Coronary Heart Disease
(CHD)
Coronary Heart Disease (CHD)
>58
million American have
at least one form of CHD.
50% of all cardiac deaths
result from CHD
Mortality From Diseases of the
Heart by Race/Ethnicity
(Deaths/100,000)
Age
Hispanic Asian Native Black White
Amer.
45-64 166
99
224
426
>65
870
1128
2181 2079
1336
244
Coronary Heart Disease
The
major underlying cause is
atherosclerosis.
Atherosclerosis is a slow,
progressive disease which
begins in childhood and takes
decades to advance
Coronary Heart Disease
Plaque
(the build-up of
lipid/cholesterol) in the artery
wall forms as a response to
injury to the endothelium in the
artery wall.
Risk Factors for
Coronary Heart Disease
 Age:
 Male > 45 years
 Female > 55 years or premature menopause
without estrogen replacement therapy

Family History of premature disease
Male first-degree relative <55 years
 Female first-degree relative < 65 years)

Risk Factors for
Coronary Heart Disease
 Hypertension

Appears to weaken the artery wall at
points of high pressure leading to
injury and invasion of cholesterol.
 Cigarette
 #1
Smoking
cause of preventable death in US
 1 in 5 CHD deaths attributable to
smoking
Risk Factors for
Coronary Heart Disease
Diabetes
 50%
of deaths related to DM is
due to CHD
Risk Factors for
Coronary Heart Disease
Inactivity
 Sedentary
person has 2x risk
for developing CHD as a person
who is active.
Risk Factors for
Coronary Heart Disease
Obesity
Risk Factors for
Coronary Heart Disease
 Abnormal
Blood Lipids

LDL Cholesterol (low density
lipoprotein)

HDL Cholesterol (high density
lipoprotein)
Cholesterol Metabolism
Liver
Diet
Cholesterol
15%
75%
Blood Lipids and Lipoproteins
 Some
LDL-C can be oxidized and
takes up by endothelial cells and
macrophages in the arterial wall,
which leads to the first stages of
atherosclerosis.
Blood Lipids and Lipoproteins
 HDL-C
is thought to be involved in
the transport of excess cholesterol
from membranes to the liver for
removal from the body.
Blood Lipids and Lipoproteins
 HDL-C IS INCREASED:
 Exercise,
loss of weight, and moderate
consumption of ETOH.
 HDL-C
is lowered:
 Obesity, inactivity, cigarette smoking,
some oral contraceptives and
steroids, hypertriglyceridemia and
some genetic factors.
Cholesterol and the CHD Patient
Goal:
 The
goal is a LDL-C level of
100 mg/dL
Blood Lipid
Cholesterol:
<200 mg/dl
200-239 mg/dl
>240 mg/dl
HDL Cholesterol
<40 mg/dl
>60 mgl/dl
LDL Cholesterol
<100 mg/dl
100 – 129 mg/dl
130-159 mg/dL
>160 mg/dl
Classification
Desirable
Borderline high-risk
High-risk
Low
High, negates one
risk factor
Desirable
Above optimal
Borderline High
High Risk
Treatment in CHD Patients
LDL-C
Diet & Life
Levels
Habits
<100 mg/dL Yes
Drug
Therapy
No
100-129
Yes
mg/dL
>130 mg/dL Yes
Clinical
Judgment
Yes
Diet Therapy of High Blood
Cholesterol
Healthy Heart Diet
Therapeutic Lifestyle
Change Diet (TLC)
8-10% calories from
<7% calories from
saturated fat
saturated fat
20 - 35% calories from fat 20-35% calories
from fat
<300 mg. cholesterol
<200 mg. cholesterol
5-10% of energy from
PUFA
Up to 20% MUFA
5-10% of energy from PUFA
Calories to maintain IBW
Calories to maintain IBW
Up to 20% MUFA
Diet Therapy of High Blood
Cholesterol
Trans-Fatty Acids
 Increase LDL Cholesterol and
decrease HDL Cholesterol
 Recommendations: Intakes of
trans-fatty acids should be as low
as possible
Trans fatty acid content of fastfood
Calories
Trans
Fatty
Acids
(g)
Saturated
Fatty
Acids
(g)
Hamburger (7 oz)
660
3
14
McDonalds chicken McNuggets
(9 oz)
510
3
6
Burger King chicken sandwich
(8 oz)
610
2
7
Burger King fries (6 oz King
size)
540
7
6
Starbucks cinnamon scone (5
oz)
530
3
13
Food
Treatment for CHD

Physical Activity
 prescribed by physician for patients with
CHD
 When aerobic activity is appropriate,
activity that places moderate stress on
the cardio-respiratory system can be
included.
Treatment for CHD
Weight

Control
5-10# weight loss
Diet Therapy of High Blood
Cholesterol
Soluble
 10-20
Fiber
g/day
Drug Treatment
Statins
Bile Acid Sequestrants
Nicotinic Acid
Dietary Issues Requiring Further
Research
Elevated
levels of
homocysteine
 Elevated
homocysteine levels
may be present in 15% of
Americans.
Steps for Lowering LDL-C in the
Diet
Eggs:
 <300
mg. cholesterol: < 4
yolks/wk
 < 200 mg. Cholesterol: < 2
yolks/wk
Guidelines for Selecting &
Preparing Foods
Milk
 2-3
and Milk Products:
servings/day
Steps for Lowering LDL-C in the
Diet
Fats,
 <6-8
oils:
tsp./day
Steps for Lowering LDL-C in the
Diet
 Monounsaturated
Fats:
Canola, olive and peanut oil
 Avocado
 Olives: black and green
 Nuts: almonds, cashews, peanuts,
pecans
 Sesame seeds

Steps for Lowering LDL-C in the
Diet
 Polyunsaturated
Fats
Margarine made with corn, soybean,
safflower, sesame oils
 Tub, squeeze or stick
 Nuts: walnuts and English
 Salad dressings
 Seeds: pumpkin, sunflower

Steps for Lowering LDL-C in the
Diet
 Saturated
Fat:
Butter, Coconut & Coconut Oil, Palm Oil
 Cream, half and half
 Cream cheese
 Shortening or lard
 Sour cream
 Fat from animal products including milk
and meats

Steps for Lowering LDL-C in the
Diet
Plant
Sterols and Stanols:
 Natural
substances derived from
wood, vegetables, vegetable oils
and other plants - sitosterol and
sitostanol
Steps for Lowering LDL-C in the
Diet
Meat,

Fish and Poultry
Select lean meat and poultry
 <6
oz/day for Step I diet and <5 oz/day
for Step II
 Eat
fish on a weekly basis
Steps for Lowering LDL-C in the
Diet
 Breads and Cereals:
 6-11 servings/day
Low fat crackers
 Tortillas
 Hot and cold cereals excepts granola or
meusli

Steps for Lowering LDL-C in the
Diet
 Vegetables:
 3-5 servings per day
 Fruits
 2-4 servings per day

Use sweets and modified fat desserts in
moderation
Reading The Label

Extra Lean


<5 g total fat, 2 g saturated fat, and 95 mg
cholesterol
Lean

< 10 g total fat, 4 g saturated fat and 95 mg
cholesterol
Guidelines for Selecting &
Preparing Foods
Try reducing fat by 1/4 to 1/3 in baked
products. E.g. if recipe calls for 1 cup oil,
try 2/3 C.
 In casseroles and main dishes, cut back or
eliminate the fat.
 Sauté or stir fry with very little fat or use
water, wine, or broth.
 Chill soups, gravies and stews and skim off
hardened fat before serving.
