Week 10 - Cardiovascular Disease Flashcards
What is CVD?
a group of disorders involving the heart
What are 5 common forms of CVD?
- coronary artery disease - the most common
- hypertension
- ischemic heart disease
- peripheral vascular disease
- heart failure
1 in _____ Canadian adults age 20+ live with diagnosed heart disease
1 in 12
how many canadian adults age 20+ live with heart disease in Canada?
2.4 million
every hour ___ Canadian adults age 20+ with diagnosed heart disease die
12
the death rate is ____x higher among adults age 20+ with diagnosed heart disease vs. those without
3x higher
the death rate is ____ x higher among adults age 20+ who had a heart atack vs those without
4x higher
the death rate is ___x higher among adults age 40+ with diagnosed heart failure vs those without
6x
who is more likely to get heart disease, men or women?
men are 2x more likely to get heart disease
men get diagnosed 10 years younger than women (at 55, instead of 65
the death rate from heart disease has DECREASED by
23%
CVD has the ______ highest death rate in Canada
2nd highest, behind cancer
What are the 3 main roles of the cardiovascular system?
What are 5 other things it does?
- regulates blood flow to tissue
- delivers oxygenated blood and nutrients
- retrieves waste products
a. thermoregulation
b. hormone transport
c. maintenance of fluid volume
d. pH regulation
e. gas exchange
what are the 3 layers of the heart?
- epicardium - outside
- myocardium
- endocardium - inside
which side of the heart is oxygenated? deoxygenated?
right side = deoxygenated (goes to the pulmonary system for oxygenation)
left side = oxygenated
which layer of the heart is the thickest?
why is it the thickest?
the myocardium (the thickest)
because it is responsible for contraction of the heart
what are the 3 types of muscle int he body?
- skeletal
- smooth - involuntary
- cardiac
the repeated contraction and relaxation of the heart is called ________
cardiac cycle
the force exerted by the blood on the walls during CONTRACTION of the ventricle is called
systole
120
the force exerted by the blood on the walls during RELAXATION of the ventricle is called
diastole
80
the volume of blood ejected with each contraction is called
stroke volume
______ is the resistance against which the ventricles must contract to eject blood into systemic circulation
mean arterial pressure (MAP)
in blood pressure regulation, the degree of resistance depends on which 3 things:
- radii of arterioles - this is most important! slight reduction in radius leads to great resistance
- length of the vessel - vasoconstriction occurs in cold temp, exercise, pain stress, plaque
- blood viscosity - increased blood viscosity can be caused by dehydration, increased rbc
what are some things that may cause a change in the blood viscosity or cause vasoconstriction
cold temp, exercise, pain, stress, plaque
the interface between blood and the vessel wall is called the
endothelium
damage to _______ attracts proinflammatory factors, platelets, and while blood cells (macrophages)
the endothelial layer
white blood cells engulf the oxidized LDL particles, forming
foam cells
why is the endotheliel layer important?
it regulates bd, produces vasodilators like nitric oxide, it produces inflammatory markers
the ____ produces substances that promote blood flow and regulate muscle tone
the endothelium
what happen when the endothlial layer gets damaged?
it attracts proimflammatory factors, platelets, and white blood cells (macrophages)
the platelets secrete substances that increase vasoconstriction
the macrophages also engulf the oxidized LDL particles, forming foam cells.
these foam cells contribute to the formation of placque
coronary artery disease is caused by:
atherosclerosis
what is coronary artery disease?
a progressive thickening of blood vessels due to an accumulation of placque + loss of elasticity
chronic sodium will reduce elasticity as well
what is placque made out of?
fatty deposits, fibrous connective tissue, and smooth muscle cells
coronary artery disease may lead to the following 3 things:
- myocardial infarction (blood flow blocked to heart)
- stroke (blood flow blocked to brain)
- peripheral arterial disease (blood flow blocked to legs)
what are the 5 stages of atherosclerosis?
- normal blood vessels
- build up of fatty streaks
- blood vessel with placque
- advanced atherosclerosis
- complete block of artery
which 14 factors contribute to atherosclerosis?
- smoking
- obesity
- hypertension
- elevated LDL cholesterol
- genes
- high saturated fat
- high serum trigs
- inactivity
- diabetes
- stress
- decreased hdl
- aging
- hyperhomocysteinemia
- endothelial dysfunction
what are the steps to atherosclerosis?
- accumulation of plaque
- produce less nitric oxide
- macrophages eat oxidized LDL cholesterol
- fatty streaks and foam cells form
what are 5 clinical signs of atherosclerosis?
- high serum total cholesterol
- high LDL cholesterol
- low HDL cholesterol
- high trigs
- high c-reactive protein
how do we do a nutrition assessment for atherosclerosis / CAD?
- do BMI evaluation
- check waist circumference and WHR
- do dietary assessment, looking at
- Saturated fats
- trans fatty acids
- omega 3s
- fibre
- sodium
- alcohol
- refined carbs
what are 8 uncontrollable risk factors of CAD?
- 40+
- postmenopausal
- 30+ with diabetes for 15yrs
- family history of early cardiovascular disease in immediate family
- family history of cholesterol
- CKD
- abdominal aortic aneurysm
- atherosclerosis
- being male
what are 8 modifiable risk factors of CAD?
- smoking
- diabetes
- abnormal blood fat (high LDL, low HDL, dyslipedmia)
- low HDL
- high BP
- inflammatory diseases
- HIV infection
- chronic obstructive pulmonary disease
- high BP during pregnancy, BMI > 30
what is an aneurism?
an air bubble in the vessel
we use this to determine someones risk for CVD
framingham risk score calculator
How does the framingham risk score factor work to determine risk for CVD?
Step 1: check point system for age, HDL, total cholesterol, and BP, smoker
Step 2: using total points from step 2, determine 10 year CVD risk factor
Step 3: determine the heart age
Step 4: determine if patient is low, moderate or high risk
____ transport lipids
lipoproteins
what are lipoproteins? what do they consist of?
they are transport lipids. they transport fat
they consist of lipid interior + protein shell (apolipoprotein). fatty core and protein shell
they protein to fat ratio in the lipoproteins indicates risk of developing athersoclerosis AND dictates function
they are a group of soluble proteins that combine with and transport fat or other lipids in the blood plasma
what are apolipoproteins?
they are the part of lipoproteins. they give structural integrity and ensure that the receptors can recognize the particles.
what part of lipoproteins determines the risk of developing athersoclerosis?
the protein to fat ratio
What has the most apolipoprotein?
HDL
what has the most trigs?
chylomicrons > VLDL > LDL > HDL
what has the least lipids
hdl
which is the smallest
HDL
hat has the biggest density
HDL
Why is HDL good?
because they are involved in reverse cholesterol transport - they remove cholesterol from tissue and return it to the liver
Why is LDL bad?
involved in the atherosclerosis process. is part of placque.
get eating by macrophages (white blood cells) and get oxidized and initiate inflammation
elevated LDL is PRIMARY risk factor, whereas HDL and trigs are secondary risk factors
what are the LDL targets for high risk people for whom treatment has begun?
< 2 mmol/L OR
> 50% reduction of LDL OR
< 2.6 mmol/L reduction of non-HDL OR
> 50% reduction for people with LDL > 5
What are diagnostic tests for atherosclerosis?
- blood tests (now they check for Apo A and apo B, which is more precise than LDL and HDL)
- ankle/brachial index - compares blood pressure in ankle with blood pressure in arm to see how well blood is flowing
- physical exam
- urine test
- doppler ultrasound
- ECG
- exercise stress test
- angiography
- heart MRI
- nuclear image tests
what are nutrition therapy recommendations for atherosclerosis?
- reduce energy intake to lose weight and adopt healthy diet (health behaviour modifications remain the cornerstone of chronic disease prevention)
Studies suggest consuming healthy diet, regular physical activity, limit alcohol, stop smoking
they primarily recommend a meditteranean dietary pattern, which has evidence of CV outcomes from systematic reviews
what are some diets they recommend for atherosclerosis?
- mediterranean
- portfolio
- DASH
- high in nuts (> 30 g/day)
- high in legumes (> 4 servings/week)
- high in olive oil (>60 ml/day)
- > 5 servings fruits and veg
- > 30 g fibre, > 3 servings whole grains
- low glycemic foods
- vegetarian diet
Which diet is more effective for CVD - meditteranean diet or vegetarian diet?
mediterannean
Medi diet decreases CV events by 30%
Vegetarian diet decreases CV mortality by 10%
what is the effect of Meditteranean diet on health outcomes?
decreases major CV events by 30%
what is the effect of the dash diet on CVD outcomes?
- decreases 10 yr Framingham risk by 20%
- reduced LDL by 3%
- decreases BP in 2 weeks with or without sodium reduction
what is the effect of the vegetarian diet on CVD outcomes?
decreases CV mortality by 10%
what is the effect of the portfolio diet on CVD outcomes?
decreases 10 yr Framingham risk score by 11%
reduces LDL by 8-14%
what is the effect of low GI diets on CVD outcomes?
decreased CHD and CVD by 10-12%
which diets are best for CVD?
mediterranean and dash
name 5+ characteristics of the mediteranean diet?
- low in saturated fat
- very low in trans fat
- high unsaturated fat
- high starch and fibre
- high phytochemicals
+ wine
eat fish 2x per week
bottom of pyramid is activity, then fruits, veggies, whole grains, olive oil, then fish, then poultry and eggs, then meat and sweets
what are the 4 main types of dietary fats?
- monounsaturated fats
- polyunsaturated fats
- saturated fats
- trans fats
what are the adverse CV effects of saturated fat?
- they reduce HDL
- they reduce vascular function
- they increase LDL
- they increase trigs
- they increase teratogenic effects in fetus
- they increase inflammation
what are the 2 types of trans fats?
added trans fats
naturally occuring trans fats (in dairy, meat) - these dont case problems
for CVD, AVOID intake of trans fats
what are the main food sources of trans fats?
- processed foods
- hydrogenated oils
- bakery products
- icing
- coffee whitener
- vegetable shortening
- hard margarine
how many grams of trans fats are ok?
if serving has < 0.5 g of trans fats, thats ok
_____ results from the HYDROGENATION of PUFAS
trans fats
most sources of ____ are made with partially hydrogenated vegetable oil
trans fat
the WHO recommends ______ total energy comes from trans fats
< 1%
which foods ahve the most trans fats
commercial baked goods!
it is ILLEGAL to add trans fats to products. but products can be listed as 0 g trans fat if they are less then 0.5 g per serving
________ the intake of saturated fats for CVD disease risk reduction
DECREASE
what are the adverse CV effects of saturated fat?
- they reduce HDL
- they reduce vascular function
- they increase LDL
- they increase trigs
- they increase inflammation
is all saturated fat the same?
no. saturated fat is different in meat vs. dairy products. it is more damaging in meat.
in meat, the heme molecule has pro-inflammatory effect on body. and then in dairy, you have addition of calciu, metc
which foods have saturated fats?
animal products:
- red meat
- chicken with skin
- butter
- cheese
- high fat milk
tropical oils
- coconut oil
- palm oil palm kernel oil
replace saturated fats with PUFAs
what are the positive health and CV effects of PUFAs?
- decreased mortality
- decreased CAD risk
- decreased stroke
- decreased LDL
- decreased trigs
- increased HDL
- increased vascular function
good for brain development, nerve transmission, skin structure, immune function
which oils have MUFAs?
- olive oil
- canola oil - not good
- peanut oil
- sunflower oil
- soybean oil
which foods have MUFAs?
avocado
peanut butter
almond butter
nuts and seeds
What is the saturated fat recommendation for CVD?
<9% of total energy
Replace saturated fat with _____
MUFAS and PUFAS
1% increase in saturated fats —> _____ % increase in blood LDL —> _____ % increase in heart diseas2
1% increase in saturated fat –> 2% increase in LDL –> 2% increase in heart disease
1% decrease in saturated fat –> ___% decrease in LDL –> ____% decrease in heart disease
Q
1% decrease in saturated fat –> 2% decrease in LDL –> 2% decrease in heart disease
avocado is an example of a ________
MUFA
Nuts are examples of a ________
MUFA
Canola oil is an example of ____
MUFAS
Margarine, mayo, are examples of_______
Omega 6 PUFA
Fatty fish and flaxseed are examples of
Omega 3 PUFA
How many grams of fibre per day should be viscous soluble fibre? (oats, barliey, pectin)
10-15g (eating more than this won’t help)
_____ are similar to cholesterol in structure.
They can lower LDL cholesterol on blood
Plant sterols
_______ block the absorption of cholesterol from the intestine, to help reduce LDL in blood. They can reduce cholesterol in 3 weeks
plant sterols
how many plant sterols should I have?
2 g / day can reduce cholesterol by 5-15%. There are no additional benefits to taking more
Where are plant sterols found?
vegetable oils
nuts
seeds
legumes
whole grains
veggies
fruits
SESAME OIL AND SEEDS
(but can’t get 2 g from these foods alone)
What are the risks to eating plant sterols?
there are no known risks or side effects from eating foods or taking supplements with added plant sterols
why do people take plant sterols?
to help reduce LDL cholesterol
how often should we eat fatty fish to be heart healthy (omega 3)?.
2-3 x per week
what are plant sources of omega 3 fats?
flaxseed
flaxseed oil
canola oil
soybean oil
nuts
Are fish oil (omega 3 EPA/DHA) supplements recommended?
fish oil supplements are NOT recommended for CVD prevention.
fish oil supplements ARE recommended for CVD management, if people have CAD or are trying to manage high trigs
in what 3 scenarios are fish oils recommended?
how much is recommended?
800-1000 mg EPA/DHA is recommended for:
- patients with CAD
- those at risk with sudden cardiac death
- managing high trigs
why is taking fish oil good for CVD management?
- it prevents sudden cardiac death
- prevents blood clots
- lowers trigs
how much fish oil should i take for cvd management?
0.8-1 g EPA/DHA
3 g is overdoing it
if someone is on blood thinners, dont do fish oil
is alcohol good for CVD?
maybe. moderate alcohol consumption (1-2) drinks per day from ANY SOURCE, including beer, can reduce risk of CVD
but HIGH intakes are associated with high trigs, hypertension, liver damage etc
What are 8 good ways to reduce LDL cholesterol in the diet?
- increase intake of MUFAs (seafood, canola oil, olive oil. Eat 30 g/day of nuts)
- Include plant sterols
- Add soluble fibre to diet - psyllium, barley, prunes, flaxseed.
- Eat more fruits and veggies - 3-4 servings each day, or 5+ servings for extra benefits
- include more plant proteins
- increase activity level - heart beat raising and resistance training
- decrease or eliminate foods that have trans fats
- decrease saturated fats
What are 4 good ways to increase HDl cholesterol in the diet?
- increase activity level
- moderate amounts of alcohol
- increase intake of omega 3 and MUFAs
- eat more fruits and veggies
What is hypertension?
It is when your blood pressure (aka the force of blood pushing against the walls of your blood vessels) is consistently high
_____ is the force at which the blood is pumped out of the heart
systolic
____ is the pressure in the blood vessels when the heart is at rest
diastolic
what is considered elevated bp?
120-129 / 80
what is considered high blood pressure (hypertension stage 1)?
130-139 / 80-90
what is considered high blood pressure (hypertension stage 2)?
140+ / 90+
what is considered hypertensive crisis?
180+ / 120+
what are the 5 categories of blood pressure?
- normal
- elevated
- high bp stage 1
- high bp stage 2
- hypertensive crisis
hypertension affects _____ Canadian adults
1 in 4 Canadian adults
7.5 million Canadians
What is the pathophysiology of hypertension? What is the difference between primary (essential) hypertension and secondary hypertension?
primary = idiopathic. influenced by lifestyle factors and inflammatory responses. There is NO CLINICAL REASON for it but lifestyle factors affect it
Secondary = result of another chronic condition like kidney disease
in what % of hypertension cases is the cause unknown?
90-95%
BP is elevated by factors that:
- increase blood volume
- increase heart rate
- increase resistance blood flow
what are 2 non-modifiable risk factors that affect bp?
- increasing age
- family history - genetics
what are 7 modifiable risk factors that influence bp?
- increased LDL cholesterol
- decreased HDL cholesterol
- alcohol
- diabetes
- obesity
- physical inactivity
- smoking
What are 3 dietary approaches to reducing hypertension?
- DASH diet
- restrict sodium
- monitor potassium intake
how to reduce hypertension?
- reduce weight
- increase physical activity
- moderate alcohol consumption
- DASH diet
- restrict sodium
- potassium intake
- 2 or more drugs
What are the 4 classes of drug therapies for hypertension?
- Diuretics (thiazide)
- ACE inhibitors (pril)
- angiotensin receptor blockers (sartan)
- calcium channel blockers (dipine)
this class of hypertension medications decreases blood volume by increasing urinary output
diuretics
this class of hypertension medications reduces BP by decreasing peripheral vascular resistance
ACE inhibitors
this class of hypertension medications interferes with renin-angiotensin system without inhibiting bradykinin degradation
angiotensin receptor blockers
with which hypertension drugs do you have to avoid grapefruit?
angiotension receptor blockers
what is one food you need to be careful about with hypertension drugs
licorice
which interventions have the biggest effect on BP in those with hypertension?
- DASH diet - reduces systolic BP by 11.4/5.5
- diet and waist circumference control - reduces systolic BP by 6/4.8
the DASH diet is a pattern that is low in:
the DASH diet emphasizes:
- saturated fat
- cholesterol
- total fat
- sodium
- fruit and veggie consumption
- low fat dairy products
- whole grains
- fish, poultry, nuts
if following the dash diet, the greatest benefits are observed with an intake of ______ mg sodium
1500 mg/day (but people are now saying that that isnt realistic, and are recommending 2000)
What is the sodium recommendation for hyertension?
AI = 2000 mg/day
Upper limit = 2300 mg/day
most people = > 3000 mg/day
EVERYONE will benefit from a reduction in sodium except hypotensive people.
Salt is ____ % sodium by weight - and is the major source of sodium
40%
What contains more sodium - iodized salt, sea salt, kosher salt,?
they all are similar
What are 5 roles of salt in the body?
- controls fluid volume
- maintains bp
- participates in proper nerve and muscle function
- helps nutrients enter body cells
- too much salt = less flexible blood vessels
why do people crave more salt the more they eat it?
because the more salt we eat, the bigger goblet cells get, so the more we crave salt
which 3 food groups contain the most sodium?
- bake products
- mixed dishes
- processed meat
what are the main dietary sources of sodium?
- restaurants/processed foods (77%)
- naturally present in foods (12%)
- salt shaker (6%)
- home cooking (5%)
The % of Canadians consuming excess sodium increases with age during childhood, and PEAKS DURING ADOLESCENCE AND EARLY ADULTHOOD, before it starts to decrease at age 30
at what age does sodium consumption peak?
19-30
List 5 tips for reducing sodium intake?
- choose low-sodium or no-sodium options
- use fresh poultry/fish rather than canned or smoked
- limit cured foods
- choose convenience foods that are lower in sodium
- rinse canned foods
- choose snacks that are lower in sodium
- dont add salt to cooking water
- flavour with fresh spices
What % sodium on label is low? how many mg?
5% (or less than 8% of daily value aka < 200 mg(
What % sodium on label is moderate?
5-20%
What % sodium on label is high?
20% (or 15% if you want to be conservative)
What are the main differences between the old labels and the new labels?
- serving size stands out more
- calories is larger
- new % daily value for total sugars
- potassium, iron, calcium instead of vitamin a, vitamin c, calcium
- New % daily value footnote for sodium
whats the AI for sodium? how many tsp?
2300 mg/day
1 tsp salt
What are some examples of low sodium foods?
mealts
poultry
fish
legumes
eggs
nuts
yogurt
cream cheese
What are the hypertension recommendations around potassium? What is the minimum? What is the AI?
minimum = 3000 mg/day
AI = 4700 mg/day
How is one diagnosed with hyperkalemia (high potassium)? What could it be a result of?
Potassium concentration above 3.5-5 mmol/L.
Can lead to:
1. CKD
2. patients taking renin-angiotensin aldosterone inhibitors
What are the main sources of potassium?
POTATOS
BANANAS
LIMA BEANS
CEREAL
YOGURT
MILK
potassium is common in veggies nad dairy, less common in protein and wheat
if you are trying to reduce hypertension, how much alcohol should you drink?
1 drink per day/women
2 drinks per day/men
