HEART HEALTH AND HEALTHY EATING HABITS

Transcription

1 HEART HEALTH AND HEALTHY EATING HABITS ELIZABETH PASH PENNIMAN RD,LD CLINICAL DIETITIAN Professional Member American Heart Association; Council on Nutrition, Physical Activity and Metabolism

2 PURPOSE: Recognize the seriousness of cardiovascular disease Learn/understand risk factors for cardiovascular disease Learn how to reduce the risk factors

3 CARDIOVASCULAR DISEASE (CVD) Includes coronary heart disease (CHD), stroke, and diseases of the blood vessels. The #1 killer of women 1 out of 2.7 deaths is from CVD (1)

4 Risk Factors High BP High Cholesterol Tobacco Use Overweight and Obesity Physical Inactivity Diabetes

5 Unchangeable Risk Factors Age Heredity Race Gender History of Previous Heart Attack or Stroke

6 Estimated 10 Year CHD Risk in 55 Year Old Adults According to Levels of Various Risk Factors Framingham Heart Study (2) Estimated 10 Year Rate (%) A B C D Men Women A B C D Blood Pressure (mm Hg) 120/80 140/90 140/90 140/90 Total Cholesterol (mg/dl) HDL Cholesterol (mg/dl) Diabetes No No Yes Yes Cigarettes No No No Yes mm Hg = millimeters of mercury mg/dl = milligrams per deciliter of blood

7 CORONARY HEART DISEASE Condition in which fat and cholesterol build up in coronary artery and block blood flow. (1) The coronary arteries are blood vessels that branch off the aorta to supply the heart with oxygen rich blood. There are 2 main coronary arteries, left and right. The left splits into 2 arteries, the circumflex and the left anterior descending artery (LAD).

8 TESTS USED TO PREDICT INCREASED RISK FOR CORONARY HEART DISEASE CRP (C reactive protein): Elevated levels may indicate increased inflammation in the body, linked to initiation or progression of CHD. CT (computed tomography): Detects calcium deposits found in arteries. Other lab values include, homocysteine and fibrinogen levels.

9 LDL <100mg/dl TESTS USED TO PREDICT INCREASED RISK FOR CORONARY HEART DISEASE Complete lipid profile every 5 years, starting at age 20. Total Cholesterol <200mg/dl Triglycerides <150mg/dl HDL >60mg/dl

10 TESTS USED TO PREDICT INCREASED RISK FOR CORONARY HEART DISEASE Blood pressure screenings The force of blood against artery walls when the heart beats and rests. Systolic pressure is the maximum pressure when the heart contracts and pumps blood out to the body <120mm/hg normal Diastolic pressure is the minimum pressure when the heart relaxes between beats <80mm/hg normal

11 NUTRITION AND HYPERTENSION Dietary Approaches to Stop Hypertension (DASH) was a clinical study funded by the National Heart, Lung, and Blood Institute (NHLBI) that showed the combination diet lowered blood pressure and may prevent and control high BP.

12 NUTRITION AND HYPERTENSION The combination diet is rich in fruits, vegetables, low fat dairy foods, and low in saturated and total fat. It is also low in cholesterol, high in dietary fiber, potassium, calcium, magnesium, and moderately high in protein. (3) The diet was designed for people with HTN, however, DASH is an eating plan we all can enjoy.

13 NUTRITION AND HTN; Clinical Trial In the DASH clinical trial, effects of diet patterns on blood pressure (BP) were assessed in 459 adults with systolic pressures <160mm/Hg and diastolic pressures of 80 95mm/Hg. * subjects not on BP meds. At first subjects were fed a control diet low in fruits, vegetables and dairy products and high fat content; typical of American diet for 3 weeks.

14 NUTRITION AND HTN; Clinical Trial Then subjects were divided into 3 groups randomly assigned to receive the control diet, diet rich in fruit/veg,, or a combination diet" rich in fruit/veg, low fat dairy, reduced saturated and total fat. Sodium around 3gm and weight at constant levels for 8 weeks. (3) Food was prepared in research kitchens, subjects ate lunch/dinner on site and breakfast off site from the kitchen s prepared packaged meal.

15 NUTRITION AND HTN; Clinical Trial Subjects (133) with HTN (140/90mm/Hg), combination diet reduced pressures by 11.4 and 5.5mm/Hg respectively than the control diet (P<.0001) Subjects w/o HTN (326), had reductions of 3.5mm/Hg and 2.1 mm/hg(3) In conclusion, a diet rich in fruits, vegetables, low fat dairy, and reduced saturated and total fat can substantially lower blood pressure. A nutritional approach to preventing and treating HTN.

16 NUTRITION AND CHD; Fish Oils Effects of N 3 N 3 fatty acids (FA) consumed as fish, or fish oils rich in eicosapentaenoic acid(epa) ) and docosahexaenoic(dha) ) or as alpha linoleneic linoleneic acid on cardiovascular disease were identified in 46 eligible studies on CHD outcomes. Most trials reported that fish oil significantly reduced mortality. (8) Results showed increased consumption of N 3 3 FA from fish and/or oil, but not of aplha linolenic linolenic acid reduced rates of all cause mortality in CHD.(8)

17 NUTRITION AND CHD, FUTURE GUIDLEINES RE: N 3 N 3 Fatty Acids Dose response data are needed for EPA and DHA (needs to be studied) (4) Studies need to be replicated in larger trails Primary prevention of CHD, as currently most guidelines are for secondary prevention. (4) Upper level of intake for benefit needs to be established. (4)

18 2006 Diet and Lifestyle Recommendations Revision from the AHA AHA incorporated new scientific evidence since last published guidelines in Aim for healthy body weight by balancing caloric intake and physical activity Aim for recommended cholesterol levels Normal BP 120/80mm/Hg and Normal glucose <100mg/dl Physical activity>30 mins most days/week Avoid use/exposure to tobacco (5)

19 2006 Diet and Lifestyle Recommendations Revision from the AHA Limit intake of saturated fat <7% total energy intake Limit trans fat <1% total energy intake Limit Cholesterol <300mg/day Limit the above by choosing lean meats and vegetable alternatives, also selecting fat free free (skim) milk, low fat dairy products, and minimizing intake of partially hydrogenated fats and oils

20 2006 Diet and Lifestyle Recommendations Revision from the AHA Diet Consume diet rich in fruits/vegetables Choose whole grain, high fiber foods Consume oily fish (Salmon, Mackerel, Trout) at least twice per week Chose foods with less salt <2.3 g/day Alcohol in moderation (2 drinks for men, 1 drink for women) * 1 drink= 12oz beer, 4oz wine, 1.5oz 80 proof liquor By adhering to this, Americans can substantially reduce their risk of CHD. (5)

21 REFERENCES 1.American Heart Association. Heart Disease and Stroke Statistics 2005 update. Dallas, Texas: American Heart Association; Centers for Disease Control and Prevention, National Center for Health Statistics Appel L, Moore T, Obarznek E, Vollmer W, Svetkey L, Sacks F, Bray B G, Vogt T, Cutler J, Windhauser M, Lin P, Karanja N. A clinical trial of the effects on dietary patterns on blood pressure. New England Journal of Medicine. 1997;336: Akabas S, Deckelbaum R. Summary of a workshop on n 3 n 3 fatty acids: current status of recommendations and future directions. Am J Clin Nutr. 2006; 83 suppl:1536s 8s. 5.Lichtenstein A, Appel L, Brands M, Carnethon M, Daniels S, Franch H, Franklin B, Kris Etheron P, Harris W, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie Rosett J. Diet and lifestyle recommendations revision Circulation. July ;

22 REFERENCES 6.Rasmussen B, Vessby B, Uustitupa M, Berglund L, Pedersen E, Riccardi G, Rivellese A, Tapsell L, Hermansen K. Effects of dietary saturated, monounstaurated, and n 3 n 3 fatty acids on blood pressure in healthy subjects. Am J Clin Nutr. 2006; 83: Seisney Matlock M, Glazewki L, McClerking C, Kachorek L. Development and evaluation of DASH diet tailored messages for hypertension treatment. Appl Nurs Res. 2006; 19(2): Wang C, Harris W, Chung M, Lichtenstein A, Balk E, Kupelnick B, B Jordan H, Laue J. N 3 N 3 fatty acids from fish or fish oil supplements, but not alpha linolenic linolenic acid, benefit cardiovascular disease outcomes in primary and secondary prevention studies: a systematic review. Am J Clin Nutr. 2006; 84:5 17. * for slide presentation at pennime@ccf.org