🍎Medical Nutrition Therapy I Unit 7 – Heart Failure and Dyslipidemias in CVD

Key Concepts and Definitions

• Heart failure occurs when the heart cannot pump enough blood to meet the body's needs
  • Characterized by reduced cardiac output and increased ventricular filling pressures
• Dyslipidemias refer to abnormal levels of lipids in the blood, including high total cholesterol, high LDL cholesterol, low HDL cholesterol, and high triglycerides
• Ejection fraction represents the percentage of blood pumped out of the left ventricle with each contraction
  • Preserved ejection fraction (HFpEF) indicates normal pumping function but impaired relaxation
  • Reduced ejection fraction (HFrEF) indicates weakened pumping function
• Cardiac remodeling involves changes in the size, shape, and function of the heart in response to stress or injury
• Atherosclerosis is the buildup of plaque in the arteries, leading to narrowing and reduced blood flow
• Lipid profile includes measurements of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides
• Statins are medications used to lower LDL cholesterol by inhibiting the enzyme HMG-CoA reductase

Pathophysiology of Heart Failure and Dyslipidemias

• Heart failure develops when the heart cannot pump efficiently due to weakened or stiffened heart muscle
• Reduced cardiac output leads to compensatory mechanisms, such as increased heart rate and fluid retention
• Dyslipidemias contribute to the development of atherosclerosis, which can lead to coronary artery disease and heart failure
• High LDL cholesterol levels promote the formation of atherosclerotic plaque in the arteries
• Low HDL cholesterol levels reduce the removal of excess cholesterol from the arteries
• Elevated triglycerides can contribute to the development of atherosclerosis and increase the risk of heart disease
• Chronic inflammation plays a role in the progression of both heart failure and dyslipidemias

Risk Factors and Causes

• Hypertension increases the workload on the heart and can lead to left ventricular hypertrophy and heart failure
• Coronary artery disease can cause myocardial infarction and lead to heart failure
• Diabetes mellitus increases the risk of heart failure and dyslipidemias through various mechanisms, including endothelial dysfunction and insulin resistance
• Obesity contributes to the development of heart failure and dyslipidemias by increasing inflammation and metabolic abnormalities
• Sedentary lifestyle and lack of physical activity can worsen heart failure symptoms and contribute to dyslipidemias
• Smoking increases the risk of heart failure and dyslipidemias by promoting atherosclerosis and endothelial dysfunction
• Genetic factors can influence the development of heart failure and dyslipidemias, such as familial hypercholesterolemia

Diagnostic Criteria and Assessment

• New York Heart Association (NYHA) functional classification assesses the severity of heart failure symptoms (Class I-IV)
• Echocardiography evaluates cardiac structure and function, including ejection fraction and ventricular size
• Brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) levels are elevated in heart failure and can aid in diagnosis and monitoring
• Lipid profile, including total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides, is used to diagnose and monitor dyslipidemias
• Cardiovascular risk assessment tools, such as the Framingham Risk Score or the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, can help determine the risk of future cardiovascular events
• Stress tests and coronary angiography may be used to evaluate the presence and severity of coronary artery disease

Nutritional Implications

• Sodium restriction is important in heart failure to reduce fluid retention and improve symptoms
  • Aim for less than 2,000 mg of sodium per day
• Adequate protein intake is necessary to maintain muscle mass and prevent cachexia in heart failure
  • Recommend 1.1-1.5 g/kg body weight per day, depending on the severity of heart failure
• Omega-3 fatty acids, particularly EPA and DHA, may have beneficial effects on heart health and lipid profiles
• Fiber intake, especially soluble fiber, can help lower LDL cholesterol levels
  • Aim for 25-35 g of fiber per day
• Saturated and trans fats should be limited to reduce LDL cholesterol and cardiovascular risk
  • Limit saturated fat to less than 7% of total calories and avoid trans fats
• Alcohol consumption should be moderated or avoided in heart failure and dyslipidemias
• Micronutrient deficiencies, such as thiamine and coenzyme Q10, may be common in heart failure and require supplementation

Medical Management Strategies

• Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used to reduce afterload and improve cardiac function in heart failure
• Beta-blockers can improve symptoms and reduce mortality in heart failure by reducing heart rate and myocardial oxygen demand
• Diuretics, such as loop diuretics (furosemide) and thiazide diuretics (hydrochlorothiazide), are used to reduce fluid retention and improve symptoms in heart failure
• Statins are the primary medication for lowering LDL cholesterol and reducing cardiovascular risk in dyslipidemias
  • Examples include atorvastatin, rosuvastatin, and simvastatin
• Ezetimibe can be added to statin therapy to further lower LDL cholesterol by inhibiting cholesterol absorption in the intestine
• PCSK9 inhibitors, such as evolocumab and alirocumab, are used in patients with familial hypercholesterolemia or those who cannot tolerate statins
• Niacin and fibrates may be used to raise HDL cholesterol and lower triglycerides, but their use has become less common due to limited evidence of cardiovascular benefit

Dietary Interventions and Recommendations

• DASH (Dietary Approaches to Stop Hypertension) diet emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy while limiting sodium, saturated fat, and added sugars
  • Beneficial for both heart failure and dyslipidemias
• Mediterranean diet, rich in fruits, vegetables, whole grains, legumes, nuts, olive oil, and fish, has been shown to reduce cardiovascular risk and improve lipid profiles
• Plant-based diets, such as vegetarian or vegan diets, can lower LDL cholesterol and reduce the risk of heart failure and cardiovascular disease
• Limit processed and high-fat meats, such as red meat and processed deli meats, to reduce saturated fat intake
• Choose lean protein sources, such as poultry, fish, legumes, and low-fat dairy
• Incorporate heart-healthy fats, such as olive oil, avocados, nuts, and seeds, in moderation
• Avoid added sugars and sugar-sweetened beverages, which can contribute to hypertriglyceridemia and obesity

Patient Education and Lifestyle Modifications

• Encourage regular physical activity, aiming for at least 150 minutes of moderate-intensity aerobic exercise per week
  • Adapt exercise recommendations based on the severity of heart failure and individual limitations
• Stress the importance of maintaining a healthy weight and provide strategies for weight management, such as portion control and mindful eating
• Educate patients on reading nutrition labels and making healthier food choices when grocery shopping and dining out
• Teach patients how to track their sodium intake and provide tips for reducing sodium in their diet, such as using herbs and spices for flavor instead of salt
• Encourage smoking cessation and provide resources and support for quitting
• Emphasize the importance of medication adherence and provide strategies for remembering to take medications as prescribed
• Discuss the role of stress management and relaxation techniques in managing heart failure and dyslipidemias
• Encourage patients to monitor their symptoms and report any changes or concerns to their healthcare provider