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Cardiovascular Disease and Diet

Cardiovascular disease (CVD) is the major killer of adults in our population and accounts for ~ 40% of all deaths in the US (2001). It is estimated that approximately 64,400,000 Americans have one or more types of CVD. [1] Risk factors for CVD include: age (Male>45, Female >55), smoking, diabetes, hypertension, family history and serum cholesterol levels of >200 mg/dl) [2]. Other factors such as an elevated serum homocysteine level (>10.0 umol/L) or elevated "highly sensitive" C-reactive protein (>2mg/L) are also being explored as independent risk factors [3], [4].

Current national recommendations for the prevention and treatment of cardiovascular disease include life style changes in diet and exercise for 3-6 months as a first approach in persons who have not had a heart attack and lifestyle modifications and medications (usually statins) in those who have already had a heart attack (NCEP III, [2]. Guidelines for targeted levels of total cholesterol, LDL-cholesterol and HDL-cholesterol are presented in this document [1] and appear at the government NHLBI website. The lifestyle intervention component of the recommendations is identified as the Therapeutic Lifestyle Changes (TLC diet) and it focuses on decreasing saturated fat and dietary cholesterol by decreasing animal products in general, especially red meat and full fat dairy products while increasing fruits, vegetables, whole grains and legumes to increase fiber intake, especially soluble fiber. Current data suggests that as much as 82% of our risk of CVD can be attributed to lifestyle habits of lack of exercise, inappropriate eating patterns, smoking and weight gain [5].

The mechanism by which saturated fat and dietary cholesterol increase ones risk of CVD is known since these products in the blood cause decreased production of receptors that remove the lipids from our blood and also decrease the activity of these receptors to be maximally effective [6], [7]. High fiber diets, especially soluble fiber binds cholesterol in the intestinal track and increases its removal via fecal output, thereby decreasing the amount that is re-absorbed from the intestines and recirculates in the blood.

International studies, case-control studies, cohort studies and intervention studies have supported the importance of diet in the development and treatment of CVD [8]. The Lyon study [9] that increased intake of polyunsaturated fat and decreased saturated fat by a substitution of a margarine high in polyunsaturated fat, over the usual spread of the population showed a maximum of a 65% reduction in heart attacks compared to the control group over a period of 5 years (p<0.01).

Data on effective changes in dietary eating patterns indicate that intense weekly sessions of 6-10 weeks, followed by monthly and then quarterly support (usually in group session) is often necessary to accomplish the dietary goals associated with significant reduced risk. An effective delivery plan for teaching lifestyle changes of diet and exercise for persons at increased risk for CVD is currently not in place.

An alternative approach to diet and prevention of CVD has been the study of the beneficial effects of specific foods such as: apples, pears, garlic, soy protein, flax seed, fish/fish oil, barley, etc. These items need to be searched in the literature database under the specific foods [10]. Use of herbal supplements and vitamin supplements in the prevention and treatment of CVD should be searched under "Herbals" and under "Vitamin supplements."

Resources and Links (Interventions):

1. NCEP III
2. American Heart Association Diet
• AHA Dietary Guidelines Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association
• An Eating Plan for Healthy Americans
• Dietary Guidelines for Health Americans
• Dietary Guidelines for Health Children
3. Pritikin Diet
4. Dean Ornish Diet and Program
5. Vegetarian Diet
• Major Types of Vegetarianism
  (from the American Heart Association)
  • Lactovegetarian: Plant foods, cheese and other dairy products.
  • Ovo-lactovegetarian (or lacto-ovovegetarian): Plant foods, cheese and other dairy products and eggs.
  • Partial or Semi-vegetarian: Plant foods, dairy products, eggs, chicken and fish.
• Vegetarian Diet
  American Dietetics Association
  Position statement, health and nutrition considerations, use throughout lifecycle, meal planning.
  Includes 44 references from medical journals and books.
• Vegetarian Nutrition Resource List
  National Agricultural Library, USDA
  Links to web resources, and bibliography of books, pamphlets and articles.
• Vegetarian Diets
  American Heart Association
  FAQ answering commonly asked questions.
• Lacto-Ovo Vegetarian Cuisine National Heart, Lung and Blood Institute, NIH
  
6. Vegan Diet - foods of plant origin only
   

Resources and Links (Conditions):

1. Cardiovascular Health Program
   National Center for Chronic Disease Prevention and Health Promotion
2. Cardiovascular Information
   National Heart, Lung, and Blood Institute
3. Vascular Diseases
   Society of Interventional Radiology
4. Research Reported in Medical Journals
   • Hooper, L. Summerbell, CD. Higgins, JPT. Thompson, RL. Clements, G. Capps, N. Davey Smith, G. Riemersma, RA. Ebrahim, S. Reduced or modified dietary fat for preventing cardiovascular disease. [Systematic Review] Cochrane Heart Group Cochrane Database of Systematic Reviews. Issue 3, 2002.
     (This links to abstract only. For electronic full-text use Ovid, search EBM Cochrane Database of Systematic Reviews database by title keyword.