2. Nutrition & Heart Disease

3. Key Concepts and Facts Heart disease is leading cause of death Dietary and lifestyle factors are important Diets that provide some “healthy fats” decrease heart disease risk more than low fat, high carbohydrate diets Lowering high blood cholesterol levels reduces risk of heart disease

4. Heart disease is the leading cause of death for both men and women. About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Fig. 19-2, p. 3

5. Average age of first heart attack is 64.7 years for men and 72.2 years for women.

6. Risk of Cardiovascular Disease

7. Fig. 19-6, p. 4

8. Fig. 19-3a, p. 3

9. Atherosclerosis

10. Fig. 19-3b, p. 3

12. Fig. 19-4, p. 4

13. CAN THESE BE SYMPTOMS OF RISK OF HEART DISEASE?

15. Xanthomas– fat deposits

16. Total Cholesterol: Not the whole story Harvard Health News

17. Fig. 19-8, p. 6

18. FOCUS ON BLOOD LIPIDS HDL helps remove cholesterol from the blood HDL carries cholesterol to the liver for excretion High HDL (> 50 mgm/dl for women, >40 in men) protects against CVD LDL cholesterol incorporated into plaque Higher the LDL level, more likely atherosclerosis will develop and progress to heart disease

19. Triglycerides and CVD Risk High levels increase heart disease risk Elevated triglycerides are one symptom of metabolic syndrome Also low HDL cholesterol Elevated fasting glucose Abdominal obesity High blood pressure, low HDL People with metabolic syndrome are at particularly high risk for heart disease

20. Other Factors: Folate and Homocysteine High blood levels of homocysteine, an amino acid, increase plaque formation Folate is required to convert the amino acid homocysteine to methionine, reducing homocysteine in the blood.

21. Harvard Health News There is some evidence that B vitamins, including folic acid, B 6, and B 12, may help lower blood levels of a substance called homocysteine The risk of heart attack or death from heart disease was nearly halved among women who consumed the most folic acid and B6 from diet and supplements compared with those who consumed the least.

22. Folate, B6 and B12 One meta-analysis showed that consumption of 400 mgm folic acid in fortified foods or supplements reduced homocysteine by 25% When folic acid was combined with vitamin B12, homocysteine levels sank another 7%

23. Since 1998 refined grain products like bread, crackers, pasta, and rice have been fortified with folic acid.

24. Oxidation and Chronic Inflammation Oxidation causes damage to endothelium (cells lining arteries) Inflammation increases plaque formation Table 19-1 Foods that reduce oxidation and chronic inflammation Fish, seafood Nuts Tea, coffee Most fruits and vegetables Wine Whole grains, high-fiber foods Vegetable oils Textbook correction: p. 19-7 line 20: change to “other components of foods that reduce oxidation…”

25. DHA and EPA Fatty fish from cold waters are sources of DHA and EPA Omega-3 fatty acids protect against heart disease by: decreasing blood clotting decreasing blocked arteries decreasing plaque build-up decreasing blood pressure decreasing blood triglyceride levels

26. Nuts Nut consumption decreases risk of CVD Nuts have good fats that lower LDL 1 oz of nuts a day decreases LDL 1 oz has ~200 calories FDA approved “heart healthy” claim for nuts and products made from them

27. A recent detailed analysis of 84 of the best studies looking at the alcohol and heart connection included more than two million men and women followed for an average of 11 years. Compared to people who didn’t drink alcohol, those who were moderate drinkers had arecent detailed analysis 29% lower risk of being diagnosed with coronary artery disease 25% lower risk of dying from a heart attack 25% lower risk of dying from any heart or blood vessel disease 13% lower risk of dying from any cause (this included cancer deaths, too)

28. Special Spreads Spreads with plant stanols lower blood cholesterol levels by blocking cholesterol absorption Daily consumption of two tbsp of spread with plant stanols or sterols causes 10% drop in cholesterol level and 14% decline in LDL concentration Blood levels of HDL are not affected Spreads are one more tool for lowering high blood cholesterol levels

29. Fruits, Veggies, Whole Grains….Fiber ! High intake of dietary fiber has been linked to a lower risk of heart disease in a number of large studies that followed people for many years. (Harvard Studies) Study of over 40,000 male health professionals, a high total dietary fiber intake was linked to a 40 percent lower risk of coronary heart disease. A related Harvard study of female nurses produced similar findings.

30. When Blood Lipids Are High Total cholesterol is sum of the levels of LDL-, HDL-, and VLDL-cholesterol Dietary recommendations: specific types of fat and foods that lower levels of LDL and triglycerides, and raise levels of HDL adequate intake of folate, and vitamins B 6 and B 12 are recommended to decrease elevated homocysteine levels

31. Fig. 19-9, p. 9

32. Reduce LDL Limit saturated fat intake to less than 7% of total calories Exclude processed foods that contain trans fats Increase monounsaturated fats, not polyunsaturated fats Increase whole grain products, fiber, vegetables, fruits, soy protein foods, and plant stanols that lower LDL without decreasing HDL levels

33. Increase HDL Levels vigorous exercise eliminate trans fats weight loss soy and nuts in the diet moderate alcohol Harvard Health

34. If Blood Lipids are still too high Cholesterol-lowering drugs if blood lipid changes achieved by diet and lifestyle improvements are insufficient

35. Statins Statins (Lipitor, Zocor, and Mevacor) markedly reduce cholesterol production in the liver Use related to a 30% drop in LDL levels and a 30-40% reduction in heart attack and stroke in both women and men Statins improve blood lipids levels more when combined with dietary and lifestyle changes than when used alone

36. Statins Side effects such as muscle pain and weakness, liver disease, and kidney failure Expense Cost and side effects have prompted alternatives like extreme cholesterol- lowering diets Therapeutic diets can lower LDL and keep statin dose as low as possible

37. Diet, Lifestyle & CVD Many factors in heart disease Prevention & Treatment need to be broad Include heart-healthy diet or therapeutic diet reduction of high blood pressure body weight drugs smoking cessation Goals: improved overall health and blood lipid profiles

38. Fig. 19-10, p. 10

39. The Future Prevention and treatment of heart disease has changed in recent years and will continue to evolve Concerns about the cost of cholesterol lowering drugs and side effects, and availability of low-cost preventive and treatment will affect these changes Diet and lifestyle modification, changes in food supply, & increased consumer involvement in risk reduction may lead to decline in heart disease An end to obesity and physical inactivity would also serve our hearts well