Heart Disease- The Silent KillerHeart Disease- The Silent Killer

Created by: Created by:

Tricia Fleming, University of Kansas Dietetic Intern Tricia Fleming, University of Kansas Dietetic Intern

Tammy Beason, MS, RD, Nutrition Education Specialist, Tammy Beason, MS, RD, Nutrition Education Specialist, Family Nutrition Education ProgramFamily Nutrition Education Program

December 2001December 2001

What is Heart Disease?What is Heart Disease?

A general term that covers a number of A general term that covers a number of diseases which affect the heart, including diseases which affect the heart, including coronary artery disease, heart-failure and coronary artery disease, heart-failure and angina.angina.

Heart Disease is the number one killer in Heart Disease is the number one killer in the United States.the United States.

What Causes Heart Disease?What Causes Heart Disease?

Atherosclerosis-fatty deposits of cholesterolAtherosclerosis-fatty deposits of cholesterol

Hypertension- we will discuss in detail Hypertension- we will discuss in detail later.later.

Coronary Artery DiseaseCoronary Artery Disease

Occurs when the coronary arteries that Occurs when the coronary arteries that supply the heart muscle become blocked.supply the heart muscle become blocked.

Partially blocked it causes angina.Partially blocked it causes angina.

Fully blocked it causes a myocardial Fully blocked it causes a myocardial infarction or a heart attack!infarction or a heart attack!

Myocardial Infarction or

Heart Attack

Myocardial Infarction or

Heart Attack

Symptoms: uncomfortable pressure, Symptoms: uncomfortable pressure, fullness, squeezing pain, pain spreading to fullness, squeezing pain, pain spreading to the shoulders, neck and arms.the shoulders, neck and arms.

Chest discomfort and light headednessChest discomfort and light headedness Anxiety/nervousnessAnxiety/nervousness Paleness or pallorPaleness or pallor Increased irregular heart rateIncreased irregular heart rate

Myocardial Infarction contd.Myocardial Infarction contd.

Feeling of impending doomFeeling of impending doom

If you or someone you know is having these If you or someone you know is having these symptoms call 911!symptoms call 911!

Congestive Heart FailureCongestive Heart Failure

Fits under the description of heart disease.Fits under the description of heart disease. Does not mean the heart has failed, simply Does not mean the heart has failed, simply

means the heart is not doing an efficient job. means the heart is not doing an efficient job. It results from an injury or a reduction of It results from an injury or a reduction of

function of the heart muscle.function of the heart muscle. Can be due to arteriosclerosis, hypertension, Can be due to arteriosclerosis, hypertension,

myocardial infarction, rheumatic fever or myocardial infarction, rheumatic fever or birth defect.birth defect.

Congestive Heart FailureCongestive Heart Failure

The right side of the heart collects the blood The right side of the heart collects the blood returning from the body and sends it to the lungs.returning from the body and sends it to the lungs.

If it is failing, the blood backs up into the veins, If it is failing, the blood backs up into the veins, and there are signs of edema.and there are signs of edema.

The left side of the heart receives the blood from The left side of the heart receives the blood from the lungs and pumps it out into the body. If it is the lungs and pumps it out into the body. If it is failing the blood is not pumped effectively.failing the blood is not pumped effectively.

Cerebrovascular Accidentor

Stroke

Cerebrovascular Accidentor

Stroke

Blood vessel in the brain becomes blocked Blood vessel in the brain becomes blocked by atherosclerosis- the tissue supplied by by atherosclerosis- the tissue supplied by the artery dies.the artery dies.

Embolus – which is a traveling blood clot.Embolus – which is a traveling blood clot.

Symptoms of StrokeSymptoms of Stroke

Sudden numbness or weakness of the face, Sudden numbness or weakness of the face, arm or leg, especially on one side of the arm or leg, especially on one side of the body.body.

Sudden confusion, trouble speaking, or Sudden confusion, trouble speaking, or understanding.understanding.

Sudden trouble seeing in one or both eyes.Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of Sudden trouble walking, dizziness, loss of

balance or coordination.balance or coordination.

Symptoms of StrokeSymptoms of Stroke

Sudden severe headache with no known Sudden severe headache with no known cause.cause.

If you have any of these symptoms you If you have any of these symptoms you need immediate medical attention!need immediate medical attention!

Unchangeable Risk FactorsUnchangeable Risk Factors

Age- the older you get, the greater the Age- the older you get, the greater the chance.chance.

Sex- males have a greater rate even after Sex- males have a greater rate even after women pass menopause.women pass menopause.

Race- minorities have a greater chance.Race- minorities have a greater chance. Family history- if family members have had Family history- if family members have had

CHD, there is a greater chance.CHD, there is a greater chance.

Unchangeable Risk FactorsUnchangeable Risk Factors

Personal Medical History- other diseases Personal Medical History- other diseases such as Diabetes Mellitus can increase such as Diabetes Mellitus can increase chances.chances.

Changeable Risk FactorsChangeable Risk Factors

HypertensionHypertension Serum cholesterolSerum cholesterol ObesityObesity Diabetes MellitusDiabetes Mellitus Physical InactivityPhysical Inactivity Cigarette SmokingCigarette Smoking Alcohol IntakeAlcohol Intake

CholesterolCholesterol

Everybody needs cholesterol, it serves a vital Everybody needs cholesterol, it serves a vital function in the body.function in the body.

It is a component of the nerve tissue of the brain It is a component of the nerve tissue of the brain and spinal cord as well as other major organs.and spinal cord as well as other major organs.

Frequently measured to promote health and Frequently measured to promote health and prevent disease.prevent disease.

A major component of the plaque that clogs A major component of the plaque that clogs arteries.arteries.

Types of CholesterolTypes of Cholesterol

Lipoproteins- 4 main classesLipoproteins- 4 main classes ChylomicronsChylomicrons Very low density lipoproteins (VLDL)Very low density lipoproteins (VLDL) Low Density Lipoprotein (LDL)Low Density Lipoprotein (LDL) High Density Lipoprotein (HDL)High Density Lipoprotein (HDL)

Good vs. BADGood vs. BAD

LDL is known as bad cholesterol. It has a LDL is known as bad cholesterol. It has a tendency to increase risk of CHD.tendency to increase risk of CHD.

LDL’s are a major component of the LDL’s are a major component of the atherosclerotic plaque that clogs arteries.atherosclerotic plaque that clogs arteries.

Levels should be <130Levels should be <130

Good vs. BADGood vs. BAD

HDL is known as the good cholesterol.HDL is known as the good cholesterol. It helps carry some of the bad cholesterol out It helps carry some of the bad cholesterol out

of the body. of the body. It does not have the tendency to clog arteries.It does not have the tendency to clog arteries. Levels should be >35.Levels should be >35. High levels of HDL >60 can actually negate High levels of HDL >60 can actually negate

one other risk factor.one other risk factor.

The Facts About FatThe Facts About Fat

Certain fats are essential for good nutrition Certain fats are essential for good nutrition and health.and health.

Fats provide essential fatty acids which the Fats provide essential fatty acids which the body can’t manufacture.body can’t manufacture.

Act as insulators to maintain body Act as insulators to maintain body temperature.temperature.

Improve the palatability of food and Improve the palatability of food and promote digestion.promote digestion.

The Facts About FatThe Facts About Fat

Provide the greatest energy output per gram Provide the greatest energy output per gram of any food source. ( 9 cals)of any food source. ( 9 cals)

Carry fat soluble vitamins- A,D,E, and K.Carry fat soluble vitamins- A,D,E, and K.

The Skinny on FatThe Skinny on Fat

Saturated fats- basically means the fat is Saturated fats- basically means the fat is saturated with hydrogen, they are solid at saturated with hydrogen, they are solid at room temperature. Examples are lard and room temperature. Examples are lard and butter. butter.

Why are they bad for you? They increase Why are they bad for you? They increase levels of LDL , decrease HDL and increase levels of LDL , decrease HDL and increase total cholesterol.total cholesterol.

The Skinny on FatThe Skinny on Fat

What are polyunsaturated fats? They are What are polyunsaturated fats? They are unsaturated fats which are liquid at room unsaturated fats which are liquid at room temperature and in the refrigerator.temperature and in the refrigerator.

Why are they good for us?Why are they good for us? They help the body get rid of newly formed They help the body get rid of newly formed

cholesterol.cholesterol.

The Skinny on FatThe Skinny on Fat

What are monounsaturated fats? What are monounsaturated fats? They are liquid at room temperature but They are liquid at room temperature but

start to solidify in the refrigerator.start to solidify in the refrigerator. Decrease total cholesterol and lower LDL Decrease total cholesterol and lower LDL

levels.levels.

The Skinny on FatThe Skinny on Fat

What are trans fatty acids? They are What are trans fatty acids? They are unsaturated fats but they tend to raise total unsaturated fats but they tend to raise total and bad cholesterol.and bad cholesterol.

Where do you find them?Where do you find them? In fast-food restaurantsIn fast-food restaurants Commercial baked goods. Examples: Commercial baked goods. Examples:

doughnuts, potato chips, cupcakes.doughnuts, potato chips, cupcakes.

What about Omega 3?What about Omega 3?

Type of polyunsaturated fat.Type of polyunsaturated fat. Consistently lowers serum triglycerides and Consistently lowers serum triglycerides and

may also have an effect on lowering blood may also have an effect on lowering blood pressure.pressure.

Found in oily fish such as salmon, tuna, and Found in oily fish such as salmon, tuna, and herring.herring.

Is available as a supplement.Is available as a supplement.

ObesityObesity

People who are obese have 2 to 6 times the People who are obese have 2 to 6 times the risk of developing hypertension. risk of developing hypertension.

Location of the body fat is significant.Location of the body fat is significant. Pears of apples?Pears of apples?

Diabetes MellitusDiabetes Mellitus

At any given cholesterol level, diabetic At any given cholesterol level, diabetic persons have a 2 or 3 x higher risk of persons have a 2 or 3 x higher risk of atherosclerosis!atherosclerosis!

Insulin is required to maintain adequate Insulin is required to maintain adequate levels of lipoprotein lipase, an enzyme levels of lipoprotein lipase, an enzyme needed to break down bad cholesterols.needed to break down bad cholesterols.

Physical InactivityPhysical Inactivity

Increasing physical activity has been shown Increasing physical activity has been shown to decrease blood pressure.to decrease blood pressure.

Moderate to intense physical activity for 30-Moderate to intense physical activity for 30-45 minutes on most days of the week is 45 minutes on most days of the week is recommended.recommended.

Cigarette SmokingCigarette Smoking

Causes an increase in blood pressureCauses an increase in blood pressure Usually have lower levels of HDLUsually have lower levels of HDL Within 1 year of quitting, CHD risk Within 1 year of quitting, CHD risk

decreases, within 2 years it reaches the level decreases, within 2 years it reaches the level of a nonsmoker.of a nonsmoker.

Alcohol ConsumptionAlcohol Consumption

In small amounts it acts as a vasodilator-In small amounts it acts as a vasodilator-Good! 1-2 drinksGood! 1-2 drinks

In large amounts it acts as a vasoconstrictor-In large amounts it acts as a vasoconstrictor-BAD! 3-4 drinksBAD! 3-4 drinks

This is a very fine line!This is a very fine line!

TreatmentTreatment

Cardiac Catherization - Dr. inserts a plastic Cardiac Catherization - Dr. inserts a plastic tube into an artery or vein and injects a dye, tube into an artery or vein and injects a dye, this can help to determine where the this can help to determine where the blockages are. Also a good method to blockages are. Also a good method to determine the amount of blood and oxygen determine the amount of blood and oxygen the heart is receiving.the heart is receiving.

TreatmentTreatment

Coronary Artery Bypass Surgery (CABG)Coronary Artery Bypass Surgery (CABG)

The most frequently performed major The most frequently performed major surgery in the United States. Surgery surgery in the United States. Surgery reroutes or bypasses blood around clogged reroutes or bypasses blood around clogged arteries.arteries.

TreatmentTreatment

Angioplasty (PCTA)Angioplasty (PCTA)

It involves creating a space in a blocker It involves creating a space in a blocker artery by inserting a small balloon and then artery by inserting a small balloon and then inflating it. Now includes the placement of inflating it. Now includes the placement of a mesh stent to improve effectiveness.a mesh stent to improve effectiveness.

How can You Stop CVD?How can You Stop CVD?

Diet and NutritionDiet and Nutrition, there are several , there are several guidelines listed by the American Heart guidelines listed by the American Heart Association:Association:

Eat a variety of fruits and vegetables every Eat a variety of fruits and vegetables every day. ( 5 servings - they are naturally low in day. ( 5 servings - they are naturally low in fat and high in vitamins and minerals)fat and high in vitamins and minerals)

Eat a variety of grain products ( 6 a day)Eat a variety of grain products ( 6 a day)

Diet and Prevention of CVDDiet and Prevention of CVD

Choose nonfat or low-fat products.Choose nonfat or low-fat products. Use lean meats- choose chicken, fish, Use lean meats- choose chicken, fish,

turkey and lean cuts of beef and pork.turkey and lean cuts of beef and pork. Switch to fat-free milk- gradually reduce Switch to fat-free milk- gradually reduce

the fat content of the milk you drink.the fat content of the milk you drink.

Dietary GuidelinesDietary Guidelines

Choose fats with 2 gms or less of saturated Choose fats with 2 gms or less of saturated fats per serving such as liquid and tub fats per serving such as liquid and tub margarines, canola oil and olive oil.margarines, canola oil and olive oil.

Balance the # of calories you eat with the Balance the # of calories you eat with the number of calories you use each day.number of calories you use each day.

Maintain a level of physical activity that Maintain a level of physical activity that keeps you fit and matches the # of calories keeps you fit and matches the # of calories you eat. you eat.

Dietary GuidelinesDietary Guidelines

Limit your intake of foods high in calories Limit your intake of foods high in calories and low in nutrition, including foods like and low in nutrition, including foods like soft drinks and candy.soft drinks and candy.

Limit foods high in saturated fat, trans fat Limit foods high in saturated fat, trans fat and cholesteroland cholesterol

Eat less than 6 gms of salt a dayEat less than 6 gms of salt a day Have no more than one alcoholic drink a Have no more than one alcoholic drink a

day.day.

Step I and II DietsStep I and II Diets

The AHA and NCEP have developed these The AHA and NCEP have developed these diets to treat high blood pressure and diets to treat high blood pressure and hypercholesterolemiahypercholesterolemia

They are designed to lower LDL levels, They are designed to lower LDL levels, while at the same time promoting good while at the same time promoting good nutrition.nutrition.

Step I Step IIStep I Step II

Total fat- 30% or lessTotal fat- 30% or less Sat fat- 7-10%Sat fat- 7-10% Poly - up to 10%Poly - up to 10% Mono Up to 15%Mono Up to 15% Carb 55% or moreCarb 55% or more Pro Approx 15%Pro Approx 15% Chol. less than 300mgChol. less than 300mg

30% or less30% or less 7%7% up to 10%up to 10% up to 15%up to 15% 55% or more55% or more Approx 15%Approx 15% less than 200 mgless than 200 mg

Exercise and CVDExercise and CVD

Serves several functions in preventing and Serves several functions in preventing and treating those at high risk.treating those at high risk.

Reduces incidence of obesity.Reduces incidence of obesity. Increases HDLIncreases HDL Lowers LDL and total cholesterolLowers LDL and total cholesterol Helps control diabetes and hypertensionHelps control diabetes and hypertension Those at high risk should take part in a Those at high risk should take part in a

specially supervised program.specially supervised program.

ConclusionConclusion

Cardiovascular disease is the number one Cardiovascular disease is the number one killer.killer.

It is highly preventable and controllable It is highly preventable and controllable with diet and exercise.with diet and exercise.

Good resource: www.americanheart.orgGood resource: www.americanheart.org 1-800-AHA-USA 1-800-AHA-USA