7 - Lipids in Health & Disease

NCEP Heart Protective Diet

- low saturated fat (<7% of daily calories) - low dietary cholesterol - eating sufficient plant sterols, stanols, and soluble fiber - weight management - physical activity

Uncontrollable risk factors for CVD

- Genes - Race (AA) - Age (45+ for men, 50+ for women) - Gender (up to age 45, men have higher rates) Why do men have higher rates to that point? - higher smoking and alcohol rates, more social isolation (more stress), and worse coping skills (stress)

4.Discuss the recommendations for intake of saturated fatty acids, trans fatty acids, and unsaturated fatty acids in relation to cardiovascular diseases.

- Limit overall saturated fat intake to 10% or less of total daily calories - the best overall strategy is to replace saturated fatty acids with unsaturated ones, and to emphasize vegetables, fruits, and whole grains in the diet. - monounsaturated fatty acids can improve blood lipid profiles, including raising HDL cholesterol and lowering overall triglyceride levels, which may reduce the risk of heart disease. Can still have too much though.

Modifiable CVD risk factors

- Smoking - Diet high in sat and trans fats, sodium, added sugar and cholesterol - Sedentary lifestyle - Obesity - Type II diabetes - High alcohol consumption - High blood pressure - High blood lipid levels (cholesterol, LDL and total triglycerides)

2.Identify at least five risk factors that affect the initiation or progression of cardiovascular disease.

1) Diets high in saturated and trans fats, cholesterol, sodium and dded sugar 2) a sedentary lifestyle 3) obesity 4) excessive alcohol consumption 5) smoking 6) high blood pressure, blood glucose, LDL and truglycerides

What are the two essential fatty acids?

1. Linoleic acid (Omega 3) => Can be converted into EPA and DHA. Human body is not efficient at making this conversion, so cold water fatty fish and supplements are good - Increase HDL and lower LDL ***Used to make Ecosanoids! 2. Linolenic acid (Omega 6) - Lower HDL and increase LDL

Which value is considered an optimal reading for LDL cholesterol?

90 mg / dl So, total LDL should be less than 100 mg per dl of blood. ***If you have a family history of CVD, should be less than 70 mg / dl

Stroke

A sudden attack of paralysis or weakness when blood flow to an area of the brain is interrupted. Heart attack for brain. TWO TYPES Ischemic Stroke: Blockage of blood vessel. Nerve cells die. 85% of cases Hemorrhagic Stroke: Blood vessel actually ruptures. 15% of cases

Arteriosclerosis vs Atherosclerosis

Arteriosclerosis: more general term. The thickening, hardening and loss of elasticity of the walls of the arteries. Atherosclerosis: is a SUBSET of arteriosclerosis; the thickening and hardening of the walls of the arteries due to PLAQUE BUILDUP.

What happens when someone has a heart attack?

Artery in the heart is completely cut off bc of clots and plaque.

Essential fatty acid deficiency

Can lead to dermatitis, stunted growth, susceptibility to infection, poor wound healing.

2015 study on types of fat & CVD

Replacing 5% of energy intake from saturated fats with equivalent energy intake from: polyunsaturated fats => reduce risk by 25% monounsaturated fats => 15% carbohydrates from whole grains => 9%

1. Summarize the events that lead to the development of atherosclerosis and arteriosclerosis.

Cardiovascular Disease: now known as heart disease, refers to conditions that impair the heart, arteries, veins, and capillaries, which move blood throughout the human body But even before people experience major events such as heart attack and stroke, the long-term narrowing and loss of elasticity in blood vessels are caused by Atheroscleroisis ATHEROSCLEROSIS: : an inflammatory disease characterized by the accumulation of fatty plaque in the walls of arteries and blood vessels. - Typically caused by the presence of elevated levels of cholesterol-rich low-density lipoproteins (LDLs) in the blood 1) As blood levels of LDL rise, they infiltrate the artery wall and become oxidized, causing inflammation and injury to the vessel wall. Plaque development begins as LDL accumulates here. 2) As lipids from LDL continue to accumulate, plaque expands and may often block a significant portion of blood flow. As plaque develops, it may also be vulnerable to rupture. 3) Plaque rupture promotes the formation of a blood clot that will further block blood flow through the artery. - When blood flow is blocked in the coronary artery, which supplies blood to the heart, people experience a heart attack, or myocardial infarction. - Most cases of stroke result when a clot impairs the supply of blood to the brain.

Leading cause of death in the US

Cardiovascular disease (CVD)

Dietary strategies to reduce risk of heart disease

Consumption of plant sterols or stanols Plant-based diets Nut consumption Oily, cold-water fish Whole grain oats Moderate alcohol consumption Substituting unsaturated oils for saturated fats

Which of the following stages is NOT present in the development of atherosclerosis? A. injury to wall of blood vessel B. plaque formation C. clot formation D. accumulation of HDL E. oxidation of LDL

D

Sx of Strokes

F.A.S.T Face - facial drooping Arms - can they move both arms? Speech - slurred Time - call 911 asap

2017 PURE study

Found that: - high-carb diet increased mortality, not CVD - Increase of all fat types reduces mortality, not related to CVD either - Higher saturated fat linked to lower stroke TERRIBLE study design. (-) Reliability of Dietary Intake Data: subjects filled out a dietary questionnaire ONCE at the beginning of the 10 year study. Have to assume they're being honest. - No lipid panels or other blood work done - Most studies in China find that fat intake is 30% of diet. This one found 17% (?) (-) Total carbs is oversimplified; whole grains are way better for you than refined (refined carbs were the main macro in diet for most countries studied (-) Diets upwards of 70% of carbs may be "poverty diets". Possibly the only carbs consumed is white rice. (-) They did not measure trans fats at all ... just a 2% reduction in diet can reduce CVD risk significantly!

Metabolic Syndrome

Having at least 3 of the following sx - Excessive abdominal fat - High blood pressure - Elevated triglycerides in the blood - Low levels of HDL - Elevated blood glucose levels

Ecosanoids

Hormone-like molecules that reduce blood clotting, inflammation, and blood pressure.

Why are Omega-3s "heart healthy"?

Increase HDL, which takes care of cholesterol, and lowers LDL, blood clotting, and atherosclerotic plaques.

Dietary Lipids & Alzheimer's link

Inds with Alzheimer's experience greater narrowing of arteries in the brain that healthy inds.

Sx of heart attacks by gender

MEN - tightness in chest - shortness of breath - cold sweat - weakness (general) - cold sweat - Dizziness / nausea - Pain in jaw / neck WOMEN - Unusual fatigue - Sleep disturbances - Shortness of breath - Anxiety (sometimes months b4) - Throat discomfort - Pain in jaw, neck, back or arms (left arm)

What is considered excessive alcohol consumption for men/women?

Men: More than two drinks a day Women: More than one drink a day

Consuming oily fish provides ________, which the American Heart Association describes as part of a heart healthy diet.

Omega-3 fatty acids

5. Discuss how consumption of omega 3 and omega 6 fatty acids (both PUFAs), respectively, affects HDL and LDL, blood clotting, formation of atherosclerotic plaques, and the risk of developing cardiovascular diseases.

Omega-6 polyunsaturated fatty acids, for instance, appear to improve blood lipid profiles, especially when they take the place of saturated fatty acids, reducing the risk of heart disease. - These appear to reduce inflammation, a culprit in the initiation of plaque development. Omega-3 fatty acids may hold particular health benefits, but the picture remains somewhat unclear - For omega-6 and omega-3s, The lower the ratio, the better (such as 5:1 or 4:1)

Bogalusa Heart Study

Point was to determine how CVD starts. 16,000+ people followed, starting from age 3-17 until death. => Starts in childhood with poor exercise and diet. "Streaky deposits" of plaque.

Development of Atherosclerosis

Presence of low-density lipoproteins (LDL) and plaque. 1) Early plaque: LDLs accumulate in the blood, they infiltrate the arterial lining and become oxidized, causing inflammation 2) Advanced plaque: Blocks blood flow and can cause ruptures 3) Clot formation: plaque rupture promotes the formation of blood clots which can further block blood flow

Heart Protective Diet

Saturated fat intake <10% of daily calories Replace saturated fats with polyunsaturated fats ***Replacing unsaturated fats with carbs leads to HIGHER levels of risk!

Ratio of Omega-6 to Omega-3

Should be 4:1, but is actually closer to 17:1 in most Western diets.

3.Describe how total cholesterol, low-density lipoproteins (LDL), and high-density lipoproteins (HDL) interact to affect the risk of cardiovascular diseases.

The LDLs ferry cholesterol to all of the cells of the body. This cholesterol forms the root of the plaques that slowly constrict blood flow through the vessels that feed the heart and brain; the lower your LDL cholesterol level, the lower your risk of heart attack and stroke HDLs, in contrast, bring cholesterol from tissues back to the liver, where it is processed and eliminated; not surprisingly, higher levels of HDL have been associated with a lower risk of heart disease

Q Based on the food labels, which are the healthiest choices?

The ones with mostly monounsaturated fat, minimal saturated fat and no transfat => Impossible to completely get rid of all saturated fat, bc even the healthiest options have a little.

Other values

Total Cholesterol: 200 mg/dl, or less HDL: 60 mg/dl, or more if possible LDL: 100 or less. 70 or less for genetic riskers. Triglycerides: 150 or less