Cardiovascular Disease

Karilyne Manahan, Alyssa Specht

FN 4360
19 February 2014

What is Cardiovascular Disease? (1)

Cardiovascular diseases are diseases related to
the heart and blood vessels and are usually
associated with atherosclerosis.

What is Cardiovascular Disease? (2)

CVD is attributed to 30% of deaths, and is the leading

cause of death worldwide
The leading cause of death in developed countries and
the second leading cause of death in medium- and lowincome countries.
The leading cause of death in the United States

CVD: Types (3)

- Coronary artery disease (CAD) #1 COD - Pericarditis
- Cardiomegaly (enlarged heart)

- Pericardial effusion

- Cardiomyopathy (heart muscle disease)

- Marfan syndrome

- Myocardial infarction (MI)

- Heart murmurs

- Arrhythmias (atrial fibrillation)

- Sudden cardiac death (SCD)

- Heart valve diseases

- Congenital heart disease (CHD)

Cholesterol

High cholesterol increase risk of developing CVD

Two types
LDL - block arteries
HDL - clears arteries
Cholesterol enables absorption and transport fatty acids (4)
High cholesterol concentration in plasma can cause
atherosclerosis (5)

Atherosclerosis

Atherosclerosis is the hardening of

arteries from buildup of plaque in the
blood vessel wall. (1)

Cholesterol esters produce fatty streak

layer
Over time worsens and turns into
atherosclerosis plaque (5)
Can start forming during adolescence (1)

Lifestyle Risk Factors (5)

Diet
Rich in cholesterol, saturated and trans fats increase LDL levels
Excercise
Secondary lifestyles
If increased can increase HDL levels but not LDL
Smoker

Genetic Risk Factors

Metabolic disorder
Determines breakdown of cholesterol
Errors in genes can increase plasma cholesterol concentration
Effect recognition of LDLs liver receptors (5)
Concomitant disease
Diabetes
Hypertension
Gender & Age
Men older than 45
Woman older than 55
Menopause (1)

Epigenetics (6)

The Genome Wide Association Studies (GWAS) have identified more than
30 genetic loci that determine the susceptibility to cardiovascular events.
chromosome 9p21 increases risk by 60%
most other loci increase risk by 5-20%

Possibility of ethnically determined risk factor due to genetic variance

among ethnicities.

Although significant, these genetic findings account for only 10% of total
risk of cardiovascular events.

History (7)
Family History:
Father or brother diagnosed with CHD before age
55; mother or sister before age 65.
Both parents before age 55 increase risk by 50%
Medical History
Lab values

Risk Factors (1)

Self Assessment (1)

The Framingham
Heart Health
Study

Diagnostics (3)
Physical Symptoms/Warning Signs:
Angina (most common)
Shortness of breath
Weakness/fatigue
Nausea
Palpitations
Sweating

Diagnostics
Tests - Values

Fasting Lipid Profile (Lipid Panel)

Measures blood levels of total cholesterol, LDL & HDL levels, and triglyceride levels
Blood Pressure
Fasting Glucose

(Walker 2013, p. 49)

(Brown 2011, Table 17.7)

Nutrition Status - Basic Diet leading to

CVD (3)

High Caloric intake

High Cholesterol intake
High Total Fat intake
High in Saturated and Trans Fats
Saturated found in animal products
Trans found in hydrogenated oils (processed foods)
Low in Omega-3 Fatty Acids
Low Fiber intake
High Sodium intake

American Heart Association Dietary

Recommendations (8)
As part of a healthy diet, an adult consuming 2,000 calories daily should aim for:
Fruits and vegetables: At least 4.5 cups a day
Fish (preferably oily fish): At least two 3.5-ounce servings a week
Fiber-rich whole grains: At least three 1-ounce-equivalent servings a day
Sodium: Less than 1,500 mg a day
Sugar-sweetened beverages: No more than 450 calories (36 ounces) a week
Other Dietary Measures:
Nuts, legumes and seeds: At least 4 servings a week
Processed meats: No more than 2 servings a week
Saturated fat: Less than 7% of total energy intake
Cholesterol: Less than 200 mg/d

Research: Where Are We At With CVD?

Inflammation (9)
Chronic: prolonged and persistent inflammation; it may
be a continuation of an acute form or a prolonged
low-grade form.
CAD has features of both autoimmune and
autoinflammatory diseases
An increased incidence of myocardial infarction was
found in patients diagnosed with rheumatoid arthritis
(RA), systemic lupus erythematosus, psoriasis, and
gout.

Inflammation Contd (10)

Abdominal obesity
Inflammation is associated with excess visceral
adipose tissue and liver fat
Ongoing therapy research to relieve stress of chronic
energy surplus in subcutaneous adipose tissue and
therefore greatly reduce chronic inflammation

Polyphenols (11)

Over 500 types with several biological actions beneficial to CVD prevention

Naturally exist in plants (fruits, vegetables, cocoa, nuts, herbs, tea)

Four classes: flavonoids, lignans, phenolic acids, stilbenes

Several foods have several types and combinations

Not much standardization

USDA Nutrient Data Laboratory recently released isoflavone,
flavonoid, and proanthocyanidin content (3 out of 500!)

Polyphenols Contd (11)

The beneficial impact of PPs is diverse, but critical to their

beneficial impact is their role in countering chronic and acute
inflammation.
Scavenge free oxygen and nitrogen species, decreasing proinflammatory activity and improving endothelial structure and
function

Clinical studies utilizing foods or beverages provide a more realistic

assessment ... to assess whether typical intakes of such provided foods will
result in cardioprotection (p8)
Different combinations in different foods have varying effects

Diet-Gene Interaction (6)

Interactions between genetic variations and dietary patterns related to risk

of MI
Study of three dietary patterns revealed a successful detection of geno-diet
interactions:
Oriental (soy sauce, tofu, pickled foods, green leafy vegetables, eggs,
low sugar)
Western (eggs, meats, fried and salty foods, sugar, nuts, and desserts)
Prudent (raw vegetables, fruits, green leafy vegetables, nuts, desserts,
and dairy products)

Diet-Gene Interaction Contd (6)

Results:
Gene activity high among highest prudent diet scores due to fruit and
vegetable intake
Low gene activity scores associated with highest hazard ratios for CVD
incidence.
Data was collected before any symptoms of disease were present
(prospective cohort study).
Findings/further research:
Which genes are the greatest determinants for CVD
Which genes interact with diet
Which genes do both
Potential to radically change the practice of cardiovascular medicine

Case Study: Average Pt.

54yo Female w/BMI 29.7 (ht. 55, wt. 178#)

Family History:
Grandfather died of CAD
Father has high cholesterol, CAD, and HTN
Medical History:
pre-HTN (140/88) last doctoral visit; previous weight 174# (BMI
29.1)
Fasting lipid test results:
total cholesterol: 261 mg/dL
Triglycerides: 372 mg/dL
referred to dietitian
gradual weight gain throughout adulthood

Case Study: Average Pt.

Sedentary lifestyle
Full-time secretary at a doctors office
Eats breakfast on the way to work, lunch at the office or out, dinner at
home with her husband

3 Day Food Record Results:

Total kcal: 2142 kcal/d
Total fat: 38% kcal
Sat. fat: 13% kcal
Cholesterol: 342 mg/d
Added Sugars: 9% kcal

Case Study - Recommendations

(Brown 2011, pg. 440

Case Study - Recommendations

Decrease total energy intake

goal is ~1800 kcal/d, or 300 kcal less than current intake
Decrease total fat intake, especially sat. fat
switch to low fat dairy products or non-dairy substitutes
trim the fat off of meat before cooking
consume less baked goods
Decrease cholesterol intake to <200 mg/d
Decrease red meat consumption, choose leaner cuts of meat/fish
Choose plant protein sources (pasta with beans instead of meat)
Decrease sodium consumption
Choose less processed foods for meals/snacks
Decrease refined grains and increase whole grains
Choose whole wheat pasta or whole wheat bread over refined versions
Increase intake of fruits and vegetables
bring fresh fruit or vegetables for snacks
add fresh fruit to breakfast cereal or oatmeal

References
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