Heart Diseases & Dietary Intervention &

Recommendations in the Prevention of Heart Disease

By Dr vinayak s hiremath

Postgraduate Internal MedicineMRMC,GULBARGA

Life Style Associated diseases●Coronary Artery disease●Cerebrovasular disease●Peripheral Vascular disease●Obesity●Hypertension●Diabetes●Cancers●Osteoporosis

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

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

Anatomy of the Heart

Figure 15.4

• Can Anyone Tell Me the Difference Between a Heart Attack and a Stroke????????

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

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.

What Causes Heart Disease?

• Atherosclerosis-fatty deposits of cholesterol

• Hypertension

• Arteries—blood vessels that carry blood away from the heart to the rest of the body

Normal Artery

What Causes Heart Disease/Stroke?

Plaque Starts to Build Up

Tear in Artery Wall

Tear in Artery Wall

Plaque Can Grow and Harden and Obstruct the Artery

Tear in Artery Wall

Tear in Artery Wall

Atherosclerosis

Ischemic Stroke

Heart Attack

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

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!

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

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.

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.

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

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

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

Common Blood Vessel Disorders

Figure 15.6

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.

Unchangeable Risk Factors

• Personal Medical History- other diseases such as Diabetes Mellitus can increase chances.

Changeable Risk Factors

• Hypertension• Serum cholesterol• Obesity• Diabetes Mellitus• Physical Inactivity• Cigarette Smoking• Alcohol Intake

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.

Types of Cholesterol

Lipoproteins- 4 main classes• Chylomicrons• Very low density lipoproteins (VLDL)• Low Density Lipoprotein (LDL)• High Density Lipoprotein (HDL)

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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!

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

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

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

• 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

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)

• 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)

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

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)

The FITT formula:• F=frequency (days/week)• I=intensity (how hard—easy, moderate)• T=time• T=type

Step 3: Stay Physically Active (cont’d)

Manage Stress

• 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

Stress Warning Signs

• 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

• 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

• 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

• 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)

Who Benefits From Eating

Heart Healthy?

The Entire Family!

Step 7: Eat Heart Healthy

• Learn to read food labels

Knowledge is power! What should I look for?

Step 7: Eat Heart Healthy (cont’d)

Start Here

Limit These Nutrients

Get Enough of These Nutrients

% DV=Percent Daily Value

• 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?

• 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

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)

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.

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.

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.

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.

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

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.

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)

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

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

Cardiac Rehabilitation

• Every year, 1 million people survive heart attacks

• Cardiac rehabilitation exercise training increases stamina and strength, and promotes recovery

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.

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.

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.

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).

Conclusion

• Cardiovascular disease is the number one killer.

• It is highly preventable and controllable with diet and exercise.