Cardioprotective Diet Research Articles

Dietary management of heart failure: room for improvement?

There is growing awareness of the role of diet in both health and disease management. Much data are available on the cardioprotective diet in the primary and secondary prevention of CVD. However, there is limited information on the role of diet in the management of heart failure (HF). Animal models of HF have provided interesting insight and potential mechanisms by which dietary manipulation may improve cardiac performance and delay the progression of the disease, and small-scale human studies have highlighted beneficial diet patterns. The aim of this review is to summarise the current data available on the role of diet in the management of human HF and to demonstrate that dietary manipulation needs to progress further than the simple recommendation of salt and fluid restriction.

Experimental Colitis Is Attenuated by Cardioprotective Diet Supplementation That Reduces Oxidative Stress, Inflammation, and Mucosal Damage.

Inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD) are multifactorial, relapsing disorders of the gastrointestinal tract. However, the etiology is still poorly understood but involves altered immune responses, epithelial dysfunction, environmental factors, and nutrition. Recently, we have shown that the diet supplement corabion has cardioprotective effects due to reduction of oxidative stress and inflammation. Since oxidative stress and inflammation are also prominent risk factors in IBD, we speculated that corabion also has beneficial effects on experimental colitis. Colitis was induced in male mice by administration of 3.5% (w/v) dextran sulfate sodium (DSS) in drinking water for a period of 3 or 7 days with or without daily gavage feeding of corabion consisting of vitamin C, vitamin E, L-arginine, and eicosapentaenoic and docosahexaenoic acid. We found that corabion administration attenuated DSS-induced colon shortening, tissue damage, and disease activity index during the onset of colitis. Mechanistically, these effects could be explained by reduced neutrophil recruitment, oxidative stress, production of proinflammatory cytokines, and internalization of the junctional proteins ZO-1 and E-cadherin leading to less edema formation. Thus, corabion may be a useful diet supplement for the management of chronic inflammatory intestinal disorders such as IBD.

Self-reported health-related behaviors and dietary habits in patients with metabolic syndrome.

There is an ongoing debate about factors affecting the maintenance of a healthy lifestyle especially in the population without coronary artery disease (CAD) symptoms and with one or several risk factors. The study was aimed at describing self-reported health-related behaviors and dietary habits in patients with metabolic syndrome (MetS). Consecutive patients with an outpatient diagnosis of MetS admitted to our cardiology department underwent clinical examination and cardiovascular risk assessment based on the SCORE scale. Self-reported intensity of pro-healthy behaviors was described using the Health Behavior Inventory (HBI) developed by Juczynski. Diet quality was assessed using the 24-h dietary recall method, diet history questionnaire and the Healthy Eating Index-2010 (HEI). A total of 113 patients were recruited (90 males, mean age 48 ± 9 years) including 85% of patients with at least moderate cardiovascular risk (SCORE ≥ 1%). Central obesity was confirmed in 100%, family history of CAD in 75%, LDL exceeding 115 mg/dL in 68% of the patients. A total of 66% of the patients had already been on antihypertensive and 30% on lipid-lowering treatment without previous counselling on lifestyle modification. Most patients reported high or medium level health-related behaviors (23% and 45%, respectively). However, 91% led sedentary lifestyle and none of the patients followed cardioprotective diet recommendations. According to the HEI, 73% required partial and 27% complete diet modification. There is a significant discrepancy between health perception and medical recommendations in patients with MetS. Effective patient education, taking into account a revision of the patient's knowledge on the principles of prophylaxis, may form the fundament for the changes in patient behavior, and cardiovascular risk reduction.

New insights into the role of nutrition in CVD prevention.

Nutrition plays an increasingly significant role in lifestyle strategies for cardiovascular prevention. Foods and dietary patterns that encompass specific foods and beverages and their combinations, with synergies among their components, are the subject of much epidemiologic and clinical research in relation to health issues, including cardiovascular disease. Foods with the highest evidence for beneficial effects on cardiovascular outcomes (mainly fatal and nonfatal coronary artery disease and stroke) and intermediate risk markers (principally cholesterol and blood pressure) are fruits and vegetables, legumes, nuts, whole grains, dairy products, fish, and alcohol consumed in moderation. Epidemiologic and clinical trial evidence on cardiovascular health issues is reviewed for these foods and for the dietary pattern with the highest probability of a causal link with cardiovascular protection, namely the Mediterranean diet. When pertinent, mechanisms of protection derived from specific nutrients in foods are also examined. The explosion of knowledge in cardioprotective foods and diets needs to be translated to the public, as dietary quality is still far from optimal in large segments of the population.

The effect of cardioprotective diet rich with natural antioxidants on chronic inflammation and oxidized LDL during cardiac rehabilitation in patients after acute myocardial infarction

BackgroundChronic inflammation, the fundamental pathogenetic process of atherosclerosis, can be modified by pharmacological and non-pharmacological measures as a part of secondary prevention after acute myocardial infarction (AMI). The aim of our study was to determine the effect of diet, rich with natural antioxidants, added to physical activity (as a part of cardiac rehabilitation (CR) program) on inflammatory markers and ox-LDL, a marker of oxidative stress, closely involved in the process of chronic inflammation. Methods41 male patients after AMI undergoing CR were divided into a diet group (supervised cardioprotective diet throughout the CR), and control group (CR without diet). We measured hsCRP, leucocytes, neutrophils, IL-6, oxLDL, exercise capacity and classic risk factors before and after CR program. ResultsPatients from the diet group presented with a significant decline in classic risk factors (BMI, waist circumference, waist to hip ratio, systolic blood pressure, heart rate, blood glucose, total cholesterol, LDL, TAG) and inflammatory markers (hsCRP, leucocytes, neutrophils) compared to control group. Furthermore, when studying nonsmokers, we observed significant decline of oxLDL in the diet group. ConclusionsThe addition of cardioprotective diet, rich with natural antioxidants, to physical activity as a part of a CR program, positively modifies not just classic risk factors and exercise capacity, but also diminishes chronic inflammation markers. These effects, and oxLDL decline were most prominent in nonsmoking patients.

The effects of centre-based rehabilitation after acute myocardial infarction on exercise capacity and risk factors for coronary heart disease

Background Rehabilitation following acute myocardial infarction (AMI) is a crucial part of secondary prevention for coronary heart disease. The aim of our study was to determine the efficiency of our national in-patient rehabilitation program in improving exercise capacity and lowering risk factors for coronary heart disease. Methods 25 patients 3-9 weeks after AMI, undergoing 2 week in-patient cardiac rehabilitation, were included in our study. We performed exercise stress testing and measurement of classic risk factors before and after the rehabilitation. Classic risk factors were compared with 25 age matched adults without known risk factors for coronary heart disease. Results Patients after AMI had lower exercise capacity than healthy adults (p≤0.002 for double product, maximal load, systolic blood pressure, heart rate and time of load). Patients recieved appropriate drug therapy after myocardial infarction, which presented as lower diastolic and a trend to lower systolic blood pressure (p=0.002 and 0.080), lower total and LDL cholesterol values (both p<0.001) than healthy adults, but higher values of metabolic syndrome parameters (higher waist cifcumference p=0.045, higher hip-waist ratio, lower HDL cholesterol, both p<0.001, and a trend to higher body mass index). Although we observed significant increases in exercise capacity (higher, maximal load, systolic blood pressure,double product and time of load, all p≤0.003), no changes in classic risk factors during rehabilitaiton were demonstrated. Conclusions In-patient program of cardiac rehabilitation efficiently elevates exercise capacity in patients after AMI, but fails to influence classic risk factors for coronary heart disease, which might be due to lack of controlled cardioprotective diet during rehabilitation.

Effect of warming on protein, glycogen and fatty acid content of native and invasive clams

Human bivalve consumption in Europe has steadily increased in the last years, particularly during summer months when seawater temperature increases. Since ocean warming is among the current global environmental threats affecting aquatic organisms, it is of paramount importance to investigate its effect on the nutritional quality of seafood products. In this context, the aim of this study was to investigate differences in the nutritional quality (in terms of protein, glycogen and fatty acid, FA, content) and condition of a native (grooved carpet shell, Ruditapes decussatus) and an invasive (Japanese carpet shell, Ruditapes philippinarum) clam species, subjected to warming. Our results clearly reveal that temperature significantly affected the nutritional quality of both clam species, particularly the FA composition. Both clam species responded similarly to warming, by significantly decreasing the content of some fatty acids, but not protein and glycogen levels. A predominance of polyunsaturated FA (PUFA) over saturated FA (SFA) and monounsaturated FA (MUFA) was observed throughout the experiment, as well as high n−3/n−6 and PUFA/SFA ratios. The native clam always revealed higher values of these fatty acids, indicating that this species has a better nutritional quality in comparison to the invasive one. Nonetheless, the loss of n−3 PUFA (in native species), eicosapentaenoic (EPA; in both species) and docosahexaenoic (DHA; in invasive species) acids was considered as the major negative outcome derived from warming, since it contributes to the loss of prime quality fatty acids for human health. However, atherogenic, thrombogenic and hypocholesterolemic/hypercholesterolemic indices (AI, TI and h/H, respectively) remained low in both species, even in warming conditions, suggesting that these food items can be used in a cardio-protective and hypocholesterolemic diet. This study provides new insights to understand and foretell the effects of climate change on nutritional quality of marine organisms.

Structured hypocaloric diet is more effective than behavioral therapy in reducing metabolic syndrome in Mexican postmenopausal women

This study aims to compare the effects of a lifestyle intervention using a behavioral therapy (BT) approach with the effects of a cardioprotective structured hypocaloric diet on metabolic syndrome in Mexican postmenopausal women. This study is a randomized clinical trial (2006-2009) of Mexican postmenopausal women with metabolic syndrome (Adult Treatment Panel III criteria) who were recruited from the Postmenopause Clinic of the National Institute of Perinatology in Mexico City. Women were assigned to one of two groups--group 1 (structured hypocaloric diet; n = 63): energy restriction (-300 to -500 kcal/d) emphasizing cardioprotective dietary changes; and group 2 (BT; n = 55): goal setting, problem-solving, and stimulus control to achieve cardioprotective dietary and lifestyle recommendations. Metabolic syndrome prevalence, as well as weight, waist circumference, fat mass, and fasting biochemical markers (glucose and lipid profile), were measured at baseline and at 2, 4, and 6 months after the intervention. Metabolic syndrome risk (relative risk and absolute risk reduction), mean differences between groups, and logistic regression were evaluated using Statistical Package for the Social Sciences software, version 17.0. A total of 118 women were studied (mean [SD] age, 53.81 [6.43] y). No baseline differences were observed between groups. At the end of the study, a higher reduction in metabolic syndrome prevalence was observed in group 1 (-38.1%) compared with group 2 (-12.7%; relative risk, 0.237; 95% CI, 0.092-0.608; P = 0.003). The effect was maintained even when adjusted by age, hormone therapy and antihypertensive drug use. A cardioprotective structured hypocaloric diet is more effective than the BT approach in reducing metabolic syndrome after 6 months of intervention. Both strategies have positive effects on different individual cardiovascular risk factors.

Variations of the diet of Galician university students (Ourense Campus) in relation to the pattern of the cardioprotective Mediterranean diet

Previous epidemiological studies have observed that adherence to Mediterranean Diet is associated with reduced cardiovascular risk, but also evident in literature are the changes in the dietary habits of the Mediterranean countries which show a departure from Mediterranean patterns. The objective of this work was to estimate the variations of the diet of Galician university students (Ourense Campus), between 2011 and 2013, in relation to the pattern of the cardioprotective Mediterranean diet. A total of 726 university students participated (344 at 2011 and 382 at 2013). A short questionnaire of adherence to a cardioprotective Mediterranean diet was used and the height and weight of each participant was recorded and BMI (Body Mass Index) was calculated. The majority of participants were normal weight. In 2013 there was an increase in low weight and obesity in women and a decrease in the prevalence of normal and overweight. In men an increase of a low weight and normal weight was observed and a decrease in the prevalence of overweight/obesity in men. In the two years studied, it was observed that there is low to intermediate adherence of students to the cardioprotective Mediterranean diet, with less adherence observed in 2013 to the Mediterranean diet, for both sexes. The dietary habits observed in 2013 have shown that the population is distancing its diet from the cardioprotective pattern of the Mediterranean diet, a decrease in the consumption of vegetables, fish, wholegrain cereals and olive oil and an increase consumption of meat. 90% of these university students need to modify their eating habits to conform to a heart-healthy diet.

TaqIB polymorphism in the cholesteryl ester transfer protein (CETP) gene influences lipid responses to the consumption of kiwifruit in hypercholesterolaemic men

Fruit and vegetables are key elements of a cardioprotective diet, but benefits on plasma lipids, especially HDL-cholesterol (HDL-C), are inconsistent both within and between studies. In the present study, we investigated whether four selected HDL-C-related polymorphisms (cholesteryl ester transfer protein (CETP) Taq1B, APOA1 -75G/A, hepatic lipase (LIPC) -514C→T, and endothelial lipase (LIPG) I24582) modulate the plasma lipid response to a kiwifruit intervention. This is a retrospective analysis of data collected during a 12-week randomised controlled cross-over trial. A total of eighty-five hypercholesterolaemic men completed a 4-week healthy diet run-in period before being randomised to one of two 4-week intervention sequences of two green kiwifruit/d plus healthy diet (kiwifruit intervention) or healthy diet alone (control intervention). The measurement of anthropometric parameters and collection of fasting blood samples were carried out at baseline 1 and after the run-in (baseline 2) and intervention periods. At baseline 2, B1/B1 homozygotes of the CETP Taq1B gene had significantly higher total cholesterol:HDL-C, TAG:HDL-C, and apoB:apoA1 ratios and small-dense LDL concentrations than B2 carriers. A significant CETP Taq1B genotype×intervention interaction was observed for the TAG:HDL-C ratio (P=0·03). B1/B1 homozygotes had a significantly lower TAG:HDL-C (-0·23 (sd 0·58)mmol/l; P=0·03) ratio after the kiwifruit intervention than after the control intervention, whereas the ratio of B2 carriers was not affected. The lipid response was not affected by other gene polymorphisms. In conclusion, the significant decrease in the TAG:HDL-C ratio in B1/B1 homozygotes suggests that regular inclusion of green kiwifruit as part of a healthy diet may improve the lipid profiles of hypercholesterolaemic men with this genotype.

Hydroxytyrosol suppresses MMP-9 and COX-2 activity and expression in activated human monocytes via PKCα and PKCβ1 inhibition

ObjectiveHydroxytyrosol (HT), the major olive oil antioxidant polyphenol in cardioprotective Mediterranean diets, is endowed with anti-inflammatory and anti-atherosclerotic activity. The production of cyclooxygenase (COX)-2-dependent inflammatory eicosanoids and the functionally linked release of matrix metalloproteinase (MMP)-9 by macrophages likely contribute to plaque instability leading to acute coronary events. Objective of the study was to examine the HT effects on inflammatory markers in human activated monocytes, including MMP-9 and COX-2 activity and expression and explore HT underlying mechanisms. Methods and resultsHuman peripheral blood mononuclear cells (PBMC) and U937 monocytes were treated with 1–10 μmol/L HT before activation with phorbol myristate acetate (PMA). HT blunted monocyte matrix invasive potential and reduced MMP-9 release and expression at zymography, ELISA and RT-PCR, with an IC50 = 10 μmol/L ( P< 0.05), without affecting tissue inhibitor of metalloproteinase (TIMP)-1. Moreover, HT inhibited prostaglandin (PG)E2 production and COX-2 expression, without affecting COX-1. These effects were mediated by inhibition of transcription factor nuclear factor (NF)-κB and protein kinase C (PKC)α and PKCβ1 activation. ConclusionHT, at nutritionally relevant concentrations, reduces MMP-9 and COX-2 induction in activated human monocytes via PKCα and PKCβ1 inhibition, thus featuring novel anti-inflammatory properties. Overall, such results contribute to explaining the vascular protective effects by olive oil polyphenols in Mediterranean diets.

It is important to control for confounders when examining the role of diet in cardiovascular disease prevention

To the Editor, We read the article “Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial” by Bernardete Weber et al. with a great interest (1). The authors evaluated the ability of the Brazilian Cardioprotective Diet Program to reduce blood pressure, fasting glucose levels, and body mass indices (BMIs) among patients with established atherothrombotic disease. They concluded that patients participating in the Brazilian Cardioprotective Diet Program showed greater decreases in these factors than patients who received the dietary therapy proposed by the Brazilian guidelines for cardiovascular disease (CVD). We thank the authors for their study, which was well designed and thoroughly documented. Cardiovascular disease is the most important cause of mortality and morbidity in developed countries worldwide. Secondary prevention is important to combat the further progression of atherosclerotic disease and to reduce mortality from coronary artery disease. Although there is an established association between regular physical activity and cardiac risk factors in the secondary prevention of coronary artery disease (2), the authors did not mention the relationships between physical activity and reductions in blood pressure, fasting glucose levels, and BMI. We think that the results of the study would be stronger if the authors addressed the issue of physical activity in their patient cohort. Cardiovascular risk modifications can also be affected by atherosclerotic risk factors, such as alcohol consumption, hypothyroidism, impaired glucose tolerance (3), and the elevated inflammatory status associated with inflammatory diseases, cardiac syndrome X, and infection (4). These risk modifications can also be affected by eating disorders, excess salt intake, major depression, and gastrointestinal disease (5). Several of these possible contributing factors were not mentioned in the present study. It would be better if the authors provided data concerning these factors. Finally, cardiovascular risk factors may be influenced by weight loss medications, aspirin, a history of drug addiction (6), and some antihypertensive therapies, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta-blockers. It would be better if the authors performed a subgroup analysis, dividing the three patient groups on the basis of the administration of antihypertensive therapy. We believe that these data would provide a more complete basis for future research concerning the clinical effects of diet on cardiovascular risk factors.

Review: Interventions to reduce or modify dietary fat reduce cardiovascular events

ACP Journal Club17 January 2012Review: Interventions to reduce or modify dietary fat reduce cardiovascular eventsScott Kahan, MD, MPH, Yoni Freedhoff, MDScott Kahan, MD, MPHJohns Hopkins Weight Management Center, Baltimore, Maryland, USA (S.K.)Search for more papers by this author, Yoni Freedhoff, MDUniversity of Ottawa, Ottawa, Ontario, Canada (Y.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-2-201201170-02005 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationHooper L, Summerbell CD, Thompson R, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev. 2011;(7):CD002137. https://pubmed.ncbi.nlm.nih.gov/21735388Clinical Impact RatingsGIM/FP/GP: References1 World Health Organization. Prevention of Cardiovascular Disease: Guidelines for assessment and management of cardiovascular risk. Geneva. World Health Organization. 2007. Google Scholar2 He FJ, MacGregor GA. Comment: Salt reduction lowers cardiovascular risk: meta-analysis of outcome trials. Lancet. 2011;378:380-2. [PMID: 21803192] Google Scholar3 Hu FB, Manson JE, Willett WC. Types of dietary fat and risk of coronary heart disease: a critical review. J Am Coll Nutr. 2001;20:5-19. [PMID: 11293467] Google Scholar4 Shai I, Schwarzfuchs D, Henkin Y, et al; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359:229-41. [PMID: 18635428] Google Scholar5 Mozaffarian D, Appel LJ, Van Horn L. Components of a cardioprotective diet: new insights. Circulation. 2011;123:2870-91. [PMID: 21690503] Google Scholar6 Wansink B, Chandon P. Can “low fat” nutrition labels lead to obesity? Journal of Marketing Research. 2006;43:605-17. Google Scholar Author, Article, and Disclosure InformationAuthors: Scott Kahan, MD, MPH; Yoni Freedhoff, MDAffiliations: Johns Hopkins Weight Management Center, Baltimore, Maryland, USA (S.K.)University of Ottawa, Ottawa, Ontario, Canada (Y.F.)This article was published at Annals.org on 3 January 2012. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoReview: Interventions to reduce dietary salt do not reduce mortality or morbidity Scott Kahan and Yoni Freedhoff Metrics 17 January 2012Volume 156, Issue 2Page: JC1-5KeywordsDietFatsFoodHeart failureMortalityMyocardial infarctionOilsProteinsSaltsSodium ePublished: 17 January 2012 Issue Published: 17 January 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Effects of Brazilian Cardioprotective Diet Program on risk factors in patients with coronary heart disease: a Brazilian Cardioprotective Diet randomized pilot trial

OBJECTIVE:To evaluate the effectiveness of the Brazilian Cardioprotective Diet Program in reducing blood pressures, fasting glucose levels and body mass indices in patients with established atherothrombotic disease.METHOD:This randomized controlled pilot trial included outpatients who were over 45 years of age with atherothrombotic cardiovascular disease. Group A, who received the Brazilian Cardioprotective Diet Program, had weekly sessions with dietitians. Groups B and C received the usual dietary therapy that is given to patients with cardiovascular diseases as proposed by the Brazilian guidelines. This diet had the same nutrient profile as that given to Group A, but it was customized by the integration of typical Mediterranean foods. The difference between Groups B and C was the number of sessions with the dietitian. Group B received weekly sessions, while group C only had monthly sessions. ClinicalTrials.gov: NCT 01453166.RESULTS:There was a greater reduction in systolic (7.8%) and diastolic (10.8%) blood pressures in Group A compared with Group B (2.3% and 7.3%), and Group C (3.9% and 4.9%, respectively). Fasting glucose decreased by 5.3% and 2% in Groups A and B, respectively. Fasting glucose increased by 3.7% in Group C. The BMIs decreased by 3.5% and 3.3% in Groups A and B, respectively. Group C did not present with any changes in BMI. However, none of these data showed statistical differences between the groups, which is methodologically acceptable in pilot trials.CONCLUSIONS:The Brazilian Cardioprotective Diet Program seems to be more effective in reducing blood pressures, fasting glucose levels, weights and BMIs in patients with previous cardiovascular disease compared with the diet that has been proposed by the Brazilian guidelines.

Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet

To compare and evaluate the reliability of several indexes of adherence to the Mediterranean diet. The ten indexes included in the analysis were: Mediterranean Diet Score (MDS), Mediterranean Score (MS), Dietary Score (DS), Mediterranean-Dietary Quality Index (Med-DQI), Mediterranean Dietary Pattern adherence index (MDP), Mediterranean Adequacy Index (MAI), Mediterranean Style Dietary Pattern Score (MSDPS), Mediterranean food pattern PREDIMED Study (MeDiet-PREDIMED), relative Mediterranean diet (rMED) and Cardioprotective Mediterranean diet index. Factor analysis using the correlations between indexes was applied. The correlation with factors and the reliability coefficient were calculated. A total of 324 healthy undergraduates at the University of Barcelona, Spain, were surveyed. The highest correlations were observed between MDP adherence index and MAI (0·82); MAI and MSDPS (0·80); and MDS and rMED (0·77). Factor analysis showed a hidden common factor that explained over 70 % of the variability (71·03 %). This factor is understood as 'adherence to the Mediterranean diet'. The indexes that showed the highest correlation with this factor were Med-DQI (0·85), MDS (0·84), rMED (0·80) and MAI (0·80). These indexes showed acceptable performance in measuring the adherence to the Mediterranean diet. The components that correlated strongly with this factor were monounsaturated-to-saturated fatty acid ratio (MS ratio), fruit and vegetables. Furthermore, a second common factor was found explaining 18 % of the variability. This second factor is highly positive related to dairy products and lean meat, and negative related to MS ratio. The indexes showed satisfactory performance in assessing adherence to the Mediterranean diet. However, in order to improve the reliability and concordance between the indexes, further studies are required to select the components, the number of components, and the scoring criteria of the indexes to improve their internal consistency.

Role of Cardioprotective Diet in Acute Coronary Syndrome

Problem statement: Nutritional factors appear to be quite important in the pathogenesis and prognosis among patients of Acute Myocardial Infarction (AMI) or Acute Coronary Syndrome (ACS). Increased consumption of proinflammatory foods; such as refined starches and sugar, trans fat, saturated fat and w-6 fatty acids may increase proi nflammatory cytokines, oxidative stress and free fatty acids causing endothelial dysfunction. Approach: Columbus foods with low w-6/w-3 ratio of fatty acids, may play a protective role. Many adver se parameters such as higher concentrations of proinflammatory cytokines, transcription factors an d adhesion molecules, free radicals and decrease in nitrite levels were shown to be related to the diet ary composition and thus may serve as independent predictors of ACS. Diets rich in w-3 fatty acids, v itamins, minerals and antioxidants and low in refin ed carbohydrates cause decrease in levels of plasma li pid peroxides, antioxidant vitamins, serum Glutamic Oxaloacetate Transaminase (SGOT) and Lactate Dehydrogenase (LDH) cardiac enzymes in patients with ACS. Results: Available evidence indicate that cardioprotective d iet can decrease sudden cardiac deaths, total cardiac deaths, non-fatal inf ractions and total cardiac events among patients receiving such diet compared to standard diet. The existing evidence support that diet rich in w-3 fat ty acids, vitamins, minerals and antioxidants with low refined carbohydrates may be beneficial to vascula r endothelium and myocardium and thus seems to function as cardioprotective in patients with ACS. Conclusion: The Western foods that lack essential vitamins, mi nerals and w-3 fatty acids and that are rapidly absorbed should be avoided in patients with ACS. More studies especially in the context of developing countries are required for establishing the vital role of the cardio protective diet.

Components of a cardioprotective diet: new insights.

The global burdens of cardiovascular diseases (CVD), type 2 diabetes mellitus (DM), and obesity are rising, producing enormous losses of life and disability-adjusted life-years in both developed and developing nations.1 Most of these burdens are preventable and are occurring at unnecessarily younger ages, largely owing to suboptimal lifestyle, which includes poor diet quality, excess caloric intake, physical inactivity, and smoking.2,–,5 Worldwide, striking differences in dietary habits and rates of chronic diseases exist. The identification and targeting of dietary factors with the greatest potential for reducing CVD, DM, and obesity are of major scientific and public health importance. The science of diet and chronic disease is relatively young, spanning perhaps only half a century.6 New advances offer substantial evidence from complementary research paradigms on cardiometabolic effects of specific dietary factors. Several recent evidence-based reviews conducted in conjunction with national and international policy-making efforts provide the context for the present report. The need to prioritize selected foods and overall dietary patterns rather than only individual nutrients, the relevance of carbohydrate and fat quality as well as quantity, the effects and policy implications of sodium consumption, the importance of energy balance, and the role of dietary supplements represent several key findings of interest. Evidence-based insights into successful individual and public health strategies for behavior change are also addressed. Overall, the present report is intended to provide a useful framework for health practitioners and policy makers to understand contemporary issues related to the effects of diet on CVD. Evidence for effects of dietary factors on cardiometabolic health was reviewed, often derived from recent comprehensive reviews performed for policy-making or similar activities, including those of the American Heart Association (AHA) 2020 Impact Goals Committee (D.M., L.J.A.),7 the AHA Nutrition Committee (D.M., L.J.A., L.V.H.),8,9 the …

The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event

The effect of the cardioprotective Mediterranean diet on the development of cardiac abnormalities and prognosis of cardiac patients has rarely been investigated. We sought to evaluate the relation between the Mediterranean diet, the development of left ventricular systolic dysfunction (LVSD) at hospitalization, and the 2-y prognosis of patients who have had an acute coronary syndrome (ACS). During 2006-2009, 1000 consecutive patients with ACS were enrolled; of these patients, 459 had LVSD (ejection fraction <40%) at hospitalization [367 men with a mean (+/-SD) age of 64 +/- 14 y, and 92 women aged 71 +/- 12 y], whereas 541 had preserved left ventricular systolic function (421 men aged 62 +/- 12 y, and 120 women aged 67 +/- 12 y). Adherence to the Mediterranean diet was assessed by the validated Mediterranean Diet Score (MedDietScore; theoretical range: 0-55). The MedDietScore was associated with less likelihood of developing LVSD at hospitalization [odds ratio (OR) per 1/55 unit: 0.93; 95% CI: 0.88, 0.99; P = 0.04], less likelihood of remodeling (ie, ejection fraction <50% at 3 mo follow-up; OR: 0.90; 95% CI: 0.78, 1.03: P = 0.06), and less likelihood of recurrent cardiovascular disease events during the 2 y of follow-up (OR: 0.88; 95% CI: 0.80, 0.98; P = 0.04), after adjustment for various confounders. Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an ACS.

Prevalence of use and potential impact of increased use of primary care interventions to prevent cardiovascular hospitalizations in patients with diabetes

Aims To estimate the reduction in hospitalizations due to cardiovascular complications of diabetes which could result from greater use of interventions of known effectiveness in a primary health care setting. Methods In a representative survey of adults with diabetes in Porto Alegre, Brazil, we estimated current prevalence of interventions use (metformin, hypertension control, ACE inhibitors, statins, influenza vaccination, cardioprotective diet) and hospitalization rate. We calculated absolute risk reductions for interventions by applying relative risk reductions derived from literature to the baseline cardiovascular hospitalization rate. Increments in interventions use were obtained by subtracting current use prevalences from potential targets. We then modelled the number of diabetic patients needing primary health care coverage to prevent 1 hospitalization (disease impact number; DIN) and the total number of hospitalizations that might be prevented through this increased use. Results In 5 years, for every 100 diabetic patients in the community, we ascertained 30 cardiovascular hospitalizations. Large gaps were observed between target and current use of interventions. With greater implementation, 48% of cardiovascular hospitalizations could possibly be prevented. Conclusions Major reduction in hospitalizations due to cardiovascular complications of diabetes could possibly be obtained through optimized use of effective treatments in primary health care settings such as this.

Future management of systemic lupus erythematosus

The management of systemic lupus erythematosus (SLE) will take on a completely new look in the next 10 years, some of which has little to do with lupus medications. By the year 2017, we will know which gene or set of genes causes lupus and under what set of circumstances these susceptibility genes are activated. Since women with SLE have a 10% risk of their daughter and a 2% risk of their son developing the disease, as well as a 50% probability of their offspring being antinuclear-antibody positive (in addition to having an increased prevalence of other autoantibodies), we should be able to identify individuals at risk [1]. It might be possible to vaccinate or give peptide toleragens to at-risk populations, with the goal being disease prevention. Additionally, environmental factors, including certain occupational exposures and immunogenic chemicals that promote autoimmune reactions will be better elucidated, which could lead to the implementation of protective measures. The future of lupus management also hinges on an improved, statistically validated definition for the various forms of lupus and its variants: SLE, chronic cutaneous lupus, undifferentiated connective tissue disease, overlap syndromes, mixed connective-tissue disease and drug-induced lupus. A national data bank complemented with an electronic medical record accrual system, which in selected centers will include updated, validated clinical indices, will permit lupologists to better understand the epidemiologic, demographic, clinical and laboratory characteristics of the disorder. Outcomes will be easier to predict and the implementation of measures to circumvent an undesirable prognosis will be more focused. An integrated health system allowing access to rheumatologic expertise will be in place. Hopefully, rheumatologists will be able to work with primary care physicians to improve the outcome and quality-of-life of the lupus patient. Some of the interventions outside of prescribing lupus medications, which in controlled studies have been shown to improve morbidity, mortality and quality-of-life, include [2]: • Screening for osteoporosis and treating those at risk; • Identifying patients at risk for antiphospholipid mediated thromboembolic events and utilizing prophylactic initiatives (e.g., low-dose aspirin); • Recommending physical measures and exercise regimens that diminish the risks of muscle atrophy and bone demineralization while utilizing optimal ergonomic workplace dynamics; • Smoking cessation measures; • Screening for and interdicting accelerated atherogenesis, hyperlipidemia, hyperglycemia (especially in those on corticosteroids) and hypertension. This can be accomplished with periodic electrocardiograms, chest x-rays, laboratory testing, cardiac imaging, carotid duplex scanning, assessments of baseline pulmonary pressures and promotion of a cardioprotective diet [3]; • Patient education about the disease; • Use of biofeedback, relaxation measures and cognitive behavioral regimens to treat the dysautonomia of lupus (e.g., Raynaud’s, lupus headache and cognitive dysfunction). Existing lupus medications will be complemented with newer agents, along with a more intelligent use of combinations of corticosteroids, immune suppressives and biologics.