NUTRITION: Diet and Cardiovascular Disease

Question 1

What are the 4 main types of CVD

Answer 1

Coronary Heart Disease
Cerebro-vascular Disease (‘stroke’)
Peripheral Arterial Disease
Aortic Disease

Question 2

describe the 2 main events that can cause coronary heart disease

Answer 2

Atherosclerosis
o LDL build up and oxidation
o Plaque formation
o Narrowed arteries

Thrombosis
o Plaque may rupture
o Clot forms and stops blood supply: Heart attack
or Ischaemic Stroke

Question 3

describe the prevalence of CVD in the uk

Answer 3

CVD is the most common cause of death in UK
41,000 premature deaths in the UK (2014)
About half of CVD deaths are from CHD & about a quarter are from stroke
One in four deaths in the UK

Question 4

what are modifiable risk factors for CVD

Answer 4

high blood pressure
smoking
diabetes mellitus
physical inactivity
obesity
high blood cholesterol

Question 5

what are non-modifiable risk factors for CVD

Answer 5

age
genetics
gender
race and ethnicity

Question 6

describe smoking as a CVD risk factor

Answer 6

Carbon monoxide and nicotine
makes heart work harder & damages linings of arteries, contributing to atherosclerosis
Affects platelets making blood more likely to clot
1/5 deaths from CHD associated with smoking
Men and women smokers under 50yrs - 10 x rate of heart attacks as non-smokers

Question 7

describe smoking cessation in relation to cvd

Answer 7

All smokers should be advised to stop
Support should be offered to help facilitate this in order to minimise cardiovascular - and general - health risks.
Nicotine-replacement therapies should be part of a smoking cessation programme, alongside professional advice, to increase long term abstinence rates.
Smokers with coronary heart disease and co-morbid clinical depression should have their depression treated both for alleviation of depressive symptoms and to increase the likelihood of stopping smoking (SIGN 97)

Question 8

describe alcohol as a risk factor for CVD

Answer 8

Mechanisms: increase in plasma HDL, reduced clotting (enhanced fibrinolysis), antioxidants
Long-term heavy drinking increases risk
No strong evidence for red wine being any better than other alcoholic drinks.
But any alcohol intake increases cancer risk

Question 9

what advice should be given regarding alcohol and CVD

Answer 9

Patients with no evidence of coronary heart disease may be advised that light-to-moderate alcohol consumption may be protective against the development of coronary heart disease. Patients with established coronary heart disease may be advised that light-to-moderate alcohol consumption may be protective against further coronary events.
Current advice to patients with coronary heart disease: no more than 2 to 3 units of alcohol per day for women and no more than 3 to 4 units of alcohol per day for men.
At least 2 drink-free days per week for both men and women.

Question 10

what are the 3 types of hyperlipidaemia

Answer 10

1.	Familial hypercholesterolemia 
•	Dominant gene encoding LDL receptor 
•	LDL very high (30mmol/l) 
•	Prevalence: 1 in 500 people 
•	Accounts for 5% of premature mortality from CHD in Europe & USA 
2.	Polygenic hyperlipidaemia
3.	Familial combined hyperlipidaemia

Question 11

what are clinical features of hyperlipidaemia

Answer 11

Corneal arcus
Xanthomata
Xanthelasma
Eruptive Xanthomata

Question 12

why is obesity a risk factor for cvd

Answer 12

Predisposes to CVD (large waist /hip ratio)
2.5 x increased risk of CHD if central obesity (apple-shaped)
6 x increased risk of stroke

Due to:
•	Unfavourable blood lipid profile
•	Increased risk of insulin resistance 
•	Increased blood pressure
•	Increased mobilisation of fats

Question 13

why should we exercise (in relation to cvd)

Answer 13

Exercise can raise HDL and decrease LDL (reduced TC:HDL ratio)
Exercise reduces blood pressure
Exercise reduces risk of obesity
Helps to reduce stress levels

An exercise regime can improve functional capacity & reduce activity- related symptoms as early as 12 weeks after initiation.

Question 14

how should patients modify diet for reduction of cvd and hypertension

Answer 14

Diets low in total and saturated fats should be recommended to all for the reduction of cardiovascular risk.
People with hypertension should be advised to reduce their salt intake as much as possible to lower blood pressure.

Question 15

what are the 4 main diets for reduction of cvd risk

Answer 15

DASH
Mediterranean
UCLP
Cardio-protective Diet (Eatwell Plate)

Question 16

describe the DASH diet

Answer 16

“Dietary Approaches to Stop Hypertension”
The DASH eating plan emphasizes vegetables, fruits, and fat-free or low-fat dairy products. Includes whole grains, fish, poultry, beans, seeds, nuts, and vegetable oils. Limits sodium, sweets, sugary beverages, and red meats

Nutrition content:
• Low in saturated and trans fat
• Rich in potassium, calcium, magnesium, fiber, and protein

Question 17

what is the mediterranean diet high in

Answer 17

• Fruit & Vegetables
• Legumes-Beans, lentils, peas, peanuts
• Cereals
• Fish
• White meat mainly eaten in place of red meat.
• Mono-unsaturated oils used in place of saturated animal fats.
• Moderate red wine intake with meals.

Question 18

describe the Ultra Cholesterol Lowering Plan

Answer 18

Step 1: Getting Motivated 
Step 2: Building Strong Foundations 
Step 3: Four ‘Cholesterol –busting’ Foods 
•	Nuts
•	Soya
•	Sterols/Stanols 
•	Soluble fibre

Question 19

what psychosocial factors increase risk of cvd

Answer 19

Lower socioeconomic class: 3 x more deaths in most deprived compared to least deprived
Stressful situations
Coronary-prone behaviour patterns
“Type A Personality”
‘Glasgow Effect’? 8.4% higher mortality than similar cities (eg, Manchester, Liverpool)