Dietary intake and coronary heart disease: A variety of nutrients and phytochemicals are important

  • Katherine L. Tucker

Opinion statement

Until quite recently, the dietary focus on prevention of coronary heart disease (CHD) has been almost exclusively centered on reducing intake of cholesterol, total fat, and saturated fat. The food industry responded vigorously with low-fat products, some of which are helpful, particularly low-fat dairy products, but others that are less so, due to increases in refined carbohydrate content. Recent research shows that a variety of foods contribute to protection against CHD, including certain types of fatty acids, and a variety of components in fruit and vegetables, whole grains, and nuts. In particular, there is now an emphasis on reducing not only saturated fat, but also trans fat, whereas mono and omega-3 fatty acids have been shown to be protective. Many new studies have shown a link between intake of fruit and vegetables and whole grains and protection against CHD. This has been ascribed to their fiber, vitamin, mineral, and phytochemical content. In particular, there is accumulating evidence of protective effects for folate, vitamin B6, vitamin B12, vitamin E, vitamin C, flavonoids, and phytoestrogens. New recommendations to prevent heart disease require a greater focus on total dietary pattern with a return to the use of a variety of minimally processed foods.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Appel LJ, Moore TJ, Obarzanek E, et al.: A clinical trial of the effects of dietary patterns on blood pressure: DASH Collaborative Research Group. N Engl J Med 1997, 336:1117–1124.PubMedCrossRefGoogle Scholar
  2. 2.
    Krauss R, Eckel R, Howard B, et al.: AHA Dietary Guidelines: revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000, 102:2296–2311. A summary of the most current AHA dietary guidelines that contains substantial changes from earlier recommendations.Google Scholar
  3. 3.
    Wilson TA, McIntyre M, Nicolosi RJ: Trans fatty acids and cardiovascular risk. J Nutr Health Aging 2001, 5:184–187.PubMedGoogle Scholar
  4. 4.
    de Roos NM, Schouten EG, Scheek LM, et al.: Replacement of dietary saturated fat with trans fat reduces serum paraoxonase activity in healthy men and women. Metabolism 2002, 51:1534–1537.PubMedCrossRefGoogle Scholar
  5. 5.
    Sanders TA, Oakley FR, Crook D, et al.: High intakes of trans monounsaturated fatty acids taken for 2 weeks do not influence procoagulant and fibrinolytic risk markers for CHD in young healthy men. Br J Nutr 2003, 89:767–776.PubMedCrossRefGoogle Scholar
  6. 6.
    Perez-Jimenez F, Lopez-Miranda J, Mata P: Protective effect of dietary monounsaturated fat on arteriosclerosis: beyond cholesterol. Atherosclerosis 2002, 163:385–398.PubMedCrossRefGoogle Scholar
  7. 7.
    Kris-Etherton PM, Hecker KD, Bonanome A, et al.: Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer. Am J Med 2002, 113(suppl 9B):71S-88S. An excellent review of the roles of bioactive compounds found in foods and health.PubMedCrossRefGoogle Scholar
  8. 8.
    Harris WS, Park Y, Isley WL: Cardiovascular disease and long-chain omega-3 fatty acids. Curr Opin Lipidol 2003, 14:9–14.PubMedCrossRefGoogle Scholar
  9. 9.
    Hu FB, Bronner L, Willett WC, et al.: Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002, 287:1815–1821.PubMedCrossRefGoogle Scholar
  10. 10.
    Albert CM, Campos H, Stampfer MJ, et al.: Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 2002, 346:1113–1118.PubMedCrossRefGoogle Scholar
  11. 11.
    Yuan JM, Ross RK, Gao YT, Yu MC: Fish and shellfish consumption in relation to death from myocardial infarction among men in Shanghai, China. Am J Epidemiol 2001, 154:809–816.PubMedCrossRefGoogle Scholar
  12. 12.
    Erkkila AT, Lehto S, Pyorala K, Uusitupa MI: n-3 Fatty acids and 5-y risks of death and cardiovascular disease events in patients with coronary artery disease. Am J Clin Nutr 2003, 78:65–71.PubMedGoogle Scholar
  13. 13.
    Mozaffarian D, Lemaitre RN, Kuller LH, et al.: Cardiac benefits of fish consumption may depend on the type of fish meal consumed: the Cardiovascular Health Study. Circulation 2003, 107:1372–1377.PubMedCrossRefGoogle Scholar
  14. 14.
    He K, Rimm EB, Merchant A, et al.: Fish consumption and risk of stroke in men. JAMA 2002, 288:3130–3136.PubMedCrossRefGoogle Scholar
  15. 15.
    Iso H, Rexrode KM, Stampfer MJ, et al.: Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA 2001, 285:304–312.PubMedCrossRefGoogle Scholar
  16. 16.
    Lee KW, Lip GY: The role of omega-3 fatty acids in the secondary prevention of cardiovascular disease. QJM 2003, 96:465–480.PubMedCrossRefGoogle Scholar
  17. 17.
    Ellsworth JL, Kushi LH, Folsom AR: Frequent nut intake and risk of death from coronary heart disease and all causes in postmenopausal women: the Iowa Women’s Health Study. Nutr Metab Cardiovasc Dis 2001, 11:372–377.PubMedGoogle Scholar
  18. 18.
    Albert CM, Gaziano JM, Willett WC, Manson JE: Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health Study. Arch Intern Med 2002, 162:1382–1387.PubMedCrossRefGoogle Scholar
  19. 19.
    Morgan JM, Horton K, Reese D, et al.: Effects of walnut consumption as part of a low-fat, low-cholesterol diet on serum cardiovascular risk factors. Int J Vitam Nutr Res 2002, 72:341–347.PubMedCrossRefGoogle Scholar
  20. 20.
    Zambon D, Sabate J, Munoz S, et al.: Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. A randomized crossover trial. Ann Intern Med 2000, 132:538–546.PubMedGoogle Scholar
  21. 21.
    Sabate J, Haddad E, Tanzman JS, et al.: Serum lipid response to the graduated enrichment of a Step I diet with almonds: a randomized feeding trial. Am J Clin Nutr 2003, 77:1379–1384.PubMedGoogle Scholar
  22. 22.
    Jenkins DJ, Kendall CW, Marchie A, et al.: Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation 2002, 106:1327–1332.PubMedCrossRefGoogle Scholar
  23. 23.
    Sacks FM, Katan M: Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease. Am J Med 2002, 113(suppl 9B):13S-24S.PubMedCrossRefGoogle Scholar
  24. 24.
    Howard BV, Wylie-Rosett J: Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2002, 106:523–527.PubMedCrossRefGoogle Scholar
  25. 25.
    Anderson JW, Hanna TJ, Peng X, Kryscio RJ: Whole grain foods and heart disease risk. J Am Coll Nutr 2000, 19:291S-299S.PubMedGoogle Scholar
  26. 26.
    Liu S, Buring JE, Sesso HD, et al.: A prospective study of dietary fiber intake and risk of cardiovascular disease among women. J Am Coll Cardiol 2002, 39:49–56.PubMedCrossRefGoogle Scholar
  27. 27.
    Mozaffarian D, Kumanyika SK, Lemaitre RN, et al.: Cereal, fruit, and vegetable fiber intake and the risk of cardiovascular disease in elderly individuals. JAMA 2003, 289:1659–1666.PubMedCrossRefGoogle Scholar
  28. 28.
    Steffen LM, Jacobs DR Jr, Stevens J, et al.: Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003, 78:383–390.PubMedGoogle Scholar
  29. 29.
    Liu S, Manson JE, Lee IM, et al.: Fruit and vegetable intake and risk of cardiovascular disease: the Women’s Health Study. Am J Clin Nutr 2000, 72:922–928.PubMedGoogle Scholar
  30. 30.
    Joshipura KJ, Hu FB, Manson JE, et al.: The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 2001, 134:1106–1114.PubMedGoogle Scholar
  31. 31.
    Rissanen TH, Voutilainen S, Virtanen JK, et al.: Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. J Nutr 2003, 133:199–204.PubMedGoogle Scholar
  32. 32.
    Food and Nutrition Board and Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein, and Amino Acids (Macronutrients). Washington, DC: National Academy Press; 2002.Google Scholar
  33. 33.
    Fernandez ML: Soluble fiber and nondigestible carbohydrate effects on plasma lipids and cardiovascular risk. Curr Opin Lipidol 2001, 12:35–40.PubMedCrossRefGoogle Scholar
  34. 34.
    Mukamal KJ, Conigrave KM, Mittleman MA, et al.: Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med 2003, 348:109–118.PubMedCrossRefGoogle Scholar
  35. 35.
    Cuevas AM, Guasch V, Castillo O, et al.: A high-fat diet induces and red wine counteracts endothelial dysfunction in human volunteers. Lipids 2000, 35:143–148.PubMedGoogle Scholar
  36. 36.
    Baer DJ, Judd JT, Clevidence BA, et al.: Moderate alcohol consumption lowers risk factors for cardiovascular disease in postmenopausal women fed a controlled diet. Am J Clin Nutr 2002, 75:593–599.PubMedGoogle Scholar
  37. 37.
    Sierksma A, van der Gaag MS, Kluft C, Hendriks HF: Moderate alcohol consumption reduces plasma Creactive protein and fibrinogen levels; a randomized, diet-controlled intervention study. Eur J Clin Nutr 2002, 56:1130–1136.PubMedCrossRefGoogle Scholar
  38. 38.
    Jiang R, Hu FB, Giovannucci EL, et al.: Joint association of alcohol and folate intake with risk of major chronic disease in women. Am J Epidemiol 2003, 158:760–771.PubMedCrossRefGoogle Scholar
  39. 39.
    Hofmann MA, Lalla E, Lu Y, et al.: Hyperhomocysteinemia enhances vascular inflammation and accelerates atherosclerosis in a murine model. J Clin Invest 2001, 107:675–683.PubMedCrossRefGoogle Scholar
  40. 40.
    Verhaar MC, Stroes E, Rabelink TJ: Folates and cardiovascular disease. Arterioscler Thromb Vasc Biol 2002, 22:6–13.PubMedCrossRefGoogle Scholar
  41. 41.
    Jacques PF, Selhub J, Bostom AG, et al.: The effect of folic acid fortification on plasma folate and total homocysteine concentrations. N Engl J Med 1999, 340:1449–1454.PubMedCrossRefGoogle Scholar
  42. 42.
    Asplund K: Antioxidant vitamins in the prevention of cardiovascular disease: a systematic review. J Intern Med 2002, 251:372–392. A very nice overview of the studies to date, showing the contrasting results by study type.PubMedCrossRefGoogle Scholar
  43. 43.
    Virtamo J, Rapola JM, Ripatti S, et al.: Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease. Arch Intern Med 1998, 158:668–675.PubMedCrossRefGoogle Scholar
  44. 44.
    U.S. Preventive Services Task Force: Routine vitamin supplementation to prevent cancer and cardiovascular disease: recommendations and rationale. Ann Intern Med 2003, 139:51–55.Google Scholar
  45. 45.
    van der Schouw YT, de Kleijn MJ, Peeters PH, Grobbee DE: Phyto-oestrogens and cardiovascular disease risk. Nutr Metab Cardiovasc Dis 2000, 10:154–167.PubMedGoogle Scholar
  46. 46.
    Lissin LW, Cooke JP: Phytoestrogens and cardiovascular health. J Am Coll Cardiol 2000, 35:1403–1410.PubMedCrossRefGoogle Scholar
  47. 47.
    Steinberg FM, Guthrie NL, Villablanca AC, et al.: Soy protein with isoflavones has favorable effects on endothelial function that are independent of lipid and antioxidant effects in healthy postmenopausal women. Am J Clin Nutr 2003, 78:123–130.PubMedGoogle Scholar
  48. 48.
    van der Schouw YT, Pijpe A, Lebrun CE, et al.: Higher usual dietary intake of phytoestrogens is associated with lower aortic stiffness in postmenopausal women. Arterioscler Thromb Vasc Biol 2002, 22:1316–1322.PubMedCrossRefGoogle Scholar
  49. 49.
    Jenkins DJ, Kendall CW, Garsetti M, et al.: Effect of soy protein foods on low-density lipoprotein oxidation and ex vivo sex hormone receptor activity--a controlled crossover trial. Metabolism 2000, 49:537–543.PubMedCrossRefGoogle Scholar
  50. 50.
    Sesso HD, Gaziano JM, Liu S, Buring JE: Flavonoid intake and the risk of cardiovascular disease in women. Am J Clin Nutr 2003, 77:1400–1408.PubMedGoogle Scholar
  51. 51.
    Freedman JE, Parker C 3rd, Li L, et al.: Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Circulation 2001, 103:2792–2798.PubMedGoogle Scholar
  52. 52.
    Kris-Etherton PM, Keen CL: Evidence that the antioxidant flavonoids in tea and cocoa are beneficial for cardiovascular health. Curr Opin Lipidol 2002, 13:41–49.PubMedCrossRefGoogle Scholar
  53. 53.
    Geleijnse JM, Launer LJ, Van der Kuip DA, et al.: Inverse association of tea and flavonoid intakes with incident myocardial infarction: the Rotterdam Study. Am J Clin Nutr 2002, 75:880–886.PubMedGoogle Scholar
  54. 54.
    Riemersma RA, Rice-Evans CA, Tyrrell RM, et al.: Tea flavonoids and cardiovascular health. QJM 2001, 94:277–282.PubMedCrossRefGoogle Scholar
  55. 55.
    Duffy SJ, Keaney JF Jr, Holbrook M, et al.: Short- and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease. Circulation 2001, 104:151–156.PubMedGoogle Scholar
  56. 56.
    Willcox JK, Catignani GL, Lazarus S: Tomatoes and cardiovascular health. Crit Rev Food Sci Nutr 2003, 43:1–18.PubMedCrossRefGoogle Scholar
  57. 57.
    Rissanen T, Voutilainen S, Nyyssonen K, Salonen JT: Lycopene, atherosclerosis, and coronary heart disease. Exp Biol Med (Maywood) 2002, 227:900–907.Google Scholar
  58. 58.
    Sesso HD, Liu S, Gaziano JM, Buring JE: Dietary lycopene, tomato-based food products and cardiovascular disease in women. J Nutr 2003, 133:2336–2341.PubMedGoogle Scholar
  59. 59.
    Hu FB, Rimm EB, Stampfer MJ, et al.: Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 2000, 72:912–921.PubMedGoogle Scholar
  60. 60.
    Fung TT, Rimm EB, Spiegelman D, et al.: Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr 2001, 73:61–67.PubMedGoogle Scholar
  61. 61.
    Millen BE, Quatromoni PA, Nam BH, et al.: Dietary patterns and the odds of carotid atherosclerosis in women: the Framingham Nutrition Studies. Prev Med 2002, 35:540–547.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Katherine L. Tucker
    • 1
  1. 1.Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonUSA

Personalised recommendations