CARDIOVASCULAR DISEASES

• Cardiovascular Vascular Disease is a general term for any disease of the heart and blood vessels
• Diseases in this category include atherosclerosis, coronary artery disease, myocardial infarction, cardiovascular accident or stroke, and hypertension and congestive heart failure
• Hypertension is defined as a sustained increase in arterial diastolic or systolic pressure (140/90mmHg or higher)
• Primary or Essential Hypertension affects 90% of all cases with high blood pressure
• Secondary Hypertension is due to a known cause, usually renal disease, endocrine disorders, or use of certain medications
• Blood Pressure Classification:

  • Optimal: Under 80 diastolic, Under 120 systolic
  • Normal: <85 diastolic, <130 systolic
  • High Normal: 85-89 diastolic, 130-139 systolic
  • Grade 1 (mild): 90-99 diastolic, 140-159 systolic
  • Grade 2 (moderate): 100-109 diastolic, 160-170 systolic
  • Grade 3 (severe): <90 diastolic, >140 systolic
• Classes of medication in the treatment of Hypertension:

  • Diuretics or "water pills"
  • Anti-adrenergic drugs (alpha and beta blockers)
  • Vasodilators
  • ACE inhibitors
  • Angiotensin receptor antagonists
  • Calcium channel blockers
• Nutrition Therapy:

  • A BMI >27kg/m2 is closely correlated with increased blood pressure
  • Lifestyle interventions like weight reduction, exercise, smoking cessation, and overall healthy eating pattern are recommended before drug therapy
  • Sodium reduction to 500mg is recommended to rapidly decrease blood pressure
• Sodium:

  • Reduction in Na intake to 500mg is recommended to rapidly decrease blood pressure
  • A diet of 2-4 g/day is sufficient
• Fat:

  • Moderately low fat diet recommended
  • Saturated fats in cooking should be reduced by substituting with unsaturated oils
• Calories:

  • Caloric intake should be adjusted to bring about weight reduction if the patient is obese
• Potassium, Calcium, Magnesium:

  • Metabolism of these minerals is interrelated with Na metabolism
  • Potassium has a more pronounced effect on lowering BP when Na intake is high
  • Mg supplementation is one of the treatments in HPN of pregnancy
• Fluid:

  • Alcoholic beverages less than 30g/day or 2 average mixed drinks may be allowed
  • Total abstinence of alcohol is recommended for addicted individuals
  • DASH diet includes high quantities of fruits, vegetables, low fat dairy products, whole grains, poultry, fish, and nuts
• Atherosclerosis:

  • Disorder characterized by accumulation of lipid in the intimal layer of the artery
  • Lipids include free cholesterol, cholesterol esters, and triglycerides
  • Proliferation and enlargement of lesions encroach upon the lumen causing formation of thrombi, thickening, and loss of elasticity of arterial walls
  • Results in ischemia and necrotic tissue known as infarct
• Non-fasting values for adult cholesterol:

  • Less than 200mg/dl desirable
  • 200-239mg/dl borderline-high
  • 240mg/dl & higher high
• Macronutrient Components of TLC Diet:

  • Total fat: 25-35%
  • Saturated fat: less than 7%
  • Polyunsaturated fat: up to 10%
  • Monounsaturated fat: up to 20%
  • Carbohydrate: 50-60% of total calories
  • Protein: Approximately 15%
• Therapeutic Lifestyle Changes:

  • Targeted to people with high LDL cholesterol to reduce risk of developing CVD
  • Goals include consuming a healthy diet, maintaining a healthy weight, normal levels of blood pressure, lipids, blood glucose, being physically active, and avoiding tobacco products
• Coronary Heart Disease:

  • Also known as ischemic heart disease, a common form of heart disease among individuals over 40 years of age
  • Major risk factors include age, family history, cigarette smoking, HPN, and low HDL
• Dietary Recommendations for Improving Lipid Levels:

  • Eat at least five to seven servings of vegetables and fruits daily
  • Eat soy products, legumes, oils containing monounsaturated and n-3 fatty acids, and monounsaturated-rich nuts in moderation
• Angina Pectoris:

  • Characterized by pain in the region over the heart and stomach
  • 2 classifications: stable angina precipitated by factors increasing heart oxygen requirement, and unstable angina characterized by angina at rest and with minimal exertion
• Myocardial Infarction:

  • Includes coronary infarction, coronary thrombosis, or heart attack
  • Severe ischemia leads to necrosis of cardiac muscle cells
  • Symptoms include precordial pain
• Congestive Heart Failure (CHF):

  • Results in reduced heart pumping efficiency in the lower 2 chambers
  • Symptoms include inadequate blood circulation, congestion, pedal edema, abdominal pain, ascites, and dyspnea
  • Nutrition therapy aims to promote rest to the heart, control edema, body weight, correct nutrient deficit, and prevent severe malnutrition
• Varicosities:

  • Abnormally dilated and tortuous veins that usually appear in the lower extremities
  • Result from an underlying problem with reverse venous flow, known as venous insufficiency syndrome
• Nutrition Therapy for Varicosities:

  • Potassium-high foods like almonds and pistachio nuts can help by reducing water retention
  • Cutting down on salty or sodium-rich foods can minimize water retention