Stage 2 - Research Project

Table of Contents By Dev Patel

TABLE OF CONTENTS 1 SACE: 181228F
INTRODUCTION 2
WHAT IS CORONARY ARTERY DISEASE? 2
ATHEROSCLEROSIS 2
CORONARY ARTERY DISEASE OCCURING IN YOUNG ADULTS 3
SMOKING 3
OBESITY 3

Coronary Artery
ALCOHOL CONSUMPTION
EMOTIONAL STRESS 4
4

Disease
SYMPTOMS 4
ANGINA (CHEST PAINS)4
SHORTNESS OF BREATH 5
DIAGNOSIS OF CORONARY ARTERY DISEASE 5
BLOOD TEST 5
IMPROVING LOW NUTRIENT LEVELS EXAMINED FROM THE BLOOD TEST 6
CHANGING THE DIET 6
SUGAR CONSUMPTION 6
SATURATED AND UNSATURATED FATS 6
PLANT-BASED FOODS 7
MEDITERRANEAN DIET 7
SUMMARY 8
GLOSSARY 9
REFERENCES 10

To what extent can the risk of Coronary

Artery Disease be reduced in young adults
through diet?
Introduction
The focus of this report is to evaluate how young adults can modify their diet to reduce the risk of
Coronary Artery Disease (CAD). CAD is caused from Atherosclerosis which is the deposition of
cholesterol on damaged artery walls to create a plaque. 1 This plaque restricts blood flow and causes
blood clots.1 The risk of CAD is increased as a result of smoking at a young age 2 along with consuming
excessive amounts of alcohol.3 Young adults who experience emotional stress can also obtain CAD. Two
major symptoms of CAD in young adults include angina 4 and shortness of breath4 and it can be
diagnosed through blood tests.1 High amounts of sugar and saturated fats are prevalent in young adults’
diets5 which increases the risk of CAD and research conducted by Loma Linda university suggests a
plant-based diet helps to reduce the risk. 6

What is Coronary Artery Disease?

Figure 1: Atherosclerosis – Blood clot forming due to a plaque on an artery wall. 7

CAD is a result of small damages occurring in artery walls and as time progresses, cholesterol
starts building up in the damaged area of the lumen in the Coronary Arteries, forming a blood clot. 8 This
is called Atherosclerosis, the leading cause of CAD. 9 As the plaque grows, the lumen of the artery
becomes restricted even further.10

Across the globe, approximately 18 million people were killed in 2017 from Cardiovascular
1
diseases11, equating to 31% of deaths, whilst CAD is not prominent in young adults. 12 However,
Page

Atherosclerosis begins developing in youth and gradually grows over time, 13 controlling risk factors
1
Fernando, T 2019, Coronary Artery Disease, interview, North East Modbury Medical & Dental Centre, South Australia, 16 August.
2
Centres for Disease Control and Prevention, Smoking and cardiovascular disease, n.d., Fact Sheet, viewed 5 September 2019.
3
Hark, L & Deen, D, Nutrients that help cardiovascular disease, 2007, Nutrition, First Edition, DK, Victoria.
4
Mayo Clinic Staff, 2018, Coronary Artery Disease, viewed 6 August 2019.
5
Harvard Health Publishing 2014, Eating too much added sugar increases the risk of dying with heart disease, viewed 12 September 2019.
6
Loma Linda University of Health (LLU Health) 2016, LIVE IT: Reduce Risk of Heart Disease with a Mediterranean Diet, online video, 19
February, viewed 12 August 2019.
7
Health Park Pharmacy, Atherosclerosis 2019, Image, viewed 6 September 2019.
8
FamilyDoctor.org 2019, Coronary Artery Disease (CAD), viewed 6 September 2019.
9
Fernando, T 2019, Coronary Artery Disease, interview, North East Modbury Medical & Dental Centre, South Australia, 16 August.
10
University of Ottawa Heart Institute 2019, Coronary Heart Disease (Atherosclerosis), viewed 3 September 2019.
11
World Health Organisation 2017, Cardiovascular Diseases (CVDs), viewed 8 September 2019.
12
National Heart, blood and lung institute, Know the Differences: Cardiovascular diseases n.d., pdf, viewed 8 September 2019.
13
Harvard Health Publishing 2009, Premature Heart Disease, viewed 8 September 2019.
during the youth lowers the risk of CAD in the future. This includes monitoring blood pressure,
cholesterol, diet, and physical activity. 14

Coronary Artery Disease in young adults

The main factor which increases the risk of CAD in young adults is smoking according to a
research conducted by Centres for Disease Control. 15 Results revealed that 27% of young adults still
consume tobacco products.15 Tobacco and nicotine damage the intimal lining 16 of the artery which leads
to the deposition of plaque17, rapidly increasing the risk of Atherosclerosis consequently leading to
CAD.15 Smoking causes approximately 140,000 premature deaths 18 annually across the world due to
CAD. Smoking creates irregular heartbeats and lower High-Density Lipoprotein (HDL) levels, leading to a
higher risk of Atherosclerosis.19

Figure 2: Difference in glucose production between healthy individuals and Diabetic patients. 20

Obesity also raises the risk of CAD 21 as it cultivates insulin resistance 22, increasing the
development rate of CAD in young adults. Insulin resistance is the inability of the body’s cells to respond
to the hormone insulin23, which leads to type II Diabetes, hence producing excessive volumes of
glucose.24 High levels of glucose in the blood damages artery walls, leading to Atherosclerosis. 25

Young adults with a Body Mass Index (BMI) of 30.0 and above are classified as obese. 26 Obesity is
commonly caused due to inactivity26, poor lifestyle and poor diet choices.26 The poor diet choices
include consuming fast food on a regular basis and excess sugar consumption. According to a survey
conducted among young adults27, 25% of the people admitted to consuming fast food more than 3
times a week.27 A poor diet primarily includes processed fast foods, chocolate products 28 and sugary
foods29 as they contain saturated fats which increase blood cholesterol levels. 28

46% of young adults had consumed alcohol regularly 30 according to a research conducted by
Australian Institute of Health and Welfare. 31 Alcohol consumption is a major risk factor of CAD for young
14
Texas Heart Institute 2019, Premature Heart Disease, viewed 8 September 2019.
15
2
Centres for Disease Control and Prevention, Smoking and cardiovascular disease, n.d., Fact Sheet, viewed 5 September 2019.
Page

16
Fernando, T 2019, Coronary Artery Disease, interview, North East Modbury Medical & Dental Centre, South Australia, 16 August.
17
American Cancer Society 2017, Harmful substances in tobacco products, viewed 5 September 2019.
18
Centers for Disease Control and Prevention 2010, How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-
Attributable Disease: A Report of the Surgeon General., viewed 10 September 2019.
19
Heartwise Staff 2012, Smoking and Coronary Artery Disease, Cardio smart, viewed 10 September 2019.
20
Honzawa, N 2019, Cell Autonomous Dysfunction and Insulin Resistance in Pancreatic α Cells, MDPI, viewed 10 September 2019.
21
Jin, J 2013, Obesity and the Heart, JAMA Network, viewed 11 September 2019.
22
Ades, P 2017, Obesity in Coronary Heart Disease, viewed 10 September 2019.
23
Harrar, S 2019, Obesity and the Heart, viewed 11 September 2019.
24
Diabetes.co.uk, Insulin Resistance 2019, viewed 10 September 2019.
25
National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes, Heart Disease and Stroke 2017, viewed 10 September 2019.
26
Cleveland Clinic, Obesity and Heart Disease 2019, viewed 10 September 2019.
27
Patel, D 2019, Coronary Artery Disease, survey, Google Forms, 24 August 2019, viewed 2 October 2019.
28
Wexler, A 2018, Foods with high cholesterol to avoid and include, viewed 11 September 2019.
29
Health Direct 2018, What causes Obesity?, viewed 12 September 2019.
30
Australian Institute of Health and Welfare 2019, Alcohol, tobacco & other drugs in Australia, viewed 22 October 2019.
31
Australian Institute of Health and Welfare 2019, Alcohol, tobacco & other drugs in Australia, viewed 22 October 2019.
adults24 as regularly consuming more than four standard drinks a day can increase blood pressure 32,
heighten triglyceride levels32 and increase the risk of stroke.32 A small amount of alcohol increases the
amount of ‘good’ cholesterol in the body 33, preventing artery damage34 but excessive amounts causes
deviant heartbeats.34 Irregular heartbeats feel almost like a heart attack with acute pain in the centre of
the chest.35 Increased alcohol consumption raises blood pressure, causing the hardening and thickening
of the arteries,36 causing damage on artery walls, making a person prone to Atherosclerosis, and
ultimately CAD.

Emotional stress is the most common risk factor for CAD among young adults according to
Mayo Clinic.37 Stress is experienced by all young adults and when an individual experiences emotional
stress38, adrenaline is released, causing blood pressure to increase and along with heavier breathing. 39
The increased blood pressure causes force against the artery walls and over time, damages the artery
walls and increases the deposition of cholesterol. 40 Stress causes the adrenal glands to produce the
hormone, cortisol, which increases the desire for sugary foods. 41 These sugary foods increase blood
cholesterol levels,40 increasing the risk of CAD as cholesterol deposits occur on artery walls. Emotional
stress is the most prominent risk factor of CAD among young adults, due to consistent stress eating. 41

Symptoms
A typical symptom of CAD experienced by young adults is Angina 42 which causes chest pains as a
result of decreased blood flow to the heart. 42 A national survey revealed that 40% of young adults with
CAD experienced Angina in 2018, making it a common symptom. 43 The heart does not receive enough
oxygen-rich blood44 and subsequently causes agony in the centre of the chest, along with sweating and
fatigue.45 There are two types of angina. Stable Angina occurs for a short time (around 10 minutes or
less)46 and it feels familiar each time, experienced during exertion or emotional stress. 47 Unstable
Angina can occur in any circumstance, including during rest or while sleeping. The indications of the
illness are more severe and last a longer time. Unlike stable Angina, unstable Angina cannot be relieved
with medicine.48 When a young adult is experiencing Angina, processed foods containing saturated fats
(fast foods, bakery products, chocolates) should be avoided. Fruits, vegetables and whole grains should
be consumed as they do not increase the deposition of cholesterol in plaques. 49

A log sheet is used to monitor the details of Angina occurring including the number of attacks, severity,
duration and treatment, as seen in figure 3.50

32
Hark, L & Deen, D, Nutrients that help cardiovascular disease, 2007, Nutrition, First Edition, DK, Victoria.
33
National Institute on Alcohol abuse and Alcoholism n.d., Drinking levels defined, viewed 2 October 2019.
3
34
Page

National Institute of Alcoholism n.d., Alcohol's effect on the risk of Coronary Heart Disease, viewed 10 September 2019.
35
Drinkaware 2018, Alcohol and heart disease, viewed 10 September 2019.
36
AlcoholThinkAgain 2014, Alcohol and Cardiovascular disease, viewed 10 September 2019.
37
Mayo Clinic Staff, 2018, Coronary Artery Disease, viewed 6 August 2019.
38
Stress and Heart Health, 2018, viewed 11 September 2019.
39
High blood pressure and Atherosclerosis, 2019, viewed 11 September 2019.
40
Gandelman, G & Cunningham, L 2017, ‘Stress can increase your risk of Heart Disease’, in Health Encyclopedia, viewed 11 September 2019.
41
Harvard Health Publishing 2018, Why stress causes people to overeat, viewed 19 September 2019.
42
Mayo Clinic Staff, 2018, Angina - Symptoms and Causes, Mayo Clinic, viewed 12 September 2019.
43
AIHW 2019, Cardiovascular disease, Australian Institute of Health and Welfare, viewed 2 October 2019.
44
Crosta, P 2017, Angina: Treatment, causes and symptoms, viewed 2 October 2019.
45
Department of Health 2019, Angina, Government of Western Australia, viewed 12 September 2019.
46
Johnson, J 2018, Stable Angina, viewed 2 October 2019.
47
MyDr.com.au 2015, Angina - MrDr.com.au, viewed 12 September 2019.
48
The Heart Foundation 2015, Angina (Chest Pain), viewed 12 September 2019.
49
Medline Plus 2018, Living with Heart disease and angina, viewed 19 September 2019.
50
The Heart Foundation 2015, Cardiac Rehabilitation Angina Log, viewed 12 September 2019.
 Figure 3: Angina log51

Another major symptom experienced by young adults includes shortness of breath according to
medical professional, Valencia Higuera.52 It is caused when insufficient blood is pumped by the heart to
meet the body’s requirements.53 Shortness of breath involves the lungs and the heart transporting
oxygen to the body and removing carbon dioxide. When the volume of carbon dioxide in the blood
increases54 or obstruction of the airflow occurs, shortness of breath is experienced. 55 Young adults
should consume large volumes of water56 when experiencing shortness of breath as it causes the blood
to become diluted56, allowing to pass through blood vessels easier. Apples, apricots, walnuts and beans
are also great products to consume as they improve lung health, allowing breathing patterns to
improve.56

Diagnosis of Coronary Artery Disease

To assess the possibility of CAD, a doctor will inspect medical/family history and the blood
pressure to examine cholesterol levels.57 A blood test is performed which is used to measure
abnormalities in nutrient levels.58 The test analyses the total cholesterol, triglycerides and lipoproteins
within the blood. In young adults, total cholesterol levels should be below 200 milligrams 59 per decilitre
(mg/dL) and high cholesterol and lipoprotein levels involves an increased risk of CAD. Triglycerides are a
variation of fat within the blood and higher triglyceride levels indicate the individual consumes more
calories than burnt, increasing the amount of fat deposits in arteries. 60 According to an experienced
General Practitioner, Dr. Fernando, it is recommended for young adults to get regular blood tests,
especially if they smoke or consume alcohol. 61

A study conducted by University of California and San Francisco showed 65% young adults with high
cholesterol levels experienced CAD later in life. 62 High levels of cholesterol and lipoproteins are caused
from consuming excessive volumes of saturated fats. 63 dairy products, animal fats and processed meats
products contain high amounts of saturated fats. They should be substituted for lean meats, eggs,
seafood and all plant-based products which contain low volumes of saturated fats. 64 Alcohol, sugary
4
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51
My Angina Log 2017, The Heart Foundation, pdf, viewed 12 September 2019.
52
Higuera, V 2018, What Is Coronary Artery Disease?, Healthline, viewed 4 August 2019.
53
Mayo Clinic Staff, 2018, Coronary Artery Disease, viewed 6 August 2019.
54
American Lung Association, 2018, Shortness of breath symptoms, causes and risk factors, viewed 12 August 2019.
55
Shiel Jr., W 2019, Shortness of Breath (Dyspnea), viewed 12 September 2019.
56
Power Breathe 2013, Foods for keeping your lungs healthy, viewed 19 September 2019.
57
Healthdirect, Diagnosis of Coronary Heart Disease 2017, viewed 12 September 2019.
58
National Heart, Blood and Lung institute 2019, Ischemic Heart Disease, U.S. Department of Health & Human Services, United States of
America, viewed 15 August 2019.
59
Mayo Clinic Staff 2019, Blood tests for heart disease, Mayo Clinic, viewed 12 September 2019.
60
Mayo Clinic Staff 2019, Blood tests for heart disease, Mayo Clinic, viewed 12 September 2019.
61
Fernando, T 2019, Coronary Artery Disease, interview, North East Modbury Medical & Dental Centre, South Australia, 16 August 2019.
62
Hammit, L 2010, Cholesterol levels in young adults predict risk of future heart disease, viewed 2 October 2019.
63
BMJ 2018, Is the LDL response to saturated fat a sign of a healthy individual?, viewed 19 September 2019.
64
Heart UK n.d., High Cholesterol foods, viewed 19 September 2019.
foods and processed grains increase triglyceride levels and if the blood test reveals high triglyceride
levels, these foods should be avoided by young adults. 65

Changing the diet

The type of diet consumed by young adults is the most important factor in reducing the risk of
CAD. Consuming too much sugar increases the risk of CAD as sucrose increases total cholesterol 67,
66

triglyceride and lipoprotein levels 67 which induce the increased risk of CAD. 67 Products such as energy
drinks and soda drinks have an immense concentration of sugar 68 and young adults develop unhealthy
eating habits by consuming these beverages on a regular basis.

Figure 4: Amount of sugar in different beverages.69

As displayed on Figure 4, the amount of sugar in common beverages is incredibly high and it is
extremely harmful to a young adult. 69 Water is the best drink to consume70 and by drinking a beverage
high in sugar, the individual must exercise moderately to lower cholesterol and triglyceride levels. 71
Constantly consuming large amounts of sugar has devastating long-term effects on the body. 72 A
research by Harvard Health Publishing supports this as revealed sugar is the main cause for fat
deposition in 72% of young adults.73

Saturated fat is required for energy, but excessive amounts of saturated fats can increase low-
density lipoprotein (LDL) cholesterol causing cholesterol deposits on artery walls. 74 Saturated fats are
molecules without a double bond with hydrogen molecules, meaning they are solid at room
temperature.75 Less than 6% of calories should be consumed from saturated fats due to the harmful
effects. 76 Many foods contain saturated fats including meat, poultry and dairy products. Baked products
also contain high levels of saturated fats along with plant-based oils. 77

In contrast, unsaturated fats are a healthier and lower LDL cholesterol levels. Approximately 25-30% of
daily caloric intake78 should include unsaturated fats to improve cardiovascular health. 79 Olive oil, nuts
(almonds, peanuts), pumpkin seeds and avocados are better options given they contain a high volume
of unsaturated fats which lower LDL cholesterol levels. 80 Instead of consuming high amounts of meat
5
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65
Woolley, E 2018, What Types of Foods and Beverages Cause High Triglycerides?, viewed 19 September 2019.
66
Lu, E & Malik, V 2018, Cardiovascular Disease Prevention by Diet Modification, viewed 12 September 2019.
67
Elsevier, 2016, Sugar consumption plays greater role in heart disease than saturated fat, Science Daily, viewed 12 September 2019.
68
Australian Department for Health 2014, How much sugar is in what we drink, viewed 12 September 2019.
69
Nutrition Australia 2012, Sugar Sweetened drinks, viewed 12 September 2019.
70
Dietitians Association Australia 2019, Which Drinks are the best choice?, viewed 2 October 2019.
71
Wexler, A 2018, Foods with high cholesterol to avoid and include, viewed 11 September 2019.
72
Harvard Health Publishing 2014, Eating too much added sugar increases the risk of dying with heart disease, viewed 12 September 2019.
73
Harvard Health Publishing 2014, Eating too much added sugar increases the risk of dying with heart disease, viewed 12 September 2019.
74
Wax, E 2018, Facts about Saturated Fats, viewed 12 September 2019.
75
Kenny, K 2018, Saturated Fat and Cardiovascular disease viewed 12 September 2019.
76
The Heart Foundation 2015, Saturated Fat, viewed 12 September 2019.
77
The Heart Foundation 2015, Saturated Fat, viewed 12 September 2019.
78
MyDr.com.au 2015, Unsaturated Fat, viewed 12 September 2019.
79
MyDr.com.au 2015, Unsaturated Fat, viewed 12 September 2019.
80
Robertson, R 2017, What are the benefits of monounsaturated fats?, viewed 12 September 2019.
and dairy products, young adults should incorporate more products with unsaturated fats. A nut bar can
be consumed by young adults as a snack instead of consuming dairy products.

A range of plant-based foods incorporated into a young adult’s diet has benefits to assist
reducing the risk for CAD.81 Research conducted by Journal of American Heart Association 81 showed a
decrease in the overall risk of CAD in 54% of young adults. 81 This was observed through decreased
cholesterol and triglyceride levels in the individual. 81 Plant-based foods are an excellent source of low
caloric products, allowing the individual to maintain their weight. 82 Fruits contain nutrients rich in
folate83 which aid in managing the body’s blood pressure and they also contain antioxidants which
preserve the heart.84 To incorporate more plant-based foods into a young adult’s diet, a meal should
consist of at least 50% vegetables.85 For non-vegetarians, the a small portion of meat in a meal can be
substituted with nuts and seeds or vegetables. 85

Research by Loma Linda University revealed that a Mediterranean diet lowers the risk of CAD. 8686 It
consists of legumes, vegetables, wholegrains, fruits, nuts and olive oil instead butter or other dairy
fats.87 The diet contains high volumes of antioxidants, protein and omega-3 fats 75 which lower the
amount of LDL cholesterol in the body. 86 Omega-3 fats are crucial as they reduce cholesterol and
triglyceride levels, hence reducing the risk of CAD. 88 Nuts, a large component of the Mediterranean diet
also aid to reduce the risk of inflammation in the arteries due to their LDL cholesterol lowering
abilities.89 Figure 5 shows the different types of foods that can be consumed in the Mediterranean diet.

6
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Figure 5: A consumption triangle of the Mediterranean diet and amounts of nutrients that should be consumed. 90

81
Kim, H 2019, Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, viewed 2 October 2019.
82
Mayo Clinic 2019, Heart-healthy diet: 8 steps to prevent heart disease, viewed 13 September 2019.
83
US National Library of Medicine 2017, Fruits for prevention and treatment of Cardiovascular disease, viewed 13 September 2019.
84
US National Library of Medicine 2017, Fruits for prevention and treatment of Cardiovascular disease, viewed 13 September 2019.
85
US National Library of Medicine 2017, Fruits for prevention and treatment of Cardiovascular disease, viewed 13 September 2019.
86
Loma Linda University of Health (LLU Health) 2016, LIVE IT: Reduce Risk of Heart Disease with a Mediterranean Diet, online video, 19
February, viewed 12 August 2019.
87
Royal Australian College of General Practitioners 2014, Mediterranean diet for reducing Cardiovascular disease risk, viewed 13 September
2019.
88
University of Rochester 2019, Omega-3 Fatty Acids and Coronary Heart Disease viewed 13 September 2019.
89
Hu, F 2003, Plant-based foods and prevention of cardiovascular disease viewed 13 September 2019.
90
Strengthening Health Institute, Mediterranean diet triangle n.d., Image, viewed 13 September 2019.
Summary
Coronary Artery Disease is a Cardiovascular disease which is caused by Atherosclerosis, the
narrowing and blockage of arteries. It can begin in a young adult’s life and develop as time
progresses, increasing the danger later in life if risk factors are not controlled. Smoking, alcohol
consumption, obesity, exercise, diet and emotional stress are the leading risk factors of CAD.
When blood tests reveal deficiencies in certain nutrition levels that can lead to CAD, young
adults should modify their diet to reduce the risk. By reducing the amount of sugar consumed,
decreasing saturated fats and consuming more plant-based foods, in fact, a Mediterranean diet
(which several beneficial products) lowers cholesterol levels can reduce the risk of CAD in
young adults.

Word count: 1991

7
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Glossary
Lumen: A channel within blood vessels or arteries.

Intimal Lining: Majorly known as the Tunica Intima which is the inner most layer of the artery.

Accumulation: A collection of something in a space or location.

Multitude: A great number of things or people.

Hinder: Limiting the ability or development of something.

High-density lipoprotein: A lipoprotein of high density. It is referred to as the ‘good’ cholesterol

as it removes cholesterol from the blood stream.

Low-density lipoprotein: A cholesterol of low density which deposits on artery walls and lumen
lining, causing blood clots.

Insulin: A type of hormone responsible for controlling glucose levels in the blood.

Cultivate: Development or improvement of something.

Triglycerides: A type of fat found in the blood which is a molecule made up of glycerol.

Deviant: Different from its usual state/ irregular.

Acute: Sudden onset and a sharp rise of something.

Exceedingly: To a great extent.

Prevalent: When something or someone is obvious.

Agony: Suffering physically or mentally to an extreme level.

Exertion: An effort applied into a task (physically or mentally).

Insufficient: Not enough of something. 8

Page

Intermittent: Occurring at irregular intervals.

Catheter: A flexible tube inserted into narrow openings of the body to remove fluid.

Saturated Fat: A type of fat containing a high amount of dense fatty acid molecules. Referred
to as the ‘unhealthy fat’.

Unsaturated Fat: A type of fat containing single bond molecules which are healthier.

Antioxidants: A substance or molecule that reduces damage to something.

Adrenal Glands: Endocrine glands in the kidneys responsible for producing hormones.

Dilute: Making a liquid thinner by adding a certain solvent to it.

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