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1、外食族與心臟病,基督教門諾會醫院心臟內科孫德光醫師,Looks great!,Hmmm!,青菜D加啦!,甚麼是心臟？,正常心臟是一個強壯的、中空的肌肉組織，約拳頭般大。位於胸腔內胸骨之後。負責輸送血液至全身。一般健康的人每天心跳約十萬次，要打出8000公升以上的血液，流經全身各處，而且每天廿四小時不眠不休的，為維持人體正常運作而努力。為了維持這樣長年不休的劇烈運動，心臟本身也需要充足的養分與氧氣，而環繞在心臟表面的冠狀動脈(coronary artery)，就是供應心臟氧氣和養分的重要血管。心臟分為左右心房和左右心室四個部分，其中以左心室最重要，擔負了將血液輸送到全身各部位的主要功能。同樣的，
2、左心室的冠狀動脈也特別重要，而且最可能發生問題。,甚麼是血管粥狀硬化？,血管粥狀硬化何時開始產生？,甚麼是冠狀動脈？,冠狀動脈心臟病,台灣有慢慢增加的趨勢,導致許多年青人或壯年人的死亡統稱冠心病心絞痛、心肌梗塞是常見的冠狀動脈心臟病，更是形成猝死的主要原因。冠狀動脈阻塞為其主因,通常是由於動脈粥樣硬化後形成一種類似脂肪的沉積的瘢塊所造成長期缺氧也會造成缺氧性心肌病變而心臟衰竭,冠心病已確認的危險因子,1)終身無法改變者:遺傳基因(家族心臟血管疾病的病史)、種族、年歲增高2)可改變的:高血壓糖尿病高脂血症肥胖症抽煙型的行為型態缺乏運動濫用古柯鹼(cocaine)或安非他命(amphetamine
3、)等等。,飲食如何影響冠狀動脈硬化？,過多的鹽份：尤其罐頭類，紅燒，燒烤，油炸類等，常因使用醬油或烤肉醬等，而造成鹽份攝取過量。鹽份攝取過量易造成高血壓。若鹽份攝取量控制得當，血壓約可降約510 mmHg.過多的油脂攝取量：易造成膽固醇過高，使罹患心臟疾病的機會比普通人多三倍，因為體內過多的膽固醇會積聚在血管內，使血管日漸狹窄，妨礙血液流通。動脈硬化症發生率與膽固醇總值及LDL膽固醇的濃度成正比關係，而與HDL膽固酵的濃度呈反比關係。,飲食如何影響冠狀動脈硬化？,過多的熱量包括碳水化合物攝取量：長久下來易誘導糖尿病產生，而糖尿病使女性有冠狀動脈心臟病的機會比一般人多一倍，男性多百分之五十。暴飲
4、暴食：酒足飯飽的大餐之後，也常使不健康的心臟血管發生絞痛，尤其在冬天，暖飽之後外出，更容易產生悲劇。肥胖：因為肥胖引致血壓高、血脂肪過高、糖尿病、代謝症候群，而這些疾病又會誘發冠狀動脈心臟病。,CURRENT GUIDELINES,Obesity/lipids/carbohydrates:saturated fat should be less than 7%of consumed calories.Complex carbohydrates:50-60%protein:15%lipid:35%20-30 gram/day of dietary fibers/2 gram of plant s
5、tanols/sterols.,Trans fatty acid should be avoidcholesterol intake should be less than 200 mg/day.Excessive intake of carbonhydrates increases TG.Limitation of sugar/high glycemic/glyceridemic carbohydrates is advisable.Total cholesterol:190 mg/dl LDL should targeted low(115 mg/dl)(ESC guideline),Nu
6、trition and cardiovascular disease,A adequate control of diet is associated to 30%reduction in cardiovascular disease:fruit&vegetables whole grains fishpoultry&lean meatlow fat&fat free products liquid vegetable oils Stampfer MJ.NEJM 343:16,2000Hu FB.Am J Clin Nutr 72:912,2000Trichopoulou A.NEJM 348
7、:2599,2003,Fruit and vegetables,A consumption of three or more servings/day Vs less than three servings was associated to 27%reduction of CV disease risk.Green leafy vegetablesfood rich in carotenoids and vitamine Cat least five servings is suggested Bazzano LA.Am J Clin Nutr 76:93,2003,whole grains
8、 and fiber,The reduction of cardiovascular risk is associated to fiber,vitamins,phytoestrogens,phenols,omega-3 fatty acids,resistant starch and minerals.A meta-analysis study indicated 27%reduction of CAD risk,specially when the intake is three servings/day.Anderson JW.J Am Coll Nutr 19:291s,2000,Le
9、gumes and nuts,Some studies demonstrated reduction of CV risk.Not consistent nuts:good source of monounsaturated fatty acids,fiber,minerals,flavonoids.Walnuts:rich in polyunsaturated fatty acids.,Fish and fish oils,The most of benefits comes from omega-3 fatty acids,eicosapentanoic acid(EPA),docosah
10、exanoic acid(DHA).Due to its influence in antiinflammatory/antiplatelet effect,reduction of electrical conductivity of cell membrane,and reduction of TG.Salmon,mackerel,albacore tuna,swordfish,herring,sardine,lake trout.AHA recommendations:two portion of fish/week.Supplemental EPA+DHA up to 1 gm/d i
11、f CAD,in consultation to physician.,Alcohol,Moderate alcohol consumption is associated to lower risk of CAD red wine is particularly helpful 1-3 drinks/daybecause of hazard associated to habituation:INDIVIDUALS SHOULD NOT BEGIN TO CONSUME ALCOHOL AS A MEAN OF REDUCING CORONARY DISEASE RISK.,三少二多的 原則,Thank you!,
