NUTRITION of The CARDIOVASCULER SYSTEMSYARIF HUSINBLOK 15

INTRODUCTIONIn United States; 37,3% cause of death, 1 in every 2,7 deaths. Atherosclerosis, ischemic heart disease and hypertension is a risk factor for all others cardiovasculer disease.Determined cardiovasculer disease: hereditary, environmental and lifestyle.Lifestyle: Prevention and treatment of cardiovasculer disase.

A. HYPERTENSIONGoal treatment: 1. Reduction risk of cardiovascular and renal disease.2. Reduction BP to < 140/80 mmHg ( or to 130/80 mmHg with diabetes and cronic renal disease)Plan treatment: weight reduction, physical activity, nutrition therapy, pharmacological intervention.

NUTRITION THERAPYLifestyle modification and nutrition therapy.Increased physical activitySmoking cessationWeight lossReduction of sodium and alcohol

NUTRITION INTERVENTIONSDecrease sodium, saturated fat and alcohol.Increase calsium, potassium and fiber : efectife lowering of BP.Sodium restriction reduce incidence Cardiovascular Disease, Renal Disease and Stroke.

INCREASED PHYSICAL ACTIVITY DASH : Recommended 30-60 min of aerobic minimum four days per week

SMOKING CESSATION To achieve success, the smoker should also be able to identify his or her reasons for quitting

WEIGHT LOSSWeight loss of greater than 5 kg reduced both diastolic and systolic.An approximate 20 lb weight loss will result in lowered systolic.Waist circumference: independent predictor of hypertension risk.BMI > 35 risk factor.

REDUCTION SODIUMThe Dietary Guidelines for Americans recommend an intake of less than 2300 mg of sodium, equivalent 6 g sodium chloride.Terapy hypertension: Mild: 1,5 2,5 g Na (3,75 6,25 gNaCl) Moderate: 0,5-1,5 g Na (1,25 - 3,75g NaCl) Severe: < 0,5 g Na ( < 1,25 g NaCl)

EFFECTS of LIFESTYLE MODIFICATION to MANAGE HYPERTENSIONRECOMMENDATION

Weight reduction (BMI 18,5-24,9).Diet rich fruits, vegetables and low fat.Intake sodium 2,4 g ( 6 g sodium chloride)Aerobic (walking) 30 min/day.

AVERAGE SYSTOLIC REDUCTION5 20 mmHg/10 Kg

8 14 mm Hg

2 - 8 mmHg

4 9 mm Hg

B. ATHEROSCLEROSIS Thickening of the blood vessel walls specifically caused by the presence of plaque.

RISK FACTORSFamily historyAgeSexObesityDyslipidemia

HypertensionDiabetesPhysical inactivitySmoking

ALTERABLE RISK FACTORSObesityDyslipidemiaHypertensionPhysical inactivityAtherogenic dietSmoking

OBESITYRisk factor of atherosclerosisWaist circumference : Men >102 cm Women > 88 cm.Abdominal fat and insulin resistanceHypothyroidism leading to obesity : risk of atherosclerosisPoorly managed hypothyroidism : greater progression of coronary atherosclerosis

INCREASING PHYSICAL ACTIVITYLowering blood pressure and triglycerides.Increasing HDLImproving endothelial fucntionDecreasing platelet aggregation

ATHEROGENIC DIET Westernized diet : high saturated fat and low fiber. Indonesian diet ?

SMOKERSHigher levels of serum cholesterol, triglycerides and LDL cholesterol.Lower HDL cholesterolEndothelial dysfucntion, inflammation and modification of lipidsNitric oxide : endothelial relaxasion.Inflammatory : increased leukocyte count and proinflammatory cytokines

C. ISCHEMIC HEART DISEASENurition Implications Immediate medical care after MI strives to reduce pain, stabilize cardiac function and when appropriate, begin the rehabilitation post MI. Nutrition therapy after MI will be consistent with these medical goal.

ISCHEMIC HEART DISEASE Nutrition interventions Many institutions treatment protocols limit initial oral intake to clear liquids with out caffeine in order to prevent arrytmias and to decrease risk of vomiting or aspiration.Oral diets usually progress from liquids to soft, easily chewed foods with smaller, more frequent meals.Therapy lifestyle.

D. HEART FAILURE Nutrition implicationsNutritional care during CHF is difficult.Nutritional therapy that restricts both sodium and fluid is crucial to control acute symptoms and may assist with reducing with the overall work of the heart.Difficulty eating and cardiac cachexia.

CACHEXIA in HFCachexua in HF include myocardial nutrient deficiencies of:L-carnitineCoenzyme Q10CreatineThiamineTaurine

Nurition interventionsRestrictions sodium and fluid.Correction of nutrient deficiencies.Nutrition education for increasing nutrient density and making food choice that enhance oral intake. Sodium 2000 mg (Standard initial recommendation).Fluid requirement 1 ml/kcal or 35 ml/Kg BB.

E. STROKE and ANEURYSMEnteral nutrition support will be necessary if an oral diet cannot meet nutritional needs.Evidence support early initiation of nutritional support to prevent complications, reduce hospital stay and promote rehabilition.