Coronary Heart Disease: Nutritional Interventions for Prevention and Therapy

Desiree Schliemann, Jayne V. Woodside, Claire T. McEvoy, and Norman J. Temple Key Points

  • • Coronary heart disease (CHD) is a major cause of morbidity and mortality in the Western world.
  • • Diets high in trans fats, processed meat, and added sugar can increase CHD risk.
  • • Evidence suggests that increased consumption of fatty fish and of n-3 polyunsaturated fatty acids (n-3 PUFA) is likely to reduce CHD risk.
  • • While supplementation with antioxidants is unlikely to reduce CHD risk, diets rich in these micronutrients (e.g., diets rich in fruits, vegetables, and whole grain cereals) are associated with lower CHD risk.
  • • Adhering to a Mediterranean diet has been shown to reduce CHD risk in both the primary and secondary prevention settings.
  • • Maintaining a healthy weight and being physically active have each been shown to reduce CHD risk factors and CHD incidence.

Keywords Cardiovascular risk factors • Coronary heart disease • Prevention

Introduction

Coronary heart disease (CHD) is a major cause of morbidity and mortality in the Western world. Factors that are strongly associated with elevated risk of CHD are increasing age, male sex, smoking, lack of exercise, hypertension, obesity, and type 2 diabetes. In addition, blood lipid levels are strong predictors of CHD risk. A pattern of blood lipids that accelerates atherosclerosis is one where total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are elevated and high-density lipoprotein (HDL-C) is relatively low [1]. A 1% reduction in circulating LDL-C is associated with a reduction in CHD risk of about 1% [2]. Research in recent years has added C-reactive protein (CRP), a biomarker of inflammation, to the list of risk factors.

D. Schliemann, B.Sc. • J.V. Woodside, Ph.D. (*) • C.T. McEvoy, Ph.D.

Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland BT12 6BJ, UK e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

N.J. Temple, Ph.D.

Centre for Science, Athabasca University, Athabasca, AB, Canada © Springer International Publishing AG 2017

N.J. Temple et al. (eds.), Nutrition Guide for Physicians and Related Healthcare Professionals, Nutrition and Health, DOI 10.1007/978-3-319-49929-1_11

A large body of evidence, collected over several decades from observational epidemiological studies and randomized controlled clinical trials (RCTs), strongly supports a major role for diet in the prevention and treatment of CHD. (Epidemiological studies refer mainly to prospective cohort studies and case-control studies). Dietary factors that have been proposed to affect the risk of CHD include saturated fatty acids (SFA), trans fatty acids (TFA), polyunsaturated fatty acids (both n-6 and n-3 PUFA), non-milk extrinsic sugars, dietary fiber, antioxidant vitamins, and vitamin D. This chapter examines how each of these food components, as well as whole dietary patterns, affects CHD risk. Obesity and exercise are also considered. Early studies focused on the effect of diet on blood lipids, but it is now accepted that diet affects CHD etiology through multiple mechanisms, including insulin resistance, blood pressure, endothelial function, inflammation, and thrombosis.

 
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