THE RISK FACTORS OF NUTRITIONAL DISORDERS TO THE

CARDIOVASCULAR SYSTEM
Dr. Dimyati Burhanudin.M,Sc.

The disease of the heart

1. Ischaemic heart disease
2. Hypertensive heart disease
3. Rheumatic heart disease
4. Pulmonary heart disease
5. Congenital heart disease
6. Thyrotoxic heart disease
7. Heart disease in other forms

Heart ; Blood Suplly Vascular Myocardium/Nutrient)

In order to perform the heart work, the myocardium needs to be Noutrished and
Oxygenated from an adequate suplly of blood through the aorta and coronary
arteries.

ISCHAEMIC HEART DISEASE (IHD)

(CORONARY HEART DISEASE = CHD)

The failure of the coronary arteries to suplly sufficient blood to the myocardium, which
are almost invariably associated with athero sclerosis of the coronary arteries.

1. Myocardial Infarction

Myocardial Ischaemia sudden death

Heal with scar

- severe
- return to normal life
- increase risk of second infarct

Thrombus blocks the lumen of coronary artery

Atherosclerosis Narrowed the lumen
The blood flow is insufficient to suplly the oxygen
2. Angina Pectoris
(Pain in the chest)

severe cardiac pain limits the activity

- remain live and free of any disability so long as the patient keeps within the
limits of exercise tolerance.
- Increase risk of - sudden death
- infarction

Due to ; - unusual exertion

- emotional stress

3. Sudden death

Have : - Angina Pectoris

- Myocardinal infarction

The death presumed to be due to IHD

Sometimes the death is unexpected
but in autopsy ; - old infarct
- exstensive atheroma

However - the cause of the suddendeathly of the death still remains

unexplained.

Might be - minor painless ischaemia interrupt the electrical

conduction
- sudden release of stored regulatory hormones (catecholamine) in
heart muscles
- disturbance of regulatory ions in heart muscles
(hypoxicdisionism)

66
Note :

The pain of ;

Angina pectoris : - directly

- quatitativately releated to exertion
- induced by emotion

Myocardial infarction - - occurs at rest

- induced by prolonged exertion or acute anxiety
ATHEROSCLEROSIS

- Degenerative arterial disease

- Habitual diet the presenting of the fatty acid in the lipid of serum
and tissues

THE DEVELOPMENT OF ATHEROMA

4 Stages (WHO)

1. fatty spot :
- in tunica intima of the vessel
- thickenings of the intima
- slightly raised a long flattened yellow streak
- the elevation of the intima due to the formation of connective tissues
cells, distended, contains cholesterol within the fat droplets.

2. fibrous plaque :
- between tunica intima and tunica media
- circumscribed, firm, grey/pearly white
- diameters, 1-several mm, irregular
- the plaques become larger, project into the lumen (medium size of artery)

3. soft plaque
- contains large amounts of fatty material, softened

4. break down
- plaque surface -, break dowm
- atheromatous ulcer ragged irregular edges
- fibrous tissue at the base of the ulcer scarring
- vessel narrowed and distort slowing down the flow of blood
- deposited of calcium in the base of the ulcer and haemorrhages may
occure

thrombus - ulcer debris /fibrin

- fat, cholesterol
- calcium
- blood corpuscles
(clotting mechanism)
The predisposition of the thickening of intima ;

- intima injury (platelet aggregation)

- lipid accumulation (irreversible)

fibrin in the process of the ulcer formation traps red corpuscles thrombus

a minute clotsdissolved by fibrinolytic system

previous meal, physical exercise, smoking, e.t.c. may affect platelet adhasiveness and
fibrinolytic activity.

eidemiology of IHD
- man in well to do classes
- men 45 yr, women unknown (> 50 yr)
- the greater percentage of death, 35-40 yr
- the lower incidence is from the poor immigrants and under/develop countries
(Include ASEAN)

aetiology

familial ; - inherited
- environmental experience of hypertension, diabetes, gout and
exanthomatosis.
- endrocine imbalances affect to fat transport system and
atherosclerotic perform

Prevention

1. Diet
Fats ; hyperlipidemia, hypercholesterolemia

- decrease intake of animal fat (SFA)

- correlation - incidence IHO - total dietary fat
- total fat - saturated fat

- no proof that dietary fats have an important role in the aetilogy of IHD
- more depend on the plasma cholesterol concentration
- intake saturated fat >> plasma cholesterol IHD
Carbohydrates

Intake sucrose Atherosclerosis

Plasma triglyceride >> deposit fat (FA)

Carbohydrate fat

Increase plasma fat Atherosclerosis

Protein

In animal research : Not to be important in the genesis of atherosclerosis

2. Sedentary Life

Exercise : - keep the balance between food intake and energy expenditure
- physically active jobs protects against IHD

3. Smoking

- Pheriperal Vascular disease

IHD (Part myoc infaction)

Heavy Cig.smokers > do not smoke

(Death Incidence 1,5 -2,5 times)

- the mechanism of nicotine or other tobaccos constituete causes this adverse

effect is still not clear

maybe due to :
- vasoconstrictor action
- undesirable effect on the level of plasma lipids
 - blood coalagualation
- the survival of platelet

4. Stress and Strain

- Suggested to be predisposed to the atherosclerotic formation

- No difference between the have and the poor group of people and also from
the modern and undevelope communities
- It is likely more close to the behaviour (The emotion)

5. Polution
higher concentration of carbon disulphide and sulphur dioxide from in the
process the facture of rayon may cause anoccupational toxic to be the aetilogy of
IHD.

Community Prophylaxis
- food technology changes the costumary diet of the people
- the anxious promotin of the new product of food industry
- looks to the medical profession for guidance
- health education
- in daily food intake

Reduce
- calorie (to prevent overweight)
- total consumption of fat
40%-30% of the total number calories

- saturated fat increase the consumption of polyunsaturated fat

- the consumption of sugar/sugar product

Increase
- vegetables, fruits, potatoes, milk, fish, lean meat, cereal/cereal product
- take regular exercise

The program require the co-operation among doctors health workers, catering (in school,
military forces, hospital, restaurants and other similar institution.
Food industries have to pay attention to the recommendation of the raw products and in
its composition an processing.
In heart failure : - salt restricted pilih high, moderate, poor, contains of salt
- restricted setengah atau sepertiga
- selanjutnya lihat daftar menu di klinik