冠状动脉疾病英文课件.ppt

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),Coronary Heart Disease,The major underlying cause is atherosclerosis. Atheros

2、clerosis 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 injury to the endothelium in the artery wall.,Risk Factors forCoronary Heart Disease,Age: Male 45

3、 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 forCoronary Heart Disease,Hypertension Appears to weaken the artery wall at points of high pr

4、essure 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 forCoronary Heart Disease,Diabetes 50% of deaths related to DM is due to CHD,Risk Factors forCoronary Heart Disease,Inactivity Sedentary

5、person has 2x risk for developing CHD as a person who is active.,Risk Factors forCoronary Heart Disease,Obesity,Risk Factors forCoronary Heart Disease,Abnormal Blood Lipids LDL Cholesterol (low density lipoprotein) HDL Cholesterol (high density lipoprotein),Cholesterol,Diet,Liver,Cholesterol Metabol

6、ism,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 to be involved in the transport of excess cholesterol from m

7、embranes 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 contraceptives and steroids, hypertriglyceridemia and some genetic factor

8、s.,Cholesterol and the CHD Patient,Goal: The goal is a LDL-C level of 100 mg/dL,Treatment in CHD Patients,Cholesterol and the CHD Patient,Scandinavian Sinvastatian Survival Study: N = 4,444 patients with history of angina or MI Cholesterol levels = 213-310 mg/dL Treatment A: Placed on cholesterol-lo

9、wering diet and B: a statin drug or a placebo.,Cholesterol and the CHD Patient,Results: Cholesterol 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 The

10、rapy of High Blood Cholesterol,Diet Therapy of High Blood Cholesterol,Total Fat 20-35% calories from fat Average of total calories consumed over a one week period. Saturated fatty acid Intake is the strongest dietary determinant of LDL-C Recommendation: 8-10% calories,Diet Therapy of High Blood Chol

11、esterol,Polyunsaturated fatty acids Reduces LDL-C and risk of CHD when substituted for saturated fat in the diet Can cause small reduction in HDL-C when present in high amounts Recommendation: 10% of energy intake,-Omega-3 Fatty Acids,Help to thin blood and prevent blood platelets from clotting and

12、sticking to artery walls. Food Sources: fatty fish, such as salmon, sardines, trout, swordfish, herring, albacore tuna, mackerel and, soy, canola and flaxseed oil. Consumption of 2 servings (8ounces)per week of fish high in -linolenic acid,Monounsaturated fatty acids If equal amounts of MUFAs are su

13、bstituted 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 Increase LDL Cholesterol and decrease HDL Cholesterol Recommendations: Intakes of trans-fatty acids should be as low

14、 as possible,Trans fatty acid content of fast-food,Treatment for CHD,Physical Activity prescribed by physician for patients with CHD When aerobic activity is appropriate, activity that places moderate stress on the cardio-respiratory system can be included.,Treatment for CHD,Weight Control 5-10# wei

15、ght 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 homocysteine Elevated homocysteine levels may be present in 15% of Americans.,Dietary Issues Requiring

16、 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,Antioxidant Vitamin Supplements - Vitamins E, C and A Results of epidemiological observations suggest a rel

17、ationship 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 Selecting & Preparing Foods,M

18、ilk 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,Steps for Lowering LDL-C

19、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, half and half Cream

20、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 Lowering LDL-C in the Diet,Me

21、at, Fish and Poultry 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

22、-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 fa

23、t, 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 fat 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 eliminat