1. Atherosclerosis and Diet Chapter 20

2. Cardiovascular Heart Disease (CHD)
The blood players in the atherosclerotic process:
- elevated plasma low density lipoprotein cholesterol (LDL-c or bad cholesterol)-LDL deposits fat on artery walls and this clogs arteries -such clogging reduces or stops blood flow and hence oxygen and nutrient delivery
- fat deposits on wall of artery are called plaque
- low plasma high density lipoprotein cholesterol (HDL-c or good cholesterol)- HDL cleans arteries of fat
- elevated plasma cholesterol (elevates LDL-c)
- elevated plasma cholesterol:HDL-c ratio-more cholesterol influx than efflux as most of the cholesterol is carried on the LDL
- elevated plasma triglycerides elevates small dense LDL (sd LDL is very aggressive in clogging arteries with fat)

3. Cardiovascular Heart Disease (CHD)
The blood players in the atherosclerotic process continued:
-elevated post-prandial triglycerides (chylomicron- triglycerides)
-elevated VLDL-cholesterol (contributes to cholesterol influx into the artery wall)
-hypertension-damages arterial endothelium which leads to lipid infiltration
-plaque rupture leading to platelet aggregation in turn leading to thrombus and embolus formation- decreased bleeding time involved here
-elevated lipoprotein (a) levels-contributes lipid to the artery wall and may contribute to elevated platelet aggregation

4. Cardiovascular Heart Disease (CHD)

7. Heart Healthy Diet and Lifestyle—(cont.)
Calories, activity, and weight
Attaining and maintaining healthy weight to reduce the risk of CVD
A decrease in calorie intake and an increase in physical activity are recommended to promote weight loss.
A physically active lifestyle with minimal sedentary activities is appropriate for all people regardless of their weight status.

8. Heart-Healthy Diet and Lifestyle—(cont.)
Fruit and vegetables
In short-term, randomized trials
Diets rich in fruits and vegetables have been shown to lower blood pressure and improve other CVD risk factors.
In long-term, observational studies
People who have a high intake of fruits and vegetables are at lower risk of developing CVD, especially stroke.
Preparation methods should preserve the fiber and nutrient content without adding saturated fat, trans fat, sugar, or salt.

9. Heart Healthy Diet and Lifestyle—(cont.)
Whole grains
Diets high in whole-grain products are associated with decreased risk of CVD.
Both soluble and insoluble fiber are associated with decreased risk of CVD.
Fatty fish
Increased intake of omega-3 fatty acids reduces risk of CVD.
Recommendation- 2 servings (approximately 8 oz.) of fatty fish per week, prepared in ways that do not add saturated or trans fats.

10. Heart Healthy Diet and Lifestyle—(cont.)
Saturated fat
Increases LDL and total cholesterol levels
Choosing lean meats and trimming away visible fat lowers saturated fat intake.
Portion sizes are limited to 6 oz. or less per day.
Monounsaturated and polyunsaturated fats are inversely related to CHD.
Recommendation- total fat provide 25% to 35% of total calories.

11. Heart Healthy Diet and Lifestyle—(cont.)
Trans fat
Increases LDL and total cholesterol levels, the ratio of LDL to HDL cholesterol, and the risk of CHD
Found in partially hydrogenated fats
Limit trans fat intake of less than 1% of total calories.

12. Heart Healthy Diet and Lifestyle—(cont.)
Cholesterol
Dietary cholesterol raises LDL levels, especially in people who are lean though the contribution of dietary cholesterol to total and cholesterol levels is small.
Found only in foods originating from animals
Added sugars
The purpose of limiting the intake of beverages and foods with added sugars is to lower calorie intake and help ensure nutritional adequacy. Added sugars in sufficient amounts can contribute to pro-atherosclerotic lipid and lipoprotein profile

13. Heart Healthy Diet and Lifestyle—(cont.)
Sodium
As the intake of salt increases, so does blood pressure.
High blood pressure is a major risk factor for CVD.

14. Heart Healthy Diet and Lifestyle—(cont.)
Alcohol
Moderate alcohol consumption from any source—beer, wine, or distilled liquor—is associated with a reduced risk of CVD.
Alcohol can be addictive, and high intakes are associated with high triglyceride levels, hypertension, liver damage, physical abuse, vehicular and work accidents, and increased risk of breast cancer.

15. Hypertension—(cont.) The DASH eating plan
DASH Food Groups
DASH Daily Servings (except as noted)
DASH Serving Sizes
Vegetables
4-5
250 mL (1 cup) raw leafy  vegetables 125 mL (½ cup)  cooked vegetables 170 ml (6 oz) juice 
Fruit
1 medium piece of fruit 63 mL (¼ cup) dried fruit 125 mL (½ cup) fresh, frozen or canned fruit
Grains (mainly whole grains)
7-8
1 slice bread 250 mL (1 cup)  ready to eat cereal 125 mL (½ cup) cooked rice, pasta or cereal
Low  Fat or No-Fat Dairy Foods
2-3
250 mL (1 cup) milk 250 ml (1 cup) yogurt 50 g (1½ oz) cheese
Lean meats, poultry and fish
2 or less
3 ounces cooked lean meats, skinless poultry, or fish
Nuts, seeds and dry beans
4-5 per week
1/3 cup (1.5 oz.) nuts 30 mL (2 tbsp) peanut butter 2 tbsp (1/2 oz.) seeds 1/2 cup cooked dry beans or peas
Fats and Oils
5 ml (1 tsp) soft margarine 15mL (1 tbsp) low-fat mayonnaise 30 mL (2 tbsp)  light salad dressing 5 ml (1 tsp) vegetable oil   

16. TLC diet Component TLC Diet Total fat 25-35% of total calories*
Saturated fat <7% total calories
Polyunsaturated fat Up to 10% of total calories
Monounsaturated fat Up to 20% of total calories
Trans fat Lower intake
Carbohydrate** % of total calories
Dietary fiber grams per day
Protein % of total calories
Cholesterol <200 mg/day
Sodium <2,300 mg/day
Dietary options
Plant sterols/stanols Add up to 2 grams per day
Soluble fiber Increase 5-10 grams per day
Fish (fatty fish) Include in weekly eating plan
* allows an increase of total fat to 35% of total calories and a reduction of carbohydrate to 50% in persons with metabolic syndrome and/or at risk for type 2 diabetes. ** Carbohydrate should derive predominantly from foods rich in complex carbohydrates including grains (especially whole grains) and fruits and vegetables.

17. Mediterranean diet Key components of the Mediterranean diet
The Mediterranean diet emphasizes:
Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
Replacing butter with healthy fats, such as olive oil
Using herbs and spices instead of salt to flavor foods
Limiting red meat to no more than a few times a month
Eating fish and poultry at least twice a week
Drinking red wine in moderation (optional)
The diet also recognizes the importance of being physically active, and enjoying meals with family and friends.

18. Mediterranean diet Focus on fruits, vegetables, nuts and grains
Key components of the Mediterranean diet
Focus on fruits, vegetables, nuts and grains
The Mediterranean diet traditionally includes fruits, vegetables and grains. For example, residents of Greece average six or more servings a day of antioxidant-rich fruits and vegetables.
Grains in the Mediterranean region are typically whole grain and usually contain very few unhealthy trans fats, and bread is an important part of the diet. However, throughout the Mediterranean region, bread is eaten plain or dipped in olive oil — not eaten with butter or margarine, which contains saturated or trans fats.
Nuts are another part of a healthy Mediterranean diet. Nuts are high in fat, but most of the fat is healthy. Because nuts are high in calories, they should not be eaten in large amounts — generally no more than a handful a day. For the best nutrition, avoid candied or honey-roasted and heavily salted nuts.

19. Mediterranean diet
The focus of the Mediterranean diet isn't on limiting total fat consumption, but rather on choosing healthier types of fat. The Mediterranean diet discourages saturated fats and hydrogenated oils (trans fats), both of which contribute to heart disease.
The Mediterranean diet features olive oil as the primary source of fat. Olive oil is mainly monounsaturated fat — a type of fat that can help reduce low-density lipoprotein (LDL) cholesterol levels when used in place of saturated or trans fats. "Extra- virgin" and "virgin" olive oils (the least processed forms) also contain the highest levels of protective plant compounds that provide antioxidant effects.
Canola oil and some nuts contain the beneficial linolenic acid (a type of omega-3 fatty acid) in addition to healthy unsaturated fat. Omega-3 fatty acids lower triglycerides, decrease blood clotting, and are associated with decreased incidence of sudden heart attacks, improve the health of your blood vessels, and help moderate blood pressure. Fatty fish — such as mackerel, lake trout, herring, sardines, albacore tuna and salmon — are rich sources of omega-3 fatty acids. Fish is eaten on a regular basis in the Mediterranean diet.

20. What is in these good diets that helps with reducing atherosclerosis?