Nutritional Advice for the Patient With Heart Disease

Abstract

Cardiovascular disease is the number one cause of death in the United States (the Table).1 The question stated in the title of this patient page is one of the most commonly asked queries by patients with cardiovascular disease in the offices of primary care physicians and cardiologists. Similarly, residents often ask, “What diet should we order for our inpatients with atherosclerosis?” Clearly, the American public believes that we are what we eat. It is not surprising that in our society, with its abundant supply of inexpensive, high-calorie food, this is a subject of consummate interest. View this table: Table. Heart Disease Facts From the AHA There can be little doubt that the Western diet is closely tied to the development of atherosclerosis. The mechanisms leading to atherosclerosis, or hardening of the arteries, involve, among other factors, elevated blood lipid (fat) values that, in part, reflect both the quantity and quality of fat in an individual's diet. Large amounts of saturated fat in the diet, combined with obesity, predict elevated blood lipids and a high chance of developing atherosclerotic vascular disease, which leads to heart attacks and strokes. For more than 50 years, population studies and experiments in animals have supported the idea that the Western diet, rich in saturated fat, was a major factor leading to atherosclerosis, heart attacks, and stroke. When the relationship between diet and atherosclerosis was first understood, cardiologists, internists, family physicians, and dieticians recommended that all Americans, and particularly those with elevated blood lipid values or a family history of coronary heart disease at younger ages, follow a diet reduced in saturated fat and cholesterol. Later studies demonstrated that it was the degree of saturated fat more than the amount of cholesterol in the diet that led to atherosclerosis. The amount of cholesterol in the diet was shown …