Nutrition ch19: Coronary Heart Disease and Hypertension

For someone with elevated blood pressure the recommended sodium per day is 2300 mg/day max and ___________ mg/day as the goal. a. 2000 b. 4700 c. 1000 d. 1500

d

Increasing _____________ in the diet could help to lower blood pressure. a. cholesterol b. sodium c. saturated fat d. potassium

d

The diagnosis of elevated blood pressure, stage 1 hypertension, and 2 hypertension is based on the _____ blood pressure. a. resting b. systolic c. diastolic d. systolic and diastolic

d

Dietary modifications directly following a myocardial infarction generally include _____________ to decrease metabolic workload on the damaged heart. a. increasing fiber intake b. avoiding cholesterol c. reducing fluid intake d. reducing energy intake

d All care after a myocardial infarction is aimed at ensuring cardiac rest so that the damaged heart can be restored to normal functioning. Energy restriction reduces metabolism and therefore reduces the workload for the heart.

What types of foods help you to prevent ASCVD?

- Eat a variety of foods from all food groups - Fresh vegetables and fruits, fiber rich whole grains, nuts, legumes, and fat-free or low-fat dairy products - Choose lean meats such as skinless poultry, turkey - Eat fish at least twice a week - Use mono- and polyunsaturated fats instead of tropical oils (palm and coconut)

What types of foods do you want to limit or consume in moderation?

- Limit the amount of saturated fat (5-6% of total daily calories if high blood cholesterol levels) - Avoid trans fat - If blood pressure is elevated limit sodium to max 2300 mg/d, with a goal of 1500 mg/d - Limit red meat, processed meat, refined carbohydrates, and sugar sweetened beverages

Tips for reducing sodium

- choose fresh, frozen, or canned low-sodium or no-salt added vegetables - cook without salt and avoid adding salt to prepared meals - avoid salt-preserved foods such as salted or smoked meat (bacon/bacon fat, bologna, dried or chipped beef, corned beef, ham, kosher meats, luncheon meats, etc), salted or smoked fish (anchovies, caviar salted and dried cod, herring, sardines, canned fish products, etc.), sauerkraut, and olives. Use fresh poultry, lean meats, and fish instead - avoid highly salted foods (crackers, pretzels, potato chips, etc). Choose foods that are lower in sodium - Limit processed foods and convenience foods (cheese, peanut butter, flavored rice and pasta, frozen dinners, canned soups) that are usually high in salt, or choose reduced-sodium versions. - limit spices and condiments such as bouillon cubes, ketchup, chili sauce, celery salt, garlic salt, onion salt, monosodium glutamate, meat sauces, meat tenderizers, pickles, prepared mustard relishes, worcestershire sauce, and soy sauce. Choose low- or reduced-sodium or no-salt added versions

The first step of atherosclerosis is damage to the endothelial layer (single layer of cells that protects the blood vessel wall). What are the three potential irritants discussed in the lecture/slides that can damage the endothelial layer?

-Excessive LDL in the blood (LDL carries cholesterol and fat in the blood and deposits it in tissues. You often here LDL cholesterol called the "bad cholesterol", but we do need a certain level of LDL in the body) -Toxins from cigarette smoking -Chronic hypertension (high blood pressure)

This is a fantastic video from Khan academy that describes how atherosclerosis begins in the body: https://www.youtube.com/watch?v=J8Va0T-_ptk

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10 best foods high in potassium

1. Beet greens 2. salmon 3. large white beans 4. avocados 5. potatoes 6. Acorn squash 7. Milk 8. White button mushrooms 9. Bananas 10. tomatoes

list the four medical nutrition therapy (MNT)recommendations for hypertension discussed on the Medical Nutrition Therapy for HTN lecture slide.

1. Weight management: - Clients can expect blood pressure to decrease by 1 mm Hg for every 1 kg weight loss. 2. DASH eating pattern: - Has been shown to lower blood pressure significantly in 2 weeks. - 4-6 servings fruit/day, 4-6 servings vegetables/day, 2-3 servings low fat dairy/day, lean meats, nuts, dried beans, high-fiber grains. - When combined with a low sodium diet the effects are substantially greater. 3. Reduce sodium intake: - 1500-2300 mg/day 4. Consume recommended levels of: - Potassium (High potassium intake lowers blood pressure, relaxes walls of blood vessels) recommended 4700 mg/day - Magnesium (helps blood vessels to relax). Most american adults don't get enough- may need supplementation. - Calcium (helps blood vessels both tighten when they need to and relax when they need to. As a single nutrient very small effect)

Lifestyle recommendations for HTN

1. Weight/body fat loss: - The best goal is to achieve an ideal body weight, but aim for at least a 1-kg reduction in body weight for most adults who are overweight. Expect about 1 mm Hg for every 1-kg reduction in body weight. - Approximate impact on SBP: Hypertension: −5 mm Hg, Normotension: −2 to 3 mm Hg 2. Healthy diet (e.g., DASH dietary pattern): - Consume a diet rich in fruits, vegetables, whole grains, and low-fat dairy products, with reduced content of saturated and total fat. - Approx. impact on SBP: Hypertension: −11 mm Hg, Normotension: −3 mm Hg 3. Reduced dietary sodium intake: - Optimal goal is <1500 mg/d, but aim for at least a 1000-mg/d reduction in most adults. Approx. impact on SBP: Hypertension: −5 to 6 mm Hg, Normotension: −2 to 3 mm Hg 4. Enhanced dietary potassium intake: - Aim for 3500-5000 mg/d, preferably by consumption of a diet rich in potassium. - Approx. SBP impact: Hypertension: −4 to 5 mm Hg, Normotension: −2 mm Hg 5. Aerobic exercise: - 90-150 minutes per week - 65%-75% heart rate reserve b Approx. SBP impact: Hypertension: −5 to 8 mm Hg, Normotension: −2 to 4 mm Hg 6. Dynamic resistance exercise - 90-150 minutes per week - 50%-80% 1 rep maximum - 6 exercises, 3 sets/exercise, 10 repetitions/set - Approx. SBP impact: Hypertension: −4 mm Hg, Normotension: −2 mm Hg 7. Isometric resistance exercise: - 4 × 2 min (hand grip), 1 min rest between exercises, 30%-40% maximum voluntary contraction, 3 session per week 8-10 weeks - Approx. SBP impact: Hypertension: −5 mm Hg, Normotension: −4 mm Hg 8. Moderation in alcohol intake: - In individuals who drink alcohol, reduce alcohol c to: Men ≤2 drinks daily, women ≤1 drink daily - Approx. SBP impact: Hypertension: −4 mm Hg, Normotension: −3 mm Hg SBP= systolic BP Dynamic resistance= move muscles through a specific range of motion squats, climbing stairs, doing push-ups or performing bicep curls. Isometric exercises are tightening (contractions) of a specific muscle or group of muscles like holding plank, wall sits

Congestive Heart Failure

A chronic heart disease in which the heart muscle progressively weakens. Client is unable to maintain adequate cardiac output to sustain tissue perfusion. The resulting fluid overload results in difficulty with breathing, eating, walking, and sleeping Medical Nutrition Therapy: - Limit sodium to no more than 2 g/day - Must American adults consume 4.7 g/day - Limit fluid intake to no more than 2 L/day for those with serum sodium <130 mEq/L - Dietary supplements depending on type of diuretic i.e. - Thiamin - Potassium - Limit alcohol to 1 drink/day for women and 2 drinks/day for men - Frequent, small meals to help with fatigue during eating The most common cause of congestive heart failure is coronary artery disease. Risk factors for coronary artery disease include: high levels of cholesterol and/or triglyceride in the blood. high blood pressure.

Helpful seasonings to use in a sodium restricted diet includes which of the following? a. Bouillon cubes b. Soy sauce c. Herbs and spices d. Sea salt

c

Fat and cholesterol are carried in the bloodstream in small wrapped packages called _____________. a. phospholipids b. adenosine triphosphate c. triglycerides d. lipoproteins

d

How much physical activity (and at what intensity) would reduce your risk of developing atherosclerotic cardiovascular disease (ASCVD)?

At least 150 minutes moderate intensity or 75 minutes vigorous intensity activity/week

Hypertension is called the "silent killer" because _____________. a. it has not been well publicized b. it cannot be heard with a stethoscope c. no signs indicate its presence d. it affects the vocal cords

c

Cardiovascular Disease

Cardiovascular disease (CVD) is the umbrella term for all diseases affecting either the heart (cardio) or the blood vessels (vascular), such as: - Coronary heart disease - Myocardial infarctions - Heart failure - Heart arrhythmias - Congenital heart defects - Cerebrovascular disease CVD is the leading cause of death in the United states. CVD accounts for 635,000 deaths in the U.S. every year: 1 out of 4 Americans deaths per year To put that number into perspective 385,000 Americans died from COVID in 2020.

Coronary Heart Disease (CHD)

Coronary heart disease Is atherogenic disease affecting the coronary arteries specifically. The coronary arteries are the major arteries that serve the heart.

One of the things metabolic syndrome is characterized by includes _____________. a. blood pressure of 110/70 mm Hg b. fasting blood sugar of 92 mg/dl c. triglyceride level of 175 mg/dl or greater d. body mass index of 22

c

Can you drink alcohol if you are trying to prevent ASCVD?

Drink alcohol in moderation (1 drink/day women; 2 drinks/day men) Avoid tobacco smoke Try to consume appropriate portion sizes while eating out

Total Cholesterol

Excess blood levels of total cholesterol (hypercholesterolemia) increase the risk for cardiovascular disease in predisposed individuals. term-8 Normal total cholesterol: <200 mg/dl Borderline high: 200-239 mg/dl High: > 240 mg/dl High cholesterol increases the risk for the following to be deposited in arteries throughout the body: - Cholesterol - Fats - Fibrous tissue - Macrophages Cholesterol is one type of lipid that can contribute to atherosclerosis. Your total blood cholesterol is a measure of LDL cholesterol, HDL cholesterol, and other lipid components. Abnormally high total cholesterol increases the risk for the atherogenic process to occur in blood vessels.

list the risk factors mentioned on the lecture slide that can raise a patient's triglycerides.

Familial hypertriglyceridemia Excessive alcohol use A diet high in added sugar and simple carbohydrates Diet high in saturated fat Sedentary lifestyle Smoking

Which type of cholesterol carrying lipoprotein is often referred to as "good cholesterol"? Why? What is one of the most effective ways to increase levels in the blood?

High-Density Lipoproteins (HDLs): - "Good cholesterol" - Removes excess cholesterol from cells and returns it to the - liver to be catabolized into: - Bile salts & salts that are excreted by the colon. - Higher levels of blood HDL are a marker for reduced cardiovascular disease risk. - Can increase through regular exercise.

What is the max amount of sodium that should be consumed each day AND the ideal, goal amount if someone has elevated blood pressure?

If blood pressure is elevated limit sodium to max 2300 mg/d, with a goal of 1500 mg/d

Which type of cholesterol carrying lipoprotein is often referred to as "bad cholesterol"? Why?

Low-Density Lipoproteins (LDLs): carries cholesterol and fat in the blood and deposits it in tissues. You often here LDL cholesterol called the "bad cholesterol", but we do need a certain level of LDL in the body Made in liver and also derived from VLDL and IDL Carries two thirds of the plasma cholesterol to body tissues. The major lipoprotein of concern in cardiovascular disease.

Triglycerides

Main form of dietary fat and how fat is stored in the body As triglycerides go up, HDL cholesterol levels often go down. High serum triglycerides (hypertriglyceridemia) is a risk factor for developing cardiovascular disease. Serum triglycerides ≥ 175 mg/dl major risk factor for cardiovascular disease and future atherosclerotic cardiovascular events. lipid that can contribute to atherogenic disease.

What are the three evidence-based eating patterns to reduce atherogenic?

Mediterranean diet: - Mostly plant based foods - Moderate amounts of dairy and eggs - Limited red meat - Olive oil as primary source of fat - Herbs and spices in place of salt - Moderate red wine intake - Fresh fruit as dessert MyPlate or Healthy Plate Guidelines: - Mostly plant foods (1/2 plate non-starchy vegetables and fruit) - Make 1/2 grains whole grains - Eat less added sugars, solid fats (saturated fat), and salt. Dietary Approaches to Stop Hypertension (DASH) diet:

Metabolic syndrome increases someone's risk for developing atherosclerotic cardiovascular disease (ASCVD). Be able to explain how metabolic syndrome is diagnosed.

Metabolic syndrome is one of the compounding conditions that increases an individual's risk for developing ASCVD. If you meet 3 of the 5 criteria below, you are diagnosed with metabolic syndrome. - increased waist circumference - elevated level of triglycerides - reduced HDL- cholesterol level - hypertension - elevated fasting glucose level Having metabolic syndrome also increases your risk of developing diabetes

Risk factors for hypertension (HTN)

Modifiable Risk Factors • Smoking and exposure to secondhand smoke • Type 2 diabetes mellitus • Hypercholesterolemia • Overweight/obesity • Sedentary behaviors and physical inactivity • Poor diet quality Risk Factors That are Difficult to Change • Low socioeconomic status • Low education • Obstructive sleep apnea • Chronic kidney disease • Psychosocial stress Non-modifiable Risk Factors • Family history • Race/ethnicity • Increasing age • Male sex

Risk Factors for Atherosclerotic Cardiovascular Disease (ASCVD):

Modifiable risk factors: - Blood cholesterol profile: High total cholesterol and high LDL coupled with low HDL= - higher risk - Poor diet quality Sedentary lifestyle: < 22% of Americans meet the physical activity guidelines - Smoking - Compounding conditions (having several co-morbidities at one time that are associated with obesity and are going to increase risk for CVD, such a metabolic syndrome, Type 2 diabetes, and HTN). Non-modifiable risk factors: - Age - Family history - Hereditary African Americans have the highest risk of CVD of any ethnicity; however, this is not only due to genetic predisposition, but also related to lifestyle, acculturation, and socioeconomic status.

Myocardial Infarction & Cerebrovascular Accident

Myocardial infarct (MI) "heart attack": - Myocardium= heart muscle - Infarct= local area of dying or dead tissue resulting from loss of blood supply If bloodflow is cut off to the heart muscle, so are oxygen and nutrients. If the blocked major artery supplies the brain it causes a cerebrovascular accident, also known as a stroke. (The middle cerebral artery is most often blocked during a stroke.) Most strokes (87%) are ischemic strokes. An ischemic stroke happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.

One of the MNT recommendations for hypertension is to increase potassium in the diet. Why? How much is recommended to be consumed daily? Be able to recommend three different high potassium foods to your patient.

Potassium relaxes the walls of blood vessels. Recommended amount per day is about 4700 mg. Most Americans only get about half of that amount per day. Beet greens, salmon, large white beans.

Hypertension (HTN)

Referred to as the "silent killer", because there are no signs that indicate its presence. 1 in 3 U.S. adults has high blood pressure. Many do not know they have it. HTN is higher among black or African-Americans individuals than in whites, Hispanics, or Asian-Americans. Essential (primary) HTN is the predominant form of HTN; it has no identifiable cause and is considered to be familial Secondary HTN is a symptom of another primary condition, such as kidney disease (10% of cases). Normal Blood Pressure: - systolic blood pressure (mm Hg): <120 - diastolic blood pressure (mm Hg): and <80 - lifestyle modification: encourage Elevated Blood Pressure: - systolic(mm Hg): 120-129 - diastolic (mm Hg): and <80 - life style modification: yes - Pharmacotherapy: Not indicated. reassess in 3-6months Stage 1 Hypertension - systolic (mm Hg): 130-139 - diastolic (mm Hg): or 80-89 - lifestyle modification: yes - pharmacotherapy: If patient's 10-year CVD risk c is <10%, the first-line therapy is strict adherence to lifestyle modifications and reassessment in 3 to 6 months. If patient has diagnosed atherosclerotic CVD or elevated 10-year CVD risk (≥10%), health care provider will initiate hypotensive medication and reassess patient in 1 month. Stage 2 Hypertension: - systolic: >/=140 - diastolic: or >/=90 - lifestyle modification: yes - pharmacotherapy: Hypotensive medication initiated. Reassess in 1 month. If goal not achieved, health care provider will adjust dose and/or add other medications to treatment regime.

What is the underlying pathologic process of coronary heart disease and why can this lead to a myocardial infarction?

The underlying pathologic process of coronary heart disease is atherosclerosis. Atherosclerosis is characterized by: - Fatty plaque on the inside lining of major blood vessels. - The plaque is made of mostly cholesterol. - The plaque forms in response to endothelial injury, which causes inflammation. - Plaque formation can begin as early as childhood. The first step of atherosclerosis is injury to the endothelial layer of blood vessels by an irritant. The endothelial layer is a single layer of cells that line the inside of all blood vessels. The fatty plaque eventually thickens to a fibrous plaque that narrows the interior of the blood vessel and can eventually cut off blood flow completely. The endothelial layer is the protective barrier for the rest of the blood vessel wall. Once this single cell layer is compromised by an irritant, LDL (low density lipoproteins) will pass through the endothelial layer and set up shop in the blood vessel wall. Macrophages (a type of white blood cell) that are patrolling the blood sense that something is not right and go to this now compromised area of the blood vessel and attempt to eat these LDL. Unfortunately, they eat so much LDL they end up dying and turning into foam cells (look like seafoam on a microscope). Smooth muscle cells will then migrate to the fatty streak to try to contain it by placing a fibrous cap over the streak. This is very similar to a scab forming when you skin your knee. The inside of your blood vessel will now have a smaller radius due to the fatty streak with a fibrous plaque and therefore resistance is increased in the blood vessel as well. When the worst-case scenario happens, the fibrous plaque ruptures. This exposes thrombogenic mater

True or False? Essential (primary) hypertension has no identifiable cause and is considered to be familial.

True

What type of fat would be recommended to consume more frequently in the diet? What type of fat would be recommended to be limited in the diet?

Use mono- and polyunsaturated fats instead of tropical oils (palm and coconut) Limit the amount of saturated fat (5-6% of total daily calories if high blood cholesterol levels)

Medical nutrition therapy for congestive heart failure may include _____________. a. sodium restriction b. potassium restriction c. high fat d. increased fluid intake

a

A localized area of dying or dead tissue is called a(n) _____________. a. infarct b. thrombus c. lesion d. atheroma

a Cells die when deprived of their normal blood supply. The local area of dying or dead tissue is called an infarct.

The underlying pathologic process in coronary heart disease appears to be _____________. a. fibrous plaques in coronary vessels b. weakened coronary vessels c. atrophy of the heart muscle d. inadequate nutrition to the heart muscle

a The underlying pathologic process in coronary heart disease is atherosclerosis. This process is characterized by the formation of fatty, fibrous plaques that may begin in childhood and develop into fatty streaks, largely composed of cholesterol, on the inside lining of major blood vessels.

A 45-year-old female (Ht.: 6'0" Wt.: 230 lbs.) was diagnosed with congestive heart failure. She has a history of coronary heart disease, hypertension, and used to smoke 2 packs of cigarettes daily. She experiences shortness of breath, making it difficult for her to eat. She consumes approximately 50% of her estimated needs and has significant edema in her lower extremities. From the list below, select all of the recommended dietary intervention strategies for this client. a. Limit fluid b. Limit sodium c. Utilize diuretics d. Supplement folate, vitamin B12, and magnesium e. Increase sodium intake f. Limit potassium intake g. Consume large frequent meals h. Incorporate soft foods if eating is exhaustive

a, b, c, d, h Rationale: Diet recommendations for congestive heart failure include restricting fluid and sodium to normalize fluid balance. Diuretics can help to manage fluid retention, but the health care team should monitor potassium levels and supplement, if indicated. Supplements, such as folate, vitamin B12, and magnesium, might be indicated in clients with congestive heart failure. Lastly, congestive heart failure can cause shortness of breath and make eating a challenge. The medical nutrition therapy guidelines for clients that feel exhausted during mealtime is to consume soft foods that do not require as much energy for physical digestion. Small frequent meals can also help these clients consume more total calories throughout the day.

How many times would you recommend eating fish per week?

at least twice a week

The underlying pathologic process in coronary heart disease is known as

atherosclerosis The underlying pathologic process in coronary heart disease is known as atherosclerosis, characterized by the formation of fatty, fibrous plaques that may begin in childhood and develop into fatty streaks, largely composed of cholesterol, on the inside lining of major blood vessels.

An optimal level for serum triglycerides is _____________. a. less than 190 mg/dl b. less than 175 mg/dl c. more than 180 mg/dl d. more than 200 mg/dl

b

Congestive heart failure results in _____________. a. dehydration b. difficulty breathing c. myocardial infarction d. anemia

b

The American Heart Association recommends fish should be consumed how frequently to reduce cardiovascular disease risk? a. Daily b. Twice a week c. Once a week d. Five times a week

b

The DASH diet recommends eating 4-6 servings of fruits, 4-6 servings of vegetables, and 2-3 servings of low-fat dairy foods per day in addition to lean meats and high-fiber grains. This diet is specifically successful in helping to control _____________. a. acute cardiovascular disease b. hypertension c. cardiac arrest d. angina

b

The Dietary Approaches to Stop Hypertension (DASH) encourages the intake of _____________. a. red meat & dairy b. Mostly plant foods, lean meats, and low-fat dairy c. mostly animal foods d. foods high in saturated fats

b

_____________ are a rich source of potassium. a. Lemonade b. Potatoes c. A bread roll d. Bottled water

b

An infarct in a major artery supplying the brain results in _____________. a. a coma b. hypertension c. a myocardial infarction d. a cerebrovascular accident

d

Water often needs to be limited in congestive heart failure due to fluid overload. What is the other nutrient that often needs to be limited?

we tell these patients to limit sodium to < 2 g/day. Water follows sodium. Most Americans consume 4.7 g of sodium/day. We also tell these patients to limit fluid intake to < 2L/day if serum sodium is <130 mEq/L.

Level that indicates a major risk for CVD:

• Elevated LDL cholesterol (≥160 mg/dL) • Elevated non-HDL cholesterol (≥190mg/dL) • Elevated triglycerides (≥175 mg/dL) • Elevated total cholesterol in combination with high triglycerides, non-HDL-cholesterol, or LDL cholesterol • Low levels of HDL cholesterol (<40 mg/dL for men; <50 mg/dL for women); >60 mg/dL is cardioprotective