Over the last 20 or 30 years and even earlier, we’ve known that if you eat better, your overall health and your CV health is better.
What this study tried to do is quantify CV health improvements using carotid artery intima-media thickness. While that has come under fire as a surrogate, it certainly is one way to track atherosclerosis, particularly subclinical atherosclerosis.
In this study, however, there are some confounders. Eating more cruciferous vegetables regularly may simply be a marker that someone is living more healthfully overall. They may be more active. They’re probably not smoking. The researchers tried their best to adjust for a lot of these things, so they made sure that they effect seems to be simply with the vegetable intake.
Are the people in this study who are eating these vegetables eating them instead of something else? As an example, if people who eat brussels sprouts and broccoli over bacon and cheese, they are probably going to do a lot better.
Overall, the study adds or corroborates to the existing knowledge base that eating better has a significant effect on CV events and atherosclerosis.
These types of findings always have major implications. First, my group recently published a few papers (Devries S, et al. Am J Med. 2017;doi:10.1016/j.amjmed.2017.04.043; Aggarwal M, et al. Am J Med. 2018;doi:10.1016/j.amjmed.2017.11.036.), where we surveyed roughly 1,000 cardiologists, and the vast majority of us have almost no nutrition knowledge whatsoever. It’s a very important reminder to physicians that they need to arm themselves with information about lifestyle, nutrition, diet, exercise, etc. because they have profound impact on patients’ outcomes. If you look at all the guidelines that have come out recently on lipids or most recently on hypertension, there are many pages dedicated to lifestyle, diet, exercise, etc., but we as physicians get very little training there.
As such, we as cardiology caregivers should be using these data in practice when we advise patients what to do and how to live to reduce their CV risk. Next, we need to do better about educating ourselves and staying current in this realm even though it may not be as exciting as the latest device or new drug. These foods are time-tested “drugs” that are very underutilized.
Further, we need to have very large-scale research papers. There was some work that was done more than 20 years ago by Dean Ornish, MD, and others which showed that you can literally reverse coronary disease — at least angiographically — with a low-fat, plant-based diet combined with exercise and stress relief (Ornish D, et al. Lancet. 1990;doi: 10.1016/0140-6736(90)91656-U.). It’s time that we do a much bigger randomized trial in this regard to see what can really happen.
There are a lot of little hints coming out with recent trials showing that stents may not have a huge impact in people’s outcomes unless they’re placed in a high-risk coronary territory. Interventions may do good things in the short term but may not have a long-term effect. Wouldn’t it be nice to have some really good quality, well-done research that shows that eating right and exercising, the things we all take for granted, can be as powerful or even more powerful than a lot of these drugs and devices.
This is a great opportunity just to highlight how important it is that everyday practice should include taking a very quick diet history and simply asking patients, “What did you have for dinner last night?” Even though it’s a small sample size with one meal, you’d be surprised to see what your patients are eating. It’s pretty amazing.
Also, taking the time to intervene in daily practice can sometimes really make a huge impact in somebody’s life. I’ve had people get rid of their high BP, high cholesterol and diabetes simply with lifestyle (diet, exercise, stress relief, etc.). That is very refreshing and rewarding for the provider, but it’s an absolute godsend for the patient.
Andrew M. Freeman, MD, FACC, FACP
Director, Cardiovascular Prevention and Wellness
Director, Clinical Cardiology and Operations
National Jewish Health, Denver
Disclosures: Freeman reports no relevant financial disclosures.