CAD & HTN diet

LDL-C goals & cut-points for TLC and drugs therapy by risk categories

# risk factors: -0-1 = LDL goal <160, start lifestyle mods = >/=160, drug therapy = >/=190 -2+ = LDL goal <130, lifestyle mods = >/=130, drug therapy = >/=130 or >/= 160 for <10% 10-yr risk -CHD or CHD risk factor equivalents (10-yr risk >20%) = LDL goal <100, w/ optimal goal <70, LDL level to start lifestyle changes = >/=100, LDL drug therapy level = >/=130

DASH study implications

-effects of combo diet comparable to pharm trials in those w/ mild HTN (independent of sodium intake or body weight) -pop wide reductions in BP similar to the DASH results would cause 15% reduced CHD & 27% reduced stroke*** -great potential in African Americans and elderly

mediterranean diet/fish diet

-high in fat, esp. MFA (olive oil) -fish -nuts -low in red meat (decreased risk of CVD & colorectal cancer) -emphasized fruit, root veggies, flax, canola -AHA state high fat diets should be used w/ caution (esp. in elderly, overweight pts)

guidelines cont.

-know your calorie needs to achieve & maintain healthy weight -know calorie content of foods & drinks you consume -track your weight, physical activity, & calorie intake -physical activity -prep & eat smaller portions

AHA on soy

-minimal evidence of direct CV health benefit from consuming soy protein -however, there may be some benefit if soy protein is used to replace animal & dairy products that contain SFA & cholesterol

AHA diet/lifestyle recommendations for CVD risk reduction

-primary prevention for gen. public -can be used clinically -new focus on weight management -more focus on practical strategies for implementation

Adult Tx Panel (ATP) III

-targets LDL-C first -DM as important risk factor for CHD -uses Framingham projections of 10 yr absolute risk to ID pts for more intensive tx -ID persons w/ multiple metabolic risk factors as candidates for lifestyle changes Risk factors: -low HDL-C (<40 mg/dl) -age (men >/=45 & women >/=55 y/o) -cigarette smoking risk factors -LDL-C -HTN >/=140/90 mmHG or on HTN meds -fam hx of premature CHD 1st degree relative (male: <55 & female <65

more guidelines

-use nutrition facts panel & ingredients list when choosing foods -eat fresh/frozen/canned veggies & fruits w/out high calorie sauces & added salt & sugars -replace high calorie foods w/ fruits & veggies -increase fiber intake by eating beans, whole grains, fruits & veggies -reduce salt intake as much as possible

nutrient composition of TLC diet

nutrient & RI of total calories: -sat fat = <7% -polyunsat. fats: up to 10% -monounsat. fat: up to 20% -total fat: 25-35% -carb: 50-60% -fiber: 20-30 grams/day -protein: 15% of total cals -cholesterol: <200 mg/day -total calories = balance w/ expenditure

antioxidant supplements

trials document potential harm: -higher risk of lung cancer w/ beta-carotene supplements in smokers*** -increased risk of HF & total mortality from high dose vit. E supplements in smokers** -food sources of antioxidants are needed but supplements are NOT

DASH study 3 ARMS

-NOT sodium restricted Control group: -macronutrients & fiber (US Avg.) Fruits & veggies: -fruits & veggies increased to 8.5 servings Combo: -add 2-3 servings low fat dairy to fruits & veggie diet

metabolic syndrome as secondary target of therapy

-abd obesity -raised BP -prothrombic state -proinflammatory state -insuline resistance (+/- glucose intolerance) -atherogenic dyslipidemia (elevated TGs, small LDL particles, low HDL)

DASH diet 1

-dietary approach to stop hypertension = DASH -lots of fruits/veggies/low fat dairy foods -can substantially lower BP in ppl w/ HTN & high nm BP -also limit simple sugars & carbs -actually DOES make a difference on morbidity & mortality -affects both systolic & diastolic BP!***

steps in therapeutic lifestyle changes

1st visit: -begin lifestyle therapies -wait 6 wks -emphasize reduced sat fat & chol. -encourage mod. physical activity -consider referral to dietitian 2nd visit: -eval LDL response -if LDL goal not met: intesnify LDL-lowering tx -reinforce reduction in sat fat & chol. -consider plant stanols/sterols -increase fiber -consider referral to dietitician 3rd visit: -6 wks later -eval LDL response -if goal not med: consider adding drug tx -consider dietitian referral -intensify weight management & activity 4th visit: -4-6 months later -monitor adherence to TLC

fish

AHA on fish oil supplements: -fish intake = decreased CVD risk -pts w/out documented CHD eat fish (oily) 2x/wk -pts w/ CVD = 1 gram/day of oily fish w/ supplements considered w/ physician examples: -salmon -sardine -trout -macrel

DASH study outcomes

Several yrs to f/u (up to 10 yrs): -27% decrease rate of stroke -15% decrease CHD rate -weight loss was an adjunct benefit Fruit & veggie diet: -decrease in systolic & diastolic BP in entire study group & in HTN group Combo diet: -sing. decrease in both systolic & diastolic BP in both groups -greatest drop was in systolic BP in HTN group (dropped systolic BP by 11.4 mmHg w/ adding 2-3 servings low fat dairy to fruit & veggie diet***)

AHA diet guidelines

To do: -balance calorie intake & physical activity -consume diet rich in veggies & fruits -choose whole grain high fiber foods -consume fish, esp. oily fish at least 2x/week -minimize intake of added sugars in foods/drinks -choose & prep foods w/ lil or no salt -ETOH in moderation, if at all

TLC diet

Up to 35% kcal fat, <7% sat, 10% PUFA 25-30 g fiber Stanols and sterols- 2g Exercise DBW bread/cereal >6 servings -veggie/fruits 3-5 veg/2-4 fruits servings -dairy 2-3 servings -eggs <2 yolks per week* -meat/fish/poultry <5 ounces/day -fats & oils (adjust to caloric level)

DASH diet

includes: -7-8 grains servings -4-5 servings veggies -4-5 servings fruits -2-3 servings low fat dairy products -2 or less servings meat/poultry/fish -2-3 servings fats & oils -nuts/seeds/dry beans 4-5 x a week -limited sweets low in fat