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Nutrition for Patients with Cardiovascular Disorders
Chapter 20
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Cardiovascular Disease (CVD)
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An umbrella term for diseases that affect the heart and blood vessels
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Atherosclerotic CVD are caused by atherosclerosis
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A progressive narrowing and hardening of blood vessels that may lead to blocked blood
flow to the heart (myocardial infarction), brain (cerebrovascular accident), or legs
(peripheral arterial disease)
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Can also cause a ballooning out of blood vessel walls (aneurysm)
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Hypertension
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A symptom, not a disease
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Arbitrarily defined as sustained elevated blood pressure greater than or equal to 140/90 mm Hg
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A major risk factor for heart disease, stroke, kidney failure, and peripheral arterial disease
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One of the most common chronic conditions in the United States
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Hypertension (cont’d)
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Compared to non-blacks, blacks have:
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A higher prevalence of hypertension
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Develop hypertension earlier in life
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Have higher risks of hypertension-related complications such as:
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Especially stroke
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Kidney failure
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Hypertension (cont’d)
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Dietary factors play a prominent role in blood- pressure regulation
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Normotensive or prehypertensive
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Dietary changes have the potential to reduce blood pressure and prevent hypertension
and its complications
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Hypertension (cont’d)
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Stage 1 hypertension
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Diet is the initial treatment before drug therapy is introduced and may eliminate the
need for medication
For those who have hypertension who are treated with medication:
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Diet can lower blood pressure and reduce the dose of medication needed
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Hypertension (cont’d)
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The DASH Diet
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DASH = Dietary Approaches to Stop Hypertension
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Multicenter feeding study
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Eating whole “real” foods rather than individual nutrients
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Significantly lowers both systolic and diastolic blood pressures as well as cholesterol
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Hypertension (cont’d)
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The DASH Diet (cont’d)
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Lowering sodium lowers blood pressure
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Greatest reduction in blood pressure occurred at 1,500 mg of sodium
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Greatest blood pressure reductions occurred in blacks; middle-aged and older
people; and in people with hypertension, diabetes, or chronic kidney disease
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Hypertension (cont’d)
Weight loss
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DASH-Sodium
Observational and clinical studies consistently show:
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Weight is directly related to blood pressure
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Weight loss lowers blood pressure, even if healthy weight is not attained
The greater the weight loss, the greater the reduction in blood pressure
Hypertension (cont’d)
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Weight loss (cont’d)
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Achieving a healthy weight (BMI <25) is an effective intervention to prevent and treat
hypertension
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Preventing weight gain is critical
Potassium
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Potassium intake increases, blood pressure decreases
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Recommended that people consume 4.7 g potassium/day
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Hypertension (cont’d)
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Alcohol
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Observational studies and clinical trials
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Show a direct, dose-dependent relationship between alcohol and blood
pressure
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Alcohol intake should be limited to less than 2 drinks per day in men and less
than 1 drink per day for women
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Question
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Is the following statement true or false?
In stage 1 hypertension, diet is the first treatment before medicine is given.
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Answer
True.
Rationale: In people with stage 1 hypertension, diet is the initial treatment before drug therapy
is introduced and may eliminate the need for medication.
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Atherosclerosis
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“Hardening of the arteries”
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Underlying cause of the most common cardiovascular diseases (CVD)
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Progressive process
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Complications depend on the size, stability, and location of the plaque
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Diet has a significant effect on the progression of atherosclerosis and CVD
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Coronary Heart Disease (CHD)
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Usually caused by atherosclerosis in the large- and medium-sized coronary arteries
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Risk factors
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Cannot be modified
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Genetics
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Gender
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Advancing age
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Major Modifiable Risk Factors for CHD
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High blood LDL cholesterol
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Low blood HDL cholesterol
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High blood pressure
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Obesity, especially abdominal obesity
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Physical inactivity
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Cigarette smoking
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An atherogenic (meaning likely to cause atherosclerosis) diet
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Coronary Heart Disease (CHD) (cont’d)
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High blood cholesterol levels
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Transported through watery blood in lipoprotein molecules
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LDL and HDL impact risk of heart disease
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As the level of LDL increases, so does the risk of developing cardiovascular disease (CVD)
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LDL goals are determined by the number of major independent risk factors an individual
has
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Coronary Heart Disease (CHD) (cont’d)
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High blood cholesterol levels (cont’d)
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Diet and lifestyle changes are appropriate for all people
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Levels of HDL, the “good cholesterol, are inversely correlated to CHD risk
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Cigarette smoking
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Contributes to the development of atherosclerosis, increases heart rate, narrows
arteries, increases blood pressure, lowers HDL, and promotes clot formation
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Coronary Heart Disease (CHD) (cont’d)
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Cigarette smoking (cont’d)
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People who smoke have a 2 to 4 times greater risk of CHD than nonsmokers
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People who smoke have approximately double the risk of stroke as nonsmokers
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People who smoke are 10 times more likely to develop peripheral arterial disease
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Smoking causes abdominal aneurysm
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Coronary Heart Disease (CHD) (cont’d)
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Metabolic syndrome (MetS)
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Cluster of metabolic abnormalities that appear to promote a relatively high long-term
risk for both atherosclerotic CVD and type 2 diabetes
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Primary objective of controlling MetS is to reduce the risk for atherosclerotic CVD
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Goals include smoking cessation, losing weight, and controlling blood pressure and
glucose levels
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Question
Atherosclerosis, or “hardening of the arteries,” is a progressive process that begins early in life.
What do complications depend on?
a. How progressed the disease process is
b. How compliant the patient is with the
treatment
c. Size, stability, and location of the plaque
d. The patient’s genetics, gender, and age
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Answer
c. Size, stability, and location of the plaque
Rationale: Complications depend on the size, stability, and location of the plaque.
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Heart-Healthy Diet and Lifestyle
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Balanced, varied, and nutritionally adequate eating plan
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Part of a healthy lifestyle that includes:
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Regular physical activity
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The avoidance of tobacco products
With few exceptions, recommendations to lower the risk of CHD are the same as the ones made
to lower the blood pressure
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Heart-Healthy Diet and Lifestyle (cont’d)
Calories, activity, and weight
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Attaining and maintaining healthy weight to reduce the risk of CVD
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A decrease in calorie intake and an increase in physical activity are recommended to
promote weight loss
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A physically active lifestyle with minimal sedentary activities is appropriate for all
people, regardless of their weight status
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Heart-Healthy Diet and Lifestyle (cont’d)
Fruit and vegetables
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In short-term, randomized trials:
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In long-term observational studies:
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Diets rich in fruits and vegetables have been shown to lower blood pressure and
improve other CVD risk factors
People who have a high intake of fruits and vegetables are at lower risk of
developing CVD, especially stroke
Preparation methods should preserve the fiber and nutrient content without adding
saturated fat, trans fat, sugar, or salt
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Heart-Healthy Diet and Lifestyle (cont’d)
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Whole grains
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Diets high in whole-grain products are associated with decreased risk of CVD
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Both soluble and insoluble fiber are associated with decreased risk of CVD
Fatty fish
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Increased intake of omega-3 fatty acids reduces risk of CVD
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AHA recommends 2 servings (approximately 8 oz.) of fatty fish per week, prepared in
ways that do not add saturated or trans fats
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Heart-Healthy Diet and Lifestyle (cont’d)
Saturated fat
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Increases LDL and total cholesterol levels
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Choosing lean meats and trimming away visible fat lowers saturated fat intake
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Portion sizes are limited to 6 oz. or less per day
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Monounsaturated and polyunsaturated fats are inversely related to CHD
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The American Heart Association recommends total fat provide 25% to 35% of total
calories
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Heart-Healthy Diet and Lifestyle (cont’d)
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Trans fat
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Increases LDL and total cholesterol levels, the ratio of LDL to HDL cholesterol, and the
risk of CHD
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Found in partially hydrogenated fats
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AHA recommends a trans fat intake of less than 1% of total calories
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Heart-Healthy Diet and Lifestyle (cont’d)
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Cholesterol
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Dietary cholesterol raises LDL levels, especially in people who are lean
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Found only in foods originating from animals
Added sugars
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The purpose of limiting the intake of beverages and foods with added sugars is to lower
calorie intake and help ensure nutritional adequacy
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Heart-Healthy Diet and Lifestyle (cont’d)
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Sodium
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As the intake of salt increases, so does blood pressure
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High blood pressure is a major risk factor for CVD
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Heart-Healthy Diet and Lifestyle (cont’d)
Alcohol
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Moderate alcohol consumption from any source—beer, wine, or distilled liquor—is
associated with a reduced risk of CVD
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Alcohol can be addictive and high intakes are associated with high triglyceride levels,
hypertension, liver damage, physical abuse, vehicular and work accidents, and increased
risk of breast cancer
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Heart-Healthy Diet and Lifestyle (cont’d)
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Other dietary components that influence CVD risk
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Fish oil supplements and plant sterols/stanols are additional options that may be used in
the treatment of heart disease
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Fish oil supplements
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AHA recommends approximately 1 g of EPA + DHA per day for people with
documented CHD
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In most cases 1 capsule per day of a 1-g fish oil supplement contains 200 to 800
mg of total n-3, enough to meet the recommendations of about 1,500 to 2,000
mg/week to prevent CHD
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Heart-Healthy Diet and Lifestyle (cont’d)
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Other dietary components that influence CVD risk (cont’d)
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Plant stanols/sterols
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Can be used as a therapeutic option to help lower LDL levels by up to 15%
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Maximum benefits occur when intake is about 2 g per day; must be taken daily
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Heart-Healthy Diet and Lifestyle (cont’d)
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Putting recommendations into practice
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DASH-Sodium diet and the Therapeutic Lifestyle Changes (TLC) diet
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“Mediterranean” diet
Is a “heart healthy” diet and lifestyle for everyone?
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There are few patients for which this “diet”—and the recommendations to lose weight,
if overweight, and exercise—is inappropriate
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Heart Failure (HF)
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Major and growing public health problem in the U.S.
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Most common Medicare diagnosis-related group
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Syndrome characterized by specific symptoms
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Shortness of breath
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Fatigue
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Edema
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CHD and high blood pressure are prevalent causes; arrhythmias and valve disorders may also
cause HF
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Heart Failure (HF) (cont’d)
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Nutrition therapy
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For people at risk of HF, the goals of therapy are to control underlying risks
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DASH-Sodium diet is appropriate for people with CHD or hypertension
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Regular exercise and smoking cessation are encouraged
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Alcohol is discouraged
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Heart Failure (HF) (cont’d)
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Nutrition therapy (cont’d)
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Stage C heart failure is defined as structural heart disease with prior or current
symptoms of HF
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Sodium is limited to 2 g of sodium/day or less
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A fluid restriction of 1.5 L/day for patients with hyponatremia
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A low-calorie diet for patients who are overweight
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Small frequent meals
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Soft easy-to-chew foods for patients with fatigue
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Increased potassium intake for patients who are taking thiazide (potassiumwasting) diuretics or digitalis
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Heart Failure (HF) (cont’d)
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Nutrition therapy (cont’d)
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Cardiac cachexia
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Need a high-calorie, high-protein, high-nutrient diet while maintaining a lowsodium diet
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Caloric and nutrient density is important