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Heart Diseases & Dietary Intervention &
Recommendations in the Prevention of Heart Disease
By Dr vinayak s hiremath
Postgraduate Internal MedicineMRMC,GULBARGA
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Life Style Associated diseases●Coronary Artery disease●Cerebrovasular disease●Peripheral Vascular disease●Obesity●Hypertension●Diabetes●Cancers●Osteoporosis
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Types Of Cardiovascular Disease
• Atherosclerosis• Coronary heart disease (CHD)• Chest pain (angina pectoris)• Irregular heartbeat (arrhythmia)• Congestive heart failure (CHF)• Congenital and rheumatic heart disease• Stroke
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cardiovascular diseases are leading cause ofdeath -worldwide
• Coronary disease -7.2 million• Cancer - 6.3 million• Cerebrovascular disease- 4.6• Acute lower respiratory tract infections- 3.9• Tuberculosis -3.0• COPD (chronic obstructive pulmonary disease) 2.9• Diarrhoea (including dysentery) -2.5• Malaria -2.1• AIDS- 1.5• Hepatitis -B 1.2
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Anatomy of the Heart
Figure 15.4
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• Can Anyone Tell Me the Difference Between a Heart Attack and a Stroke????????
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Stroke vs Heart Attack
• Stroke—blocked blood flow to the brain
• Heart attack—blocked blood flow to the heart
• Risk factors are the same for both
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What is Heart Disease?
• A general term that covers a number of diseases which affect the heart, including coronary artery disease, heart-failure and angina.
• Heart Disease is the number one killer in the world.
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What Causes Heart Disease?
• Atherosclerosis-fatty deposits of cholesterol
• Hypertension
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• Arteries—blood vessels that carry blood away from the heart to the rest of the body
Normal Artery
What Causes Heart Disease/Stroke?
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Plaque Starts to Build Up
Tear in Artery Wall
Tear in Artery Wall
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Plaque Can Grow and Harden and Obstruct the Artery
Tear in Artery Wall
Tear in Artery Wall
Atherosclerosis
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Ischemic Stroke
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Heart Attack
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Artherosclerosis
• Characterized by deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of the artery
• Hyperlipidemia – abnormally high blood lipid level
• Plaque – the buildup of deposits in the arteries
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Coronary Artery Disease
Occurs when the coronary arteries that supply the heart muscle become blocked.
• Partially blocked it causes angina.
• Fully blocked it causes a myocardial infarction or a heart attack!
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Myocardial Infarction or
Heart Attack
• Symptoms: uncomfortable pressure, fullness, squeezing pain, pain spreading to the shoulders, neck and arms.
• Chest discomfort and light headedness• Anxiety/nervousness• Paleness or pallor• Increased irregular heart rate
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Congestive Heart Failure
• Fits under the description of heart disease.• Does not mean the heart has failed, simply
means the heart is not doing an efficient job. • It results from an injury or a reduction of
function of the heart muscle.• Can be due to arteriosclerosis, hypertension,
myocardial infarction, rheumatic fever or birth defect.
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Congestive Heart Failure
• The right side of the heart collects the blood returning from the body and sends it to the lungs.
• If it is failing, the blood backs up into the veins, and there are signs of edema.
• The left side of the heart receives the blood from the lungs and pumps it out into the body. If it is failing the blood is not pumped effectively.
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Angina Pectoris
• Ischemia – reduction of the heart’s blood and oxygen supply
• The more serious the oxygen deprivation the more severe the pain
• Nitroglycerin – drug used to relax (dilate) the veins
• Beta blockers control potential overactivity of the heart muscle
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Arrythmias
• An irregularity in heart rhythm• Tachycardia – racing heart in the absence of
exercise or anxiety• Bradycardia – abnormally slow heartbeat• Fibrillation – heart beat is sporadic, quivering
pattern
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Congenital And Rheumatic Heart Disease
• Congenital heart disease affects 1 out of 125 children born
• May be due to hereditary factors, maternal diseases, or chemical intake (alcohol) during fetal development
• Rheumatic heart disease results from rheumatic fever which affects connective tissue
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Common Blood Vessel Disorders
Figure 15.6
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Unchangeable Risk Factors
• Age- the older you get, the greater the chance.
• Sex- males have a greater rate even after women pass menopause.
• Race- minorities have a greater chance.• Family history- if family members have had
CHD, there is a greater chance.
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Unchangeable Risk Factors
• Personal Medical History- other diseases such as Diabetes Mellitus can increase chances.
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Changeable Risk Factors
• Hypertension• Serum cholesterol• Obesity• Diabetes Mellitus• Physical Inactivity• Cigarette Smoking• Alcohol Intake
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Cholesterol
• Everybody needs cholesterol, it serves a vital function in the body.
• It is a component of the nerve tissue of the brain and spinal cord as well as other major organs.
• Frequently measured to promote health and prevent disease.
• A major component of the plaque that clogs arteries.
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Types of Cholesterol
Lipoproteins- 4 main classes• Chylomicrons• Very low density lipoproteins (VLDL)• Low Density Lipoprotein (LDL)• High Density Lipoprotein (HDL)
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Good vs. BAD
• LDL is known as bad cholesterol. It has a tendency to increase risk of CHD.
• LDL’s are a major component of the atherosclerotic plaque that clogs arteries.
• Levels should be <130
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Good vs. BAD
• HDL is known as the good cholesterol.• It helps carry some of the bad cholesterol out
of the body. • It does not have the tendency to clog arteries.• Levels should be >35.• High levels of HDL >60 can actually negate one
other risk factor.
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The Facts About Fat
• Certain fats are essential for good nutrition and health.
• Fats provide essential fatty acids which the body can’t manufacture.
• Act as insulators to maintain body temperature.
• Improve the palatability of food and promote digestion.
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The Facts About Fat
• Provide the greatest energy output per gram of any food source. ( 9 cals)
• Carry fat soluble vitamins- A,D,E, and K.
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The Skinny on Fat
• Saturated fats- basically means the fat is saturated with hydrogen, they are solid at room temperature. Examples are lard and butter.
• Why are they bad for you? They increase levels of LDL , decrease HDL and increase total cholesterol.
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The Skinny on Fat
• What are polyunsaturated fats? They are unsaturated fats which are liquid at room temperature and in the refrigerator.
• Why are they good for us?• They help the body get rid of newly formed
cholesterol.
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The Skinny on Fat
• What are monounsaturated fats? • They are liquid at room temperature but start
to solidify in the refrigerator.• Decrease total cholesterol and lower LDL
levels.
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The Skinny on Fat
• What are trans fatty acids? They are unsaturated fats but they tend to raise total and bad cholesterol.
• Where do you find them?• In fast-food restaurants• Commercial baked goods. Examples:
doughnuts, potato chips, cupcakes.
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What about Omega 3?
• Type of polyunsaturated fat.• Consistently lowers serum triglycerides and
may also have an effect on lowering blood pressure.
• Found in oily fish such as salmon, tuna, and herring.
• Is available as a supplement.
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Associations between the percent of calories derived from specific foods and CHD mortality in the 20 Countries Study*
Butter 0.546All dairy products 0.619Eggs 0.592Meat and poultry 0.561Sugar and syrup 0.676Grains, fruits, and starchy -0.633and nonstarchy vegetables
Food Source Correlation Coefficient†
*1973 data, all subjects. From Stamler J: Population studies. In Levy R: Nutrition, Lipids, and CHD. New York, Raven, 1979. †All coefficients are significant at the P<0.05 level.
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Obesity
• People who are obese have 2 to 6 times the risk of developing hypertension.
• Location of the body fat is significant.• Pears of apples?
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Diabetes Mellitus
• At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of atherosclerosis!
• Insulin is required to maintain adequate levels of lipoprotein lipase, an enzyme needed to break down bad cholesterols.
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Physical Inactivity
• Increasing physical activity has been shown to decrease blood pressure.
• Moderate to intense physical activity for 30-45 minutes on most days of the week is recommended.
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Cigarette Smoking
• Causes an increase in blood pressure• Usually have lower levels of HDL• Within 1 year of quitting, CHD risk decreases,
within 2 years it reaches the level of a nonsmoker.
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Alcohol Consumption
• In small amounts it acts as a vasodilator-Good! 1-2 drinks
• In large amounts it acts as a vasoconstrictor-BAD! 3-4 drinks
• This is a very fine line!
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Women And Cardiovascular Disease
• 2003, CVD deaths– 426,800 men– 483,800 women
• Estrogen– Once estrogen production stops, risk for CVD death
increases• Diagnostic and therapeutic differences
– Delay in diagnosing possible heart attack– Complexity in interpreting chest pain in women– Less aggressive treatment of female heart attack victims– Smaller coronary arteries in women
• Gender bias in CVD research – typically CVD research has been conducted on male subjects
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1. Know your numbers:– Cholesterol (LDL=lousy, HDL=healthy)– Triglycerides– Blood pressure– Blood glucose
2. Maintain a healthy weight3. Stay physically active4. Manage stress5. Do not smoke6. Do not drink alcohol excessively7. Eat heart healthy
HDL=high-density lipoprotein, LDL=low-density lipoprotein
7 Steps to a Healthier You
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Do You Know?• Your total cholesterol—under 200
– HDL—60 or higher (less than 40 milligrams (mg)/deciliter (dL) increases risk)
– LDL—under 100 mg/dL• Your triglycerides—less than 150
mg/dL• Your blood pressure—less than
120/80• Fasting blood glucose—less than
100 mg/dLKnowledge Is Power, So Learn and
Live!
Step 1: Know Your Numbers
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• Blood pressure• Cholesterol level• Triglyceride level• Blood sugar level• Risk for developing type 2 diabetes
If overweight, take action to lose weight to improve your overall health and lower your:
Step 2: Maintain a Healthy Weight
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Body Mass Index (BMI)
Underweight <18.5Normal Weight 18.5-24.9
Overweight 25-29.9Obesity 30+
Step 2: Maintain a Healthy Weight (cont’d)
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• Weight loss:– Reduces risk for cardiovascular disease– Lowers blood pressure– Lowers blood sugar– Improves lipid levels
Source: Office of Surgeon General. http://www.surgeongeneral.gov/topics/obesity/calltoaction/1_6.htm.
Benefits of Weight Loss (cont’d)
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ACSM and AHA Recommendations:• Do moderately intense cardio
30 minutes/day, 5 days/week OR• Do vigorously intense cardio
20 minutes/day, 3 days/week AND• Do 8 to 10 strength-training
exercises, 8 to 12 repetitions of each exercise, twice/week ACSM=American College of Sports Medicine, AHA=American Heart
Association
Step 3: Stay Physically Active
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Staying physically active can reduce your:
• Blood pressure• Cigarette smoking• Diabetes• Extra body weight in the overweight/obese• Triglyceride level
Step 3: Stay Physically Active (cont’d)
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The FITT formula:• F=frequency (days/week)• I=intensity (how hard—easy, moderate)• T=time• T=type
Step 3: Stay Physically Active (cont’d)
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Manage Stress
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• If left unmanaged, stress can cause emotional, psychological, and physical problems (heart disease, high blood pressure, chest pain, and irregular heart beat)
• Stress also may cause you to overeat, exercise less, and possibly smoke more
• You can think yourself into clinical depression
Step 4: Manage Stress
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Stress Warning Signs
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• Identify the stressor first• Avoid hassles and minor irritation, if
possible• Try to continue doing the things that
you enjoyed before the change that caused stress occurred in your life
• Learn how to manage your time efficiently
• Do one thing at a time• Learn to take a break• Ask for help when you need it
Tips to Reduce Stress
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• If you do smoke, stop• Support is available:
– 800-ACS-2345 (American Cancer Society) – 800-QUIT-NOW (US Dept of Health and
Human Services) or http://1800quitnow.cancer.gov
– 877-448-7848 (National Cancer Institute) or www.cancer.gov/cancertopics/smoking
Step 5: Do Not Smoke
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• But I heard alcohol is good for the heart!
– Doctors do not recommend it• Moderate drinking is defined as:
– No more than one drink/day for women– No more than two drinks/day for men
• Drinking more than three drinks/day has a detrimental effect on the heart
Step 6: Do Not Drink Alcohol Excessively
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• One drink is equal to:– 12 fluid ounces (fl oz) of beer or wine
cooler– 5 fl oz of wine– 1.5 fl oz of 80-proof liquor
Step 6: Do Not Drink Alcohol Excessively (cont’d)
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Who Benefits From Eating
Heart Healthy?
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The Entire Family!
Step 7: Eat Heart Healthy
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• Learn to read food labels
Knowledge is power! What should I look for?
Step 7: Eat Heart Healthy (cont’d)
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Start Here
Limit These Nutrients
Get Enough of These Nutrients
% DV=Percent Daily Value
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• Reduce your calories if you are overweight and want to lose weight:– Calories are the energy in food that
contribute to weight loss and weight gain– 1 pound of fat=3500 calories
Why Reduce Calories?
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• Eat breakfast• Keep regular mealtimes• Look for lower-fat alternatives• Drink enough fluids (water)• Focus on fruits and vegetables• Choose lean meats and skim dairy
products• Limit extra sugars to 40 grams (g)/day
or 10 teaspoons (tsp)/day
• Eat slowly• Practice potion control
Ways to Reduce Calories
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How can You Stop CVD?
Diet and Nutrition, there are several guidelines listed by the American Heart Association:
• Eat a variety of fruits and vegetables every day. ( 5 servings - they are naturally low in fat and high in vitamins and minerals)
• Eat a variety of grain products ( 6 a day)
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Diet and Prevention of CVD
• Choose nonfat or low-fat products.• Use lean meats- choose chicken, fish, turkey
and lean cuts of beef and pork.• Switch to fat-free milk- gradually reduce the
fat content of the milk you drink.
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Dietary Guidelines
• Choose fats with 2 gms or less of saturated fats per serving such as liquid and tub margarines, canola oil and olive oil.
• Balance the # of calories you eat with the number of calories you use each day.
• Maintain a level of physical activity that keeps you fit and matches the # of calories you eat.
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Dietary Guidelines
• Limit your intake of foods high in calories and low in nutrition, including foods like soft drinks and candy.
• Limit foods high in saturated fat, trans fat and cholesterol
• Eat less than 6 gms of salt a day• Have no more than one alcoholic drink a day.
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Step I and II Diets
• The AHA and NCEP have developed these diets to treat high blood pressure and hypercholesterolemia
• They are designed to lower LDL levels, while at the same time promoting good nutrition.
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Step I Step II
• Total fat- 30% or less• Sat fat- 7-10%• Poly - up to 10%• Mono Up to 15%• Carb 55% or more• Pro Approx 15%• Chol. less than 300mg
• 30% or less• 7%• up to 10%• up to 15%• 55% or more• Approx 15%• less than 200 mg
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Exercise and CVD
• Serves several functions in preventing and treating those at high risk.
• Reduces incidence of obesity.• Increases HDL• Lowers LDL and total cholesterol• Helps control diabetes and hypertension• Those at high risk should take part in a
specially supervised program.
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other Weapons Against Heart Disease
• Techniques for diagnosing heart disease– Electrocardiogram (ECG)– Angiography– Positron emission tomography (PET)– Single positron emission color tomography
(SPECT)– Radionuclide imaging– Magnetic resonance imaging (MRI)– Ultrafast CT– Digital cardiac angiography (DSA)
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Angioplasty Versus Bypass Surgery
• Angioplasty – a thin catheter is threaded through the blocked arteries. The catheter has a balloon on the tip which is inflated to flatten the fatty deposits against the wall of the artery
• Coronary bypass surgery – a blood vessel is taken from another site and implanted to bypass blocked arteries and transport blood
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Thrombolysis
• If victim reaches an emergency room and is diagnosed quickly, thrombolysis can be performed
• Thrombolysis involves injecting an agent such as tissue plasminogen activator (TPA) to dissolve the clot and restore some blood flow
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Cardiac Rehabilitation
• Every year, 1 million people survive heart attacks
• Cardiac rehabilitation exercise training increases stamina and strength, and promotes recovery
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Los Angeles VA study
• 846 men in Veterans Home, 5-8 years• Groups randomized to diets in which 2/3 of fat
given either as vegetable oil (corn, cottonseed, safflower, soybean) or animal fat
• Saturated fat 11% vs. 18%, polyunsaturated fat 16% vs. 5% of calories
• 31% decrease in CVD endpoints
Dayton et al. Circulation 1969; 40:1.
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Lyon Diet Heart study
• 302 men and women with CHD• Treatment group randomized to low saturated
fat, high canola oil margarine (5% alpha linolenic, 16% linoleic, and 48% oleic acid, also 5% trans)
• 46 month follow-up• 65% lower CHD death rate in treatment group
(6 vs. 19 death)
de Lorgeril et al. Circulation 1999; 99:779-785.
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Benefits of fish oil supplementation
• In the Diet and Reinfarction Trial (DART) in 2033 men with CHD increased intake of fish or use of 2 fish oil caps/day reduced CHD mortality 29% over 2 years
• In GISSI 11324 men and woman with CHD use of 1 gr. of n-3 PUFA decreased CVD events including mortality 15%
Lancet 1989; 2;757-761, and 1999; 345:447-455.
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Nuts, Soy, Phytosterols, Garlic• Nurses’ Health Study: five 1oz servings of nuts per
week associated with 40% lower risk of CHD events• Metaanalysis of 38 trials of soy protein showed 47g
intake lowered total, LDL-C, and trigs 9%, 13%, and 11%
• Phytosterol-supplemented foods (e.g., stanol ester margarine) lowers LDL-C avg. 10%
• Meta-analysis of garlic studies showed 9% total cholesterol reduction (1/2-1 clove daily for 6 months).
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Conclusion
• Cardiovascular disease is the number one killer.
• It is highly preventable and controllable with diet and exercise.
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