冠状动脉疾病英文

CoronaryHeartDisease(CHD)CoronaryHeartDisease(CHD)>58millionAmericanhaveatleastoneformofCHD.50%ofallcardiacdeathsresultfromCHDMortalityFromDiseasesoftheHeartbyRace/Ethnicity

(Deaths/100,000)CoronaryHeartDiseaseThemajorunderlyingcauseisatherosclerosis.Atherosclerosis

isaslow,progressivediseasewhichbeginsinchildhoodandtakesdecadestoadvanceCoronaryHeartDiseasePlaque(thebuild-upoflipid/cholesterol)inthearterywallformsasaresponseto

injury

totheendotheliuminthearterywall.RiskFactorsfor

CoronaryHeartDiseaseAge:Male>45yearsFemale>55yearsorprematuremenopausewithoutestrogenreplacementtherapyFamilyHistoryofprematuredisease

Malefirst-degreerelative<55yearsFemalefirst-degreerelative<65years)RiskFactorsfor

CoronaryHeartDiseaseHypertension

Appearstoweakenthearterywallatpointsofhighpressureleadingtoinjuryandinvasionofcholesterol.CigaretteSmoking#1causeofpreventabledeathinUS1in5CHDdeathsattributabletosmokingRiskFactorsfor

CoronaryHeartDiseaseDiabetes50%ofdeathsrelatedtoDMisduetoCHDRiskFactorsfor

CoronaryHeartDiseaseInactivitySedentarypersonhas2xriskfordevelopingCHDasapersonwhoisactive.RiskFactorsfor

CoronaryHeartDiseaseObesityRiskFactorsfor

CoronaryHeartDiseaseAbnormalBloodLipidsLDLCholesterol(lowdensitylipoprotein)HDLCholesterol(highdensitylipoprotein)CholesterolDietLiverCholesterolMetabolism15%75%BloodLipidsandLipoproteinsSomeLDL-Ccanbeoxidizedandtakesupbyendothelialcellsandmacrophagesinthearterialwall,whichleadstothefirststagesofatherosclerosis.BloodLipidsandLipoproteinsHDL-Cisthoughttobeinvolvedinthetransportofexcesscholesterolfrommembranestotheliverforremovalfromthebody.BloodLipidsandLipoproteinsHDL-CISINCREASED:Exercise,lossofweight,andmoderateconsumptionofETOH.HDL-Cislowered:Obesity,inactivity,cigarettesmoking,someoralcontraceptivesandsteroids,hypertriglyceridemiaandsomegeneticfactors.CholesterolandtheCHDPatientGoal:ThegoalisaLDL-Clevelof100mg/dLTreatmentinCHDPatientsCholesterolandtheCHDPatientScandinavianSinvastatianSurvivalStudy:N=4,444patientswithhistoryofanginaorMICholesterollevels=213-310mg/dLTreatmentA:Placedoncholesterol-loweringdietandB:astatindrugoraplacebo.CholesterolandtheCHDPatientResults:CholesterolLevels-totalcholesteroldecreased25%,LDLdecreased35%34%decreaseinmajorcoronaryevents42%decreaseinCHDmortality30%decreaseintotalmortality37%decreaseinsurgeryforCHDDietTherapyofHighBloodCholesterolDietTherapyofHighBloodCholesterolTotalFat

20-35%caloriesfromfatAverageoftotalcaloriesconsumedoveraoneweekperiod.Saturatedfattyacid

IntakeisthestrongestdietarydeterminantofLDL-CRecommendation:8-10%caloriesDietTherapyofHighBloodCholesterolPolyunsaturatedfattyacids

ReducesLDL-CandriskofCHDwhensubstitutedforsaturatedfatinthedietCancausesmallreductioninHDL-CwhenpresentinhighamountsRecommendation:~10%ofenergyintakeα-Omega-3FattyAcidsHelptothinbloodandpreventbloodplateletsfromclottingandstickingtoarterywalls.FoodSources:fattyfish,suchassalmon,sardines,trout,swordfish,herring,albacoretuna,mackereland,soy,canolaandflaxseedoil.Consumptionof2servings(~8ounces)perweekoffishhighinα-linolenicacidMonounsaturatedfattyacidsIfequalamountsofMUFAsaresubstitutedforsaturatedfattyacids,LDL-CdecreasesMUFAsdonotlowerHDL-CRecommendedintakes:upto20%oftotalcaloriesDietTherapyofHighBloodCholesterolTrans-FattyAcidsIncreaseLDLCholesterolanddecreaseHDLCholesterolRecommendations:Intakesoftrans-fattyacidsshouldbeaslowaspossibleFoodCaloriesTransFattyAcids(g)SaturatedFattyAcids(g)Hamburger(7oz)660314McDonaldschickenMcNuggets(9oz)51036BurgerKingchickensandwich(8oz)61027BurgerKingfries(6ozKingsize)54076Starbuckscinnamonscone(5oz)530313

(DatacompiledfromNutritionActionHealthLetter,June1999)Transfattyacidcontentoffast-foodTreatmentforCHDPhysicalActivityprescribedbyphysicianforpatientswithCHDWhenaerobicactivityisappropriate,activitythatplacesmoderatestressonthecardio-respiratorysystemcanbeincluded.TreatmentforCHDWeightControl

5-10#weightlossDietTherapyofHighBloodCholesterolSolubleFiber

10-20g/dayDrugTreatmentStatins-BileAcidSequestrantsNicotinicAcidDietaryIssuesRequiringFurtherResearchElevatedlevelsof

homocysteine

Elevatedhomocysteinelevelsmaybepresentin15%ofAmericans.DietaryIssuesRequiringFurtherResearchSeveralvitamins,includingfolicacid,vitaminB6andB12,functionarecofactorsinthemetabolismofmethionineandhomocysteine.DietaryIssuesRequiringFurtherResearchAntioxidantVitaminSupplements-VitaminsE,CandAResultsofepidemiologicalobservationssuggestarelationshipbetweenincreasedintakeofthesevitaminsanddecreasedCHDrisk.DietaryIssuesRequiringFurtherResearchVerylow-fatdiets(<15%fat)StepsforLoweringLDL-CintheDietEggs:<300mg.cholesterol:<4yolks/wk<200mg.Cholesterol:<2yolks/wkGuidelinesforSelecting&PreparingFoodsMilkandMilkProducts:2-3servings/dayStepsforLoweringLDL-CintheDietFats,oils:<6-8tsp./dayStepsforLoweringLDL-CintheDietMonounsaturatedFats:Canola,oliveandpeanutoilAvocadoOlives:blackandgreenNuts:almonds,cashews,peanuts,pecansSesameseedsStepsforLoweringLDL-CintheDietPolyunsaturatedFatsMargarinemadewithcorn,soybean,safflower,sesameoilsTub,squeezeorstickNuts:walnutsandEnglishSaladdressingsSeeds:pumpkin,sunflowerStepsforLoweringLDL-CintheDietSaturatedFat:Butter,Coconut&CoconutOil,PalmOilCream,halfandhalfCreamcheeseShorteningorlardSourcreamFatfromanimalproductsincludingmilkandmeatsStepsforLoweringLDL-CintheDietPlantSterolsandStanols:Naturalsubstancesderivedfromwood,vegetables,vegetableoilsandotherplants-sitosterolandsitostanolStepsforLoweringLDL-CintheDietMeat,FishandPoultry

Selectleanmeatandpoultry

<6oz/dayforStepIdietand<5oz/dayforStepIIEatfishonaweeklybasisStepsforLoweringLDL-CintheDietTongue,kidneysLiver,sweetbreads,heartandbrainsarehighincholesterol.StepsforLoweringLDL-CintheDietBreadsandCereals:6-11servings/dayLowfatcrackersTortillasHotandcoldcerealsexceptsgranolaormeusliStepsforLoweringLDL-CintheDietVegetables:3-5servingsperdayFruits2-4servingsperdayUsesweetsandmodifiedfatdessertsinmoderationReadingTheLabelExtraLean

<5gtotalfat,2gsaturatedfat,and95mgcholesterolLean

<10gtotalfat,4gsaturatedfatand95mgcholesterolReadingTheLabelFatFree lessthan0.5gmfatLowFat

3gramsorlessfatReducedfat

atleast25%lessfatLight

one-thirdfewercaloriesor50%lessfatGuidelinesforSelecting&PreparingFoodsTryreducingfatby1/4to1/3inbakedproducts.E.g.ifrecipecallsfor1cupoil,try2/3C.Incasserolesandmaindishes,cutbackoreliminatethefat.Sautéorstirfry