Cardiovascular disease (CVD) is a group of conditions that include coronary heart disease (CHD), atherosclerosis, hypertension, ischemic heart disease, small vessel disease, and heart failure (HF).These conditions are interrelated and often coexist. Atherosclerosis involves the narrowing of the arteries that provide nutrients and oxygen to the heart muscle.
What are the risk factors for CVD?
|Major Risk Factors||Modifiable ClinicalRisk Factors||Modifiable LifestyleRisk Factors**|
|High blood pressure||Raised Low-density lipoprotein cholesterol (LDL-C)*||Obesity (BMI > 30 kg/m2)|
|Age(>45 yrs. for men, >55 yrs. for women)||Raised triglycerides*||Poor Diet|
|Diabetes mellitus||Low High-density lipoprotein cholesterol (HDL-C)*||Physical inactivity|
|Impaired kidney function||Raised inflammatory markers||Stress|
|Family history of premature CVD(men <55 yrs., women <65 yrs.||Raised blood clotting factor||Insufficient sleep|
|Tobacco use – particularly cigarettes|
|Excessive alcohol consumption|
How can I reduce my risk for CHD?
- Achieve and maintain a healthy body weight
Match your intake of total energy (kilojoules) to your total energy requirement daily. To control your kilojoule intake, it is important to manage the timing, type and quantity of food consumption optimally. Your dietitian will develop an eating plan that will take these factors as well as your lifestyle into consideration. Being physically active can help you manage your weight, as well as reduce your stress levels. Ensuring that you get sufficient sleep can also help you to achieve and maintain a healthy weight.
Aim to engage in aerobic physical activity 3 to 4 times per week, lasting on average 40 minutes per session and involving moderate to vigorous intensity physical activity.
- Don’t smoke and avoid being around second hand smoke
There is a large body of evidence that outlines the risk of smoking and developing CVD and therefore we encourage you to avoid secondary exposure to tobacco products and to quit smoking.If you need support in this area, please speak to your dietitian.
- Eat a variety of nutritious foods from each of the food groups
You may be eating plenty of food but your body may not be getting the nutrients its needs to function optimally. Nutrient-rich foods have minerals, proteins, fibre and other nutrients but are lower in kilojoules. These can help you control your weight, cholesterol levels and blood pressure. Follow an overall dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, low fat dairy products, fish and skinless poultry, legumes and nuts and certain vegetable oils.
- Select your fat sources wisely
Replace saturated fats with monounsaturated and polyunsaturated fatswithout increasing the total amount of fat in your diet.
The current recommendations to prevent CVD are to consume 20-35% of your total energy from fat with saturated fat being limited to <7% of your total energy, Trans fats limited to <1% of your total energyand the balance of fat as unsaturated(monounsaturated and polyunsaturated) fat. Dietary cholesterol raises total cholesterol and LDL-C but to a much lesser extent than saturated fatty acids. The recommendation is to have no more than 300mg dietary cholesterol / today.
- How many eggs can I eat a day?
Seafood liver and eggs are foods high in cholesterol. A 300 mg cholesterol intake can be achieved by the consumption of 4 eggs per week and eating seafood and liver on an occasional basis.
- Omega 3 essential fatty acids
In addition, include two servings of fatty fish in your diet per week, as they are a source of long-chain omega 3 fatty acids (EPA & DHA) that can help reduce your risk for CVD by improving the rhythm of your heart and keeping the arteries elastic and healthy.
- Increase your intake of whole grains and dietary fibre
Research suggests that there is a protective effect against CHD of a diet rich in whole grains that contain dietary fibre. Choose whole grains such as rolled oats, barley, brown rice, quinoa over refined grain products. Oats, as a source of whole grain, has shown that together with a healthy diet to reduce LDL – cholesterol levels.
- Avoid/limit your intake of refined carbohydrates and sugar
Reducing your intake of refined carbohydrate to achieve a healthy weight has been shown to assist in preventing CVD.
Research has established that optimal blood glucose control is essential to maintain the health of the arteries as well as for optimal weight control. High blood glucose levels after a meal through mechanisms such as oxidative stress, high levels of insulin, triglycerides and glycated proteins are detrimental to the health of the arteries. To achieve optimal blood glucose control, it is recommended to avoid refined sugars (e.g. sweets, chocolates, soft drinks) and refined starches (e.g. white / brown bread and all bakery items / confectionary). You can reduce your intake of sweetened foods and beverages by substituting sweetened beverages such as soft drinks, specialty coffees, cocktails or punches with water or herbal teas. You can also snack on whole fruit or chopped vegetables instead of sweets, chocolates, biscuits, cakes, pastries, doughnuts, pies or ice-cream.
- Eat a variety of vegetables and fruit of different colors
Eating a plant-based diet rich in vegetables and fruit helps you meet your nutrient requirements without adding a lot of extra kilojoules. Consuming more than 5 servings of vegetables and fruits a dayhas been associated with a decreased risk of CHD and stroke. By including a variety of different types and colours of these foods, you are better able to get vitamins, minerals, fiber and phyto – nutrients that help to keep your arteries healthy and elastic. Ask your dietitian about new and exciting ways to increase your intake of these foods, tools to help you track your intake and more information about seasonal vegetables and fruits.
- Use alcohol in moderation (if you drink at all)
An excessive intake of alcohol contributes to high triglyceride levels and blood pressure. Alcohol is energy dense (~600kJ / drink) and can easily contribute to weight gain. The maximum intake of alcohol is of 1 to 2 drinks per day for men and 1 drink per day for women. A standard drink is equivalent to 1 beer dumpy (340ml), 150ml medium dry white wine / red wine or a 30ml tot of tequila / brandy / gin / vodka or whiskey.
- Limit your intake of salt
Many of us consume in excess of what our body requires when it comes to salt. This can raise blood pressure which is a risk factor for CVD. Avoid adding salt to your food before eating. Cook with the minimum added salt by using a variety of herbs and spices to flavor food. Limit your intake of salty snacks such as salted peanut nuts and biltong.
- How many nuts should I be eating?
Consuming the correct amount and type of fats is important to prevent and treat CVD, and are a good source of monounsaturated fats. Nuts also contain substances that keep your arteries healthy and studies have shown that including nuts four times a week can lower your risk of CHD. As nuts are energy dense it is recommended to ask your dietitian how many portions are suitable for inclusion into your eating plan.
Yours in Health,
Mbali Mapholi – Dietitian