Traditional Dietary Recommendations for the Prevention of Cardiovascular Disease: Do They Meet the Needs of Our Patients?

The characteristics of patients with CVD have changed: whereas smoking prevalence declines, obesity and metabolic syndrome are on the rise. Unfortunately, the traditional low-fat diet for the prevention of cardiovascular disease (CVD) still seems to be the “mainstream knowledge” despite contradicting evidence. But lowering LDL-cholesterol by the wrong diet even may be counterproductive, if sd-LDL is raised and HDL is lowered. New insights into the pathophysiology of insulin resistance and its influence on the effects of dietary changes have led to a better approach: (1) the higher a patient's insulin resistance, the more important is the glycemic load of the diet. (2) Fat quality is much more important than fat quantity. (3) The best principle for a reduced calorie intake is not fat counting, but a high volume diet with low energy density, which means fibre rich vegetables and fruits. (4) And finally, satiation and palatability of a diet is very important: there is no success without the patient's compliance. Thus, the best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly.

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Association between plasma fatty acids and inflammatory markers in patients with and without insulin resistance and in secondary prevention of cardiovascular disease, a cross-sectional study

Nutrition Journal ◽

10.1186/s12937-018-0342-1 ◽

2018 ◽

Vol 17 (1) ◽

Cited By ~ 9

Author(s):

Ângela Cristine Bersch-Ferreira ◽

Geni Rodrigues Sampaio ◽

Marcella Omena Gehringer ◽

Elizabeth Aparecida Ferraz da Silva Torres ◽

Maria Beatriz Ross-Fernandes ◽

...

Keyword(s):

Insulin Resistance ◽

Cardiovascular Disease ◽

Fatty Acids ◽

Secondary Prevention ◽

Inflammatory Markers ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Plasma Fatty Acids ◽

Prevention Of Cardiovascular Disease

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Prepregnancy adherence to dietary recommendations for the prevention of cardiovascular disease in relation to risk of hypertensive disorders of pregnancy

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa214 ◽

2020 ◽

Vol 112 (6) ◽

pp. 1429-1437 ◽

Cited By ~ 1

Author(s):

Mariel Arvizu ◽

Jennifer J Stuart ◽

Janet W Rich-Edwards ◽

Audrey J Gaskins ◽

Bernard Rosner ◽

...

Keyword(s):

Cardiovascular Disease ◽

General Population ◽

Gestational Hypertension ◽

Health Study ◽

Hypertensive Disorders Of Pregnancy ◽

Dietary Recommendations ◽

Cvd Risk ◽

Adherence To Diet ◽

Hypertensive Disorders ◽

Prevention Of Cardiovascular Disease

ABSTRACT Background It is unclear whether adherence to diet recommendations for the prevention of cardiovascular disease (CVD) in the general population is also related to the risk of hypertensive disorders of pregnancy, including pre-eclampsia and gestational hypertension (GHTN). Objectives The aim was to evaluate the relation of prepregnancy adherence to the American Heart Association (AHA) diet recommendations and the Dietary Approaches to Stop Hypertension (DASH) with the risk of pre-eclampsia and GHTN. Methods Between 1991 and 2009, we prospectively followed 16,892 singleton pregnancies among 11,535 women who participated in the Nurses’ Health Study II. Prepregnancy diet was assessed every 4 y, from which we calculated dietary pattern scores from the DASH diet (8 components) and the diet recommendations from the AHA 2020 Strategic Impact Goals (primary score: 5 components; secondary score: primary score plus 3 components). Pregnancy outcomes were self-reported, and we estimated the RR (95% CI) of pre-eclampsia and GHTN with log-binomial regression using generalized estimating equations to account for repeat pregnancies and adjusting for potential confounders. Results Women had a mean (SD) age of 34.4 (34.0) y at pregnancy. Pre-eclampsia was reported in 495 (2.9%) pregnancies and GHTN in 561 (3.3%) pregnancies. The RR (95% CI) of pre-eclampsia for women in the highest quintile of the DASH was 0.65 (0.48, 0.87) compared with women in the lowest score quintile. A similar inverse trend was observed for the AHA primary (0.74; 95% CI: 0.55, 1.00) and secondary (0.81; 95% CI: 0.61, 1.07) scores comparing women in the highest versus the lowest score quintile. Neither the DASH nor the AHA scores were related to GHTN. Conclusions Women with higher adherence to dietary recommendations for the prevention of CVD in the general population had a lower risk of pre-eclampsia—a common pregnancy complication related to higher CVD risk among women—than women with lower adherence to these recommendations.

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Alternative Dietary Patterns for Americans: Low-Carbohydrate Diets

Nutrients ◽

10.3390/nu13103299 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3299

Author(s):

Jeff S. Volek ◽

Stephen D. Phinney ◽

Ronald M. Krauss ◽

Richard J. Johnson ◽

Laura R. Saslow ◽

...

Keyword(s):

Insulin Resistance ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Dietary Patterns ◽

Wide Spectrum ◽

Evidence Base ◽

Dietary Guidelines ◽

Dietary Carbohydrate ◽

Eating Pattern ◽

Low Carbohydrate

The decades-long dietary experiment embodied in the Dietary Guidelines for Americans (DGA) focused on limiting fat, especially saturated fat, and higher carbohydrate intake has coincided with rapidly escalating epidemics of obesity and type 2 diabetes (T2D) that are contributing to the progression of cardiovascular disease (CVD) and other diet-related chronic diseases. Moreover, the lack of flexibility in the DGA as it pertains to low carbohydrate approaches does not align with the contemporary trend toward precision nutrition. We argue that personalizing the level of dietary carbohydrate should be a high priority based on evidence that Americans have a wide spectrum of metabolic variability in their tolerance to high carbohydrate loads. Obesity, metabolic syndrome, and T2D are conditions strongly associated with insulin resistance, a condition exacerbated by increased dietary carbohydrate and improved by restricting carbohydrate. Low-carbohydrate diets are grounded across the time-span of human evolution, have well-established biochemical principles, and are now supported by multiple clinical trials in humans that demonstrate consistent improvements in multiple established risk factors associated with insulin resistance and cardiovascular disease. The American Diabetes Association (ADA) recently recognized a low carbohydrate eating pattern as an effective approach for patients with diabetes. Despite this evidence base, low-carbohydrate diets are not reflected in the DGA. As the DGA Dietary Patterns have not been demonstrated to be universally effective in addressing the needs of many Americans and recognizing the lack of widely available treatments for obesity, metabolic syndrome, and T2D that are safe, effective, and sustainable, the argument for an alternative, low-carbohydrate Dietary Pattern is all the more compelling.

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Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

10.20944/preprints201705.0135.v1 ◽

2017 ◽

Author(s):

Michelle A. Briggs ◽

Kristina S. Petersen ◽

Penny M. Kris-Etherton

Keyword(s):

Cardiovascular Disease ◽

Fatty Acids ◽

Unsaturated Fatty Acids ◽

Saturated Fatty Acids ◽

Saturated Fat ◽

Dietary Guidelines ◽

Dietary Recommendations ◽

Cvd Risk ◽

Dairy Fat ◽

Refined Carbohydrates

Dietary recommendations to decrease the risk of cardiovascular disease (CVD) have focused on reducing intake of saturated fatty acids (SFA) for more than 50 years. While the 2015-2020 Dietary Guidelines for Americans advise substituting both monounsaturated and polyunsaturated fatty acids for SFA, evidence supports other nutrient substitutions that will also reduce CVD risk. For example, replacing SFA with whole grains, but not refined carbohydrates, reduces CVD risk. Replacing SFA with protein, especially plant protein may also reduce CVD risk. While dairy fat (milk, cheese) is associated with a slightly lower CVD risk compared to meat, dairy fat results in a significantly greater CVD risk relative to unsaturated fatty acids. As research continues, we will refine our understanding of dietary patterns associated with lower CVD risk.

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Cost effectiveness of cardiovascular disease prevention strategies: a perspective on EU food based dietary guidelines

Public Health Nutrition ◽

10.1079/phn2001161 ◽

2001 ◽

Vol 4 (2b) ◽

pp. 711-715 ◽

Cited By ~ 41

Author(s):

Eric Brunner ◽

David Cohen ◽

Lynn Toon

Keyword(s):

Cardiovascular Disease ◽

Cost Effectiveness ◽

Healthy Eating ◽

Health Gain ◽

Cost Effective ◽

Dietary Guidelines ◽

Member States ◽

Eu Member States ◽

Health Gains ◽

Prevention Of Cardiovascular Disease

AbstractFor policymakers considering strategy options for the prevention of cardiovascular disease (CVD) the distinction between effectiveness and cost effectiveness is critical. When cost limitations apply, an evaluation of cost effectiveness is essential if a rational decision is to be made. Policy changes and resource reallocation have opportunity costs, and therefore it is necessary to compare the cost of health gains achievable by means of different policies. Here the broad question is: How cost effective are diet change strategies compared to other measures aimed at reducing cardiovascular disease in EU member states?An overview of published studies of cost effectiveness in the primary and secondary prevention of cardiovascular disease was conducted. Few comprehensive studies were available.Estimated costs per life year gained were as follows: population-based healthy eating £14–560; smoking cessation £300–790; nurse screening and life style advice £900 (minimum); simvastatin (HMGCoA reductase inhibitor) £6200–11 300. Cost effectiveness is dependent on the underlying level of CVD risk in the target population, and the duration of the achieved alterations in behaviours and risk factors.The limited evidence from these studies tends to support the view that health protection strategies which promote healthy eating are likely to be more cost-effective than strategies involving modern cholesterol-lowering drugs, screening and advice in primary care, and are comparable to or less expensive per year of life saved than anti-smoking strategies. Given the considerable diversity in food habits, health care and public health systems among current and prospective EU member states, careful appraisal of the policy options within each member state is desirable to ensure that health gain is maximised. EU wide food based dietary guidelines are potentially the basis of large health gains in Europe, and cost-effectiveness studies tend to support their adoption.

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Evidence For and Against Dietary Recommendations to Prevent Cardiovascular Disease

Texas Heart Institute Journal ◽

10.14503/thij-15-5072 ◽

2015 ◽

Vol 42 (3) ◽

pp. 234-236 ◽

Cited By ~ 5

Author(s):

Theresa Dildy

Keyword(s):

Cardiovascular Disease ◽

Saturated Fatty Acids ◽

Low Density Lipoprotein ◽

Saturated Fat ◽

Density Lipoprotein ◽

Dietary Guidelines ◽

Dietary Recommendations ◽

Fresh Meat ◽

The Public ◽

Whole Foods

Evidence-based dietary guidelines for the prevention of cardiovascular disease have changed significantly over the past 9 years. Now less emphasis is placed on total dietary fat and cholesterol restriction and more emphasis on restricting saturated fat. The public outcry to stop demonizing saturated fats has been around for some time. We are now hearing more agreement from medical researchers and clinicians alike, as they become aware of evidence that some saturated fatty acids are not harmful and some are actually beneficial. Another criticism of the dietary guidelines is their failure to look at more meaningful outcomes in research. Instead of using low-density-lipoprotein cholesterol to measure risk, they should use markers for inflammation, obesity, diabetes mellitus, and metabolic syndrome—all well-known risk factors for cardiovascular disease. Perhaps the recommendations that arise from dietary research would be more meaningful if they were presented more simply: in terms of whole foods (like dairy products and fresh meat), rather than nutrients (like saturated fat).

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SEA/SEMERGEN 2019 consensus document 2019. Dietary recommendations in the prevention of cardiovascular disease

Clínica e Investigación en Arteriosclerosis (English Edition) ◽

10.1016/j.artere.2019.02.006 ◽

2019 ◽

Vol 31 (4) ◽

pp. 186-201

Author(s):

Vicente Pascual ◽

Pablo Perez Martinez ◽

José Manuel Fernández ◽

Rosa Solá ◽

Vicente Pallarés ◽

...

Keyword(s):

Cardiovascular Disease ◽

Dietary Recommendations ◽

Consensus Document ◽

Prevention Of Cardiovascular Disease

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Adherence to international dietary recommendations in association with all-cause mortality and fatal and non-fatal cardiovascular disease risk: a prospective analysis of UK Biobank participants

BMC Medicine ◽

10.1186/s12916-021-02011-7 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Maryam Kebbe ◽

Min Gao ◽

Aurora Perez-Cornago ◽

Susan A. Jebb ◽

Carmen Piernas

Keyword(s):

Cardiovascular Disease ◽

Lower Risk ◽

Fruits And Vegetables ◽

Dietary Guidelines ◽

Uk Biobank ◽

Dietary Recommendations ◽

Cross Sectional ◽

Free Sugars ◽

Saturated Fats ◽

All Cause Mortality

Abstract Background International dietary guidelines aim to reduce risks of all-cause mortality, cardiovascular disease (CVD), and fatal CVD often associated with poor dietary habits. However, most studies have examined associations with individual nutrients, foods, or dietary patterns, as opposed to quantifying the pooled health effects of adherence to international dietary recommendations. We investigated associations between total adherence to the World Health Organization (WHO) dietary recommendations for saturated fats, free sugars, fibre, and fruits and vegetables and all-cause mortality and fatal and non-fatal CVD. Methods We included participants from the UK Biobank cohort recruited in 2006–2010, which provided at least two valid 24-h dietary assessments. We defined adherence to dietary recommendations as ≤ 10% saturated fats, ≤ 10% free sugars, ≥ 25 g/day fibre, and ≥ 5 servings of fruits and vegetables/day. Multivariable Cox-proportional hazards models were used to investigate prospective associations with all-cause mortality and fatal and non-fatal CVD. In cross-sectional analyses, multivariable linear regression was used to examine associations with cardiometabolic risk factors. Results Among 115,051 participants (39–72 years), only 29.7%, 38.5%, 22.3%, and 9.5% met 0, 1, 2, or 3–4 recommendations, respectively. There was a lower risk of all-cause mortality among participants meeting more dietary recommendations (Ptrend < 0.001), with a significantly lower risk among participants meeting 2: HR 0.91 (95% confidence interval [CI] 0.85–0.97) and 3–4: HR 0.79 (95% CI 0.71–0.88) recommendations. There was no trend with CVD risk, but a significantly lower risk of fatal CVD with 3–4 recommendations: HR 0.78 (95% CI 0.61–0.98). Meeting more recommendations resulted in significant cross-sectional trends (Ptrend < 0.001) towards lower body fat, waist circumference, LDL cholesterol, apolipoprotein B, triglycerides, alkaline phosphatase, gamma glutammyltransferase, and hs-CRP, but higher glucose and aspartate aminotransferase. Conclusions Meeting dietary recommendations is associated with additive reductions in premature mortality. Motivating and supporting people to adhere to dietary guidelines may help extend years of healthy life expectancy.

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