Coronary Artery Disease (CAD)

CAD is the most common type of heart disease. In the United States, it is the #1 cause of death for both men and women. Lifestyle changes, medicines, and medical procedures can help prevent or treat CAD. These treatments may reduce the risk of related health problems. CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and plaque, on the inner walls. This buildup is called atherosclerosis. As it grows, less blood can flow through the arteries. As a result, the heart muscle can’t get the blood or oxygen it needs. This can lead to chest pain (angina) or worse. Most heart attacks happen when a blood clot suddenly cuts off the hearts’ blood supply, causing permanent heart damage.

A patient seen today was admitted in the intesive care unit (ICU) and was referred to the nutrition staff for support in cardiac care.

Background:
The patient experienced a myocardial infarction (MI) and had coronary artery disease (CAD). He was a male, 85 y/o, and admitted for an MI protocol. He was currently on a cardiac diet with no gastric irritants (NGI). NGIs are foods like juices, chili, and black pepper. He was not experiencing shortness of breathe (SOB), nausea, fever, chills, or vomiting.

Anthropometrics:
Ht: 69 in.
CBW: 195# (88.5kg)
BMI: 28.86 (overweight)
IBW: 160# (72.73kg)

Past Medical History (PMH):
• CAD/Cornoary Artery Bypass graft (CABG)
• Deep Veing Thrombosis (DVT)
• Chronic Kidney Disease (CKD)
• Carotid Stenosis
• Hypertension (HTN)
• Peripheral Vascular Disease (PVD)
• Gallbladder Disease
• Microvascular Decompression (MVD)
• Aortic Atherosclerosis
• Renal Neoplasm
• Cholecystitis
• Stable Angina
• Asbestos Exposure
• B-12 Deficiency

Labs:
Glucose: 132 mg/dl (70-109: normal)
Cholesterol: 144 mg/dl (160-200: normal)
TGs: 205 mg/dl (35-160: normal)
HDL: 36.3 mg/dl (40-60: normal)

Assessment:
TLC Diet
• Limit saturated and trans fats
• Limit cholesterol: less than 200 mg/d
• Limit total fats: 25%
• Consume dietary fiber
• Consume more omega-3 fats
• Consume more plant-based meals

Blausen_0259_CoronaryArteryDisease_02

The Big “C” in Food

eggs

People everywhere are looking for easy and affordable ways to add healthy protein to their diet. It seems that eggs appear to be the perfect little protein package. But since the advice from health professionals seems to change often about eggs, consumers are becoming increasingly confused. Healthy consumers really shouldn’t worry about this but, individuals who at-risk for cardiovascular disease (CVD) or who have CVD, may want to be aware of this.

What seems to be more important than the food itself is the total cholesterol intake from food. Regardless of where the cholesterol comes from, like eggs or other animal products, consumers who are more susceptible to CVD should keep account of the cholesterol and saturated fat that they are consuming from these food sources.

Remember that eggs are contained in many foods, including bread, cakes, ice cream, muffins and even such entrees as breaded fish, meat dishes and meatloaf. Each of those might add just a fraction of an egg per serving, but together they can increase your cholesterol intake, especially since many of those items contain other ingredients that can be high in cholesterol and saturated fat, such as butter or cream.

Consumers should be careful about not confusing dietary cholesterol with blood cholesterol (LDL, HDL, and triglycerides). The major contributing factor of blood LDL cholesterol is saturated fat. There is a recommendation to limit dietary sources of saturated fat, largely found in dairy and animal protein. Although the saturated fat in eggs is relatively low compared with that in many other animal-based protein sources (one large egg has less than 2g of saturated fat), many of the foods that often accompany eggs (such as bacon, butter, cheese and sausage) are high in saturated fat as well. The combination of foods high in cholesterol, like these, can really add up.

According to the 2010 Dietary Guidelines for Americans, cholesterol intake by men averages about 350 mg per day, which exceeds the recommended level of less than 300 mg per day. Average cholesterol intake by women is 240mg per day. Independent of other dietary factors, evidence suggests that one egg (including egg yolk) per day does not result in increased blood cholesterol levels, nor does it increase the risk of cardiovascular disease in healthy people. Consuming less than 300mg per day of cholesterol can help maintain normal blood cholesterol levels. Consuming less than 200mg per day can further help individuals at high risk of cardiovascular disease.

On the plus side, eggs have many nutritional benefits. They’re a good source of high-quality protein, with relatively few calories (6.3 grams of protein for only 72 calories in a large egg). Eggs also contain vitamins B12 and D, and several essential micronutrients, including choline (important for brain health) and lutein (for eye health).

NHANES satd fat

cholesThe Washington Post