Lecture Presentation Outline
I.
Diet and Heart Disease
 200 years ago people who died of heart attacks had fatty streaks and deposits in arteries
 Now diets high in saturated fat and trans fat are major risk factor for heart disease
 Other risk factors can also be modified (except genetic tendencies and age)
 Heart disease now highly preventable
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Instructor Resources: Unit 19 Nutrition Scoreboard transparency master; Unit 19 PowerPoint
presentation on Multimedia Manager
A. Declining Heart Disease
1. Cholesterol levels falling
a. 240 mgm in ‘70s to 203 mgm today
2. Rate of heart disease declining
3. 50% drop in deaths from heart disease related to:
a. Declines in blood cholesterol levels
b. Reduced rates of smoking
c. Improved blood pressure control
d. Advances in medical care
4. Rising obesity slowing improvements in CVD
B. Heart Disease
 Instructor Resources: transparency #11: Top 10 Causes of Death in the U.S. (2001)
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Heart disease accounts for one out of every four deaths
It strikes as many women as men, but women on average die 10 years later
African Americans are more likely to die from it than are Caucasian Americans
II. What Is Heart Disease?
A. Coronary heart disease covers several disorders from inadequate blood circulation to the heart
1. Always due to narrowing of arteries leading to heart
2. Arteries become narrow due to a buildup of plaque
3. This is atherosclerosis, or “hardening of the arteries”
B. Heart disease develops silently over decades
C. Arteries narrowed by 50%, produces pain called angina
D. Extensive blockage lets blood clot cut off blood to heart; that is a heart attack
E. Heart disease primarily affects individuals over age of 55; it is a progressive disease that begins in
childhood
1. Plaque builds up in arteries in legs, neck, brain, and others
2. If blood supply to legs is reduced, pain and muscle cramps result after brief exercise
3. Plaque build-up in arteries of the brain contribute to stroke when the blood supply to the
brain is inadequate
4. Health problems due to atherosclerosis in arteries of the heart, brain, neck, and legs are
cardiovascular disease
F. What Causes Atherosclerosis?
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Higher blood cholesterol level leads to plaque build up
Plaque causes heart disease to occur
Cholesterol level is determined by several factors:
a. Dietary intake
b. Smoking
c. Exercise
d. Heredity
e. Diets high in saturated fat elevate cholesterol levels in most people
f. Trans fat raises blood cholesterol levels more than saturated fat
III. What Raises Cholesterol?
A. Blood cholesterol levels raised by high cholesterol intakes, but respond less to dietary cholesterol
intake than to trans or saturated fat intake
 Instructor Resources: transparency #51: Healthy and Unhealthy Fats; Activities 19-1: Margarine
versus Butter & 19-2: Cholesterol Reduction of a Diet
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Some experience rise in cholesterol with large dietary cholesterol
Others experience no change when they consume cholesterol
For many the addition of an egg or two a day to a low-fat diet has little or no effect on blood
cholesterol levels
B. All Cholesterol Is Not Equal
1. Cholesterol is soluble in fat; blood is mostly water
2. Cholesterol must be emulsified to mix in with blood
3. Cholesterol in blood is bound to protein, which is soluble in water
4. That is a “lipoprotein”; several different types exist
5. Two have a role in heart disease
a. HDL-cholesterol is “good” cholesterol, you want high levels in your blood
b. LDL-cholesterol is the “bad” one
C. HDL and LDL
 Instructor Resources: transparency #52: LDL- and HDL-Cholesterol
1. HDL helps remove cholesterol from the blood
2. HDL escorts cholesterol to the liver for excretion
3. High HDL (> 60 mgm/dl) protects against CVD
4. LDL carries more cholesterol than does HDL
5. LDL cholesterol incorporated into plaque
6. Higher the LDL level, more likely atherosclerosis will develop and progress to heart disease
D. Triglycerides and CVD Risk
1. Triglycerides are transported attached to VLDL cholesterol
2. High levels of triglycerides increase heart disease risk
3. Elevated triglycerides mean metabolic syndrome
a. Characterized by elevated triglycerides and glucose
b. Insulin resistance
c. Abdominal obesity
d. High blood pressure, low HDL
4.
People with metabolic syndrome are at particularly high risk for heart disease
IV. Folate and CVD
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Instructor Resources: Activity 19-3: Folate Enhancement of a Diet
A. Inadequate folate is related to plaque-lined arteries
1. Folate reduces the homocysteine that increases plaque formation
 Instructor Resources: Activity 19-7: What is Homocysteine?
B. Naturally occurring folates are only about 50% absorbed, synthetic folic acid is 90% absorbed
1. Consumption of 250 - 400 mgm folic acid in fortified foods or supplements reduces
homocysteine by 20%
2. Since 1998 refined grain products like bread, crackers, pasta, and rice are fortified with folic
acid
V. DHA and EPA
A. Fatty fish from cold waters are sources of DHA and EPA
B. Omega-3 fatty acids protect against heart disease by:
1. Decreasing blood clotting
2. Decreasing blocked arteries
3. Decreasing plaque build-up
4. Decreasing blood pressure
5. Decreasing blood triglyceride levels
VI. Nuts
A. Nut consumption decreases risk of CVD
B. Nuts have good fats that lower LDL
1. 1 oz of nuts a day decreases LDL
2. FDA approves “heart healthy” claim for nuts and products made from them
VII. Special Spreads
A. Spreads with plant stanols lower blood cholesterol levels by blocking cholesterol absorption
1. Daily consumption of two tbsp of spread with plant stanols or sterols causes 10% drop in
cholesterol level and 14% decline in LDL concentration
2. Blood levels of HDL are not affected
B. Spreads are one more tool for lowering high blood cholesterol levels
VIII. Who’s at Risk?

Instructor Resources: Activity 19-6: Heart Disease Risk Assessment
A. Americans at risk for heart disease have high cholesterol levels, hypertension, a family history of
heart attack before age 55, smoke, are inactive, are obese, or have diabetes or high blood pressure
 Instructor Resources: Activity 1 in Instructor’s Activity Book: Putting Together a Family Tree
Health History
B. High blood cholesterol levels are common
C. Infants of less than 5.5 pounds at birth may have increased risk for heart disease later in life
1. Fetal origins hypothesis
2. Small, malnourished infants may be at increased risk as adults due to sub-optimal
development of liver
3. Heart disease begins in childhood, but the risk may begin even earlier
D. Risks for Women and Men
1. Heart disease is a major health problem of women
a. It is the leading cause of death among women in many countries
2. But risk factors identified in studies of men do not always apply to women
3. Gender Differences
a. Cholesterol level a poor predictor of CVD in older women, low HDL is more significant
than for men
b. Diabetes, obesity, high triglyceride levels, and age are strong risk factors for CVD in
women
c. Risk for heart disease in women increases substantially after menopause
1. Menopause brings declines of estrogen and HDL and increases in LDL
d. Compared to men, LDL-cholesterol levels are a weaker predictor of heart disease in
women
e. Women have higher HDL and total blood cholesterol than men
1. Since high levels of HDL are protective against heart disease one can’t allocate risk
based on total cholesterol or LDL alone
2. Many women advised to modify diets based on total cholesterol results
f. Weight loss by overweight women, substitution of monounsaturated fats for trans and
saturated fats, increased fish intake, adequate folate, and high fiber diets may be best
way for women to reduce their risk of CVD, rather than consumption of low-fat diets
E. Diet and Lifestyle and CVD
 Instructor Resources: transparency #53: Diets that Lower Heart-Disease Risk; CNN Today Nutrition
Vol. 3: Tomato Products (2:59) & Chocolate Health (2:04); Activities 19-4: Menu Analysis & 19-5:
Evaluation of Frozen Prepared Dinners
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Many factors in heart disease, treatment needs to be broad
Treatment includes
a. Reduction of high blood pressure
b. Body weight
c. Drugs
d. Smoking cessation
Goals of heart disease treatment are improved overall health and blood lipid profiles
Blood Lipid Levels
a. Total cholesterol is sum of the levels of LDL-, HDL-, and VLDL-cholesterol
b. Dietary recommendations for heart disease focus on consumption of specific types of fat
and foods that lower levels of LDL and triglycerides, and raise levels of HDL; adequate
F.
intake of folate, and vitamins B6 and B12 are recommended to decrease elevated
homocysteine levels
c. High levels of LDL are reduced by limiting saturated fat intake to less than 7% of total
calories, and by excluding processed foods that contain trans fats
d. Monounsaturated fats are preferred for LDL lowering because they do not decrease HDL
e. Whole grain products, fiber, vegetables, fruits, soy protein foods, and plant stanols lower
LDL without decreasing HDL levels
f. HDL levels can be increased by exercise, weight loss, and inclusion of soy protein
products and nuts in the diet.
g. Recommendations say consume fats and foods that lower LDL and maintain triglyceride
and HDL
h. Cholesterol-lowering drugs are for treatment of heart disease if blood lipid changes
achieved by diet and lifestyle improvements are insufficient
5. Statins
a. Statins (Lipitor, Zocor, and Mevacor) markedly reduce cholesterol production in the liver
b. Use related to a 30% drop in LDL levels and a 30-40% reduction in heart attack and
stroke in both women and men
c. Statins improve blood lipids levels more when combined with dietary and lifestyle
changes than when used alone
d. Statins are expensive and have side effects such as muscle pain and weakness, liver
disease, and kidney failure
e. Cost and side effects have prompted alternatives like extreme cholesterol-lowering diets
1. Therapeutic diets can lower LDL and keep statin dose as low as possible
Low Cholesterol Level Risk?
1. Do low cholesterol levels cause cancer or aggressive behavior? Answer likely ‘No’
2. Very low cholesterol more likely due to over use of statins and diseases than to low saturated
fat and cholesterol diets
3. Total cholesterol levels below 160 mg/dl have been correlate to increased risk of suicide in
people with depression
4. Also related to violence when combined with depression
IX. The Future
A. Prevention and treatment of heart disease has changed in recent years and will continue to evolve
B. Concerns about the cost of cholesterol lowering drugs and side effects, and availability of lowcost preventive and treatment will affect these changes
C. Diet and lifestyle modification, changes in food supply, increased consumer involvement in risk
reduction will lead to decline in heart disease
D. An end to obesity and physical inactivity would also serve our hearts well