1. Role of nutrition in prevention of cardiovascular diseases

Cardiovascular disease = CVD
- Ischaemic heart disease
- Stroke
Epidemiology of cardiovascular disease
- CVD is the leading cause of death in the world
Risk factors for CVD
- Behavioural (modifiable)
  - Behavioural risk factors are responsible for about 80% of CVD
  - Unhealthy diet
  - Physical inactivity
  - Tobacco use
  - Harmful use of alcohol
- Non-modifiable
  - Family history
  - Old age
2018 study in British Medical Journal (BMJ):
- Healthy dietary patterns can decrease the effect of genetic factors that would otherwise predispose to obesity.
- Also, improved diet quality had a more significant effect on people with high genetic risk for obesity.
2012 Cochrane review:
- Reducing saturated fat in diet decreases risk for cardiovascular disease by 14%
2014 study in BMJ:
- Replacing saturated fat in diet with polyunsaturated fat did not decrease risk for cardiovascular disease (later studies contradict this, but those studies are not mentioned in the lecture)
Oslo diet heart study:
- Diet low in saturated fat, cholesterol and high in polyunsaturated fat -> reduced serum cholesterol, reduced cardiovascular disease
Lyon diet heart study:
- Diet low in saturated fat, high in unsaturated fat -> reduced cardiovascular mortality
Stanford coronary risk intervention project (SCRIP):
- Low fat, saturated fat, cholesterol diet + exercise -> decreased dyslipidaemia, decreased cardiovascular disease

Cardiometabolic risk

The risk for developing diabetes, heart disease or stroke (basically metabolic syndrome)
The risk factors for atherosclerosis, obesity, and cardiovascular disease are all the same or very similar
Risk factors:
- Hypertension
- Inflammation
- Age
- Race
- Gender
- Family history
- Dyslipidaemia
- Overweight
- Insulin resistance
- Smoking
- Physical inactivity
- Unhealthy eating

Benefits of fish oils:

Fish oils contain omega-3 (n-3, ω-3) polyunsaturated fatty acids (PUFAs)
DART trial: Men with cardiovascular disease who increased intake of fish or used fish oil tablets had reduced cardiovascular mortality
GISSI trial: Men and women with cardiovascular disease who took 1 g omega-3 daily decreased the number of cardiovascular events

Other nutrients

Nurses health study:
- Increased nut intake -> decreased risk for cardiovascular events
PREDIMED study:
- Increased nut intake -> decreased cardiovascular mortality
Zhaoli meta-analysis:
- Increased soy intake -> decreased cardiovascular risk
Phytosterol-supplemented foods intake -> decreased LDL-cholesterol
Increased intake of garlic -> decreased total cholesterol

Recent changes in the view of associated between diet and cardiovascular disease

Dietary cholesterol is not the major determinant of blood cholesterol
Individual nutrients may not be responsible for risk, but rather complex foods
- Example: Increased consumption of fish is better than omega-3 fat supplementation

Vitamin D

Therapeutic lifestyle changes (TLC) in LDL-lowering therapy:

Nutrients	Recommended intake
Saturated fat	< 7% of total calories
Polyunsaturated fat	< 10% of total calories
Monounsaturated fat	< 20% of total calories
Total fat	25 – 35% of total calories
Carbohydrate	50 – 60% of total calories
Fibre	20 – 30g daily
Protein	15% of total calories
Cholesterol	< 200mg/day
Total calories	Balanced so that body weight is stable or reached desirable levels

Summary:

Reducing LDL levels is beneficial for preventing cardiovascular disease or events
Decreased saturated fat intake
Decreased total fat intake
Decreased trans fat intake
Increase unsaturated fat intake
Increased fibre intake
Sufficient vitamin D intake
Increased fish consumption
Decreased weight
Increased intake of plant sterols
Decreased dietary cholesterol
Increased physical activtiy
See also Mediterranean diet, DASH diet