Lecture 8: Diet and CV Disease Flashcards
What is atherosclerosis?
Buildup of fatty plaques in the walls of arteries, resulting in narrowing of the arteries.
What are the main risk factors for atherosclerosis?
- DM
- HLD/Hypercholesterolemia
- HTN
- Poor lifestyle habits
Poor lifestyle habits that inc risk of atherosclerosis
*Obesity
*Smoking
*Physical inactivity
*Poor diet
What is the #1 cause of death in the US?
CV disease
Western diet
increased intake of fat, red meat, and carbs with minimal fruits and vegetables
How do we assess ASCVD risk?
- 10 year risk calculator (risk of MI or CVA)
When do we suggest lifestyle changes with ASCVD?
*LDL >/= 190.. start +/- meds
- 10 year risk > 20% with LDL >/= 100
- 10 year risk </= 20%…
(with 2+ CAD risk and LDL >/= 130)
(or with 0-1 CAD risk and LDL >/= 160)
What are the 7 risk factors for CAD?
- DM
- HLD/Hypercholesterolemia
- HTN
- Obesity
- Smoking
- Poor physical activity
- Poor Diet
What are the general recommendations regarding fat intake for atherosclerosis?
- Low sat/trans fatty acids
- Low cholesterol
- < 7% of calories should be saturated for those with ASCVD risk.
How do dietary fats contribute to atherosclerosis?
- Increased saturated fats = increased LDL
- Acute ingestion of high amts of fatty acids = cardiac stressor
What is the suggestion from the AHA/ACC regarding saturated fats?
Replace them with MUFAs and PUFAs.
Where do men tend to get their saturated fats from? Women? Children?
- Men: Meat
- Women: Dairy
- Children: Milk
What is the effect of saturated fats on our lipids?
Increasing TC and LDL.
What are the 2 PUFAs we cannot synthesize?
- Omega-3
- Omega-6
Which PUFA is commonly low in the diet?
Omega 3
What has happened to the modern diet in regards to omega-3:omega-6 ratio?
Increased ratio of 1:20. Omega-6 is high now due to corn.
When might we suggest omega-3 supplementation for a patient?
Those with existing heart disease.
What is the general recommendation regarding omega-3 supplementation?
Reasonable, but not efficacious enough as monotherapy.
What diet has very high MUFAs?
Mediterranean diet
What is the general recommendation regarding MUFAs?
Regarded as healthy fats and may be promoted as part of an overall heart-healthy diet.
Why are MUFAs good for you?
Promote reductions of LDL and elevations in HDL.
What are the two major approaches to preventing heart disease in regards to dietary fats?
- Limiting overall dietary fats (low fat diet)
- Liberalizing intake of MUFAs and omega-3 PUFAs. (Medi diet)
How much can optimal dietary intake affect LDL and TC? What about statins?
- Optimal dietary fat intake: LDL down 20%, TC down 30%.
- Statins: LDL lowered by up to 60%
What are the general recommendations regarding carb intake for atherosclerosis?
- Avoid refined carbs, grains, and added sugars.
- High intake of fruits and veggies
- Ketogenic diets may promote atherosclerosis.
- Low-carb with high protein may worsen atherosclerosis.
What are the general recommendations regarding protein intake for atherosclerosis?
Plant protein is best.
Poultry/fish is best among animals, processed red meat is worst.
How do antioxidants work?
Inhibit LDL oxidation and nitric oxide degradation, which slows atherosclerosis.
What falls under antioxidants? Effects?
Vit E, Beta-carotene, Vit C: no benefit by taking supplement versions.
Bioflavonoids: improved overall cardiac health in moderation.
What contains bioflavonoids?
- Dark choco
- cocoa
- tea
- red wine
- grape juice
How do B vitamins help with atherosclerosis?
B6/12/9 help metabolize homocysteine and methionine.
Elevated homocysteine is found in 1/3 of CAD patients.
Low folate leads to elevated homocysteine.
No benefit to supplement.
When is CoQ10 helpful?
Existing heart-related conditions with cardiomyopathy or HF.
Where is CoQ10 found naturally?
All plant-based foods.
How does alcohol affect atherosclerosis?
Low-moderate consumption = reduced ASCVD risk. (specifically red wine)
What is resveratrol?
Polyphenol with high antioxidant properties, found mainly in red wine and non-alcoholic red wine.
What nuts are best for atherosclerosis?
Tree nuts, mainly walnuts and then almonds.
What additional dietary element has no effect on CVD mortality, but lowers BP?
Garlic
What additional dietary element may work well with statins?
Plant stanols/sterols, which reduce cholesterol absorption.
Whole grains, bran, peanuts.
How prevalent is HTN in the US?
29-45% of adults.
What is stage 1 HTN?
SBP 130-139 OR DBP 80-89.
What special population considerations should we consider with HTN?
- Blacks
- Non-obese patients may develop insulin resistance
What lifestyle modifications are generally good for HTN?
- Weight reduction
- Aerobic exercise 30m/5days
- Moderation of alcohol intake
- General diet recommendations (Na < 2300mg, DASH diet)
What is the DASH diet?
- Dietary approaches to stop hypertension.
- High carb, but low GI foods.
- Na intake < 2300mg daily (but you need 1500mg minimum)
What dietary supplement is noticeably good in younger pts for lowering BP?
Calcium
What 3 things in our diet have bad effects on HTN?
- SODIUM
- Alcohol
- Caffeine
