© 2007 Thomson - Wadsworth

Chapter 21

Nutrition & Disorders of the Heart & Blood

Vessels

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CVD Deaths in the U.S.

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Athrosclerosis

• Artery walls become progressively thickened due to accumulation of plaque

• Occurs due to minimal but chronic injuries that damage the inner arterial wall

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Consequences

• Lumen narrows• Plaque can

rupture, forming a clot (thrombus)

• Thrombus can break free & shut off blood flow (embolism)

• Ischemia occurs within the tissueCoronary arteries

(angina pectoris & heart attack)

Brain (stroke)

• Aneurysm (sac-like distention of blood vessel wall)

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Causes of Athrosclerosis

• Inflammation & infection

• Hypertension • Smoking

• Diabetes mellitus• Aging• Elevated LDL &

VLDL

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Coronary Heart Disease

• Most common type• Leading cause of

death in U.S.• Evaluating Risk

SmokingHigh LDLHigh blood pressureDiabetesObesity Inactivity

• Non-modifiable risk factorsAgeMale genderFamily history

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Lifestyle Changes for CHD

• Cholesterol-lowering diet (<200 mg)

• Weight reduction• Regular physical

activity• Decrease saturated

fat <7% total kcalories

• Decrease total fat 25-35% of kcalories

• Decrease trans fat• Increase soluble fiber• Plant sterols &

stanols• Eat soy products• Increase fish &

omega-3 fatty acids• Moderate alcohol

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Lifestyle Changes for Hypertriglyceridemia

• MildWeight reductionPhysical activityQuit smokingAvoid high-CHO

dietRestrict alcohol

• SevereWeight reductionPhysical activityVery-low-fat diet:

<15% of kcaloriesMedication

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Vitamin Supplementation

• No conclusive research results have been obtained for vitamins being preventative for CVD

• Study is underway for increasing:Folate, vitamin B6 & B12 to decrease

homocysteine levelsVitamin C and E for antioxidant effects

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Drug Therapies for CHD Prevention

• Statins Reduce cholesterol

synthesis in the liver

• Bile acid sequestrants Reduce cholesterol &

bile absorption in small intestine

• Nicotinic acid Lowers triglycerides &

raises HDLs

• Anticoagulants & aspirin Suppress blood

clotting

• Blood pressure medications

• Nitroglycerin for angina

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Treatment for Heart Attack

• Drug therapyThrombolyticsAnticoagulantsAspirinPainkillersBlood pressure

medicationsRhythm stabilizers

• No food until stableSoft foodsLow sodiumLow saturated fat

• Cardiac rehabilitation

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Hypertension

• Affects 1/3 of adults in U.S.

• Factors influencing BPCardiac outputPeripheral resistanceSecretion of hormones

by kidneys

• Desirable BP < 120/80

• Prehypertension 120-139/80-89

• Hypertension > 140/90

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Contributing Factors

• Aging• Genetics

More prevalent in African Americans

• ObesityAlters kidney

function & promotes fluid retention

• Salt sensitivity30-50% of cases

• Alcohol3-4 drinks daily

• DietFruits, vegetables,

nuts, low-fat milk can lower BP

Potassium, calcium, & magnesium can lower BP

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Treatment of Hypertension

• Weight reduction• Low-sodium diet• Diet rich in

potassium, calcium, & magnesium

• Regular physical activity

• Moderate alcohol

• DASH Diet - Limits: Red meatsSweetsSugar-containing

beveragesSaturated fat to <7%Cholesterol to 150

mg/day

• Drug therapy

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Congestive Heart Failure

• Heart’s inability to pump adequate blood

• Fluids build up in veins & tissues

• Heart enlarges• 75% are 65 or

older

• ConsequencesFluid accumulation in

liver, abdomen, & lower extremities

Chest pain; swelling legs, ankles, feet; SOB

Impaired liver & kidneysHeart failureCardiac cachexia

© 2007 Thomson - Wadsworth

© 2007 Thomson - Wadsworth

Medical Management

• Sodium & fluid restrictions• Diuretics• Small, frequent meals• Vaccinations for influenza

& pneumonia• Adequate fiber• Avoid alcohol• Liquid supplements, tube

feedings, parenteral support

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Stroke

• 3rd leading cause of death

• Types IschemicHemorrhagicTransient ischemic

attacks (TIAs)

• PreventionRecognize risk factorsLifestyle changes

• ManagementThrombolytic drugsMaintain nutrition statusProblems

• Lack of coordination• Difficulty swallowing