2.  Cardiovascular disease refers to any abnormal condition involving dysfunction of the heart and blood vessels.  When blood vessels supplying the heart become blocked or constricted, such blockage reduces blood flow to the heart and can result in a myocardial infarction (heart attack).  Blockage of one of the blood vessels supplying the brain can cause a cerebrovascular accident (stroke).

3.  The leading cause of death in the U.S.  The major cause of permanent disability.  More than half of the people die of heart and blood vessel disease in the U.S. each year.  About 75% of all hospitalized adults show symptoms of heart problems.

4. 1. Elevated cholesterol and triglycerides 2. Obesity or overweight 3. Hypertension 4. Sedentary lifestyle 5. Smoking: Smokers have a 70% greater chance of developing CVD than nonsmokers. Nonsmokers who are exposed to secondhand smoke increase their risk of developing heart disease by 25-30%.

5. 6. High blood pressure: HTN stresses the heart and increases the change that blockage or rupture of a blood vessel will occur. 7. Type 2 diabetes Mellitus: the risk for CVD is 2-8 times higher in diabetic individuals compared to individuals without diabetes.

6. 1. Elevated cholesterol  Limiting saturated fats 2. Elevated triglycerides  Limiting sugar intake 3. Obesity  Limiting total energy value of diet 4. Hypertension  limiting sodium intake 5. Sedentary lifestyle  regular exercise

7.  LDL Cholesterol: When diet is high in saturated fat, it decreases the removal of the bad cholesterol (LDLs). The high levels of LDL-cholesterol increase our risk of heart disease.  LDL is often called the “bad cholesterol”.

8.  HDL-cholesterol picks up cholesterol and returning it to the liver. The liver takes up the HDLs and the cholesterol they carry, effectively removing it from our circulatory system. Then liver then uses this cholesterol to make bile to assist in fat digestion. High levels of HDL-cholesterol are associated with a lower risk of heart disease.  HDL is often referred to as the “good cholesterol”.

9.  Total cholesterol: -- *Desirable: <200 mg/dl -- *Borderline high: 200-239 mg/dl -- High: > 240 mg/dl  *Optimal LDL Cholesterol: <100 mg/dl  Desirable HDL Cholesterol: >40 mg/dl.

10.  Dietary and lifestyle recommendations: -- Reduce saturated fat, cholesterol, and keep trans fat as low as possible. -- Increase intake of whole grains, fruits, and vegetables. -- Maintain blood glucose within normal range. High blood glucose levels are associated with high triglycerides. -- Small and frequent meals. -- Exercise regularly. -- Maintain a healthy body weight.

11. * Low calorie: 40 calories or less per serving. *Low saturated fat: 1 g or less per serving. *Low cholesterol: 20 mg or less per serving. *Low sodium: 140 mg or less per serving. High fiber: 5 g or more per serving. *Cholesterol Free: Less than 2 mg per serving. **Sodium free: Less than 5 mg per serving.

12.  Priority is given to life-saving measures immediately following a heart attack.  *The goals of diet therapy: -- Reduce the workload of the heart -- Restore and maintain electrolyte balance -- After a brief period of undernutrition, to maintain an adequate nutritional intake.

13.  Diet Therapy:  *-- For the first 24-48 hours after oral feedings are ordered: Clear Liquid Diet.  -- Clear liquid diet  low-residue diet  soft diet  gradual return to regular diet with restriction of sodium, fat, and/or cholesterol for certain patients.  -- 5 to 6 small meals.  -- May restrict sodium and/or fluids.  -- Restrict caffeine.

14.  When counseling heart attack patients regarding diet management, a nurse should: -- Discuss food preparation methods -- Need more information regarding patients’ usual habits -- Explain the importance of weight control.

15.  As with a heart attack, the first measures after a stroke are life-saving, not dietary. Diet Therapy: -- *First 24-48 hours: an IV (intravenous line) is used. Fluids must be restricted if cerebral edema is present. -- Tube feeing after IV therapy if comatose. Oral liquid feedings may begin if conscious.

16.  If patient develops paralysis on one side of the throat, very thick liquids or very soft solids may be necessary to prevent choking on liquids.  -- Eventually, with training, may return to regular diet with restriction in calories, sodium, fat, and/or cholesterol depending on the patient.

17.  Used to reduce the risk for cardiovascular disease.  About two-thirds of the total fat in the U.S. diet is of animal origin and therefore mainly saturated.

18.  *Major features of TLC:  -- reduction in saturated fat and cholesterol intakes. Total fat allowed is 25-35% of total calorie.  -- weight reduction  -- physical activity

19. Dietary sodium restriction is important to treat hypertension and congestive heart failure. Congestive heart failure occurs when the heart fails to pump out the returning blood fast enough, allowing blood to accumulate in the right side of the heart. This raises venous pressure (pressure in the vein from the accumulation of blood), causing fluid retention (edema) in the heart and its associated parts.

20.  Although hypertension is a symptom, not a disease, it is one leading contributor to heart attack and stroke and is also associated with kidney diseases.

21.  Diet factors that may cause hypertension: obesity and excessive use of salt (especially for salt-sensitive individuals).  A low-sodium diet is usually supplemented with drug therapy (antihypertensive medicine). Most antihypertensives contain diuretics. While most diuretics remove water and sodium from the body, some also remove potassium.

22.  *Low-potassium levels are a problem for persons who are taking antihypertensive medicine.  High-potassium foods should be encouraged if hypertensive medicine causes loss of potassium in the urine. Some physicians prescribe special potassium supplements.

23.  1. Stanfield, P., & Hui, Y. (2003). Nutrition and Diet Therapy (Fourth Edition). Sudbury: Jones and Bartlett Publishers.  2. Manore, M., & Thompson, J. (2009). Nutrition: An Applied Approach (2nd Edition). San Francisco: Benjamin Cummings.