Definition of Coronary Artery Disease

Progressive occlusion of coronary arteries compromises blood flow and oxygenation leading to angina and increased risk of myocardial infarction and possible death.

Prevalence of Coronary Artery Disease

• 61 million Americans have plaque formation
  
• 250,000 sudden deaths annually
  
• Leading cause of death in both men and women
  
• 1 death per minute in U.S. due to CHD
  
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Risk Factors of Coronary Artery Disease

• Dyslipidemia
  
• Smoking
  
• Hypertension
  
• Diabetes mellitus
  
• Family history
  
• Inactivity
  
• Obesity
  
• Race/ethnicity and gender
  
• Imbalance in diet/nutrients
  

Outcome Measures for Coronary Artery Disease

• Maintain reasonable weight:
  

         BMI 22-27 or attain individually prescribed weight reduction goals
         BMI = 27-30, weight reduction measures may be indicated
         Serum albumin > 3.5 g/dl
         Smaller waist circumference, if appropriate

• Achieve recommended lipid levels per ATP III Guidelines (NCEP)
  
• Maintain/improve functional status
  
• Increase levels of physical activity
  
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Therapeutic Objectives for Coronary Artery Disease

• Maintain healthy weight
  
• Maintain serum lipid levels consistent with the ATP III Guidelines (NCEP)
  
• Improve levels of physical activity
  

Medications for Coronary Artery Disease

Commonly used drugs may have nutritional implications, e.g.:

•        Cardiac glycosides (digitalis) may result in anorexia and/or nausea
  
•        Statins may result in elevated liver enzymes
  
•        High doses of niacin (nicotinic acid) may be associated with flushing, hyperglycemia, hypotension, hypoalbuminemia, upper GI distress and liver enzyme elevation (hepatotoxicity)
  

Supplements for Coronary Artery Disease

• Consider high calorie, nutrient-rich foods or liquid supplements if food intake is poor.
  
• Caution: high doses of fish oil supplements (e.g. omega-3 fatty acid capsules) may increase the risk of hemorrhagic stroke
  

Nutrition Education for Coronary Artery Disease Nutrition

• Moderate total fat intake (maximum 1-3 Tbsp. added fat/day)
  

       Reduce intake of saturated fat (fat solid at room temperature, i.e. animal fats, hydrogenated fats and tropical oils and trans-fatty acids)
       Monounsaturated fats may lower triglycerides (e.g. olive oil, peanut oil, flax seed oil and canola oil)
       Polyunsaturated fats may lower LDL levels (e.g. safflower oil, sunflower oil and corn oil)

• Three or more broiled/baked fish meals/week (e.g. salmon, mackerel, tuna and herring)
  
• Increase daily intake of foods rich in or fortified with folate (e.g. leafy green vegetables, whole grains)
  
• Calorie intake to achieve optimal weight
  

Treatment Options for Coronary Artery Disease Nutrition

• Nutrition Education
  
• Supplements
  
• Medications
  
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Screening Parameters of Coronary Artery Disease

• Body weight assessment
  

      BMI 22-27
      Waist circumference = 40 inches for men, = 35 inches for women)

• Dietary history of cholesterol, saturated and total fat, and calories
  
• Determine serum cholesterol, (LDL, HDL) triglycerides and C-reactive protein (CRP)
  
• Diabetes mellitus
  
• Depression
  
• Use of vitamins/minerals and complementary/alternative therapies
  
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