Exam 3 - CVD II Flashcards
What is the underlying cause of most forms of CVD?
Atherosclerosis
What can atherosclerosis lead to?
- coronary arteries –> MI and angina
- cerebral arteries –> strokes
- peripheral circulation –> claudication and gangrene
What are the disease risk factors of atherosclerosis?
- HTN (may initiate lesion and/or cause plaque to rupture)
- DM
- Metabolic syndrome
- Impaired fasting glucose
- Obstructive sleep apnea (symptom of obesity)
Describe the FRAMINGHAM HEART STUDY
Prospective cohort to study the prevalence/incidence of CVD and factors related to its development - found risk factors and prevention
• Major findings/links:
- cigarette smoking
- cholesterol level, BP, and ECG abnormalities
- obesity
- high BP linked to stroke
- menopause
- high HDL linked to decreased disease
Describe NCEP
National Cholesterol Education Program
- Mission to reduce prevalence of hypercholesterolemia in US (Adult Treatment Panel 1 - ATP I)
- Panel recognizes that DIET, MEDICATIONS, SERUM CHOLESTEROL, SATURATED FAT INTAKE AND PA are major factors in primary and secondary prevention of CVD
What is the primary therapy outlined by NCEP/ATP?
Lowering LDL-C levels
Describe C-Reactive Protein’s link to CVD
Synthesized in the liver, C-RP is a very general marker of acute illness/inflammation (inflammation has central role in CVD)
Give the risk ranges for C-Reactive Protein
Low Risk: <1.0mg/L
Average Risk: 1.0-3.0 mg/L
High Risk: > 3.0mg/L
List five modifiable risk factors for CVD
- tobacco use
- physical activity
- poor diet
- stress
- alcohol consumption
Describe the Dietary CAGE Questions. When/how are they used?
C: CHEESE (and other sources of dairy fats)
A: ANIMAL FATS
G: GOT IT AWAY FROM HOME
E: EAT (EXTRA) HIGH FAT COMMERCIAL PRODUCTS (candy, pies, doughnuts, and cookies)
Used as an assessment tool to pinpoint saturated fats intake
Nutrition diagnosis for Atherosclerosis will focus on what?
- Fat
- Fiber
- Weight
- Food choices
- Physical inactivity
What is the primary target of MNT for atherosclerosis?
Reducing saturated fat (5-7% reduction)
Describe monounsaturated fatty acids and their relation to CHD
- One double bond in carbon chain
- OLEIC ACID is most prevalent MUFA in American diet
- Replacing SFA with MUFA lowers LDL and TGs to same extent as PUFAs
- Mediterranean high-fat diets high in MUFAS are assoc with lower cholesterol and CHD incidence
What are some dietary MUFA sources?
- Avocados
- Canola oil
- Olive oil
- Olives
- Nuts
- Peanut oil
- Nut butters
Name and describe the two categories of PUFAs. What is their link to CVD?
- Omega-6: most common; primarily in vegetable oils
- Omega-3: alpha-linolenic accounts for ~85% of omega-3 FA (EPA and DHA); anti-inflammatory (alter prostaglandin synthesis)
Replacing SFAs with PUFAs in a low-fat diet lowers LDL and HDL
What are the current dietary recommendations for Omega-3s?
Eat fish high in omega-3s at least 2x/week (salmon, tuna, mackerel, sardines)
- Patients with CVD should have 1gm EPA and DHA/day
- Patients with high TGs should have 2-4gms EPA and DHA/day
Describe STANOLS and STEROLS and their role in CVD
- Found in wheat, corn, rye, barley, oats, and olive oil
- Similar in structure to cholesterol, so inhibit micelle/cholesterol absorption
- Effective in lowering LDL-C up to 10%
How does alcohol affect blood lipid levels?
- Effects both TG and HDL levels
- See big increases in HDL levels in people with high TAGs
- MODERATION
Describe the Assessment part of Atherosclerosis nutrition therapy
- Use TLC as nutrient standard (dietary fat; saturated fat <6% SFA)
- Dietary CAGE questions
- REAP questionnaire
Describe the Diagnosis part of Atherosclerosis nutrition therapy. What will you prioritize and focus on?
• Prioritize nutrition problems • Will focus on: 1. saturated fat 2. fiber 3. weight 4. food choices 5. physical activity
Describe the Intervention part of Atherosclerosis nutrition therapy. What will you focus on?
- Weight loss
- Physical activity
- Total dietary fat
- Saturated fat
- Monounsaturated fat
- Omega-3 FAs: linolenic acid
- PUFAs
- Cholesterol
- Fiber
Describe the Monitoring and Evaluation part of Atherosclerosis nutrition therapy. What will you focus on?
- Dietary intake should be monitored for amount and type of fat, energy and fiber
- Lab tests like lipid panel should be monitored if available
