MNT CVD Flashcards
(24 cards)
What are the types of Cardio Vascular Disease?
All diseases of the heart and blood vessels
The main types in Australia
- Coronary Heart Disease (CHD)
- Peripheral Vascular Disease (PVD)
- Heart Failure (HF) / Cardiomyopathy
What are the CVD statistics?
In 2017-2018, 1.2 million
Australians had heart disease
It’s more common in males,
27% (43,447) of all deaths in
Australia was attributed to
CVD
What are CVD modifiable and unchangeable risk factors?
Modifiable o Smoking/EtOH o Hypercholesterolemia o Hypertension o Diabetes o Physical inactivity o Overweight/Obese o Stress/Depression
Unchangeable
o Sex, Age, Family History
What is the most common form of CVD?
Coronary Heart Disease (CHD)
Failure of coronary arteries to
supply sufficient blood to the
myocardium due to blockage (O2
deficient).
Outcomes: Angina, MI, Stroke,
Sudden Death
What is peripheral vascular disease?
Reduced circulation to other body parts (not heart or brain)
Due to narrowed or blocked
vessels
Functional impairment,
limb ischemia delayed wound
healing, ulcers, amputation
What is Heart Failure?
An underlying structural abnormality or cardiac
dysfunction impairs the ability of the heart to
fill or eject blood
Chronic Cardiac Failure (CCF)
Cardiomyopathies
Outcomes: Declining physical capacity, shortness of
breath (SOB), chronic tiredness, oedema,
hospitalisation, death
What are the phases of atherogenesis?
1) Asymptomatic, small fatty streaks
2) Characterised by plaque, high lipid content
(LDL)
3) Lesion ruptures and forms a non-occlusive
thrombi
4) Lesion ruptures and is occlusive (associated
with angina, MI, stroke and sudden death)
5) Fibrotic or occlusive lesions with similar
clinical outcomes to above
What are the 3 types of hypertension?
Essential/Primary HTN
• 80% of cases (multifactorial – hormones,
electrolytes, fluid balance mechanisms)
Secondary HTN
• Outcome of other diseases (e.g. renal, liver,
endocrine)
Uncontrolled HTN
• Damage kidneys, eyes, other organs
• Stroke
• Chronic / Congestive Heart Failure
What are the four conditions that can lead to a diagnosis of metabolic syndrome?
Waist circumference Hypertension High blood glucose levels High TG levels Low HDL-C
pt >3 = Diagnosis
What are the negatives of smoking?
1 cause of preventable
death
Directly influences coronary
events thrombus formation, plaque instability, arrhythmias, atherosclerosis
What is the medical management of CVD?
Diagnostics: ECG, chest x-ray
Drugs: Statins, Bile Acid Resins (prevent fat reabsorption)
Surgical: CABG (coronary artery bypass graft), PTCA (percutaneous transluminal coronary angioplasty), Coronary Stent
Diet: Low salt (DASH), the Mediterranean diet (fats), AGHE (i.e.whole foods/variety), fluid restriction, weight management.
other: Smoking cessation, increase physical activity
What are the facts about the Australian Diet?
In 15-25% of the population, diet therapy is as effective as drug therapy
By meeting 5 serves of vegetables/day risk of CVD would ↓16% and could avoid $1.4 billion of health expenditure (Heart Foundation, 2019)
What does the Heart Foundation suggest for lowing LDL levels?
Reduced-fat dairy, unflavored yoghurt & <7 eggs/wk (this includes T2DM)
What are the lipid profile goals?
Total C: <4.0mmol/L
LDL C: <2.0mmol/L
HDL C: >1.0mmol/L
TG: <1.5mmol/L
What is the difference between saturated fats and Trans fats?
Saturated:
Hard at room temp (visible fat on meat)
Increase cholesterol/LDL
Recommend 10% EI (Heart Foundation recommend ↓ to 7% EI)
Dairy products, biscuits, cakes, pastries, meat, poultry (processed meats)
Trans:
Type of unsaturated fat (uncommon in nature)
Used in hydrogenation process (USA margarine)
Small amounts = potent (aim <1g per 100g)
Associated with ↑ risk CHD
snack foods, packaged baked goods, fried fast food
What are monounsaturated fatty acids?
They lower LDL / rates of CHD when replacing SF enriched diet.
E.g of foods that contain MUFA:
Avocados Almonds, macadamias, peanuts, cashews Brazil & pine nuts Linseed (flaxseed), sunflower seed Olives Tahini Plant oils (sunflower, canola, olive, sesame, peanut) Margarine Lean meat, poultry, eggs
What are polyunsaturated fatty acids?
Omega 6:
Pro-inflammatory properties
5% to 10% of total energy intake should be from omega-6 PUFA to reduce the risk of heart disease
Safflower/sunflower oils, margarine, sesame seed (tahini), linseed (flaxseed); pine nuts, brazil nuts, fish
AA is found in meats, eggs, some fish
Omega 3:
ALA (alpha-linolenic acid) – walnut, pecan, edible seeds, seed oils
EPA & DHA (docosahexaenoic acid) – oily fish (tuna, salmon, sardines, blue mackerel, krill oil)
Essential Reduce inflammation (Lowers risk of stroke, MI, cancer, arthritis)
Inhibits/prevents platelet aggregation
Antithrombotic, anti-HTN & anti-arrhythmic effects
Slows growth of atherosclerotic plaques
Reduces VLDL production, reducing TG levels
Ratio of n-3 & n-6
N-6:N-3 ratio (<5:1)
What is homocysteine/folate?
Hyperhomocysteinaemia has been linked to CHD
Toxic effects of homocysteine on vascular endothelium, and in the proliferation of arterial wall smooth muscle cells
It is a by-product of B12/folate pathway if a deficiency exists
To prevent elevated homocysteine levels, ensure adequate B12 / folate / B6 in the diet
Fruit and vegetables; legumes; fish and grains
What are stanols/sterols.
Is a natural substance found in plants.
Similar structure to cholesterol, however poorly absorbed
Decreases cholesterol by competition
Fortification of margarine, milk, yoghurt (Pro Active, Logicol, Heart Active, ProHeart)
Must maintain intake for effect (2-3g, 2tsp/d)
Expensive
What are the potential benefits of antioxidants?
Prevent lipoprotein oxidation
Restoration of normal endothelial function in people with early atherosclerosis
What are the CVD Meat Restrictions?
Limit red meat 1-3 times/week (350g)
Aim to include 2-3 serves fish/week
Limit to 7 eggs/week (i.e. T2DM, CVD w high LDL-C)
30g Nuts/Seeds per day
What is the Dairy and Grain recommendation for patients with CVD?
Dairy: 2 ½ - 4 serves a day
Reduced-fat/ unflavoured milk, cheese and yoghurt for those to benefit from LDL-C lowering dietary intervention
Bread & Cereals: 4-6 serves a day
Choose wholegrain varieties (more fibre, Vit B/E, unsaturated fats)
What is the DASH Diet?
DASH (Dietary Approaches to Stop Hypertension):
Encourages a wide variety of whole foods across food groups
Low-fat dairy
Limit saturated fats/sweets/sugary beverages
Encourage vegetables/fruit/whole grains
Differs from the Mediterranean diet
Nil emphasis on olive oil/fish/nil inclusion of wine
what are the CVD Listeltye targets?
Focus on whole food changes (i.e. 5 serves veg, lean meat, whole grains, nuts, seeds, plant oils) Saturated fat (10-7% total EEI) replace w MUFA – Mediterranean diet Cholesterol <4.0mmol/L LDL <2.0mmol/L, HDL >1.0mmol/L Sodium <2300mg/d (DASH diet) Fluid Restriction (as per treating team) Fibre (men 30g/d; women 25g/d) Limit alcohol
