chapter 019

Williams' Basic Nutrition & Diet Therapy

Chapter 19

Coronary Heart Disease and Hypertension

Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 1

14th Edition

Lesson 19.1: Cardiovascular Disease

Cardiovascular disease is the leading cause of death in the United States.

Several risk factors contribute to the development of coronary heart disease and hypertension, many of which are preventable by improved food habits and lifestyle behaviors.

Other risk factors are nonmodifiable, such as age, gender, family history, and race.

2Copyright © 2013 Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Introduction (p. 379)

Coronary heart disease Leading cause of death in the United States More than 615,000 deaths each year Similar in other Western developed nations More than 1 million live with various forms of

rheumatic and congestive heart disease


Atherosclerosis (p. 379)

Major cause of CVD Fatty fibrous plaques develop into fatty streaks on

inside lining of major blood vessels Plaques largely composed of cholesterol Narrows interior part of the blood vessel If affected vessel is major artery supplying heart

muscle, result could be myocardial infarction Local area of dead tissue is an infarct


Atherosclerosis (cont’d) (p. 379)

If affected vessel is major artery supplying brain, result could be cerebrovascular accident


Atherosclerosis (cont’d) (p. 379)

Identified as coronary heart disease Common symptom is angina pectoris, chest pain

usually radiating down the arm, sometimes brought on by excitement or physical effort


Key Terms Related to Atherosclerosis (p. 380)

Myocardial infarction Cerebrovascular accident Coronary heart disease Angina pectoris Lipids


Atherosclerotic Plaque (p. 381)


Relation to Fat Metabolism(p. 381)

Elevated blood lipids associated with coronary heart disease Triglycerides: Simple fats in body or food Cholesterol: Fat-related compound produced in

body; also in foods from animals Lipoproteins: “Packages” wrapped with protein

that carry fat in the bloodstream


Types of Lipoproteins (p. 381)

Chylomicrons Lipoprotein particles that carry absorbed dietary triglycerides

to fat and tissues Very-low-density lipoproteins (VLDLs)

Carry large load of fat to cells Intermediate-density lipoproteins (IDLs)

After VLDLs deposit triglycerides, IDLs remain in circulation Low-density lipoproteins (LDLs)

Carry two thirds of total plasma cholesterol to body tissues High-density lipoproteins (HDLs)

Carry less total fat and more protein


Cholesterol and Lipoprotein Profile (p. 383)


Risk Factors (p. 382)

Gender: CVD more common in men until women reach menopause

Age: risk increases with age Family history Heredity: certain ethnic groups Compounding diseases: type 2 diabetes,

hypertension, metabolic syndrome Blood cholesterol profile: high total and LDL and low

HDL cholesterol


Case Study

Mr. Elliott is a 68-year-old male who is referred to the dietitian for a fat-controlled meal plan. Mr. Elliott is 5 feet 10 inches tall and weighs 250 lbs. His blood pressure is 155/95. Recent labs reveal a total cholesterol of 245 mg/dL, LDL 171 mg/dL, HDL 36 mg/dL, and TG 200 mg/dL.


Case Study (cont’d)

List Mr. Elliott’s risk factors for heart disease. Which risk factors can be modified? What additional information would be helpful to look

at risk factors?



What other lab value and assessment data would you consider in assessing Mr. Elliott? Why?


Dietary Recommendations(p. 383)

Dietary recommendations for reduced risk Reduce fat and cholesterol National Cholesterol Education Program (NCEP): reduce

high blood cholesterol Therapeutic Lifestyle Changes (TLC):

• Total energy intake equals energy expenditure• Exercise to expend at least 200 kcal/day• Total fat no more than 25% to 35% of intake• Avoid trans-fatty acids• Carbohydrates equal 50% to 60% of energy intake• Protein equals about 15% of energy intake• Total cholesterol intake less than 200 mg/day


Drug Therapy (p. 386)

NCEP ATP III guidelines: drug therapy initiated depending on risk factors

TLC guidelines should be continued as adjunct therapy



Discuss interventions that could assist Mr. Elliott in reducing his cardiovascular risk.


Acute Cardiovascular Disease(p. 387)

Acute cardiovascular disease: myocardial infarction Cardiac rest: analgesics Principles of medical nutrition therapy

• Energy intake reduced to reduce load on heart• Soft or easily digested foods• Fat: Mediterranean-type diet• Limited sodium


Heart Failure (p. 388)

Objective: control of pulmonary edema Fluid shift mechanism Hormonal alterations

Principles of diet therapy Sodium restriction Fluid restriction Texture Nutritional adequacy Little or no alcohol


Lesson 19.2: Hypertension

Hypertension, or chronically elevated blood pressure, may be classified as essential (primary) or secondary hypertension.

Hypertension damages the endothelium of blood vessels.

Early education is critical for the prevention of cardiovascular disease.


Essential Hypertension (p. 389)

Incidence and nature 31% of American adults have high blood pressure

(hypertension) Injury to inner lining of blood vessel wall appears

to be underlying link to cause Secondary hypertension is symptom or side effect

of another primary condition Hypertension called the “silent disease”


Hypertensive Blood Pressure Levels (p. 390)

Prehypertension: focus on lifestyle modifications Stage 1 hypertension: diet therapy and drugs as

needed Stage 2 hypertension: diet therapy and vigorous drug

therapy



What stage of hypertension does Mr. Elliott have?


Principles of Medical Nutrition Therapy (p. 391)

Weight management: lose excess weight and maintain healthy weight

Sodium control: limit sodium to 1500 to 2400 mg/day DASH diet: lower blood pressure through diet alone Additional lifestyle factors: limit alcohol, stop

smoking, reduce saturated fat, increase aerobic activity



Discuss additional nutrition factors that may assist Mr. Elliott in controlling his blood pressure.


Education and Prevention(p. 393)

Food planning and purchasing Control energy intake; read labels Eat fresh foods with small selection of processed

foods Food preparation

Use less salt and fat Use seasonings instead (herbs, spices, lemon,

onion, garlic, etc.) Special needs

Personal desires, ethnic diets, food habits


Education Principles (p. 396)

Start early Prevention begins in childhood, especially with

children in high-risk families Focus on high-risk groups

Direct education to people and families with risk of heart disease and hypertension

Use variety of resources National organizations, community programs,

registered dietitians


chapter 019

Health & Medicine