冠状动脉疾病英文PPT课件

1、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 Amer. Black White 45-64 166 99 224 426 244 65 1336

2、870 1128 2181 2079 Coronary Heart Disease The major underlying cause is 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 to the endothelium in the artery w

3、all. 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 Hypertens

4、ion Appears to weaken the artery wall at points of high pressure leading to injury and invasion of cholesterol. Cigarette Smoking #1 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 R

5、isk 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 d

6、ensity lipoprotein) Cholesterol Diet Liver Cholesterol Metabolism 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

7、 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 contraceptiv

8、es and steroids, hypertriglyceridemia and some genetic factors. Cholesterol and the CHD Patient Goal: The goal is a LDL-C level of 100 mg/dL Treatment in CHD Patients L L D D L L - -C C L L e e v v e e l ls s D D i ie e t t & & L L i if fe e H H a a b b i it ts s D D r ru u g g T T h h e e r ra a p

9、p y y 1 1 3 3 0 0 m m g g / /d d L L Y e s Y e s Cholesterol and the CHD Patient N = 4,444 patients with history of angina or MI Cholesterol levels = 213-310 mg/dL Treatment A: Placed on cholesterol-lowering diet and B: a statin drug or a placebo. Cholesterol and the CHD Patient Results: Cholesterol

10、 Levels - total cholesterol decreased 25%, LDL decreased 35% 34% decrease in major coronary events 42% decrease in CHD mortality 30% decrease in total mortality 37% decrease in surgery for CHD Diet Therapy of High Blood Cholesterol Diet Therapy of High Blood Cholesterol 20-35% calories from fat Aver

11、age of total calories consumed over a one week period. Intake is the strongest dietary determinant of LDL-C Recommendation: 8-10% calories Diet Therapy of High Blood Cholesterol Reduces LDL-C and risk of CHD when substituted for saturated fat in the diet Can cause small reduction in HDL-C when prese

12、nt in high amounts Recommendation: 10% of energy intake -Omega-3 Fatty Acids Help to thin blood and prevent blood platelets from clotting and sticking to artery walls. Food Sources: fatty fish, such as salmon, sardines, trout, swordfish, herring, albacore tuna, mackerel and, soy, canola and flaxseed

13、 oil. Consumption of 2 servings (8ounces)per week of fish high in -linolenic acid If equal amounts of MUFAs are substituted for saturated fatty acids, LDL-C decreases MUFAs do not lower HDL-C Recommended intakes: up to 20% of total calories Diet Therapy of High Blood Cholesterol Trans-Fatty Acids In

14、crease LDL Cholesterol and decrease HDL Cholesterol Recommendations: Intakes of trans-fatty acids should be as low as possible Food Calories Trans Fatty Acids (g) Saturated Fatty Acids (g) Hamburger (7 oz)660314 McDonalds chicken McNuggets (9 oz)51036 Burger King chicken sandwich (8 oz)61027 Burger

15、King fries (6 oz King size)54076 Starbucks cinnamon scone (5 oz)530313 (Data compiled from Nutrition Action Health Letter, June 1999) Trans fatty acid content of fast-food Treatment for CHD prescribed by physician for patients with CHD When aerobic activity is appropriate, activity that places moder

16、ate stress on the cardio- respiratory system can be included. Treatment for CHD 5-10# weight loss Diet Therapy of High Blood Cholesterol Soluble Fiber 10-20 g/day Drug Treatment Statins - Bile Acid Sequestrants Nicotinic Acid Dietary Issues Requiring Further Research Elevated levels of Elevated homo

17、cysteine levels may be present in 15% of Americans. Dietary Issues Requiring Further Research Several vitamins, including folic acid, vitamin B6 and B12, function are cofactors in the metabolism of methionine and homocysteine. Dietary Issues Requiring Further Research Results of epidemiological obse

18、rvations suggest a relationship between increased intake of these vitamins and decreased CHD risk. Dietary Issues Requiring Further Research Very low-fat diets (15 % fat) Steps for Lowering LDL-C in the Diet Eggs: 300 mg. cholesterol: 4 yolks/wk 200 mg. Cholesterol: 2 yolks/wk Guidelines for Selecti

19、ng & Preparing Foods Milk and Milk Products: 2-3 servings/day Steps for Lowering LDL-C in the Diet Fats, oils: 6-8 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 Ste

20、ps 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

21、, 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 Lowerin

22、g LDL-C in the Diet 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 Tongue, kidneys Liver, sweetbreads, heart and brains are high in cholesterol. Steps for Lowering LDL-C in the Diet Breads and Cereals: 6-

23、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

24、, and 95 mg cholesterol Lean 10 g total fat, 4 g saturated fat and 95 mg cholesterol Reading The Label Fat Free less than 0.5 gm fat Low Fat 3 grams or less fat Reduced fat at least 25% less fat Light one-third fewer calories or 50% less fat Guidelines for Selecting & Preparing Foods Try reducing fa

25、t 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. Saut 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. Risk Factors fo

26、r Coronary Heart Disease Triglycerides Normal: 1000 mg/dl Risk Factors for Coronary Heart Disease High Triglycerides (200 mg/dl) and low HDL cholesterol is associated with increased risk. Stronger in women than men and older adults Hypertriglyceridemia Factors Associated with Increased Triglycerides

27、: Diets - low fat, high refined sugar Estrogens Alcohol Obesity Untreated Diabetes, hypothyroidism, chronic renal failure and liver disease Hypertriglyceridemia Treatment: Weight Loss Low cholesterol, low saturated fat diet Increased physical activity Smoking cessation Management of Diabetes Restricted alcohol use Mortality From Diseases of the Heart by Race/Ethnicity (Deaths/100,000) Age Hispanic Asian Native Amer. Bla