Coronary Artery Disease
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Coronary Heart Disease (CHD)
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Coronary Heart Disease (CHD)
>58 million American have at least one form of CHD.
50% of all cardiac deaths result from CHD
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Mortality From Diseases of the Heart by Race/Ethnicity (Deaths/100,000)
Age Hispanic Asian Native Amer.
Black White
45-64 166 99 224 426 244
>65 1336 870 1128 2181 2079
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Coronary Heart Disease
The major underlying cause is atherosclerosis.atherosclerosis.
AtherosclerosisAtherosclerosis is a slow, progressive disease which begins in childhood and takes decades to advance
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Coronary Heart Disease
Plaque (the build-up of lipid/cholesterol) in the artery wall forms as a response to injuryinjury to the endothelium in the artery wall.
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Risk Factors forCoronary Heart Disease
Age:Male > 45 yearsFemale > 55 years or premature menopause
without estrogen replacement therapyFamily History of premature disease
Male first-degree relative <55 years Female first-degree relative < 65 years)
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Risk Factors forCoronary Heart Disease
Hypertension Appears to weaken the artery wall at
points of high pressure leading to injury and invasion of cholesterol.
Cigarette Smoking#1 cause of preventable death in US1 in 5 CHD deaths attributable to
smoking
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Risk Factors forCoronary Heart Disease
Diabetes 50% of deaths related to DM
is due to CHD
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Risk Factors forCoronary Heart Disease
InactivitySedentary person has 2x risk
for developing CHD as a person who is active.
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Risk Factors forCoronary Heart Disease
Obesity
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Risk Factors forCoronary Heart Disease
Abnormal Blood Lipids LDL Cholesterol (low density
lipoprotein)
HDL Cholesterol (high density lipoprotein)
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Cholesterol
Diet Liver
Cholesterol Metabolism
15% 75%
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Blood Lipids and Lipoproteins
Some LDL-C can be oxidized and takes up by endothelial cells and macrophages in the arterial wall, which leads to the first stages of atherosclerosis.
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Blood Lipids and Lipoproteins
HDL-C is thought to be involved in the transport of excess cholesterol from membranes to the liver for removal from the body.
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Blood Lipids and Lipoproteins
HDL-C IS INCREASED:Exercise, loss of weight, and
moderate consumption of ETOH.HDL-C is lowered:
Obesity, inactivity, cigarette smoking, some oral contraceptives and steroids, hypertriglyceridemia and some genetic factors.
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Cholesterol and the CHD Patient
Goal:The goal is a LDL-C level of
100 mg/dL
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Blood Lipid Classification Cholesterol: <200 mg/dl 200-239 mg/dl >240 mg/dl
Desirable Borderline high-risk High-risk
HDL Cholesterol <40 mg/dl >60 mgl/dl
Low High, negates one risk factor
LDL Cholesterol <100 mg/dl 100 – 129 mg/dl 130-159 mg/dL >160 mg/dl
Desirable Above optimal Borderline High High Risk
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Treatment in CHD Patients
LDL-C Levels
Diet & Life Habits
Drug Therapy
<100 mg/dL Yes No
100-129 mg/dL
Yes Clinical J udgment
>130 mg/dL Yes Yes
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Diet Therapy of High Blood Cholesterol
Healthy Heart Diet Therapeutic Lifestyle Change Diet (TLC)
8-10% calories from saturated fat
<7% calories from saturated fat
20 - 35% calories from fat 20-35% calories from fat
<300 mg. cholesterol <200 mg. cholesterol
5-10% of energy from PUFA
5-10% of energy from PUFA
Up to 20% MUFA Up to 20% MUFA
Calories to maintain IBW Calories to maintain IBW
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Diet Therapy of High Blood Cholesterol
Trans-Fatty AcidsIncrease LDL Cholesterol and
decrease HDL CholesterolRecommendations: Intakes of
trans-fatty acids should be as low as possible
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FoodCalories
TransFattyAcids
(g)
Saturated Fatty Acids
(g)Hamburger (7 oz) 660 3 14
McDonalds chicken McNuggets (9 oz)
510 3 6
Burger King chicken sandwich (8 oz)
610 2 7
Burger King fries (6 oz King size)
540 7 6
Starbucks cinnamon scone (5 oz)
530 3 13
(Data compiled from Nutrition Action Health Letter, June 1999)
Trans fatty acid content of fast-food
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Treatment for CHD
Physical ActivityPhysical Activityprescribed by physician for patients with
CHDWhen aerobic activity is appropriate,
activity that places moderate stress on the cardio-respiratory system can be included.
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Treatment for CHD
Weight ControlWeight Control 5-10# weight loss
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Diet Therapy of High Blood Cholesterol
Soluble Fiber 10-20 g/day
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Drug Treatment
Statins -Bile Acid SequestrantsNicotinic Acid
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Dietary Issues Requiring Further Research
Elevated levels of homocysteinehomocysteine
Elevated homocysteine levels may be present in 15% of Americans.
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Steps for Lowering LDL-C in the Diet
Eggs:<300 mg. cholesterol: < 4
yolks/wk< 200 mg. Cholesterol: < 2
yolks/wk
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Guidelines for Selecting & Preparing Foods
Milk and Milk Products:2-3 servings/day
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Steps for Lowering LDL-C in the Diet
Fats, oils:<6-8 tsp./day
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Steps for Lowering LDL-C in the Diet
Monounsaturated Fats:Canola, olive and peanut oilAvocadoOlives: black and greenNuts: almonds, cashews, peanuts,
pecansSesame seeds
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Steps for Lowering LDL-C in the Diet
Polyunsaturated FatsMargarine made with corn, soybean,
safflower, sesame oilsTub, squeeze or stickNuts: walnuts and EnglishSalad dressingsSeeds: pumpkin, sunflower
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Steps for Lowering LDL-C in the Diet
Saturated Fat:Butter, Coconut & Coconut Oil, Palm OilCream, half and halfCream cheeseShortening or lardSour creamFat from animal products including milk
and meats
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Steps for Lowering LDL-C in the Diet
Plant Sterols and Stanols:Natural substances derived from
wood, vegetables, vegetable oils and other plants - sitosterol and sitostanol
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Steps for Lowering LDL-C in the Diet
Meat, Fish and PoultryMeat, Fish and Poultry Select lean meat and poultry
<6 oz/day for Step I diet and <5 oz/day for Step II
Eat fish on a weekly basis
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Steps for Lowering LDL-C in the Diet
Breads and Cereals: 6-11 servings/day
Low fat crackersTortillasHot and cold cereals excepts granola or
meusli
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Steps for Lowering LDL-C in the Diet
Vegetables:3-5 servings per day
Fruits2-4 servings per day
Use sweets and modified fat desserts in moderation
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Reading The Label
Extra Lean <5 g total fat, 2 g saturated fat, and 95 mg
cholesterolLean
< 10 g total fat, 4 g saturated fat and 95 mg cholesterol
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Guidelines for Selecting & Preparing Foods
Try reducing fat by 1/4 to 1/3 in baked products. E.g. if recipe calls for 1 cup oil, try 2/3 C.
In casseroles and main dishes, cut back or eliminate the fat.
Sauté or stir fry with very little fat or use water, wine, or broth.
Chill soups, gravies and stews and skim off hardened fat before serving.