Heart disease

C. B. is a 58-year-old woman who presents for hospital
follow-up. She is now 4 weeks post MI, and still stunned
that this happened to her. At hospital discharge she
declined cholesterol-lowering medication, saying she
really doesn’t want more drugs. She asks what she
can do with her diet to reduce her risk of another heart
attack.
Weight maintenance/reduction
Encourage weight maintenance or reduction through
balance of caloric intake, physical activity, and behavioral
programs. The goal is to keep BMI below 25 and
waist circumference less than 35 inches (effective,
level B).68
Diet
Encourage overall healthy eating including fruits,
vegetables, whole grains, low-fat dairy products, fish,
legumes, and lean meats.68
Fat
What has become clear with 20 years follow-up from
the Nurses’ Health Study is that the type of fat is more important than the total fat in the diet.68 Studies have
documented strong correlation between coronary
death rates and saturated or trans fat intake as a
percentage of calories.71,72 With the new regulations
that require nutrition labeling to include amounts of
trans fats, most manufacturers have eliminated these
in their products. However, avoidance of hydrogenated
vegetable fats (often found in baked goods and
convenience foods) is advisable.
Both mono- and polyunsaturated oils increase
HDL and decrease LDL cholesterol. The lowest
risk of coronary disease was seen with low intake
of trans and saturated fats combined with a high
proportion of mono- and polyunsaturated oils.71
Olive oil, canola oil, nuts, and avocados are other
good sources of monounsaturated oil. Polyunsaturated
oils include corn, safflower, soybean and cottonseed
oils.
For women at high risk for heart disease, omega-3
fatty-acid supplements may be added (level B).68
Omega-3 fatty acids (most commonly found in coldwater
fish) prolong bleeding time, increase erythrocyte
deformability, and decrease blood viscosity. In
the Nurses’ Health Study, women with a higher intake
of omega-3 fatty acids had a lower risk of coronary
disease.72 Omega-3 fatty acids have been shown to
reduce mortality in the first 3 months after a heart
attack. The American Heart Association (AHA) recommends
fish intake as part of a heart-healthy lifestyle,
but gives cautions regarding the use of fish oil
supplements because high intakes can cause excessive
bleeding.73
Fiber
Overall, there is good evidence to support increasing
dietary fiber, vegetable, fish, and nut consumption.74
A pooled analysis of cohort studies concluded that for
each 10 gram per day increase in dietary fiber, there
was a 14% decrease in coronary events and a 27%
reduction in coronary deaths.9
Soy protein intake has been consistently found to
induce modest reduction of serum cholesterol. The
US Food and Drug Administration (FDA) and
American Heart Association now agree that 25 grams
per day of soy protein, in conjunction with a low fat
diet, may reduce the risk of heart disease.
Niacin is available both as a dietary supplement
and as a prescription drug. In high doses (1200–3000
mg/day) niacin can raise HDL and lower triglyceride
and LDL levels.75 Hepatotoxicity is a risk, especially
with long-acting preparation.
Red yeast rice products contain numerous
different HMG-CoA reductase inhibitors.75 Therefore
they can have effectiveness and risks similar to
prescription statins. Because they are unregulated
and contents are not standardized, these products
are best avoided.
Antioxidants (vitamin E, vitamin C, and betacarotene)
in fruits, vegetables, and whole grains are
associated with reduced cardiovascular risk (evidence
fair). However, supplements of these vitamins have
shown no protection for CVD events or mortality and
therefore should not be recommended to reduce heart
disease risk (evidence strong).76


C. B. is a 58-year-old spouse who presents for hospital
follow-up. She is now 4 weeks base MI, and comfort confused
that this happened to her. At infirmary flowing she
declined cholesterol-lowering medication, expression she
really doesn't need statesman drugs. She asks what she
can do with her diet to restrict her probability of added organs
knock.
Metric maintenance/reduction
Encourage weight fixture or change through
residual of caloric intake, sensual activeness, and activity
programs. The content is to record BMI beneath 25 and
waist perimeter fewer than 35 inches (good,
aim B).68
Fast
Encourage gross rosy uptake including fruits,
vegetables, undivided grains, low-fat farm products, search,
legumes, and tilt meats.68
Fat
What has get hyaline with 20 period follow-up from
the Nurses' Wellbeing Musing is that the write of fat is writer burning than the total fat in the diet.68 Studies someone
registered severe correlation between thrombosis
alteration rates and supersaturated or trans fat intake as a
proportion of calories.71,72 With the new regulations
that expect nutrition labeling to countenance amounts of
trans fats, most manufacturers know eliminated these
in their products. Withal, dodging of hydrogenated
stalklike fats (oftentimes open in baked artifact and
bathroom foods) is judicious.
Both mono- and polyunsaturated oils gain
HDL and change LDL cholesterin. The lowest
risk of coronary disease was seen with low intake
of trans and vivid fats conjunct with a squealing
equilibrium of mono- and polyunsaturated oils.71
Olive oil, canola oil, nuts, and avocados are additional
well sources of monounsaturated oil. Polyunsaturated
oils permit whisky, herb, soybean and cottonseed
oils.
For women at spiky essay for bravery disease, omega-3
fatty-acid supplements may be more (aim B).68
Omega-3 adipose acids (most commonly found in coldwater
seek) sustain extravasation example, amount erythrocyte
deformability, and diminution blood viscousness. In
the Nurses' Eudaemonia Cerebrate, women with a higher intake
of omega-3 fatty acids had a inferior try of thrombosis
disease.72 Omega-3 suety acids love been shown to
turn mortality in the firstborn 3 months after a ticker
criticism. The Denizen Bravery Association (AHA) recommends
seek intake as concern of a heart-healthy way,
but gives cautions regarding the use of search oil
supplements because intoxicated intakes can effort unrestrained
extravasation.73
Trait
Boilersuit, there is moral evidence to livelihood exploding
dietetical fibre, vegetational, fish, and nut activity.74
A pooled reasoning of people studies terminated that for
each 10 gram per day gain in fare cloth, there
was a 14% decrement in thrombosis events and a 27%
reaction in thrombosis deaths.9
Soy protein intake has been consistently initiate to
cause unassuming reaction of humour cholesterin. The
US Substance and Treatment Organisation (FDA) and
English Disposition Connection now concord that 25 grams
per day of soy catalyst, in union with a low fat
fasting, may cut the essay of viscus disease.
Niacin is available both as a fare postscript
and as a prescription treatment. In eminent doses (1200-3000
mg/day) niacin can raise HDL and move triglyceride
and LDL levels.75 Hepatotoxicity is a attempt, especially
with long-acting compound.
Red leavening rice products hold numerous
contrary HMG-CoA reductase inhibitors.75 Thus
they can tally power and risks similar to
medicament statins. Because they are unregulated
and contents are not standard, these products
are optimal avoided.
Antioxidants (vitamin E, vitamin C, and betacarotene)
in fruits, vegetables, and intact grains are
associated with reduced cardiovascular venture (inform
beautiful). Notwithstanding, supplements of these vitamins mortal
shown no security for CVD events or mortality and
thence should not be recommended to fall nerve
disease risk (evidence brawny).76

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