CVD- dyslipidemia and hypertension

Question 1

Risk factors

Answer 1

Age 
Gender
Family history 
Previous CVD event 
Social- support, culture, depression 
Smoking 
Dyslipidaemia 
Hypertension 
Diabetes 
Overweight and obesity

Question 2

Lifestyle targets

Answer 2

Physical activity- 150-300 mins moderate activity or 75-150 mins vigorous per week. Muscle strengthening on at least 2 days per week.

Weight- <94cm males, <90cm Asian males, <80cm females. Target BMI <25

Diet- fat 20-35% of energy, reduce salt to <6g/d for primary prevention and <4g/d for secondary. Aim for five veg and two fruit

Smoking cessation- assess readiness

Alcohol intake- limit to guidelines

Question 3

Overweight and obesity

Answer 3

Aim for weight loss if patient is overweight or obese. Combination of physical activity and dietary advice most effective, but needs to be realistic (weight loss of 5-10%) 
Benefits: 
- reduce BP, LDLC, TG 
- increasing HDLC 
- improving glucose control

Question 4

Hypertension

Answer 4

Major risks actor for CVD- affects 1/3
Influenced by obesity, high alcohol intake, high sodium intake, low potassium intake, reduced physical activity, smoking
Aim: systolic no <130mmHg, diastolic bp <85mmHg
Management is lifestyle dietary and physical, or anti hypertensive medications

Question 5

Salt

Answer 5

Physiological requirements are small (69-460mg/d)
Aim for intake <1600mg

Label reading education:
Low salt- <120mg
Moderate- 120-400mg
High- >400mg

Question 6

Dyslipidaemia

Answer 6

Targets: 
Total chol: <4.0mmol/L 
HDLC: >1.0mmol/L 
LDLC: <1.8mmol/L 
TG: <2.0mmol/L 
Non HDLC: <2.5mmol/L 
Blood pressure: <130/80mmHg 
Waist circumference: men <94cm, women <80cm 
BMI: 18.5-25 
Hba1c: <7% 
CRP: 10mg/L

Question 7

Saturated fat

Answer 7

Stearin acid 
Palmitic acid 
- fat in and on meat 
- dairy products 
- butter/ cream/ lard 
- pastries/ cakes / biscuits 
- confec 
Plant sources 
- coconut and coconut milk 
- palm oil- often used in fried food 

Increase total and LDL cholesterol and TGs

Question 8

MUFA

Answer 8

Decrease cholesterol level when used in place of sat fat

Eg olive /canola oil, olive oil margarine, peanuts, cashews, almonds and avocado

Question 9

PUFA

Answer 9

Decrease cholesterol level when used in place of sat fat

Eg PU margarine, sunflower/ soybean oil, soybeans, tofu, walnuts, hazelnuts, Brazil nuts

Question 10

Omega 3 PUFA

Answer 10

Three types:

• EPA and DHA, come mainly from fish - shouldncinsume 500mg/ d combined, 1000mg/d For secondary prevention or 1200-1400mg/d for hypertriglyceridemia
• alpha linoleic ALA, comes from veg oils, nuts, leash veg. Usually used for energy, conversion into EPA and DHA is limited. Should have 1.3g/d in men, 0.8g/ d in women and 2g/d for secondary prevention

Highly concentrated in the brain and appears to be important for cognitive and behavioural function, inflammation reduction, reducing triglycerides and decreasing blood clots. Starting point of hormone production which regulates blood clotting, contraction and relaxation of artery walls and inflammation. 
Therefore have 
Antiinflammatory effect 
Antithrombotic effect 
Anti arrhythmic effect 
Reduced TGs 
Improved insulin sensitivity

Question 11

Dietary cholesterol

Answer 11

Relatively small influence on lipid levels
Large intake can increase lipid levels, aim for <300mg/ d
No more than 6 eggs a week
Limit egg yolks, shellfish, liver

Question 12

Dietary fibre

Answer 12

> 30g/d
Soluble fibre- bells slow the emptying of our stomachs, allowing us to feel fuller, lower cholesterol and stabilise blood glucose levels. Found in fruits, veg, oats, barley and legumes, can assist reduction of LDLC, but has no effect on HDLC or TG
insoluble fibre absorbs water to soften stool, support regular bowel movements. Helps keep us full and promote health bowel environment. Found in wholehrain breads and cereals, nuts, seeds, wheat bean and skin of fruit and veg.

Question 13

Plant sterols and stanols

Answer 13

Naturally occurring ingredient that can help reduce how much cholesterol is absorbed from the food. Found in small amounts in nuts, seeds, legumes, fruits, veg and veg oils
One serve (1g) is 10g margarine spread, 45g cereal, 250ml low fat milk, 200g reduced fat yoghurt
Little effect on TH and HDLC
No additional benefit >3G/d
Considerations: lipid profile, cost, weight goals, other mechanisms?

Question 14

Krill oil vs fish oil

Answer 14

EPA and DHA absorption up to 35% greater than in normal fish oil- may be due to greater concentration of free fatty acid.
Kris oil appears to be more effective than fish oil at lowering glucose, TGs and LDLC to lower and equal dose
Also contains an antioxidant which regular fish oils do not contain- help prevent oxidation of the oil and thought to be related to relief of joint pain.
Is more expensive so requires more research