Effectiveness of Changes in Diet Composition on Reducing the Incidence of Cardiovascular Disease
- 185 Downloads
Purpose of Review
To highlight dietary changes shown to be associated with a lower risk of cardiovascular events in epidemiological studies and that have been proven to be effective in preventing cardiovascular diseases in clinical trials
Since dietary changes always involve multiple variables, recent observational and intervention studies on dietary prevention of cardiovascular disease focus not only to the limitation of a single nutrient/food intake but also to the other dietary changes implemented to replace it.
The available evidence supports three major dietary strategies for cardiovascular disease prevention: (1) the replacement of saturated fat with unsaturated fat and/or fiber-rich carbohydrate foods; (2) the reduction of salt intake; (3) the implementation of dietary patterns resembling the traditional Mediterranean diet. This support derives not only from RCTs but also from the combination of large observational cohort studies and relatively short-term randomized trials on cardiovascular risk factors.
KeywordsDietary fats Dietary carbohydrates Sodium intake Mediterranean diet Cardiovascular disease Mortality
The expert linguistic revision of R. Scala is gratefully acknowledged.
Compliance with Ethical Standards
Conflict of Interest
Ilaria Calabrese and Gabriele Riccardi declare that they have no conflicts of interests in relation to the content of this article.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Forouhi NG, Krauss RM, Taubes G, Willet W. Dietary fat and cardiometabolic health: evidence, controversies and consensus for guidance. BMJ. 2018:361–k2139. https://doi.org/10.1136/bmj.k2139 This article takes a critical look at the evolution of scientific understanding about dietary fats and health, the difficulties of establishing public health dietary guidelines, and what the current advice should be for dietary fat consumption.
- 2.•• Sacks, FM LAH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, et al. Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation. 2017;136(3):e1–e23. https://doi.org/10.1161/CIR.0000000000000510 This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD.CrossRefPubMedGoogle Scholar
- 3.Van Horn L, Carson JA, Appel LJ, Burke LE, Economos C, Karmally W, et al. Recommended dietary pattern to achieve adherence to the American Heart Association/ American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016(22):134, e505–e509. https://doi.org/10.1161/CIR.0000000000000462.
- 9.Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, et al. Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease a prospective cohort study. J Am Coll Cardiol. 2015;66(14):1538–48. https://doi.org/10.1016/j.jacc.2015.07.055.CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease (Review). Cochrane Database Syst Rev 2015, Issue 6. Art.No.:CD011737. Doi: https://doi.org/10.1002/14651858.CD011737.
- 11.Willett W. Nutritional epidemiology, vol. 2013. 3rd ed. New York, NY: Oxford University Press. p. 1, 317–16, 319.Google Scholar
- 12.US Department of Agriculture, Agricultural Research Service, National Nutrient Database for Standard Reference, release 28, 2016. https://ndb.nal.usda.gov/ndb/search/list
- 13.• Wang DD, Li Y, Chiuve SE, Stampfer MJ, Manson JE, Rimm EB, et al. Association of specific dietary fats with total and cause – specific mortality. JAMA Intern Med. 2016;176(8):1134–45. https://doi.org/10.1001/jamainternmed.2016 The paper highlights the results of the follow-up on two large cohorts showing that different types of dietary fats have divergent associations with total and cause-specific mortality.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Farvid MS, Ding M, Pan A, Sun Q, Chiuve SE, Steffen LM, et al. Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta – analysis of prospective cohort studies. Circulation. 2014;130(18):1568–78. https://doi.org/10.1161/CIRCULATIONAHA.114.010236.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.• Betchold A, Boeing H, Schwedhelm C, Hoffmann G, Knuppel S, Iqbal K, et al. Food groups and risk of coronary heart disease, stroke and heart failure: a systematic review and dose-response meta- analysis of prospective studies. Crit Rev Food Sci Nutr. 2019;59(7):1071–90. https://doi.org/10.1080/10408398.2017.1392288 A meta-analysis synthesizing the knowledge about the relation between intake of 12 major food groups and the risk of coronary heart disease, stroke, and heart failure.CrossRefGoogle Scholar
- 18.Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017;390(10107):2050–62. https://doi.org/10.1016/S0140-6736(17)32252-3.CrossRefPubMedGoogle Scholar
- 24.•• Reynolds A, Mann J, Cumming J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta – analyses. Lancet. 2019;393(10170):434–45. https://doi.org/10.1016/S0140-6736(18)31809-9 This paper examines key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomized trials.CrossRefPubMedGoogle Scholar
- 25.Poggio R, Gutierrez L, Matta MG, Elorriaga N, Irazola V, Rubinstein A. Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies. Public Health Nutr. 2015;18(4):695–704. https://doi.org/10.1017/S1368980014000949.CrossRefPubMedGoogle Scholar
- 27.Abete I, Romaguera D, Vieira AR, Lopez de Munain A, Norat T. Association between total, processed, red and white meat consumption and all-cause, CVD, and IHD mortality: a meta-analysis of cohort studies. Br J Nutr. 2014;112(5):762–75. https://doi.org/10.1017/S000711451400124X.CrossRefPubMedGoogle Scholar
- 29.• Mozaffarian D. Dietary and policy priorities for cardiovascular disease, diabetes and obesity. A comprehensive review. Circulation. 2016;133(2):187–225. https://doi.org/10.1161/CIRCULATIONAHA.115.018585 This review considers the history, new evidence, controversies, and corresponding lessons for modern dietary and policy priorities for cardiovascular diseases, obesity, and diabetes mellitus.CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, et al. Whole grain consumption and risk of cardiovascular disease, cancer and all-cause and cause specific mortality: systematic review and dose – response meta-analysis of prospective studies. BMJ. 2016;353:i2716. https://doi.org/10.1136/bmj.i2716.CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta- analysis of randomized controlled trials. PLoS Med. 2010;7(3):e1000252. https://doi.org/10.1371/journal.pmed.1000252.CrossRefPubMedPubMedCentralGoogle Scholar
- 44.• Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72(1):30–43. https://doi.org/10.1038/ejcn.2017.58 This is an umbrella review of the evidence across meta-analyses of observational studies and randomized clinical trials on the evidence and the validity of the association between the adherence to the Mediterranean diet and multiple health outcomes.CrossRefPubMedGoogle Scholar
- 45.Grosso G, Maraventano S, Yang J, Micek A, Pajak A, Scalfi L. A comprensive meta- analysis on evidence of Mediterranean diet and cardiovascular disease: are individual components equal? Crit Rev Food Sci Nutr. 2017;57(15):3218–32. https://doi.org/10.1080/10408398.2015.1107021.CrossRefPubMedGoogle Scholar