1. Nutrition and Cardiovascular Disease

2. Cardiovascular Disease Includes heart attack, stroke Includes heart attack, stroke Leading cause of death in the U.S. Leading cause of death in the U.S. Annually, 500,000 people die of CHD in the U.S. (1 million including strokes and other CVD) Annually, 500,000 people die of CHD in the U.S. (1 million including strokes and other CVD) Each year, 1.5 million Americans have a heart attack Each year, 1.5 million Americans have a heart attack

3. CVD Deaths by State

4. Heart Attack (Myocardial Infarction)

5. When blood supply to the heart is disrupted, the heart is damaged When blood supply to the heart is disrupted, the heart is damaged May cause the heart to beat irregularly or stop altogether May cause the heart to beat irregularly or stop altogether 25% of people do not survive their first heart attack 25% of people do not survive their first heart attack

6. Symptoms of a Heart Attack Intense, prolonged chest pain or pressure Intense, prolonged chest pain or pressure Shortness of breath Shortness of breath Sweating Sweating Nausea and vomiting (especially women) Nausea and vomiting (especially women) Dizziness (especially women) Dizziness (especially women) Weakness Weakness Jaw, neck and shoulder pain (especially women) Jaw, neck and shoulder pain (especially women) Irregular heartbeat Irregular heartbeat

7. Cerebrovascular Accident (CVA) or Brain Attack

8. Brain Attack (Stroke) or Cerebrovascular Accident

9. Symptoms of Stroke (Brain Attack) Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden confusion, trouble speaking or understanding Sudden trouble seeing in one or both eyes Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance or coordination Sudden trouble walking, dizziness, loss of balance or coordination Sudden severe headache Sudden severe headache

10. Blood Lipid Levels are Related to Risk of CVD

11. Blood Lipids (Lipoproteins) Lipids (fat) cannot mix with water Lipids (fat) cannot mix with water Blood is high in water Blood is high in water Lipids cannot travel in blood without help Lipids cannot travel in blood without help Lipoproteins are formed to carry lipids Lipoproteins are formed to carry lipids

12. Lipoproteins combine Lipids (triglycerides, cholesterol) Lipids (triglycerides, cholesterol) Protein Protein Phospholipids Phospholipids

13. Low-Density Lipoproteins (LDL-C) Also called “bad cholesterol) Also called “bad cholesterol) Contain relatively large amounts of fat, and less protein Contain relatively large amounts of fat, and less protein Deposits cholesterol in arteries Deposits cholesterol in arteries Thus, ↑ LDL-C is associated with ↑ CVD risk Thus, ↑ LDL-C is associated with ↑ CVD risk Serum LDL-C should be < 130 mg/dL Serum LDL-C should be < 130 mg/dL

14. High-Density Lipoproteins (HDL) Also called “good cholesterol” Also called “good cholesterol” Relatively high in protein, lower in lipid Relatively high in protein, lower in lipid Acts as scavenger, carrying cholesterol from arteries to liver Acts as scavenger, carrying cholesterol from arteries to liver –Liver packages as bile –Excretes ↑ HDL-C is associated with ↓ risk of CVD ↑ HDL-C is associated with ↓ risk of CVD Serum HDL-C should be >60 mg/dL (optimal) or at least >40 in men and 50 in women Serum HDL-C should be >60 mg/dL (optimal) or at least >40 in men and 50 in women

15. Triglycerides The most diet-responsive blood lipid The most diet-responsive blood lipid Should be ≤150 mg/dL in fasting state Should be ≤150 mg/dL in fasting state

16. Total Cholesterol Includes HDL-C, LDL-C, and a fraction of the triglycerides Includes HDL-C, LDL-C, and a fraction of the triglycerides Total cholesterol should be ≤ 200 mg/dL Total cholesterol should be ≤ 200 mg/dL Total cholesterol does not tell whole story Total cholesterol does not tell whole story

17. Lipoprotein Summary

18. Evaluating Blood Lipids: LDL <100 mg/dL Optimal 100-129 Near optimal 130-159 Borderline high 160-189High ≥190 Very high Source: ATP-III Guidelines, NHLBI, accessed 2-2005

19. Evaluating Blood Lipids: Total Cholesterol <200 mg/dL Desirable 200-239 mg/dL Borderline high ≥240 mg/dL High Source: ATP-III Guidelines, NHLBI, accessed 2-2005

20. Evaluating Blood Lipids: HDL < 40 mg/dL Low ≥ 60 mg/dL High Source: ATP-III Guidelines, NHLBI, accessed 2-2005

21. Blood Pressure Measured in mmHg Measured in mmHg Systolic blood pressure: the pressure in the arterial blood vessels associated with the pumping of the heart Systolic blood pressure: the pressure in the arterial blood vessels associated with the pumping of the heart Diastolic blood pressure: the pressure in the arterial blood vessels when the heart is between beats Diastolic blood pressure: the pressure in the arterial blood vessels when the heart is between beats

22. Hypertension: Either Systolic blood pressure > 140 mmHg Systolic blood pressure > 140 mmHg Diastolic blood pressure > 90 mmHg Diastolic blood pressure > 90 mmHg

23. Risk Factors (other than LDL) for CVD Cigarette smoking Cigarette smoking Hypertension (BP ≥140/90 mmHg or on anti-hypertensive tx Hypertension (BP ≥140/90 mmHg or on anti-hypertensive tx Low HDL-C* (<40 mg/dL) Low HDL-C* (<40 mg/dL) Family history of premature CHD in first degree relative (in male <55 years, in female <65 years) Family history of premature CHD in first degree relative (in male <55 years, in female <65 years) Age (men ≥45 years, women ≥55 years) Age (men ≥45 years, women ≥55 years) *HDL-C ≥ 60 mg/dL counts as a negative risk factor Source: ATP-III Guidelines, NHLBI, accessed 2-2005

24. Risk Factors (other than LDL) for CVD Diabetes (considered equivalent to a history of CHD) Diabetes (considered equivalent to a history of CHD) Obesity Obesity Inactivity Inactivity Source: ATP-III Guidelines, NHLBI, accessed 2-2005

25. Screening for CVD Risk Everyone 20 and older should have his cholesterol measured at least every 5 years Everyone 20 and older should have his cholesterol measured at least every 5 years Lipoprotein profile: includes TC, LDL-C HDL-C, and TG Lipoprotein profile: includes TC, LDL-C HDL-C, and TG At least should include TC and HDL-C At least should include TC and HDL-C If TC> 200 mg/dL or HDL-C 200 mg/dL or HDL-C< 40 mg/dL, obtain full lipid profile Source: National Cholesterol Education Program, National Institutes of Health, accessed 2-05

26. Total Cholesterol John and Marty each have total cholesterol levels of 200 mg/dL. John and Marty each have total cholesterol levels of 200 mg/dL. Their health risk is different Their health risk is different

27. Total Cholesterol is Not Enough John’s Lipid Profile TC: 200 mg/dL TC: 200 mg/dL LDL-C: 140 mg/dL LDL-C: 140 mg/dL HDL-C: 30 mg/dL HDL-C: 30 mg/dL TG: 150 mg/dL TG: 150 mg/dL Marty’s Lipid Profile TC: 200 mg/dl TC: 200 mg/dl LDL-C: 95 mg/dL LDL-C: 95 mg/dL HDL-C: 75 mg/dL HDL-C: 75 mg/dL TG: 150 mg/dL TG: 150 mg/dL

28. What Affects Cholesterol Levels? Diet Diet Weight Weight Physical activity Physical activity Age and gender Age and gender Heredity Heredity You control the first three!

29. Lowering LDLs See your doctor to assess for other conditions See your doctor to assess for other conditions Reduce dietary saturated fat, trans fatty acids, and cholesterol Reduce dietary saturated fat, trans fatty acids, and cholesterol Increase MUFA and PUFA Increase MUFA and PUFA Increase dietary fiber (soluble) Increase dietary fiber (soluble)

30. Lowering Blood TG Is the most diet-responsive blood lipid Is the most diet-responsive blood lipid Avoid overeating Avoid overeating Limit alcohol Limit alcohol Limit simple sugars Limit simple sugars Small frequent meals Small frequent meals Include fish in the diet Include fish in the diet

31. Raise the HDL Physical activity Physical activity At least 45 min./day, 4 days a week At least 45 min./day, 4 days a week Avoid smoking Avoid smoking Eat regularly Eat regularly Eat less total fat Eat less total fat Moderate intake of alcohol increases HDL Moderate intake of alcohol increases HDL

32. Therapeutic Lifestyle Changes (TLC) TLC Diet TLC Diet Physical activity (30 minutes on most, if not all, days) Physical activity (30 minutes on most, if not all, days) Weight management: will help manage triglycerides, increase HDL, Weight management: will help manage triglycerides, increase HDL,

33. DASH: Dietary Approaches to Stop Hypertension Eat foods that are low in fat, saturated fat, and cholesterol Eat foods that are low in fat, saturated fat, and cholesterol Eat more fruits, vegetables, whole grains, and lowfat dairy products Eat more fruits, vegetables, whole grains, and lowfat dairy products Eat more poultry, fish, nuts, and legumes Eat more poultry, fish, nuts, and legumes Eat less red meat, fats, sweets, and sugared beverages Eat less red meat, fats, sweets, and sugared beverages Eat foods low in salt and sodium Eat foods low in salt and sodium NHLBI. DASH Eating Plan, revised 2003. Accessed 2-2005