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nutrition > Diet and CV > Flashcards

Diet and CV Flashcards

1
Q

buildup of fatty plaques in the walls of arteries that causes those arteries to narrow
is what condition

A

Atherosclerosis

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2
Q

complications with atherosclerosis

A
  1. Decreases blood flow to an area
  2. Can rupture, causing a blood clot
  3. Precursor to numerous diseases including:
    - Ischemic heart disease (Coronary artery disease)
    - Myocardial infarction
    - Cerebrovascular accident
    - Kidney disease
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3
Q

risk factors for atherosclerosis

A
  1. Diabetes Mellitus
  2. Hyperlipidemia/Hypercholesterolemia
  3. Hypertension
  4. Poor lifestyle habits
    - Obesity
    - Smoking
    - Physical inactivity
    - Poor diet
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4
Q

the #1 cause of mortality in the US? what contributes to it?

A

CV disease
- Western diet - increased intake of fat, red
meat, and carbs with minimal fruits and
and vegetables
- Increased rates of obesity and DM

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5
Q

how do you assess risk of atheroscelerotic disease?

A
  1. 10-year Risk Calculator - calculates risk of having MI or CVA in next 10 years
  2. LDL Levels at which to start therapeutic lifestyle changes
    - If 10-year risk is >20%… start if LDL is ≥ 100 mg/dL or more
    - If 10-year risk is ≤ 20%…
    — 2+ risk factors for CAD, start if LDL is ≥ 130 mg/dL
    — <1 risk factor for CAD, start if LDL is ≥ 160 mg/dL
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6
Q

general recommendations for fat intake for atherosclerosis

A
  1. “Saturated fatty acid, trans fatty acid, and cholesterol consumption should be as low as possible while still getting adequate nutrition”
  2. replace saturated fats with MUFAs/PUFAs to reduce cardiovascular risk
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7
Q

what macronutrient can raise total cholesterol and LDL

A

saturated fats
- Flesh of domestic mammals raised for consumption
- Dairy products
- Several vegetable oils (coconut, palm, palm kernel)

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8
Q

US men, women, and children get most of their saturated fats from what foods?

A
  1. men - red meat
  2. children - milk
  3. women - combo of dairy and processed foods
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9
Q

include the 2 essential fatty acids in the human diet that we cannot synthesize on our own
is what type of fat?

A

Polyunsaturated Fats (PUFAs)
- Omega-3: found in flaxseed oil, linseed oil, marine oils (seafood), canola oil
- Omega-6: found in soybeans, safflower oil, sunflower seeds/oil, and corn
— Omega 3:Omega 6 ratio - native diet 1:4, modern diet 1:20

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10
Q

PUDA has greater benefit in who ?

A

already have heart disease

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11
Q

what is the general recommendations for PUFAs

A

Supplementing with, or increasing dietary intake of, omega-3 PUFAs – reasonable, but not enough alone to prevent heart disease

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12
Q

olive or canola oils, peanuts, tree nuts, avocado are examples of what type of fat?

A

Monounsaturated Fats (MUFAs)

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13
Q

which diet is rich in MUFAs and is considered heart-healthy

A

Mediterranean Diet

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14
Q

High intake of MUFAs (as part of Mediterranean Diet) linked to lower:

A

Mortality - All-cause, cardiovascular, cancer
Cancer incidence
Neurodegenerative diseases
Metabolic syndrome

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15
Q

general recommendations for MUFAs

A

generally regarded as healthy fats and may be promoted as part of an overall heart-healthy diet

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16
Q

two major approaches to prevent heart disease and limit worsening of existing heart disease

A
  1. Limiting overall dietary fats (low-fat diet)
    - Limited intake of meats, dairy (especially whole-fat), oils, and fats in general
    - Avoid processed fats (cheese and cream-based sauces, fatty spreads)
    - Encourage healthy carbohydrates (fruits, veggies)
    - Encourage lean, grilled/baked protein, especially seafood for omega-3 fatty acids
    - Eggs - high in cholesterol but low in fat - controversial
  2. Liberalizing intake of MUFAs and omega-3 PUFAs (Mediterranean diet)
    - Not as much emphasis on how much fat, rather on healthy fats
    - Slightly more evidence to support positive outcomes
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17
Q

what drug can lower LDL by up to 60%

A

statin drugs

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18
Q

general recommendations for carb intake for atheroscelerosis

A
  1. Low carb and high animal fat/protein intake → increased mortality rates, especially for cardiac causes
  2. reduce Refined carbohydrates and grains and added sugars to limit risk of atherosclerotic cardiovascular disease (ASCVD)
  3. High intake of fruits and vegetables is protective for general health, including reduced ASCVD risk
    - Promotes intake of vitamins, minerals, antioxidants, fiber
    - Displaces other, less-healthy food alternatives
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19
Q

what diet May worsen arterial endothelial function, promote atherosclerosis!

A

keto
Animal-derived proteins/fats associated with higher mortality than plant-derived

20
Q

which type of protein is associated with the lowest mortality rate

A

Plant-based protein

21
Q

rank animal-based protein by their mortality rate

A
  1. Processed red meat - 34%
  2. Eggs - 19%
  3. Unprocessed red meat - 12%
  4. Dairy - 8%
  5. Poultry and fish - 6%
22
Q

what can reduce oxidative stress, which reduces cell damage for atherosclerosis
Inhibits LDL oxidation and protects nitric oxide from degradation → slows/inhibits atherosclerotic disease process

A

antioxidants

23
Q

what antioxidants are not shown to be helpful to prevent ASCVD or improve disease course

A

Vitamin E, Beta-Carotene, and Vitamin C supplementation
foods naturally rich in these compounds are associated with better overall health

24
Q

found in dark chocolate/cocoa, tea, red wine, grape juice
Associated with improved overall cardiac health

A

Bioflavonoids
Should be consumed in moderation and with overall nutrition in mind, but could have potential benefit in cardiac patients

25
Q

what vitamins help in the metabolism of methionine and homocysteine for atherosclerosis

A

B vitamins - B6 (pyridoxine), B12 (cobalamin), and B9 (folate)
- Elevated homocysteine levels have been found in up to ⅓ of all patients with coronary artery disease

26
Q

____ thought to be most likely to contribute to elevated homocysteine

A

folate levels

27
Q

ubiquitous in plant-based foods; functions in mitochondria to help with ATP synthesis

A

Coenzyme Q10 (CoQ10)
May be benefit to supplementation, especially in patients with heart failure

28
Q

what is the evidence for CoQ10 benefit in several heart conditions

A
  1. Heart failure - HF and cardiomyopathy
  2. Post-MI - reduced post-MI complications, better hemodynamics s/p CABG
  3. Angina - improved functional status and symptoms
  4. ASCVD - reduced ASCVD mortality
29
Q

CoQ10 is not as beneficial for these heart conditions

A

glycemic control, blood pressure (marginal but not major), dyslipidemia

30
Q

Most studies found benefit with consumption of how many drink/day for atherosclerosis

A

<1 drink/day
1 drink per day, at most 2 (if male), considered reasonable for CVD reduction

31
Q

what is the preferred alcohol for atherosclerosis

A

red wine
Similar benefits seen with dealcoholized red wine

32
Q

what is the relationship between alcohol and atherosclerosis

A

low-moderate consumption has been linked to reduced cardiovascular disease risk

33
Q

the health benefits of alcohol and atherosclerosis is primarily due to what?

A

esveratrol and other polyphenic compounds found in the skin of grapes

34
Q

what other health effects of alcohol consumption can it have on atherosclerosis

A

Increased cancer risk
Increased inflammation and oxidative stress
Damage to the cardiovascular system itself
Overconsumption and potential for addiction

35
Q

what nuts are seen to be beneficial in cardiac risk reduction (7)

A

Tree Nuts - walnuts, almonds, hazelnuts, cashews, pecans, pistachios, Brazil nuts

36
Q

which nut show the greatest degree of benefit

A

walnuts, then almonds

37
Q

what are the other select dietary elements for atherosclerosis

A
  1. Garlic - may lower BP somewhat, but not associated with lower CVD morbidity and mortality
  2. Red Yeast Rice - can help reduce cholesterol levels
    - Similar MOA to statins, but questionable potency
  3. Magnesium - lower levels associated with higher CVD risk
    - Increasing dietary intake preferred to adding a supplement
    - Whole grains, green leafy vegetables, nuts, legumes
  4. Plant Stanols/Sterols - help reduce cholesterol by interfering with absorption; may be of greater benefit when combined with statin
    - Whole grain cereals, bran, peanuts
38
Q

consistent elevation of blood pressure above
predefined normal levels for a patient’s age

A

HTN

39
Q

what BP is concerning for adults

A

> 120/80

40
Q

how prevalent is HTN in US?

A

29-45% of adults
Thought to be due to multiple factors, including:
- Higher intake of dietary sodium
- Western diet
- Higher incidence of obesity
- Higher incidence of metabolic syndrome
- Decreased physical activity

41
Q

what are the BP categories?

A
  1. normal: <120 and <80
  2. elevated: <120-129 and <80
  3. High BP stage 1: 130-139 or 80-89
  4. high BP stage 2: >140 or >90
  5. HTN crisis (CONSULT): >180 and/or >120
42
Q

what are the special population considerations with HTN?

A
  1. Association between higher BMI and HTN esp prevalent in Black pts
    - Possible increased activity of RAAS and increased sodium retention
  2. <50% nonobese pts with HTN may be insulin resistant!
  3. Modest wt loss (as little as 3 kg) associated with lower BP readings
43
Q

general tx considerations/recommendations in HTN

A
  1. Wt Reduction - achieve normal BMI (18.5 - 24.9)
  2. Aerobic exercise - 30 min/day, most days/wk (5+ days)
  3. Moderation of alcohol intake
    - ≤ 2/day (men) or ≤ 1/day (women); < 1/day for elderly
  4. General diet recommendations
    - Rich in fruits/vegetables, low in saturated fat, low-fat dairy products, and restricted sodium intake
    - Sodium restriction to < 2300 mg/day for adults
    - Consider adoption of Mediterranean Diet or DASH Diet
44
Q

what is the DASH diet?

A

“Dietary Approaches to Stop Hypertension”
1. Focuses on whole grains, legumes, vegetables, fruits, low-fat dairy, lean animal protein, nuts/seeds
- Has a relatively high carb, but low glycemic index, profile
2. Limits red meat, processed meat, sweets, saturated fats, sodium
- Average US diet - +3400 mg/day sodium
- DASH diet - <2300 mg/day
— 1500 mg/day - minimum adequate intake of sodium

45
Q

what dietary foods/elements has positive effects on HTN?

A
  1. Calcium - lowered BP in trials by 1-3 mmHg; greater effect in younger pts
  2. Garlic - weak evidence, but may have some positive effect on HTN
    - Not likely to cause harm, but can cause “thinner blood” especially in patients already on anticoagulant/antiplatelet drugs
  3. Magnesium - increased amounts associated with lower blood pressure
  4. Fiber - higher intake from diet or supplements associated with lower BP
  5. Cocoa - may have some small benefit in lowering BP
  6. Potassium - abundant in fruits and vegetables; associated with lower BP
46
Q

what dietary elements have negative effects on HTN?

A
  1. Sodium - strong evidence supporting sodium reduction leading to BP reduction in all populations
    - Especially patients with higher net cardiovascular disease risk
    - Processed and commercially prepared foods are a very common source!
    — Educate patients on looking at nutritional food labels!
  2. Alcohol - regular intake associated with higher BP, worse BP control
    - Abstinence recommended until BP under control
  3. Caffeine - natural stimulant; excess intake may worsen BP
47
Q

what can be used as salt substitutes for sodium for HTN?

A

calcium or potassium salts

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