THE RISK FACTORS OF NUTRITIONAL DISORDERS TO THE CARDIOVASCULAR SYSTEM

Dr. Dimyati Burhanudin.M,Sc. The disease of the heart 1. Ischaemic heart disease 2. Hypertensive heart disease 3. Rheumatic heart disease 4. Pulmonary heart disease 5. Congenital heart disease 6. Thyrotoxic heart disease 7. Heart disease in other forms Heart ; Blood Suplly Vascular Myocardium/Nutrient)

In order to perform the heart work, the myocardium needs to be Nourished and Oxygenated from an adequate suplly of blood through the aorta and coronary arteries. ISCHAEMIC HEART DISEASE (IHD) (CORONARY HEART DISEASE = CHD) The failure of the coronary arteries to suplly sufficient blood to the myocardium, which are almost invariably associated with athero sclerosis of the coronary arteries. 1. Myocardial Infarction Myocardial Ischaemia sudden death

Heal with scar

severe return to normal life increase risk of second infarct blocks the lumen of coronary artery Narrowed the lumen The blood flow is insufficient to suplly the oxygen

Thrombus Atherosclerosis

2. Angina Pectoris

(Pain in the chest) severe cardiac pain limits the activity - remain live and free of any disability so long as the patient keeps within the limits of exercise tolerance. - Increase risk of - sudden death - infarction Due to ; - unusual exertion - emotional stress

3. Sudden death Have : - Angina Pectoris - Myocardinal infarction

The death presumed to be due to IHD Sometimes the death is unexpected but in autopsy ; - old infarct - exstensive atheroma However Might be - the cause of the suddendeathly of the death still remains unexplained. - minor painless ischaemia interrupt the electrical conduction - release of stored regulatory hormones (catecholamine) - disturbance of regulatory ions (hypoxic disionism)

Note : The pain of ; Angina pectoris : - directly - quatitativately releated to exertion - induced by emotion - occurs at rest - induced by prolonged exertion or acute anxiety

Myocardial infarction -

ATHEROSCLEROSIS

Degenerative arterial disease Habitual diet the presenting of the fatty acid in the lipid of serum and tissues

THE DEVELOPMENT OF ATHEROMA 4 Stages (WHO) 1. fatty spot : - in tunica intima of the vessel - thickenings of the intima - slightly raised a long flattened yellow streak - the elevation of the intima due to the formation of connective tissues cells, distended, contains cholesterol within the fat droplets. 2. fibrous plaque : - between tunica intima and tunica media - circumscribed, firm, grey/pearly white - diameters, 1-several mm, irregular - the plaques become larger, project into the lumen (medium size of artery) 3. soft plaque - contains large amounts of fatty material, softened

4. break down - plaque surface -, break dowm - atheroatous ulcer ragged irregular edges - fibrous tissue at the base of the ulcer scarring - vessel narrowed and distort slowing down the flow of blood - deposited of calcium haemorrhages occure in the base thrombus - ulcer debris /fibrin fat, cholesterol calcium blood corpuscles (clotting mechanism)

The predisposition of the thickening of intima ;

intima injury (platelet aggregation) lipid accumulation (irreversible) thrombus

fibrin in the process of the ulcer formation traps red corpuscles a minute clotsdissolved by fibrinolytic system

previous meal, physical exercise, smoking, e.t.c. may affect platelet adhasiveness and fibrinolytic activity. eidemiology of IHD - man in well to do classes - men 45 yr, women unknown (> 50 yr) - the greater percentage of death, 35-40 yr - the lower incidence is from the poor immigrants and under/develop countries (Include ASEAN) aetiology familial ; - inherited - environmental experience of hypertension, diabetes, gout and exanthomatosis.

Prevention 1. Diet Fats ; hyperlipidemia, hypercholesterolemia decrease intake of animal fat (SFA) correlation - incidence IHO - total dietary fat - total fat - saturated fat no proof that dietary fats have an important role in the aetilogy of IHD more depend on the plasma cholesterol concentration intake saturated fat >> plasma cholesterol IHD

Carbohydrates

Intake sucrose

Atherosclerosis

Plasma triglyceride >> Carbohydrate fat Increase plasma fat Protein

deposit fat (FA)

Atherosclerosis

In animal research : Not to be important in the genesis of atherosclerosis 2. Sedentary Life Exercise : 3. Smoking Pheriperal Vascular disease IHD (Part myoc infaction) - keep the balance between food intake and energy expenditure - physically active jobs protects against IHD

Heavy Cig.smokers > do not smoke (Death Incidence 1,5 -2,5 times) the mechanism of nicotine or other tobaccos constituete causes this adverse effect is still not clear

maybe due to : - vasoconstrictor action - undesirable effect on the level of plasma lipids - blood coalagualation - the survival of platelet 4. Stress and Strain

Suggested to be predisposed to the atherosclerotic formation No difference between the have and the poor group of people and also from the modern and undevelope communities It is likely more close to the behaviour (The emotion)

5. Polution higher concentration of carbon disulphide and sulphur dioxide from in the process the facture of rayon may cause anoccupational toxic to be the aetilogy of IHD.

Community Prophylaxis - food technology changes the costumary diet of the people - the anxious promotin of the new product of food industry - looks to the medical profession for guidance - health education - in daily food intake Reduce - calorie (to prevent overweight) - total consumption of fat 40%-30% of the total number calories saturated fat increase the consumption of polyunsaturated fat the consumption of sugar/sugar product

Increase - vegetables, fruits, potatoes, milk, fish, lean meat, cereal/cereal product - take regular exercise The program require the co-operation among doctors health workers, catering (in school, military forces, hospital, restaurants and other similar institution. Food industries have to pay attention to the recommendation of the raw products and in its composition an processing.