Cholesterol, blood pressure, and heart disease

By Melissa Bess

Nutrition and Health Education Specialist

University of Missouri ExtensionFNEP STAFF TRAINING ONLY, DO NOT USE WITH FNEP PARTICIPANTS

06/2007

Introduction

• About cholesterol

• LDL vs. HDL

• Triglycerides

• Healthy levels

• Common misconceptions

• What affects cholesterol?

• Why does it matter?

• Prevention of high cholesterol

Introduction (continued)

• About blood pressure

• Common misconceptions

• Controlling high blood pressure

• Heart disease risk factors

About cholesterol

• Soft, fat-like, waxy substance• Bloodstream and cells• Needed for cell membranes and

hormones and to make vitamin D• Comes from 2 sources

– Body produces it (mostly genetic) in liver (1000 mg day)

– Food sources (animal products – meats, poultry, fish, eggs, butter, whole milk, and cheese, not from plant sources) (100 – 500 mg day)

– Foods with trans fats or saturated fats may cause the body to produce more cholesterol

About cholesterol

• Must be transported through blood

• Carriers are called lipoproteins– Low-density lipoprotein (LDL)– High-density lipoprotein (HDL)

• Lipoprotein = protein + fat– LDL, more fat, less protein– HDL, more protein, less fat

LDL vs. HDL

• LDL = “bad”

• Too much can clog arteries by forming plaque

• Atherosclerosis can cause heart attack or stroke

LDL vs. HDL

• HDL = “good”

• Tends to carry cholesterol away from arteries and back to liver

• May also remove excess cholesterol from plaque in arteries, slows buildup

Triglycerides

• Form of fat

• Also made in body (body fat stored as triglyceride) and from food

• Help transport dietary fat, metabolism

• Trigger liver to make more cholesterol, rising LDL and total cholesterol

Healthy Levels

• Total cholesterol– Optimal – under 200 mg/dL– Borderline high risk – 200-239 mg/dL– High risk – 240 mg/dL and up

• LDL– Optimal – less than 100 mg/dL– Near/Above optimal – 100-129 mg/dL– Borderline high – 130- 159 mg/dL– High – 160 – 189 mg/dL– Very high – 190 mg/dL

Source: National Cholesterol Education Program, National Heart, Lung, and Blood Institute

Healthy Levels

• HDL– Low - less than 40 mg/dL– High – above 60 mg/dL (may lower

risk for heart disease)– Women tend to have higher HDL due

to estrogen (needs to be over 50 mg/dL)

• Triglycerides– Normal – less than 150 mg/dL– Borderline high – 150 – 199 mg/dL– High – above 200 mg/dL

Source: National Cholesterol Education Program, National Heart, Lung, and Blood Institute

Common misconceptions

• Using margarine instead of butter will help lower my cholesterol

• Thin people don’t have to worry about high cholesterol

• If a label lists no cholesterol, it’s a “heart-healthy” choice

• Eggs – good or bad?• Women don’t need to worry about

cholesterol• Only middle-aged people should

have their cholesterol checked

What affects cholesterol?

• Diet– Poly and monounsaturated fats may help

lower cholesterol when used in place of saturated fats, but still limit

– High carbs, excessive alcohol may increase triglycerides

– Soluble fiber may lower LDL, not HDL

• Weight• Physical activity• Age• Gender• Heredity

Why does it matter?

• Coronary heart disease is caused by atherosclerosis

• Single leading cause of death• The higher LDL you have plus risk

factors increases risk for heart attack– Smoking– High Blood pressure– Low HDL– Family history of early heart disease– Age

Prevention of high cholesterol

• Get it checked• Watch fats, eat healthy• Consume less than 300 mg of

cholesterol a day• Be active• Quit smoking• Some may need medication

– Lipitor, Crestor, Zocor– Vytorin– Zetia

Blood pressure

• 1 in 3 adults has hypertension• No symptoms, nearly 1/3 of those

people don’t know they have it• No known cause• 2 forces

– Blood pumps to arteries and through circulatory system

– Arteries resist blood flow

• Arteries elastic, stretchy• Heart beats 60-80 times a minute

Blood pressure

• Systolic (top) – heart is beating• Diastolic (bottom) – heart resting• Normal – 120/80 mm Hg• Pre-hypertensive – 120-139/80-89 mm

Hg• Hypertensive – 140/90 mm Hg• May take several readings• “White coat hypertension”• Hypertension increases risk for heart

disease and stroke• Number 1 controllable risk factor for

stroke

Blood pressure

• Sodium/salt– Holds excess fluid in body, heart has

to work harder

• Potassium– Blunts effects of salt on blood

pressure

Common misconceptions

• Symptoms of high blood pressure include nervousness, sweating, and difficulty sleeping

• High cholesterol = high blood pressure

• Everyone has high blood pressure, I don’t need to worry

• Women don’t need to worry about high blood pressure

Controlling hypertension

• Reduce fat (particularly saturated fat)

• Stop smoking

• Cut back on alcohol

• Be active

• May need medication

• Stress management

Heart disease risk factors

• Uncontrollable– Age– Male gender– Heredity (including race) – African

Americans = higher blood pressure. Also higher among other races

• Controllable– Smoking (2-4x higher than non-

smokers)– High cholesterol (high HDL can be

positive risk factor)– High blood pressure

Heart disease risk factors

• Controllable– Physical inactivity– Obesity/overweight (especially in

abdominal area)– Diabetes

• Other factors– Stress– Too much alcohol

• Moderate drinkers = less risk than non-drinkers (may increase HDL cholesterol)

Phytonutrients

• Soy protein may reduce risk of heart disease– Especially when replacing foods high in

saturated fat

• Plant sterols/stanols– Found naturally in fruits/veggies, plant oils

may lower LDL

• Omega-3 fatty acids– Two weekly servings of fish may be heart

healthy

• Folic Acid– May lower homocysteine levels

• Antioxidants

• Questions??

• Activity time!