1. Role of nutrition in prevention of cardiovascular diseases

From greek.doctor
  • 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

  • High serum vitamin D concentration -> decreased cardiovascular events
  • Hypovitaminosis D leads to:
    • Decreased anti-inflammatory cytokines
    • Increased pro-inflammatory cytokines
    • Increased inflammation -> increased atherosclerosis
    • Increased angiotensin II activity -> increased myocardial remodelling
    • Increased insulin resistance

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
  • TLC can reduce LDL levels by 20 – 30%

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