How does diet and lifestyle affect the risk of coronary heart disease, and how can it be reduced?
Coronary heart disease: atherosclerosis and the link between blood cholesterol, saturated fat, salt and the disease, the dietary, lifestyle and non-modifiable risk factors, the consequences, and the dietary advice for prevention.
A CCEA A-Level Nutrition and Food Science answer on coronary heart disease: atherosclerosis and the role of blood cholesterol, saturated fat and salt, the dietary, lifestyle and non-modifiable risk factors, the consequences, and the dietary advice for prevention.
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What this dot point is asking
CCEA wants you to explain coronary heart disease (CHD): the process of atherosclerosis, the link between blood cholesterol, saturated fat and salt and the disease, the dietary, lifestyle and non-modifiable risk factors, the consequences, and the dietary advice that reduces risk.
Atherosclerosis and the cholesterol link
A high intake of saturated and trans fat raises the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL is deposited in the artery walls, forming plaques that narrow and harden the arteries. Reduced blood flow to the heart muscle causes angina (chest pain on exertion); if a plaque ruptures and a clot blocks the artery, the heart muscle is starved of oxygen and a heart attack (myocardial infarction) results. A high salt intake raises blood pressure, adding strain to the arteries and heart.
Prevention and dietary advice
Because several risks compound, the advice is to change the whole diet and lifestyle rather than one factor. Current research and policy (the SACN saturated-fat review, salt-reduction targets and reformulation) underpin this guidance, and CCEA expects you to connect the science to the recommendations.
Examples in context
Example 1. The Mediterranean-style swap. A person replaces fried and processed foods with olive oil, oily fish, wholegrains, pulses, fruit and vegetables. This lowers saturated fat and salt while raising unsaturated fat, omega-3 and soluble fibre, which together lower blood cholesterol and blood pressure. Over time this reduces atheroma formation, showing the dietary advice working through the cholesterol mechanism.
Example 2. Population salt reduction. When manufacturers reformulate bread, processed meat and sauces to contain less salt, average blood pressure across the population falls, lowering rates of CHD and stroke. This illustrates how government strategy on a single nutrient can reduce a major disease at scale, connecting CHD to the guidelines content.
Try this
Q1. Name the process by which fatty deposits build up in the coronary arteries. [1 mark]
- Cue. Atherosclerosis (forming atheroma).
Q2. Explain how a high salt intake increases the risk of coronary heart disease. [2 marks]
- Cue. It raises blood pressure, which strains the arteries and heart and increases CHD risk.
Q3. State two pieces of dietary advice that help reduce the risk of coronary heart disease. [2 marks]
- Cue. Any two of: reduce saturated fat and replace with unsaturated, cut salt below 6 g, eat oily fish, increase soluble fibre and fruit and vegetables.
Exam-style practice questions
Practice questions written in the style of CCEA exam questions on this dot point, with worked answer explainers. The year tag is the paper they imitate, not the source.
CCEA AS 20198 marksDiscuss the dietary and lifestyle factors that increase the risk of coronary heart disease, and explain the dietary advice given to reduce that risk.Show worked answer →
An 8-mark answer needs the risk factors (modifiable and non-modifiable), the mechanism, and the dietary advice.
Coronary heart disease develops through atherosclerosis, in which fatty deposits (atheroma) containing cholesterol build up in the walls of the coronary arteries. This narrows the arteries and reduces blood and oxygen supply to the heart muscle, causing angina; if a vessel is blocked by a clot, a heart attack (myocardial infarction) follows.
Dietary risk factors include a high intake of saturated and trans fat, which raises blood LDL cholesterol deposited in artery walls, a high salt intake, which raises blood pressure, and an excess of energy leading to obesity. Lifestyle risk factors include smoking, physical inactivity, excessive alcohol and stress. Non-modifiable factors include increasing age, being male, and a family history of the disease.
Dietary advice is to reduce saturated fat to no more than about 11 percent of food energy and replace some with unsaturated fat, eat oily fish for omega-3, cut salt to no more than 6 grams a day, eat more fruit, vegetables and soluble fibre (such as oats) to help lower cholesterol, and maintain a healthy weight.
Markers reward the atherosclerosis mechanism, at least two dietary and two lifestyle risk factors, a non-modifiable factor, and clear dietary advice with reasons for the higher marks.
CCEA AS 20214 marksExplain how a high intake of saturated fat can increase the risk of coronary heart disease.Show worked answer →
A 4-mark answer needs the cholesterol mechanism linking saturated fat to the disease.
A high intake of saturated fat raises the level of low-density lipoprotein (LDL) cholesterol in the blood. LDL cholesterol is deposited in the walls of the arteries, forming fatty plaques (atheroma) in a process called atherosclerosis.
These plaques narrow and harden the coronary arteries, reducing the flow of oxygen-rich blood to the heart muscle. This can cause angina, and if a plaque ruptures and a clot blocks the artery, a heart attack results. Replacing some saturated fat with unsaturated fat helps lower LDL and the risk.
Markers reward raised LDL cholesterol, deposition in artery walls (atheroma/atherosclerosis), narrowing reducing blood supply, and the consequence of angina or heart attack.
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Sources & how we know this
- CCEA GCE Nutrition and Food Science specification — CCEA (2016)
- Saturated fats and health (SACN report) — Scientific Advisory Committee on Nutrition (2019)