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Nutrition for Nurses

12.2 Nutrition and Long-Term Cardiovascular Illnesses

Nutrition for Nurses12.2 Nutrition and Long-Term Cardiovascular Illnesses

Learning Outcomes

By the end of this section, you should be able to:

  • 12.2.1 Discuss the impact of nutrition on cardiovascular illness.

Cardiovascular Diseases

The American Heart Association defines cardiovascular disease as any disease of the heart and blood vessels, many of which are related to atherosclerosis (2017). Although some cardiovascular problems are congenital, meaning the client was born with it, most cardiovascular diseases develop over the lifespan. Cardiovascular diseases that develop over the lifespan are often linked with atherosclerosis (National Heart, Lung and Blood Institute, 2022).

Cardiovascular heart disease indicates a decrease in the amount of blood, and therefore oxygen, available to the heart muscle (American Heart Association, 2017). CVD is often the result of narrowed cardiovascular arteries due to the buildup of cholesterol plaque or atherosclerosis. Lipids—LDL, HDL, and triglycerides—are components of cell membranes; they assist with energy movement and storage, production of hormones, and vitamin absorption. However, having too much LDL or triglycerides or too little HDL negatively impacts the body (Cleveland Clinic, 2022b). For this reason, a heart-healthy diet seeks to control high cholesterol (hyperlipidemia) (American Heart Association, 2020).

When clients have hyperlipidemia, consider what happens in their vascular system over time. As the buildup of cholesterol begins to form plaques, the vascular system becomes constricted or narrowed. This narrowing causes the heart to pump more forcefully to push blood throughout the cardiovascular system, resulting in hypertension and, potentially heart failure, if the cardiac muscle becomes fatigued. Additionally, when the plaque area leading to the cardiovascular arteries supplying blood and oxygen to the heart muscle continues to narrow until it eventually becomes too stenosed for blood to flow through it, a myocardial infarction will occur.

Optimally, individuals will adopt a heart-healthy diet early in life that minimizes hyperlipidemia. This eating style provides the nutrients needed to fuel the body while minimizing foods and food preparation styles that increase cholesterol levels. Heart-healthy diets reduce saturated and trans fat by limiting red meat and whole milk dairy products. Additionally, food is prepared by grilling or baking instead of by frying; healthy oils, such as olive oil, are used, when cooking. Heart-healthy diets focus on fruits, vegetables, poultry, fish—especially fish that contains omega-3 such as salmon (Medical News Today, 2021)—whole grains, and nuts. Sodium intake for clients on a healthy heart diet should be limited to 2300 mg/day (FDA, 2022b; American Heart Association, 2020).

Hypertension

Hypertension, or high blood pressure is when the pressure needed to push blood throughout the body’s circulation is consistently high and reads over 130/80 mm Hg (CDC, 2023a). The formation of plaques can cause constriction or narrowing of the arteries (Figure 12.4). If left untreated, hypertension can increase the risk for cardiovascular diseases. Heart healthy diets are designed to decrease cholesterol levels, decrease blood pressure, and reduce risk for developing congestive heart failure. In addition, hypertensive clients may also follow a low-sodium diet. One of the most effective diets to lower blood pressure is the DASH diet (Mayo Clinic, 2021). In addition to limiting the intake of sodium to 2300 mg/day, the DASH diet also includes foods high in potassium, calcium, and magnesium. The DASH diet encourages limiting saturated fats and sugars (Table 12.8).

An illustrated cutaway of the heart of a patient with high blood pressure shows an enlarged heart muscle. An inset illustrates an artery with atherosclerosis and how that causes increased pressure on the artery walls as the blood goes through the artery.
Figure 12.4 Atherosclerosis is a primary cause of hypertension. (credit: “Hypertension (High Blood Pressure)” by Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”/Wikimedia Commons, CC BY 3.0)
Food Types Serving Size Recommended Foods
Grains 6–8 servings daily 1 slice of whole grain bread
1 oz of dry cereal
½ cup of cooked rice or pasta
Vegetables 4–5 servings daily 1 cup of raw leafy green vegetables
½ cup raw or cooked vegetables
½ cup vegetable juice
Fruits 4–5 servings daily 1 medium fruit
½ cup fresh
frozen or canned fruit
½ cup fruit juice
Low-fat/no-fat dairy 2–3 servings daily 1 cup milk or yogurt
1½ oz cheese
Lean meat/poultry/fish 6 servings daily Each serving = 1 oz
Cooked meat, poultry, fish, or egg
Fats/oils 2–3 servings daily 1 tsp butter substitute or vegetable oil
1 tbsp mayonnaise
2 tbsp salad dressing
Nuts, seeds, legumes 4–5 servings weekly ⅓ cup nuts
2 tbsp nut butter
2 tbsp seeds
Sweets/added sugars 5 or fewer servings weekly 1 tbsp sugar, jelly, or jam
1 cup sweetened lemonade or tea
Table 12.8 DASH Diet Recommended Foods (source: Mayo Clinic, 2021)

Holistic Assessment of Cultural Considerations

A holistic assessment of the client extends beyond a physical assessment and a nutritional assessment. The nurse should examine which individual characteristics, aspects of medical history, challenges to maintaining health, interest in wellness promotion and family, community, and cultural aspects impact the client’s ability to develop and adhere to a nutritional plan designed to optimize cardiovascular function. For the cardiovascular client, the nurse should focus attention on providing education to decrease cholesterol levels and hypertension, while providing a nutrient-dense eating plan that fuels the body.

What are the client’s personal characteristics related to food that may impact their ability to adhere to a healthy heart eating plan? For example, the nurse should consider if there are issues related to food enjoyment, food intolerances, and likes and dislikes of certain foods. The nurse can do the following to get a better picture of how to help the client achieve success in developing and adhering to a heart-healthy meal plan:

  • Determine if the client likes to engage in the cooking process—plan, prepare, and cook meals—in lieu of eating ready-made processed meals.
  • Consider aspects of the client’s overall health history, paying specific attention to cardiovascular-related issues.
  • Identify if there are long-term cardiovascular issues or if the issue is an acute exacerbation. If the medical issue is long-term, determine what issues in the past have helped or hindered the client to identify and maintain a heart-healthy diet. Incorporate pertinent family members into this assessment.

Special Considerations

Risks for Heart Disease Vary by Ethnicity

The risk for heart disease varies across different ethnic groups. Black women are more likely to have a heart attack, whereas Black men are more likely to die from having a heart attack. Asian people typically have less coronary artery disease than other ethnic groups, although Asian Indian men and Filipino men and women do have a higher risk in comparison to White people. Hispanic women who are young and have a heart attack are at greater risk for dying than young Hispanic men, young Black adults, and young White adults. (Cleveland Clinic, 2023). In the United States, heart disease is the leading cause of death for people in most ethnic groups (CDC, 2023d).

Planning a heart-healthy menu using the cuisines of diverse cultures can improve adherence as well as provide variety. Table 12.9 outlines different cultures and food choices that would be appropriate for heart health.

Culture Healthy Food Choices
Mexican
  • Grilled shrimp, chicken, or fish
  • Black or pinto beans
  • Salsa, pico de gallo, cilantro, black olives, jalapeno peppers
  • Guacamole, fat-free sour cream
  • Onions, peppers, mushrooms, tomatoes
  • Whole grain brown rice, corn tortillas
Asian
(Chinese, Thai, Japanese)
  • Steamed rice
  • Vegetables such as bok choy, napa cabbage, bean sprouts, daikon, bamboo shoots, and watercress
  • Mung bean
  • Rice noodles
  • Low-sodium soy sauce, chili sauce, oyster sauce, and fish sauce
  • Curry paste
  • Curry such as Thai, Japanese, Chinese, or Malaysian curries
  • Lemongrass
  • Rice vinegar
  • Cilantro, mint, ginger, galangal, and green onion
  • Tofu and bean curd
  • Edamame
Indian
  • Berries such as strawberries, blackberries, and blueberries
  • Avocado
  • Fish and fish oil
  • Whole grains such as whole wheat, barley, oats, millet, brown rice, and high fiber cereal
  • Legumes such as lentils, mung beans, and kidney beans
  • Seeds and nuts
  • Chia seeds
  • Spinach
  • Collard and mustard greens
  • Curry
Italian
  • Chicken or turkey (grilled, or baked)
  • Low-fat ricotta cheese
  • Farro or whole grain rice
  • Tomatoes and bell peppers
  • Whole wheat pastas
  • Olive oil
  • Low-sodium marinara sauce
  • Grilled vegetables such as zucchini, eggplant, and radicchio
  • Mussels, octopus, squid
Soul food/traditional southern cooking
  • Roasted vegetables such as okra and bell bepper
  • Berries and stone fruits
  • Baked chicken without skin
  • Baked sweet potato
  • Roasted turkey or pork
  • Brown rice
  • Cauliflower pasta
  • Collard, mustard, and turnip greens
Table 12.9 Cultural Appropriate Food Choices for a Heart Healthy Diet (sources: Cleveland Clinic, 2020a; Cleveland Clinic, 2020b; Patiala Heart Institute, 2023; Martin, 2023; WebMD, 2022; National Lipid Association, 2020)
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