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6 CVD - Lecture notes 6

Nutrition and Health?(formerly PHED 2007) (Mount Royal University)

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HPED 2507
Nutrition and CVD

Nutrition and Cardiovascular Disease (CVD)

Cardiovascular disease is the 2nd leading cause of death in Canada

 ~ 70,000 deaths per year (CVD is one of the top 2 causes of deaths in Canada)
 $22.2 billion spent per year on health care costs, lost wages and productivity

Fat is the New Tobacco

 Smoking rates have declined since the 1970s
 Prevalence of overweight and obesity have increased
 Obesity can increase a person’s risk of developing CVD by 50% (BMI > or = 30)

What is CVD?
 Damage to the heart, the blood vessels of the heart and the system of the blood vessels (veins and
arteries) throughout the body and within the brain

 Heart disease (e.g., heart failure)

 Heart attacks
 Stroke
 Congenital conditions

Root cause of most CVD is atherosclerosis (“hardening of the arteries”)

Hardening of the Arteries

 Gradual – may take decades to develop
 Fatty streaks become hardened plaques
 Narrowing of arteries leads to poor blood flow

Heart Attack
 Sudden heart tissue death caused by blood vessel blockage
• Thrombus – blood clot
• Embolism – mobile blood clot

Stroke
 Stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without
oxygen, brain cells start to die after a few minutes.
 Types
• Ischemic stroke
 Occurs if an artery that supplies oxygen-rich blood to the brain becomes blocked
 Blood clots often cause the blockages that lead to ischemic strokes
• Hemorrhagic stroke
 Occurs if an artery in the brain leaks blood or ruptures

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HPED 2507
Nutrition and CVD

Risk Factors (Table 11-2)

 Non-modifiable:
• age
• gender
• family history
 Modifiable:
• High LDL cholesterol • Obesity (especially central obesity)
• Low HDL cholesterol • Physical inactivity
• High blood pressure (hypertension) • Smoking
• Diabetes
•
Understanding Serum Cholesterol
 Cholesterol must be emulsified to mix in with blood
 Cholesterol in blood is bound to protein, which is soluble in water
 This is Serum Cholesterol aka - “lipoprotein”
 Several different types exist

 Serum cholesterol vs blood cholesterol - these terms can be used interchangeably

What is Serum Cholesterol?

Chylomicrons -the largest lipoprotein
VLDL (very low density lipoproteins) aka: blood triglycerides
LDL = low density lipoproteins
HDL = high density lipoprotein

Cholesterol Function
 Essential for cell structure
 Manufacture of bile, hormones and some vitamins
 LDL carries cholesterol to the cells
• Can deposit and build up in blood vessels
 HDL takes cholesterol from cells to the liver for use and disposal
• “Scrub brush”

Understanding Cholesterol Levels

 It is important to note that there is no “ideal” level for any type of cholesterol level
 Cholesterol levels must be interpreted in the context of your risk factors, medical history and
present health
General Guideline for Healthy Blood Lipid Levels
LDL HDL
 < 3.4 mmol/L Men: > 1.0 mmol/L
Women: > 1.3 mmol/L
What should my cholesterol level be?
 Cholesterol levels must be determined based on CVD risk
 Risk Assessment
• Not an exact science
• Provides a reasonable estimate of risk

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Nutrition and CVD

Assessing CVD Risk:

 All recommendations for LDL are based on risk levels
Risk Assessment LDL should be
Low Risk less than 5.0 mmol/L
Moderate Risk less than 3.5 mmol/L
High Risk less than 2.0 mmol/L
 Have diabetes less than 2.0 mmol/L
 Have had a heart attack

Diet and Cardiovascular Disease

 Dietary recommendations for heart disease should focus on consumption of specific types of fat
and foods that
decrease LDL cholesterol
decrease serum triglycerides
increase HDL cholesterol

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Lowering LDL with Diet (Table 11-3

 Limiting saturated fat intake to less than 7% of total calories may reduce LDL chol. 8-10%
 Restricting dietary cholesterol to less than 200mg per day may reduce LDL chol 3-5%
 Weight reduction (if overweight) of lose 4.5kg may reduce LDL chol 5-8%
 Adding soluble, viscous fibre 5-10 g per day may reduce LDL chol 3-5%

Strategies: Reducing Fat Intake Strategies: Healthy Fats

 Avoid ALL trans fat  EPA and DHA found in fish - long chain
• E.g., commercial baked goods omega-3 fatty acids
 Avoid high-fat, processed foods  CFG recommends 2 servings of fish per week
• Fast food, pastries, etc.
 Choose lean cuts of meat, poultry  Monosaturated fats (MUFA) are preferred for
 Opt for low-fat dairy choices LDL lowering because they don’t lower
 Cook using little or no added fat HDL cholesterol
 Choose healthier fats…  Portion control is ESSENTIAL!
28 g (1 oz) serving of nuts/day is
sufficient to decrease serum LDL

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Strategies: Fibre
 Lower LDL cholesterol without decreasing HDL cholesterol
 Consumption of whole grains, fruits, vegetables, legumes [rich in fibre and phytochemicals] correlate
with low CVD risk
bile (made from cholesterol) is reabsorbed in the ileum and sent to the liver to be recycled and reused.

Soluble fiber binds bile and prevents reabsorption - liver must use cholesterol to make more bile, thereby
reducing serum cholesterol.

Other Diet Strategies

 Alcohol  Soy products
• Effect is small  Plant sterols
• moderation is key  Table 11-4, p. 418

Increasing HDL
1. Increasing Physical Activity
2. Weight loss
3. Consuming soy protein products
4. Nuts in the diet
5. Consuming carbohydrates in moderation

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