Heart disease factor

Animal studies using extracts of the seeds of Vitis vinifem have shown beneficial effects relevant to heart disease factors. These extracts generally contain up to 85% of procyanidins. Clinical trials have mainly concentrated on effects in peripheral vascular disease. One trial investigated the antioxidant potential of a commercial extract in healthy volunteers and found that serum antioxidant activity increased significantly for up to three hours after ingestion. 

Cholesterol is biosynthesized in the liver trans ported throughout the body to be used in a va riety of ways and returned to the liver where it serves as the biosynthetic precursor to other steroids But cholesterol is a lipid and isn t soluble in water How can it move through the blood if it doesn t dis solve in if The answer is that it doesn t dissolve but IS instead carried through the blood and tissues as part of a lipoprotein (lipid + protein = lipoprotein) The proteins that carry cholesterol from the liver are called low density lipoproteins or LDLs those that return it to the liver are the high-density lipoproteins or HDLs If too much cholesterol is being transported by LDL or too little by HDL the extra cholesterol builds up on the walls of the arteries caus mg atherosclerosis A thorough physical examination nowadays measures not only total cholesterol con centration but also the distribution between LDL and HDL cholesterol An elevated level of LDL cholesterol IS a risk factor for heart disease LDL cholesterol is bad cholesterol HDLs on the other hand remove excess cholesterol and are protective HDL cholesterol IS good cholesterol... 

Low density lipoprotein (LDL) (Section 26 11) A protein which cames cholesterol from the liver through the blood to the tissues Elevated LDL levels are a nsk factor for heart disease LDL is often called bad cholesterol... 

In 1986, the FDA s Sugars Task Force assessed the impact of sugar consumption on human health and nutrition and concluded that sucrose is not an independent risk factor for heart disease, nor does it cause or contribute to the development of diabetes (62). Although diet is important after the onset of diabetes, sucrose can be well tolerated by insulin-dependent diabetics (63—65). 

Sugar is one of the purest foods made, from natural sources, and has never been known to contain any toxic or harmful components. Intensive investigations by the U.S. Food and Dmg Administration resulted in a book in 1986 on the health and safety factors of sugar (cane and beet) in the diet (18). The conclusion was that sugar has no deleterious effect on health in regard to heart disease, diabetes, or other metaboHc disorder. 

Ascorbic acid also forms soluble chelate complexes with iron (142—145). It seems ascorbic acid has no effect on high iron levels found in people with iron overload (146). It is well known, in fact, that ascorbic acid in the presence of iron can exhibit either prooxidant or antioxidant effects, depending on the concentration used (147). The combination of citric acid and ascorbic acid may enhance the iron load in aging populations. Iron overload may be the most important common etiologic factor in the development of heart disease, cancer, diabetes, osteoporosis, arthritis, and possibly other disorders. The synergistic combination of citric acid and ascorbic acid needs further study, particularly because the iron overload produced may be correctable (147). 

Hypertension is one of the two principal risk factors of many cardiovascular diseases, such as coronary heart disease (CHD), stroke, and CHF. Individuals are considered hypertensive if their systoHc arterial blood pressure is over 140 mm Hg (18.7 Pa) or their diastoHc arterial blood pressure is over 90 mm Hg (12 Pa). Over 60 million people, or one-third of the adult population in the United States are estimated to be hypertensive (163). About 90% of these patients are classified as primary or essential hypertensive because the etiology of their hypertension is unknown. It is generally agreed that there is a very strong genetic or hereditary component to this disease. 

HDL cholesterol protects against heart disease so the higher the numbers the better. An HDL level less than 40 mg dL is low and considered a major risk factor for heart disease Triglyceride levels Hiat are borderline (150-190 mg dL) or high (above 190 mg dL) may need treatment in some individuals. 

Hyperlipidemia, particularly elevated serum cholesterol and LDL levels, is a risk factor in the development of atlierosclerotic heart disease. Other risk factors, besides cholesterol levels, play a role in the development of hyperlipidemia. Additional risk factors include ... 

In general, the higher the LDL level and the more risk factors involved, the greater the risk for heart disease. The main goal of treatment in patients with hyperlipidemia is to lower the LDL to a level that will reduce the risk of heart disease ... 

These drugp are contraindicated in patients with known hypersensitivity to the drug or to any constituents of the drug, after a recent myocardial infarction (heart attack), or in patients with thyrotoxicosis. When hypothyroidism is a cause or contributing factor to a myocardial infarction or heart disease, the physician may prescribe small doses of thyroid hormone... 

Additional factors considered to play a part in coronary heart disease include high blood pressure, smoking, male gender, obesity (particularly abdominal obesity), lack of exercise, and drinking soft as opposed to hard water. Factors associated with elevation of plasma FFA followed by increased output of triacylglycerol and cho-... 

The general recommendations on energy and fat intake are similar to those for the avoidance of heart disease. However, the recommendation to consume a variety of fruits and vegetables is based partly on the putative presence of diverse protective factors in plant foods. This concept does provide, at least in principle, a rationale for the functional health benefits of plant foods beyond the simple provision of nutrients at a level that prevents symptoms of deficiency. 

Observational studies have suggested possible favourable effects of estrogen replacement therapy (ERT) on the risk of coronary heart disease in postmenopausal women. Since elevated plasma cholesterol has been identified as the primary risk factor for cardiovascular disease, investigations have focused on the inverse association between plasma cholesterol concentration and soy protein consumption. The cholesterol-lowering properties of soy have been demonstrated, and a good correlation has been found in... 

Some prospective and case-control studies also investigated the relationship of carotenoids and the evolution of CCA-IMT. Although the EVA study showed no association between total carotenoids and IMT, others like the ARIC study, the Los Angeles Atherosclerosis Study, " and the Kuopio Ischaemic Heart Disease Risk Factor Study demonstrated the protective role of isolated carotenoids such as lycopene, lutein, zeaxanthin, and P-cryptoxanthin on IMT. Thus, findings from prospective and case-control studies have suggested that some carotenoids such as lycopene and P-carotene may present protective effects against CVD and particularly myocardial infarcts and intima media thickness, a marker of atherosclerosis. 

Epidemiological data on carotenoids and cerebral infarcts or strokes indicate a protective effect of P-carotene and lycopene. Indeed, the Basel prospective study, the Kuopio Ischaemic Heart Disease Risk Factor study, and the Physicians Health Study " have shown an inverse correlation between carotenoid plasma level and risk of stroke. In the same way, Hirvonen et al. demonstrated, in findings from the ATBC cancer prevention stndy, an inverse association between P-carotene dietary intake and stroke. However, clinical data on carotenoids and stroke are nonexistent and they are needed to confirm this possible protective effect of carotenoids on stroke. 

Rissanen, T.H. et al.. Serum lycopene concentrations and carotid atherosclerosis the Kuopio Ischaemic Heart Disease Risk Factor Study, Am. J. Clin. Nutr, 77, 133, 2003. 

Persky, V.W., Dyer, A.R, Idris-Soven, E., Stamler, J., Shekelle, R.B., Schoenberger, T.A., Berkson, D.M. and Lindberg, H.A. (1979). Uric acid a risk factor for coronary heart disease. Circulation 59, 969-977. 

Identify risk factors for the development of ischemic heart disease. 

Early detection and aggressive modification of risk factors is one of the primary strategies for delaying ischemic heart disease progression and preventing ischemic heart disease-related events including death. 

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

TABLE 4-2. Major Risk Factors for Ischemic Heart Disease... 

Identify RJ s risk factors for ischemic heart disease. 

Devise a pharmacotherapy and risk-factor modification treatment plan for secondary prevention of coronary heart disease events in a patient following myocardial infarction. 

Hyperlipidemia has not clearly been established as a risk factor for stroke, although it is a modifiable risk factor for coronary heart disease. Recent studies show that statin use may reduce the incidence of a first stroke in high-risk patients (e.g., hypertension, coronary heart disease, or diabetes) including patients with normal lipid levels. A recent meta-analysis showed a 25% risk reduction for fatal and non-fatal strokes with statin use.4 Patients with a history of MI, elevated lipid levels, diabetes, and... 

TABLE 9-4. Risk Factors for Coronary Heart Disease... 

Assess the patient s risk factors for heart disease and breast cancer. 

Assess the patient for use of HRT by evaluating for the presence of vasomotor symptoms. If the patient is experiencing bothersome vasomotor symptoms, consider the use of HRT only after assessing for risk factors for heart disease and breast cancer. If vasomotor symptoms are tolerable and/or the patient has risk factors for heart disease and/or breast cancer, consider alternative, non-hormonal treatments for vasomotor symptoms. 

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