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)

Age

Hispanic Asian Native Black White

Amer.

45-64 166

99

224

426

>65

870

1128

2181 2079

1336

244

Coronary Heart Disease

The

major underlying cause is

atherosclerosis.
Atherosclerosis 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 for

Coronary Heart Disease
Age:
Male

> 45 years
Female > 55 years or premature menopause
without estrogen replacement therapy
Family
Male

History of premature disease

first-degree relative <55 years

Female first-degree relative < 65 years)

Risk Factors for

Coronary Heart Disease
Hypertension

Appears to weaken the artery wall at

points of high pressure leading to
injury and invasion of cholesterol.

Cigarette
#1

Smoking

cause of preventable death in US

1 in 5 CHD deaths attributable to
smoking

Risk Factors for

Coronary Heart Disease
Diabetes
50% of deaths related to DM
is due to CHD

Risk Factors for

Coronary Heart Disease
Inactivity
Sedentary

person has 2x risk

for developing CHD as a person
who is active.

Risk Factors for

Coronary Heart Disease
Obesity

Risk Factors for

Coronary Heart Disease
Abnormal

Blood Lipids

LDL Cholesterol (low density

lipoprotein)

HDL Cholesterol (high density

lipoprotein)

Cholesterol Metabolism
Liver

Diet
Cholesterol

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 membranes 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 factors.

Cholesterol and the CHD Patient

Goal:
The

goal is a LDL-C level of

100 mg/dL

Treatment in CHD Patients

LDL-C
Diet & Life
Levels
Habits
<100 mg/dL Yes

Drug
Therapy
No

100-129
Yes
mg/dL
>130 mg/dL Yes

Clinical
J udgment
Yes

Diet Therapy of High Blood

Cholesterol

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
as possible

Trans fatty acid content of fastfood

Calories

Trans
Fatty
Acids
(g)

Saturated
Fatty
Acids
(g)

Hamburger (7 oz)

660

14

McDonalds chicken McNuggets

(9 oz)

510

Burger King chicken sandwich

(8 oz)

610

Burger King fries (6 oz King

size)

540

Starbucks cinnamon scone (5

oz)

530

13

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# weight loss

Diet Therapy of High Blood

Cholesterol
Soluble
10-20

Fiber

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.

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
Milk
2-3

and Milk Products:

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
Canola,

Fats:

olive and peanut oil

Avocado
Olives: black and green
Nuts: almonds, cashews, peanuts,
pecans
Sesame seeds

Steps for Lowering LDL-C in the

Diet
Polyunsaturated
Margarine

Fats

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
Butter,

Fat:

Coconut & Coconut Oil, Palm Oil

Cream, half and half
Cream 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
Meat, 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
Breads
6-11

Low

and Cereals:

servings/day

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

Use

servings per day

sweets and modified fat desserts in

moderation

Reading The Label

Extra

Lean

<5

g total fat, 2 g saturated fat, and 95 mg

cholesterol

Lean
<

10 g total fat, 4 g saturated fat and 95 mg

cholesterol

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
eliminate the fat.
Saut or stir fry with very little fat or use
water, wine, or broth.
Chill soups, gravies and stews and skim off
hardened fat before serving.