Nutrition in Cardiovascular Disease

Nutrition in Cardiovascular Disease Overview of Cardiovascular Disease ●​ ●​ ●​ Cardiovascular disease (CVD) affects approximately ⅓ of Americans and is responsible for 1 in every 3 deaths in the U.S.. Coronary artery disease (CAD) and hypertension (HTN) are the most common types of CVD. Nutrition plays a major role in both preventing and managing CVD. The Link Between Diet and Heart Disease ⇒ SERUM LIPIDS ●​ ●​ ●​ Diet influences serum lipids, inflammation, and blood pressure, all of which impact CVD risk. High saturated fat intake raises LDL cholesterol, increasing the risk of atherosclerosis and CAD. Reducing LDL levels slows atherosclerosis and decreases heart attack and stroke risk. Lipids and Cardiovascular Disease Lipoprotein Composition Function Impact on CVD VLDL (Very-Low-Density Lipoproteins) High triglycerides Made by the liver, transports lipids from liver to tissues High levels increase CVD risk LDL (Low-Density Lipoproteins) High cholesterol Transports lipids to the tissues “Bad cholesterol” – promotes plaque formation HDL (High-Density Lipoproteins) High protein Transports cholesterol from cells to the liver “Good cholesterol” – protects against CVD The Role of Fats in Cholesterol Regulation ●​ ●​ ●​ ●​ ●​ ALL dietary fats provide 9 kcals/gram Saturated Fats: ○​ Increases LDL cholesterol the MOST by reducing LDL receptor activity. ○​ Found in butter, cheese, processed meats, and full-fat dairy ⇒ Solid at room temperature ○​ Intake recommendations: ■​ <10% of total calories for healthy adults. ■​ <7% of total calories for those at risk of CVD. ■​ For every 1% increase in kcal from saturated fat intake, LDL increases by 2% Polyunsaturated Fats (PUFAs): ○​ Lowers LDL levels and reduce CVD risk. ○​ Omega-6 sources: Corn oil, nuts, sunflower seeds, soybean oil. ○​ Omega-3 sources: Flaxseed, fatty fish (salmon, tuna). ■​ Shown to decrease serum TG, inflammation and platelet aggregation ○​ AHA recommends eating fish twice per week. ○​ Food is better than supplements Monounsaturated Fats (MUFAs): ○​ Lower LDL and triglycerides without reducing HDL, reducing CAD risk ○​ Found in olive oil, canola oil, avocados, nuts. Trans Fats: ○​ Increase LDL and decrease HDL, worsening heart disease risk. ○​ Found in hydrogenated vegetable oils, margarine, processed baked goods (increases shelf life) ●​ Dietary Cholesterol: ○​ Found in animal products. ○​ Historically thought to raise LDL? Hyperlipidemia and Atherosclerosis Definition and Risks ●​ ●​ ●​ ●​ Hyperlipidemia refers to elevated total cholesterol (TC), LDL, or triglycerides (TG). Leads to atherosclerosis, increasing risk for heart attacks, strokes, and peripheral vascular disease. LDL is the primary driver of plaque formation. Fasting lipid panels should be assessed & include total cholesterol, LDL, HDL and TG per the AHA guidelines for assessing patient risk of CAD Secondary Causes of Hyperlipidemia ⇒ Non-lipid-related conditions contribute to elevated cholesterol: ○​ ○​ ○​ ○​ ○​ ○​ Type 2 Diabetes (DM2) Hypothyroidism Excess alcohol intake Liver and kidney disease Obesity Certain medications (steroids, diuretics, beta-blockers) ASCVD Risk Assessment The American Heart Association (AHA) / American College of Cardiology (ACC) developed a 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator. Factors include: ■​ ■​ ■​ ■​ ■​ Age (40-79), gender, race Total cholesterol, LDL, HDL • Blood pressure Diabetes status, smoking, aspirin use Use of statins or BP medications Interventions depend on ASCVD risk score, ranging from lifestyle changes to medication therapy. Metabolic Syndrome and Cardiovascular Disease Definition: Metabolic syndrome is a cluster of risk factors that significantly increase CVD risk. Diagnostic Criteria (ATP III) ●​ An individual has metabolic syndrome if three or more of the following are present: 1.​ Elevated fasting glucose: >100 mg/dl 2.​ Elevated BP (≥130/85 mmHg) 3.​ Reduced HDL a.​ Men <40 b.​ Women <50 4.​ Elevated TGs <150 5.​ Elevated Waist Circumference a.​ Men > 40 in b.​ Women >35 in Medical Nutrition Therapy (MNT) for Metabolic Syndrome: ●​ Therapeutic Lifestyle Changes (TLC) Diet: ○​ Reduce LDL raising nutrients ■​ Saturated fat < 7% of calories ■​ Total fat intake: 20-35% of daily calories ■​ Dietary cholesterol < 200 mg/day ■​ Trans fats <1% of total kcals ○​ If after 2 wks the LDL hasn’t dropped 8-10% ■​ Increase soluble fiber (10-25g/day) ●​ Soluble fiber can decrease LSL ●​ Block absorption of cholesterol from the digestive track ●​ Want at least 5-10 g/day, optimal 10-25 g/day ■​ Include plant sterols (2g/day) ●​ Similar to cholesterol but made by plants ●​ Helps to lower LDL ●​ 2 tbsp = 1 fl oz 2-3g Medical Nutrition Therapy (MNT) for Cardiovascular Disease MNT for Coronary Artery Disease (CAD) 1.​ Weight loss: A 7-10% weight reduction can eliminate the need for medications. a.​ If possible, attempt weight loss BEFORE starting meds 2.​ Alcohol in moderation: ○​ Light to moderate ■​ 1 drink/day for women, 2 for men. ■​ More than 2/day is associated with inc. mortality ○​ Red wine may provide antioxidants. ○​ Excessive alcohol intake increases mortality risk. MNT for Hypertension (HTN) ●​ ●​ ●​ ●​ ●​ Key risk factors for HTN: ○​ Obesity ○​ High sodium intake ○​ Low potassium & calcium intake ○​ Excess alcohol consumption Continue weight control/oss Reduce sodium intake ○​ No more than 2,300 ○​ Ideal no more than 1,500 Generous amounts of K and Ca via diet Decrease alcohol intake DASH Diet (Dietary Approaches to Stop Hypertension): ●​ ●​ ●​ ●​ Low-fat dairy High in fruits and vegetables Moderate nuts/seeds/legumes intake Rich in potassium, calcium, and magnesium MNT for Heart Failure (HF) ●​ ●​ Clinical Challenges: ○​ Cardiac cachexia (muscle wasting + undernutrition) ■​ Protein/Fat Malabsorption ■​ Decreased nutrient intake ○​ Reduced energy intake due to fatigue, nausea ○​ Hypermetabolic state requiring increased nutrition Nutritional Goals: 1.​ Sodium restriction: 2-3 g/day 2.​ Fluid restriction: ~2 quarts/64 ounce/8 cups per day 3.​ Adequate caloric intake: 1.5 x BMR 4.​ Protein intake: 1.1–1.4 g/kg/day 5.​ Small, frequent meals to prevent fatigue 6.​ High-calorie, high-protein supplements if needed