocysteine in Heart Disease
Homocysteine is byproduct of the metabolism of the essential amino acid methionine. It can be recycled back into methionine or converted into the amino acid cysteine by B vitamins.
Elevated levels of homocysteine cause arterial wall damage & contribute to blood clots, heart attacks, and stroke. Some research also indicates higher risks of developing dementia and Alzheimer’s disease
Folic acid (folate), B6 & B12 function as cofactors for the enzymes driving the inter conversion of cysteine & methionine, thus adequate intakes prevent hyper-homocystemia.
methionine (B12)
homocysteine
Cysteine (B6) B6
B12
Folate

14. Preventive Factors for Heart Disease
High doses of Niacin: Increases HDL, decreases LDL.
Statin type cholesterol lowering drugs: Reduce the synthesis of cholesterol in the liver.
Cholesterol absorption inhibitor drugs.
Benecol spreads: Contain plant stanol esters that reduce the absorption of cholesterol in the digestive tract.
Wine: Reduces blood viscosity. Red wine and/or grape juice increases HDL.
Alcohol: 1 serving per day decreases risk of a cardiovascular accident. It is an anticoagulant.
Aerobic Activity: Increases HDL, decreases LDL.
Soluble Fiber: Decreases LDL.
Soy Protein: Increases HDL, decreases LDL.

15. Lipids in Cancer
Cancer is the 2nd leading cause of death in Americans.
Characterized by uncontrolled cell growth.
Occurs through a process of initiation, promotion, and progression.
Increased Cancer Risk by Lifestyle Practices
Smoking tobacco, UV light, Obesity, Sedentary Lifestyle
Increased Cancer Risk by Dietary Practices
~ 45% of all cancer deaths are diet-related
Low F&V, antioxidant nutrient, & fiber intake
High total fat and PUFA, sodium intake
P:S ≥3:1 + high fat diet = cancer risk
P:S ≤0.33:1 (or ≤1:3) + high fat diet = heart disease risk
* P =polyunsaturated S = saturated

16. Carcinogenesis

17. Obesity, Fat Intake and Cancer Risk
Obese individuals often have increased levels of insulin and insulin-like growth factor-1 (IGF-1) in their blood (a condition known as hyperinsulinemia or insulin resistance), which may promote the development of certain tumors.
Fat cells produce hormones that may stimulate or inhibit cell growth. Ex: leptin, which is more abundant in obese individuals seems to promote cell proliferation.
Concurrently, obesity increases leptin production but decreased its sensitivity to inhibit hunger though sufficient calories have been consumed and stored.
Fat cells may also have direct and indirect effects on other tumor growth regulators.
Obese individuals often have chronic low-level inflammation, which has been associated with increased cancer risk.
High levels of fat intake have particularly indicated potential higher risks of colon cancer due to proliferation of colon stem cell mutations that lead to tumor formation.