Cardiovascular Disease

The myocardium- the middle layer

right side

left side

Hypertension, chornic elevation in blood pressure

140/90 mm Hg

<120/80 mm Hg

• systolic 120-139 mm Hg or
• diastolic 80-89 mm Hg

• systolic: 140-159 mm Hg or
• diastolic: 90-99 mm Hg

• systolic: 160 or higher or
• diastolic: 100 or higher

• released during inflammation, (+ relationship w/ hypertension)
• less than 1 mg/mL = low risk
• 1-3 mg/mL = average
• more than 3 mg/mL = high risk

smoking decreases NO, Nitrous Oxide, which dilates blood vessels, so it results in constriction of blood vessels because there is less NO to dilate blood vessels

• -inhibits sodium reabsorption which decreases water and decreases BP.
• -decreased water means decreased potassium, so consumption of potassium rich foods such as baked potatoes, bananas and oranges should be increased

-also inhibits Na+ reabsorption

dilates blood vessels because it blocks angiotensin I from being converted to angiotensin II, which constricts blood vessels.

Decreases stroke volume

allows blood vessels to relax

• Dietary Approach to Stop Hypertension
• -decrease sodium, saturated fat, alcohol
• -increase calcium, potassium, fiber
• -variety of foods- high fruit and vegetable intake
• -promotes weight loss

nuts contain NO, Nitrous Oxide, which decreases BP because NO dilates blood vessels putting less pressure on the walls of the vessels

• exogenous fat, cholesterol and fat soluble vitamins
• -mainly made of TAGs

• exogenous and indogenous fat
• -mainly made of TAGs

mainly cholesterol left once some fat stored in body cells, can become oxidized and deposit in arteries, causing atherosclerosis.

• Mouth: lingual lipase
• Stomach: gastric lipase
• small intestine: triggers gallbladder to release bile, bile emulsifys fat, which increases the surface area that can be acted on by enzymes
• -pancreatic lipase breaks down to glycerol, cholesterol and fatty acids.
• -it is made into a chylomicron, which travels in the lymph to the liver.
• -The liver repackages it into VLDL, which travels through the blood. When it comes across a cell with LDL triglycerides are pulled out and stored in the cell and now the VLDL becomes an LDL or cholesterol.

-Mainly protein and phospholipid

nitrogen containing compound in the body

• -Injury to the lining of an artery, due to inflammation, increased homocyteine, or unknown cause
• -The body tries to repair the damage and sends monocytes to the area, which burrow into the blood vessel walls where they mature into macrophages
• -macrophages consume oxidized LDL and die causing a buildup of tough fibrous scar tissue that can inhibit blood flow and promote clot formation called, plaque and fatty streaks.
• -This build up can lead to atherosclerosis, or a thickening of blood vessel walls, and loss of vascular elasticity

High homocysteine levels can contribute to the initial damage to the artery. Homocysteine levels can be decreased by increasing folate, B12, and B6 in the diet. These can be found in fortified breakfast cereals, green vegetables, orange juice and animal products.

a high fat diet can contribute to increased amounts of LDL available to be oxidized.

• Anitoxidants prevent LDL from becoming oxidized and depositing, so it can't be consumed by mature macrophages, decreasing cell death and scar tissue build up.
• -found in sources of Vitamin E, Vitamin C, and Beta- carotene

• < 200 mg/dL
• < 100 mg/dL
• > 60 mg/dL
• < 150 mg/dL

• thickening of the blood vessel walls caused by presence of plaque
• -includes loss of vascular elasticity
• -results in restriction of blood flow and possibly
• ~myocardial infarction
• ~cerebrovascular incident
• ~peripheral vascular disease
• ~CAD and CHF

• -family history
• -age and sex
• -obesity
• -dyslipidemia
• -hypertension
• -physical inactivity
• -atherogenic diet- low in vegetables, fruits and whole grains
• -diabetes mellitus
• -impaired fasting glucose/metabolic syndrome
• -smoking

• - a substance naturally produced by endothelial cells
• -controls the normal relaxation of smooth muscles in the arteries and arterioles
• -regulates leukocyte adhesion, platelet adhesion and thrombosis

• -decrease cholesterol production by the liver
• -worry about liver damage

Niacin given in large amounts, often given with statin drugs (decrease LDL and increase HDL)

prevents some fat absorption

• Therapeutic Lifestyle Changes
• -modifications in fat and cholesterol
• -rich in fruits, vegetables, grains, fiber (focus on water soluble fiber)
• -limit sodium to 2400 mg
• - include plant stanol esters

• -total fat: 25-35% of calories
• -very low fat diets
• -saturated fat < 7% of calories
• -avoid trans fats
• - increase intake of monounsaturated fats and polunsaturated omega 6 fatty acids
• -increase intake of omega-3 essential fatty acids
• -limit dietary cholesterol < 200 mg daily

• inadequate blood supply to the heart
• -may be asymptomatic
• -angina = chest pain
• -can precipitate MI causing necrosis of tissue

• chest pain when exercising = stable angina
• chest pain when resting = unstable angina

• -Decrease oral intake
• -clear liquids, no caffeine- avoid temperature extremes in liquids and foods
• -progress to soft, more frequent meals
• -smaller meals limited in calories to avoid increased work of the heart for digestion not necessarily weight control
• -individualized- use TLC recommendations

impairment of the ventricles' capacity to eject or fill with blood

• -decrease sodium
• -decrease fluid, due to edema
• - treat underlying cause
• -control BP
• -prevent continued damage
• -medications
• -exercise
• -nutrition therapy
• -prevention of respiratory infections

malnutrition/wasting, fatigue, anorexia

coronary artery disease

cardiovascular disease

Coronary heart disease

cerebrovascular accident

heart failure

myocardial infarction

hypertension

blood pressure

high blood pressure

average macronutrient distribution range

adequate intake

upper tolerable limit

saturated fatty acid

monounsaturated fatty acid

polyunsaturated fatty acid

eicosapentanoic acid

docohexaenoic acid

cholesterol

triglyceride

apolipoprotein B

low density lipoprotein

high density lipoprotein

hydrogenation

• Carbohydrate: 45-65% energy intake
• Protein: 10-35% energy intake
• Fat: 20-35% energy intake

abnormal condition of the heart and its vascular system including those associated with atherosclerosis

abnormal condition of the heart and its vascular system, such as heart failure and coronary heart disease

choronic accumulation of cholesterol and lipid deposits on the arterial walls, resulting in the formation of fatty streaks and hardened plaque called atheroma

an insufficiency of the heart as a pump.

the accumulation of cholesterol and lipid, causing narrowing of the arteries of the heart.

• -muscle wasting due to lack of blood flow
• -limited salt and water
• -ensure or supplement
• -high protein, low sodium bar

TLC diet, salt restricted, less than 2 g per day, may be fluid restricted

a stable intake of vitamin K, make them aware of vitamin K sources, such as spinach

the largest lipoproteins, the most enriched in triglycerides, and the least dense. They transport dietary triglycerides and cholesterol.

the smallest lipoproteins and the richest in proteins, and they therefore have the highest density.

principally constituted of triglycerides. They transport endogenous triglycerides originating in the liver.

Intermediate density lipoproteins are intermediate lipoprotein particles that contain as much triglyceride as cholesterol.

lipoproteins rich in cholesterol and represent about 70% of the total cholesterol in humans.

• they are classified according to their chemical composition and by physical characteristics such as their size, density, flotation index, and electrophoresis mobility
• -By weight: more fat = decreased weight.

• proteins on the surface of lipoproteins.
• 1. structural components
• 2. cofactors
• 3. bind to specific cell receptors
• 4. competitive inhibitors

the presence of abnormally high concentrations of cholesterol in the blood

the presence of abnormally high concentrations of triglycerides in the blood

the presence of abnormally high concentrations of lipoproteins in the blood.

abnormally elevated arterial blood pressure or (high blood pressure)

a cerebral stroke

an acute brain attack due to an impairment of cerebral blood flow and resulting in a reduction or loss of consciousness, sensations, and voluntary movement.

a reduction of blood supply to a localized tissue or organ, usually caused by arterial narrowing or obstruction of blood inflow to the tissue.

a redution of blood supply in the brain, which results in impaired cerebral oxygen supply.

unexpected, abrupt, frequently recurring episodes of temporary reduction of blood supply to a localized tissue or organ, which can lead to a stroke.

reduction of blood supply to the heart muscle.

a disease characterized by intense, often constricting, spasmodic pain attacks in the chest due to myocardial ischemia caused by a lack of oxygen supply to the heart muscle.

characterized by the inability of the heart muscle to maintain sufficient blood flow to tissues or to pump out the blood coming back to the heart by the venous circulation. As a result, edema and congestion develop tissues.

a heart attack or the necrosis of an area of the heart muscle due to an obstruction of the coronary arterial blood flow by a thrombus or embolus

a surgery to repair stenosed arteries of the heart. This type of intervention involves the introduction of a catheter through the skin and into the lumen of a cardiac artery that is stenosed and needs to be enlarged to re-establish blood flow.

a major surgery to treat obstructed or almost obstructed arteries of the heart. During surgery, another blood vessel is taken from another part of the body and used to replace one or more occluded heart arteries and re-establish blood circulation past the obstruction.

a lipid-containing yellowish plaque or nodule, especially of the skin of individuals with very high blood cholesterol concentrations.

• -Age > 55
• -male gender
• -sedentary lifestyle
• -body mass index > 25
• -abdominal obesity
• -diet high in SFA, trans fats, cholesterol, sugars, alcohol, and salt and low in fibers
• -cigarette smoking
• -diabetes mellitus
• -hyperlipidemia
• -high blood pressure, especially high in systolic blood pressure
• -family history of hyperlipidemia or coronary heart disease
• -peripheral vascular disease or carotid atherosclerosis
• -high blood homocysteine concentrations
• -presence of xanthomata

• lipoproteins in excess in the blood: chylomicrons
• Consequence: elevated blood cholesterol concentrations

• lipoproteins in excess in the blood: LDLs
• Consequence: elevated blood cholesterol concentrations

• Lipoproteins in excess in the blood: LDLs and VLDLs
• Consequence: elevated blood cholesterol and triglyceride concentrations

• lipoproteins in excess in the blood: IDLs
• Consequence: elevated blood cholesterol and triglyceride concentrations

• Lipoproteins in excess in the blood: VLDLs
• Consequence: elevated blood triglyceride concetrations

• Lipoproteins in excess in the blood: chylomicrons and VLDLs
• Consequence: elevated blood triglyceride concentrations