Lecture No.

06 BS-HND- 7 th

Course: Dietetics III

Instructor: Dr. Anam Aman

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Coronary heart disease (CHD)
CHD is characterized by impaired blood flow through the coronary
arteries, which may lead to angina pectoris, heart attack, or sudden
death.
CHD is usually caused by atherosclerosis but occasionally results
from spasm or inflammatory conditions that cause narrowing of the
coronary arteries.
The lifetime risk of developing CHD is 49 percent for men and 32
percent for women

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Symptoms of CHD
In angina pectoris and heart attacks, the pain or discomfort usually occurs
in the chest region and may be perceived as a feeling of heaviness,
pressure, or squeezing.
Pain may radiate to the left arm, shoulders, back, throat, jaws, or teeth.
In angina pectoris, the symptoms are often triggered by exertion, persist for
several minutes, and subside with rest.
In a heart attack, the pain may be severe, last longer, and occur without
exertion.
Other symptoms of CHD include shortness of breath, nausea, vomiting,
sweating, lightheadedness, weakness, and anxiety.
 In some cases, a feeling of indigestion or lower abdominal pain may occur.

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Risk Factors
Major Risk Factors for CHD (not modifiable)
• Increasing age
• Male gender
• Family history of premature heart disease
Major Risk Factors for CHD (modifiable)
• High blood LDL cholesterol
• Low blood HDL cholesterol
• High blood pressure (hypertension)
• Diabetes
• Obesity (especially abdominal obesity)
• Physical inactivity
• Cigarette smoking
• An “atherogenic” diet (high in saturated fats and low in vegetables, fruits, and whole
grains)
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 Standards for CHD Risk Assessment

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Dietary Management of CHD

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Dietary Management of CHD
Plant sterols and stanols are added to various food products, such as
margarine or cheese, or supplied in dietary supplements. These plant
compounds work by interfering with cholesterol and bile absorption
Plant sterols are extracted from soybeans and pine tree oils, and they
are then hydrogenated to produce the plant stanols that are added to
commercial products
 The American Heart Association recommends consuming two
servings of fish per week, with an emphasis on fatty fish.
 Fish oil supplements (providing 1 gram of EPA and DHA daily) may be
helpful for individuals with documented CHD, and they are particularly
useful for treating individuals with elevated triglyceride levels

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 Physical activity

• At least 30 minutes of moderate-intensity endurance activity should

be undertaken on most days of the week.
• Regular aerobic activity reverses a number of risk factors for CHD: it
can lower triglycerides, raise HDL, lower blood pressure, promote
• weight loss, improve insulin sensitivity, strengthen heart muscle,
and increase coronary artery size and tone.
• Smoking cessation:
Exposure to any form of tobacco smoke should be minimized.

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 Smoking Cessation
Compounds in smoke damage blood vessel cells, cause chronic
inflammation, decrease the oxygen-carrying capacity of the blood
(contributing to ischemia), promote vasoconstriction and blood
coagulation, and raise heart rate and blood pressure.
Smokers also tend to have higher levels of LDL and lower HDL.
Secondhand smoke can cause these effects as well.
The risk from smoking depends on the amount and duration of
exposure: it is related to the age when smoking started, the number
of cigarettes smoked daily, and the degree of inhalation.
Even one or two cigarettes daily increase CHD risk, and cigarettes
that have low tar and nicotine do not lower the risk.
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 Weight reduction
Weight reduction may improve other CHD risk factors.
The general goal of a weight-management program should be to
prevent weight gain, reduce body weight, and maintain a lower body
weight over the long term.
The initial goal of a weight-loss program should be to lose no more
than 10 percent of original body weight.

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Weight reduction
In obesity, the enlarged adipose cells become more active, increasing their
synthesis and release of inflammatory mediators and blood-clotting factors;
these changes raise the risks of both atherosclerosis and heart attack.
Obesity also strains the heart and blood vessels by increasing total blood
volume, cardiac output, and the workload of the left ventricle (which
pumps blood to the major arteries).
 Several metabolic changes that accompany obesity increase CHD risk as
well; these include insulin resistance, hypertension, elevated triglycerides,
low HDL levels
Weight reduction can improve such CHD risk factors as high blood pressure,
elevated blood triglycerides, low HDL cholesterol, and insulin resistance.
However, individuals should focus on weight reduction only after they have
adopted other dietary measures to lower LDL.
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