Cardioprotective Diet for CHD Flashcards by Carla Ferrusca

Explain coronary heart disease (CHD)

A disease of the blood vessels supplying the heart muscle, loss of oxygen to part of the heart, angina, myocardial infarction, and heart failure. Ischaemic heart disease. Build-up of fatty substances in the coronary arteries.

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Explain cerebrovascular disease

A disease of blood vessels supplying the brain; loss of oxygen to the brain, stroke.

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Explain Peripheral artery disease

A disease of blood vessels supplying the arms and legs; loss of oxygen to the extremities (usually fingers or feet).

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Explain Rheumatic heart disease

Damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria.

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Explain congenital heart disease

Birth defects that affect the normal development and functioning of the heart caused by malformations of the heart structure from birth

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Explain deep vein thrombosis and pulmonary embolism

Blood clots in the leg veins, which can dislodge and move to the heart and lungs.

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Explain valve disease and congenital heart disease

Heart deformities which are present at birth

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What causes CHD?

Gradual build-up of fatty deposits inside the walls of the coronary arteries. This can cause the artery to narrow, reducing blood and oxygen supply to the heart muscle.

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What are the two main forms of CHD?

Angina and heart attack

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What is CHD Angina?

It is the pain or discomfort in the chest that results from the narrowing of the coronary artery. In some people, the pain may affect only the arm, neck, stomach or jaw. Angina is often brought on by physical activity.

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Explain how does a heart attack occurs

It occurs when a piece of fatty deposit breaks away from the artery wall and forms a blood clot. This may block the artery, starving the heart muscle of blood and oxygen. A heart attack can be fatal.

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What is atherosclerosis?

When the walls of the arteries become furred up with fatty deposits.

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What is the name of the fatty deposits in atherosclerosis?

Atheroma

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What are the causes of atherosclerosis?

High cholesterol and triglyceride levels
High blood pressure
Smoking
Type 1 diabetes
Obesity
Physical inactivity
High saturated fat diet

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What are the further tests to confirm a diagnosis of CHD?

MRI scan
Computerised tomography (CT) scan
Coronary angiography

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Explain treatment for coronary heart disease

CHD cannot be cured; treatment can help manage the symptoms and reduce the chances of problems such as heart attacks.
Treatment includes lifestyle changes, as well as medication and surgery.

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What is the main cause of death in the UK?

CVD

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What are the vulnerable groups at risk of CVD?

South Asians
Men living in the UK but born in Pakistan or Bangladesh
In some cases, Pakistan women

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What is the name of the lipid-lowering drug?

Statins

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What is the cost of CHD to the healthcare system in the UK?

around £3.2 billion a year

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Explain LDL-Cholesterol

LDL-Cholesterol (Bad cholesterol) LDL sticks to the artery’s walls and causes plaque to build up.

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Explain HDL-Cholesterol

HDL carries LDL back to the liver, Which is the central station for cholesterol. Any leftover cholesterol here will be turned into bile and released to the gut for digesting food.

What can help raise HDL cholesterol while reducing LDL?

Fibre. Oat products with a high percentage of the soluble fibre (beta-glucan) has the effect of lowering LDL while HDL levels remain the same

Why physical activity is important?

Maintain desirable body weight
Association with endorphin release, which suppresses appetite
Increase efficiency of the heart muscle
-Reduces BP
Lower SES exercise less

Why stress is a risk factor?

Stressful situations cause an increase in catecholamine release; these promote fat breakdown, energy release, and increased cholesterol synthesis. Synergy effects - cigarette use, poor diet, excess alcohol, drugs, poor social support, unfavourable SES

Why is hypertension a risk?

- contributing factor to atherogenesis - contributes to an environment which encourages atheroma development

Explain primary prevention

Change lifestyles; health promotion, community dietitians, public health nutritionists.

Explain secondary prevention

Early detection of illness to prevent progression. Screening clinics, nutrition education, weight loss goals (e.g.; DART diet and reinfarction trail).

Explain tertiary prevention

Rehabilitation in diseased individuals, counselling/support, education.

Explain fat intake in the Cardioprotective diet

- Total fat intake is 30% or less of total energy intake - Saturated fats are 10% or less of total energy intake - Dietary cholesterol intake is less than 300mg/day - MUFA replace Sat FA 20% - PUFA replace Sat FA 10%

In the cardioprotective diet, we should advise eating at least:

- 5 portions of fruits and veg per day - 2 portions of fish per week (including oily fish) - Advise pregnant women to limit their intake of oily fish to 2 portions a week

What are other dietary factors that may reduce baseline risk for CHD?

- Omega-3 PUFA - Vitamins/antioxidants - Intakes of alcohol - Salt intake

What are additional dietary options for LDL lowering?

- Increasing viscous fibre in the diet - Plant stanols/sterols - Soy protein

What are the major nutrient components of the Cardioprotective Diet?

- Fat (Saturated FA, dietary cholesterol, mono/poly UFA, total fat) - CHO - Protein

What are the major sources of saturated FA in the diet?

- High-fat dairy products - High-fat meats - Tropical oils such as palm oil, coconut oil, and palm kernel oil - Baked products and mixed dishes containing dairy fats and shortening - Fats solid at room temperature

What are the major dietary determinants of LDL cholesterol levels?

Saturated FA

True or false Reduction in intake of saturated fatty acids lowers LDL Cholesterol levels.

True

Explain trans fatty acids

Trans FA are those in which double bonds are in the trans configuration

How are trans fatty acids produced?

By hydrogenation of vegetable oils but some are found naturally in animal fats.

Does trans fatty acids raise LDL cholesterol levels?

Yes

What are the major sources of Trans FA in the diet?

- Baked products (crackers, cookies, doughnuts, breads) - Fried products in hydrogenated shortening - Animal sources, including dairy products, provide smaller amounts of trans FA - Soft margarines, vegetable oil spreads

What is the recommended intake for Trans Fats?

No more than 2% of the energy For adults, this is no more than about 5g a day

Effects from other fats to LDL levels

+ Sat FA + Trans FA + Dietary Cholesterol - MUFA (relative to Sat FA) - PUFAs

Dietary cholesterol levels:

* > 240 mg/dL >6.2mmol/L = High risk * 200-239 mg/dL 5.2-6.2mmol/L = Borderline high risk * <200 mg/dL <5.0 mmol/L = Desirable level

What are some dietary sources of Cholesterol?

Animal products: dairy, meats, poultry, and shellfish

Does dietary cholesterol increase heart disease risk?

Yes

What are the major sources of MUFA in the diet?

Olive oil, canola oil, peanut oil, safflower oil and sesame oil.

What is the most common form of MUFA?

Oleic Acid, which occurs in the cis form

Recommendationf for sources of MUFA

Vegetable sources, including plant oils and nuts.

What consists of Polyunsaturated fatty acids (PUFAs)?

Mainly of n-6 linoleic acid. Reduce LDL levels when substituting saturated FA

Effects from high intakes of PUFAs

Small reduction in HDL, cholesterol and triglycerides.

True or False Substitution of PUFAs for saturated FA reduces the risk of CHD

True

Recommendation for sources of PUFAs

Can replace saturated fat. Liquid vegetable oils, semi-liquid margarine, and other margarine low in trans-FA. Intake can range up to 10% of total calories.