Search continues for ideal diet to reduce CVD risk
Healthy dietary patterns are critical for the future health of patients, but the perfect dietary pattern still has yet to be determined, according to a review published in the Journal of the American College of Cardiology.
“This paper was written exclusively for clinical use, meaning it’s meant for the day-to-day practice of a provider,” Andrew M. Freeman, MD, FACC, FACP, associate professor, director of cardiovascular prevention and wellness and director of clinical cardiology and operations in the division of cardiology at National Jewish Health in Denver, told Cardiology Today. “The goal was for those people to read this article and then have the information they need when patients are asking questions.”
Saturated fat sources
The leading source of saturated fat in the U.S. is dairy products, which are also sources of sodium and cholesterol. Although the evidence on its effects on CV risk is difficult to interpret, there may be an association between some dairy products and increases in fractures, LDL concentration and overall mortality and a decrease in BP. Nevertheless, reduced fat dairy products are recommended for high-quality protein and some essential vitamins and minerals, according to the review.
Growing evidence has shown that the intake of added sugars has been associated with stroke, CHD and CVD mortality. Based on this, various expert bodies have recommended a limited intake of added sugars since they have been linked to atherosclerotic CVD and cardiometabolic risk.
Legumes, including beans, pulses, lentils, chickpeas, peas and soybeans, are rich in protein, dietary fiber, complex carbohydrates, saponins and polyphenols and low in fat, according to the review.
“Legumes are an affordable and sustainable source of protein and fiber,” Freeman and colleagues wrote. “Consumption is associated with a reduction in CHD incidence and improved blood glucose, LDL-C, systolic BP and body weight.”
Although coffee can increase BP in those who do not drink coffee often, glucose metabolism and insulin sensitivity may be improved by the polyphenolic antioxidants in coffee. It also offers a dose-response protective benefit by lowering the risk for CVD mortality and all-cause mortality.
Tea also contains flavonoids and polyphenols that may improve blood lipids and CVD health. Green tea has been shown to have favorable effects on the LDL:HDL ratio. However, milk and sugar may decrease the benefit of tea, the authors wrote.
Sufficient evidence is currently not available to recommend certain alcoholic beverages for CV risk reduction.
The consumption of energy drinks should also be avoided even with limited evidence showing the potential for harm, according to Freeman and colleagues.
Mushrooms can be cardioprotective, as they have antioxidant and anti-inflammatory benefits, the authors wrote, noting that even with the absence of high-quality evidence, they may have beneficial effects on CVD comorbid risk factors.
Fermented foods, such as kimchi, fermented milk and yogurts, and seaweed may potentially offer benefit regarding dyslipidemia, CVD and weight, although high-quality evidence is not currently available, according to the review.
Omega-3 fatty acids from fish may decrease triglycerides, but may raise the risk for methylmercury consumption.
“Some evidence favors incorporating plant or marine-based [omega-3] daily into a heart-healthy diet, and probably in non-supplement forms,” Freeman and colleagues wrote.
B12 supplementation can have a positive effect on CV health, although several large studies do not support its use for CVD prevention.
“The bottom line is that there’s really only one dietary pattern that appears to be predominately cardioprotective, but also has an effect in other areas of health like cancers,” Freeman said in an interview. “This is a predominately plant-based low fat, whole food, no added salt, no added sugar type of a diet. If we can get people to start practicing this, then it would be a lot easier to do more research on this.” – by Darlene Dobkowski
For more information:
Andrew M. Freeman, MD, FACC, FACP, can be reached at National Jewish Health Main Campus, 1400 Jackson St., Denver, CO 80206; email: firstname.lastname@example.org.
Disclosures: Freeman reports he has performed nonpromotional speaking for Boehringer Ingelheim. Please see the study for all other authors’ relevant financial disclosures.